Correlation Between Insulin, Leptin and Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of fertile age. Insulin can stimulate ovarian androgen production in normal women and in women with PCOS. Leptin levels were reduced among women with PCOS treated with insulin sensitizers. Aim: This study aims to investigate the serum levels of insulin and leptin in and their relationship with the endocrine and metabolic peculiarities of PCOS. Subjects and Methods: The study was carried out on 125 women during the reproductive age group, had primary infertility and diagnosed as having PCOS according to Rotterdam criteria. Patients were recruited from Tanta University Hospital, during the period May 2011 to December 2012. Cases were classified into two groups: Patient’s group comprised 75 women having PCOS and control group entailing 50 normal fertile healthy women. All women were subjected to: History taking, clinical examination, assessment of body mass index (BMI), ultrasonographic examination and hormonal assay to estimation serum leptin, insulin, follicle stimulating hormone, luteinizing hormone, progesterone and free testosterone value. Statistical analysis was performed by Statistical Product and Service Solutions (IBM, USA) version 10.0. Student t‑test was used to compare numerical variables while correlation was performed to determine the relationship between the variables. The value of P < 0.05 was taken as significant. Results: We found a significant positive correlation between leptin, BMI, age and a trivial upbeat correlation between leptin and insulin. The most interesting result is the significant positive correlation between insulin and leptin. Conclusion: There is a link between elevated serum leptin and insulin levels to obesity in PCOS suggesting that most probably they are responsible for the complicated picture of PCOS in obese patients.Keywords: Hyperinsulinemia, insulin, leptin, obesity, polycystic ovary syndrom

Ultrasound Evaluation of the Uterine Scar Thickness after Single Versus Double Layer Closure of Transverse Lower Segment Cesarean Section

Background: The degree of the lower uterine segment (LUS) thinning and the risk of uterine scar defect have been studied. However, the relationship between the methods of closure and the degree of thinning needs further elucidation. Aim: The aim of this study was to determine whether a LUS transverse cesarean section (CS) closure method in one or two layers affects subsequent scar thickness.Subjects and Methods: In this prospective study, 150 women were enrolled and randomly assigned to one‑ or two‑layer closure of the LUS incision. Patients were divided into two groups. Each group included 75 patients, of primigravidae with gestational age from 38 weeks to 40 weeks one group had a single layer closure and the other had a double layer closure.Results: We found an increase in the thickness of LUS‑CS scar in cases with double layer closure of the incision than a single layer closure as depicted by ultrasonography after 2 days and 2 weeks post‑operative.Conclusion: These findings suggest that the number of closing layers of CS directly affect the thickness of the scar. Keywords: Cesarean section, one layer, scar thickness, two layer

Salivary Versus Serum Approaches in Assessment of Biochemical Hyperandrogenemia

Background: Biochemically, hyperandrogenism is established by elevated circulating levels of free or total serum testosterone and an increased free androgen index. Approximately, 60‑80% of women with polycystic ovarian syndrome (PCOS) demonstrate elevated circulating androgen levels. Aim: This prospective observational randomized study was to investigate the likelihood of using the salivary luteinizing hormone (LH), free testosterone (FT) and dehydroepiandrosterone sulfate (DHEAS) levels instead of serum values in diagnosing biochemical hyperandrogenemia in women with PCOS. Subjects and Methods: This study was conducted on 75 women having PCOS in addition to 20 normal fertile women (control group). Venous blood and salivary samples were taken in the 3rd day of the cycle to measure LH and FT and DHEAS levels. Results: Biochemical hyperandrogenemia prevails in 40% of women with PCOS. Salivary levels of LH, FT and DHEAS correlate with their corresponding serum values, with a higher sensitivity of salivary more than serum approach. Conclusion: Saliva provides a sensitive, simple, reliable, non‑invasive and uncomplicated diagnostic approach for biochemical hyperandrogenemia.Keywords: Biochemical hyperandrogenemia, dehydroepiandrosterone sulfate, luteinizing hormone, polycystic ovarian syndrome, saliva, testosteron

Frontal Electroencephalogram α‑Asymmetry during the Luteal Phase of the Menstrual Cycle in Women with Premenstrual Syndrome

Background: Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that causes significant distress and interferes with normal functioning. Aim: The aim of this work was to assess the resting frontal electroencephalographic patterns in females who meet criteria for PMS and PMDD. Subjects and Methods: This prospective observational study was conducted on 150 female participants, of which 145 had PMS, and 45 were control women. All cases were counseled about the procedure. Furthermore, a written consent was taken from every patient. Cases were asked about their current phase of the cycle, in order to determine cycle timing. The custom PMDD interview involved asking each woman a series of questions concerning PMDD symptoms. This structured interview was created from the DSM‑IV‑TR criteria for PMDD. Women with PMDD were asked to complete a daily symptom rating checklist for three consecutive cycles. The ensuing methods were undertaken for each patient, including history taking, general, local and fundus examination, and routine investigations, and were submitted to resting electroencephalogram (EEG) examination during both follicular and luteal phases of the cycle. Results: Seventy percent of women with PMS and 75% of women with PMDD exhibited left frontal activity at rest, during the luteal phase of the cycle (P <0.001). Conclusions: We concluded that resting luteal phase of EEG frontal asymmetry must be added to the research criteria for PMDD (DSM‑IV‑TR).Keywords: Electroencephalogram, premenstrual dysphoric disorder, premenstrual tension, premenstrual syndrome, Tanta University Hospita

Prediction of Gestational Diabetes by Measuring First Trimester Maternal Serum Uric Acid Concentration

Background: Gestational diabetes mellitus (GDM) is a common complication in pregnancy, affecting more than 10% pregnancies worldwide. However, the true underlying causes remain to be fully elucidated.Aim: This study aimed at searching for any relation between first trimester uric acid concentration and the development of GDM.Subjects and Methods: The study was conducted on 250 first trimester pregnant females at risk of diabetes mellitus attending the outpatient clinic of Tanta University Hospital. All cases underwent estimation of first trimester‑fasting blood sugar and maternal serum uric acid concentration. Between 24 and 28 weeks’ gestation random blood sugar and glucose challenge test were done. Positive cases were confirmed by 3 h glucose tolerance curve.Results: The results demonstrated an association between first trimester maternal serum uric acid concentration obesity and GDM. Approximately, 41.4% (60/145) of non‑diabetic women were at first quartile, while 44.8% (47/105) of the diabetic women were at fourth quartile.Conclusion: We concluded that the cut‑off level of maternal serum uric acid of 4 mg/dl in the first trimester was associated with developing GDM. Therefore, we suggest that serum uric acid level should be done as routine test during the first antenatal care visit.Keywords: Impaired fasting glucose, multiple logistic‑regression analysis, type 2 diabetes mellitus, uric aci

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Second Trimeter Recurrent Pregnancy Loss in Women with History of PCOS

Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown. Hyper insulinemia ascribed to PCOS and insulin resistance (IR) seem to be a contributing factor to RPL.&nbsp;The aim of this study was to assess the relationship between serum homocysteine level and insulin resistance in PCOS women with a history of send trimester recurrent pregnancy loss.The present study was carried out on 100 non-pregnant women in the reproductive period; their age ranged from 20 to 35 years. They were classified under two groups: Group 1: women having a history of second trimester recurrent pregnancy loss with PCOs (60 women). Group 2: women having a history of second trimester recurrent pregnancy loss and non-PCOs (40 women).&nbsp;We assessed plasma insulin and homocysteine (Hcy) levels in all cases. In addition, insulin resistance was determined using homeostasis model assessment (HOMA2-IR).&nbsp;The results: We found that homocysteine and insulin resistance are higher in PCOS women with recurrent pregnancy loss than non PCOS women.&nbsp;Conclusion: We conclude that that women with PCOS having a history of recurrent pregnancy loss had a higher serum level of homocysteine and a higher score of HOMA2-IR women without PCOS.</p