Effects of Hormone Replacement Therapy on Insulin Resistance, Waist-to-Hip Ratio and Lipid Profiles in Postmenopausal Women

Amaç: Çalışmamızda, postmenopozal kadınlarda hormon replasman tedavisinin (HRT) metabolik sendromüzerine olan etkisini araştırmayı amaçladık. Yöntem: Bu çalışmaya SSK İzmir Ege Doğumevi ve Kadın Hastalıkları Eğitim ve Araştırma Hastanesi Menopoz Polikliniğine 01.10.2004 ve 31.03.2005 tarihleri arasında başvuran ve menopoz tanısı sırasında bilinen metabolik hastalık (diyabetes mellitus, kardiyovaskuler hastalık ve dislipidemi) öyküsü olmayan 91 olgu dahil edildi. Menopoz tanısı sonrası HRT başlanmış ve halen kullanmakta olan 36 olgu ile hiç HRT kullanmamış 55 olgunun açlık kan şekeri, açlık insülini, serum lipid profili ve kan basıncı düzeyleri karşılaştırıldı. Her bir olguda, Homa İnsülin Rezistansı (HOMA-IR) formülü ile insülin rezistansı (İR) hesaplandı, obezite ve santral obezite varlığını değerlendirmek için sırası ile vücut kitle indeksi (VKİ) ve bel-kalça oranları ölçüldü. Her iki grup arasında bu veriler karşılaştırıldı. Bulgular: İki grup karşılaştırıldığında, HRT almayan grupta İR pozitif olan olgu sayısı HRT alan gruba göre istatiksel olarak anlamlı derecede fazla bulundu (P=0,006). İki grup arasında obezitesi ve santral obezitesi olan olgu sayısı, serum biyokimyası parametreleri, kan basıncı değerleri açısından istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Postmenopozal dönemde kullanılan HRT’nin glukoz metabolizması üzerine etkisi net olarak ortaya konmamıştır. Çalışmamızın sonucuna göre, postmenopozal kadınlarda HRT, insülin rezistansını azaltıyor gibi görünmektedir. Bu konuda yapılacak daha detaylı çalışmalara gereksinim vardır.Objective: in our study, we aimed to investigate the effect of hormone replacement therapy (HRT) on metabolic syndrome in postmenopausal women. Method: This study included 91 patients who applied to SSK İzmir Ege Maternity and Gynecology Training and Research Hospital Menopause Outpatient Clinic between 01.10.2004 and 31.03.2005 and who don’t have a history of metabolic disease (diabetes mellitus, cardiovascular disease and dyslipidemia). Fasting blood glucose, fasting insulin, serum lipid profile and blood pressure levels were compared in 55 patients who never used HRT and 36 cases in whom HRT was started after the diagnosis of menopause and was still in use. in each case, the insulin resistance (IR) was calculated with the formula of Homa Insulin Resistance (HOMA-IR). the body mass index (BMI) and waist-hip ratios (WHR) were measured to evaluate the presence of obesity and central obesity. These data were compared between the two groups. Results: When the two groups were compared, the number of patients who are positive for IR was significantly higher in the group who don’t receive HRT, than the group who receive HRT (P=0.006). There was no statistically significant difference between the two groups in terms of number of cases with obesity and central obesity, serum biochemistry parameters, and blood pressure values. Conclusion: the effect of HRT used in postmenopausal period on glucose metabolism has not been clearly demonstrated. According to the results of our study, HRT appears to decrease insulin resistance in postmenopausal women. More detailed studies should be conducted on this subject

The Effect of Maternal Body Composition and Triglyceride Levels on Newborn Weight in Non-Diabetic Women with Positive Diabetic Screens

OBJECTIVE: To determine the effect of maternal body composition and triglyceride levels on newborn weight in nondiabetic women with positive diabetic screening. STUDY DESIGN : 40 pregnant women with positive diabetic screenings and negative glucose tolerance tests were enrolled as the study group. 72 pregnant women with negative diabetic screenings were enrolled as the control group. 50-gram glucose challenge tests were performed at 24-32 weeks of gestations and serum lipid levels were measured. The association between maternal serum triglyceride (TG) levels, maternal pre-pregnant body mass index (BMI), maternal weight gain during pregnancy and newborn weight in both groups were compared. RESULTS: The incidence of the infants with >75 percentile newborn weight and the incidence of maternal hypertriglyceridemia were significantly higher in the study group (p<0.05). In this group maternal weight gain during pregnancy was significantly correlated with newborn weight and mean serum triglyceride levels were higher than the control group (p<0.05). CONCLUSION: In non-diabetic pregnant women with positive diabetic screens maternal weight gain during pregnancy was significantly correlated with newborn weight and incidences of infants with >75 percentile newborn weights were significantly higher than control group

RISK FACTORS AND PREVALANCE OF POSTPARTUM DEPRESSION DURING THE COVID-19 PANDEMIC IN A UNIVERSITY HOSPITAL IN WESTERN TURKEY: A CROSSSECTIONAL STUDY

Aim: This study aimed to examine the prevalence and risk factors of postpartum depression in a university hospital in Turkey during the COVID-19 pandemic. Methods: A cross-sectional study was performed from November 2020 to December 2020. Totally 517 women, who are all in the first month of the postpartum period were evaluated by using the Edinburgh Postpartum Depression Scale (EPDS). A total score equal to or above 13 was accepted as PPD. Multivariant regression analysis was used to identify factors associated with PPD during the pandemic. Results: The prevalence of PPD was 15.7%. Patients who were delivered by the vaginal route, who were at earlier gestational age at delivery, and who needed neonatal intensive care unit (NICU) care for their babies were significantly more likely to develop PPD. The risk of PPD during the COVID-19 pandemic was 5.5 times higher in patients who had a previous depressive episode. The PPD risk was 44% lower in women who properly attend regular antenatal care visits. Conclusion: Identification of pregnant women who had a previous depressive episode in their first prenatal visit and ensuring regular attendance of pregnant women to antenatal care visits may help early detection of women who are at high-risk for PPD and taking timely preventive approaches

Serviks ve overleri koruyarak yapılan histerektominin seksüel fonksiyonlar üzerindeki etkisi

Aim: The aim of our study was to assess the effect of cervical and ovarian protection during hysterectomy on sexual functions. Material and methods: Study group consisted of patients who had undergone subtotal hysterectomy (STH), total abdominal hysterectomy (TAH) or total abdominal hysterectomy and bilateral salpingooopherectomy (TAH+BSO); and received hormonal replacement therapy (HRT) in our maternity hospital. An inquiry form was prepared to determine pre-and postoperative sexual functions and was applied to patients in whom address informations could be reached and to whom approved join the study. The results were assessed by making comparison between the groups of STH and TAH, TAH and, TAH+BSO There were no demographic differences between the three groups. In the patients who undergone TAH; orgasm, multiple orgasm, coital frequency and whole sexual sufficiency scores were worse than the patients who had undergone STH (p=0.024, p=0.012, p-0.032 and p=0.003; consecutively).The only statistically significant difference between TAH+BSO and TAH groups was in postoperative libido changes and it was better in TAH group(p=0.014). Discussion:Results of our study shows that procting cervix and ovaries during hysterectomy has positive effects on sexual functions.Larger prospective studies are needed on this subject which is hard to make objective assessment to make certain decisions.Amaç: Çalışmamızın amacı, histerektomide serviksin ve överlerin korunmasının, seksüel fonksiyonlara etkisini belirlemektir. Materyal ve Metod: Çalışmamız SSK Ege Doğumevi ve Kadın Hastalıkları Hastanesinde subtotal histerektomi (STH), total abdominal histerektomi (TAH) ve total abdominal histerektomi ve bilateral salpingoooferektomi (TAH+BSO) uygulanıp hormon replasman tedavisi (HRT) alan hastalar üzerinde uygulanmıştır. Adres kayıtlarına ulaşılan ve çalışmaya katılmayı kabul eden hastalara, prepostoperatif seksüel fonksiyonu değerlendirmek amacıyla hazırlanan anket formu uygulandı. Sonuçlar, STH ve TAH ile TAH ve TAH+BSO grupları arasında karşılaştırılma yapılarak değerlendirildi. Sonuçlar: Anket çalışmasına katılan 32'si STH, 34'ü TAH ve 30'u TAH+BSO geçirmiş hasta, verdikleri cevaplarla değerlendirildi. Her üç grup arasında demografik özelliklerde fark yoktu. TAH uygulanan hastalarda, STH olanlara kıyasla, orgazm, çoklu orgazm ve koital sıklık ile tüm seksüel yeterlilik daha kötü idi (p= 0.024, p=0.012, p=0.032 ve p=0.003 sırasıyla). TAH+BSO grubu ile TAH grubu arasında ise, sadece postoperatif libidoda değişim konusunda, TAH grubu lehine anlamlı fark elde edildi (p=0.014). Tartışma: Çalışmamızın sonuçları, serviksin ve överlerin korunmasının seksüel fonksiyonlara olumlu etkileri olduğu yönündedir. Ancak, objektif değerlendirmenin ve sağlıklı analiz yapabilmenin oldukça güç olduğu bu konuda, kesin yargıya varabilmek için daha çok kontrollü çalışmaya ihtiyaç vardır

Antenatal diagnosis of left atrial isomerism and heterotaxy syndrome in fetus with Meckel-Gruber syndrome

We aimed to present a fetus with Meckel-Gruber syndrome (MKS) who had left atrial isomerism, heterotaxy syndrome and complete heart block. A 26-year-old healthy female was referred to our clinic in the 23rd week of her preg- nancy. the fetus had multiple systemic anomalies including fetal heart. Fetal echocardiography revealed a horizontal liv- er, left-sided stomach and vena cava interruption with azygos continuation. There was also an apical trabecular ventricular septal defect, aorta and pulmonary artery arising from the left ventricle, pulmonary artery hypoplasia, pulmonary valve stenosis and left atrial isomerism. the heart rate was 46/min, consistent with third-degree atrioventricular block. Multiple anomalies including occipital encephalocele, bilateral poly- cystic kidneys, cleft lip, cleft palate, and polydactyly were also detected in the obstetric ultrasonography. the pregnan- cy was terminated in the 23rd gestational week based on the consensus of perinatology council. the autopsy examination confirmed the diagnosis of MKS, left atrial isomerism and heterotaxy syndrome. Although some cardiac defects have been reported previously in MKS fetuses, here we expand the cardiac spectrum of anomalies associated with MKS to include left atrial isomerism and heterotaxy syndrome.Bu yazıda, sol atriyum izomerizmi, heterotaksi sendromu ve tam kalp bloğu olan Meckel-Gruber sendrom’lu (MKS) bir fetüs sunuldu. Yirmi altı yaşındaki sağlıklı anne gebeliğinin 23. haftasında kliniğimize başvurdu. Fetüsün kalbi de içeren çok sayıda sistemik anomalisi vardı. Fötal ekokardiyografide horizontal karaciğer, sol yerleşimli mide ve azigos devamlılığı olan kesintili kaval veni vardı. Ayrıca apikal trabeküler ventriküler septal defekt, sol ventrikülden çıkan aorta ve pulmoner arter, pulmoner arter hipoplazisi, pulmoner kapak stenozu ve sol atriyum izomerizmi mevcuttu. Kalp hızı 46/dk idi ve üçüncü derece kalp bloğu ile uyumlu idi. Obstetrik ultrasonografisinde oksipital ensefalosel, iki taraflı polikistik böbrekler, yarık dudak, yarık damak ve polidaktiliyi içeren çok sayıda anomali saptandı. Perinatoloji konseyi kararı ile 23. gebelik haftasında gebelik sonlandırıldı. Otopsi incelemesi sol atriyum izomerizmi heterotaksi sendromu ve MKS tanısını doğruladı. Meckel-Gruber sendromlu fetüslerde daha önce birtakım kardiyak defektler bildirilmiş ise de, biz burada sol atriyum izomerizmi ve heterotaksi sendromunu da içeren MKS ile ilişkili kardiyak anomaliler spektrumunu genişletmiş olduk