Nutritional Management in Polycystic Ovary Syndrome: Challenges and opportunities

PCOS is one of the most common endocrine diseases affecting women of reproductive age. Its etiology remains unresolved but it is thought to have a genetic basis as well as interactions with other environmental factors. This disease is diagnosed through the Rotterdam 2003 criteria but there is no definite treatment for the disorder. However, cure involves targeting the multiple symptoms of PCOS where weight loss is the first-line intervention. Obesity may not be the universal feature of PCOS, but studies have shown that there is a high prevalence among diseased females. Since the patients are more likely to be obese, they are also more likely to develop insulin resistance. The proper diet for PCOS thus targets these two characteristics of the disorder and through their management, the other symptoms of PCOS including hirsutism, acne and infertility are targeted. Saturated fats consumption should be reduced to a minimum whereas the unsaturated fat intake must be balanced with the carbohydrate and protein intake. Carbohydrate intake should not be abundant in the diet because high GI foods prove to reduce insulin sensitivity and increase the risk of type 2 diabetes. As for the protein intake, it should not exceed 20% of the total macronutrient calorie intake. A healthy lifestyle must be followed which includes at least 30 minutes of exercise, five times a week. A properly managed diet combined with a balanced lifestyle addresses insulin resistance, cardiovascular health and metabolism, all of which target PCOS symptoms and alleviate them

Pioglitazone administration alters ovarian gene expression in aging obese lethal yellow mice

<p>Abstract</p> <p>Background</p> <p>Women with polycystic ovary syndrome (PCOS) are often treated with insulin-sensitizing agents, e.g. thiazolidinediones (TZD), which have been shown to reduce androgen levels and improved ovulatory function. Acting via peroxisome proliferator-activated receptor (PPAR) gamma, TZD alter the expression of a large variety of genes. Lethal yellow (LY; C57BL/6J Ay/a) mice, possessing a mutation (Ay) in the agouti gene locus, exhibit progressive obesity, reproductive dysfunction, and altered metabolic regulation similar to women with PCOS. The current study was designed to test the hypothesis that prolonged treatment of aging LY mice with the TZD, pioglitazone, alters the ovarian expression of genes that may impact reproduction.</p> <p>Methods</p> <p>Female LY mice received daily oral doses of either 0.01 mg pioglitazone (n = 4) or an equal volume of vehicle (DMSO; n = 4) for 8 weeks. At the end of treatment, ovaries were removed and DNA microarrays were used to analyze differential gene expression.</p> <p>Results</p> <p>Twenty-seven genes showed at least a two-fold difference in ovarian expression with pioglitazone treatment. These included leptin, angiopoietin, angiopoietin-like 4, Foxa3, PGE1 receptor, resistin-like molecule-alpha (RELM), and actin-related protein 6 homolog (ARP6). For most altered genes, pioglitazone changed levels of expression to those seen in untreated C57BL/6J(a/a) non-mutant lean mice.</p> <p>Conclusion</p> <p>TZD administration may influence ovarian function via numerous diverse mechanisms that may or may not be directly related to insulin/IGF signaling.</p

Ovarian teratoma: yet another cause of immune thrombocytopenia

Dalia Khalife,1 Joseph Nassif,1 Ali Khalil,1 Ghina Ghazeeri,1 Ali Taher2 1Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon; 2Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon Abstract: A hematologic disorder occurred simultaneously with an ovarian cystic teratoma in a young woman. The blood disorder was a severe thrombocytopenia, with no spontaneous remission, or improvement after steroids tapering. To date, this is the second report in literature of immune thrombocytopenia associated with an ovarian teratoma, completely resolving following surgical excision of the ovarian teratoma. This case may suggest a potential peptide secreted by the ovarian teratoma toxic to platelets, and or a genetic predisposition in patients displaying the syndrome. Further research is needed in this area to highlight the mechanism of association. Keywords: mature ovarian teratoma, immune thrombocytopenia purpura, laparoscopic surger

Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

Abstract Objective  This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. Study Design  This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. Results  A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p  = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin ( p  = 0.79). Conclusion  There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. Key Points Transabdominal uterine compression and uterine massage are appropriate to prevent postpartum hemorrhage. No significant difference in blood loss or maternal discomfort observed between the two techniques. Both methods are equally effective and either one can be used based on provider preference