The novel predictor of metabolic risk in patients with polycystic ovary syndrome: could it be the visceral adiposity index?

OBJECTIVE

Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age, often accompanied by high androgen levels, irregular menstrual cycles and polycystic ovaries. In addition, patients with PCOS also present with an increase in abdominal adipose tissue and insulin resistance. Recently, the gender-specific mathematical formulation called visceral adiposity index (VAI) has been widely used in assessing cardiometabolic risk. This study aimed at comparing the VAI values of patients with PCOS, patients with idiopathic hirsutism (IH) and a control group.

PATIENTS AND METHODS

We obtained demographic data, laboratory results and anthropometric measurements of patients from the hospital database. We retrospectively grouped all cases included in the study as PCOS (n = 52), IH (n = 57) and control (n = 58) according to the diagnoses. We also took venous samples for hormone and biochemical tests in the early follicular phase of the menstrual cycle, at least 8-10 hours after fasting in the early morning hours. Finally, we evaluated the variables using SPSS 22.0 software (IBM Corp., Armonk, NY, USA).

RESULTS

We included 167 female individuals in the study. Of these, 57 (34.1%) were diagnosed with IH, while 52 (31.1%) were diagnosed with PCOS. The control group comprised 58 (34.8%) healthy female individuals. The median age of the study group was 25 years [interquartile range (IQR) = 8 years]. The age, height, weight, body mass index (BMI) and waist circumference values of the groups were similar. We found that the VAI values among the groups were significantly different (p = 0.028). Post-hoc analysis determined that this was due to the difference between the group with PCOS and the control group. In addition, we found significantly high HOMA-IR, fasting insulin and androgen levels in the group with PCOS (p < 0.001).

CONCLUSIONS

After comparing data in groups with similar BMI levels, we found significantly high VAI values in patients with PCOS. The results reinforce the idea that VAI is a useful marker easily obtained in daily practice for assessing the cardiometabolic risk of patients with PCOS.

THE FAMILIAL HYPOCALCIURIC HYPERCALCEMIA PRESENTED WITH ADVANCED HYPERCALCEMIA AND EXTREMELY HIGH PARATHORMON LEVELS (CASE REPORT)

Familial Hypocalciuric Hypercalcemia (FHH) is a rare benign condition inherited in an autosomal dominant pattern with high penetrance. This rare genetic condition is detected in approximately 2% of cases examined as primary hyperparathyroidism (PH). The Calcium Sensing Receptor (CaSR) gene's inactivating mutations result in a calcium-parathormone level-saturation curve shift to the right. Generally, the calcium level does not exceed 11,5 mg/dl and the PTH is seen normal. In our case and in her family, extreme high blood calcium levels up to 14 mg/dl and accompanying advanced parathyroid hormone levels rising up to five times the upper limit of normal were detected. Due to these high PTH levels and advanced hypercalcemia, she was thought to have PH as a primary diagnosis. The case and her family are an interesting phenomenon that do not clinically fit classical FHH.

Establishing a new screening 17 hydroxyprogesterone cut-off value and evaluation of the reliability of the long intramuscular ACTH stimulation test in the diagnosis of nonclassical congenital adrenal hyperplasia

OBJECTIVE

Nonclassical congenital adrenal hyperplasia (NCAH) is a common genetic transmitted endocrinological disease. The validity of screening by using a 17 hydroxyprogesterone (17 OH-P) cut-off level of 2 ng/ml is controversial due to the frequent overlap with the polycystic ovary syndrome (PCOS). The availability of the standard intravenous cosyntropin (ACTH) formula is a problem in many countries including our country and the diagnostic test is performed by using the intramuscular depot form. In this study, we aimed to determine our own cut-off value for screening and to test the reliability of long intramuscular ACTH stimulation test in our patients.

PATIENTS AND METHODS

One hundred and seventy-five fertile age women whose basal follicular phase 17 OH-P level above 2 ng/ml were included in the study. All of the patients underwent an intramuscular long cosyntropin (ACTH) stimulation test.

RESULTS

17 OH-P levels were above 10 ng/ml in 16 of 175 (9.14%) patients who were compatible with the diagnosis of NCAH. There was no significant difference between NCAH, PCOS and idiopathic hyperandrogenism (IH) groups in terms of hirsutism and hyperandrogenemia. In ROC analysis, 3.19 ng/ml was found to be a reliable cut-off value (AUC: 0.698, 95% GA: 0.540-0.855, p <0.05). In the extended intramuscular ACTH stimulation test, sensitivity increased from 56.2% to 91.6% at 180th minute CONCLUSIONS: Our study gives a perspective about the detection of screening threshold value for the diagnosis of NCAH and the availability of the intramuscular long ACTH stimulation test.

INFLAMMATORY CELL RATIOS IN THE PATIENTS WITH FIBROMYALGIA

Fibromyalgia is a chronic disease with undefined aetiology which commonly results in muscle sensitivity, pain, and sensitivity at certain anatomical points. The pathogenesis and aetiology of fibromyalgia are not yet fully understood. The objective of this study was to assess the diagnostic value of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/ monocyte ratio (LMR) as simple systemic inflammatory response biomarker sin patients with fibromyalgia. A total of 489 patients with fibromyalgia (group1) and 227 healthy controls (group2) were included in the study. Demographic data, Body Mass Index (BMI) neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded. Baseline NLR, PLR, and LMR were calculated by dividing the absolute neutrophil, platelet and lymphocyte counts by the respective divisor absolute values. The NLR, PLR, and LMR levels of the two groups were then compared. There were no significant differences in gender and age between the two groups (p>0,05). BMI levels (29.6 vs 24.8 kg/m2), mean NLR (3.63 vs. 2.11) and PLR (222.55 vs. 114.28) values were found to be statistically higher (p <0.001), and mean LMR (2.73 vs. 3.85) values were found to be statistically lower, in the patient group (p <0.001). The present study showed that NLR, PLR, AND LMR levels can be used in the diagnosis of fibromyalgia and systemic inflammation may play a role in fibromyalgia.

Isotretinoin increased carotid intima-media thickness in acne patients

BACKGROUND

Isotretinoin (Iso) in acne treatment may cause dyslipidemia and increase in liver enzymes. Moreover, its effect on lipid and glucose metabolism may induce atherosclerotic complications. The aim of this study was to evaluate carotid intima-media thickness (CIMT), osteopontin (OPN), lipid, high sensitive C-reaktive protein (hs-CRP) levels, and insulin resistance (HOMA-IR) in acne patients before and after Iso treatment.

MATERIALS

Twenty-one acne patients were treated with Iso (0.5-0.8 mg/kg) for four months. Blood tests for lipid profile, fasting glucose, liver enzymes, OPN, HOMA-IR, hs-CRP and CIMT measurements were performed before and after Iso treatment. Serum levels of OPN and, hs-CRP were measured by ELISA and particle-enhanced turbidimetric immunoassay respectively.

RESULTS

Iso treatment significantly increased lipid levels, CIMT (0.60-0.74 mm; p ˂0.001); whereas it non-significantly increased HOMA-IR (0.91-1.87; p =0.70), OPN (4.32-5.44 ng/ml; p =0.27), and hs-CRP (0.08-0.09 mg/dl; p =0.88) levels. There was no correlation between OPN and CIMT (p =0.77).

CONCLUSION

Isotretinoin treatment for four months significantly increased CIMT in acne patients. Hippokratia 2016, 20(1): 14-18.

A successful management of a giant mucinous ovarian tumor with intraoperative controlled fluid aspiration

BACKGROUND

The aim of this article was to present management of a giant ovarian mass.

CASE REPORT

A 61-year-old patient was admitted with compliants of abdominal swelling and dyspnea. Ultrasound revealed a giant ovarian mass with dimesnions 47x43x30 cm. The patient underwent laparatomy and the cyst's content was aspirated before total cyst excision. The total weight of the mass was calculated to be 42.5 kg. Postoperatively, the patient was discharged on her postoperative seventh day.

CONCLUSION

Giant ovarian cysts can be managed with controlled aspiration before total cyst excision.

Successful management of a second-trimester post-abortion hemorrhage with the Bakri balloon tamponade

Hemorrhage after abortion is rare but it is a significant cause of abortion-related mortality and morbidity. Conservative management of hemorrhage is gaining popularity. The authors describe a case which a uterine tamponade balloon which was successfully used to control second-trimester post-abortion hemorrhage.

Is gynaecological laparoscopic surgery safe for elderly women? A comparison study

The aim of this study was to evaluate the efficacy and safety of gynaecological laparoscopic surgery in an elderly group, by comparing the operative outcomes of the elderly group with those of the younger group. We analysed retrospective data of 121 women who underwent laparoscopic surgery for benign gynaecological disease. Women aged > 60 years were compared with women aged between 30 and 50 years who had the same operation. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, haemoglobin change, postoperative complications, hospital stay and return of bowel activity. There were no significant differences between the elderly and a matched younger group in number of previous abdominal surgeries, operating time, ASA score distribution, changes in haemoglobin level, hospital stay and postoperative complications (p > 0.05). Laparoscopic surgery can be safely performed in elderly patients with benign gynaecological disease, and surgeons should not hesitate to perform laparoscopic surgery in elderly patients.

Is laparoscopic surgery safe in patients with an elevated shock index due to ruptured ectopic pregnancy?

PURPOSE

To evaluate the effectiveness of laparoscopic surgery in patients with elevated shock index (SI), which is a unique determinant of acute hemorrhage.

MATERIALS AND METHODS

A retrospective chart review of all patients treated for ectopic pregnancy (EP) in the present gynaecology department between January 2007 and March 2011 was performed. For each measurement of heart rate (HR) and systolic blood pressure (SBP), a SI was calculated by dividing HR by SBP (normal, 0.5 - 0.7).

RESULTS

One hundred sixty patients were selected as SI above 0.7. There were 111 (69.4%) patients in the laparotomy group and 49 (30.6%) patients in the laparoscopy group. The postoperative hemoglobin (Hb) level was 8.46 +/- 1.56 (g/dl) in the laparotomy group and 9.37 +/- 1.52 (g/dl) in the laparoscopy group, with lower postoperative levels in the laparotomy group. The mean duration of postoperative hospital stay was 2.37 +/- 0.74 days in the laparotomy group and 2 +/- 0.84 days in the laparoscopy group.

CONCLUSION

The availability of suitable operative equipment, nursing teams, and advanced laparoscopic skills, all justify operative laparoscopy for the surgical treatment of EP in women with elevated SI.

Acute radiation effect in the brain in infant rats: Neurocognitive and histopathological examination

PURPOSE

The aim of the present study was to evaluate the radiation-induced cognitive dysfunction and the radioprotective effect of amifostine (AMI) in the brain of infantile rats.

METHODS

Thirty 2-week-old rats were randomly assigned into 3 groups of 10 rats each. Group 1: control (CONT), group 2: radiation alone (RT), and group 3: AMI before radiation (AMI+RT). The rats in the RT and AMI+RT groups were irradiated individually with a single dose of 20 Gy. All animals were evaluated by using the Morris water maze test to evaluate of their cognitive functions. Histopathological analyses of the hippocampus were also carried out after euthanasia.

RESULTS

The study showed that the place navigational function and the spatial probe test were not significantly different between the groups.

CONCLUSION

It can be said that it is very important to determine when the radiation-induced brain injury is formed. From a clinical perspective, the patients can be intervened before irreversible functional deficits are formed and may be amenable to treatment.

Do contraceptive choices of Turkish married adolescents differ from those of older women?

OBJECTIVE

To compare contraceptive choices of Turkish married adolescents to those of women of reproductive age and perimenopausal women.

METHODS

Demographic variables, fertility goals and contraceptive choices of adolescents (Group A, n = 95) were compared with those of women of reproductive age (Group B, n = 5224) and perimenopausal women (Group C, n = 2208).

RESULTS

All women in the study group were married and had delivered at least once. A past history of voluntary terminations of pregnancy (TOPs) was reported often, although significantly less so by adolescents (43.1%) than by women belonging to the other two groups (66.5 and 77.4%, respectively). The percentage of women who applied no contraception was significantly higher in Group A (p < 0.05). The rate of use of withdrawal, oral contraceptives and intrauterine devices did not differ significantly between the three groups. The percentage of women who were indecisive about future pregnancy or wanted to have more children was greatest in Group A (87.4, 46.9 and 25.7%, respectively; p < 0.05).

CONCLUSION

The distribution of contraceptive methods used was similar among the three age groups, but the absence of contraception was most frequent in the adolescent group. The adolescents we assessed, being married and having delivered at least once, are a highly selected group and not representative of adolescents in general. Nevertheless, their contraceptive choices did not differ from those of older women. The incidence of TOPs among them was quite high. Minimization of the frequent neglect of application of contraceptive measures by adolescents requires improvement of family planning services for this age group.

The results of surgery in a series of partially accommodative esotropic patients

Three different surgical procedures were performed in 32 partially accommodative esotropic patients with a high accommodative convergence/accommodation (AC/A) ratio. The patients were followed-up for an average period of 2.5 years (range: four months to seven years). Recession of the medial rectus and resection of the lateral rectus (group I), bimedial recession (group 2) or bimedial recession with bimedial Faden operation (group 3) were performed, guided by the preoperative AC/A ratio, the difference between the distance and near deviations, and the alternation pattern. At the end of the follow-up period, the average distance and near deviations were found to be less than 10$DL in all three groups. The AC/A ratio of all patients was normal or close to normal in the postoperative period.

Effect of bimedial rectus recession with a loop on the deviation in essential infantile esotropia

Thirty-two patients with essential infantile esotropia were treated by using a 2.5 millimeter loop, added to a 4 millimeter medial recti recession bilaterally. Objective deviation was more than 45 prism diopters (PD) in all of the patients preoperatively. After surgery the deviation ranged between -10 PD and +IO PD in 26 (81.2%) patients, and limitation of abduction disappeared in all of the cases. A slight limitation of adduction was encountered in two (6.2%) patients. The authors concluded that bimedial rectus recession with a loop is an effective method as an early surgical procedure in patients with infantile esotropia with a large deviation.