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    The effects of rosiglitazone and metformin on insulin resistance and serum androgen levels in obese and lean patients with polycystic ovary syndrome
    (Springer, 2005) Yiımaz, M.; Biri, Aydan; Karakoç, A.; Törüner, Füsun; Bingöl, Berfin; Cakir, N.; Arslan, Müyesser
    Aim: The aim of this study was to assess the effects of metformin and rosiglitazone on insulin resistance and serum androgen levels in both obese and lean patients with polycystic ovary syndrome (PCOS). Materials and methods: Forty lean [body mass index (BMI) < 25 kg/m(2)] and 40 overweight and obese (BMI > 25 kg/m(2)) patients were included in the study. Waist and hip measurements, serum sex steroid levels, insulin response to 75-g oral glucose tolerance test, fasting insulin, fasting C-peptide levels and homeostasis model assessment of insulin resistance (HOMA-IR) were determined in all patients. The degree of hirsutism was determined by the Ferriman-Gallwey scoring system. Patients were divided into two groups, with 40 (20 overweight and obese; 20 non-obese) patients each. One group was treated with metformin (MET group) 850 mg bid while the other received rosiglitazone (ROSI group) 4 mg/day for 12 weeks. All measurements were repeated at the end of this period. Results: After the 12-week treatment period, HOMA-IR, area under the curve of insulin, fasting insulin and C-peptide levels were observed to have be decreased significantly in all groups. The decrease in the parameters mentioned above was similar in the four groups. The serum levels of free testosterone, androstenedione and DHEA-S decreased in all groups, but the decrease was statistically significant only in the ROSI groups. Within the lean MET group one patient became pregnant and was hence excluded from the final data analysis. Menstruations became regular after metformin therapy in 41.6% of lean and 35.7% of obese patients who had menstrual disturbance prior to the study. Rosiglitazone therapy improved menstrual disturbance in 61.5% of lean and 53.8% of obese patients. Conclusions: Our data showed that both metformin and rosiglitazone increased insulin sensitivity in obese patients with PCOS as expected, and in lean patients as well. Rosiglitazone seemed to be more effective in decreasing the androgen levels and in achieving slightly greater improvement in menstrual disturbance than metformin.
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    Evaluation of rapid urine screening tests to detect asymptomatic bacteriuria in pregnancy
    (Natl Inst Infectious Diseases, 2006) Kaçmaz, Birgül; Çakır, Özenç; Aksoy, Altan; Biri, Aydan
    In order to compare the performance of leukocyte esterase and nitrite urine dipstick tests with enhanced urinalysis (uncentrifuged urine white blood cell count/mm(3) plus Gram stain) in detecting asymptomatic bacteriuria in obstetric patients, clean-catch midstream urine specimens were collected from 250 consecutive asymptomatic pregnant women. Ten of the women (4.0%) showed urine culture results indicating significant bacteriuria. The nitrite test was the most specific (99.2%) of these tests, however, its sensitivity was found to be the lowest (60.0%). The sensitivity of the leukocyte esterase test was 70.0%, on the other hand, while its positive predictive value was 28.0%. The sensitivity and specificity of enhanced urinalysis were found to be 50.0 and 96.7%, respectively. None of the rapid tests was found to be a reliable alternative for culture screening of all pregnant women. Nitrite tests are useful screening tests for detecting asymptomatic bacteriuria only if their limitations are fully understood, while leukocyte esterase and enhanced urinalysis tests are not suitable for screening for asymptomatic bacteriuria. Our findings support previous conclusions that quantitative urine cultures are required to rule out asymptomatic bacteriuria in pregnant women.
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    Levels of lipoprotein and homocysteine in non-obese and obese patients with polylcystic ovary syndrome
    (Taylor & Francis Ltd, 2005) Yılmaz, Murat; Biri, Aydan; Bukan, Neslihan; Karakoç, Ayhan; Sancak, Banu; Toruner, Füsun; Paşaoğlu, Hatice
    Aim. This study was designed to examine the relationship between homocysteine (Hcy), lipoprotein levels and insulin resistance in obese and non-obese patients with polycystic ovary syndrome (PCOS). Materials and methods. Eighty-five patients (38 obese, 47 non-obese) with PCOS and 50 healthy subjects (25 obese, 25 nonobese) were included in the study. PCOS was defined according to the Homburg criterion. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), insulin, 17-hydroxyprogesterone, free testosterone, androstenedione, vitamin B-12 and folate were measured. Also, serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), lipoprotein (a) (Lp(a)), apoprotein B (Apo B) and apoprotein A (Apo A) were determined. Plasma Hey levels were measured. Insulin resistance was evaluated by homeostasis model assessment (HOMA). Results. Plasma Hey levels were significantly higher in women with PCOS than in healthy women. HOMA-R (insulin resistance) was significantly higher in women with PCOS compared with healthy women. Serum fasting TC, LDL-C, TG, Apo B, vitamin B-12 and folate levels were similar between PCOS and control groups. Lp(a) levels were higher in PCOS patients than in control subjects, whereas HDL-C and Apo A levels were lower. Compared with obese PCOS subjects, nonobese PCOS subjects had low HOMA-R, TC, LDL-C, TG, Apo B, Lp(a) and androgen levels. Plasma Hey levels, serum HDL-C and Apo A levels were similar between obese and non-obese women with PCOS. Levels of HDL-C and Apo A were lower in both obese and non-obese PCOS patients than in obese and non-obese control subjects, whereas Lp(a) levels were higher. No correlation was observed between Plasma Hey, body mass index, HOMA-R, serum androgen levels, TC, LDL-C, HDL-C, Apo A, Apo B and Lp(a) levels. Conclusion. These results showed that elevated insulin resistance and plasma Hey levels, and changes in serum lipid profile, which are possible risk factors for cardiovascular disorders, play important roles in the development of cardiovascular disease in both obese and non-obese patients with PCOS.