Tranexamic Acid: A Potential Adjunct to Resectoscopic Endometrial Ablation

Abnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. In this study, our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB. Sixty patients were enrolled in this study. All patients underwent resectoscopic surgery. Patients were randomly divided into two groups. Group 1 (n = 30) received 500 mg of tranexamic acid. Group 2 (n = 30) served as the control group and underwent surgery without the administration of tranexamic acid. Total pictorial blood loss assessment chart (PBAC) scores were significantly lower postoperatively (152.14 +/- 9.65 versus 6.6 +/- 0.90; P 15 was lower in the tranexamic group (11 versus 17), but the differences were not statistically significant (P > 0.05). AUB is a complex disease that may need repeated treatments. In expert hands, the treatment rate of resectoscopic surgery seems acceptable. However, some patients may require additional interventions, like repeated surgery, hysterectomy, or a drug therapy in the long run. Introduction of tranexamic acid as a potential adjunct to rollerball endometrial ablation may present an interesting option that requires additional well-designed studies before firm conclusions can be made

Assessment of impaired glucose tolerance prevalence with hemoglobin A(1c) and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study

What is the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and controls in a Turkish population? The total prevalence of glucose abnormalities in PCOS patients was 16.3 [impaired glucose tolerance (IGT) 14.3; type 2 diabetes mellitus (T2DM) 2] and was higher than in healthy subjects (IGT 8.5; T2DM 0, respectively). One of the most common markers of chronic glycemia is hemoglobin Alc (HbA(1c)). However, little is known about whether the use of HbA(1c) results in diagnosis of more cases of glucose intolerance in the PCOS population than the oral glucose tolerance test (OGTT) alone. This was a prospective study, including 252 women with PCOS and 117 control women without PCOS. The study was carried out in the gynecological outpatient department of Namik Kemal University Hospital, Turkey, between 2010 and 2012. Women with PCOS (n 252) were diagnosed according to Rotterdam criteria. The control group included 117 women (aged 1745 years) who were selected randomly. BMI of participants ranged between 15.6 and 47.9 kg/m(2). Patients with PCOS were comparable to controls in terms of age (24.8 versus 25.9 years, respectively) and had higher BMI (26.1 versus 24.9 kg/m(2), respectively). Of 252 patients with PCOS, 41 had glucose intolerance (IGT 14.3; T2DM 2) when compared with 10 of the 117 control patients (IGT 8.5; T2DM 0; odds ratios 2.08; P 0.045) during the OGTT. When an HbA(1c) value 5.6 was used to divide the total population, the prevalence of abnormal glucose metabolism was 7.9 in the patients with PCOS, below the value detected in the control patients (8.5), which showed that 20 of 41 patients with abnormal glucose tolerance would not have been diagnosed, if the HbA(1c) alone had been used. When compared with the OGTT results, HbA(1c) provided 52.4 sensitivity, 74.4 specificity, 67.1 positive and 60.9 negative predictive values with a threshold value of 5.6 in abnormal glucose tolerance. The receiver operating characteristic analysis suggested a threshold value of 5.35 in HbA(1c) (75.6 sensitivity and 52.6 specificity) for the prediction of abnormal glucose tolerance. This study did not involve weight-matched healthy subjects, which may cause a difference in prevalence of abnormal glucose metabolism between the groups, and the results are limited to an unselected population of patients who have the full PCOS phenotype. In addition, the incidence of T2DM among the first-degree relatives and 2-h insulin levels could not be reported in full. Further investigation of the efficacy of HbA(1c) for the prediction of abnormal glucose tolerance should be undertaken in long-term prospective studies and in different geographic populations. At present, the only way to reliably detect abnormal glucose metabolism in Turkish women with PCOS appears to be using the OGTT. No financial support. The authors have no competing interests to declare. Not applicable

Cervical Priming Before Diagnostic Operative Hysteroscopy in Infertile Women: A Randomized, Double-Blind, Controlled Comparison of 2 Vaginal Misoprostol Doses

The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH.Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [26324]An earlier version of this research was presented at the 42nd Annual Meeting of American Society of Reproductive Medicine in San Diego, 2012. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (grant 26324)

Ovarian stem cells and aging

Objective To review successes to date in the field of ovarian stem cell research and discuss the evidence supporting their potential to rejuvenate the follicular pool during adult life; to present factors that may contribute to their competence; and to address the question of why menopause is an inevitable outcome of advanced age if ovarian stem cells exist

Nature of Light: Spectroscopic Techniques in Obstetrics and Gynecology Applications

In recent years, advances in spectroscopic techniques led to an increase in their medical applications. In medical sciences, emphasis is increasingly placed on instrumental techniques and accurate, quantitative measurements. It is especially apparent in diagnosis, where imaging techniques and laboratory results have became invaluable and compulsory. Breakthroughs in biochemistry made it possible to characterize physiological processes and living organisms at the molecular level. This led to a proliferation of new methods such as DNA tests and the use of biomarkers in daily clinical practice. Characterization of molecular structure and determination of the composition of a mixture are the fields of analytical chemistry and analytical biochemistry

THE EFFECT OF GnRH AGONIST VERSUS GnRH ANTAGONIST ON PREGNANCY RATE

Context. Comparison of GnRH analogues and their impact on IVF treatment to improve pregnancy outcome

Validity and efficacy of office hysteroscopy before in vitro fertilization treatment

Office hysteroscopy (OH) allows assessment of the uterine cavity. The aim of this study is to investigate uterine cavity of infertile patients with OH, to treat pathologies and to measure the impact of OH on live birth rates and IVF treatment costs