Recommendations on the Use of Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders: Current Evidence and Clinical Practice.

Background: 'Temporomandibular joint disorders (TMDs)' denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available 'oral splints' or 'oral orthotic occlusal devices' remain ambiguous. Methods: A joint international consortium was formulated involving the subject experts at TMJ Foundation, to resolve the current ambiguity regarding the use of oral orthotic occlusal appliance therapy for the temporomandibular joint disorders based on the current scientific and clinical evidence. Results: The recommendations and the conclusion of the clinical experts of the joint international consort has been summarized for understanding the indications of the various available oral orthotic occlusal appliances and to aid in the future research on oral occlusal orthotics. Conclusion: The use of the oral orthotic occlusal appliances should be based on the current available scientific evidence, rather than the archaic protocols.

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope?

AIM: To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. METHODS: A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. RESULTS: Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. CONCLUSION: In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.

Does the Cannula Diameter Affect Outcomes of Temporomandibular Joint (TMJ) Arthrocentesis?

PURPOSE: Since its implementation, temporomandibular joint (TMJ) arthrocentesis can be performed with cannulas of different diameters. The aim of this study was to determine the differences in cannula diameter for TMJ arthrocentesis on intraoperative and postoperative parameters. METHODS: A prospective randomized clinical study was conducted using the documentation of Wilkes stage 3 patients with TMJ disorders. Patients were assigned to 2 groups using a system of computer-assisted randomization. Double puncture arthrocentesis (DPA) was performed with 21-gauge cannulas (group 1) and 18-gauge cannulas (group 2). The primary predictor variable was cannula diameter. Pain values assessed using a Likert-type (0 to10) visual analog scale (VAS) were selected as primary outcome variable. Mandibular movements including maximum mouth opening (MMO), lateral excursions (LE) and protrusion (P), were selected as secondary outcomes. Mandibular movements and pain values were recorded before treatment and at 1st day and 3rd months intervals. Descriptive, comparative, and bivariate analyses were conducted. Intraoperative complications were also recorded. RESULTS: DPA was applied to 33 patients (29 females, 4 males). Although group 1 was found to be significantly more advantageous than group 2 in terms of pain levels (P < .05), no statistically significant difference was discovered in terms of total complication numbers and mandibular movements at the follow-up periods (P >.05). CONCLUSIONS: Despite the limited sample size cannula thickness affects postoperative pain level significantly in conventional TMJ arthrocentesis.

Evaluation of the effectiveness of different puncture points for second cannula in double puncture arthrocentesis of temporomandibular joint.

The study at checking if treatment outcomes in double puncture temporomandibular joint (TMJ) arthrocentesis (DPTMJA) changed when the puncture points of the second cannula punctate were changed. Using a retrospective cohort study design, the investigators enrolled a sample of temporomandibular joint disorder (TMD, internal derangement) patients receiving DPTMJA. The decision of whether to perform a modified or traditional arthrocentesis was made by the patients: Patients who accepted the close cannula relationship were evaluated as group 1 (modification group), and those who did not agree as group 2 (traditional group). The predictor variable was puncture points of the second cannula (close to vs. far from the first cannula; group 1 and 2, respectively). The main outcome variables included maximum mouth opening (MMO), and pain assessed using a Likert-type (0-10) visual analogue scale (VAS) before treatment and at 1st day and 3rd months intervals. Appropriate statistics were computed using P < .05 was considered significant. The study sample comprised 32 patients (93.8% females; 50% in each study arm) with an average age of 36.9 ± 15.3 years (range, 18-78). Although, patient age and gender, and baseline VAS in both groups were not significant different (P > .05), the baseline MMO in group 2 was significant higher than that in group 1 (P = .03). The within-group analyses demonstrated the significant improvement of both MMO and VAS at postoperative month 3 (P < .05). However, the between-group analyses rejected the significant differences between the 2 groups at day 1 and month 3 (P > .05). Within the limitations of the study the choice of one or the other technique should be left to the discretion of the surgeon.

Sacrospinous Ligament Fixation Under Local Anesthesia in Elderly Patients at High Risk of General Anesthesia.

Introduction and Hypothesis: Sacrospinous ligament fixation(SSLF) is a commonly used surgical procedure in pelvic organ prolapse due to high treatment success rates. Many intraoperative and postoperative anesthesia-related obstacles may be encountered by the elderly population. Local anesthesia alone or with intravenous sedation may provide simple, cheap, and safe anesthesia. For elderly patients at high risk for general anesthesia according to the American Society of Anesthesiologists(ASA), it is better to operate through the vaginal route under local anesthesia. To perform minimal invasive SSLF surgery, the Pelvic Floor Repair Tissue Fixing Anchor, which is a target-specific system, can be used. In this prospective observational study, evaluation was made of elderly patients who underwent SSLF under local anesthesia. Materials and Methods: The study included 11 patients evaluated as high risk for general and regional anesthesia who underwent SSLF under local anesthesia as pelvic organ prolapse surgery. All operations were performed by a single experienced surgeon using 1% lidocaine infiltration and the Pelvic Floor Repair Tissue Fixing Anchor system. Results: The mean age of the patients was 69.6 years. Stage IV prolapse was determined in 7 (63.6%) patients, 4 (36.3%) had a history of hysterectomy, 5 (45.4%) were classified as ASA 3, and 6 (54.6%) as ASA 4. No complications occurred and patients were followed up for 24 months. In two patients, recurrence of POP was observed at postoperative 8 and 10 months, respectively. Conclusions: The results of this study demonstrated the surgical and anesthetic safety of SSLF under local anesthesia for pelvic organ prolapse in elderly patients.

Radiographic Evaluation of Low-Level Laser Therapy-Enhanced Maxillary Sinus Augmentation with Simultaneous Dental Implant Placement.

BACKGROUND: To evaluate the effect of low-level laser therapy (LLLT) on bone healing in patients undergoing bilateral sinus lifting and simultaneous dental implant application. METHODS: Twelve patients with total/partial posterior maxillary edentulism who needed bilateral sinus bone augmentation were included in the study. Dental implants were inserted in the same session. LLLT (λ = 630-660 nm, 25 mW/cm2, 6 min) was used for one operation side on the 1st, 3rd, 5th, and 7th days, whereas contralateral side served as control side. Preoperative and postoperative 1st, 3rd, and 6th month orthopantomograms were obtained using the aluminum step-wedge technique. Optic density analyses were performed using a Cardinal Health Digital Densitometer (Fluke Biomedical 07-443) with 1 mm diameter. Digital densitometry results were obtained as the equivalent aluminum thickness for each radiograph. These data were used to evaluate the changes in optical bone density and to compare the treatment side with the control side for each patient. RESULTS: The LLLT side showed better results than the control side according to the densitometry results. Increase in the bone density at all the postoperative intervals was statistically significant (P < 0.05). CONCLUSIONS: LLLT enhances bone regeneration in sinus augmentation with simultaneous dental implant placement.

Evaluation of ultrasonography guidance for single-puncture temporomandibular joint arthrocentesis: A randomized clinical study.

Objective To evaluate ultrasonography (US) guidance on the single-puncture temporomandibular joint (TMJ) arthrocentesis technique. Methods Twenty-four patients were randomly divided into two groups (n = 12 in each group), and single puncture arthrocentesis (SPA) was performed with and without US guidance in groups 1 and 2. During the one-year follow-up period, the groups were statistically evaluated by the visual analog scale for pain, maximum mouth opening, lateral excursion, and protrusion within each group and between the two groups. Results Both treatment groups showed significant improvement, compared to the baseline levels for almost all outcome variables. However, there were no statistically significant differences between groups 1 and 2 (p > 0.05). Conclusion US guidance can be used for cannula placement in SPA. However, the outcome results are the same with or without its use.

Cosmetic outcomes of infraumbilical, supraumbilical, and transumbilical entry routes in laparoscopic surgery.

OBJECTIVE: The aim of the present study was to determine which of the umbilical entry routes for intraperitoneal access has a better cosmetic result. MATERIAL AND METHODS: This was a prospective study (Canadian Task Force classification II-1). In total, 105 patients who underwent laparoscopic surgery were included. A vertical or transverse umbilical incision is appropriately made for the trocar to be inserted, and an infraumbilical, supraumbilical, or transumbilical route was preferred for initial intraperitoneal access. Demographic data of patients, body mass indices, entry point of the trocars (infraumbilical-transumbilical-supraumbilical), type of incision (vertical-transverse), duration of the operation, and scar properties at postoperative week 12 were prospectively collected and analyzed. The Vancouver scar scale was used to evaluate the cosmetic results. RESULTS: Cosmetic results did not differ statistically between the transumbilical-infraumbilical-supraumbilical groups. The variables, such as vascularity, height, and total score, of the Vancouver scar scale were significantly higher in patients who had transverse incisions. There was no statistically significant effect of using a Veress needle with the cosmetic results. There was no statistically significant correlation between age, gravida, body mass indices, skin thickness, time of entry, duration of the operation, and cosmetic results in terms of vascularity, height, and total score. CONCLUSION: During laparoscopic surgery, each patient should be assessed individually for the satisfaction of the patient and, thereby, of the surgeon in terms of cosmetic outcomes. Vertical incision offers superior cosmetic effects than transverse incision. Further research is required to define long-term scar-related outcomes of the laparoscopic intraperitoneal access techniques.

Modified abdominal packing method in "near miss" patients with postpartum hemorrhages.

OBJECTIVE: To describe a more effective abdominal packing method in patients with disseminated intravascular coagulation following peripartum hysterectomy due to postpartum hemorrhage (PPH). MATERIALS AND METHODS: The present retrospective and descriptive study was conducted to document six cases with refractory pelvic bleeding who underwent a second surgery for PPH between January 2016 and December 2017 at Istanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital. RESULTS: Karateke packing was performed to control intra-abdominal massive hemorrhages of five women who were referred to our clinic due to PPH who had undergone peripartum hysterectomy and hypogastric artery ligation but hemostasis could not be provided. In addition, a case of hypovolemic shock due to placenta percreta rupture in a woman who had also undergone an emergency hysterectomy and hypogastric artery ligation, which had failed. Hemostasis was provided in all patients. No method-related complication developed. CONCLUSION: Karateke packing is a very easy method to perform, it is more effective than the classic abdominal packing technique, with a low complication rate, and most importantly, life-saving in patients undergoing a peripartum hysterectomy due to PPH and thereafter experiencing diffuse hemorrhage.

Postpartum urinary retention: Evaluation of risk factors.

OBJECTIVE: Postpartum urinary retention means the absence of spontaneous micturition more than 6 hours after birth or when residual volume after urination is less than 150 cc. If neglected, postpartum urinary retention may result in bladder denervation and detrusor muscle weakness requiring intermittent catheterization or permanent micturition dysfunction. Our goal was to identify the possible risk factors for postpartum urinary retention. MATERIALS AND METHODS: Five hundred sixty female subjects were included in this retrospective study. All data obtained including variables such as age, parity, body mass index, duration of labor, prepartum bladder catheterization were compared between female subjects with and without postpartum urinary retention. RESULTS: Among the 560 patients recruited to our study, 124 (22.1%) had postpartum urinary retention. Third stage duration, time from birth to the first void, and number of peripartum micturitions were found to be potential risk factors for postpartum urinary retention. Different than other studies, our study revealed a correlation between peripartum catheterization and postpartum urinary retention. There were no statistically significant differences between patients with and without postpartum urinary retention in terms of other variables. CONCLUSION: In this study, a correlation between peripartum catheterization and postpartum urinary retention was found. There are studies that reported the possible risk factors related to the occurrence of postpartum urinary retention. More studies should be conducted to investigate long-term results with larger populations.

Serum, salivary, and tissue levels of plasminogen in familial Mediterranean fever, amyloidosis, and chronic periodontitis.

BACKGROUND: There are no published studies regarding the role of the plasminogen (PLG) system in familial Mediterranean fever (FMF), FMF-associated secondary amyloidosis, or chronic periodontitis (CP), although recent limited data have focused on the association between FMF and chronic periodontitis. Therefore, the aim of this study was to evaluate the serum, salivary, and gingival tissue levels of PLG in patients with CP, FMF, and amyloidosis. METHODS: The study population included 122 patients with FMF (only FMF, and FMF and amyloidosis and 128 individuals who were systemically healthy controls. Blood and salivary samples were obtained from the cases and controls, and clinical periodontal parameters were recorded. Serum and salivary PLG levels were assessed. The gingival tissue samples of the case and control groups were analyzed histopathologically and immunohistochemically for amyloid deposition and PLG. RESULTS: The amyloidosis group had significantly more severe clinical periodontal parameters than those of the FMF and systemically healthy groups (P < 0.05). Salivary levels of PLG were significantly higher in the FMF and amyloidosis groups compared with those in the control group (P < 0.001). The FMF with periodontitis and amyloidosis with periodontitis groups had higher salivary PLG levels compared with those in the CP group. Serum and salivary PLG levels were significantly associated with the clinical periodontal parameters in the FMF group. The amyloidosis cases had hyperplasia, severe inflammation, and activation of the gingiva. CONCLUSION: The PLG system could play an important role in inflammatory diseases, such as chronic periodontitis, FMF, and FMF-associated secondary amyloidosis.

Techniques and modifications for TMJ arthrocentesis: A literature review.

OBJECTIVES: To discuss advantages and disadvantages of TMJ arthrocentesis techniques, identifying modifications as reported in the literature. METHODS: A PubMed web-based search was carried out, using the terms TMJ and arthrocentesis, to determine the scope of coverage in well-documented articles in English. RESULTS: Among 237 articles, 12 distinct techniques were described for TMJ arthrocentesis in 12 articles. Among 12 techniques, 5 were classified as double puncture arthrocentesis (DPA) and 7 as single puncture arthrocentesis (SPA). In total, 17 well documented articles about SPA were found in literature. DISCUSSION: Arthrocentesis of the temporomandibular joint (TMJ) was first described in 1991. To make the traditional procedure even less invasive, many arthrocentesis methods have been described. However, in 2015, TMJ arthrocentesis techniques were divided into two groups to limit the complexities surrounding the concepts related to TMJ arthrocentesis techniques.

Vaginal axis on MRI after unilateral and bilateral sacral hysteropexy: a controlled study.

The objective of this study was to evaluate the vaginal position on magnetic resonance imaging (MRI) after bilateral abdominal sacral hysteropexy (BASH) and classical abdominal sacral hysteropexy (ASH) and to investigate which method keeps the vagina the most proximate to its original anatomical position. Ten patients, with 10 having BASH, 10 ASH and 10 being nulliparous, were compared. The angle between the vagina and the pubococcygeal plate, the angle between the upper and lower vaginal segments, the distance between the posterior fornix and the 2nd vertebra and the distances between the lateral fornices and spina ischiadica were measured on MRI. A p value less than .05 was considered statistically significant. The distance between the vaginal axis and the left spina ischiadica was greater in the ASH group compared to the control and the BASH group (p = .011, .047), while it was similar between the BASH group and the control individuals (p = .473). The angle between the upper and lower vaginal segments was greater in the ASH group compared to the control group (p = .004), while no significant difference was found between the BASH and control groups (p = .112). BASH keeps the vaginal axis at a more proximate location to its original anatomical position. IMPACT STATEMENT What is already known on this subject: In pelvic reconstructive surgery; the anatomic correction serves the functional results. What the results of this study add: On MRI examination bilateral abdominal sacral hysteropexy (mimicking uterosacral ligament), keeps the vagina closer to the original anatomic position than classical abdominal sacral hysteropexy. Hence functional outcomes could be better, especially in the long term. What the implications are of these findings for clinical practice and/or further research: This study may be of interest for clinicians in terms of different methods for pelvic floor surgery and may be of interest for researchers to investigate the relationship between anatomic position and functional outcomes especially in younger patients.

Predictive value of some hematological parameters for non-invasive and invasive mole pregnancies.

AIM: The aim of this study was to discriminate mole pregnancies and invasive forms among cases with first trimester vaginal bleeding by the utilization of some complete blood count parameters conjunct to sonographic findings and beta human chorionic gonadotropin concentration. MATERIALS AND METHODS: Consecutive 257 cases with histopathologically confirmed mole pregnancies and 199 women without mole pregnancy presented with first trimester vaginal bleeding who admitted to Zeynep Kamil Women and Children's Health Training Hospital between January 2012 and January 2016 were included in this cross-sectional study. The serum beta HCG level at presentation, and beta hCG levels at 1st, 2nd and 3rd weeks of postevacuation with some parameters of complete blood count were utilized to discriminate cases with molar pregnancy and cases with invasive mole among first trimester pregnants presented with vaginal bleeding and abnormal sonographic findings. RESULTS: Levels of beta hCG at baseline (AUC = 0.700, p < 0.05) and 1st (AUC = 0.704, p < 0.05), 2nd (AUC = 0.870, p < 0.001) and 3rd (AUC = 0.916, p < 0.001) weeks of postevacuation period were significant predictors for the cases with persistent disease. While area under curve for mean platelet volume is 0.715, it means that mean platelet volume has 21.5% additional diagnostic value for predicting persistency in molar patients. For 8.55 cut-off point for mean platelet volume, sensitivity is 84.6% and specificity is 51.6%. Area under curve for platelet/lymphocyte ratio is 0.683 means that platelet/lymphocyte ratio has additional 18.3% diagnostic value. For 102.25 cut-off point sensitivity is 86.6% and specificity is 46.2. CONCLUSIONS: Simple, widely available complete blood count parameters may be used as an adjunct to other risk factors to diagnose molar pregnancies and predict postevacuation trophoblastic disease.

Sphenoethmoid Cell: The Battle for Places Inside of the Nose Between a Posterior Ethmoid Cell and Sphenoid Sinus: 3D-Volumetric Quantification.

BACKGROUND: Sphenoethmoid cells may be above the sphenoid sinus with/ or without con-tact to optical nerve. Although sphenoethmoid cells are theoretically considered to possibly influence the sphenoid sinus volume, we could not find any study in the literature on this issue. AIMS: The aim of our study was to detect sphenoethmoid cells and measure the sphenoid sinus vol-ume using multiplanar computerized tomography and also investigate the correlation between the presence of sphenoethmoid cells and the sphenoid sinus volume. METHODS: Retrospectively 141 patients who had available paranasal computerized tomography images were included in this study. The sphenoid sinus volumes of each patient were calculated individually for each side, and the relationship between the presence of sphenoethmoid cell and sphenoid sinus volume was investigated. RESULTS: Sphenoethmoid cells were detected at 106 (37.5%) of the total 282 sides in 141 patients. No gender difference was observed. The total sphenoid sinus volume was significantly lower in the group of patients who had bilateral sphenoethmoid cells than in the sphenoethmoid cell negative group. In patients with a unilateral sphenoethmoid cell, a significant decrease in the sphenoid sinus volume was observed only for the side where the sphenoethmoid cell was located. CONCLUSION: It was observed that the sphenoethmoid cells caused a significant reduction in the sphe-noid sinus volume on the side where they were located. In the case of low sphenoid sinus aeration, the sphenoethmoid cell should be kept in mind. Further studies with an extended patient series are required to explore this issue.

Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

OBJECTIVE: Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. METHOD: A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. RESULTS: While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). CONCLUSION: This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

Extraoral approach of the surgical treatment of sublingual epidermoid cyst: A case report.

Epidermoid and dermoid cysts account for <0.01% of all oral cavity lesions with dermoid cyst which is twice as common to epidermoid. Epidermoid cysts are benign lesions that occur rarely in children. They usually present early in life as an asymptomatic mass. The treatment option is surgical and intraoral or extraoral approaches can be performed according to the localization and size of the mass. This report presents an 11 year old child with a sublingual epidermoid cyst treated extraorally.

Effect of platelet rich fibrin on edema and pain following third molar surgery: a split mouth control study.

BACKGROUND: To evaluate the efficacy of platelet-rich fibrine (PRF) on postoperative edema and pain after impacted mandibular third molar surgery. METHODS: The prospective study was comprised 30 patients who presented for the removal of bilateral impacted mandibular third molar teeth. After extraction, the sockets were filled with PRF or without PRF in the study and control groups, respectively. Postoperative edema was measured with a flexible tape measure by calculating the distance between several facial landmarks on postoperative days two and seven. Postoperative pain was evaluated with a line-type visual analogue scale (VAS) and a verbal scale (VRS). SPSS version 20.0 was used for data analysis. RESULTS: Both groups recorded significant improvement compared to the baseline levels in almost all of the outcome variables. There was no statistically significant difference between the study and control groups (p > 0.05). CONCLUSIONS: Using or not using PRF to reduce postoperative pain and edema in third molar surgery was equally successful. TRIAL REGISTRATION: This study was retrospectively registered at the ISRCTN registry ( ISRCTN16849867 ) on 6 March 2017.

Serum serotonin, leptin, and adiponectin changes in women with postpartum depression: controlled study.

PURPOSE: Postpartum depression (PPD) affects nearly 10% of mothers after delivery and has many serious results. Although many factors associated with PPD, the etiology, and pathophysiology of PPD are not known completely. The relationship between serum serotonin concentration and depression is well known, but there are no enough data regarding the serum change of leptin and adiponectin. The aims of this study are to research the level of serum serotonin, leptin,s and adiponectin concentrations in women with PPD. MATERIALS AND METHODS: A controlled trial has been conducted in three centers. Two hundred and forty four women were evaluated at postpartum day 10 with the Edinburgh Postnatal Depression Scale (EPDD). Venous blood samples were collected and serotonin, and leptin and adiponectin levels were studied using human enzyme-linked immunosorbent assay. Mann-Whitney U test was used for comparison of serum levels of serotonin, leptin, and adiponectin between women with PPD and without. A p value of <0.05 was considered significant. RESULTS: PPD was detected in 70 postpartum women. The mean serum serotonin level was significantly lower in the group with PPD (p = 0.001), while mean serum adiponectin level was higher (p = 0.001). The mean serum leptin level was not different (p = 0.133). CONCLUSIONS: The serum adiponectin and leptin levels were high in women with PPD. This could play important role in the pathophysiology of PPD. Elevation of serum levels also may play antidepressant role against PPD, especially the early postpartum period.