Clinical significance of risk-reducing salpingo-oophorectomy in patients with BRCA1/2 mutation

OBJECTIVE

Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion which is located in the distal fallopian tube and causes high grade serous ovarian carcinoma (HGSOC). The incidence of STIC for women underwent risk reducing salpingo-oophorectomy for BRCA mutation varies from 0.6 to 7% and its clinical outcomes are still unclear. The aim of this study was to demonstrate the incidence of STIC and HGSOC in BRCA1/2 mutation carriers after risk reducing salpingo-oophorectomy (RRSO) and the clinical outcomes of these patients.

MATERIAL AND METHODS

We retrospectively reviewed the records of 48 BRCA1 and/or 2 mutation carriers who underwent prophylactic salpingo-oophorectomy with or without hysterectomy at the Department of Obstetrics and Gynecology, Bursa Uludag University between January 2000 and January 2022.

INCLUSION CRITERIA

BRCA 1 and/or 2 mutation carriers diagnosed by genetic testing, asymptomatic patients with no abnormal findings on pelvic examination.

EXCLUSION CRITERIA

patients with no abnormal findings on pelvic examination and a presence of a personal history of ovarian, fallopian tube or peritoneal cancer.

RESULTS

A total of 48 BRCA 1 and/or 2 mutation carriers underwent RRSO. STIC was diagnosed in 1 (2,0%) patient and restaging surgery was not performed. Primary peritoneal carcinoma (PPC) did not develop during the 20 months follow-up period. One (2.0%) patient was diagnosed with occult ovarian cancer. Restaging surgery was performed and chemotherapy treatments were given after surgery. A pelvic recurrence developed 25 months after the occult cancer diagnosis in the follow up period. One (2.0%) patient with normal histopathological findings after RRSO was diagnosed with peritoneal cancer 57 months after the operation.

CONCLUSION

The risk of PPC continues after RRSO. Therefore, close follow-up procedure is very important for early diagnosis and effective treatment of patients with PPC after RRSO.

Role of increased plasminogen activator inhibitor-1 and vitronectin in gestational diabetes mellitus

OBJECTIVE

The aim of this study was to analyze the second-trimester levels of vitronectin and plasminogen activator inhibitor-1 in gestational diabetes mellitus.

METHODS

This study was conducted between September 2020 and December 2020 at the University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology. A total of 30 pregnant women with gestational diabetes mellitus and 60 healthy controls between 24 and 27/6 weeks of gestation were included. The inclusion criteria were as follows: being between 18 and 45 years old and 24-27/6 gestational weeks, having singleton pregnancy, diagnosed with gestational diabetes mellitus by using a two-step challenge test. The exclusion criteria of this study were as follows: chronic inflammatory or infectious disease, fasting blood glucose>126 mg/dL, intolerance to glucose tolerance testing, abnormal liver or kidney function tests, as well as pregnancy with pre-gestational diabetes history of adverse perinatal outcomes. Serum vitronectin and plasminogen activator inhibitor-1 levels were measured using the enzyme-linked immunosorbent assay method.

RESULTS

Vitronectin and plasminogen activator inhibitor-1 levels were higher in the gestational diabetes mellitus group compared with controls [91.85 (23.08) vs. 80.10 (39.18) ng/mL, for vitronectin and 6.50 (1.05) vs. 4.35(1.0) ng/mL, for plasminogen activator inhibitor-1 (for both p<0.001)]. vitronectin >84.7 ng/mL was found to predict gestational diabetes mellitus with a sensitivity of 70% and specificity of 63.3%. Moreover, vitronectin had a significant positive correlation with fasting blood glucose (r=0.476, p<0.001), postprandial blood glucose (r=0.489, p<0.001), HbA1c (r=0.713, p<0.001), and plasminogen activator inhibitor-1 (r=0.586, p<0.001).

CONCLUSION

This study revealed that second-trimester vitronectin and plasminogen activator inhibitor-1 are increased in gestational diabetes mellitus and vitronectin could be a candidate for the prediction of gestational diabetes mellitus.

The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum

AIM

Hyperemesis gravidarum (HG) is one of the most common serious diseases in early pregnancy. This study aimed to investigate the clinical significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score and systemic immune inflammation (SII) index in the presence and severity of HG.

METHODS

This retrospective case-control study was conducted in a training and educational university hospital between January 2019 and July 2022. A total of 521 pregnant women, of whom 360 were diagnosed with HG at 6-14 weeks of gestation and 161 were low-risk pregnancies, were included in the study. Patients' demographic characteristics and laboratory parameters were recorded. Patients with HG were divided into three categories: mild (n = 160), moderate (n = 116), and severe (n = 84), according to disease severity. The modified PUQE scoring was used to determine the severity of HG.

RESULTS

The mean age of the patients was 27.6 (16-40) years. We divided the pregnant women into the control group and HG group. The HALP score was significantly lower in the HG group (average, 2.8 ± 1.3), whereas the SII index was found to be significantly higher (average, 895.8 ± 458.1). A negative correlation was found between the increase in the severity of HG and HALP score. The HALP score was the lower in severe HG (mean, 2.16 ± 0.81) and was significantly different from other HG categories (p < 0.01). Moreover, a positive correlation was noted between increased HG severity and SII index levels. The SII index was higher in the severe HG group and was significantly different from the others (1001.2 ± 437.2) (p < 0.01).

CONCLUSIONS

The HALP score and SII index can be useful, cost-effective, and easily accessible objective biomarkers to predict the presence and severity of HG.

Can early pregnancy decorin levels be a potential predictor for preterm birth?

Objective: This study investigates the role of maternal decorin levels measured in the early second trimester of pregnancy in detecting the potential for preterm birth in late pregnancy. Methods: The prospective, case-control study was carried out in tertiary university hospital from June to December 2021.Maternal serum samples were collected from 350 women aged 18–40 years with a singleton pregnancy during early second-trimester screening for aneuploidy, and stored at -80°C. All participants were followed up until delivery and 25 patients diagnosed with preterm birth group and 40 full-term healthy women were included in the study. Results: The median maternal serum decorin level was 3.82 (1.15–12.37) ng/ml in the preterm birth (PTB) group and 4.63 (1.20–10.02) ng/ml in the control group, there was no statistically difference between the groups (p = 0.111). The mean gestational age was statistically significantly lower in the preterm birth group (33.1±2.7 weeks) than in the control (39±1.16 weeks) (p <0.001). The mean fetal weight was statistically significantly lower in the preterm birth group (2023.8±477 g) than in the control group (3309.7±353 g) (p <0.001). Conclusion: Early second-trimester serum levels of decorin alone may not be a sufficiently accurate biomarker as a biochemical model for the prediction of preterm birth in asymptomatic women. doi: https://doi.org/10.12669/pjms.38.8.6551 How to cite this:Ozgen L, Ozgen G. Can early pregnancy decorin levels be a potential predictor for preterm birth? Pak J Med Sci. 2022;38(8):---------. doi: https://doi.org/10.12669/pjms.38.8.6551 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Are women diagnosed with early pregnancy loss at risk for anxiety, depression, and perinatal grief?

OBJECTIVES

To examine the effects of early pregnancy loss on emotions such as depression, grief, or a sense of hopelessness, while investigating different types of diagnoses, hospital stays, and treatments.

METHODS

A prospective cohort epidemiological study was carried out in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January and September 2019. The study included women diagnosed with early pregnancy loss classified into 3 groups: missed abortus, anembryonic pregnancy, and spontaneous abortion. The patients were screened via the Spielberger state-anxiety inventory (STAI-1) before initiating treatment. The Edinburgh postpartum depression scale (EPDS) and Perinatal Grief Scale (PGS) were also carried out in the first week of their hospital discharge.

RESULTS

The study was carried out with a total of 116 patients. The median gestational week of the patients was calculated at 9, their median hospital stay was 2 days, and their median dose of misoprostol was 800 mcg. The STAI-1 revealed that median values computed for women in all groups indicated moderate anxiety. The EDPS also demonstrated depression-positive median values for women in all 3 groups (EPDS>13). However, no statistically significant difference was noted in comparisons of the 3 groups apropos STAI-1, EPDS, and PGS.

CONCLUSION

Moderate anxiety, depressed mood, and perinatal grief were found in women diagnosed with early pregnancy loss, regardless of the type of abortion.

Optical Coherence Tomography Angiography Findings in Polycystic Ovary Syndrome

OBJECTIVE

To evaluate microstructure and vascularity of macula and optic disc in polycystic ovary syndrome (PCOS) by optical coherence tomography (OCT) and OCT angiography (OCTA).

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Department of Ophthalmology and Department of Obstetrics and Gynecology, University of Health Sciences, Yüksek lhtisas Training and Research Hospital, Bursa, Turkey between January and June 2019.

METHODOLOGY

Fifty-nine patients with PCOS and 35 healthy controls were enrolled in the study. Foveal avascular zone (FAZ), the capillary density assessed in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the macula and was also measured in optic disc using the OCTA. The thicknesses of the retinal nerve fiber (RNFL), ganglion cell complex (GCC), and macula were measured by OCT.

RESULTS

The capillary density in the macula and optic disc region were not a significant difference between the PCOS patients and healthy controls.The parafoveal superior, inferior, and temporal quadrant thickness was significantly higher in the study group compared to control group (p=0.047, p=0.033,and p=0.033, respectively). In patients with PCOS, there were negative correlations between IR and inferior RNFL, total and superior GCC thickness (r=-0.29 p= 0.027, r=-0.27 p=0.050, r=-0.31 p=0.029, respectively).

CONCLUSION

Although no microvascular macular abnormalities were seen in PCOS patients, the parafoveal thickness significantly increased in all quadrants, except the nasal quadrant. In patients with PCOS, IR, dyslipidemia may affect the structural integrity of the retina. Further longitudinal follow-up studies are needed to determine whether PCOS has any effect on OCTA findings. Key Words: Polycystic ovary syndrome, Retina, Optical coherence tomography, Optical coherence tomography angiography.

Correlation between maternal plasma thrombomodulin and infant birth weight in hypertensive disorders of pregnancy

OBJECTIVE

To evaluate the association between maternal plasma thrombomodulin levels and infant birth weights in pregnancy-induced hypertension.

STUDY DESIGN

Plasma thrombomodulin levels were measured in 80 pregnant women living in the Trakya region of Turkey. Of these patients, 30 were with severe preeclampsia, 10 with HELLP syndrome, 10 with eclampsia, and 30 were normotensive healthy pregnant women. Plasma thrombomodulin levels were determined by the enzyme-linked immunosorbent assay method. The correlation analysis between thrombomodulin and birth weight and placental weights was done using analysis of variance and Bonferroni test (significance at P < .05). Kruskal-Wallis statistical analysis was performed in comparison of the descriptive and laboratory data (significance at P < .05).

RESULTS

The plasma thrombomodulin values in hypertensive disorders in pregnancy were found to be highly correlated with the infant birth weights (P < .001). In HELLP syndrome, the highest thrombomodulin levels (94.69 + 10.41 ng/mL) were associated with the lowest infant birth weight (1509.70 + 187.55 g) in the study population. Thrombomodulin in eclampsia (81.37 + 3.59 ng/mL) showed an association with infant birth weight (2078 + 132.65 g). Although thrombomodulin levels in severe preeclampsia (67.15 + 3.72 ng/mL) were associated with the values (1748.20 + 132.62 g) in infant birth weight, thrombomodulin levels of the control group demonstrated the mean (48.06 + 2.45) with the highest infant birth weight (3228.85 + 84.83) in the total group.

CONCLUSION

Elevated plasma thrombomodulin levels in hypertensive disorders of pregnancy were well correlated with related infant birth weights of these pathologies. Plasma thrombomodulin levels might point out placental vascular endothelial damage reflecting on infant birth weights.