Effectiveness of air purifiers in intensive care units: an intervention study.

BACKGROUND: Effective design and operation of intensive care unit (ICU) ventilation systems is important to prevent hospital-acquired infections. Air purifiers may contribute. AIMS: To detect the number and types of micro-organisms present in the air and on high-touch surfaces in ICUs, and to evaluate the effectiveness of air purifiers in reducing the microbial load and thus the rate of nosocomial infections in ICUs. METHOD: This intervention study was conducted in two similar ICUs between May to November 2020. Novaerus air purifiers were located in the intervention ICU for 2 months. Routine cleaning procedures and high-efficiency particulate air filtration continued in the control ICU as well as in the intervention ICU. After 2 months, the air purifiers were moved to the other ICU for the next 2 months to reduce any possible bias in the results. Air and surface samples were evaluated. FINDINGS: Evaluation of changes in the intervention ICU over time revealed a significantly lower colony concentration in the air and on surfaces on Day 60 compared with Day 1 (Pair<0.001 and Psurface<0.001). There was a significant positive correlation between the number of colonies detected and the rate of hospital-acquired infections in the intervention ICU (r=0.406, P=0.049) and in the control ICU (r=0.698, P=0.001). CONCLUSION: Using air purifiers in addition to heating, ventilation and air conditioning systems in hospitals may be an effective way to reduce the microbial load in the air and on surfaces, and thus hospital-acquired infections.

A new and feasible uterine compression suture technique in uterine atony to save mothers from postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus. AIMS: The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us. SUBJECTS AND METHODS: In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure. RESULTS: All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis. CONCLUSIONS: We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.

Can plateletcrit, an underestimated platelet parameter, be related with preterm labour?

OBJECTIVE: Noninvasive and simple markers are needed for the prediction of preterm delivery in women at risk for preterm labour. The aim of this study was to determine the value of platelet indices in the prediction of preterm delivery. DESIGN: A retrospective study. SETTING: Routine antenatal care in Zonguldak Bülent Ecevit University between 2008 and 2011. SAMPLE: Ninety patients who delivered between 28 and 37 weeks of gestational age and 128 patients who delivered at term. METHODS: Plateletcrit and other haematological markers, cervical dilatation and effacement, and the neutrophil-to-lymphocyte ratio as an inflammation marker. MAIN OUTCOME MEASURE: The role of platelet indices in predicting the preterm delivery. RESULTS: The platelet count, plateletcrit, white blood cell count, red cell distribution width, and neutrophil count were significantly higher in the preterm delivery group. Receiver operating characteristic curve analysis showed that the plateletcrit cut-off value for predicting spontaneous preterm labour was 0.201%, with a sensitivity of 95.6% and specificity of 87.5%; the cut-off value for the platelet count was 234 ? 103/mm3 with a sensitivity of 81.0% and specificity of 71.0%. CONCLUSION: Plateletcrit is a low-cost, widely available, and noninvasive marker that might be used for the prediction of preterm delivery in patients with a history of preterm labour.

ICSI cycle outcomes in oligozoospermia.

AIM: The aim of this study was to evaluate the sole effect of sperm concentration on fertilization, embryo quality and pregnancy rates in patients undergoing ICSI cycles. MATERIALS AND METHODS: 560 ICSI cycles performed for male factor infertility were divided into four groups according to sperm concentration retrospectively. Group 1 consisted of 86 couples whose sperm concentration was less than 1x10(6), group 2 consisted of 169 couples whose sperm concentration ranged between 1x10(6) and 5x10(6), group 3 consisted of 95 couples whose sperm concentration ranged between 5x10(6) and 10x10(6) and group 4 consisted of 210 couples whose sperm concentration ranged between 10x10(6) and 20x10(6). RESULTS: Fertilization rate was significantly lower in the first three groups compared to the last group (p<0.05). The first three groups were comparable with each other. There were no differences according to ovarian response to stimulation, embryo quality and clinical pregnancy rates between the four groups. CONCLUSION: Lower sperm concentration has detrimental effects on the outcomes of ICSI cycles. This situation is more evident in men with severe and extremely severe oligozoospermia.

Cesarean section with relative indications versus spontaneous vaginal delivery: short-term outcomes of maternofetal health.

AIM: The aim of the study was to compare maternal and perinatal mortality and short-term outcomes of maternal and perinatal health between a cesarean group with relative indications and a vaginal delivery group. METHODS: A total of 1,119 patients were included; 582 were delivered by spontaneous vaginal birth and 537 delivered by cesarean section without labor. The indication for cesarean section was tocophobia and fear of childbirth for all patients. Maternal and perinatal morbidity and mortality were compared between the groups. RESULTS: No maternal mortality was recorded. Maternal morbidity was significantly lower in the vaginal birth group than the cesarean group (7 vs 30, p<0.05). Perinatal mortality (2 vs 0) and perinatal morbidity were not significantly different between the two groups (33 vs 17). The vaginallly delivered group had significantly higher newborn hospitalization rates than the cesarean group (p<0.05), but hospitalization time did not differ. Newborns with the first minute Apgar score below 7 were higher in the cesarean group (p<0.05). Fifth minute Apgar scores and umblical cord pH values were similiar. Cesarean neonates weighed more than vaginally delivered ones (p<0.05). CONCLUSION: Short-term maternal complications were more frequently seen in cesarean deliveries with relative indications than spontanous vaginal deliveries but no difference was found in perinatal mortality and morbidity. There is a clear need for research on health outcomes for mothers and infants associated with cesarean delivery without any medical indication.

ICSI outcome of patients with severe oligospermia vs. non-obstructive azoospermia.

OBJECTIVE: To compare the results of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles in men with severe oligoospermia and non-obstructive azoospermia. MATERIALS AND METHODS: This study included 91 ICSI cycles performed due to male factor infertility. Patients are divided into two groups according to source of spermatozoa. Group 1 consisted of 38 cycles in which sperm was obtained from testicles (cases with non-obstructive azoospermia). In Group 2, 53 consecutive cycles were included in which ejaculated sperm was available for ICSI in spite of severe oligospermia (< 100,000/ml). Fertilization, embryo quality and clinical pregnancy rates were compared between the groups. RESULTS: Although, the female age and mean number of oocytes retrieved were similar among the two groups, fertilization rate was significantly lower in the non-obstructive azoospermia (34.6%) group compared to group in which patients underwent ICSI with ejaculate spermatozoa (55.3%) (p < 0.05). However, there were no differences regarding mean number of available grade 1 embryos on day 3 and pregnancy rate between the two groups. CONCLUSION: Testicular sperm from non-obstructive azoospermia patients had significantly lower fertilization rates than the ejaculated spermatozoa from severe oligospermia patients in ICSI cycles. However, it did not bring about improved pregnancy rate.

Effect of sperm morphology on clinical outcome parameters in ICSI cycles.

OBJECTIVE: To assess the effect of isolated teratozoospermia with a normal sperm count and total motility by means of the fertilization rates, embryo quality and clinical pregnancy rate only in ICSI cycles. MATERIALS AND METHODS: We retrospectively analyzed the records of patients who underwent ICSI at Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Fertility and Reproductive Endocrinology between July 2001 and January 2010. Only patients with normal sperm count and total motility were recruited. The remaining cycles were further divided into two groups according to their sperm morphology with respect to Kruger's strict criteria. In Group 1, 537 consecutive cycles were enrolled whose sperm morphology was <4%. In Group 2, 118 cycles were identified with a morphology of > or = 4%. RESULTS: A total of 655 ICSI cycles were included in the final analysis. The fertilization rates were 72.0% and 70.8% in Groups 1 and 2, respectively. There were no differences regarding embryo quality, clinical pregnancy and implantation rates between the two groups. CONCLUSION: Our data suggest that detection of morphology defect has no value in the prediction of fertilization, embryo quality and clinical pregnancy in ICSI cycles.

Car-borne survey of natural background gamma dose rate in Çanakkale region, Turkey.

Natural background gamma radiation was measured along roads in the environs of Çanakkale region by using a car-borne spectrometer system with a plastic gamma radiation detector. In addition, activity concentrations of ²³8U, ²²6Ra, ²³²Th and 4°K in soil samples from the Çanakkale region were determined by using a gamma spectrometer with an HPGe detector. A total of 92,856 data of the background gamma dose rate were collected for the Çanakkale region. The background gamma dose rate of the Çanakkale region was mapped using ArcGIS software, applying the geostatistical inverse distance-weighted method. The average and population-weighted average of the gamma dose are 55.4 and 40.6 nGy h⁻¹, respectively. The corresponding average annual effective dose to the public ranged from 26.6 to 96.8 µSv.

Acne: prevalence and relationship with dietary habits in Eskisehir, Turkey.

BACKGROUND: Acne vulgaris is a common disease affecting adolescents. There is not comprehensive data on acne prevalence in the Central Anatolia Region in particular. Etiology of acne is not clarified yet. Acne might be related to environmental factors. There is increasing evidence supporting acne and diet relationship. OBJECTIVES: The aim of the study was to determine the acne prevalence in adolescents in the city of Eskisehir, located in the Central Anatolia, Turkey in addition to evaluate factors affecting acne and its relationship with dietary habits. METHODS: A cross-sectional study was conducted on 2300 participants aged 13-18 years. The participants were asked to complete a questionnaire form consisting information about acne and a questionnaire form consisting information about dietary habits (The Adolescent Food Habits Checklist). In addition an objective evaluation of acne was determined. RESULTS: The mean age of students with acne was 15.10±1.53. The current acne prevalence was 60.7%. Although 21% of the participants had severe acne (grade 3-4) and 25% developed sequelaes, only 11.5% of all participants consulted a doctor. The participants without acne had healthier dietary habits than participants with acne (P<0.05). Frequent fat intake (OR=1.39, 95% CI: 1.06-1.82), frequent sugar intake (OR=1.30, 95% CI: 1.05-1.60), frequent eating sausages, burgers (OR=1.24, 95% CI: 1.03-1.48), frequent eating pastries, cakes (OR=1.20, 95% CI: 1.01-1.43) were associated with increased risk for acne. CONCLUSIONS: Acne prevalence is high among adolescents in Eskisehir but the rate of consulting doctor is low. Increasing public awareness is critical for convincing adolescents to seek medical help earlier. Acne was related with dietary habits. Fat, sugar and fast food consumption is found to be positively correlated with acne prevalence.

Effect of progesterone as a tocolytic and in maintenance therapy during preterm labor.

AIMS: To assess the efficacy of vaginal micronized natural progesterone as a tocolytic and in maintenance therapy during threatened preterm birth. METHODS: Eighty-three women with symptoms of threatened preterm birth were either randomized to study groups receiving tocolytic treatment combined with intravaginal micronized natural progesterone (200 mg daily) or to a control group receiving only tocolysis. RESULTS: Micronized natural progesterone treatment resulted in a prolonged latency period of 32.1 ± 17.8 versus 21.2 ± 16.3 days in the control group and heavier birth weights of 2,982.8 ± 697.8 g versus 2,585.3 ± 746.6 g. No significant differences were found between the groups in admission to the neonatal intensive care unit, stay at the neonatal intensive care unit, need for a mechanical ventilator, respiratory distress syndrome or neonatal sepsis. CONCLUSION: The treatment of threatened preterm birth with tocolytics combined with intravaginal micronized natural progesterone significantly prolonged pregnancy and increased birth weight. However, an improvement in adverse perinatal outcomes was not observed.

Metastatic primitive neuroectodermal tumor of the ovary in pregnancy.

Primitive neuroectodermal tumor (PNET) is a small round tumor belonging to the PNET/Ewing's sarcoma family. We hereby report a case of PNET of the ovary, which was detected at the second trimester of pregnancy. Chemotherapy was administered and a healthy baby was delivered by cesarean section. After the pregnancy, the mother was found to have metastatic disease. Chemotherapy was continued, but she died due to progressive disease 13 months after the initial diagnosis. In this case report, we discuss chemotherapy options during pregnancy and the importance of multidisciplinary approach to unusual presentations of rare tumors.