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1.
Turk J Gastroenterol ; 30(3): 260-265, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30541714

RESUMO

BACKGROUND/AIMS: The vertical transmission of hepatitis B virus, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are essential public health problems. In this study, we aimed to investigate the seroprevalence of the aforementioned infections among pregnant women. MATERIALS AND METHODS: This study was done retrospectively on pregnant women who presented for antenatal follow-up and delivery between 2013 and 2016. Data were collected from the hospital's electronic health records and patient files. Blood samples were analyzed at the microbiology laboratory of the hospital. HBsAg, anti-HBs, anti-HCV, and anti-HIV titers were tested using the chemiluminescence enzyme immunoassay method (Architect, Abbott Laboratories, USA). RESULTS: HBsAg and anti-HBs levels were tested in 35,295 pregnant women aged 18-45 years. The HBsAg and anti-HBs levels were positive in 425 (1.2%) and 9583 (27.7%) patients, respectively. From 2013 to 2016, the HBV carrier rates have continuously decreased from 1.4% to 0.8%, whereas the anti-HBs positivity has increased from 25.4% to 30.2%. Anti-HCV was detected in 6 of the 9709 (0.06%) patients. All the 7113 pregnant women screened for HIV showed negative results. CONCLUSION: Hepatitis B carrier rates among pregnant women gradually decreased with a simultaneous increase in the immunity rates. HCV seroprevalence was low and HIV positivity was not encountered in the study population.


Assuntos
Anticorpos Antivirais/sangue , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Testes para Triagem do Soro Materno/estatística & dados numéricos , Adolescente , Adulto , Anticorpos Antivirais/imunologia , Feminino , HIV/imunologia , Anticorpos Anti-HIV/sangue , Hepacivirus/imunologia , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Estudos Soroepidemiológicos , Turquia/epidemiologia , Adulto Jovem
2.
J Obstet Gynaecol ; 37(5): 585-590, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28285555

RESUMO

The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM. Impact statement The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups. Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.


Assuntos
Cesárea/estatística & dados numéricos , Ruptura Prematura de Membranas Fetais , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Adulto Jovem
3.
Ulus Travma Acil Cerrahi Derg ; 22(2): 195-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27193989

RESUMO

Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section. The patient had massive bleeding from the uterus due to atony. Her hemoglobin (Hb) dropped to 3.5 g/dL. Six units of WFWB were transfused during surgery. Hemodynamic parameters and complete blood count (CBC) stabilized. She was transferred from the intensive care unit (ICU) to obstetrics on day 2 and was discharged on day 7. Described second is the case of a 35-year-old female patient who also underwent emergency cesarean section, and for whom massive bleeding was due to uterine atony. Hb dropped to 2 g/dL and hematocrit (HCT) to 5.4%. Nine units of WFWB were transfused, after which hemodynamic and laboratory parameters stabilized. The patient was extubated the following day, transferred from the ICU to obstetrics on day 3, and was discharged on day 8. Described third is the case of a 36-year-old male patient with stab injuries and hemorrhagic shock who underwent emergency surgery. The patient had injuries to the right renal artery and kidney. Nine units of WFWB were transfused due to continued hemorrhage during surgery. Following surgical control of bleeding and transfusion, hemodynamic parameters improved. The patient was transferred from the ICU on day 5 and discharged on day 10. WFWB transfusion nearly disappeared from civilian medicine after blood was separated into components, and whole blood is not usually available at blood banks. In massive transfusions, WFWB effectively replaces red blood cells (RBCs), platelets, plasma volume, and coagulation factors, while preventing hypothermia and dilutional coagulopathy. Blood components go through biochemical, biomechanical, and immunological changes during long storage, the duration of which affects both transfusion efficacy and associated risks. In the future, with the use of fast donor tests, fast ABO compatibility tests, platelet-sparing leukocyte filters, and developments in pathogen-decreasing technology, fresh whole blood (FWB) may be the first choice for massive transfusion. Future studies will reveal new procedures.


Assuntos
Transfusão de Componentes Sanguíneos , Cesárea , Choque Hemorrágico/terapia , Hemorragia Uterina/terapia , Adolescente , Adulto , Tratamento de Emergência , Feminino , Humanos , Rim/lesões , Masculino , Medicina Militar , Gravidez , Resultado do Tratamento , Ferimentos Perfurantes
4.
Gynecol Endocrinol ; 32(4): 281-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26654523

RESUMO

PURPOSE: To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS). METHODS: PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment. RESULTS: The median 25(OH)D levels were 9.40 (range 4.40-24.50) µg/l and 7.00 (5.00-13.50) µg/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055). CONCLUSION: This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.


Assuntos
Anticoncepcionais Orais Combinados/uso terapêutico , Resistência à Insulina , Síndrome do Ovário Policístico/tratamento farmacológico , Vitamina D/análogos & derivados , Adolescente , Adulto , Anticoncepcionais Orais Combinados/farmacologia , Feminino , Humanos , Ovário/efeitos dos fármacos , Síndrome do Ovário Policístico/diagnóstico por imagem , Estudos Prospectivos , Ultrassonografia , Vitamina D/sangue , Adulto Jovem
5.
Int Neurourol J ; 19(3): 164-70, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26620898

RESUMO

PURPOSE: Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. METHODS: Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. RESULTS: Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P=0.018) and menopause (P=0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P=0.006). CONCLUSIONS: The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations.

6.
Case Rep Med ; 2015: 520715, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26345271

RESUMO

Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele) and iniencephaly clausus (without encephalocele). Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1-5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination.

7.
Blood Coagul Fibrinolysis ; 26(8): 862-5, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25402193

RESUMO

Polycystic ovary syndrome (PCOS) is a prevalent disease with many potential long-term metabolic and cardiovascular risks if not managed appropriately. Mean platelet volume (MPV) is a marker associated with adverse cardiovascular events. In this study, we aimed to investigate MPV levels under ethinyl estradiol/cyproterone acetate or metformin therapy for the previous 6 months in PCOS. A total of 114 individuals [metformin treatment (n = 18), ethinyl estradiol/cyproterone acetate treatment (n = 29), newly diagnosed PCOS patient with no treatment (n = 35), and control group of eumenorrheic healthy individuals (n = 32)] were included in the current study. Hematologic parameters other than MPV were similar in all groups. The MPV value was significantly higher in the newly diagnosed PCOS patients compared with the other three groups independent of age, BMI, and C-reactive protein level in multiple regression analysis (P < 0.01). The MPV value of control group was comparable to the groups under ethinyl estradiol/cyproterone acetate or metformin therapy (P = 1.0). There was no statistically significant difference in the white blood cell count among the groups. The MPV values were positively correlated with the homeostatic model assessment-insulin resistance and Ferriman-Gallwey Score (P = 0.044, r = 0.261; P = 0.037, r = 0.229, respectively). Ethinyl estradiol/cyproterone acetate and metformin similarly appear to decrease MPV, a marker of cardiovascular risk. Therefore, a possible beneficial effect of ethinyl estradiol/cyproterone acetate and metformin on long-term cardiovascular morbidities in PCOS may be suggested.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Acetato de Ciproterona/uso terapêutico , Etinilestradiol/uso terapêutico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Síndrome do Ovário Policístico/tratamento farmacológico , Adolescente , Adulto , Biomarcadores/análise , Plaquetas/metabolismo , Plaquetas/patologia , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Estudos de Casos e Controles , Combinação de Medicamentos , Feminino , Humanos , Resistência à Insulina , Contagem de Leucócitos , Volume Plaquetário Médio , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/patologia , Análise de Regressão , Resultado do Tratamento
8.
J Psychosom Obstet Gynaecol ; 33(4): 171-5, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22946891

RESUMO

OBJECTIVE: The aim of this study was to evaluate the impact of hyperemesis gravidarum (HG) and sociodemographic parameters on depression during pregnancy. STUDY DESIGN: Between September 2010 and September 2011, 200 consecutive women with HG were defined as the study group and 200 consecutive pregnant women without any signs and symptoms of HG, and matched for age, parity, and gestational age were defined as the control group. The Beck depression inventory-II (BDI-II) questionnaire and sociodemographic questionnaire evaluating educational level, occupation, economic status, and obstetric history were given to all participants for self-completion. The forms were collected within 6 h of hospital admission. Groups were compared according to the presence of depression and predictors of depression were analyzed by regression analysis. RESULTS: Median BDI-II scores in study and control groups were 15 and 5, respectively. The difference was statistically significant (p < 0.001). In the HG group, 35.1% of patients had mild depression, 26.0% moderate, and 17.8% had severe depression, while only 5% of patients in the control group had mild depression and 95% had no depression. Multivariate analysis showed that HG, age and family relationship were related to depression during pregnancy. Moreover, depression risk was increased 76-fold in patients with HG (odds ratio = 76.000; 95% confidence interval: 36.840-156.788; p < 0.001). CONCLUSION: Depression risk is increased in patients with HG, therefore not only medical therapy of HG, but also psychiatric evaluation should be considered for these patients.


Assuntos
Depressão/diagnóstico , Depressão/epidemiologia , Hiperêmese Gravídica/epidemiologia , Cuidado Pré-Natal/métodos , Saúde da Mulher , Adulto , Atitude Frente a Saúde , Estudos de Casos e Controles , Causalidade , Comorbidade , Intervalos de Confiança , Feminino , Nível de Saúde , Humanos , Hiperêmese Gravídica/diagnóstico , Razão de Chances , Gravidez , Qualidade de Vida/psicologia , Adulto Jovem
9.
Gynecol Endocrinol ; 28(8): 611-4, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22296561

RESUMO

The aim of this study was to examine the effect of adrenal versus ovarian androgen (dehydroepiandrosterone sulfate/total testosterone [DHEAS/TT]) on clinical presentation and related metabolic disturbances in Turkish women with polycystic ovarian syndrome (PCOS). Two hundred eighty PCOS cases were taken into the study. For all cases, the DHEAS/TT ratio was calculated. The median value of this ratio was 4.40. Patients with an androgen ratio lower than 4.40 were included in Group 1 and cases with a ratio higher than 4.40 were Group 2. The two groups were compared in terms of hormonal, biochemical and clinical parameters. Body mass index and waist circumference were lower, the Ferriman-Gallwey score was higher and the cycle length was shorter in Group 2. High DHEAS level was associated with better lipid profiles and lower levels of inflammatory markers, meaning good metabolic control in these women, in spite of increased hirsutism rates. In patients with PCOS, both androgens are usually high in proportion to each other. Therefore, it would be more meaningful to use the DHEAS/TT ratio for an assessment of the metabolic and phenotypic effects of PCOS.


Assuntos
Sulfato de Desidroepiandrosterona/sangue , Hiperandrogenismo/etiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/fisiopatologia , Testosterona/sangue , Acne Vulgar/epidemiologia , Acne Vulgar/etiologia , Adolescente , Adulto , Algoritmos , Amenorreia/epidemiologia , Amenorreia/etiologia , Índice de Massa Corporal , Feminino , Hirsutismo/epidemiologia , Hirsutismo/etiologia , Humanos , Hiperandrogenismo/epidemiologia , Hiperlipidemias/epidemiologia , Hiperlipidemias/etiologia , Incidência , Mediadores da Inflamação/sangue , Resistência à Insulina , Obesidade/epidemiologia , Obesidade/etiologia , Oligomenorreia/epidemiologia , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/imunologia , Síndrome do Ovário Policístico/metabolismo , Índice de Gravidade de Doença , Turquia/epidemiologia , Adulto Jovem
10.
Endocrine ; 41(3): 473-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22173824

RESUMO

The aim of the study was to determine the association between birthweight, maternal medical history and acne, hirsutism, and menstrual disorder symptoms in Turkish adolescent population. Self-administered questionnaires were distributed to all volunteer female students at 15 secondary schools. The subjects' body mass index, birthweight, age at menarche, pattern of menstrual cycle, and presence of acne or hirsutism problems were recorded. Maternal obstetric parameters, menstrual cycle, presence of acne or hirsutism at present and at adolescent period were also asked. The impact of birthweight and maternal history on acne, hirsutism, and menstrual disorder symptoms was evaluated. The results of the study showed that after exclusion of subjects born prematurely, total of 1,309 students filled the questionnaires properly and included in the study. Of these students, 174 had low birthweight (LBW) (<2,500 g), 925 had appropriate (2,500-4,000 g), and 210 had high birthweight (>4,000 g). LBW students had higher incidence of menstrual disorder and acne problems (P = 0.032 and P = 0.011, respectively). Maternal acne and hirsutism problems were significantly often in LBW group. Multivariate analysis showed that LBW was a predictor of acne, hirsutism, and menstrual disorder at adolescent period (P = 0.001; P = 0.01, and 0.02, respectively). In addition, maternal menstrual disorder was also a predictor of menstrual disorder (P = 0.035). We concluded that LBW is a good predictor of acne, hirsutism, and menstrual disorder problems in Turkish adolescent population.


Assuntos
Acne Vulgar/etiologia , Peso ao Nascer , Saúde da Família , Hirsutismo/etiologia , Distúrbios Menstruais/etiologia , Síndrome do Ovário Policístico/etiologia , Acne Vulgar/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Hirsutismo/epidemiologia , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Distúrbios Menstruais/epidemiologia , Mães , Oligomenorreia/epidemiologia , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/fisiopatologia , Inquéritos e Questionários , Turquia/epidemiologia , Adulto Jovem
11.
Eur J Obstet Gynecol Reprod Biol ; 154(2): 177-81, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21051133

RESUMO

OBJECTIVE: To find diagnostic values and thresholds of ovarian volume and follicle number for Turkish patients with polycystic ovarian syndrome (PCOS) and to clarify whether the Rotterdam ultrasound criteria are optimal for the diagnosis of PCOS in Turkish patients. STUDY DESIGN: Two hundred and fifty-one newly diagnosed PCOS cases according to Androgen Excess Society (AES) criteria (using clinical and biochemical parameters) and 65 regularly menstruating healthy, non-hirsute, normo-ovulatory volunteers as a control group were taken into the study. Evaluation of the ovaries and measurement of ovarian volumes of all cases were performed by transvaginal ultrasound. Ovarian volume (OV) and follicle number (FN) were recorded in all cases. RESULTS: Mean and median OV were 12.5 ± 8.1 and 10.1cm(3) in PCOS cases. Mean and median FN in the PCOS group were 9.8 ± 2.8 and 10, respectively. In the control group, the mean and median OV were 5.4 ± 1.8 and 5.5 cm(3). Mean and median FN of controls was 5 ± 1.5 and 5, respectively. There were statistically significant differences in both OV and FN between PCOS patients and controls (all p < 0.001). Cut off values for ovarian volume in PCOS cases for the Turkish population were determined by receiver-operating characteristics (ROC) analysis. The areas under the curve (AUCs) for mean OV and mean FN were 0.938 and 0.998, respectively, indicating a good diagnostic power of the tested variables. Combining sensitivity and specificity using the Youden index, setting the cut off value for threshold OV and FN at 6.43 cm(3) and 8, respectively, yielded the best compromise between sensitivity and specificity. CONCLUSION: There may be some differences in ultrasound characteristics of PCOS, resulting in differing diagnostic power and cut off points for different populations. OV and FN have powerful diagnostic value in determination of PCOS with different threshold values for different ethnicities.


Assuntos
Folículo Ovariano/diagnóstico por imagem , Ovário/diagnóstico por imagem , Síndrome do Ovário Policístico/diagnóstico , Adulto , Etnicidade , Feminino , Humanos , Ovário/patologia , Síndrome do Ovário Policístico/diagnóstico por imagem , Curva ROC , Valores de Referência , Turquia , Ultrassonografia
12.
J Turk Ger Gynecol Assoc ; 11(3): 141-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-24591920

RESUMO

OBJECTIVE: To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS: Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS: Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION: If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.

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