Clinical aspects; Authors: M. Gözüküçük, E. Türkyilmaz, O. Küçükşahin, Ş. Erten, Y. Üstün, A.F. Yavuz

Background: This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods: Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results: The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm³, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions: Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

Objectives: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in infertile women characterized by both reproductive and metabolic dysfunctions of different degrees. Furthermore, it has been associated with increased cardiovascular disease (CVD) risk and related long-term health sequela. The aim of this study is to evaluate serum homocysteine (Hcy) and C-reactive protein (CRP) levels in women with PCOS and to evaluate their relationship with clinical and laboratory parameters in women with PCOS. Materials and Methods: The prospective single-center study included 45 women with PCOS (study group) and 41 control subjects. Demographic variables and Hcy, CRP, fasting blood glucose, insulin, follicle-stimulating hormone, luteinizing hormone, estradiol, total and free testosterone, dehydroepiandrosterone sulfate, thyroid-stimulating hormone levels, and lipid profiles of the subjects were recorded. homeostatic model assessment for insulin resistance (HOMA-IR) indexes were calculated. Results: Fasting plasma glucose, insulin, HOMA-IR, free and total testosterone levels, and clinical hirsutism were significantly higher in the study group. There was no statistically significant difference in lipid profile between groups. Hcy and CRP levels were higher in the study group, which was not statistically significantly different (P > 0.05). Conclusion: Some of the parameters that are correlated with CVD risk were found to be higher in women with PCOS, although the difference for Hcy and CRP did not reach statistical significance. However, the current study reveals that the CVD risk associated with PCOS deserves more comprehensive prospective studies with long-term outcomes.

Full Papers; Authors: M. Gözüküçük, E. Türkyilmaz, O. Küçükşahin, Ş. Erten, Y. Üstün, A.F. Yavuz

Nausea and vomiting occur 50–90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8–2% before the 20th week of gestational age. The symptoms generally start during the 5–6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16–20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting. The study population consisted of two groups of pregnant volunteers at 5–12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups. In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD3 levels were significantly lower than in the control group (p < 0.001). The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms. NCT02862496 Date of registration: 21/07/2016.

Single-organ vasculitis (SOV) has rarely been reported to involve the female genital tract but mostly the uterine cervix. A 39-year-old woman was diagnosed to have a high-grade cervical intraepithelial lesion and was treated by large loop excision of the transformation zone. Histopathological evaluation of the excised specimen confirmed the diagnosis of cervical intraepithelial neoplasia grade III accompanied by human papillomavirus infection. The excised second specimen showed the evidence of vasculitis of medium-sized vessels of the cervix, which is a quite rare form of SOV. It seems to be important to be aware of the localized form of polyarteritis nodosa limited to the female genital tract to prevent unnecessary immunosuppressive therapies.