Evaluation of Serum Selenium Level, Quality of Sleep, and Life in Pregnant Women With Restless Legs Syndrome

Restless legs syndrome (RLS) is a multifactorial disease that patients describe as restlessness in their legs, which creates a desire to move their legs, especially in the evening and at rest. This study aims to investigate serum selenium levels in RLS and document the quality of sleep and life in pregnant women with RLS according to International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria. Thirty-eight moderate to severe RLS patients with pregnancy at 38-41 weeks of gestation were determined as the case group, and 38 women with healthy gestational age-matched pregnancies were determined as the control group. Maternal serum selenium levels were compared between the RLS case group and the group of healthy pregnant women at the time of hospitalization for delivery. The Pittsburgh Sleep Quality Index (PSQI) and The Quality of Life Scale (SF-36) were applied to the patients. The mean selenium level (µg/L) was statistically significantly lower in the RLS group (53.24 ± 10.28), compared to the healthy pregnant population (58.95 ± 11.29) (P = 0.024). The PSQI score was significantly higher in the RLS case group (P = 0.033). Especially sleep efficiency (P = 0.018) and daytime dysfunction (P = 0.032) sub-parameters were affected. The SF-36 questionnaire was examined and a significant difference was detected between the two groups in role emotional (P = 0.026), social functioning (P = 0.023), and body pain (P = 0.044) sub-parameters. Serum selenium level was significantly lower, the sleep quality of the RLS group was impaired and their quality of life was affected in pregnant women with RLS. Further studies are needed to determine whether selenium replacement in pregnant women with RLS is feasible or not.

The relationship between diaphragm thickness and the severity of the disease in pregnant patients with Covid-19

OBJECTIVE

We aimed to investigate whether there is a relationship between diaphragm thickness and disease severity in Covid-19 pregnant subgroups.

MATERIAL AND METHODS

In this prospective study 100 pregnant patients were enrolled. Thickness of the diaphragm muscle at end-expiration was measured using B-Mode US. Hemoglobin,WBC, NLR, procalcitonin and LDH levels were measured.

RESULTS

There was a statistically significant difference between the groups in terms of diaphragm thickness, and the diaphragm thickness was thinner in the severe disease group (p < 0.001). There was no statistically significant difference between the groups with mild to moderate disease severity (p = 0.708).

CONCLUSION

Covid-19 patients who developed serious infection has thinner diaphragms than those who did not. Low diaphragm muscle thickness at the outset of Covid-19 disease, may predispose to poor clinical outcomes. Diaphragmatic ultrasound may be a promising tool to evaluate the risk of Covid-19 disease severity.

Do First-Trimester Subchorionic Hematomas Affect Pregnancy Outcomes?

OBJECTIVE

The aim of this study is to investigate the relationship between first trimester subchorionic hematomas and pregnancy outcomes in women with singleton pregnancies.

MATERIAL AND METHODS

Between January 2018 and January 2019, patients who had a single pregnancy between the 6th and 14th weeks of their pregnancy and were hospitalized with the diagnosis of abortus imminens in the early pregnancy service were included in the study. According to the ultrasonographic examination, those with subchorionic hematoma and those with no hematoma were compared in terms of demographic data, pregnancy outcomes and pregnancy complications.

RESULTS

400 abortus immines cases with subchorionic hematoma and 400 abortus imminens cases without subchorionic hematoma were compared. Preterm delivery percentages were similar in both groups, however abortus percentage was significantly higher in the hematoma group (34.2 vs. 24.7%; p=0.007). In addition, it was revealed that the presence of subchorionic hematoma before the 20th gestational week increased the risk of miscarriage 1.58 times. However, no data could be found in the study that could correlate the size of the hematoma with pregnancy loss.

CONCLUSION

The presence of subchorionic hematoma increases abortion rates in abortus imminens cases. And the presence of subchorionic hematoma in cases with ongoing pregnancy does not increase the complications of delivery.

Could Birth Weight to Placental Weight Ratio Predict Postpartum Haemorrhage and Neonatal Intensive Care Unit Admission?

OBJECTIVE

To evaluate the usability of the ratio of birth weight to placental weight [fetoplacental ratio (FPR)] in predicting postpartum haemorrhage (PPH) and neonatal intensive care unit (NICU) admission.

STUDY DESIGN

Prospective observational study.

PLACE AND DURATION OF STUDY

Bursa Yuksek Ihtisas Training & Research Hospital, Bursa, Turkey, between July 2020 and July 2021.

METHODOLOGY

Women who were supposed to have an uncomplicated delivery with a live, single, term pregnancy without any concomitant disease, were included in the study. Patients with PPH were accepted as the study group and patients without PPH were the control group. For NICU requirement, babies who were admitted to NICU were the study group, and babies who did not require NICU were the control group. The fetoplacental ratio was calculated by dividing the newborn weight to placental weight and evaluated in the prediction of NICU admission and PPH.

RESULTS

The number of patients included in the study was 812. Approximately 7% of women had postpartum haemorrhage. The FPR was found as an independent predictor for PPH by nearly 3.5 fold. Women who experienced PPH had heavier placenta and lower fetoplacental ratio. Patients whose babies were admitted to NICU also had lower FPR with statistically significant differences.

CONCLUSION

The fetoplacental ratio could be a promising predictor for PPH and NICU admission in the postpartum period. Since novel studies are needed using ultrasonographic measurements during antenatal surveillance to predict PPH or NICU admission.

KEY WORDS

Birth weight, Neonatal intensive care unit, Placental weight, Postpartum haemorrhage, Cesarean birth, Vaginal birth, Fetoplacental ratio.

Could sestrin protein in serum be a new marker of oxidative stress in patients with polycystic ovary syndrome?

OBJECTIVE

PCOS (polycystic ovary syndrome) is one of the most common endocrinological disorders and it is the threshold of many systemic disorders. There are many studies in the literature on the mechanisms that cause increased oxidation in PCOS. Sestrin protein is known to regulate the oxidation. In this study, it is aimed to examine the changes in the level of sestrin protein in women with PCOS.

METHODS

A total of 60 women participated the study, 30 of whom were diagnosed with PCOS according to the Rotterdam criteria. Also, 30 women were included in the study as the control group. Demographic information, biochemical analysis results, and sestrin levels of the patients in each group were compared.

RESULTS

The median sestrin level was 6.2 ± 0.8 in the PCOS group and 3.38 ± 0.4 in the control group (p < 0.001). As a result of the evaluation made with ROC analysis, it is observed that serum sestrin levels may be meaningful in the diagnosis of polycystic ovary syndrome. The area under the curve (AUC) value for the 4.69 level was 99.4% (p < 0.001, 95% CI: 96.7% vs. 100%, sensitivity: 100%, specificity: 96.7%).

CONCLUSIONS

Sestrin protein is associated with oxidative stress. Sestrin protein can be used as an indicator of increased oxidative stress in PCOS.

Risk factors for brachial plexus injury and permanent sequelae due to shoulder dystocia

AIM

The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury.

SUBJECTS AND METHODS

ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia.

RESULTS

Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth.

CONCLUSION

In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.

The neglected secret: Association of abdominal striae with stress urinary incontinence in primigravid pregnant women

OBJECTIVE(S)

To compare the presence and severity of striae gravidarum in pregnant women with and without stress urinary incontinence and to evaluate whether there is a relationship between the severity of striae gravidarum and the severity of incontinence in pregnant women with stress urinary incontinence.

STUDY DESIGN

Healthy primigravid pregnant women with an uneventful singleton pregnancy at 36-37 weeks of gestation were included. All women were asked two questions to assess the presence of urinary incontinence. Women who answered 'yes' to the question 'Do you have any involuntary urinary leakage during coughing/laughing/sneezing/running/jumping?' and 'no' to the question 'Do you have any involuntary urinary leakage accompanied by a strong urge to void?' were classified as women with stress urinary incontinence, and women who answered 'no' to both questions were classified as women without stress urinary incontinence. The presence and severity of striae gravidarum of these two groups were evaluated with the Davey score, and the severity of incontinence of women with stress urinary incontinence was evaluated with the Incontinence severity index questionnaire.

RESULTS

The Davey score of pregnant women with stress urinary incontinence was significantly higher than the score of women without stress urinary incontinence and the presence of severe striae gravidarum was more common in women with stress urinary incontinence. There was a positive, significant correlation between Incontinence severity index and Davey scores in women with stress urinary incontinence, and this was the only independent correlation that was significant in linear regression analysis.

CONCLUSION(S)

Presence and severity of striae gravidarum is correlated with the presence and severity of stress urinary incontinence in primigravid pregnant women. Evaluation of striae gravidarum may be useful in predicting the development of stress urinary incontinence and taking necessary precautions against it. This issue should be evaluated with good quality studies.

Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women

Objective:

To compare the psychological resilience and anxiety levels of patients diagnosed with hyperemesis gravidarum (HG) and healthy pregnant women.

Materials and Methods:

A sociodemographic data form and the Resilience scale for Adults (RSA) and the State-Trait Anxiety Inventory (STAI) were administered. The sociodemographic data form was completed by the physician, and the RSA and STAI were completed by the participant. The sample of the study consisted of 60 pregnant women with HG and hospitalized and 97 healthy voluntary pregnant women with similar characteristics to the research group without any pregnancy complications. Data were evaluated using descriptive statistical analyses, the independent samples t-test, the Mann-Whitney U test and Pearson’s correlation analysis.

Results:

The age range was 18-42 years for HG group and 20-43 years for control group. The average age of the HG group was 28.17±5.96 years and that of the control group was 29.45±5.83 years. There was no statistically significant difference between the groups in terms of pregnancy week. Regarding the prevalence of state and trait anxiety between the groups, it was found that 66.7% of the HG group had a high level of trait anxiety and 51.7% had a high level of state anxiety. It was found that 61.9% of the control group had a high level of trait anxiety and 38.1% had a high level of state anxiety. There was no difference between the healthy pregnant group and the HG group in terms of anxiety (p=0.125). It was found that there was a significant difference between the groups in terms of only sub-dimensions of RSA, which were perception of self (U=2385.00, p=0.044) and perception of future (U=2350.50, p=0.030). The perception of self and perception of future scores of the healthy control group were higher.

Conclusion:

There was no difference between the healthy pregnant group and the HG group in terms of anxiety. It was observed that the HG group had a lower perception of self and future. Apart from the usual increase in anxiety levels during pregnancy, HG accompanied by stubborn nausea and vomiting does not create an extra psychological burden, either as a cause or a result.

The feasibility of the platelet count and mean platelet volume as markers of endometriosis and adenomyosis: A case control study

INTRODUCTION

The aim of the study is to investigate the role of platelet count (PC) and mean platelet volume (MPV) in determining adenomyosis and endometriosis.

MATERIAL AND METHODS

This was a retrospective case control study that included adenomyosis, endometriosis and control groups. The adenomyosis group included 84 women diagnosed between January 2013 and January 2015 based on hysterectomy specimen. The endometriosis group included 102 patients underwent diagnostic laparoscopy and confirmed by histopathologic examination. Lastly, the control group included 88 women had no medical problem and underwent tubal ligation.

RESULTS

MPV (fl) was significantly lower in adenomyosis group (8.5) compared to endometriosis (9, p<0.05) and control groups (9, p<0.01). Modified platelet activity (MPV/PC) was significantly lower in adenomyosis group compared to control group (p<0.01). Bivariate logistic regression model was used to assess the odds ratio of risk factors and serum markers related to endometriosis and adenomyosis. Variables showing significant differences based on post-hoc Bonferroni test were included in the logistic regression model for comparison of each disease with the control group. MPV was not found to be a risk factor both for presence of endometriosis and adenomyosis after adjusting for demographic and clinical characteristics.

DISCUSSION

Our study suggested that PC and MPV were not useful diagnostic markers for endometriosis or adenomyosis. Further research on how platelet indices and other inflammatory markers are related to inflammation might help better understand their potential as markers for these diseases.

Serum Vitamin D Levels in Fertile and Infertile Women with Polycystic Ovary Syndrome

Introduction In polycystic ovary syndrome, serum vitamin D levels are known to correlate with metabolic conditions such as diabetes mellitus, metabolic syndrome and cardiovascular disease. However, there are not enough studies showing such a relationship with female fertility. We aimed to compare serum vitamin D levels in fertile and infertile women with polycystic ovary syndrome to evaluate whether vitamin D may play a role in the pathogenesis of fertility problems in women with polycystic ovary syndrome.

Materials and Methods 274 infertile and 111 fertile women with polycystic ovary syndrome were included in this retrospective study. Infertile and fertile groups were matched by age, body mass index and homeostasis model assessment of insulin resistance. Anthropometric, clinical and laboratory characteristics of the women were recorded. Serum 25(OH)D ₃ levels were used to assess serum vitamin D levels.

Results No significant differences were detected between groups in terms of anthropometric, clinical and laboratory features except for serum 25(OH)D ₃ levels and the incidence of vitamin D deficiency. Vitamin D levels were significantly lower and vitamin D deficiency was more common in the infertile group compared to the fertile group. When the groups were stratified into obese/non-obese or insulin resistance positive/negative, infertile obese and infertile insulin resistance-positive women had the lowest serum 25(OH)D ₃ levels.

Conclusion Serum vitamin D levels are lower in infertile women with polycystic ovary syndrome compared to fertile women. When insulin resistance or obesity was present, vitamin D levels were reduced further. Thus, in polycystic ovary syndrome, lower vitamin D levels may play a role in the pathogenesis of fertility problems.

A study of serum Apo A-1 and Apo B-100 levels in women with preeclampsia

OBJECTIVE

To investigate Apo A-1 and Apo B-100 levels and Apo B-100/Apo A-1 ratios in preeclamptic (PE) patients.

MATERIALS AND METHODS

Forty-eight PE and 48 without PE patients (healthy pregnancies) matched for gestational age were included. Maternal age, parity, gestational age at delivery, obstetrical complications including intrauterine growth restriction (IUGR) and gestational diabetes mellitus (GDM), serum Apo A-1 and Apo B-100 levels, and the Apo B-100/Apo A-1 ratio were compared.

RESULTS

Preeclamptic patients had significantly lower Apo A-1 levels (167.07mg/dl±14.61mg/dl vs. 244.37mg/dl±20.84mg/dl, p<0.001), higher Apo B-100/Apo A-1 ratio (0.63±0.07 vs. 0.42±0.05, p<0.001), but similar Apo B-100 levels (104.84mg/dl±7.05mg/dl vs. 102.39mg/dl±8.08mg/dl, p=0.118). Mean Apo A-1 and Apo B-100 levels and the Apo B-100/Apo A-1 ratio were similar in patients with severe PE, HELLP syndrome, IUGR, and patients requiring antihypertensive therapy compared to PE patients who did not have these complications (p>0.05). Apo A-1 levels had the best accuracy followed by the Apo B-100/Apo A-1 ratio in patients with PE.

CONCLUSION

Apo A-1 and the Apo B-100/Apo A-1 ratio may be useful markers in patients with PE. Further studies are required to elucidate this issue.

Evaluation of ADAMTS12, ADAMTS16, ADAMTS18 and IL-33 serum levels in pre-eclampsia

OBJECTIVE

Pre-eclampsia is the result of impaired trophoblast invasion and spiral artery remodeling managed by inflammatory response in its etiology and physiopathology. The aim of this study was to compare serum molecules including IL-33, ADAMTS12, ADAMTS16 and ADAMTS18 levels between pre-eclampsia and control groups and to investigate the role of these molecules in pre-eclampsia.

METHODS

Forty-one women diagnosed as pre-eclampsia between 30 and 40 weeks of gestation and 41 non-complicated pregnant women were enrolled in this cross-sectional, case-control prospective study. ELISA method was used to determine IL-33, ADAMTS12, ADAMTS16 and ADAMTS18 levels within serums in two groups.

RESULTS

Serum ADAMTS12 and IL-33 levels were significantly lower in pre-eclampsia group (p < 0.001 and p: 0.028, respectively), however, in sub-group analysis, no significant difference was observed (p > 0.05). The cut-off value of ADAMTS12 levels to discriminate pre-eclampsia with %73.17 sensitivity and %92.68 specificity was 8.27 ng/ml while the cut-off value for IL-33 was 0.23 pg/ml with 82.93% sensitivity and 53.66% specificity.

CONCLUSION

Pre-eclampsia is associated with lower serum IL-33 and ADAMTS12 levels.

DNA-responsive uniform latex particles based on p-chloromethylstyrene

In this study, DNA binding properties of poly(ethylenimine) (PEI)-attached uniform poly(p-chloromethystyrene) (PCMS) particles were investigated. Spherical PCMS latex particles with an average size of 1.75 microm were obtained by the dispersion polymerization of p-chloromethylstyrene (CMS). PEI was covalently attached onto the PCMS particles via a direct chemical reaction between amine and chloromethyl groups, with the equilibrium binding capacities up to 41 mg PEI/g PCMS. In aqueous media, PEI attached-uniform PCMS particles showed an irreversible aggregation behaviour in the presence of DNA. To predict unknown DNA concentration, the aggregation response of these particles to the presence of DNA was quantified by spectrophotometry. Plain PCMS and PEI attached-uniform PCMS particles were also utilized as sorbents in DNA adsorption experiments conducted at +4 degrees C in a phosphate buffer medium at pH 7.4. DNA immobilization capacities up to 45 mg DNA/g PCMS could be achieved with the PEI attached particles.

Cohen syndrome with acanthosis nigricans and insulin resistance

Cohen syndrome is a rare genetic disorder consisting of truncal obesity, hypotonia, mental retardation, microcephalia, characteristic facial appearance and ocular anomalies. Other diagnostic clinical features include narrow hands and feet, low growth parameters, neutropenia and chorioretinal dystrophy. Acanthosis nigricans is a cutaneous disorder characterized by hyperpigmentation and papillomatosis. Syndromal acanthosis nigricans may occasionally appear as a feature of several specific syndromes. We report a patient showing the typical characteristics of Cohen syndrome with acanthosis nigricans and hyperinsulinemia.

Effects of recombinant human erythropoietin on physiological inhibitors of coagulation in children on continuous ambulatory peritoneal dialysis

The effects of recombinant human erythropoietin (rHuEPO) on plasma and peritoneal effluent levels of antithrombin III (AT-III), protein C (PC) activity, and protein S (PS) activity were evaluated in 10 uremic children on continuous ambulatory peritoneal dialysis (CAPD). The findings were compared with values obtained from ten healthy children. Levels of AT-III and of PC and PS activity in plasma and peritoneal effluent were measured before, and at 8 and 12 weeks after, rHuEPO treatment. Baseline levels of AT-III and PC activity in plasma were lower than the control values. Levels of PC activity increased during the trial, while levels of AT-III remained unchanged, and levels of PS activity decreased. Baseline levels of PC activity in peritoneal effluent were lower than those obtained during rHuEPO treatment, while no change in peritoneal levels of PS activity and AT-III was observed after rHuEPO treatment. A significant positive correlation was seen between plasma and peritoneal levels of PC activity at baseline. A significant positive correlation was also seen between plasma levels of PS activity and hemoglobin at week 12, and a significant negative correlation between plasma levels of AT-III and albumin at week 8. No correlation was found between the plasma natural coagulation inhibitors and CAPD duration. These results suggest that plasma PS activity can be decreased, and plasma PC activity increased, by rHuEPO treatment in children.