Metabolic approaches to the subclassification of polycystic ovary syndrome

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Citations from the literature/International

Journal of Gynecology & Obstetrics 51 (1995) 87-97

Prevalence of kptitis B, hepatitis C, nod human immtmodet% ciency virns infection among women attending prenatal clinics in San Juan, Puerto Rico, from 1989-1990

Deseda C.C.; Sweeney P.A.; Woodruff B.A.; Lindegren M.L.; Shapirb C.N.; Onorato I.M. USA

OBSTET GYNECOL 1995 85/l (75-78) Objective: To evaluate the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among pregnant women in Puerto Rico. Methods: An anonymous serosurvey was conducted in four prenatal clinics in San Juan, Puerto Rico, involving women presenting consecutively for their first prenatal visit. Results: Nineteen of 997 pregnant women (1.9%, 95% confidence interval [CI] 1.2-3.0) tested positive for HCV antibody (anti-HCV), and eight (0.8%, 95% CI 0.4- 1.6) were HIV seropositive. Of the 992 women for whom serum samples were tested for HBV markers, 91 (9.2%, 95% CI 7.5-l 1.2) had evidence of past or current HBV infection, and four (0.4%, 95% CI 0. 1- 1.1) were HBV carriers. The age-specific HBV prevalence ranged from 4.1% among women 15-19 years old to 18.5% among those at least 30 years old (P < 0.001, chi’ test for trend). Anti-HCV prevalence was also higher among women at least 30 years old compared to younger women (3.1 vs. 1.9%; prevalence ratio 1.6,95% CI 0.6-4.9), although the difference was not statistically significant. AntiHCV prevalence was higher among women with past or current HBV infection than among women who were not infected (7.7 vs. I .3%; prevalence ratio 5.8, 95% CI 2.3- 14.3). Conclusions: The prevalence of chronic HBV and HCV infection among pregnant women tested in San Juan, Puerto Rico, is comparable to that among pregnant women in the United States. The prevalence of HIV infection among pregnant women in San Juan is higher than among childbearing women in the United States. DiagnesB of Chlamydir traehomatis genitourinary infection in women by ligase &ii n&ioo assay of u&e Lee H.H.; Chemesky M.A.; Schachter J.; Burczak J.D.; Andrews W.W.; MuIdoon S.; Leckie G.; Stamm W.E. USA

LANCET 1995 345/8944 (213-216) Genitourinary infection with Chlamydia trachomatis is a common and potentially serious sexually transmitted disease. Diagnosis of C trachomatis infection in women typically relies on culture of endocervical swabs, an invasive and expensive procedure. The ligate chain reaction (LCR) is an in-vitro nucleic acid amplification technique that exponentially amplifies selected DNA sequences. We have compared an LCR-based assay to detect C trachomatis plasmid DNA in first void urine with culture of endocervical swabs for matched specimens from 1937 women from four geographic regions. Discordant specimen pairs were further tested by direct fluorescent antibody staining for elementary bodies and an alternative LCR assay based on the chlamydial outer membrane protein gene. An ‘expanded gold standard’ was defined to include ah culturepositive as well as culture-negative, confirmed LCR-positive women. The sensitivity and speciticity of the LCR assay with tirst void urine samples compared with the expanded gold stan-

dard were 93.8% and 99.9%, respectively; the corresponding values for culture were 650% and lOO%,respectively. Thus, an automated LCR assay of readily obtained urine samples showed a detection rate for infected women almost 30% greater than that of endocervical swab culture. The LCR assay was highly effective for the detection of C trachomatis in urine from women with or without signs or symptoms of chlamydial genitourinary tract infection. Improving offiee-hased pbysiciad

prevention practices for sexlc

allytranomitteddiseases

Rabin D.L.; Boekeloo B.O.; Marx E.S.; Bowman M.A.; Russell N.K.; Gonzalez Willis A. USA

ANN INTERN MED 1994 121/7 (513-519) Objective: To determine whether office-based interventions increase primary care physicians’ risk assessment of and counseling practices for patients regarding sexually transmitted diseases and the human immunodeficiency virus (HIV). Design: Randomized controlled clinical trial. Setting: Washington, D.C., Metropolitan Statistical Area Study Participants: ORicebased primary care physicians (family or general practice, internal medicine, and obstetrics-gynecology). Intervention: Mailed educational materials alone or coupled with a simulated patient instructor office visit. Measurements: Self-reported and observed frequency of assessing and counseling patients regarding their risk factors for sexually transmitted diseases and HIV infection. Participants were interviewed by telephone before and after the intervention (n = 757). A subset of participants (n = 194) was also observed after the intervention by simulated patient evaluators in blinded office visits. Results: 89% of physicians who received both educational materials and a simulated patient instructor visit reported that they reviewed the educational materials compared with 53% of those who only received the educational materials (P 0.001). Physicians in the combined intervention group had higher self-reported and observed rates for several risk assessment questions and counseling recommendations than did physicians in the control group or the group that only received educational materials. Seventy-three percent of physicians of the combined intervention group reported an increase. in counseling patients about reducing risky sexual behavior compared with 53% of the group receiving only educational materials and 42% of the control group (P s 0.001). Conclusions: Mailed educational materials combined with an office visit by a simulated patient instructor for role-play and feedback on clinical performance increased the frequency of office-based physicians’ risk assessment and risk reduction counseling of patients for sexually transmitted diseases and HIV infection.

ENDOCRINOLOGY Metabolic approaches to tbe subelnssificntion of polycystic ovary mome

Norman R.J.; Masters S.C.; Hague W.; Beng C.; Pannall P.; Wang J.X. AVS

FERTIL STERIL 1995 63/2 (329-335)

Citations from the literature /International Journal of Gynecology & Obstetrics 51 (1995) 87-97 Objectives: To examine the relationship between various hormonal and metabolic variables in a large group of women with unequivocal evidence of polycystic ovarian syndrome (PCOS) to dissect out the metabolic heterogeneity of this condition. Design: Cross-sectional observational study of PCOS (n = 122) and non-PCOS (n = 26) subjects. Setting: Reproductive medicine unit in a tertiary teaching hospital. Patients: Subjects with presumed PCOS were recruited from the Reproductive Medicine and Gynaecological Clinics and later confirmed as PCOS with recognized criteria. Several other subjects were identilied through recruiting reference subjects. The PCOS population consisted of 122 patients. Reference subjects were recruited from partners of male factor infertility patients in the clinics and from the general population (n = 27). Interventions: A 75 g 2-h oral glucose tolerance test was performed on all subjects in their midluteal phase. Blood was taken at fasting and at 30, 60,90, and 120 min. Main Outcome Measures: Age, body mass index (BMI), waist to hip ratio, levels of integrated glucose and insulin, concentrations of maximum insulin, sex hormonebinding globulin, T, triglyceride, apolipoproteins (Apo Al, B), highdensity lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDLC). Results: Five clusters could be identified. They are characterized as a nonobese group, a moderately obese group, and three very obese groups. The nonobese group (n = 41, BMI = 24. I) exhibited the lowest level of integrated insulin (236.4 mIU/l or au/ml) and concentration of serum T (5.5 mnoYL). The moderately obese group had the second lowest level of integrated insulin (497.1 mIU/L) whereas the three very obese groups (n = 15, 13, and 5, respectively) had significantly higher but different levels of integrated insulin (group 3:850.8 mIU/L; group 4: 1,131.5 mIU/L; and group 5: 1,531.9 mIU/L), triglyceride (group 3: 1.39 mmol/L; group 4: 1.76 mmohL; and group 5: 2.78 mmovl [l mmol/l = 88 mg/ml]), Apo B (group 3: 1.18 g/L; group 4: I .08 g/L; and group 5: 1.55 glL) and LDLC (group 3: 3.81 mmoYL; group 4: 3.05 mmovL, and group 5: 5.06 mmoyl [l mmoyl = 38.6 mg/lOO ml]). Conclusions: The metabolic heterogeneity of the PCOS population is reflected at least partly in patients’ levels of insulin, lipids, and lipoproteins, dependent and independent of BMI. Nenr&rmonal and hemodynamlc changes ln severe cases of the ovarian hypelstInnlIatlon syndmme Balasch J.; Arroyo V.; Fabregues F.; Salo J.; Jimenez W.; Pare J.C.; Vanrell J.A. ESP ANN INTERN MED 1994 121/l (27-33) Objective: To evaluate systemic hemodynamics, endogenous vasoactive neurohormonal factors (renin-angiotensin and sympathetic nervous systems, antidiuretic hormone, atrial natriuretic factor, and renal prostaglandins), and renal function in the severe ovarian hyperstimulation syndrome. Design: Prospective longitudinal study. Setting: Assisted-reproduction unit of a tertiary care hospital in Barcelona, Spain. Patients: 31 consecutive patients having in vitro fertilization with development of ascites because of severe ovarian hyperstimulation syndrome. Measurements: Mean arterial pressure; cardiac output; peripheral vascular resistance; hematocrit concentration; renal function; plasma renin activity; plasma aldosterone,

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norepinephrine, antidiuretic hormone, and atrial natriuretic peptide determinations; and urinary excretion of prostaglandin E2 and Cketo-prostaglandin-Ft were measured during the syndrome and 4 to 5 weeks after recovery (baseline). Results: During the syndrome, patients showed increased hematocrits (mean of the paired difference, 0.047; 95% Cl, 0.029 to 0.064), decreased mean arterial pressure (-16.6 mmHg; Cl, -19.8 to -13.6), increased cardiac output (2.6 L/mitt; Cl, 2.13 to 3.17). and reduced peripheral vascular resistance (-709 dyne/s - cm$ Cl, -792 to -627). This was accompanied by marked increases of plasma renin (14.4 rig/l - s; Cl, 9.87 to 18.90), norepinephrine (1.857 nmol/L; Cl, 0.533 to 3.161), antidiuretic hormone (3.3 pgml; Cl, 1.89 to 4.71). and atrial natriuretic peptide levels (9.7 fmohml; Cl, 6.1 to 13.2). Hemoconcentration developed in 16 patients (mean of the paired difference in hematocrit concentration, 0.082; Cl, 0.063 to 0.101) but not in 15 others (0.009, Cl, 0.003 to 0.021). Both groups showed similar values for arterial pressure, cardiac output, and peripheral vascular resistance, but patients with hemoconcentration had higher (P < 0.05) levels of renin (mean, 20.97 rig/l - s [Cl, 13.3 to 28.631 compared with 7.83 ngA - s [Cl, 4.08 to 1l.58]), norepinephrine (3.907 nmovL [Cl, 3.057 to 4.7571 compared with 2.417 [Cl, 2.035 to 2.799]), and antidiuretic hormone (6.0 pg/ml [Cl, 4.1 to 7.9) compared with 2.4 [Cl, 1.7 to 3.031).Conclusions: In addition to increased capillary permeability, severe ovarian hyperstimulation syndrome is consistently associated with arteriolar vasodilation. The simultaneous occurrence of these disorders leads to hyperdynamic circulatory dysfunction with marked stimulation of the sympathetic nervous system, reninangiotensin system, and antidiuretic hormone. ‘Ihe momlng-after piu - How long at%? Grou F.; Rodrigues I. CAN AM J OBSTET GYNECOL 1994 17116(1529-1534) Postcoital contraception has been prescribed for more than two decades. The current regimen is given within 72 h of unprotected intercourse. After this period, not many choices remain; either the woman may wait until her next menses hoping she is not pregnant or she may have a postcoital intrauterine contraceptive device inserted. Since these alternatives are not always acceptable, we reviewed the literature looking for evidence supporting the current maximum time limit for treatment. Our conclusion is that the limit could theoretically be extended; therefore we think it is time to challenge the time period of current treatment by conducting clinical trials. Intranterlne and snMermal pmgestla adrnlnlstratior~ in podmenopausal bormow repiacement tbefapy Suhonen S.P.; Holmstrom T.; Allonen H.O.; Lahteenmaki P. FIN FERTIL STERIL 1995 6312 (336-342) Objective: To compare the effects of intrauterine and subderma1 administration of levonorgestrel on control of bleeding and on the endometrium in postmenopausal hormone replacement therapy. Interventions: Nineteen women started continuous oral E, valerate therapy (2 mg daily) together with continuous parenteral progestin therapy. The subjects randomly received