Analysis of Myomectomy during Cesarean Section: A Tertiary Center Experience.

PURPOSE: This study analyzed the safety of myomectomy during the cesarean section (CS). METHODS: Pregnant women who underwent myomectomy during CS in a tertiary center between January 2015 and November 2019 were included in the study in Group A, and pregnant women who did not have myoma and who underwent only CS were included in the study in Group B. The following information was obtained from patient files in hospital archives and was then recorded and compared: age, gravidity, parity, gestational week, characteristics of the myomas (i.e., location, size, number, and type), duration of surgery, perioperative complications, need for blood transfusion, preoperative and postoperative hemoglobin (Hb) values, duration of surgery, and hospital stay duration. RESULTS: A total of 83 patients underwent CS plus myomectomy (Group A), and 80 patients (without myoma) underwent only CS (Group B).There were no statistically significant differences between the groups in terms of preoperative and postoperative Hb values or blood transfusion rates (p > 0.05). Hospitalization and surgery duration were significantly higher in the group that underwent CS myomectomy (p = 0.001 and p = 0.001, respectively). The mean myoma size was 8.3 ± 4.1 cm in Group A. There was a statistically significant and inverse correlation between the size of the myoma and the delivery week (p = 0.035). There was a statistically significant and positive correlation between the myoma size and hospital stay (p = 0.01). CONCLUSION: Myomectomy during CS is safe and can be applied regardless of the location, size, type, and number of myomas. However, to make myomectomy routine during CS, multi-center studies that include more cases are needed.

Does rotation during catheter withdrawal in embryo transfer increase pregnancy rates?

BACKGROUND: The aim of this study was to determine whether there is a difference in pregnancy rates between groups that we removed directly and removed by rotating the embryo transfer catheter 360°. METHODS: The study group consisted of 552 patients who were withdrawn by 360° rotation and 797 patients who were withdrawn without catheter rotation. All patients underwent one or two fresh ETs on day 3 or 5. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. RESULTS: There were no significant differences in demographic and clinical characteristics of both groups, such as age, body mass index (BMI), duration of infertility, causes of infertility, and basal hormone levels. Clinicals pregnancy rate, in the study group, 48% (265/552) and in the control group, 50.8% (405/797) were similar in both groups. When the implantation rate and miscarriage rate were examined, both groups were found to be similar. CONCLUSION: It was found that 360° rotation while pulling catheter during embryo transfer had no effect on pregnancy and clinical pregnancy.

Rapid, sensitive, and reusable detection of glucose by highly monodisperse nickel nanoparticles decorated functionalized multi-walled carbon nanotubes.

Addressed herein, functionalized multi-walled carbon nanotube (MWCNT) supported highly monodisperse nickel nanoparticles modified on glassy carbon electrode (Ni@f-MWCNT/GCE) were synthesized through microwave assisted method and examined for non-enzymatic glucose sensing in ionic liquids by cyclic voltammetry and chronoamperometry. The results of Ni@f-MWCNT/GCE electrode were compared with Ni NPs/GCE electrode and the results revealed that f-MWCNTs increased the electrocatalytic properties of Ni nanoparticles regarding glucose oxidation. They also demonstrated a good linear span of 0.05-12.0mM and a detection boundary of 0.021µM. Specifically, in the amperometric signal of the electrodes after 200th cycles, no major change was observed. This non-enzymatic glucose sensor presents one of the record electrocatalytic activity, stability and response towards glucose under the optimized situations. As a result, prepared novel Ni@f-MWCNT/GCE was utilized to detect glucose in real serum species.

Evaluation of Breast Cancer Knowledge and Awareness Among Hospital Staff in a Women Heath Hospital in Turkey.

The purpose of this study was to examine breast cancer prevention knowledge, beliefs, and information sources among people which are employed in healthcare system including nurses and hospital staff. A cross-sectional survey was conducted among hospital staff of the largest women health hospital in Turkey. Self-administered questionnaires were delivered to participants. A total of 200 hospital staff participated to the study with a response rate of 80.5 %. One-way ANOVA with post-hoc Tukey test was used for multiple comparisons. The results showed that the overall knowledge of hospital staff about breast cancer is inadequate. The mean total knowledge score of the participants was approximately 60 %. The overall mean score of the survey for all participants was 16.69 (SD, 3.12) out of 27. Significant difference was detected in mean total score among educational levels. Education and increasing awareness about the disease can be identified as the major determinants for improving the percentages of early diagnosis and decreasing the mortality rates. Hospital staff education should be the key target for increasing the awareness of whole population especially for developing countries.

Prognostic value of 18F-FDG PET/CT for identifying high- and low-risk endometrial cancer patients.

OBJECTIVES: To assess the usefulness of adding PET/CT as a preoperative test for determining the extent of endometrial cancer and discriminating low- and high-risk patients to identify candidates for surgical staging. MATERIAL AND METHODS: We retrospectively reviewed 86 patients with pathologically proven endometrial cancer who had undergone preoperative ¹8F-FDG PET/CT. The prognostic relationships between PET/CT parameters and pathology reports were assessed. RESULTS: The SUVmax was significantly higher in patients with FIGO stage IB or higher compared with those with stage IA; for stage III-IV compared with stage I-II; and for patients with lymph node metastasis compared with those without lymph node metastasis. Using 6.70 as a cut-off for SUVmax, low-risk patients can be identified with a sensitivity of 92.9%. CONCLUSIONS: PET/CT imaging can be used not only for determining malignancy and lymph node involvement but also for determining candidates for surgical staging with high sensitivity.

Synthesis and Characterization of Nearly Monodisperse Pt Nanoparticles for C1 to C3 Alcohol Oxidation and Dehydrogenation of Dimethylamine-borane (DMAB).

Highly efficient nearly monodisperse Pt NPs catalyze C1 to C3 alcohol oxidation with very high electrochemical activities and provides one of the highest catalytic activities (TOF = 21.50 h(-1)) in the dehydrogenation of DMAB at room temperature. The exceptional stability towards agglomeration, leaching and CO poisoning for the prepared catalyst allow these particles to be recycled and reused in the catalysis of both DMAB dehydrogenation and C1 to C3 alcohol oxidation. After four subsequent reaction and recovery cycles, catalyst retained ≥ 80% activity towards the complete dehydrogenation of DMAB. The prepared catalyst structures were determined by the X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), atomic force microscopy (AFM) and transmission electron microscopy (TEM) respectively.

Monodisperse Pt Nanoparticles Assembled on Reduced Graphene Oxide: Highly Efficient and Reusable Catalyst for Methanol Oxidation and Dehydrocoupling of Dimethylamine-Borane (DMAB).

Herein, monodisperse platinum (0) nanocatalyst assembled on reduced graphene oxide (Pt(0)@RGO) was easily and reproducibly prepared by the double solvent reduction method at room temperature. Pt(0)@RGO was characterized by X-ray diffraction (XRD), X-ray photoelectron microscopy (XPS) and transmission electron microscopy (TEM) measurements that verify the formation of monodisperse Pt (0) nanoparticles on RGO. The catalytic and electrocatalytic performances of Pt(0) @ RGO in terms of activity, isolability and reusability were investigated for both methanol oxidation and the dehydrocoupling of dimethylamine-borane (DMAB) in which Pt(0)@RGO was found to be highly active and reusable heterogeneous catalyst even at room temperature. The prepared nanoparticles can also electrocatalyze methanol oxidation with very high electrochemical activities (5.64 A/cm2 at 0.58 V for methanol). The activation energy (Ea), activation enthalpy (ΔH#), and activation entropy (ΔS#) for DMAB dehydrogenation were calculated to be 59.33 kJ mol(-1), 56.79 kJ mol(-1) and -151.68 J mol(-1) K(-1), respectively. The exceptional stability of new Pt(0) @ RGO nanoparticles towards agglomeration, leaching and CO poisoning allow these particles to be recycled and reused in the catalysis of DMAB dehydrogenation and methanol oxidation. After four subsequent reaction and recovery cycles, Pt(0) @ RGO retained ≥ 75% activity towards the complete dehydrogenation of DMAB.

Efficacy of a real time optoelectronic device (TruScreen™) in detecting cervical intraepithelial pathologies: a prospective observational study.

OBJECTIVE: To assess the effect of TruScreen™ (an objective optoelectronic cervical screening device) in improving the sensitivity of cervical screening programs either alone or in combination with Papanicolaou (PAP) smear or human papilloma virus (HPV) DNA screening. MATERIAL AND METHODS: Our study was performed in 285 patients with abnormal Pap test results. TruScreen™ and HPV screening methods were performed in all participants. Consistency and differences between the tests were compared with cervical biopsy results. RESULTS: TruScreen™ was found to be an approach method in the determination of cervical pathologies (ROC curve area underlined=0.606) and with an 89.5% negative predictive value. HPV screening remains a counterpart to TruScreen™ with a 0.620 area underlined in the ROC curve and an 83% negative predictive value. CONCLUSION: As determined in our study, TruScreen™ with a sensitivity of 86.1% can be used as a screening test with instant and not professional dependent results for cervical cancer screening. Avoiding from subjectivity in interpretation of Pap smears and requirement for pathologists, TruScreen™ can be a used for cervical cancer screening especially in countries with a low socio-economic status. The combination of TruScreen™ and HPV screening was not able to demonstrate a significant rise of effectiveness in screening.

Alterations in pituitary gland volume in polycystic ovary syndrome: a structural magnetic resonance imaging study.

The purpose of this prospectively designed cross-sectional observational study was to evaluate the effect of polycystic ovary syndrome (PCOS) on pituitary gland volume (PGV) under the hypothesis that endocrinologic changes may lead to morphologic changes of the pituitary gland. Twenty-six PCOS patients and 31 control subjects underwent magnetic resonance imaging (MRI) of the pituitary. Informed consent was obtained from all subjects. PGV was significantly larger in PCOS patients than in control subjects. Luteinizing hormone/follicle-stimulating hormone ratio was the only predictor of PGV. The association between pituitary gland enlargement and PCOS should be kept in mind when pituitary hypertrophy is detected on MRI.

Birth weight for gestational age: a reference study in a tertiary referral hospital in the middle region of Turkey.

BACKGROUND: The purpose of this study was to establish a fetal birth weight curve for gestational age for patients who presented to our tertiary referral hospital. The curve can be used for epidemiological analysis and also to develop Turkey's first national nomogram. METHODS: A total of 68,255 live singleton pregnancies delivered during the study period in a tertiary referral hospital were initially reviewed in this study. The data were carefully collected from hospital records and patients' files. Gestational age (weeks) was assessed by either ultrasound examination or according to the patient's last menstrual period, or both. Sex-specific reference tables for fetal birth weight by gestational age were created, and statistical analyses were carried out for descriptive variables using SPSS 15.0 for Windows. RESULTS: Most newborns weighed between 3000 g and 4000 g. The percentile fetal birth weight curves for gestational age showed that fetal birth weight increased with the increase in gestational age. Typically, male infants were noted to have higher birth weights than female infants. When our results were compared with those of previous studies, it was demonstrated that values for the 10(th) percentile were higher in our study, whereas values for the 90(th) percentile were similar to those of previous studies. CONCLUSION: To the best of our knowledge, this is the first study evaluating the correlation between gestational age and fetal birth weight with such a large sample size in Turkey. Therefore, the results of this reference study can be helpful in defining normal and abnormal fetal growth in Turkish newborns.

Urinary tract infection in pregnant population, which empirical antimicrobial agent should be specified in each of the three trimesters?

OBJECTIVE: We aimed to investigate the bacterial profile and the adequacy of antimicrobial treatment in pregnant women with urinary tract infection. MATERIAL AND METHODS: This retrospective observational study was conducted with 753 pregnant women who needed hospitalization because of UTI in each of the three trimesters. Midstream urine culture and antimicrobial susceptibility tests were evaluated. RESULTS: E. Coli was the most frequently isolated bacterial agent (82.2%), followed by Klebsiella spp. (11.2%). In each of the three trimesters, E. Coli remained the most frequently isolated bacterium (86%, 82.2%, 79.5%, respectively), followed by Klebsiella spp. (9%, 11.6%, 12.2%, respectively). Enterococcus spp. were isolated as a third microbial agent, with 43 patients (5.7%) in the three trimesters. The bacteria were found to be highly sensitive to fosfomycin, with 98-99% sensitivity for E.Coli and 88-89% for Klebsiella spp. and for Enterococcus spp. 93-100% nitrofurantoin sensitivity for each of the three trimesters. CONCLUSIONS: We demonstrated that E. Coli and Klebsiella spp. are the most common bacterial agents isolated from urine culture of pregnant women with UTI in each of the three trimesters. We consider fosfomycin to be the most adequate first-line treatment regimen due to high sensitivity to the drug, ease of use and safety for use in pregnancy

Effect of luteal phase support with vaginal progesterone in intrauterine insemination cycles with regard to follicular response: a prospective randomized study.

OBJECTIVE: To investigate the effect of luteal phase support with vaginal progesterone on pregnancy rates of the gonadotropin-stimulated intrauterine insemination (IUI) cycles in patients with unexplained infertility with regard tofollicular growth. STUDY DESIGN: A total of 149 patients with unexplained infertility who underwent 166 recombinant follicle stimulated hormone--stimulated IUI cycles were prospectively randomized into 2 groups for luteal phase support. The study group (n = 71) received vaginal progesterone gel supplementation, and the control group (n = 78) received no drug for luteal support. The clinical pregnancy rates and live birth rates per cycle and per patient were compared between the groups. RESULTS: The differences between the groups with regard to clinical pregnancy rates and live birth rates per patient or per cycle were not different among all patients. In cycles with > 1 dominant follicle (multifollicular response), the clinical pregnancy rate per patient was significantly higher in the supported cycles as compared with the unsupported cycles (28.2% vs. 11.4%, respectively, p = 0.04). Reproductive outcomes in cycles with a single dominant follicle (monofollicular response) were not different between supported and unsupported cycles. CONCLUSION: Luteal phase support with vaginal progesterone affects the success of gonadotropin-stimulated IUI cycles with multifollicular response but not with monofollicular response.

Multicenter analysis of gestational trophoblastic neoplasia in Turkey.

BACKGROUND: To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. MATERIALS AND METHODS: A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period between January 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the International Federation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agent chemotherapy, surgical interventions and prognosis were evaluated. RESULTS: From 2003-2013, there were 1,173,235 deliveries and 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluated data of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was present for 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66) and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7 (1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. CONCLUSIONS: Because of the differences between countries, it is important to provide national registration systems and special clinics for the accurate diagnosis and treatment of GTN.

Serum adiponectin level and clinical, metabolic, and hormonal markers in patients with polycystic ovary syndrome.

BACKGROUND: To investigate the relationship between adiponectin, metabolic and hor- monal parameters, and insulin resistance in patients with non-treated polycystic ovary syndrome. MATERIALS AND METHODS: In this cross-sectional observational study, 81 patients admitted to out-patient clinic with complaints of menstrual irregularity, hirsutism and obesity were enrolled. Serum adiponectin, biochemical and hormonal parameters, and 75 gram oral glu- cose tolerance test (OGTT) were measured. Spearman's correlation coefficient was used for statistical analysis. RESULTS: We observed inverse correlations between serum adiponectin level and body mass index, homeostasis model assessment insulin-resistance score, insulin level, fast- ing glucose level, and prolactin level (p=0.001, p=0.02, p=0.04, p=0.02, and p=0.005, respectively). No significant correlations were found between serum adiponectin level and age, height, weight, Ferriman-Gallwey score, 2 hours OGTT test value and free tes- tosterone level (p=0.3, p=0.6, p=0.2, p=0.8, p=0.9, and p=0.01, respectively). CONCLUSION: The present study demonstrated that in polycystic ovary syndrome patients, when serum adiponectin level decreased, degree of insulin resistance increased. Our find- ings indicate that serum adiponectin level is likely to be an adequate marker for deter- mination of the degree of insulin resistance, and may be a predictor of diseases, such as type 2 diabetes mellitus (T2DM) and metabolic syndrome, which develop on the basis of insulin resistance.

The relationship between third trimester maternal hemoglobin and birth weight/length; results from the tertiary center in Turkey.

OBJECTIVE: The aim of this study was to investigate the relationship between third trimester maternal hemoglobin values and fetal birth weight/length. METHODS: Retrospective study was conducted on 28600 Turkish pregnant women who delivered between January 2010 and December 2011. Hemoglobin values at third trimester, all birth weights/lengths of newborns were retrospectively analyzed. Maternal third trimester hemoglobin values and birth weights/lengths were compared and correlated. RESULTS: The high hemoglobin concentrations at third trimester were associated with high birth weight (odds ratio 1.08; 95% confidence interval 1.05-1.11; p=0.00) and significant positive correlation was determined between maternal third trimester hemoglobin and birth weights/lengths (p=0.00). Low hemoglobin was associated with low length of newborns (p=0.00). CONCLUSIONS: The low hemoglobin values at third trimester gestation were associated with low birth weight and length in Turkish women. The anemia can be a direct cause of deterioration of in utero fetal growth due to lack of oxygen flow to placental tissue or can be an indirect indicator of maternal nutrition deficit. In both circumstances this study reveals that treatment of anemia is directly correlated with better fetal outcomes.

Comparison of serum granulocyte colony-stimulating factor levels between preterm and term births.

OBJECTIVE: Preterm birth (PTB) is the major obstetric problem in developed countries, accounting for the majority of neonatal mortality and morbidity. Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine that mediates the increase in leukocytes in pregnancy and may play a role in placentation. We aimed to investigate the differences of serum G-CSF levels between subsequent spontaneous PTB and term-delivered healthy pregnant women. MATERIAL AND METHODS: Serum samples, collected from total of 600 singleton otherwise healthy pregnants at 24-28 weeks of gestation during a routine antenatal visit, were used to assess G-CSF levels; 40 of the total pregnants who delivered their infants spontaneously after preterm labor before 37 weeks of gestation were selected as the study group. Also, 120 pregnants were selected as a control group using a 1/3 ratio. Student's t-test, chi-square test, Mann-Whitney U-tests, and ROC curve analysis for prediction of PTB were used for the comparison of groups. P<0.05 was accepted as statistically significant. RESULTS: There was no significant difference in maternal serum G-CSF levels between the study and control groups (p=0.28) but maternal white blood cell (WBC) count was significantly different between them (p=0.00). In addition, G-CSF was insufficient in the prediction of PTB (AUC=0.419). In the preterm and term groups, no correlation was found between WBC and G-CSF (p=0.165 vs. p=0.703). CONCLUSION: There were no differences in serum levels of G-CSF between term- and preterm-delivered pregnants. There was no predictive role for serum G-CSF in PTB.