Metabolic and hormonal effects of a combined Myo-inositol and d-chiro-inositol therapy on patients with polycystic ovary syndrome (PCOS)

Objectives: To evaluate the effects of a combined Myo-inositol (MI) and D-chiro-inositol (DCI) therapy on the hormonal and metabolic parameters of women with PCOS. Prospective clinical study. Clinical Study registration number — EUPAS25705 Material and methods: Seventy women diagnosed with PCOS according to the Rotterdam criteria were enrolled in this study. Patients received a combined therapy of one tablet that contained 550 mg of inositol (myo-inositol (MI) and D-chiro-inositol (DCI) in a ratio of 10:1) twice a day for 6 months. At each of 3 visits, the body weight, height and BMI were all recorded; and serum levels of free testosterone (fT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and glucose with insulin during standard OGTT (75 g) were measured. Also at each visit, transvaginal ultrasonography and skin condition assessments were performed. Results: Significant body weight reduction and decreases in fT, FSH, LH and insulin levels, as well as significant increase of serum SHBG concentrations were observed. Serum glucose levels during OGTT decreased after 6 months of treatment. Also, skin conditions improved after only three months of treatment. Conclusions: Combination of MI and DCI in a ratio 10:1 seems to be efficient in improving both metabolic and hormonal parameters in patients with PCOS.

Zespół policystycznych jajników (PCOS), a ryzyko występowania cukrzycy ciążowej (GDM)

Gestational diabetes mellitus (GDM) is a common complication of pregnancy. In the course of pregnancy, elevated levels of hormones and other proteins having insulin-antagonistic effects lead to higher insulin resistance in peripheral tissues, followed by hyperinsulinemia. Risk factors for the development of GDM have been well-established. However, the debate whether polycystic ovary syndrome (PCOS) may predispose to GDM continues. Patients with PCOS are often affected by obesity, dyslipidemia, hyperinsulinemia ,and tissue-specific insulin resistance. Obesity occurs in 50% of the cases, while tissue-specific insulin resistance is observed in 20-40% of the affected patients. This paper aims at systematizing risk factors that could contribute to the development of GDM, as well as reviewing literature reports and analyses on the occurrence of a potential correlation.Cukrzyca ciążowa (gestational diabetes mellitus – GDM) jest częstym stanem patologicznym wikłającym ciążę. W przebiegu ciąży dochodzi do zwiększenia stężenia w organizmie hormonów oraz innych białek o działaniu antagonistycznym w stosunku do insuliny, co prowadzi do wzrostu insulinooporności tkanek obwodowych, a następnie do hiperinsulinemii. Pomimo, że znane są czynniki ryzyka prowadzące do rozwoju GDM, od lat toczy się dyskusja czy zespół policystycznych jajników (PCOS) może predysponować do wystąpienia cukrzycy ciążowej. U pacjentek z PCOS często występuje otyłość, dyslipidemia, hiperinsulinemia oraz brak wrażliwości tkankowej na insulinę. Otyłość występuje u 50% przypadków, a brak wrażliwości na insulinę u 20-40% pacjentek. Celem poniższego opracowania jest usystematyzowanie czynników ryzyka, które mogłyby u pacjentek z PCOS prowadzić do rozwoju GDM, a także przegląd badań oraz analiz dotyczących występowania potencjalnej korelacji

Risk factors for cesarean section after using the Foley catheter for labor induction

Objective: The aim of the study was to investigate the value of the Bishop score and ultrasound examination of the cervix in predicting the success of labor induction with the use of the Foley catheter determined by the mode of delivery. Material and methods: Foley catheter induction of labor was performed in 135 pregnancies between 38 to 42 weeks gestation. The study group was divided into two groups, depending of the mode of delivery: vaginal vs. cesarean. Results: The Bishop score was significantly higher in the vaginal delivery group when compared to the caesarean section group (5.2; 95%CI: 4.4 – 6.2 vs. 3.9; 95%CI: 2.8-4.9). Cervical length was not statistically significantly different between the two groups. Multivariate logistic regression showed that patient-specific risk for caesarean section decreases with increasing maternal age and the Bishop score (Detection Rate [DR] of 52% at fixed False Positive Rate [FPR] of 10%). Conclusions: Failure of labor induction with the use of the Foley catheter can be predicted by maternal age and pre-induction Bishop score

Ostre poprzetoczeniowe uszkodzenie płuc u młodej kobiety z ciążą ektopową – opis przypadku i przegląd literatury

Background: Transfusion-related acute lung injury (TRALI) is a major cause of death associated with transfusion. Nevertheless it is still misdiagnosed and underreported. We present a case of this serious complication in order to make it more familiar to clinicians and indicate proper medical management, which is significant not only for the patients presenting TRALI symptoms but also for future recipients of blood components. Case presentation: A 32-year-old white woman with in-vitro fertilization in anamnesis was admitted to Department of Obstetrics and Gynecology because of abdominal pain. Ultrasonography examination revealed pathological mass in left adnexa. The patient underwent laparoscopic left salpingectomy. The following day she reported progressive pain in lower abdomen with signs of peritoneal irritation. Emergency laparotomy was performed and active bleeding from fallopian tube was stopped. Four units of red blood cells concentrate and six units of fresh frozen plasma were transfused. Within two hours of surgery acute respiratory distress symptoms occurred, bilateral infiltrates were found on chest X-ray. The patient responded to supportive treatment (oxygen therapy, dexamethasone, diuretics) and her state improved within 12 hours. Serological diagnostics revealed anti-HLA antibodies in one donor which reacted with patient’s granulocytes. Clinical picture and anti-leukocyte antibodies detected in blood component allowed to identify the immune-mediated TRALI. Conclusions: Transfusion-related acute lung injury is a life-threatening complication of transfusion which manifests as non-cardiogenic pulmonary edema. Each suspected case of this syndrome should be reported to blood center in order to confirm the diagnosis and implement preventive measures (exclusion of implicated donor from further blood donation).  Cel pracy: Ostre poprzetoczeniowe uszkodzenie płuc (TRALI) jest jedną z głównych przyczyn zgonów związanych z transfuzją składników krwi. Niemniej jednak powikłanie to pozostaje często nierozpoznawane lub niezgłaszane do odpowiednich ośrodków. W niniejszej pracy prezentujemy przypadek tego poważnego powikłania w celu przybliżenia jego obrazu klinicznego i wskazania prawidłowego postępowania, które jest nie tylko istotne dla pacjenta z objawami TRALI, ale także dla przyszłych biorców preparatów krwiopochodnych. Opis przypadku: 32-letnia kobieta rasy kaukaskiej z wywiadem zapłodnienia pozaustrojowego została przyjęta do Kliniki Położnictwa i Ginekologii z powodu bólu brzucha. Badanie ultrasonograficzne ujawniło obecność patologicznej masy w obrębie lewych przydatków macicy. Pacjentka przebyła lewostronną laparoskopową salpingektomię. Następnego dnia zgłosiła narastające dolegliwości bólowe w podbrzuszu z cechami podrażnienia otrzewnej. Przeprowadzono pilną laparotomię, w trakcie której zatamowano aktywne krwawienie z kikuta jajowodu. Pacjentce przetoczono 6 jednostek koncentratu krwinek czerwonych i 4 jednostki świeżo mrożonego osocza. Po 2 godzinach od operacji wystąpiły objawy ostrej niewydolności oddechowej a w rentgenogramie klatki piersiowej stwierdzono obustronne zacienienia. Zastosowano leczenie podtrzymujące: tlenoterapia bierna, deksametazon, diuretyki. Stan pacjentki uległ poprawie w ciągu 12 godzin. Diagnostyka serologiczna ujawniła u jednego dawcy krwi obecność przeciwciał anti-HLA reagujących z granulocytami pacjentki. Obraz kliniczny i przeciwciała antyleukocytarne wykryte w przetoczonym składniku krwi pozwoliły rozpoznać immunologiczną postać TRALI. Wnioski: Ostre poprzetoczeniowe uszkodzenie płuc jest zagrażającym życiu powikłaniem potransfuzyjnym, które manifestuje się jako niekardiogenny obrzęk płuc. Wszystkie przypadki z objawami wskazującymi na wystąpienie tego zespołu powinny być zgłaszane do Centrów Krwiodawstwa i Krwiolecznictwa celem potwierdzenia diagnozy i wdrożenia odpowiednich środków profilaktycznych (wyłączenie dawcy z przeciwciałami antyleukocytarnymi z dalszego oddawania krwi dla celów klinicznych).

Predictors of COVID-19 severity among pregnant patients

Coronavirus disease 2019 (COVID-19) was declared a pandemic and has spread around the globe, unsparingly affecting vulnerable populations. Effective prevention measures for pregnant women, who are particularly affected, include early identification of those patients at risk of developing in-hospital complications, and the continuous improvement of maternal-fetal treatment strategies to ensure the efficient use of health resources. The objective of our retrospective study was to determine which patient biomarkers on hospital admission correlate with disease severity as measured by disease course classification, the need for oxygen supplementation and higher demand for oxygen, the need for mechanical ventilation, intensive care unit admission, and length of hospital stay. Analysis of 52 PCR SARS-CoV-2 positive pregnant women revealed that the median date of hospital admission was the 30th gestational week, with dyspnoea, cough, and fever as the leading symptoms. The presence of diabetes and hypertension predisposed pregnant women to the severe course of illness. Lung involvement shown by CT scans on admission correlated with the greater clinical severity. The main laboratory predictors of disease progression were lymphocytopenia, hypocalcemia, low total cholesterol, low total protein levels, and high serum levels of C-reactive protein, ferritin, interleukin-6, glucose, lactate dehydrogenase, procalcitonin, and troponin I. Further research with a larger cohort of pregnant women is needed to determine the utility of these results for everyday practice

MicroRNA expression profiles in liver and colon of sexually immature gilts after exposure to Fusarium mycotoxins

To improve our knowledge of the role of microRNAs (miRs) in responses of the porcine digestive system to two Fusarium mycotoxins, zearalenone (ZEN) and deoxynivalenol (DON), we examined the expression of 7 miRs (miR-9, miR-15a, miR-21, miR-34a, miR-122, miR-125b, and miR-192), previously found to be deregulated in diseased liver and colon cells. In this study, immature gilts were exposed to NOEL doses of ZEN (40 μg/kg/d), DON (12 μg/kg/d), ZEN+DON (40+12 μg/kg/d), and placebo (negative control group) for 7, 14, 21, 28, 35, and 42 days. Before the treatment, expression levels of the selected miRs were measured in the liver, the duodenum, the jejunum, and the ascending and the descending colon of the gilts. Hierarchical clustering of the tissues by their miR expression profiles was consistent with what would be expected based on the anatomical locations and the physiological functions of the organs, suggesting that functions of the miRs are related to the specificities of the tissues in which they are expressed. A subset of 2 pairs of miRs (miR-21+miR-192 and miR-15a+miR-34a), which were assigned to two distinct clusters based on their tissue abundance, was then evaluated in the liver and the ascending and the descending colon during the treatment. The most meaningful results were obtained from the ascending colon, where a significant effect of the treatment was observed, suggesting that during the exposure to mycotoxins, the pathways involved in cell proliferation and survival were disordered. Changes in miR expression in the liver and the descending colon of the treated gilts were smaller, and were associated more with treatment duration than the exposure to ZEN, DON, or ZEN+DON. Further research should focus on identification of genes whose expression is regulated by these aberrantly expressed miRs. This should facilitate understanding of the miRNA-regulated biological effects of mycotoxins

Assessment of mutagenic activity of methyl- and phenylphenanthrenes based on Salmonella test and micronucleus test

Polycyclic aromatic hydrocarbons (PAHs) are widely spread environmental pollutants mainly originating from anthropogenic sources such as fossil fuel combustion, industries, and others. Although a large body of literature exists on the toxicity and carcinogenicity of PAHs, primarily benzo[a]pyrene, toxicity data for phenanthrene deriveratives are very limited. The main aim of the experiment was to investigate if there exists correlation between molecular structure and mutagenic activity of four phenanthrene derivatives: 1 methylphenanthrene, 4 methylphenanthrene, 1 phenylphenanthrene, and 4 phenylphenanthrene. An Ames assay using two strains of histidine dependent Salmonella Typhimurium (TA98 and TA100) was conducted to assess the mutagenic activity of studied compounds both in the presence (+S9) and in the absence (-S9) of an exogenous source of metabolic activation. The compounds were also tested in an in vitro chromosome aberration assay in which V-79 cells were exposed to the phenanthrene derivatives investigated both in the presence and in the absence of metabolic activation. The phenylphenanthrenes showed no mutagenic effect. These compounds occasionally induced significant decrease in the number of revertants in the Ames test. The greatest mutagenic effects were observed for 1 methylphenanthrene after metabolic activation (+S9). In the micronucleus test the greatest mutagenic effect was observed for 4 methylphenanthrene also in the presence of metabolic activation system. The results obtained are comparable to those reported earlier for the methylphenanthrenes

Satisfaction and compliance in hormonal contraception: the result of a multicentre clinical study on women's experience with the ethinylestradiol/norelgestromin contraceptive patch in Italy

<p>Abstract</p> <p>Background</p> <p>For many women finding the right contraceptive method can be challenging and consistent and correct use over a lifetime is difficult. Even remembering to take a birth control pill every day can be a challenge. The primary objective of this study was to evaluate women's experience with a weekly ethinylestradiol/norelgestromin contraceptive patch (EE/NGMN patch), given new technologies recently developed in hormonal contraception to increase women's options in avoiding daily dosing.</p> <p>Methods</p> <p>In 24 Italian sites, 207 women received the EE/NGMN patch for up to 6 cycles. At study end, overall satisfaction and preference, as well as compliance, efficacy and safety, were evaluated.</p> <p>Results</p> <p>175 women (84.5%) completed the study. The overall satisfaction rate was 88%; convenience and once-a-week frequency of the patch were especially appreciated. At baseline, 82 women (39.4%) were using a contraceptive method, mainly oral contraceptives and barrier methods, but only 45.1% were very satisfied/satisfied; after 6 months with the patch, 86.3% of this subset was very satisfied/satisfied. Considering the method used in the 3 months before the study entry, 78.1% strongly preferred/preferred the patch, for convenience (53.9%), ease of use/simplicity (28.9%), fewer (9.2%) and less severe (2.6%) side effects. Compliance was very high: 1034/1110 cycles (93.2%) were completed with perfect compliance and the mean subject's compliance score was 90%. One on-therapy pregnancy occurred. The patch was safe and well tolerated: adverse events frequency was low, with predominantly single reports of each event. Most of them started and subsided during cycle 1.</p> <p>Conclusion</p> <p>This study demonstrated that the EE/NGMN patch is associated with high satisfaction levels and excellent compliance. At study end, the majority of women indicated that they would continue using the patch.</p

Inhibin removes the inhibitory effects of activin on steroid enzyme expression and androgen production by normal ovarian thecal cells

Activin and inhibin are important local modulators of theca cell steroidogenesis in the ovary. Using a serum-free primary theca cell culture system, this study investigated the effects of inhibin on theca cell androgen production and expression of steroidogenic enzymes. Androstenedione secretion from theca cells cultured in media containing activin, inhibin and follistatin was assessed by RIA over 144 h. Activin (1–100 ng/ml) suppressed androstenedione production. Inhibin (1–100 ng/ml) blocked the suppressive effects of added activin, but increased androstenedione production when added alone, suggesting it was blocking endogenous activin produced by theca cells. Addition of SB-431542 (activin receptor inhibitor) and follistatin (500 ng/ml) increased androstenedione production, supporting this concept. Infection of theca cells with adenoviruses expressing inhibitory Smad6 or 7 increased androstenedione secretion, confirming that the suppressive effects of activin required activation of the Smad2/3 pathway. Activin decreased the expression levels of steroidogenic acute regulatory protein (STAR), whereas STAR expression was increased by inhibin and SB-431542, alone and in combination. CYP11A was unaffected. The expression of CYP17 encoding 17α-hydroxylase was unaffected by activin but increased by inhibin and SB-431542, and when added in combination the effect was further enhanced. The expression of 3β-hydroxysteroid dehydrogenase (3β-HSD) was significantly decreased by activin, while inhibin alone and in combination with SB-431542 both potently increased the expression of 3β-HSD. In conclusion, activin suppressed theca cell androstenedione production by decreasing the expression of STAR and 3β-HSD. Inhibin and other blockers of activin action reversed this effect, supporting the concept that endogenous thecal activin modulates androgen production in theca cells