Clinical, hormonal and metabolic characteristics of polycystic ovary syndrome among obese and nonobese women in the Croatian population

Obesity has a deteriorating impact on women with PCOS, although prevalence and the impact of specific traits of PCOS remain inconstant in different populations. Therefore, the aim of this study was to explore the differences in clinical, hormonal and metabolic features between obese and nonobese Croatian women diagnosed as having PCOS according to Rotterdam consensus criteria. The study included 74 obese and 208 nonobese women with PCOS. Clinical, biochemical and metabolic variables were compared among those PCOS subgroups. Obese subjects with PCOS had a higher risk of developing oligo-amenorrhea (OR 3.7; 95% CI, 1.1-12.5) and lower risk for developing hirsutism and acne (OR 0.2; 95% CI, 0.1-0.3 and OR 0.8; 95% CI 0.5-1.4, respectively). Obese PCOS subjects also had a higher risk of developing hyperandrogenemia (OR 2.5; CI 95% 0.9-6.7), insulin resistance (OR 4.5; CI 95%, 2.6-7.9), hypercholesterolemia (OR 5.0, CI 95% 2.5-10.2), hypertriglyceridemia (OR 5.2; 95% CI, 2.9-9.2) as well as elevated serum CRP levels (OR 4.1; 95% CI 1.4-12.2) compared to nonobese PCOS women. In conclusion, nonobese Croatian women with PCOS are more inclined to cosmetic problems associated with PCOS then metabolic ones. This is the first study to report the impact of obesity on acne and irregular menses as a study outcome. Obesity deteriorates menstrual regularity, insulin sensitivity and lipid profile in Croatian women with PCOS; therefore one of the fundamental treatment strategies of PCOS should be obesity prevention.

Emergency contraception: can we benefit from lessons learned?

The aim of the paper was to evaluate current emergency contraception (EC) methods and policies in order to implement lessons learned and maximize potential population impact while introducing dedicated EC pills in Croatia. Literature search for potential reasons for EC failing to show positive population impact and detecting actionable points to be implemented in national guidelines. Six potential reasons for ECs failure to show population impact were evaluated and four actionable points were detected: low use of EC compared to the numbers of risk events, low awareness on EC in general population, differences in efficacy of EC methods and EC vailability. In order to ensure EC's population impact in Croatia it is of a critical relevance to establish continuous education programs for population of women at risk. When recommending an EC method, superior efficacy must be a key decision-making criteria therefore cooper IUD and ulipristal acetate should be our primary options. Counseling is a critical step to ensure maximal efficacy of the EC method, but also to encourage future use of regular contraceptives. Finally, national ECP dispension protocol is needed to close the loop from effective women screening, prompt yet appropriate ECP administration/dispensing towards structured follow up after EC pills intake.

[Guidelines for antimicrobial treatment and prophylaxis of urinary tract infections]

Recommendations for antimicrobial treatment and prophylaxis of urinary tract infections (UTI) have been made according to the results of investigation of resistance of the most frequent causative agents of UTI to antimicrobial drugs. This investigation has been conducted for the past seven years by the Committee for monitoring bacterial resistance to antibiotics in the Republic of Croatia, with consensus of eight professional societies of the Croatian Medical Association. Uncomplicated cystitis is treated 1, 3, or 7 days, complicated 7 days, pyelonephritis 10-14 days, and complicated UTI 7 to 14 days, rarely longer. For the treatment of cystitis fluorokinolons, nitrofurantoin, betalactam antibiotics, and in the fields of lower resistance trimethoprim/sulfamethoxazol are being used. Single treatment with fluorokinolons is administered to otherwise healthy young women with normal urinary tract in whom cystitis symptoms have been present for less than 7 days. Empiric antimicrobial treatment of pyelonephritis, recurrent and all complicated UTI must be reviewed after urine culture finding is obtained. In the treatment of bacterial prostatitis and febrile UTI in males, the drug of first choice is ciprofloxacin. Asymptomatic bacteriuria (AB) is treated in pregnant women, newborns, preschool children with urinary tract abnormalities, before invasive urologic and gynecologic procedures, in kidney transplant recipients, and in the first days of short term urinary bladder catheterization. Recommendations for the treatment of AB in patients with diabetes mellitus have been controversial in the past two years. Antimicrobial prophylaxis is administered mostly one hour prior to the diagnostic or therapeutic invasive urological procedure, using selected antimicrobial agents.

Estrous-cycle-related changes in the expression of mouse endometrial and oviductal glycoproteins

Glycoproteins of mouse endometrium and oviduct were analyzed by lectin overlay blotting of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)-separated whole-cell extracts, sampled at each of the four phases of the normal estrous cycle. Nine endometrial and 5 oviductal glycoproteins were found only in one of these two organs or showed cyclic changes in their expression as revealed by wheat germ or Ricinus communis I lectin blotting. Glycoproteins of the same molecular weight showed different expressions in the endometrium as compared with the oviduct. Thus one can conclude that the expression of the endometrial and oviductal glycoproteins is cyclic, but organ specific.

Changes related to the oestrous cycle in the expression of endometrial and oviductal proteins of mice

Soluble proteins extracted from the endometria and oviducts of normal sexually mature cycling Swiss Webster mice were analysed by two-dimensional high-resolution sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Thirty endometrial and 25 oviductal proteins showed differential expression related to the oestrous cycle. In the endometrium, 19 proteins were maximally expressed in the oestrous phase, and significantly decreased or could not be detected in dioestrus. Eleven additional proteins were more prominent in dioestrus. Most of these endometrial cyclic proteins were acidic. In the oviduct, almost two-thirds of cycle-related, differentially expressed proteins were more strongly expressed in dioestrus and were significantly less prominent or could not be detected in the oestrous phase. In contrast to the endometrial proteins, most of the oviductal cyclic proteins were basic. Fourteen proteins appeared to be identical in both organs, and five of these showed the same cyclic pattern of expression. The remaining cyclic proteins were organ specific and showed uterus- or oviduct-specific changes during the oestrous cycle. Among the cyclic proteins, four endometrial and two oviductal proteins were restricted to oestrus, whereas two endometrial and seven oviductal proteins were restricted to dioestrus. These proteins could serve as markers for specific phases of the oestrous cycle. Our data show that the mouse oestrous cycle is associated with consistent and predictable changes in protein expression in both the endometrium and oviduct.

Lectin cytochemistry of mouse vaginal smears

Lectin cytochemistry was used to determine whether phase-specific changes could be detected in the smears of mouse vagina taken during the different phases of the estrous cycle. The strongest and most specific lectin reactivity was seen in the proestrus phase of the cycle. Several lectins reacted with mucinous cells typical of the proestrus phase and stained either diffusely the entire cytoplasm or only the cytoplasmic granules of desquamated cells. Nucleated squamous epithelial cells showed reactivity of the cell membrane or the entire cytoplasm in late metestrus and diestrus phase. Cornified squamous cells were essentially unreactive with the lectins tested in this study. Lectin cytochemistry is a reliable method for identification of mucinous cells in mouse vaginal smears and for establishing the cyclicity of the mouse estrous cycle.

Oviductal glycoproteins in sexually immature mice

The expression of oviductal glycoproteins was studied in prepubertal mice by lectin overlay of electrophoretically separated cellular extracts. Two N-acetylgalactosamine specific lectins [Maclura pomifera (MPA), and Ricinus communis (RCA-I)] were used to study samples obtained from 7, 14, 21 and 28 day old virgin mice. A total of 9 developmentally regulated glycoprotein bands were identified. Several patterns of glycoprotein expression were noticed: glycoproteins expressed equally strongly in all stages of development; glycoproteins that were weakly expressed or not found in 7 day old or 14 and 21 day old mice but became more prominent and reached maximal expression in mature mice; glycoproteins expressed under the influence of maternal hormones at 7 days that became barely detectable in 14 and 21 day old mice but were strongly expressed in mature mice. These data show that the pattern of expression of oviductal glycoproteins changes during the prepubertal maturation of the oviduct.

Lectin histochemistry of mouse vagina during the estrous cycle

Estrous cycle-related histochemical changes in the vaginal epithelium of sexually mature female mice were studied with 30 fluorescein isothiocyanate (FITC)-labeled lectins. On the basis of the staining pattern the lectins were divided into five groups: I, seventeen lectins that reacted with mucinous surface layer of proestrus. This group comprised two subgroups: Ia, seven lectins that reacted exclusively with the mucinous layer, and Ib, ten lectins that reacted with mucinous cells and the underlying squamous epithelium of proestrus; II, two lectins that reacted with squamous epithelium of proestrus only but were unreactive with mucinous cells; III, three lectins that reacted in a phase-specific manner with squamous epithelium; IV, six lectins that showed increased luminal surface reactivity in diestrus and/or metestrus; and V, eleven lectins that were unreactive with vaginal epithelium. These data indicate that the cyclic changes in the morphology of the vaginal epithelium are accompanied by distinct lectin reactivity patterns.

[Validity of the direct immunofluorescent monoclonal antibody test in the diagnosis of chlamydial infection]

The sensitivity and specificity of direct fluorescent monoclonal antibody staining were compared with the isolation of the organisms in McCoy cells. For both diagnostic methods cervical smears were taken in 120 women. Of 120 women 25 (20.8%) were infertile, 60 (50.0%) healthy fertile women and 35 (29.8%) adolescents who came for control gynecological examination. C. trachomatis was isolated in 5/25 (20.0%) of infertile women, in 5/60 (8.3%) of healthy fertile women and in 4/35 (11.4%) adolescents. With the cell culture as the reference method, the antigen detection test had a sensitivity of 92.8%, a specificity of 98.1%, a positive predictive value of 86.7% and a negative predictive value of 99.1%.