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- Kataoka, Josefin, et al.
(författare)
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Circulating Anti-Mullerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention
- 2022
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Ingår i: Reproductive Biology and Endocrinology. - : Springer Science and Business Media LLC. - 1477-7827. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Women with polycystic ovary syndrome (PCOS) have high circulating anti-Mullerian hormone (AMH) levels which is correlated with antral follicle count and polycystic ovarian morphology and negatively correlated with body mass index (BMI). Moreover, diet-induced weight loss in women with PCOS and overweight or obesity, reduce or normalize AMH-levels. There is, however, no previous study investigating the circulating AMH levels in women with severe obesity and how a structured diet-induced weight loss program affects circulating AMH levels in these women. Therefore, this study aims to investigate circulating AMH levels in a population of women with severe obesity (BMI >= 35 kg/m(2)) with and without PCOS, as diagnosed by the NIH-criteria, and to investigate the effect of a one-year weight loss program with a very low-energy diet (VLED) on circulating levels of AMH. Methods In a prospective cohort-study, were 246 women with severe obesity were screened for PCOS diagnosis with the NIH-criteria, circulating AMH and anthropometry were measured at baseline and after a 12-month weight loss intervention with very low-energy diet (VLED). Results Mean BMI was 39.9 +/- 4.7 (PCOS), 39.6 +/- 4.3 (non-PCOS) P = 0.960. Circulating AMH was higher in women with PCOS (5.47 +/- 4.89 mu g/L) compared with non-PCOS (2.66 +/- 3.71 mu g/L) P < 0.001 and was positively correlated with circulating total testosterone in both groups. Next, we performed ROC-analyses, and show that circulating AMH could not discriminate women with PCOS and severe obesity from non-PCOS women with severe obesity. Finally, a one-year weight reduction program does not affect circulating AMH levels despite significant weight loss neither in women with PCOS, nor without PCOS and severe obesity. Conclusion Women with severe obesity and PCOS have elevated levels of circulating AMH compared to women without the syndrome. AMH-levels could not discriminate women with PCOS from non-PCOS because of low sensitivity and specificity. Significant weight loss was not associated with changes in circulating AMH levels, neither in women with, nor without PCOS and severe obesity. These results imply that in women with severe obesity, a greater weight loss may be needed to improve reproductive features, independent of PCOS diagnosis.
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- Kindstrand, Eva
(författare)
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Peripheral neuropathy in Lyme borreliosis
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Tick-transmitted Lyme borreliosis (LB) is frequently associated with manifestations from the peripheral nervous system. One aim of the thesis was to describe the relationship between peripheral neuropathy and LB by prospective studies of a) LB in some defined neurological conditions with peripheral nerve engagement and b) peripheral neuropathy in the late dermatological LB manifestation acrodermatitis chronica atrophicans (ACA). A second aim was to evaluate the effect of antibiotic treatment on ACA associated neuropathy in a prospective study. Lyme neuroborreliosis (LNB) was diagnosed in 6/37 consecutive adult patients with isolated cranial neuropathy of primarily unknown etiology. Four patients had unilateral facial palsy and two had unilateral abducens palsy. All patients with LNB and cranial neuropathy had associated symptoms and/or signs, suggesting LNB, In patients with cranial neuropathy, a careful history to elicit other LB symptoms and tick exposure will usually identify the patients with a probable LNB as etiology. Routine testing for borrelia serology is not indicated in patients with cranial neuropathy without tick exposure or other symptoms/signs of LB. A serological screening for LB in 94 consecutive patients with neurophysiologically verified carpal tunnel syndrome (CTS) showed no statistically significant difference in seroposititivity prevalence compared to 127 age- and sexmatched control persons. None of the seropositive CTS patients had symptoms or signs, suggesting ongoing or past LB. The results indicate that LB is not a common cause to CTS, and routine serological screening for LB in patients with CTS does not seem indicated. Symptoms and signs of peripheral neuropathy were significantly more frequent in 63 consecutive patients with untreated ACA than in 30 age- and sexmatched control persons. Pain and paresthesia were the most frequent symptoms and polyneuropathy the most common finding. An exaggerated pain reaction in extremities with ACA lesions was prominent in many patients but was considered as nociceptive and secondary to inflammatory skin lesions. Polyneuropathy characteristics were described in detail in 17 patients with ACA and polyneuropathy. The clinical and neurophysiological findings were consistent with a large fibre sensory polyneuropathy. Sural nerve biopsy, performed in three patients, showed a mainly axonal neuropathy. The histopathological appearance did not suggest any particular underlying pathogenesis. Forty-seven patients with ACA and with abnormal clinical and/or neurophysiological findings were followed up after antibiotic treatment with neurological, neurophysiological, dermatological and serological controls. The therapy effect on symptoms of irritative nerve lesions, inflammatory skin changes and serum antibody titres to Borrelia burgdorferi was good, while there was no improvement of neuropathy signs. The neuropathy did not progress during the follow up time. The interpretation of these results is that the remaining neuropathy signs after antibiotic treatment of ACA patients with borrelia induced neuropathy are neurological sequelae and not manifestation of ongoing borrelia infection.
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