The problem of hormonphobia in the practice of obstetrician–gynecologists in Kazakhstan

Abstract

Of the total number of 45–69 years old women in the Republic of Kazakhstan, the frequency of use of hormone replacement therapy (HRT) drugs does not tend to increase and remains at a low level amounting to only 0.8% in 2010 and 0.9% in 2013. Frequency of HRT drugs use among women who are obstetricians and gynecologists from different regions of Kazakhstan between the ages of 45 to 69 years old was only 10% in 2008 and 14% in 2013. The reasons for low use of HRT among obstetricians and gynecologists were associated with fear of cancer, obesity, thromboembolism and stroke. Moreover, this information is supported by other doctors, especially oncologists and endocrinologists. There is low use of different types of contraceptives for the prevention of unwanted pregnancy. Thus, contraceptives were used by 30.4% of women of reproductive age in 2000, and by 38.2% in 2012. Frequency of use of hormonal contraceptives remains at extremely low levels with a slight increase from 1.8% in 2004 to 2.2% in 2013, which has resulted in the fact that abortion remains primary birth control method. Low use of hormonal contraception methods and HRT drugs indicates hormonophobia among doctors of all specializations. There is a need to increase the knowledge of obstetrician–gynecologists, internists, cardiologists, endocrinologists, urologists, and healthy living office employees in urban clinics of modern methods of contraception, and nosotropic therapy for menopausal symptoms with the use of HRT drugs.     

The role of hysteroscopy in the diagnosis of infertility in materials of the 2nd Gynecological Clinic of the Medical Academy in Lódź

Hysteroscopy is one of the routine methods use in gynaecology for diagnosis of "uterine factor" in infertility. The range of the indications for hysteroscopy is very wide and few side effects make it relatively safe. The main aim of the study was the retrospective evaluation of hysteroscopic results among patients with infertility. Physiologic shape of the uterine cavity was diagnosed in 57.1% patients. The number of adhesions inside uterine cavity was lower than described in literature. Different pathology of uterine cavity was diagnosed as frequently as described by other authors.     

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center

Objective  

To analyse treatment outcomes after SET law enforcement and to evaluate the contribution of cryopreservation in a SET policy.     

“Centers of excellence in endometriosis surgery” or “centers of excellence in endometriosis”

Centers of excellent endometriosis surgery could improve the care of women with endometriosis, especially if combined with control of the quality of the surgery performed, e.g., through systematic taping of entire interventions. Centers of excellence in endometriosis without emphasis on providing excellent surgery seem of little value and could do more harm than good.     

The analisys of complications in forceps delivery in Institutute of Obsterics and Women Disease Medical University of Gdańsk

INTRODUCTION: The forceps are the oldest obstetrics instrument using to quickly finishing delivery in situation of imminent fetal death. Forceps delivery increase the risk of new-born and women complications AIM OF STUDY: The aim of the study was retrospective analysis of 215 forceps deliveries in Institute of Obstetrics and Gynecology, Medical University of Gdańsk between years 1991 and 2004. MATERIAL AND METHODS: 26653 deliveries took place in Institute of Obstetrics and Gynecology, Medical University of Gdańsk between years 1991 and 2004 and in 215 cases deliveries finished by forceps operations. The fetal and mothers complications were assessed. RESULTS: Percentage of forceps delivery was low 0.81%. About 30% of new-borns were born with different types of birth's complications. 16.7% of new-borns had extravasations of skin and 14.8% had subperiosteal haematoma. More than half of examined women had various injuries of their birth canal and the more common was unilateral rupture of cervix--18.6%. Conclusions: The risk of complications after forceps delivery in rather high. 37.2% of newborn and 58,1% of women had various complications after forceps delivery. Our results indicate that percentage of forceps deliveries is decreased and in the 14 years periods was only 0.81%.     

Analysis of twin pregnancies on the ground of women hospitalized in the Department of Reproduction and Obstetrics Medical University in Wrocław in 1995-1999

The aim of this study was the general valuation of the course and the delivery means of the twin pregnancies. The research material composed of 83 from among 5540 pregnant women hospitalized in the Department of Reproduction and Obstetrics Medical University of Wroc?aw in the years 1995-1999. The mean body mass values and the condition of the newborns have been analyzed on the ground of Apgar's scale, according to the date of delivery. In the period between 23 and 42 week of pregnancy a very high correlation between fetus' body mass and a high correlation between Apgar's scale and the pregnancy's duration has been ascertained. These values have also been estimated in particular periods: 23-27, 28-32, 33-37 and 38-42 weeks of gestation. Statistical analysis didn't indicate any difference between the mean values of Apgar's scale of the newborns from the periods of 33-37 and 38-42 weeks of gestation. There was no evidence of differences either in Apgar's scale values or in the twins' I and II body masses, as well in the whole examined group as in particular periods.     

Role of estrogen receptor-β in endometriosis

Endometriosis is an estrogen-dependent disease. The biologically active estrogen, estradiol, aggravates the pathological processes (e.g., inflammation and growth) and the symptoms (e.g., pain) associated with endometriosis. Abundant quantities of estradiol are available for endometriotic tissue via several mechanisms including local aromatase expression. The question remains, then, what mediates estradiol action. Because estrogen receptor (ER)β levels in endometriosis are >100 times higher than those in endometrial tissue, this review focuses on this nuclear receptor. Deficient methylation of the ERβ promoter results in pathological overexpression of ERβ in endometriotic stromal cells. High levels of ERβ suppress ERα expression. A severely high ERβ-to-ERα ratio in endometriotic stromal cells is associated with suppressed progesterone receptor and increased cyclo-oxygenase-2 levels contributing to progesterone resistance and inflammation. ERβ-selective estradiol antagonists may serve as novel therapeutics of endometriosis in the future.     

Analysis of Proteinuria Estimation Methods in Hypertensive Disorders of Pregnancy

Purpose of the Study

The gold-standard 24-h urine collection method for protein estimation is inconvenient and is associated with a delay in laboratory analysis. This study was undertaken to compare sulphosalicylic acid test, urine dipstick test, urine protein-to-creatinine ratio with 24-h urine protein estimation in pre-eclampsia cases.

Methods

This is a comparative study and consists of a single group of 764 subjects. This study was conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Biochemistry, JIPMER, Pondicherry, India, from February 2011 to January 2014. The subjects included were 764 pre-eclampsia women. A first voided morning sample was obtained for sulphosalicylic acid test, dipstick test, urine protein and creatinine estimation and urine culture, and subsequent urine samples were collected for the 24-h urine protein estimation.

Main Findings

For significant proteinuria, sulphosalicylic acid test with 1 + proteinuria has sensitivity, specificity, PPV and NPV of 59, 48, 39, 67, whereas with 2 + has sensitivity, specificity,PPV and NPV of 44, 88, 75 and 67%, respectively, dipstick test with 1 + proteinuria has sensitivity, specificity, PPV and NPV of 71, 52, 54 and 70%, whereas with 2 + has sensitivity, specificity,PPV and NPV of 49, 87, 75 and 69%, respectively. The spot urine protein-to-creatinine ratio and 24-h urine protein were significantly correlated (r = 0.98; p < 0.0001). The cut-off value for the protein-to-creatinine ratio as an indicator of protein excretion ≥ 300 mg/day was 0.285. The sensitivity, specificity PPV and NPV were 100, 99, 100 and 99%, respectively.

Conclusion

The spot urine protein-to-creatinine ratio is a better method for estimation of proteinuria in pre-eclampsia.

     

Activation of NF-κB in Placentas of Women with Preeclampsia

Objective. Placentas are oxidatively stressed during preeclampsia and produce more tumor necrosis factor α (TNFα) and more thromboxane than normal. Oxidative stress may cause these abnormalities by activating nuclear factor-κB (NF-κB). We measured the levels of activated NF-κB in normal and preeclamptic placentas and determined whether oxidative stress activates NF-κB in a trophoblast-like cell line. Methods. We used immunohistochemistry to determine the percentage of the total tissue area that stained for the p65 subunit of NF-κB in placentas obtained from normal and preeclamptic pregnancies. In a second set of experiments, we used a reporter plasmid bearing the NF-κB binding site and transfected it into trophoblast-like cells. The cells were incubated with medium control, linoleic acid (LA), an oxidizing solution (Ox), or Ox enriched with LA (OxLA), TNFα, or OxLA plus TNFα for 20 h. Cell lysates were analyzed using a dual luciferase assay kit. Results. Placentas obtained from women with preeclampsia showed nearly a 10-fold increase in the extent of area stained for activated NF-κB as compared to normal placentas. In cell culture experiments, Ox and OxLA induced a threefold increase in NF-κB activation as compared to medium control or LA. TNFα induced a threefold increase in NF-κB activation. The combination of TNFα with OxLA caused a 10-fold increase in NF-κB activation. Conclusions. Placental NF-κB is activated nearly 10-fold in preeclampsia. Oxidative stress causes NF-κB activation in a trophoblast-like cell line, which is enhanced by TNFα. These data suggest that oxidative stress is likely an important in vivo activator of placental NF-κB in preeclampsia.     

The creation of “monsters”: the discourse of opposition to in vitro fertilization in Poland

In Poland, there is a campaign to criminalise in vitro fertilization, led by the Catholic church. This article explores how this campaign makes “monsters” of IVF children in its discourse, that is, embodiments of “the other” in the sense of Frankenstein's monster. Basing the analysis primarily on Catholic mass media publications, the article investigates the discursive strategies employed to oppose IVF, most notably by the Catholic clergy and activists and journalists associated with the Church. They attribute “monstrosity” to the children in the following ways: physical (possible bodily deformity), psychological (survivor syndrome, identity crisis), social (loneliness, uncertain place in family relations), and ethical (a life burdened with the deaths of many embryos). Although the world of families with IVF does not provide examples of children who could be considered monsters in any of these terms, these arguments have become the primary reasons given for banning IVF.     

The role of blood in early endometrial–peritoneal interactions in a syngeneic mouse model of endometriosis

Purpose

The aim of this study was to clarify the role of blood in the early stage of development of endometriotic lesions by developing a syngeneic transplantation model using immunocompetent mice.

Methods

Endometriotic lesions were induced in C57BL/6 mice by an intraperitoneal injection of endometrial fragments plus saline or endometrial fragments plus blood. Some endometrial fragments plus blood were injected with heparin, hirudin or tissue plasminogen activator (tPA). Endometriotic lesions on days 1, 3 and 5 were evaluated by gross and microscopic findings.

Results

The areas of endometriotic lesions in the blood group (6.4 ± 1.7 mm²) were significantly larger than those in the saline group (0.5 ± 0.3 mm²). The areas of endometriotic lesions were significantly reduced by the addition of heparin, hirudin or tPA. On day 1, endometriotic lesions in the blood group were observed on the peritoneum in five of the six mice. Endometriotic lesions on days 3 and 5 were significantly larger than those on day 1. On day 5, endometriotic lesions appeared cystic in all the mice.

Conclusions

Blood accelerates the early stage of development of endometriotic lesions when endometrial fragments plus blood are injected. Blood property might be involved in early endometrial–peritoneal interactions.     

Serological estimation of the occurrence of chlamydiosis in children with the upper respiratory tract inflammation and pneumonia in 1993-1996 in the area of Wrocław

The investigation were made of the seasonal occurrence of the upper respiratory tract inflammation and pneumonia probably caused by ch. trachomotis. The immunofluorescence tests of chlamydia trachomatis were done in the blood serum of 1831 children aged from 2 weeks to 6 years hospitalised in Wroc?aw. The research was conducted from 1993 to 1996. The obtained results allowed to assume that the occurrence of the infections confirmed by serologically positive reactions is not connected with the season predisposing the organism of child to the diminished immunity.     

Evaluation of Spot Urinary Albumin–Creatinine Ratio as Screening Tool in Prediction of Pre-eclampsia in Early Pregnancy

Objective

The aim of this study was to establish whether a spot urinary albumin/creatinine ratio (ACR) measured between 20 and 28 weeks of gestation can predict subsequent pre-eclampsia in asymptomatic pregnant women.

Design

Prospective observational study.

Subjects

The patients included sixty-two women with singleton pregnancy, normal renal function and no evident proteinuria, attending antenatal clinics between 20 and 28 weeks of gestation in a tertiary care hospital.

Methods

The ACR was determined from midstream urine sample taken between 20 and 28 weeks of gestation. Estimation of albumin was done by immunoturbidimetric microalbumin method and creatinine by modified Jaffe’s method.

Results

Incidence of pre-eclampsia in the study group was 12.90%. The cut-off value for ACR was taken as 35.5 mg/mol. The mean ACR in normotensive group was 19.26 ± 7.99, and in pre-eclampsia group it was 51.95 ± 18.78. For pre-eclampsia, screening in early pregnancy, spot ACR cut-off ≥35.5 mg/mol has sensitivity of 87.5%, specificity of 96.30%, PPV of 77.78% and NPV of 98.11%.

Conclusions

Spot urinary ACR values are higher in asymptomatic women in early pregnancy, who developed pre-eclampsia later on. When measured early in the second trimester, an ACR ≥ 35.5 mg/mmol predicted pre-eclampsia well before the onset of clinical manifestations with high sensitivity and specificity. It can be used as a good screening tool for predicting pre-eclampsia in early pregnancy.