Oxidative stress in polycystic ovary syndrome: a case-control study.

OBJECTIVE: To compare the serum levels of biochemical and oxidative stress markers i.e., malondialdehyde (MDA) and paraoxonase-1(PON1) in polycystic ovary syndrome (PCOS) patients and healthy female individuals of reproductive age group (18-40 years). METHODS: This case-control study was conducted in Dow University of Health Sciences (DUHS), Karachi from June 2019 to October 2020. Seventy Subjects including 35 PCOS patients that have primary subfertility problem (cases) and 35 healthy and fertile females (controls) were recruited. Serum samples were collected for analysis of insulin, sex hormone-binding globulin, testosterone, fasting blood glucose and lipid profile. PON 1 and MDA levels were estimated by ELISA. Comparison between the two groups was done using independent t-test. RESULTS: The patients had significantly increased mean body mass index (28.5+4.6 kg/m2 vs 25.7+4.5 kg/m2, p=0.014), systolic (129.6±13.9 mm of Hg vs 113±7.7 mm of Hg, p<0.001) and diastolic (78.7±8.8 mm of Hg vs 74.6±6.7 mm of Hg, p=0.032) blood pressures compared to controls. The high-density lipoprotein cholesterol levels were significantly lower in PCOS (42.2±8.6mg/dl) than controls (48.8±11.8mg/dl, p=0.009, p=0.009). Serum insulin (14.3±5.8 uIU/mL) vs (10.0±5.2 uIU/mL), p=0.002 and testosterone levels (1.3±0.9 nmol/L) vs (0.82±0.3 nmol/L), p<0.001 were significantly higher whereas sex hormone binding globulin (SHBG) levels (35.2±19.7nmol/L vs 58.8±31.0 nmol/L) were significantly lower in patients than healthy controls (p<0.001). Both oxidative stress markers, paraoxonase 1 (7.7±2.4 vs 6.4±2.6 µg/mL, p=0.04) and malondialdehyde (2.5±1.0 vs 1.9+0.51µg/mL, p=0.034) levels were significantly elevated in PCOS patients than controls. No significant correlation was found between dietary habits and life style between cases and controls. CONCLUSIONS: The study reported significantly elevated levels of oxidative stress markers in PCOS patients.

Peripartum cardiomyopathy characteristics and outcome in a tertiary care hospital.

OBJECTIVE: To assess the incidence, risk factors ,maternal and foetal outcome in women with peripartum cardiomyopathy. METHODS: A descriptive study was conducted in the department of gynae obstetrics Civil Hospital, and Dow University of Health Sciences, Karachi from Oct, 2003 till Sept, 2007. Thirtytwo patients of any parity and age in their last months of pregnancy or within five months of delivery who met the criteria for diagnosis of peripartum cardiomyopathy were included in the study. Their epidemiologic data, risk factors, NYHA class and pregnancy outcomes were recorded till recovery or discharge. Analysis of results was done using descriptive analysis on SPSS version 15. RESULTS: Thirty two patients presented with PPCM, which was a frequency of 1 per 837 deliveries. The mean age was 32 +/-3 years and the mean parity 3.66 +/- 1.5. All patients were obese with mean body weight of 71.91 +/- 12.9 kg. The most frequent diagnosis of cardiomyopathy was made in 12 (37.57) Balochi and 7 (21.87) mohajir women. Twenty (62.57) presented late in post partum period and 20 (62.58) were in NYHA class IV. Chronic hypertension 10 (31.257), long term tocotysis 6 (18.757), pre-eclampsia 6 (18.757) and multiple pregnancy were main riskfactors. Eighteen (52.527) women had spontaneous vaginal delivery, 2 had assisted vaginal delivery and 2 had twin vaginal delivery. Ten (31.257) required caesarean section. The main complication was congestive cardiac failure in 20 (62.57) patients and 3 maternal deaths occurred. There were 27 live births and 5 perinatal deaths were recorded. CONCLUSION: This study showed that peripartum cardiomyopathy is associated with high morbidity and mortality. Multiple risk factors are associated with it, the most important being advancing age, parity, obesity, chronic and gestational hypertension and long term tocolysis.

Use of recombinant factor VIIa for massive postpartum haemhorrage: case series and review of literature.

Recombinant activated factor VII is indicated mainly for the treatment of patients with haemophilia inhibitors. It has also been found successful in the treatment of platelet disorder Glanzmann's thrombasthenia. Recently, its use in trauma patients and in patients with intracereberal haemorrhage has become well established. We present three cases of massive post partum haemorrhage treated with rFVIIa, following caesarean section. The response of these three patients is discussed along with review of literature.

Impact of metformin therapy in patients with polycystic ovarian syndrome.

OBJECTIVE: To determine the effect of metformin therapy in achieving menstrual regularity, pregnancy, reducing obesity and hyperinsulinemia in patients with polycystic ovarian syndrome (PCOS). DESIGN: Interventional, quasi-experimental study. PLACE AND DURATION OF STUDY: Civil Hospital, Karachi from January 2002 to December 2003. PATIENTS AND METHODS: Thirty patients with PCOS diagnosed on clinical symptoms, ultrasound examination and hormonal assays were selected. All patients either had raised serum fasting insulin levels or fasting blood sugar/serum fasting insulin ratio of < 4:5. Patients were then given treatment with Metformin 500 mg TID and continued for six months. The patients were called back for follow-up on monthly basis and clinical and bio-chemical variables were recorded on a proforma at 3 months and 6 months of initiating metformin treatment. The chi-square test was done and p-value determined to assess the outcome. RESULTS: Significant effect of metformin therapy was observed at 3 months follow-up visit, 5 (16.7%) women achieved pregnancy while 20 (66.6%) women had a regular menstrual cycle (p = 0.001), and a significant reduction in weight (67.4 vs. 65.4, p = 0.001) and hyperinsulinemia (FBS: FI = 3.34 vs. 6.63, p = 0.001) was noted. After 6 months follow-up visit, 25 women were examined. Of these, 7 (28%) achieved pregnancy while 16 (64%) had regular menstrual cycle (p = 0.001) and a significant reduction in weight and hyperinsulinemia (p = 0.001). CONCLUSION: Metformin is very effective in achieving menstrual regularity, ovulation and pregnancy in patients with polycystic ovarian syndrome.