Associatons between hormones related to energy balance, basal metabolic rate and body composition measures in patients withhyperthyroidism

Hipertiroidili hastaların iştah artışı ve kilo kaybı yaşadıkları bilinmektedir. Hipertiroidi hastalarında iştah artışı ile kalori alımında artışla beraber BMH ve dolayısıyla enerji tüketiminde artış ve hastalarda kilo kaybı oluşmaktadır. Ancak iştah artışı ve kilo kaybının mekanizması bilinmemektedir. Çalışmamızda, hipertiroidide iştah ilişkili hormonlar olan Nesfatin-1, oreksin A, NPY ve AgRP'nin periferik kan düzeyleri ve bu hormonlarla kalori alım miktarı, bazal metabolizma hızı, vücut kompozisyon ölçümleri arasındaki ilişkinin incelenmesi amaçlanmıştır. Bu amaçla; bilinen bir hastalığı olmayan, yeni tanı konulmuş, 21 aşikar hipertiroidi tanısı olan (laboratuar değerleri ve klinik bulguları olan) hasta ile yaş, cinsiyet,VKİ açısından benzer 33 sağlıklı gönüllü kişi kontrol grubu olarak incelenmiştir. Hasta grubu hem tedavi öncesi, hem de tedavi sonrası ortalama 10,2 ayda ötiroidi sağlandıktan sonra değerlendirilmiştir. Bazal metabolizma hızı ölçümü için ortalama O2 tüketim kapasitesinden (VO2), dinlenme metabolizma hızı saptanmıştır. Besin tüketimi için 24 saatlik bireysel besin tüketim yöntemi kullanılmış ve bilgisayar destekli beslenme programı, beslenme bilgi sistemi kullanılarak dietle alınan kalori düzeyi hesaplanmıştır.Kanda oreksin A, Nesfatin-1, NPY, AgRP ELİSA yöntemi ile ölçülmüştür. Aşikar hipertiroidisi olan hastalarda bazal metabolizma hızı sağlıklı kontrol grubuna göre yüksek saptanmıştır. Hipertiroid hastalarda ötiroidi sağlandığında dietle kalori alım miktarında azalma, beden kitle indeksinde artış olduğu görülmüştür. Aşikar hipertiroidisi olan grupta oreksin-A düzeyi, sağlıklı kontrol grubundan belirgin olarak düşük bulunmuştur. Hasta grubu ötiroid olduğunda ölçülen oreksin-A düzeyi kontrol grubuna benzer düzeyde bulunmuştur. Aşikar hipertiroidisi olan grupta nesfatin-1 düzeyi, sağlıklı kontrol grubundan yüksek bulunmuştur, ötiroidi sağlandığında anlamlı düzeyde azalarak kontrol grubuyla benzer düzeyde saptanmıştır. Hipertiroidisi olan grupta, nöropeptid Y ve agouti related peptid düzeyleri hem ötiroid durumdaki ölçümleri, hemde sağlıklı kontrol grubu ile karşılaştırıldığında istatistiksel anlamlı farklılık izlenmemiştir. Tüm çalışma grubunda hipertiroidi tanısı olmasının, oreksin A düzeyini öngören bağımsız bir faktör olduğu ve yine tüm çalışma grubunda oreksin-A düzeyinin, BMH düzeyini öngören bağımsız bir faktör olduğu saptanmıştır. Çalışmamızda hipertiroidi ile nesfatin-1 ve oreksin A düzeyleri arasında ilişki saptanmıştır. Hipertiroidili hastalarda iştah artışı olduğu halde oreksijenik bir peptid olan oreksin-A düzeyinin düşük, anoreksijenik olan nesfatin-1 düzeyinin yüksek saptanması, hipertiroidili hastalarda iştah artışının başka mekanizmalara bağlı olabileceğini düşündürmektedir. Nesfatin-1 ve oreksin-A sadece anoreksijenik ve oreksijenik etkileri olan peptidler değildir. Hipertiroidide de görülebilen duygu durum değişiklikleri, SVT, uyku siklus bozuklukları, termogenez gibi durumların nesfatin-1 ve oreksin-A düzeyi üzerine olan etkileri gösterilmiştir. Çalışmamızda hipertiroidili hastalarda nesfatin-1 düzeyinin yüksek, oreksin-A düzeyinin düşük bulunması, belkide hipertiroidide de görülebilen bu sistemlerdeki bozukluklar ile nesfatin-1 ve oreksin-A düzeyindeki değişikliklerin ilişkili olabileceği düşüncesini akla getirmektedir. Hipertiroidili hastalarda enerji ilişkili hormonların rolü, halen tartışmaya açık ve tam olarak aydınlatılamamış bir konu olduğundan, gelecekte bu peptidlerin hem santral hem periferik düzeylerinin araştırıldığı daha kapsamlı çalışmalara ihtiyaç vardır.Hyperthyroidism is associated with increased appetite but also with weight loss, however the responsible mechanisms are not conclusively clarified. Hyperthyroid patients are characterized by increased appetite, but also they have increased basal metabolic rate and energy expenditure thus resulting in weight loss. We aimed to investigate the association between appetite related hormones; nesfatin- 1, orexin-A, neuropeptide Y, Agouti related peptide levels and daily food intake, basal metabolic rate, body composition measurements in hyperthyroidism. The study group included 21 patients with overt hyperthyroidism and 33 healthy euthyroid volunteers well matched for sex, age and BMI. The patient group was assessed before treatment and in averagely 10,2 months after treatment when euthyrodism is achieved. In order to measure basal metabolic rate, we used maksimum O2 uptake capacity (VO2). 24-hour dietary recalls were recorded and computer assisted programmes were used to estimate daily food intake. Blood orexin-A, nesfatin-1, neuropeptide Y and AgRP levels were measured using ELISA method. Patients with overt hyperthyroidism had higher basal metabolic rate than healthy controls. In the hypertyhroid group, food intake decreased and BMI increased when patients achieved euthyroidism. In the overt hyperthyroidism group, orexin-A levels were significantly lower than healthy controls which were similar to healthy controls when patients achieved euthyroidism. In the overt hyperthyroidism group, nesfatin-1 levels were significantly higher than in healthy controls which decreased significantly and were similar to healthy controls when euthyroidism was achieved. There was no statistically significant difference in NPY and AgRP levels between healthy controls and patient group, neither in euthyroid nor hyperthyroid state. We observed that hyperthyroidic state is an independent predictive of orexin-A levels, while orexin-A level is predictive for basal metabolic rate. We discovered that hyperthyroidism is related with blood nesfatin-1 and orexin-A levels. We found lower orexigenic peptid orexin-A levels and higher anorexigenic peptid nesfatin-1 levels in hyperthyroid patients than healthy controls, which suggests a compensation since hyperthyroid patients have increased appetite already. Therefore other mechanisms may be responsible for the increased appetite in hyperthyroidism. There are several studies reporting nesfatin-1 and orexin-A levels are altered in mood disorders, supraventricular tachycardia, sleep disturbances, thermogenesis which are also observed in hyperthyroidism, suggesting that nesfatin-1 and orexin-A have more comprehensive effects than being solely anorexigenic and orexigenic peptides. In our study, high levels of nesfatin-1 and low levels of orexin-A in hyperthyroid patients may be associated with these systematic disturbances in hyperthyroidism. The role of appetite related hormones in hyperthyroidism remains to be a subject of discussion. Therefore further studies which evaluate peripheral and central levels of these peptides are necessary to clarify the relationship between thyroid hormones and energy metabolism

Granulocyte colony-stimulating factor for intracytoplasmic sperm injection patients with repeated implantation failure: which route is best?†

The aim of this study was to assess whether the dual administration of granulocyte colony-stimulating factor (G-CSF) increases the effect of only systemic administration in patients with RIF. This retrospective study included 111 infertile normoresponder cases with two or more unsuccessful in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatments, despite the transfer of good quality embryos. Patients were divided into three groups according to using G-CSF and administration route; Group 1 included patients who received subcutaneous (SC) G-CSF only (n = 38), Group 2 comprised patients who received both intrauterine (IU) and SC G-CSF (n = 39), the control group included patients who did not receive G-CSF who were matched by age (n = 34). The IU route of G-CSF was employed on ovulation triggering day. G-CSF was administered via an IU insemination catheter. SC injection was started on the day of oocyte retrieval and administered for 15 days at 100,000 IU/kg. Foetal cardiac activity (clinical pregnancy) was present in 50 patients (46.2%) after embryo transfer, with 20 patients included in SC group (Group 1) (52.6%), 25 in SC + IU group (Group 2) (64.1%) and 8 (23.5%) in control group and significant difference was observed between groups (p: .001). Pregnancy resulted in live birth in 43 patients (39.8%), with 13 patients belonging in Group 1 (34.2%), 25 in Group 2 (61.5%) and 8 (23.5%) in control group; significant differences were observed between groups (p: .001). In conclusion, our results showed that dual administration of G-CSF was significantly more effective that the SC only method.Impact statement What is already known on this subject? A number of studies reported the possible benefits of granulocyte colony-stimulating factor (G-CSF) administration in recurrent implantation failure (RIF) and recurrent pregnancy loss patients; however, it is unclear which administration route is better. What do the results of this study add? Our results showed that G-CSF is a promising and safe agent for increasing live birth rates in patients with RIF. Additionally, dual administration is considered the better method than SC only administration. What are the implications of these findings for clinical practice and/or further research? Clinicians should consider a combination of IU use before ovulation triggering with SC administration starting from the day of oocyte collection for using G-CSF for the treatment of recurrent implantation failure. Additionally, our data show the need for research in the field of administration route of G-CSF for RIF. We suggest that further studies be performed in this field

Screening for Syphilis During Pregnancy in Turkey

OBJECTIVE: To assess the prevalence of syphilis among patients at a tertiary referral center in Turkey and determine the need for antenatal syphilis screening based on the results. STUDY DESIGN: A retrospective cohort study based on patient data obtained from a tertiary referral center in Turkey. Serological syphilis screening using the Venereal Disease Research Laboratory (VDRL) was performed on all pregnant women as a part of routine antenatal care at their first hospital visit during pregnancy. Treponema pallidum hemagglutination assay (TPHA) was used to confirm positive screening results for syphilis. RESULTS: Patients’ mean age was 27.4 years. The incidence of positive syphilis serology was 0.013% (one patient), which was supported by a positive confirmatory test (0.013%).The TPHA-positive pregnant woman diagnosed with syphilis was treated with benzathine penicillin, and she gave birth to normal infants without any signs of congenital syphilis. CONCLUSION: Syphilis prevalence should be determined in each developing country with population-based studies. According to the prevalence of syphilis, each country should determine its own syphilis antenatal screening policies

Bilateral synchronous ovarian tumours: an uncommon case and review of the literature

Synchronous ovarian tumours are rare. Management of these patients can differ from that of patients with uniform tumours. We present a case of synchronous epithelial ovarian cancer and malignant mixed Mullerian tumour in different ovaries, its follow-up and management until death. To our knowledge this is the second case in the English literature to date. A 61-year-old woman with bilateral adnexal masses underwent complete debulking surgery for ovarian cancer. The final pathology was reported as malignant mixed Mullerian tumour in the right ovary with intact borders and stage 2 grade 3 serous carcinoma in the left ovary. She had a 17-month disease-free interval after 6 cycles of paclitaxel and carboplatin. Recurrence of malignant mixed Mullerian tumour was reported in the pathology after secondary debulking including a partial ileal resection. After 6 cycles of gemcitabine and cisplatin she had a widespread recurrence in the thorax and abdomen. The patient died of disease recurrence at the 25th month after diagnosis. Coexistence of serous and malignant mixed Mullerian tumour in different ovaries is very rare. The main treatment is complete cytoreduction followed with chemotherapy. Platinum-taxane based chemotherapy resulted in an acceptable disease-free interval in our case, but it is not standard yet. A management protocol may be developed with the increasing number of similar cases in the literature

Analysis of the effectiveness of ultrasound and clinical examination methods in fetal weight estimation for term pregnancies

Objective: To compare the accuracy of clinical and ultrasonographic (USG) estimation of fetal weight in non-complicated, term pregnancies. Materials and Methods: Two hundred term pregnant women were included in the study. We used three formulae for the estimation of fetal weight at term; the Hadlock formula for the USG method, and two different formulas for clinical methods, maternal symphysis-fundal height and abdominal circumference at the level of umbilicus. Accuracy was determined by mean percentage error, mean absolute percentage error and proportion of estimates within 10% of actual birth weight (birth weight +/- 10%). Patients were divided into two groups according to actual birth weight, the normal birth weight group (2500-3999 g) and high birth weight group (>= 4000 g). Results: All three methods statistically overestimated birth weight for the high and normal birth weight groups (p<0.001, p=1.000, p=0.233) (p=0.037, p<0.001, and p<0.001). For both groups, the mean absolute percentage errors of USG were smaller than for the other two clinical methods and the number of estimates were within 10% of actual birth weight for USG was greater than for the clinical methods; the differences were statistically significant (p<0.001). No statistically significant difference of accuracy was observed for all three methods for the high birth weight group (p=0.365, p=0.768, and p=0.540). However, USG systematically underestimated birth weight in this group. Conclusion: For estimation of fetal birth weight in term pregnancies, ultrasonography is better than clinical methods. In the suspicion of macrosomia, it must be remembered that no method is better than any other. In addition, if ultrasonography is used, careful management is recommended because ultrasonography overestimates in this group

Do preeclampsia symptoms resolve after intrauterine death of a fetus?

We present two cases of twin pregnancies without resolution of preeclamptic symptoms after intrauterine death of one twin. Case 1: A nulliparous woman aged 37 years was referred at 26 weeks of gestation because of arterial hypertension, edema, and growth restriction in one twin. Three weeks later the restricted twin died. During the following three weeks, ultrasound examinations showed a reduced growth velocity of the surviving fetus and reversed umbilical flow. At the end of the 34th week of gestation, cesarean section was performed and a healthy female infant was delivered. Case 2: A nulliparous woman aged 33 years with a 27-week twin pregnancy was referred because of arterial hypertension and discordant growth. The restricted twin died at 31 weeks of gestation. Following the death, within two weeks the growth of the co-twin started to slow down and reversed end diastolic flow presented. At the end of the 33rd week of gestation, cesarean section was performed and a healthy female infant was delivered. The interesting point of these cases was the secondary effects on the co-twins. During the time after intrauterine deaths of one twin, the surviving fetuses started to show a reduced growth velocity and reversed umbilical flow and mothers had increased blood pressure and proteinuria again. We think that both cases are evidence of late on-set systemic maternal effects (such as systemic maternal endothelial activation and/or systemic maternal inflammatory response) depends on preeclampsia

Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre’s 10 years’ experience

The aim of this study is to present our clinical experience about fertility-sparing procedures in early stage cervical cancer and its obstetrical and oncological outcomes. Between the years 2006 and 2016, a total of 22 early stage cervical cancer patients who underwent a fertility-sparing radical abdominal trachelectomy in our clinic were retrospectively analysed. The median age was 33 (range: 28–39) years. The median follow-up was 47 (range: 22–125) months. Five patients (22.7%) had Stage IA1, three patients had (13.6%) Stage IA2, and 14 patients (63.6%) had Stage IB1 disease. Only one patient had a recurrence. A pregnancy was obtained in five patients (22.7%) and one of them (20%) had a live birth. A pregnancy was obtained spontaneously in two patients (40%), whereas assisted reproductive techniques were used in three of the patients (60%). A miscarriage occurred in two patients (40%), and one of them was within the first trimester and the other was within the second trimester.Impact statement What is already known on the subject? Currently, the first-line treatment of early stage cervical cancer is surgery. However, a fertility-sparing trachelectomy is the most widely adopted approach in the reproductive aged patients who have a desire to be pregnant later. What does this study add? In the literature, there is a growing number of studies on this subject. However, it would take time to obtain adequate knowledge. We believe that our study would contribute to the existing data. What are the implication of these findings for clinical practice? This study is important as it indicates that a multidisciplinary approach is required to preserve fertility among gynaecologic oncologists and the outcomes would be reflected into the clinical practice. In addition, we believe that our study would pave the way for further studies regarding this subject among oncologists

Assessment of Antimicrobial and Antioxidant Activities of Nepeta trachonitica: Analysis of Its Phenolic Compounds Using HPLC-MS/MS

Continuing our work on the sources of natural bioactive compounds, we evaluated the antimicrobial and antioxidant activities of Nepeta trachonitica as well as its major phenolic content using the high-performance liquid chromatography-mass spectrometry/mass spectrometry (HPLC-MS/MS) technique. For antioxidant activity, ferric reducing antioxidant power (FRAP) and cupric ion reducing antioxidant capacity (CUPRAC) methods were performed to measure the reducing power and 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay was employed to evaluate the radical scavenging activity of the sample. For antimicrobial activity, three Gram-positive and four Gram-negative microbial species as well as three fungi species were tested. N. trachonitica appeared to have reasonable antioxidant activity and decent antimicrobial activity as indicated by the inhibition of the organisms’ growth. The most susceptible species were Bacillus subtilis ATCC 6633 and Escherichia coli ATCC 11229 among the organisms tested. Ethanol extract of the plant has the highest effect on Saccharomyces cerevisiae but no effect on Yarrowia lipolytica. The HPLC-MS/MS analysis showed that at least 11 major phenolic compounds of N. trachonitica exist, the major ones being rosmarinic acid, chlorogenic acid and quinic acid. The obtained results suggest that N. trachonitica could be a promising source for food and nutraceutical industries because of its antimicrobial and antioxidant properties and phenolic compounds

Gut dysbiosis may be associated with hyperemesis gravidarum

Purpose:In this study, we aimed to determine the frequency of different intestinal microorganisms of patients with normal pregnancies and HG and to compare these frequencies between the two groups. Materials and methods:This case-control study was carried out in Baskent University Department of Obstetrics and Gynecology and included 20 patients; 10 of whom had normal pregnancies and 10 of whom had HG. A stool flora scan was routinely planned for all patients. Transient and continuous fecal bacteria and fungal flora were analyzed. All data were evaluated statistically and their relationships with clinical condition were discussed. Results:The study group consisted of 20 pregnant women with a mean age of 31.5 years. All patients were nonsmokers and free of chronic diseases and of any medications. Aerobic and anaerobic bacteria groups, fungal colonies, and parasites were examined and bowel pH values were measured separately for each patient. Bacterial and fungal species outside the reference ranges were recorded for each patient. There was a statistically significant increase inClostridiumspp. (p:.01) andCandidaspp. (p:.033) and a statistically significant decrease inBifidobacteriumspp.(p:.008) in patients with HG compared to women with normal pregnancies. There was a significant difference between the group with HG and the group with normal pregnancies in terms of flora dysbiosis (p:.001). Conclusion:Our results suggest that gut dysbiosis may be a factor in HG. The effect of the severity of gut dysbiosis on the disease may be the subject of future studies