How does the ERAS protocol work in patients who underwent cesarean section? (HERMES study).

OBJECTIVE: To assess the effect of the enhanced recovery after surgery (ERAS) protocol for cesarean deliveries (CD) on postoperative outcomes. METHODS: This multicenter prospective cohort study was conducted in six different centers between September 2020 and March 2021 and involved women who underwent either planned or unplanned CD. The primary outcome was time to the first passage of flatus following CD. Secondary outcomes included postoperative pain score, postoperative complications, and patient satisfaction. The protocol included early postoperative oral intake of ice cream and coffee, multimodal analgesia, antiemetic medications, and early ambulation. RESULTS: A total of 448 patients were included. The median time to the first passage of flatus was 10 h in the Hermes group and 18 hours in the control group (P < 0.001). Postoperative visual analog scale scores were significantly higher in the control group. Patient satisfaction scores and the frequency of postoperative complications did not differ between the groups (P = 0.08, P = 0.604, respectively). CONCLUSIONS: The ERAS protocol, including early serving of ice cream and coffee in the early postoperative period, enabled early discharge and a faster return of bowel function. Implementation of the ERAS protocol for patients who underwent planned and unplanned CD appeared to be safe and effective.

Symptom-related Ki-67 expression in endometrial polyps.

OBJECTIVE: The aim of this study was to compare Ki-67 expression in endometrial polyps that present with different abnormal uterine bleeding patterns. STUDY DESIGN: A total of 120 women diagnosed with endometrial polyps were included in the study. In this prospective study, tissue samples taken by hysteroscopic polypectomy method between September 2019 and September 2020 at Bursa City Hospital were examined. The main study groups were determined as premenopausal and postmenopausal patients. The patients' complaints at first admission to the hospital, demographic, histopathological and immunohistochemical features were recorded. RESULTS: Ki-67 glandular and stromal expressions were higher in the premenopausal patient group (p = 0.016 and p = 0.005 respectively). Median Ki-67 gland and stroma measurements; was higher in patients with heavy menstrual bleeding (HMB) than in patients with intermenstrual bleeding (IMB), patients with postmenopausal bleeding (PMB), and patients who were asymptomatic [(p = 0.012, p = 0.011 and p = 0.009 respectively); (p < 0.001, p < 0.001 and p = 0.004 respectively)]. The median Ki-67 stroma measurement was found to be higher in the patient group whose complaint persisted after polypectomy (p = 0.034). In the estimation of response to treatment, the cut-off value for Ki-67 stromal expression was determined as ≤ 6%. CONCLUSION: High Ki-67 expression in endometrial polyps is associated with HMB and may predict the continuation of abnormal uterine bleeding after polypectomy.

The effects of pregnancy on nasal physiology.

BACKGROUND: Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy. METHODS: The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls. RESULTS: The NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm(2), third trimester 0.31 cm(2). There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = -0.10, p = 0.318; r = -0.04, p = 0.654, respectively). CONCLUSION: Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters.