Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications

Aims: The aim of this study was to evaluate the predictive value of sex-hormone-binding globulin (SHBG) for the diagnosis of gestational diabetes mellitus (GDM), and to clarify the association between SHBG levels and GDM complications/medication requirements. Material and Methods: Among the participants (n = 93) who provided blood samples between 13 and 16 weeks’ gestation, 30 cases subsequently developed GDM. Complications and medical interventions were noted. The best cut-off point of SHBG and diagnostic performance were calculated. Results: The mean age was 28.45 - 5.0 years. SHBG levels were lower in the GDM group (n = 30) when compared with non-GDM (n = 63) cases (<0.01). Among the GDM women, SHBG was lower in the insulin therapy group (n = 15) compared with medical nutritional therapy alone (n = 15) (P < 0.01). A good predictive accuracy of SHBG was found for GDM requiring insulin therapy (area under the curve: 0.866, 95% confidence interval: 0.773–0.959). An SHBG threshold for 97.47 nmol/L had a sensitivity of 80.0%, specificity 84.6%, positive predictive value 50.0% and negative predictive value 95.7%. The calculated odds ratio for SHBG < 97.47 nmol/L was 12.346 (95% confidence interval: 1.786–83.33). Conclusions: SHBG is valuable for screening women early in pregnancy for GDM risk; however, a standard assay for analyses and a threshold level of serum SHBG for a constant gestational week has to be determined

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations

Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion. Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed. Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem. Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature

The levels of matrix metalloproteinase-9 and neutrophil gelatinase-associated lipocalin in different stages of endometriosis

This study was designed to explore matrix metalloproteinase-9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) levels and MMP-9/NGAL ratio in women with and without endometriosis diagnosed surgically and/or histopathologically. The correlation between biomarkers and the severity of the disease is analysed. The revised American Fertility Society classification system was used to determine the severity of endometriosis. Serum MMP-9 and Ca125, urine NGAL levels were measured in all participants. Serum MMP-9 levels were significantly higher in the study group (n¼60) compared to controls (n¼31) (15.0 pg/mL (6.0–143.0) vs. 12.0 (4.0–18.0), respectively; p¼.002). MMP-9 levels were significantly higher in severe endometriosis compared to mild endometriosis subgroups (p<.001). No significant difference was found between NGAL levels in study and control groups (p>.05). The diagnostic value of MMP-9 and NGAL is not superior than CA-125 for endometriosis. Nevertheless, MMP-9 might be a potential predictive marker for advanced stage of the disease

Oral antibiotic prophylaxis in elective cesarean deliveries: pilot analysis in tertiary Care Hospital

Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortal ity. Those infections occur more likely after cesarean delivery (CD). Prophylactic antibiotics are administered at the time of CD to prevent complications. In addition to intraoperative prophy laxis; prescription of antibiotics during hospital discharge to prevent surgical site infections (SSI) is quite common. Purpose of this study is to determine the utility of prophylactic oral antibiotic prescription in a cohort of low-risk women undergoing CD. Materials and methods: A prospective observational study was conducted between 2014 and 2018 at Ufuk University School of Medicine, Department of Obstetrics and Gynaecology. Total of 389 low risk elective cesarean deliveries were selected. All cases received intraoperative prophy laxis. In group I (157 subjects), no further antibiotics were given and in group II (232 cases), oral cephuroxime 500 mg was given during hospital discharge. Primary outcome was SSI. Secondary outcomes were endometritis and other infectious conditions. Results: Overall SSI rate was 2.5%. Only 2 SSIs were noted in group 1 (1.2%) compared to eight in group II (3.4%). There was no statistical difference in SSI rate between two groups. Secondary outcomes were also comparable. Conclusion: In this study, we failed to reveal any beneficial effect of oral antibiotic prescription during hospital discharge in low risk elective CDs. Therefore, use of oral antibiotics in addition to intraoperative prophylaxis should be questioned in terms of increased costs, emergence of bacterial resistance and long term effects on new born as a consequence of changes in gut microbiom

Tubal Polyp Causing Postmenopausal Bleeding: Case Report

This is the first case of tubal polyp detected at the age of menapouase causing postmenapousal bleeding. The only finding was thickened endometrium at transvaginal ultrasonography. After hysteroscopic polypectomy, the endometrial thickness were within normal range for menapouse and at the follow-up the bleeding did not recur. Hysteroscopic polypectomy lead to subjective improvement in symptoms of bleeding and high satisfaction rates in this case. In postmenopausal persistent vaginal bleeding and increased endometrial thickness, intramural tubal polyps might be kept in mind in differential diagnosis. In such a situation hysteroscopy seems to be a simple method both for diagnosis and treatment instead of repetetive endometrial biopsies

Obesity and insulin resistance associated with lower plasma vitamin B-12 in PCOS

Polycystic ovary syndrome (PCOS) shares some or most components of metabolic cardiovascular syndrome, manifested by abdominal obesity, insulin resistance, dyslipidaemia and at hero sclerosis. It has been previously demonstrated that folate and vitamin B-12 treatment improved insulin resistance in patients with metabolic syndrome. This study first investigated whether PCOS patients have lower or higher vitamin B-12, folate and homocysteine concentrations when compared with healthy, age and body mass index matched controls, and, then examined associations between vitamin B-12, folate, homocysteine and insulin resistance and obesity in PCOS patients. Homocysteine concentrations and homeostasis model assessment index were higher, whereas concentrations of vitamin B-12 were lower in PCOS patients with insulin resistance compared with those without insulin resistance. Serum vitamin B-12 concentrations were significantly lower in obese PCOS women in comparison with obese control women (P < 0.05). Fasting insulin, insulin resistance and homocysteine are independent determinants of serum vitamin B-12 concentrations in PCOS patients. Insulin resistance, obesity, and elevated homocysteine were associated with lower serum vitamin B-12 concentrations in PCOS patients

Postmenopozal kanamaya neden olan tubal polip: Olgu sunumu

Bu olgu postmenopozal kanamaya neden olan ve menopoz döneminde saptanan ilk tubal polip olgusudur. Hastadaki tek bulgu transvajinal ultrasonografide saptanan artmış endometriyal kalınlıktı. Histeroskopik polipektomi sonrasında endometriyal kalınlık normal sınırlara döndüğü ve takiplerde vajinal kanama tekrarlamadığı görüldü. Bu olguda histeroskopik polipektomi kanama bulgusunu tamamen ortadan kaldırarak yüksek başarı sağlamıştır. Postmenopozal kadınlarda sebat eden vajinal kanama ve artmış endometrial kalınlık varlığında, intramural tubal polipler ayırıcı tanıda göz önünde bulundurulmalıdır. Böyle durumlarda tekrarlayan endometriyal örneklemeler yerine histeroskopik inceleme yapmak hem tanı hem de tedavi açısından daha faydalı olacaktır.This is the first case of tubal polyp detected at the age of menapouase causing postmenapousal bleeding. The only finding was thickened endometrium at transvaginal ultrasonography. After hysteroscopic polypectomy, the endometrial thickness were within normal range for menapouse and at the follow-up the bleeding did not recur. Hysteroscopic polypectomy lead to subjective improvement in symptoms of bleeding and high satisfaction rates in this case. In postmenopausal persistent vaginal bleeding and increased endometrial thickness, intramural tubal polyps might be kept in mind in differential diagnosis. In such a situation hysteroscopy seems to be a simple method both for diagnosis and treatment instead of repetetive endometrial biopsies

Conservative surgical management of multiple myometrial abscesses; an unusual case with review of the literature

Myometrial abscess, especially with multiple foci, is quite rare and previous literature prevalently discusses unique locus of intramyometrial abscesses, usually treated with hysterectomy accompanied with or without bilateral salpingo-oophorectomy. The presented case, to the authors' knowledge, is the first multiple myometrial abscess case treated with conservative surgical approach

Outcome of hereditary thrombophilia managed with salicylic acid and low molecular weight heparin in pregnancy

Amaç: Herediter trombofililer, kötü gebelik sonuçları ve tromboembolik olaylarla ilişkili bir durumdur. Herediter trombofili gen mutasyonları saptandığında tedavi ile ilgili halen tartışmalar mevcuttur. Bulgular: Bu çalışmada polikliniğimize tekrarlayan gebelik kayıpları, önceki gebeliklerinde tromboz şikayeti ve bebek istemi ile başvuran hastaları ele aldık. Yapılan taramalarda trombofili gen analizinde mutasyonları olan 54 hasta herediter trombofili tanısı aldı. Takipte 42 hastanın 46 gebeliği aspirin ve düşük molekül ağırlıklı heparin tedavisi ile izlendi. Sonuç: Gebelik sonuçlarını retrospektif olarak değerlendirdik. Hastaların tedavi almadıkları önceki gebeliklerine baktığımızda %81 oranında düşük/biyokimyasal abort ve %14 erken doğum, erken membran rüptürü ve preeklampsiye bağlı fetal kayıp mevcuttu. Tedavi sonrası ise %4,3 abortus izlenirken, canlı doğum oranları %95,6 olarak tespit edildi. Tartışma: Bu veriler ışığında heparin ve aspirin tedavisi muhtemel plasental patolojiye bağlı erken gebelik komplikasyonlarını azaltıyor olabilir ancak intrauterin gelişme geriliğinin %25 ve oligohidramniosun %20 oranında tespit edilmesi plasental mikrotrombüslere bağlı tedavi ile önlenemeyen bir patolojiyi akla getirmektedir.Objective: Hereditary thrombophilia is associated with adverse pregnancy outcomes and thromboembolic events during pregnancy. There is still controversy on the management and optimal treatment when gene mutations of hereditary thrombophilias are detected. Methods: Patients with a past medical history of more than two pregnancy losses and pregnancies associated with thrombosis are investigated. Fifty four patients were detected to have genetic mutations of thrombophilia. Fourty six pregnancies of 42 patients were followed and managed with salicylic acid and low molecular weight heparin when pregnancy was diagnosed. Results: Pregnancy outcomes of these cases were analyzed. Pregnancies occurring before the diagnosis of the hereditary trombophilias resulted in abortion or biochemical pregnancy in 81% and 14% of these pregnancies were complicated by preterm delivery, preterm premature rupture of membranes or preeclampsia. After the administration of salicylic acid and low molecular weight heparin, only 4,3% of these pregnancies resulted in abortion and the live birth rate was 95,6%. Conclusions: Considering the above results, salicylic acid and low molecular weight heparin therapy might help in early pregnancy complications that might be related with placental pathologies. However, intrauterine growth retardation and oligohydroamnios seen in 25% and 20% of the cases respectively, might indicate placental microthrombosis despite salicylic acid and low molecular weight heparin therapy