Effect of 25-hydroxyvitamin D on metabolic parameters and insulin resistance in patients with polycystic ovarian syndrome

ObjectivesTo investigate the correlation between the levels of 25-hydroxyvitamin D and insulin resistance in patients with polycystic ovarian syndrome (PCOS).Patients and methodsIn 30 untreated PCOS patients and 15 control subjects, levels of 25-hydroxyvitamin D were measured. In addition, endocrine and metabolic variables were evaluated and a glucose tolerance test was performed to assess indices of insulin resistance.ResultsObese PCOS women (n = 15) had lower 25-hydroxyvitamin D levels than lean PCOS women (n = 15) and control subjects (8.9 ± 3.1 vs 26.5 ± 6.4 vs 79.2 ± 19.1 nmol/l respectively; P < 0.001). In the entire cohort, 25-hydroxyvitamin D levels were negatively correlated with body mass index (r = ?0.390), fasting insulin (r = ?0.707), HOMA-β (r = ?0.705), and HOMA-IR (r = ?0.635), and positively correlated with QUICKI (r = 0.723) (all P < 0.001).ConclusionIn PCOS women, low 25-hydroxyvitamin D levels are associated with obesity and insulin resistance.     

Ejercicio físico durante el embarazo y su relación con los tiempos de las etapas del parto

ObjectiveTo determine the influence of aerobic exercise during the second and third trimesters of pregnancy on the duration of stages of labor.Subjects and methodsAn experimental (casecontrol) study was performed. Four hundred eighty women were interviewed at their first prenatal visit. One hundred forty-two pregnant women without complications or multiple pregnancies were randomly selected and were divided into two groups: cases (n = 72) and controls (n = 70).ResultsCases: stage 1 (n = 65): 7.0 ± 3.4 hours. Stage 2 (n = 61): 32.5 ± 24.7 min. Stage 3 (n = 61): 8.0 ± 2.2 min. Controls: stage 1 (n = 62): 6.5 ± 2.5 hours. Stage 2 (n = 59): 35.9 ± 31.5 min. Stage 3 (n = 59): 7.7 ± 1.7 min. The SPSS statistical program was used to analyze the results.ConclusionPhysical exercise seems not to influence the duration of stages of labor. Future studies with more homogeneous groups and different intensities of exercise are required.     

Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery

ObjectiveTo evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective cesarean delivery.MethodsA randomized controlled trial was conducted among 400 women scheduled for elective cesarean delivery. The study group (n = 200) received 400 μg of misoprostol. The control group (n = 200) received placebo. Study medications were administered rectally after catheter insertion and shortly before skin incision. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24 hours, and difference between preoperative and postoperative hematocrit values.ResultsThe mean intra-operative and postpartum blood loss was significantly lower in the study group than the control group: 429 ± 234 mL and 185 ± 95 mL versus 620 ± 375 mL and 324 ± 167 mL, respectively (P = 0.001 for both comparisons). The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.62 ± 2.45 versus 8.15 ± 3.84; P = 0.02). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5 minutes were comparable between the 2 groups.ConclusionPreoperative treatment with 400 μg rectal misoprostol significantly reduced blood loss related to elective cesarean delivery.Clinical trial registration No.: ACTRN12611000638932.     

Maternal serum ratio of ghrelin to obestatin decreased in preeclampsia

ObjectiveGhrelin, an endogenous for the growth hormone secretagogue receptor, has been shown to participate in blood pressure regulation. Obestatin, encoded by the same gene as ghrelin, is described as a physiological opponent of ghrelin. We hypothesized that ghrelin/obestatin imbalance played a role in the pathogenesis. This study was designed to determine the alterations of ghrelin and obestatin concentrations and ghrelin/obestatin ratio in maternal serum in preeclampsia.MethodThis retrospective case–control study included 31 preeclampsia and 31 gestational week-matched normal pregnancies. Ghrelin and obestatin concentrations in maternal serum were determined by radioimmunoassay, and the ghrelin/obestatin ratio was calculated.ResultsThe ghrelin concentration and ghrelin/obestatin ratio in maternal serum were significantly lower in preeclampsia than in normal pregnancies (214.34 ± 14.27 pg/mL vs 251.49 ± 16.15 pg/mL, P = 0.041, 1.07 ± 0.09 vs 0.82 ± 0.08, P = 0.023). The obestatin concentration in maternal serum was significantly higher in preeclampsia than in normal pregnancies (276.35 ± 15.38 pg/mL vs 223.53 ± 18.61 pg/mL, P = 0.019). The systolic blood pressure in preeclampsia was negatively correlated with ghrelin concentration and ghrelin/obestatin ratio (r = −0.549, P = 0.003; r = −0.491, P = 0.004) and was positively correlated with obestatin concentrations in preeclampsia (r = 0.388, P = 0.013).ConclusionsThe findings of this study suggested disturbance of ghrelin and obestatin in maternal serum in preeclampsia, and ghrelin/obestatin imbalance might play a role in the pathogenesis of preeclampsia.     

Treatment of 161 Men with Symptomatic Late Onset Hypogonadism with Long-Acting Parenteral Testosterone Undecanoate: Effects on Body Composition,Lipids, and Psychosexual Complaints

IntroductionElderly men may suffer from late-onset hypogonadism (LOH). The long-term effects of long-acting testosterone undecanoate (TU) in a large number of LOH men have not yet been reported.AimsWe analyzed the effects of normalization of plasma testosterone (T) in LOH men.MethodsThe records of 161 men with LOH (baseline T < 300 ng/dL) were reviewed and 100 men had used parenteral TU for >12 months. The mean duration of treatment was 90.6 weeks (54 to 150 weeks).Main Outcome MeasuresBody mass index (BMI), waist circumference, percentage body fat, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, prostate-specific antigen (PSA), and hematocrit were measured. Further the Aging Male Symptoms' scale (AMS) and the International Index of Erectile Function (IIEF-5 and 15) were scored.ResultsT therapy was associated with a significant decline in waist circumference (P = 0.028) and percentage body fat (P < 0.001), but no change of BMI. Total cholesterol and LDL cholesterol declined significantly (P = 0.005 and P = 0.024, respectively), with no significant changes of HDL cholesterol and triglycerides. The scores of sub-scales of AMS (psychological, somotovegetative and sexual factors) decreased (P = 0.044, P = 0.200 and P = 0.071, respectively). The mean IIEF-5 (P = 0.011) and IIEF-15 scores (P = 0.021) improved significantly. Erectile function domain, orgasmic function domain, sexual desire domain, intercourse satisfaction domain, and overall satisfaction domain improved. Median PSA rose from 0.95 (0.640; 1.558) ng/mL to 1.480 (1.015; 2.275) ng/mL (P < 0.001), with 11 patients >4 ng/mL (4.01–13.21). On biopsy there was no evidence for malignancy. The mean hematocrit level increased significantly from 42.3 ± 3.4% to 47.1 ± 3.8%.ConclusionsNormalizing serum T in men with LOH resulted in improvement of the metabolic syndrome, mood and sexual functions and appeared acceptably safe. Permpongkosol S, Tantirangsee N, and Ratana-olarn, K. Treatment of 161 men with symptomatic late onset hypogonadism with long-acting parenteral testosterone undecanoate: Effects on body composition, lipids, and psychosexual complaints.     

Serum S100B in pregnancy complicated by preeclampsia: A case-control study

BackgroundSerum S100B is a protein produced and released primarily by astrocytes of the Central Nervous System (CNS). Elevated levels of serum S100B are associated with several types of pathological conditions of the brain, including the eclampsia in pregnant women. The aim of this study was to compare serum S100B concentrations in pregnant women with severe and mild preeclampsia (PE) with S100B serum levels in normotensive pregnant women.Material and methodsSerum S100B protein was measured in normotensive pregnant women (n = 15) and in women with mild PE (n = 12) or severe PE (n = 34). The serum S100B level (μg/L) was determined by an luminometric assay.ResultsSixty-one expectant mothers were studied, aged 26.6 ± 8.7 (mean ± SD) years and with a gestational age of 33.3 ± 4.2 weeks. The severe PE group demonstrated higher S100B levels (0.20 ± 0.19), as compared with mild PE (0.07 ± 0.05) or normotensive groups (0.04 ± 0.05).ConclusionElevated serum S100B levels in pregnant women with severe PE suggest that some kind of neural damage and subsequent astrocytic release of S100B is not dependent on the progression from severe preeclampsia to eclampsia.     

Combined Implantation of a Penile Prosthesis and Adjustable Continence Therapy ProACT in Patients with Erectile Dysfunction and Urinary Incontinence after Radical Prostatectomy: Results of a Prospective Pilot Study

IntroductionThe treatment of postradical prostatectomy erectile dysfunction (post-RP-ED) and stress urinary incontinence (post-RP-SUI) may require the combined implantation of a penile prosthesis and incontinence surgery. However, there is a lack of consensus regarding which incontinence surgery should be associated with a penile implant.AimsTo evaluate the combined implantation of a penile prosthesis and the adjustable continence therapy ProACT in patients with post-RP-ED and post-RP-SUI.MethodsWe implanted the ProACT device and a penile prosthesis synchronously (n = 6) and asynchronously (n = 4) in 10 patients with moderate post-RP-SUI and severe post-RP-ED. We evaluated the effects on urinary incontinence using the ICIQ and PGI-I scores and pad use. We evaluated the effect on sexual function using the EHS and Global Assessment Questionnaire (GAQ), and we evaluated satisfaction with the penile prosthesis on a 5-point scale. Postoperative pain associated with each procedure was evaluated by a numeric rating scale.ResultsNo cases of urinary retention or prosthesis infection were observed. Postoperative pain was mainly related to penile prosthesis implantation. After a mean follow-up of 22.7 ± 20.9 months (range: 6–53), significant improvements of the ICIQ score (15.3 ± 3.7 vs. 4.7 ± 2.3, P < 0.001) and pad use per day (2.8 ± 1.2 vs. 0.3 ± 0.5, P < 0.001) were observed compared with baseline. According to the PGI-I questionnaire, eight patients described a very much improved (n = 6) or much improved (n = 2) urinary condition. All patients declared an EHS = 4 with the use of penile prosthesis; all patients were very satisfied (n = 6) or satisfied (n = 4) with their penile prosthesis. All patients answered the GAQ positively.ConclusionThe combined implantation of a Pro-ACT device and penile prosthesis represents a feasible therapeutic option in patients with post-RP-SUI and post-RP-ED. The absence of postoperative pain associated with the ProACT procedure may represent the main interest in this therapy.     

Evaluation of coagulation abnormalities among women with vaginal bleeding in the first trimester of pregnancy

ObjectiveTo compare blood coagulation parameters between pregnant women with vaginal bleeding in the first trimester of pregnancy and pregnant women with normal pregnancy in the first trimester.MethodsA prospective controlled study of 98 women in the first trimester of vital pregnancy was conducted at the University Medical Centre Maribor, Slovenia. The study group comprised women with vaginal bleeding (n = 50) while the control group women with normal pregnancy, admitted for artificial abortion (n = 48). Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen concentration, number of platelets, hemogram, coagulation factor VIII (FVIII) and von Willebrand factor (VWF) activity were compared between the 2 groups.ResultsNo significant between-group differences were detected in mean PT, fibrinogen concentration, FVIII, and VWF activity. Mean aPTT was significantly higher in the control group than the study group (32.47 versus 30.46 seconds; P < 0.05). The mean number of platelets was significantly lower in the study group than the control group (181.69 versus 203.52 × 10⁹/L; P < 0.05). All measured coagulation parameters, except VWF activity, were within normal ranges.ConclusionCoagulation abnormalities are rarely the cause of vaginal bleeding in the first trimester of pregnancy among women with no previous symptoms of bleeding disorders.     

Evaluation of the value of the first and third trimester maternal mean platelet volume (MPV) for prediction of pre-eclampsia

IntroductionPre-eclampsia is one of the most serious complications of pregnancy and one of the major causes of maternal mortality. Thus its prediction is a matter for serious concern.ObjectiveThe purpose of the present study is to determine the value of mean platelet volume (MPV) measurement in the first and third trimesters of pregnancy for the prediction of pre-eclampsia.MethodA prospective nested case–control study was performed on pregnant women who were at 9–12 weeks of pregnancy. In the first trimester and again in 26–28 weeks, MPV was calculated. All eligible women were then monitored to delivery and the MPV of women who were pre-eclamptic was compared with the MPV of normotensive women.ResultsPre-eclamptic women were compared with 269 normotensive women. MPV at the first trimester of pre-eclamptic women was significantly higher than normotensive women (10.2 ± 1.06 fl VS 9.68 ± 1.09 fl, P = 0.008). Also, MPV at the third trimester of pregnancy of pre-eclamptic women was more than normotensives (10.16 ± 1.23 fl VS 9.62 ± 1.12 fl, P = 0.009).Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.64 for the predictive value of MPV at the first and third trimesters of pregnancy, which showed a low value of this test for predicting of pre-eclampsia.ConclusionMPV at the first and third trimesters of pregnancy are higher in women who eventually would be pre-eclamptic, but has low predictive value and is not a good predictor of pre-eclampsia.     

Suivi pédiatrique de 30 grossesses gémellaires monochoriales consécutives traitées par fœticide sélectif

ObjectivesTo describe perinatal and pediatric outcome after selective feticide for complicated monochorionic twin pregnancy.Patients and methodsWe reviewed all consecutive cases of umbilical cord occlusion performed for complicated monochorionic twin pregnancy over a 16-year period. Pediatric follow-up was based on medical records and updated by phone calls to the parents.ResultsThirty procedures were performed. Indications were: twin-to-twin transfusion syndrome (TTTS) progressing despite serial amniodrainage (n = 12) ; twin reversed arterial perfusion (n = 9) ; selective growth restriction (n = 5) ; severe discordant structural anomalies (n = 4). Mean gestational age at procedure was 21.8 ± 3.1 gestational weeks (GW) and 31.8 ± 4.8 GW at birth. Overall survival rate was 87%, i.e. 83%, 100%, 60% and 100% for each indication, respectively. Mean pediatric follow-up was 5 years (range: 6 months to 15 years). Medical charts and parents declared normal development in 88% of surviving children, i.e. 67%, 100%, 100%, and 100% for each indication. Cross-comparison between the four groups revealed that in the TTTS group, gestational age at procedure was more advanced (P = 0.01) while delivery was slightly earlier (P = 0.1), and pediatric development was poorer (P = 0.02).Discussion and conclusionPediatric outcome after selective feticide appeared to be poorer for TTTS progressing despite serial amniodrainage than for other indications.     

Zinc sulfate treatment of secondary male infertility associated with positive serum and seminal plasma anti-sperm antibody test

ObjectiveThe traditional use of corticosteroids in the treatment of infertile patients who developed anti-sperm antibodies may be associated with many systemic side effects of such administered drugs. So the use of alternatives for corticosteroids becomes mandatory in order to minimize these systemic side effects. Like the use of immune modulator zinc sulfate.DesignProspective study.SettingInstitute of the Embryo Research and Infertility Treatment, College of Medicine, AL – Nahrain University.Patients and methodsForty-eight infertile men with poor semen parameters and elevated serum and seminal plasma level of ASA were classified into three groups. The first group (n = 18 patients) received oral zinc sulfate, the second group (n = 20 patients) received oral prednisolone and the third group (n = 10 patients) received oral placebo. Drugs were administered for 45 days.Main outcome measure(1) Standard semen analysis was performed, including semen volume, sperm concentration, percent motility, sperm vitality and sperm morphology. (2) Serum and seminal plasma Anti-Sperm Antibody ELISA test.ResultsStatistical analysis of serum and seminal plasma level of ASA reveals that the level is decreased significantly (P < 0.001, P < 0.002) in zinc sulfate treatment group as compared to the control group (67.5 ± 2.64 vs. 71.6 ± 2.5, 66.94 ± 3.24 vs. 71 ± 2.54), respectively, but the decrease in prednisolone treatment group is significantly higher (P < 0.001) as compared to the zinc sulfate treatment group (57.3 ± 6.30 vs. 67.5 ± 2.64, 56.5 ± 6.83 vs. 66.94 ± 3.24), respectively. This improvement in serum and seminal plasma level of ASA, result in a significant enhancement of the seminal fluid parameters including sperm concentration, sperm motility, vitality and normal sperm morphology in both zinc sulfate and prednisolone treatment groups.ConclusionIn conclusion, infertile men with elevated level of ASA and poor basic parameters of seminal fluid characters can be treated with zinc sulfate protocol with great chance for decreasing the level of serum and seminal plasma ASA, and alleviating the serious side effects associated with corticosteroids.     

Increased intravenous hydration of nulliparas in labor

ObjectiveTo assess the effects of intravenous hydration on the duration of active labor in nulliparous women also allowed unrestricted oral consumption of fluids.MethodsIn a randomized clinical trial 120 nulliparous women with uncomplicated singleton pregnancies at term were randomly assigned to drink fluids at will and receive either no intravenous hydration (group 1) or a Ringer lactate solution at rates of 60 mL, 120 mL, or 240 mL per hour (groups 2–4) throughout active labor.ResultsThere were differences in duration for the active phase of the first stage of labor (252.3 ± 40.9 min in group 1 vs 206.7 ± 38.3 min in group 4; P < 0.001) and for the second stage (64.3 ± 13.9 in group 1 vs 49.8 ± 11.4 min in group 4; P = 0.01), but not for the third stage. The percentage of participants who needed labor augmentation with oxytocin was less when intravenous hydration was provided (53.3% in group 1 vs 20.0% in group 4; P = 0.02).ConclusionIntravenous hydration significantly decreased the duration of active labor and reduced the frequency of both prolonged labor and oxytocin administration in nulliparous women.htpp://www.irct.ir registration number: IRCT201105256575N2     

Maternal hemodynamics influence fetal hemodynamics in normal and hypertensive pregnancy

ObjectivesThis observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy.Study designFour groups of non-pregnant women (n = 18), pregnant controls (n = 25), women with gestational hypertension (n = 21) and preeclampsia (n = 10) were included.Main outcome measuresMaternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy.ResultsHigher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r = ?.51, p < 0.01 and r = ?.49, p < 0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r = ?.35, p = 0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r = ?0.33, p = 0.03).ConclusionsIt seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase.     

Intérêt d’un combipatch de thrombine et de fibrinogène dans la prévention des lymphocèles après curage axillaire

ObjectiveTo evaluate the effect of combipatch TachoSil^® in the prevention of seromas after axillary dissection in local breast cancer.Patients et méthodesA retrospective, case-control study conducted between January 2007 and December 2009, in two departments of Obstetrics and Gynecology of the AP–HP. Sixty-six patients (45 in the control group and 22 in the group TachoSil^®) who have undergone an axillary dissection alone, with establishment of a redon or with lumpectomy, were included. The total amount of lymph drained during the stay, the number of days of drainage, duration of hospitalization, the number of lymphoceles and the number of retrievals performed at the waning of hospitalization were collected.ResultsThe population was similar in age, body mass index (BMI), clinical and pathological data. There was no significant difference in terms of total volume of lymph drained (268.2 ± 220.7 mL without TachoSil^® and 228.6 ± 128.8 mL with TachoSil^®, P = 0.89) and the number of days of drainage (3.9 ± 1.6 days without TachoSil^® and 3.1 ± 0.9 days with TachoSil^®, P = 0.10). The duration of hospitalization was significantly higher in the group TachoSil^® (5 ± 1.6 days with TachoSil^® and 3.8 ± 1.1 days without TachoSil^®, P = 0.006).ConclusionThis study shows no benefit of combipatch (TachoSil^®) in prevention of seromas after axillary lymph node dissection. A randomized study with large effective is necessary.     

First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome

ObjectiveTo determine the pregnancy outcome as a function of the first-trimester serum 25-hydroxyvitamin D₃ [25(OH)D] status and to compare the 25(OH)D levels in the first and third trimesters.MethodsPregnant women (n = 466) tested for serum 25(OH)D levels during the first trimester were followed up until the end of pregnancy, and the obstetric and neonatal outcomes were compared in reference to the baseline 25(OH)D status. The third-trimester 25(OH)D levels were additionally measured in a subset of women (n = 148).ResultsThe obstetric and neonatal outcomes did not vary as a function of the first-trimester 25(OH)D status. Neither did the 25(OH)D levels vary as a function of pregnancy outcomes. Overall, the 25(OH)D levels significantly decreased from the first to the third trimester. The first- and third-trimester 25(OH)D levels of samples initially taken during autumn/winter were significantly lower than those that were initially taken during spring/summer. Interestingly, the decrease in 25(OH)D levels during the third trimester was independent of the season of sampling.ConclusionThe pregnancy outcome was independent of the first-trimester 25(OH)D status. Overall, the 25(OH)D levels significantly decreased in the third trimester. More research in this area is warranted.     

Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS)

BackgroundRecurrent miscarriage affects 1–2% of women. Thrombophilia included antiphospholipid syndrome has been identified in about 50% of women with recurrent miscarriage. Aspirin and heparin therapy is frequently prescribed for APS, yet there is no robust evidence for the most efficacious regime.ObjectiveTo determine maternal and foetal outcomes in women with APS managed with aspirin or enoxaparin plus aspirin during pregnancy.DesignProspective non randomized study.SettingHigh-risk pregnancy unit-Benha University Hospital.MethodsSeventy selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome were divided into two Groups: Group A (n = 47) had received aspirin (81 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day) while Group B (n = 23) had received low-dose aspirin (81 mg day orally).Main outcome measuresMaternal outcomes included thromboembolic, haemorrhagic complications and pregnancy-induced hypertension. Prematurity, intrauterine growth restriction and neonatal death were considered as foetal complications.ResultsThere were significant differences between Groups A and B in the rate of miscarriages (4 in Group A (9%) versus 8 in Group B (35%); p = 0.02), number of live births (43/47(91%) versus 15/23(65%); p = 0.02), mean gestational age (37.86 ± 1.8 versus 36.13 ± 2.39 weeks; p = 0.005), neonatal birth weight (3252 ± 459 versus 2907 ± 618 g; p = 0.03) and rate of pre-eclampsia (3/43 (7%) versus 6/15 (40%); p = 0.009). Although not statistically significant, women in Group A tended to have lower rates of preterm births (6/43 (14%) versus 3/15 (20%); p = 0.89) and IUGR (5/43 (12%) versus 5/15 (33%); p = 0.13) than in Group B.ConclusionsUse of low dose aspirin and enoxaparin 40 mg subcutaneously daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates compared to low dose aspirin alone. Solid conclusions from this study are limited due to the small number of patients, non-randomization of groups and discrepancy in number between groups because the choice of the interventional drug was left to patient’s preference after counselling. A larger RCT is needed.     

ORIGINAL RESEARCH—ENDOCRINOLOGY: Comparison of Free Testosterone Results by Analog Radioimmunoassay and Calculated Free Testosterone in an Ambulatory Clinical Population

IntroductionThe most widely used method for measuring free testosterone (FT) is by analog immunoassay (aFT); however, this assay has been criticized as unreliable based on laboratory studies in small groups of men. Calculated FT (cFT), derived from total testosterone (TT) and sex-hormone binding globulin (SHBG) values has been recommended in its place. There are limited data comparing aFT and cFT in clinical populations.AimThe purpose of this study was to compare aFT with cFT in a population of ambulatory men in a clinical setting.MethodsMedical records were reviewed for 100 randomly selected men in a urology practice, yielding 140 test results complete for TT, aFT, and SHBG. Calculated FT was determined via an online calculator. Comparisons were made with Pearson rank coefficients.Main Outcome MeasuresPearson rank correlation between aFT and cFT.ResultsMean patient age was 52.3 ± 14.3 years (range 24–80). Mean TT was 443.0 ± 208.3 ng/dL (range 110–1276). Mean aFT was 1.22 ± 0.54 ng/dL (range 0.24–3.8) and mean cFT 9.4 ± 4.5 ng/dL (range 1.8–27.8). Mean SHBG was 34.2 ± 19.5 nmol/L (range 9–127). A strong correlation was observed for aFT and cFT (r = 0.88, P < 0.0001), particularly at low concentrations. Significant correlations were also noted between aFT and TT (r = 0.73, P < 0.0001), and between cFT and TT (r = 0.82, P < 0.0001). Numerical values for aFT were approximately one-eighth of the values obtained for cFT. Neither aFT nor cFT correlated with SHBG.ConclusionsA strong correlation was observed between aFT and cFT in this clinical population of ambulatory men. Different sets of reference values must be applied for each of these tests. Moreno SA, Shyam A, and Morgentaler A. Comparison of free testosterone results by analog radioimmunoassay and calculated free testosterone in an ambulatory clinical population.     

The Effect of Renal Transplantation for End-Stage Renal Disease on Female Sexual Function and Depression

IntroductionStudies have suggested that women with end-stage renal disease (ESRD) had higher risk of sexual dysfunction than healthy women.AimsTo prospectively determine the effect of renal transplantation for ESRD on female sexual function and depression.MethodsDuring a 5-year period, the study included 21 sexually active women who underwent renal transplantation for ESRD at a single university hospital. After obtaining demographic characteristics, female sexual function was evaluated with a detailed 19-item questionnaire (The Female Sexual Function Index, FSFI), and depression was assessed using Beck Depression Inventory (BDI) scale.Main Outcome MeasuresIn all women, FSFI and BDI scores were compared before and after the renal transplantation surgery.ResultsThe mean age of the women was 35.04 ± 9.6 years, and mean follow-up duration after renal transplantation was 27.5 ± 20.4 months. Mean total sexual function score increased from 17.57 ± 7.07 to 25.3 ± 3.28, revealing significant difference (P = 0.001). Compared with preoperative period, sexual function domains including sexual desire (P = 0.001), arousal (P = 0.001), lubrication (P = 0.003), orgasm (P = 0.001), satisfaction (P = 0.001), and pain (P = 0.02) significantly improved after renal transplantation. Mean BDI score significantly decreased from 17.91 ± 8.56 to 3 ± 4.17 after renal transplantation (P = 0.001).ConclusionsSuccessful renal transplantation may improve female sexual functions and depression. Therefore, life quality increases as sexual functions and depression improve after the renal transplantation surgery. Ketta? E, Çayan F, Efesoy O, Akbay E, and Çayan S. The effect of renal transplantation for end-stage renal disease on female sexual function and depression.     

The role of matrix metalloproteinase-2 in the culture media in embryo implantation rate in normogonadotrophic cases undergoing ICSI

ObjectiveThe aim of the study is to correlate the changes in the biochemical marker MMP-2 in the culture media with the outcome of normogonadotrophic cases undergoing ICSI.MethodologyA prospective study of infertile females was conducted in El-Shatby Maternity University Hospital between October 2011 and May 2012 utilizing a sample of 40 normogonadotrophic infertile women (22 females with unexplained infertility and 18 females with tubal factor infertility).ResultsClinical pregnancy was 57.5%; 15 out of the 22 females with unexplained infertility and 8 out of the 18 females with tubal factor infertility. There was no abortion, ectopic or chemical pregnancy. Ongoing pregnancy after 14 weeks of gestational age was 100%.Total (MMP-2) ranged between (4.1 and 21.1) and (3.5–37) ng/ml with the mean of (9.91 ± 5.48) and (13.91 ± 8.87) ng/ml for non pregnant and pregnant groups respectively. There were no statistical significant differences between the two groups regarding total MMP-2 (P = 0.055).The mean of MMP-2/embryo/h ranged between (0.05 ± 0.05) and (0.06 ± 0.08) ng/ml/embryo/h for non pregnant and pregnant groups respectively. There were no statistical significant differences between the two groups regarding MMP-2/embryo/h (P = 0.234).ConclusionsMMP-2 concentration in the culture media cannot be used as a biochemical marker for embryo selection or prediction of implantation in the normogonadotrophic cases undergoing ICSI.RecommendationsResults of the present study suggest searching for other markers in the culture media for better embryo selection and for prediction of implantation in the normogonadotrophic cases undergoing ICSI.     

Vitamin D Deficiency in Type 2 Diabetic Patients with Hypogonadism

IntroductionBoth type 2 diabetes and secondary hypogonadism may be associated with low vitamin D levels.AimThe aim of this study was to evaluate 25‐hydroxyvitamin D (25(OH)D) concentrations in type 2 diabetic males with and without hypogonadism.MethodsWe performed a case–control study among 122 male adults with type 2 diabetes, 51 with associated hypogonadism (Group 1) and 71 with normal gonadal function (Group 2). One hundred age‐matched nondiabetic males with normal gonadal function served as a control group.Main Outcome MeasuresLevels of 25(OH)D were assessed by a chemiluminescent immunoassay in all patients. Morning testosterone, pituitary, thyroid, parathyroid hormones, fasting glucose, and hemoglobin A1c were also evaluated.ResultsThe overall diabetic population showed a mean 25(OH)D concentration (22.3 ± 6.09 ng/mL) significantly lower than the control group (34.3 ± 7.2, P < 0.001), with 81% of diabetic patients presenting 25(OH)D deficiency (<20 ng/mL) or insufficiency (20–29.9 ng/mL). The lowest 25(OH)D concentration was found in Group 1 (20.1 ± 6.58 ng/mL). Concentration of 25(OH)D was significantly lower in the 42 patients with hypogonadotropic hypogonadism as compared with the 9 patients with hypergonadotropic hypogonadism (19.4 ± 7.06 vs. 23.8 ± 6.11 ng/mL, P < 0.001). No difference in erectile dysfunction (ED) prevalence between Group 1 and Group 2 was found, nor was there a correlation between the severity of ED and vitamin D levels (r = −0.10, P = 0.39).ConclusionsThese results show that type 2 diabetic patients with hypogonadism present lower 25(OH)D concentration and higher prevalence of vitamin D deficiency, compared with patients without hypogonadism. The finding that 25(OH)D concentrations were similar between type 2 diabetic patients with hypergonadotropic hypogonadism and those with normal gonadal function deserves further study. Bellastella G, Maiorino MI, Olita L, Capuano A, Rafaniello C, Giugliano D, and Esposito K. Vitamin D deficiency in type 2 diabetic patients with hypogonadism. J Sex Med 2014;11:536–542.