Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study

Abstract BACKGROUND: Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. OBJECTIVES: Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. DESIGN AND SETTING: This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. METHODS: We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. RESULTS: We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. CONCLUSION: This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study.

BACKGROUND: Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. OBJECTIVE: Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. DESIGN AND SETTING: This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. METHODS: We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. RESULTS: We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. CONCLUSION: This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Role of platelet indices in prediction of preeclampsia.

OBJECTIVES: To compare platelet indices in preeclamptic and normotensive pregnants and to investigate the clinical use of these parameters in preeclampsia prediction. MATERIAL AND METHODS: This retrospective case- control study included 257 preeclampsia patients and 264 healthy pregnant women as the control group. The groups were compared in terms of platelet count (PC), mean platelet volume (MPV), platelet distribution range (PDW), plateletcrit (Pct), Pct / MPV ratio and PC / MPV ratio. RESULTS: Between the preeclampsia group and the control group; mean platelet count (227.22 ± 78.58 vs 236.69 ± 64.30), plateletcrit (PCT) (0.21 ± 0.06 vs 0.24 ± 0.27), and platelet distribution width (PDW) (17.11 ± 0.80 vs 17.29 ± 0.82) were not significantly different (p> 0.05). However, MPV values were significantly higher in the preclampsia group compared to the control group (9.66 ± 1.62 and 8.92 ± 1.33, respectively) (p < 0.001). In our study, the optimum cut-off value of MPV was 9.15 with 58.7% sensitivity and 61.7% specificity for the prediction of preeclampsia. Pct/MPV ratio (0.02 ± 0.007 vs 0.027 ± 0.029) ( p = 0.01) and PC/MPV ratio ( 24.63 ± 10.90 vs 27.63 ± 10.24) (p = 0.001) were significantly lower in the preeclampsia group than in the control group. CONSLUSIONS: In preeclampsia, changes in platelet functions, destruction and production lead to changes in platelet indices. Compared with normal healthy pregnant women, preeclamptic pregnant women have higher MPV values. In preeclampsia prediction, MPV and PC/MPV ratio are promising as a diagnostic parameter.

The Role of Ischemia-modified Albumin as a Biomarker in Preeclampsia.

OBJECTIVE: Ischemia-modified albumin (IMA)is a modified type of albumin protein that is formed under oxidative stress. This study aims to compare the levels of serum IMA between normotensive and preeclamptic pregnancies and to evaluate the relationship between the severity of the disease. METHODS: A total of 90 pregnant women aged between 18 and 45 years participated in this prospective study. The levels of serum IMA were measured by enzyme-linked immunosorbent assay in 30 preeclamptic pregnant women with the severe signs of the disease, 30 preeclamptic pregnant women, and 30 normotensive pregnant women.. The study was designed as a cross-sectional clinical study. RESULTS: When the demographic characteristics were examined, statistically significant differences were found between the groups in terms of age, gestational week at birth and blood pressure. Age was higher in the preeclampsia with signs of severity group than in the normotensive group (p = 0.033). Pregnancy week was significantly the lowest in the preeclampsia with the severity signs group (p = 0.004). In normotensive patients, IMA levels were lower than in the preeclampsia groups (p = 0.000) but there was no significant difference in terms of severity of disease (p = 0.191). According to laboratory data; only the creatinine level was significantly different between the groups. CONCLUSION: The levels of serum IMA were higher in patients with preeclampsia than in healthy pregnancies. However, there was no significant correlation in terms of preeclampsia severity; more extensive, prospective and long-term studies are needed.

The role of ischemia-modified albumin as a biomarker in preeclampsia

Abstract Objective Ischemia-modified albumin (IMA)is a modified type of albumin protein that is formed under oxidative stress. This study aims to compare the levels of serum IMA between normotensive and preeclamptic pregnancies and to evaluate the relationship between the severity of the disease. Methods A total of 90 pregnant women aged between 18 and 45 years participated in this cross-sectional study. The levels of serum IMA were measured by enzyme-linked immunosorbent assay in 30 preeclamptic pregnant women with the severe signs of the disease, 30 preeclamptic pregnant women, and 30 normotensive pregnant women.. The study was designed as a cross-sectional clinical study. Results When the demographic characteristics were examined, statistically significant differences were found between the groups in terms of age, gestational week at birth and blood pressure. Age was higher in the preeclampsia with signs of severity group than in the normotensive group (p = 0.033). Pregnancy week was significantly the lowest in the preeclampsia with the severity signs group (p = 0.004). In normotensive patients, IMA levels were lower than in the preeclampsia groups (p = 0.001) but there was no significant difference in terms of severity of disease (p = 0.191). According to laboratory data; only the creatinine level was significantly different between the groups. Conclusion The levels of serum IMA were higher in patients with preeclampsia than in healthy pregnancies. However, there was no significant correlation in terms of preeclampsia severity; more extensive, prospective and long-term studies are needed.

Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding.

Aim: To define the risk factors for relaparotomy after cesarean delivery (RLACD) and related maternal near-miss event due to bleeding.Methods: In this retrospective descriptive case-control study, women who underwent RLACD (n = 46) only for bleeding between 2012 and 2017 were reviewed. Factors that could predict relaparotomy and related near-miss event were evaluated. Maternal characteristics, laboratory findings and surgical features were compared with a control group (n = 230) that included noncomplicated cesarean deliveries (CD). Logistic regression analysis was used to identify independent factors for relaparotomy.Results: RLACD for bleeding was required in 0.26% of patients and the incidence increased gradually over years (0.16% in 2013 versus 0.44% in 2017). Mean interval between CD and subsequent relaparotomy was 15.7 ± 3.2 hours. The sources of bleeding in descending order of frequency included; uterine fundus and placental bed (39.1%), cervix (21.7%), undetermined (17.3%), superior epigastric artery (13%), superficial epigastric artery (8.1%). Longer duration of CD (adjusted odd ratio (aOR) 1.82, 95% CI 1.02-2.53), increased number of prior CDs (aOR 2.51, 95% CI 1.09-5.78), preeclampsia (aOR 3.48, 95% CI 1.21-7.19) were found to be independent risk indicators for RLACD. Moreover, longer duration of interval between CD and relaparotomy (p = .005), longer relaparotomy duration (p = .012) and greater drop in hemoglobin level (p = .001) were found to be the predictors of maternal near-miss event.Conclusions: Patients with identified risk factors should be managed properly in order to prevent relaparotomy and near-miss event after CD. Also, urgent decision of surgical intervention might reduce the risk of maternal near-miss event.

Serum caveolin-1 levels in patients with preeclampsia.

Aim: The expressions of caveolin-1 have only been examined in the placental tissue of patients with preeclampsia and were reported to be low. Therefore, we decided to investigate the maternal serum levels of caveolin-1 in patients with preeclampsia.Material and methods: This cross-sectional study was conducted including 87 pregnant women; 32 with normal pregnancy and 55 with preeclampsia. Maternal serum levels of caveolin-1 were measured by using enzyme-linked immunosorbent assay kit (ELISA).Results: The mean serum caveolin-1 level was significantly lower in women with preeclampsia (PE) compared with the control group (11.48 ± 0.92 versus 12.94 ± 1.36 ng/ml) and being lowest in the early onset PE group (11.24 ± 0.74 ng/ml). Serum caveolin-1 concentrations did not correlate with maternal age and BMI. However, caveolin-1 concentrations were negatively correlated with systolic blood pressure (r = -0.467, p = .001) and diastolic blood pressure (r = -0.441, p = .001) as well as with umbilical artery resistance index (r = -0.275, p = .01).Conclusion: Maternal serum caveolin-1 levels are significantly lower in patients with PE than controls. The serum caveolin-1 levels inversely correlate with blood pressure and umbilical artery Doppler parameters.

Oxytocin infusion reduces bleeding during abdominal myomectomies: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of oxytocin infusion to reduce intraoperative bleeding during abdominal myomectomies. METHODS: This randomized, parallel group, blinded study was conducted between October 2017 and May 2018. Patients undergoing abdominal myomectomies were randomized 1:1 either to the oxytocin group or to the control group (saline). In the oxytocin group, 10 IU oxytocin in 500 ml of saline at a rate of 120 ml/h was given during the course of the operation. The primary outcome of this study was to measure intraoperative blood loss between the study groups. Correlation and multiple regression analysis were performed to illustrate factors associated with intraoperative blood loss during the myomectomy. RESULTS: The mean intraoperative blood loss during the surgery was 489.20 ± 239.72 ml in the oxytocin group and was 641.40 ± 288.21 ml in the control group. The hemoglobin decline was more evident in the control group than in the oxytocin group. Positive correlations were also observed between the intraoperative blood loss and number of fibroids removed during the surgery, largest fibroid removed and weight of fibroids removed. The use of oxytocin infusion during the myomectomy resulted in a reduction of bleeding in the regression model. CONCLUSION: Intravenous oxytocin infusion is a safe and practical method to reduce intraoperative blood loss during the abdominal myomectomy.

Serum collectrin levels in patients with early- and late-onset preeclampsia.

AIM: The aim of this study is to investigate the maternal levels of collectrin in early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE). To assess the correlation between serum collectrin levels and blood pressure in humans. MATERIAL AND METHODS: This cross-sectional study was conducted including 79 pregnant women, 27 with normal pregnancy, 30 with EOPE and 22 with LOPE. Maternal serum levels of collectrin were measured by using enzyme-linked immunosorbent assay kits. RESULTS: The mean serum collectrin level was significantly lower in women with PE compared with the control group (8.49 ± 3.12 ng/ml (EOPE), 9.69 ± 3.01 ng/ml (LOPE) versus 11.51 ± 4.33 ng/ml) and was found to be the lowest in the EOPE group (8.49 ± 3.12 ng/ml). The mean serum urea and uric acid levels were significantly higher in the PE group than the control group. Serum collectrin concentrations did not correlate with maternal age, BMI and serum creatinine levels. However, collectrin concentrations were negatively correlated with systolic blood pressure (r = -0.284, p = .011) and diastolic blood pressure (r = -0.275, p = .014) as well as with maternal serum urea (r = -0.269, p = .017) and uric acid (r = -0.219, p = .049) concentrations. CONCLUSION: Maternal serum collectrin levels are significantly lower in patients with preeclampsia than in the control group. There is an inverse correlation between serum collectrin levels and blood pressure.

Increased serum neuregulin 4 levels in women with polycystic ovary syndrome: A case-control study.

Neuregulin 4 (NRG4) is an adipokine that is synthesized in many tissues and has been shown to be associated with the development of obesity and metabolic disorders in animals and humans. The aim of this study is to investigate the relationship between serum NRG4 levels and various metabolic parameters in women with PCOS. This cross-sectional study included 40 women with PCOS and 40 age- and BMI-matched controls without PCOS. NRG4, fasting blood glucose (FBG), insulin, hs-CRP, LDL-C, HDL-C, SHBG, DHEA-SO4 and total-testosterone levels were measured in all the participants. HOMA-IR was used to calculate the insulin resistance. Serum NRG4 levels were higher in women with PCOS than in healthy women (24.89 ± 9.32 [ng/mL] vs. 18.98 ± 6.40 [ng/mL], p = 0.002). FBG, LDL-C, HDL-C, LH, SHBG, FAI, DHEA-SO4, insulin, hs-CRP, HOMA-IR and total-testosterone levels were significantly higher in women with PCOS than controls. Circulating NRG4 levels were positively correlated with HOMA-IR, insulin and hs-CRP for both groups. There was a positive correlation between NRG4 and FBG in the PCOS group. HOMA-IR and hs-CRP were associated with NRG4. The high concentration of circulating NRG4 in PCOS may be associated with insulin resistance and low-grade chronic inflammation.

Maternal serum autotaxin levels in early- and late-onset preeclampsia.

PURPOSE: We aimed to compare the serum autotaxin levels in early- and late- preeclamptic and healthy pregnant patients at a university hospital. METHODS: A total of 55 singleton preeclamptic women who delivered at Cerrahpasa Medical Faculty were included in the study. The patients were subdivided into two groups: early-onset preeclampsia (n = 31) and late-onset preeclampsia (n = 24). Demographic and clinical data were compared between early-onset and late-onset preeclamptic patients. The control group was composed of 32 healthy pregnant patients. RESULTS: The mean autotaxin levels were 1.16 ± 0.97 and 0.7 ± 0.35 ng/ml in the early- and late-onset preeclampsia groups, respectively. Autotaxin levels were significantly higher in early-onset preeclampsia group compared with late-onset preeclampsia group. Autotaxin levels were found to be significantly higher in preeclamptic patients compared with control group. Serum autotaxin levels showed a significant positive correlation with maternal systolic, diastolic blood pressures and uric acid levels. CONCLUSION: Autotaxin might be a promising marker for detecting early-onset preeclampsia. However, further studies are necessary to confirm this hypothesis.

Elevated circulating levels of xenopsin-related peptide-1 are associated with polycystic ovary syndrome.

PURPOSE: This study was conducted to compare serum xenopsin-related peptide-1 (XP-1) levels in women with polycystic ovary syndrome (PCOS) and in healthy women and to determine the role of XP-1 levels in PCOS. METHODS: Forty patients with PCOS and 38 healthy women were included in the study and matched with age and body mass index. Fasting blood glucose, insulin, high sensitivity C-reactive protein (hs-CRP), XP-1 and total testosterone levels of all participants were measured. RESULTS: Serum XP-1 levels significantly increased in women with PCOS compared to the control group (6.49 ± 1.57 vs 5.29 ± 1.45 ng/ml, p = 0.001). Serum insulin, hs-CRP, HOMA-IR, total testosterone levels and waist circumference were higher in women with PCOS than in control group. High XP-1 levels were associated with PCOS after adjustment for potential confounders. Receiver operating characteristic (ROC) curve analysis confirmed that the area under ROC curves was 0.703 (95% CI 0.588-0.818, p < 0.002) for XP-1 levels. The optimal cut-off value of XP-1 for detecting PCOS was ≥5.87 ng/ml. CONCLUSIONS: Our results indicate that increased XP-1 levels were associated with PCOS after adjustment for potential confounders, which has been shown to be effective in the function of the insulin signaling pathway.

Adolescent pregnancies: complications, birth outcomes and the possible solutions.

OBJECTIVES: In this study we aim to evaluate antenatal, perinatal and postnatal outcomes and complications of adolescent pregnancies, as well as to discuss the social and psychological consequences of these pregnancies. MATERIAL AND METHODS: We compare a total of 243 pregnant women at age 14-18 years to a vast control group at age 19-36 who all delivered at Bursa Yüksek Ihtisas Training and Research Hospital between years 2005-2014. RESULTS: Antenatal care (folic acid supplementation, pre-conception counseling) was significantly higher in adolescent pregnancy group. Unplanned pregnancy rate was significantly higher in in study group (p < 0.001). Preterm delivery (before 37th week) ratio was statistically higher in pregnancy complications. CONCLUSIONS: Adolescent pregnancy is a social entity which should be regulated and prevented by legal measures. Planned pregnancies should be promoted and the public should be educated and informed about the Hazards of adolescent pregnancies. Press institutions, public broadcasting services support the efforts to decrease adolescent pregnancies.

The relationship between maternal and umbilical cord adropin levels with the presence and severity of preeclampsia.

AIM: To investigate both maternal and umbilical cord adropin levels in patients with preeclampsia and the possible relations with its severity and perinatal outcomes. MATERIALS AND METHODS: In this study, a total of 38 preeclamptic and 40 age-matched healthy pregnant women between January and June 2016 were included. Serum and cord adropin levels were measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The maternal and umbilical cord adropin levels were significantly lower in the preeclamptic group compared to controls [71.19±22.21 vs. 100.76±27.02 ng/L and 92.39 (59.77:129.89) vs. 106.20 (74.42:208.02) ng/L, P<0.001, respectively]. While maternal adropin levels were significantly lower in the severe preeclampsia group as compared to the mild preeclamptic group [66.45 (21.49:98.02) vs. 76.17 (58.06:109.58), P=0.007], umbilical cord adropin levels did not differ between each group [91.32 (59.77:113.34) vs. 92.87 (63.12:129.89), P=0.750]. Maternal adropin level was negatively correlated with systolic and diastolic blood pressures (r=-0.60, P<0.001 and r=-0.58, P<0.001, respectively) and positively correlated with platelet count (r=0.27, P=0.016). Moreover, umbilical cord adropin levels were weakly correlated with gestational age at delivery (r=0.28, P=0.012) and birth weight (r=0.28, P=0.014). CONCLUSION: The present study is the first to demonstrate a significant association between maternal and umbilical adropin levels and the presence and severity of preeclampsia. Adropin might be a useful parameter for predicting the presence and severity of preeclampsia.

Unusual uterine metastasis of invasive ductal carcinoma: A case report.

Metastatic carcinoma of the uterus usually originates from other genital sites. Extragenital metastases such as breast are rare. A woman aged 34 years with a history of breast cancer was referred to the gynecology outpatient clinic for routine follow-up. Diagnostic tests and gynecologic examination revealed a uterine mass, which was removed with laparotomy. The pathologic investigation revealed metastasis of invasive lobular breast cancer. Chemotherapy was given and the patient has been under follow-up for 3 years with normal imaging on comput-erized tomographic examination and positron-emission tomography-computerized tomographic. It should be kept in mind that patients with breast cancer who have received tamoxifen may develop primary endometrial cancers, and may also demonstrate uterine metastases. With successful treatment these patients can obtain dis-ease-free survival.

Shoulder Tip Pain After Cesarean Section.

AIM: The aim of this study was to investigate the frequency of postoperative shoulder tip pain (STP) after cesarean section and compare spinal and general anaesthesia with respect to STP. MATERIALS AND METHODS: Three hundred patients who underwent cesarean section were randomly assigned to either spinal anaesthesia group (Group SA, n=143) or general anaesthesia group (Group GA, n=157). Postoperative STP was assessed at 8 hours and 24 hours after operation by Visual Analogue Scale of Pain (VAS). RESULTS: There were no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. The overall incidence of STP in study population was 35.7%. The incidence of STP in group SA (26.6%) was lower than that in group GA (43.9%)(p=0.005). Moreover VAS scores for STP at 6 hours and 24 hours were significantly lower in Group SA (p=0.001 and p<0.001, respectively). CONCLUSION: Shoulder tip pain is a common complaint after cesarean section, which is more prevalent in general anaesthesia.

Staging laparotomy for endometrial cancer in a patient with situs inversus totalis: A case report.

Situs inversus is a rare congenital anomaly in which the organs are transposed from their normal site to the opposite side of the body. To the best of our knowledge, this is the first study of staging laparotomy performed in a patient with endometrial carcinoma and situs inversus totalis (SIT). This study presents a patient with early endometrial carcinoma with SIT who underwent staging laparotomy. Total abdominal hysterectomy with bilateral salphingoophorectomy, omentectomy and pelvic para-aortic lymph node dissection was successfully performed without additional blood loss and time. The number of retrieved lymph nodes was 47. No abnormal course of blood vessels except for the right/left inversion was found. The postoperative course was favorable and the patient was discharged eight days after surgery.

Effects of amniotic and maternal CD-146, TGF-ß1, IL-12, IL-18 and IFN-γ, on adverse pregnancy outcome.

OBJECTIVE: Our aim was to determine the effects of maternal serum and amniotic fluid levels of cluster of differentiation 146 (CD-146), transforming growth factor (TGF)-ß1, interleukin (IL)-12, IL-18, and interferon (IFN)-γ on intrauterine growth restriction and preterm labor. METHODS: In this retrospective cohort study, we included pregnant women who underwent amniocentesis at Istanbul University Cerrahpasa Medical School. Women were followed up to labor. The study group comprised 23 women with adverse pregnancy outcomes (intrauterine growth restriction and preterm labor), and the control group comprised 105 women with normal pregnancy outcome. RESULTS: The study group was further divided into two subgroups of preterm labor and intrauterine growth restriction. No significant differences were found for IL-12, IFN-γ, TGF-ß1, or CD-146 levels in either plasma or amniotic fluid between the study and control groups. Serum IL-18 levels were similar, but the amniotic fluid level of IL-18 was significantly higher in the intrauterine growth restriction subgroup than that in the preterm labor subgroup and that in the control group (p < 0.01). CONCLUSIONS: Increased IL-18 level in amniotic fluid may be a predictor for intrauterine growth restriction. IL-12, IFN-γ, TGF-ß1, and CD-146 were not related to adverse pregnancy outcome.

Serum levels of epidermal growth factor, transforming growth factor, and c-erbB2 in ovarian cancer.

OBJECTIVE: This study aimed to investigate serum levels of epidermal growth factor (EGF), transforming growth factor α (TGF-α), and c-erbB2 in patients with ovarian cancer. MATERIALS AND METHODS: In this retrospective cohort study, the study and control groups were composed of 43 women with a prediagnosis of ovarian cancer and 43 healthy women, respectively. Blood samples from all women were obtained and studied by enzyme-linked immunosorbent assay kits for EGF, TGF-α, and c-erbB2. After surgery of the study group, ovarian cancer was confirmed and compared with control group. Stage, grade, and histological types were defined after histopathologic examination, and subgroups were constructed and compared. RESULTS: Serum EGF, TGF-α, and c-erbB2 levels were significantly increased in study group compared with those in the control group (P < 0.001). There were no differences in serum levels of EGF, TGF-α, and c-erbB2 among all stages, grades, and histological types of ovarian cancer. If 47.90 pg/mL was selected as the cutoff value, EGF has an 80% sensitivity and a 65% specificity for detecting ovarian cancer. The cutoff value of 41,095.00 pg/mL for TGF-α has a 90% sensitivity and a 72% specificity for detecting ovarian cancer. The c-erbB2 level of 4.63 pg/mL as the cutoff value has an 83% sensitivity and a 76% specificity for predicting ovarian cancer. CONCLUSIONS: Serum levels of EGF, TGF-α, and c-erbB2 may be used for diagnosing ovarian cancer.