Irem Onur, MD

Dr. Onur is an associate professor of pathology with subspecialty certification in cytopathology in Turkey. She is deeply interested in medical writing and conveying the latest scientific information to medical professionals as well as the public.

Mortality of 49956 midlife women with surgically verified endometriosis

Saavalainen L. et al., from Finland recently published a retrospective large cohort study in the journal Human Reproduction, where they retrospectively examined the data of surgically verified endometriosis patients to find out if all-cause and the cause-specific mortality rate is increased in endometriosis patients. All endometriosis-associated diagnoses 1987 to 2012 were identified from the Finnish Hospital Discharge Register to identify surgically diagnosed cases. Altogether 57713 endometriosis diagnoses were detected among 49956 women. The reference cohort (n =98824) was randomly drawn…

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Botox as a promising treatment for chronic pelvic pain in endometriosis

Botulinum toxin (Botox) for treating chronic pelvic pain specifically addressing women with endometriosis has been studied for the first time by Tandon et al., from Bethesda, Maryland, USA. Their paper has recently been published in the journal Regional Anesthesia & Pain Medicine. In this proof-of-concept case series, 13 women with surgically diagnosed endometriosis and chronic pelvic pain persisting despite optimal surgical and hormonal treatments and pelvic floor muscle spasm were included in the study. Patients were recruited nationally within the…

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Chronic Fatigue Syndrome and Endometriosis: Comorbid Conditions

In the study of Dr. Boneva et al., from Atlanta, GA, the United States which has recently been published in the journal Frontiers in Pediatrics evaluated the impact of endometriosis on the health of women with chronic fatigue syndrome (CFS). The authors compared selected health characteristics and laboratory parameters in women with CFS with and without endometriosis. Thirty-six women with CFS from a cross-sectional study of CFS conducted between 2002 and 2003 were included in the study. The health characteristics and laboratory parameters…

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Control on endometriosis progression by a "tyrosine kinase inhibitor"

B cells, which are important players of the immune system, are increased in the blood and peritoneal cavity of endometriosis patients. Activation of B cells and the presence of anti-endometrial autoantibodies have been also been described in women with endometriosis, but their exact role in the disease mechanism is not known. Ibrutinib is a tyrosine kinase inhibitor which is essential for development and function of B cells. In order to better characterize the role of B cells on endometriosis, Riccio…

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"Endometriosis", "Fibromyalgia" and "Autoimmune diseases"

Greenbaum et al. from Israel, investigated the prevalence of and the association between endometriosis, fibromyalgia and autoimmune diseases in a large population database and described healthcare resource utilization in affected women. Their study has been published in the "American Journal of Reproductive Immunology". The authors performed a retrospective cross-sectional study using the computerized database of Maccabi Healthcare Services which has over 2.1 million members in Israel. Women aged ≥15 years who were registered in Maccabi Healthcare Services on 31/12/2015, had…

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Urocortin: A biomarker deserving investigation for endometriosis patients

Urocortin is a neuropeptide in the corticotropin-releasing hormone family and is expressed by eutopic and ectopic human endometria. Since it has paracrine and immunomodulatory effects, urocortin is thought to contribute to the pathogenesis of endometriosis. Its expression has been thoroughly investigated in the field of endometriosis. To find out if urocortin may be used as a screening and/or prognostic biomarker of endometriosis, Pergialiotis V. et al. from Athens, Greece, reviewed the literature and published their results in the "International Journal of…

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The association of significant hemoperitoneum (blood in the abdominal cavity) and deep pelvic endometriosis

 Although there are several theories to explain the etiology of deep endometriosis, the cause is unknown and there are currently no effective strategies to prevent its development. Bean E. et al., from University College London Hospital, UK,  observed that some women in their gynecology clinic who were referred with symptoms of chronic pelvic pain following conservative management of hemoperitoneum developed deep endometriosis. Based on this observation, the authors conducted a prospective observational cohort study to test their hypothesis that the…

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The relationship between periodontal disease and endometriosis

Thomas et al. have recently studied the association between endometriosis and periodontal disease which may share a common pathogenesis, and have published it in the Journal of Human Reproductive Sciences. The authors screened a total of50 women; 25 with and 25 without endometriosis, for periodontal diseases. The periodontal parameters included plaque index, gingival index, probing pocket depth, and loss of attachment. Scores for plaque index, the measures for probing pocket and loss were similar among cases and controls. The proportion of…

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Vaginal Sexual Intercourse during Menstruation

Mazokopakis and Samonis from Greece examined and discussed the vaginal sexual intercourse during menstruation from a biblical as well as a modern medical point of view in their paper published in MAEDICA – a Journal of Clinical Medicine in September 2018. According to the Old Testament (Provisions of clean and unclean of the Mosaic Law), menstruating women were perceived as unclean for 7 days and must not be approached to have sexual intercourse by men. Otherwise, men will be regarded as…

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The association of endometriosis and peritoneal malignant mesothelioma

Endometriosis is well known to cause chronic inflammation of the serosa and incite mesothelial hyperplasia. Although multilocular peritoneal inclusion cysts and well-differentiated papillary mesothelioma were reported to be associated with endometriosis, the association of malignant mesothelioma has not been reported before. Butnor et al. reported 6 cases of peritoneal malignant mesothelioma arising in the setting of endometriosis. Their study which is the first report of malignant mesothelioma in women with endometriosis has recently been published in the Journal of Clinical Pathology in November…

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Extragenital endometriosis and ultrasound

Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging method with no exposure to radiation. There are a few reports on the use of CEUS in the assessment of endometriosis in the literature. Dong et al. reported 3 histopathologically proven cases of extragenital (sigmoid colon, pancreas, posterior bladder wall) endometriosis and reviewed the relevant literature. Their paper has recently been published in the Journal of Ultrasonography. The patient with intestinal endometriosis showed a rapidly and heterogeneously enhancing lesion during the arterial and…

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Endometriosis: A review on anatomic principles and the management

In the study of Alimi et al. which has been published in the journal Cureus, various aspects of endometriosis such as the pathophysiology, the anatomy, the pain mechanism, the perineural spread theory, clinical manifestations, diagnosis, and imaging, infertility, unusual cases, the management, and treatment are reviewed. The hypotheses of the pathophysiology of endometriosis include the implantation or metastatic, metaplasia, induction, and endometriosis disease theories, and most recently, the stem cell theory. Endometriosis that begins with endometrial stem cells tends to…

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Programmed-cell death pathway and immune dysfunction in endometriosis

Endometriosis is an estrogen-dependent, immune-associated disease. Women with endometriosis have different proportions of the activated forms of immunocompetent cells, such as T cells and macrophages compared to those from women without. Immune cell dysfunction in the uterine and abdominal cavity microenvironment enhances the ability of endometrial cells to adhere and invade. This leads to an increased proliferation and angiogenesis, as well as poor clearance of ectopic endometrium by immune cells. The molecule named “programmed-death-1 (PD-1)” is a negative regulator of…

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Preoperative Staging of Endometriosis: The Value of MRI After Dynamic Transvaginal Ultrasound

Since endometriosis is a chronic and progressive disease, early diagnosis and proper staging are important for the patient and for the clinician to discuss and plan the required surgical procedures for treatment. Common diagnostic tools for pre-operative staging of deep infiltrating endometriosis are the clinical history, physical examination, dynamic TVUS, and MRI. A team of researchers from Netherlands, Berger et al., evaluated the added value of each step (history, clinical examination, dynamic TVUS, and MRI) in the diagnostic pathway for…

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Any adjustable risk factor for Endometriosis?

Endometriosis is believed to be estrogen and progesterone-dependent. Lifestyle factors such as alcohol/caffeine intake, smoking, and physical activity influence estrogen levels in the body and, therefore, may impact the development of endometriosis. In the study of Hemmert et al. which has been published in Paediatric and Perinatal Epidemiology, the relationships between caffeine and alcohol intake, smoking, and physical activity levels reported prior to the diagnosis of endometriosis were evaluated. Four hundred and seventy-three women, ages 18-44 years, who underwent laparoscopy…

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A novel neurotransmitter, Ninj1, has been found to be expressed in endometriosis

Chronic inflammation is involved in the pathogenesis of endometriosis and adenomyosis, and inflammatory cytokines such as IL-1b are highly expressed in them. Inflammation and subsequent hyperinnervation are involved in the pathophysiology of pain generation. High levels of expression of various neurotransmitters are also present in these tissues. Nerve injury-induced protein 1 (Ninjurin, Ninj1), an adhesion molecule originally identified in dorsal root ganglion neurons and Schwann cells after nerve injury. It mediates hemophilic adhesion and promotes neurite outgrowth. The Ninj1 is…

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Anatomic distribution of endometriosis

In the study of Audebert et al. which has been published in the journal European Journal of Obstetrics and Gynecology, the anatomic distribution of endometriosis, the rate of deep infiltrating endometriosis during the various study periods, laterality of endometriosis, pelvic adhesions’ anatomic distribution and prevalence according to past history were analyzed. 1101 patients diagnosed with endometriosis through laparoscopy procedure were included in the study. The mean age of the 1101 patients was 33.06 years (range 15-63 years). Pain, infertility or…

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Quality of life for women with endometriosis

Endometriosis symptoms may cause difficulties in daily activities and social life, altering general health and personal relationships and severely decrease the quality of life. Yoldemir T. evaluates the factors affecting the quality of life in endometriosis patients and the management strategies in his recently published paper in the journal Climacteric. Since symptoms are linked to complex sensory and neural mechanisms related to the depth of endometriotic implants rather than the extent of disease, the stage of the disease and severity of symptoms…

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Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis

Abdominal wall endometriosis is a rare clinical entity frequently diagnosed with a significant delay and easily misinterpreted despite multimodality imaging. In the study of Jaramillo-Cardoso et al. which has recently been published in the journal Abdominal Radiology, the clinical, multimodality imaging, and pathologic characteristics of endometriosis in the abdominal wall were reviewed. Eighteen patients who had the prebiopsy or presurgical imaging studies and sufficient field of view to assess the AWE lesion were included in the study. Patients presented with…

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Fighting with endometriosis

Maduro M.R. reviewed three separate studies on potential new targets to successfully manage endometriosis in her recent paper titled “Novel Strategies to Fight Endometriosis” published in the journal Reproductive Sciences. In the autotransplantation rat model of Torres-Reveron et al., the rats were exposed to environmental enrichment (EE) (endo-EE, toys and nesting materials, 4 rats per cage, larger enclosed area) or no enrichment (endo-NE, 2 rats per cage) from postnatal day 21 and after 8 weeks performed sham surgery or induced…

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