Association of antepartum vitamin D levels with postpartum pelvic floor muscle strength and symptoms.

INTRODUCTION AND HYPOTHESIS: Vitamin D affects skeletal muscle strength and functions via various mechanisms. Strength and/or functional dysfunctions of the pelvic floor muscles may be associated with the distortion of pelvic floor functions. We hypothesized that vitamin D deficiency may contribute to pelvic floor dysfunction (PFD) by affecting pelvic floor muscle strength (PFMS). The aim of this study was to assess the effect of vitamin D deficiency during pregnancy on postpartum PFMS. METHODS: This cross-sectional study was conducted in a university hospital. One hundred and eighty pregnant women were admitted to our hospital in their third trimester and compared with 156 healthy nulliparous women. Venous blood samples for examining vitamin D levels were taken from each participant and stored at -80 °C. At 8-10 weeks postpartum, patients were invited to the hospital, asked about their PFD symptoms, and PFMS was measured using a perineometer. RESULTS: There was no statistical significance among groups regarding mean age, maternal age, and weight at delivery. Postpartum PFMS and duration in vitamin D-deficient women were significantly lower than those without the deficiency. Vitamin D-deficient vaginal delivery cases (group I) had a postpartum PFMS average of 21.96 ± 7.91 cm-H2O, nonvitamin D-deficient normal delivery cases (group III) had a PFMS of 29.66 ± 10.3 cm-H2O (p = 0.001). In the cesarean delivery groups, vitamin D-deficient (group II) and nonvitamin D-deficient (group IV) cases had PFMS values of 32.23 ± 9.66 and 35.53 ± 15.58 cm-H2O respectively (p = 0.258). CONCLUSIONS: Lower vitamin D levels in the third trimester correlates with decreased PFMS.

Obturator Nerve Injury: An Infrequent Complication of TOT Procedure.

Transvaginal mid-urethral slings have become the most preferred surgical treatment option for female stress urinary incontinence. However, various complications have been reported for these operations occurring especially during penetration of the retropubic space. It can negatively affect patient's quality of life. Early treatment increases the chance of complete normalization of the functions. In this case report we presented a case of obturator nerve damage that was diagnosed and treated at early stage after TOT operation.

The use of HbA1c as an aid in the diagnosis of gestational diabetes mellitus.

The ability of HbA1c was evaluated in the diagnosis of gestational diabetes mellitus (GDM) and for the implications of its use in clinical practice. A total of 339 pregnant women with an estimated gestational age of 24-28 weeks were evaluated for GDM using an oral glucose tolerance test (OGTT) based on International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. A ROC curve was drawn to determine the sensitivity and specificity of HbA1c in detecting GDM. An HbA1c cut-off value of ≥ 5.2% had sensitivity of 64.15% and specificity of 67.48% in diagnosing GDM, and a positive predictive value of 26.77%. Using two cut-offs in the 'rule-in and rule-out' algorithm, 94.4% of the GDM cases would have been detected but 33% (43 of the 130) women would had been misclassified. HbA1c is not suitable to use alone for the diagnosis of GDM and is not useful in decreasing the need for OGT testing.

Surgical outcome of bronchiectasis in children: long term results of 60 cases.

BACKGROUND: Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis. METHODS: We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome. RESULTS: There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method. CONCLUSIONS: Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

The prevalence of Familial Mediterranean Fever common gene mutations in patients with simple febrile seizures.

BACKGROUND: Febrile seizures (FS) represent the most common form of childhood seizures that occurs in 2-5 % of the children younger than 6 years. There have been many recent reports on the molecular genetic and pathogenesis of FC. It has been recognized that there is significant genetic component for susceptibility of FC with different reported mutation. FEB1, FEB2, FEB4, SCNA1, SCNA2, GABRG2 and IL-1ß are related to with febrile convulsions (FCs). Interleukin 1ß (IL-1ß) is a cytokine that contributes to febrile inflammatory responses. There are conflicting results on increasing this cytokine in serum during FC. AIM: The determine the association between mutations of MEFV gene product pyrine and febrile seizures. PATIENTS AND METHODS: The study was carried out on 104 children that were diagnosed as FS and 96 healthy children. MEFV gene mutations were detected and analyzed with PyroMark Q24. PCR was performed using the PyroMark PCR Kit and pyrosequencing reaction was conducted on instrument instructions. RESULTS: M694V is the most common mutation in our patient group and we found a significant association between MEFV gene mutations and FSs. Of 104 patients, 68 were heterozygotes for any mutation and 10 patients were compound. 17.7% of control group were heterozygotes for any studied mutation.Statistical analyses showed that there was strongly significant statistical difference between results obtained from FS and control group (X = 46.20, p < 0.0001). CONCLUSIONS: MEFV gene mutations, especially M694V mutation, are positively associated with FSs.

FeNO levels in children with asthma and other diseases of the lung.

BACKGROUND: Prolonged cough in children is one of the major complaints seen in hospitals. It is difficult to make a proper diagnosis and start the appropriate treatment. Fraction of exhaled nitric oxide (FeNO) measurement is a valuable non-invasive diagnostic tool in determining the cause of prolonged cough in children. Although there are several studies on asthma and COPD, there is a lack of them on other lung diseases such as tuberculosis, bronchiectasia, bronchiolitis obliterans (BO), and pneumonia. PATIENTS AND METHODS: In this study, pre-treatment FeNO levels of patients with various lung diseases were measured and results from the sick patient groups were compared with the results from the control group. RESULTS: Pre-treatment FeNO levels in BO, asthma, and tuberculosis patient groups were higher than in the control group (p < 0.001). There was no significant difference between the acute bacterial pneumonia and bronchiectasia groups, and the control group (p > 0.05). CONCLUSIONS: FeNO measurement is a highly important guiding tool in diagnosis and treatment of various lung diseases.

Community-acquired urinary tract infections in children: pathogens, antibiotic susceptibility and seasonal changes.

AIM: Urinary tract infections (UTIs) are common infections affecting children. The aim of our study is to determine microorganisms that cause community-acquired urinary tract infections and their antibiotic susceptibility in children. MATERIALS AND METHODS: Our investigation includes 150 cases which has positive urine culture. The cases are detected at Pediatric Polyclinics of Dicle University between June 2010 and June 2011. RESULTS: The study included 118 (78.7%) female and 32 (21.3%) male children. Urinary tract infections were seen in autumn 10.7% (n = 16), summer 35.3% (n = 53), winter 30.7% (n = 46) and spring 23.3% (n = 35). The culture results indicated 75.3% (n = 113) Escherichia coli; 20.7% (n = 31) Klebsiella; 2.7% (n = 4) Proteus and % 1.3 (n = 2) Pseudomonas. The antibiotic resistance against Escherichia coli was found out is amikacin (3%), ertapenem (7%), imipenem (0%), meropenem (0%), nitrofurantoin (9%), trimethoprim/sulfamethoxazole (58%), piperacillin (83%), amoxicillin/clavulanate (50%), ampicillin/sulbactam (65%), cefazolin (54%), cefotaxime (51%), cefuroxime sodium (51% ) and tetracycline (68%). The resistance ratios of Klebsiella are amikacin (0%), imipenem (0%), levofloxacin (0%), meropenem (0%), amoxicillin/clavulanate (57%), ampicillin/sulbactam (79%), ceftriaxone (68%), cefuroxime sodium (74%) and trimethoprim/sulfamethoxazole (61%). CONCLUSIONS: The results represent the increasing antibiotic resistance against microorganisms among the community-acquired UTI patients in a developing country such as Turkey. So, the physicians should consider resistance status of the infectious agent and choose effective antibiotics which are nitrofurantoin and cefoxitin for their empirical antibiotic treatment. Furthermore, they should be trained about selection of more effective antibiotics and check the regional studies regularly.

An evaluation of cases of pneumonia that occurred secondary to hydrocarbon exposure in children.

OBJECTIVE: Hydrocarbon pneumonia is distinct among the types of childhood pneumonia in that it has a different pathogenesis and treatment and is preventable. In this study, the cases of 54 children with hydrocarbon pneumonia admitted to the Dicle University Medical Faculty Pediatric Chest Diseases Unit between the years 2006 and 2010 were analyzed retrospectively. PATIENTS AND METHODS: The medical records of 54 patients diagnosed with pneumonia after ingesting/inhaling hydrocarbons were analyzed retrospectively. Age, sex, presenting symptoms, clinical status, radiological and laboratory findings and response to treatment and prognosis were noted. RESULTS: 35 (64.8%) of the patients were male, 19 (35.2%) were female and the ages of the patients ranged from 1 to 5 with an average of 2.49 ± 0.80. The etiologies of the pneumonia were thinner (33%), naphta (3.7%) and kerosene. In 49 of the patients (90.7%), the symptoms started to occur the day the patient was exposed to hydrocarbons. The average length of hospital stay was 4.0 ± 2.3 days. Six patients were treated in the intensive care unit (ICU), and one patient with hydrocarbon pneumonia due to kerosene ingestion died. Inhaled corticosteroids were administered to 18 patients who were progressively deteriorating and inhaled salbutamol was given to 16 patients with bronchospasm. Patients with radiological findings on their chest X-rays and auscultatory findings were found to have longer hospital stays (p < 0.05). CONCLUSIONS: To prevent chemical pneumonia, precautions must be taken to stop children under 5 years of age from using/abusing chemical substances. Although some cases of chemical pneumonia lead to death, with diligent care and treatment, the outcomes are promising. The patients in this study group responded well to treatment with inhaled corticosteroids and salbutamol.

A newborn with trisomy 13 who had tetralogy of Fallot and metopic synostosis: Case report.

BACKGROUND AND AIM: Trisomy 13 (Patau syndrome) was first described by Patau et al in 1960. It is characterized by serious head, facial, and extremity anomalies, congenital heart defects, and mental abnormalities. The incidence rate of Trisomy 13 is 1/10.000 live births. Accompanying symptoms and findings vary in rate and severity among the cases. Tetralogy of Fallot and metopic synostosis are very rare abnormalities in patients with Trisomy 13. In this study, we aimed to present a newborn girl with trisomy 13 who had multiple congenital malformations accompanied by tetralogy of Fallot and metopic synostosis. Description of the case: The patient was delivered at 40 weeks of gestation, and admitted to the neonatal intensive care unit due to respiratory distress and physical abnormalities. The newborn examination revealed multiple dysmorphic features. She had boot-shaped appearance on the chest radiograph. Chromosome analysis demonstrated mosaic trisomy 13. CONCLUSION: Patients with trisomy 13 may have different type of gene variations and malformations; however, the most common type of gene variation is classic trisomy 47, XX +13, and the most common malformations are facial anomalies and congenital heart defects. In addition, tetralogy of Fallot and metopic synostosis may accompany trisomy 13.

The frequency of MEFV gene mutation in patients admitted to hospital with preliminary diagnosis of familian mediterranean fever who undergone a prior appendectomy.

OBJECTIVES: Familial mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent and self-limiting fever, peritonitis, arthritis, synovitis, pleuritis, carditis, and erysipelas-like lesions. The aim of this study was to investigate the frequency of the MEFV gene mutation in patients who admitted to hospital with preliminary diagnosis FMF and who had undergone a prior appendectomy. PATIENTS AND METHODS: We retrospectively reviewed the files of 52 patients between the ages of 7-18 who admitted to hospital with preliminary diagnosis of FMF and who had undergone a prior appendectomy. Age, gender and the MEFV gene mutations were included in the data. The 12 known, common MEFV gene mutations [E148Q, P369S, F479L, M6801 (G/C), M6801 (G/A), 1692del, M694V, M6941, K695R, V726A, A744S, R761H] were investigated in the patients. RESULTS: Of these 52 cases, 29 (55.8%) were female and 23 (44.2%) were male. Their mean age was 12.1 +/- 3.1 years (range 7-18 yr). MEFV gene mutation was detected in 31/52 cases (59.6%). In this study was found an high frequency of the MEFV gene mutation in patients admitted to hospital with a preliminary diagnosis FMF who had undergone a prior appendectomy. MEFV gene mutations were M694V 16/41 (39%), E148Q 13/41 (31%), M6801 6/41 (15%), V726A 4/41 (10%) and R761H 2/41 (5%). Other genes mutations were F479L, M6801 (G/A), 1692del, M6941, K695R and A744S. CONCLUSION: There are too much indications of unnecessary appendectomy in MEFV gene mutation carriers. In MEFV gene mutation carriers the frequency of appendicitis can be higher than the normal population. A more detailed and extensive study should be done about it.

The relationships between clinical outcome and the levels of total antioxidant capacity (TAC) and coenzyme Q (CoQ 10) in children with pandemic influenza (H 1 N1) and seasonal flu.

BACKGROUND AND AIM: This study was planned to evaluate the relationships between the levels of total antioxidant capacity (TAC) and Coenzyme Q (CoQ10) and clinical outcome in hospitalized children with pandemic influenza (H1N1). Serum copper (Cu) and zinc (Zn) levels were also determined to evaluate the changings of oxidative stress's enzyme activities depending on their cofactor concentrations. PATIENTS AND METHODS: Children with suspected H1N1 virus infection were hospitalized and nasal swabs were sent to laboratory for confirmation of H1N1 by rRT-PCR assay. Age and sex matched 31 healthy children were included as Control Group. Total antioxidant capacity and CoQ10 were determined by spectrophotometry and HPLC, respectively, and Cu and Zn were determined using atomic absorption spectrometer. RESULTS: Totally 28 children had H1N1 and 37 children had seasonal influenza (SI). TAC, CoQ10 and Zn levels were found to be significantly decreased in H1N1 patients (1.01 +/- 0.19, 752.2 +/- 163, 69 +/- 27, respectively) compared to Control Group (1.64 +/- 0.36, 934 +/- 21, 92 +/- 4, respectively). Seasonal Influenza group had significantly decreased TAC and Zn levels (1.31 +/- 0.27, 78 +/- 34 respectively) compared with control group (1.64 +/- 0.36, 92 +/-41, respectively). CoQ10 levels were also found as decreased in H1N1 compared to seasonal influenza (752.2 +/- 163 vs 1022 +/- 199, p = 0.003). There was a significant correlation between CoQ10 levels of sera and chest radiographic findings of patients with H1N1 pneumonia. No significant differences were found in serum Cu levels between patients with H1N1 and SI or control group (150 +/- 45 vs 127 +/- 37, p = 0.215). CONCLUSIONS, Pandemic influenza infection had increased oxidative stress compared to the seasonal influenza.

Skin tag and acanthosis nigricans: do they have a predictive value for gestational diabetes mellitus?

BACKGROUND: Gestational diabetes mellitus (GDM) is a metabolic condition that can cause severe fetal and maternal morbidity. Early diagnosis and treatment of GDM can significantly prevent maternal and perinatal morbidity. OBJECTIVE: To investigate and compare the prevalence of gestational diabetes mellitus in pregnant women with skin tag (ST) and/or acanthosis nigricans (AN) and a control group. METHODS: This cross-sectional study was conducted at Adana Numune Educational and Research Hospital, Seyhan Practice Center, Dermatology and Obstetrics Clinics between March, 2006 and July, 2008. All 249 pregnant women without risk factors for GDM examined dermatologically in terms of AN and ST in the first antenatal visit. A 50 g glucose screening test and, if test positive, 100 g oral glucose tolerance test was performed between theirs 24 and 28 weeks of pregnancy. GDM was diagnosed according to American Diabetes Association (ADA) criteria. AN and ST prevalence were compared in women with GDM and without GDM. RESULTS: 35.8% of the pregnant women with AN had GDM, while the same ratio was 9.2% for the women without AN. The probability of pregnant women with AN having GDM is 5.5 (95%CI: 2.6-11.6) times more than the pregnant women without AN. Among the pregnant women with both ST and AN, 40.0% of them had GDM, while the same ratio was 12.3% for the women free of both ST and AN. In this instance, the difference between the ratios was found statistically significant (p=0.001). Based on the results, the probability of pregnant women with both ST and AN having GDM is 4.8 (95%CI: 1.9-11.7) times more than the pregnant women without ST and AN. CONCLUSIONS: AN or AN with ST may be a risk factor for GDM. If this supported with large case-control study, early screening for GDM to prevent serious complications of disease should be done in pregnant women with AN.

Prenatal diagnosis of type I sacrococcygeal teratoma and its management.

PURPOSE: To report a case of type I sacrococcygeal teratoma (SCT) diagnosed prenatally and managed surgically successfully in the neonatal period. CASE REPORT: A gravida 2, para 1, woman at 32 week's gestation was referred for suspected fetal anomaly. On US a 14 x 12 cm mass with solid and cystic components was detected in the sacral region of the fetus. On MRI the tumor had no apparent intrapelvic or intraabdominal extent, indicating type I SCT. Cesarean section was performed at 34 weeks' gestation due to signs of deteriorating high output cardiac compromise in the fetus. In the neonatal period stabilization of the infant was achieved. At age ten days the mass was successfully excised surgically. CONCLUSION: Prenatal determination of SCT, follow-up with sonography, time, and mode of delivery are indicative factors for prognosis in SCT.

Can increased nuchal translucency in the first trimester of pregnancy predict gestational diabetes mellitus.

The current study was designed to evaluate whether increased nuchal translucency can predict gestational diabetes mellitus. This was a prospective observational study. Among the pregnant women at 11-14 weeks of pregnancy who came to our prenatal unit for a first trimester screening test, 389 pregnant women whose nuchal translucency above 95th centile were selected as the study group and 386 age-matched pregnant women whose nuchal translucency were within the normal range were enrolled as a control group. First, subjects underwent a 50 g glucose screening test; if it was positive then a 100 g oral glucose tolerance test was performed. The main outcome measures were the prevalence of gestational diabetes mellitus and impaired glucose tolerance and the number of macrosomic infants. Impaired glucose tolerance was more common in pregnant women whose nuchal translucency was above the 95th centile (p = 0.048). In addition, macrosomic infants were also more common in pregnant women with a fetal nuchal translucency above the 95th centile (p = 0.045). Macrosomia was more common in the study group with gestational diabetes mellitus (p = 0.046). In conclusion, increased nuchal translucency seems to be predictive for impaired glucose tolerance and macrosomia, which are associated with gestational diabetes mellitus.

The role of hormone replacement therapy in endometrial polyp formation.

OBJECTIVE: To evaluate the iatrogenic effect of different protocols of hormone replacement therapy (HRT) on endometrial polyp formation adjusting for the confounding effects of other factors such as age, parity, weight and menopausal status at menopause. METHODS: Out of 2685 menopause patients 375 (13.9%) eligible patients were enrolled. Patients were randomized to three HRT types and three equal groups were formed. The first group received Premelle 2.5 mg (Group-I) (0.625 mg conjugated estrogen + 2.5 mg medroxyprogestorone), the second received Kliogest (Group-II) (2 mg estradiol + 1 mg norethisterone) and the last received Livial (Group-III) (2.5 mg tibolone) at least for 36 months without giving a break. After the first 18 months patients had their first office hysteroscopy and it was repeated in every 6 months until the end of third year to find out new and recurrent endometrial polyps. RESULTS: Multiple regression analysis revealed that the type of HRT, late menopause and obesity increased the occurrence of endometrial polyps. In Group-I five polyps, in Group-II ten polyps and in Group-III two polyps were detected. There were significant differences between G-II and G-I and G-II and G-III (P < 0.05), but there was no significant difference between G-I and G-III (P > 0.05). 82.3% of the polyps were detected in the third and fourth hysteroscopic examinations. Endometrial polyp recurrence was encountered in 4 (23.5%) patients, 1 in G-I and 3 in G-II without a significant difference (P > 0.05). No malignancy was detected in any of the specimen. CONCLUSION: We observed that endometrial polyp formation may be dependent on the type and dosage of the estrogen and progestogen. Especially a progestogen with high antiestrogenic activity may play an important preventive role in the development of endometrial polyps.

Doppler study of myometrium in invasive gestational trophoblastic disease.

OBJECTIVE: In this prospective study, we aimed to assess the prognostic and diagnostic role of color Doppler flow of myometrium in patients with invasive gestational trophoblastic disease (GTD). METHODS: Thirty-seven patients, who were enrolled in the study with invasive mole, were assessed with the help of transvaginal color Doppler ultrasound before and after chemotherapy. The place and the size of the myometrial invasions were assessed. RESULTS: Thirty patients of 37 were treated with the help of single-agent chemotherapy--methotrexate (mtx). In this group, the resistance index (RI) ratios ranged between 0.26 and 0.45 and the size of the myometrial invasion varied between 10 and 50 mm. On the other hand, six patients were treated with mtx and actinomycin D combination and one patient was treated with the help of total abdominal hysterectomy. In this group, the RI ratios ranged between 0.16 and 0.25 and the size of the myometrial invasion varied between 60 and 90 mm. Remission was achieved in all patients. CONCLUSION: Transvaginal color Doppler study can easily detect invasive GTD. When the depth and the width of the myometrial invasion increase and when there is a low diastolic/systolic ratio, the number of courses and the need for combination of chemotherapy increase.

A trial of a new regimen with clomiphene citrate administration to reduce the antiestrogenic effects on reproductive end organs.

OBJECTIVE: To determine the endocrinological and clinical outcomes of a 3-day clomiphene citrate (CC) regimen and compare it with the classical 5-day clomiphene citrate regimen. STUDY DESIGN: 59 patients, diagnosed with Class II ovulatory deficiency according to the criteria defined by WHO, were randomized into two groups. Patients in Group I received 50mg per day of CC for 3 days starting on the first day of the cycle during 72 cycles. Group II received 50mg per day of CC for 5 days starting on the fifth day during 64 cycles. RESULT(S): The ovulation rate was significantly higher in Group II (78.11%) compared to Group I (63.88%) (P < 0.05). However, the implantation rate was higher in Group I than Group II. CONCLUSION: We observed that starting CC on the first day of the cycle for 3 days would lead to higher implantation rates compared to the classical 5-day CC therapy.

Comparison of ethacridine lactate and prostaglandin E2 in second trimester medical abortion.

BACKGROUND: A comparison of ethacridine lactate and prostaglandin E2 (PGE2) with or without oxytocin infusion in second trimester medical abortion cases. METHODS: A prospective study was performed on 151 women requiring second trimester medical abortions between 1989 and 1995. Patients were randomly assigned to PGE2 group (n = 30), ethacridine lactate group (n = 48), ethacridine lactate combined with oxytocin infusion group (n = 49) and PGE2 combined with oxytocin infusion group (n = 24). Rates of successful abortion (i.e., complete evacuation of fetal and placental tissues from the uterus) within 24 hours for each group were determined and compared by chi2 and the Student t-test. RESULTS: Statistically significant difference concerning successful abortion rates was observed between ethacridine lactate and PGE2 groups, PGE2 and PGE2+oxytocin infusion groups, and ethacridine lactate+oxytocin infusion and PGE2 groups, while there was no significant difference between ethacridine lactate and ethacridine lactate+oxytocin infusion groups, ethacridine lactate and PGE2+oxytocin infusion groups, and PGE2+oxytocin infusion and ethacridine lactate+oxytocin infusion groups. CONCLUSIONS: Extra-amniotic ethacridine lactate instillation alone and intracervical PGE2 gel application are effective and safe methods for second trimester abortion.