The efficacy of onion extract in the management of subsequent abdominal hypertrophic scar formation.

OBJECTIVE: Development of postoperative scars is often a problem. This study aimed to evaluate the efficacy of gel containing Allium cepa extract, allantoin and heparin (Contractubex, Merz Pharmaceuticals GmbH, Frankfurt, Germany) in reducing scarring after a caesarean section by comparing it with a control group, and also intra-individually, using the Vancouver Scar Scale (VSS). METHOD: A total of 120 patients who underwent a second elective caesarean delivery and who presented with hypertrophic scar development after their first caesarean section were included in the study. A scar revision was performed for all patients during the second caesarean operation. Patients in the study group (n=60) were advised to apply the topical scar gel postoperatively for a period of 6 months. The control group (n=60) received no treatment. RESULTS: Significant reductions were observed in the vascularity, pigmentation and height subgroups of the VSS for those in the group who continued the treatment to 24 weeks. An intra-individual analysis showed that the gel effectively reduced scarring after the second caesarean section. CONCLUSION: The prophylactic use of the gel to reduce scar development offers better results for vascularity, pigmentation and height subscales of the VSS after surgical removal of the primary caesarean scar during the second caesarean section. The results were better both intra-individually, and also in comparison with the control group and support the use of a gel containing Allium cepa extract, allantoin and heparin to reduce scarring after a caesarean section.

Effect of intrauterine insemination treatment on sexual function and quality of life for infertile women.

OBJECTIVES: To evaluate the effect of intrauterine insemination (IUI) on sexual functioning, quality of life and psychological well-being. METHODS: One hundred and thirty four infertile women going to IUI treatment as study group and 134 women who do not report any infertility complaint attending to gynecology clinic for routine control as control group were enrolled. Demographic data of the patients were collected. Patients were asked to complete Female Sexual Functioning Index (FSFI), Beck Depression Inventory (BDI) and SF 36 form. RESULTS: Total FSFI score (mean±SD) for study group was 23.4±4.1 and 24.8±3.4 for control group (p<0.05). This means a lower sexual function for patients going to IUI. There were also statistically significant differences according to subscales of FSFI scores for sexual desire, arousal and satisfaction. Mean±SD scores for Beck Depression Inventory analysis was 18.6±9.8 for study group and 18.5±7.1 for control group. According to SF-36 scores, there were statistically significant differences between the groups for four subscales: Role physical,bodily pain,general health and vitality. CONCLUSIONS: Going to an IUI treatment has negative effects on FSFI scores and some of SF 36 scores but we did not find a significant negative effect on BDI scores.

Effect of Betamethasone on Fetal Pulmonary and Umbilical Artery Doppler Velocimetry and Relationship With Respiratory Distress Syndrome Development.

OBJECTIVES: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is primarily a disease of premature neonates. The aim of this study was to evaluate the impact of maternal betamethasone administration on the fetal pulmonary arteries (PAs) and umbilical arteries (UAs) and the correlation between RDS development and PA Doppler results. METHODS: Forty singleton pregnancies between 24 and 34 gestational weeks with a diagnosis of preterm birth were included prospectively. They received corticosteroids to enhance fetal lung maturity. Fetal PA and UA Doppler parameters were evaluated before and 48 to 72 hours after steroid administration. Maternal records were matched to neonatal charts, and demographic and outcome data were abstracted. RESULTS: There were no differences between groups for maternal age, body mass index, mode of delivery, and mean GA at steroid administration. Apgar scores at 1 and 5 minutes were significantly lower for neonates who developed RDS (P < .05). There were no statistically significant differences in PA Doppler results between fetuses who developed RDS and those who did not, and there were no significant differences in PA Doppler results before and after steroid administration for both groups. The UA pulsatility and resistive indices were significantly lower after steroid administration for the neonates who developed RDS (P < .05). CONCLUSIONS: There were no significant differences in PA Doppler indices for fetuses with or without RDS after steroid administration.

Is Maternal Blood Procalcitonin Level a Reliable Predictor for Early Onset Neonatal Sepsis in Preterm Premature Rupture of Membranes?

BACKGROUND: This study is aimed at comparing the early diagnostic accuracy of maternal blood white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin in predicting early onset neonatal sepsis (EONS) among early preterm premature rupture of membrane (PPROM) pregnancies. METHODS: A total of 57 consecutive pregnancies, complicated with PPROM, between 24 and 34 gestational weeks were recruited to the study at Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey between January 2012 and January 2013. All patients were hospitalized and followed up with expectant management. Maternal blood WBC count, CRP and procalcitonin levels were measured in the first 12 h of membrane rupture. EONS was diagnosed using clinical and laboratory findings, and obstetric and neonatal outcomes were noted. RESULTS: The cutoff value for maternal blood CRP was ≥9.49 mg/dl. This value predicted EONS with 77.8% sensitivity, 80.0% specificity, 77.8% positive predictive value (PPV) and 80.0% negative predictive value (NPV). The cutoff value for maternal blood procalcitonin was 0.071 ng/ml. This value predicted EONS with 85.2% sensitivity, 86.7% specificity, 85.2% PPV and 86.7% NPV. CONCLUSION: Maternal blood procalcitonin levels were superior to maternal blood CRP and WBC count in predicting EONS. Consequently, the maternal blood procalcitonin level is a clinically useful, non-invasive and reliable biomarker in antenatal prediction of EONS.

The impact of mode of delivery on the sexual function of primiparous women: a prospective study.

AIM: The purpose of this study was to evaluate the impact of mode of delivery on the sexual function of women using the Female Sexual Function Index (FSFI). METHODS: This was a prospective study of 452 nulliparous women, comparing their sexual function before and after birth. A Turkish version of the FSFI questionnaire was administered within the first 8 weeks of pregnancy, at 3 and 6 months postpartum in a face-to-face manner and subsequently at the 12th month and 24th month over the telephone. RESULTS: Age, BMI, education level, house income, duration of marriage, birthweight, and feeding at each time point were similar between group 1 [vaginal birth and mediolateral episiotomy (MLE)] and group 2 [caesarean section (CS)]. In the postpartum period, there were 265 and 138 participants at 3rd month, 216 and 121 participants at 6th month, 189 and 111 participants at 12th month, and 133 and 85 participants at 24th month in group 1 and 2, respectively. The FSFI total scores decreased at 3 and 6 months postpartum in both groups (27.3 to 23.1 in group 1 and 27.5 to 25 in group 2; p < 0.05 for both). Desire, arousal, lubrication, satisfaction and pain scores were significantly decreased at 3 months postpartum in group (1) In group 1, desire, arousal and pain scores remained decreased at the 6th month compared to initial scores. Group 2 had significantly lower desire, lubrication, satisfaction and pain scores at 3 months postpartum compared to their initial scores. Decline in desire and lubrication domains persisted at the 6th month for group (2) None of the FSFI domain scores differed after 6th months when compared to pre-delivery scores in both groups. Compared with the caesarean group, the vaginal birth with MLE group had lower satisfaction and higher pain levels at 3 months postpartum (p < 0.0001, for both). None of the FSFI domains differed at the 6th, 12th or the 24th month between the groups. CONCLUSION: Our study revealed that caesarean section is not superior to vaginal birth in terms of preservation of normal sexual function, regardless of short-term postpartum effects. Women should be informed that, irrespective of their type of delivery, sexual function 6 months after childbirth is similar to that in pre-pregnancy.

Psychologic and sexual dysfunction in primary and secondary infertile male patients.

OBJECTIVE: The aim of this study was to compare depression and sexual dysfunctions observed in primary and secondary infertile patients. MATERIAL AND METHOD: The study was performed in 39 primary and 31 secondary infertile male patients. Male sexual health was evaluated using the International Index of Erectile Function (IIEF) score and depression with Beck Depression Inventory (BDI). RESULTS: Mean age of the participants and their partners were 31.54 ± 5.37 (range, 24-48 yrs), and 28.16 ± 5.58 (range, 20- 46 yrs) years, respectively. Mean duration of their marriage ranged between 1 and 17 years (mean, 5.06 ± 4.15 yrs). A statistically significant intergroup difference was detected between groups as for BDI scores (p = 0.015; p < 0. 05). BDI scores of the primary group were significantly lower than those of the secondary group. A statistically and extremely significant difference was detected between IIEF scores of the groups (p = 0.006; p < 0.01). IIEF scores of the primary infertile group were higher than those of the secondary group. CONCLUSION: Our study, frequency of the depression and erectile dysfunction seen in the patients with secondary infertility was seen significantly higher than the patients with primary infertility.

What influences women's contraceptive choice? A cross-sectional study from Turkey.

OBJECTIVES: In our study, we tried to investigate the determinants of women's choices about contraception with the aim of discovering whether or not there is a difference in their preferences before and after consultation with a gynaecologist. MATERIAL AND METHODS: A total of 1058 women were enrolled. They were given detailed information regarding contraception and contraceptive methods. Subsequently, a survey which was made of 21 questions was administered. RESULTS: Contraceptive counselling significantly changed the contraceptive choice of women. However, influences from social media and friends, their partners and religious belief affected their contraceptive choices. Significant differences in contraceptive choice were observed when women were categorized according to their marital status, education level, household income, age, and number of children. CONCLUSIONS: Although contraceptive counselling influenced Turkish women's choices, there were still other determinants like social media and input from outside sources such as clerics and husbands, which should be overcome.

Low antimullerian hormone levels may be associated with cardiovascular risk markers in women with diminished ovarian reserve.

There is growing evidence that diminished ovarian reserve (DOR) may be associated with cardiovascular disease (CVD). The aim of the study was to investigate whether there was any relationship between antimullerian hormone (AMH) and CVD risk markers in the study. Ninety women with DOR and 90 women with normal ovarian reserve (NOR) attending the infertility unit at XXXX, were enrolled in the study. CVD risk markers such as insulin resistance [defined by the homeostasis model assessment ratio (HOMA-IR)], C-reactive protein (CRP), low density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) were assessed. HOMA-IR, CRP, TG, LDL levels were higher and HDL and AMH were lower among patients with DOR compared with controls (p < 0.05, for all). There were positive associations between low AMH and HOMA-IR, CRP, TG, LDL levels and a negative correlation with HDL (p < 0.05, for all). However, multivariate logistic regression analysis showed that HOMA-IR, CRP, TG and HDL were independent variables that were associated with low AMH. There was a close relationship between low AMH and CVD risk markers in the study. Further studies with larger groups are needed to investigate the nature of this link in these patients.

Comparison of two different antibiotic regimens for the prophylaxisis of cases with preterm premature rupture of membranes: a randomized clinical trial.

OBJECTIVES: The aim of the study was to assess the effect of 1 g ampicillin prophylactic dosage whether it is as effective as the dosage of 2 g to prevent maternal and neonatal morbidity in a randomized manner. MATERIALS AND METHODS: One hundred and fourty eight singleton pregnant women with preterm premature rupture of membranes between 21 and 33 weeks of gestation were followed-up during the study period in our institution. We com-pared the efficacy of two different different dosages of ampicillin. The study population was randomized into 2 groups. In the group 1, 1 g of intravenous ampicillin was given every 6 hours. In the group 2, 2 g of intravenous ampicillin was given every 6 hours. RESULTS: There was no significant difference between groups interms of fetal complications (RDS, icterus, mortality, sepsis, transient tachypnea of newborn and the pneumonia), rate of intensive care unit admission, fetal gender, fever, rate of clinical chorioamnionitis, high white blood cell count and the CRP, rate of cases < 30 weeks (p > 0.05). There was a significant differ-ence between the groups for the rate of previous preterm premature rupture of membranes history, steroid administration and the need for tocolysis (p < 0.05). CONCLUSIONS: Although antibiotics seems to be innocent, several side effects have been introduced. It is reasonable to use the lowest dosages in shortest period in order to minimize these unwanted effects.

Is there any relationship between cardiovascular risk markers and young women with diminished ovarian reserve?

OBJECTIVE: It has been widely known that cardiovascular disease (CVD) risk is increased in menopause. The aim of the study was to evaluate whether this risk was elevated in young women with diminished ovarian reserve (DOR). METHODS: A hundred women with DOR and 100 women with normal ovarian reserve (NOR) attending the infertility unit at Suleymaniye Maternity, Research &Training Hospital, were enrolled in the study. CVD risk markers such as insulin resistance (defined by the homeostasis model assessment ratio [HOMA-IR]), C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) were assessed. RESULTS: HOMA-IR, CRP, TG, LDL levels were higher and HDL was lower among patients with DOR compared to the controls (p < 0.05 for all). There were positive associations between DOR and HOMA-IR, CRP, TG, LDL levels and a negative correlation with HDL (p < 0.05 for all). However, multivariate logistic regression analysis showed that HOMA-IR, CRP, TG, and HDL were independent variables that were associated with DOR. CONCLUSIONS: CVD risk markers were increased in women with DOR. Further studies with larger groups are needed to investigate the nature of the link in these patients.

Serial ultrasonographic examination of the fetal thymus in the prediction of early neonatal sepsis in preterm premature rupture of membranes.

BACKGROUND/AIMS: To evaluate the diagnostic accuracy of fetal thymus transverse diameter (FTTD) in predicting fetal infection in preterm premature rupture of membranes (PPROM) and compare its accuracy with cord blood tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). METHODS: Forty consecutive pregnancies complicated with PPROM between 26(1/7) and 36(6/7) gestational weeks were evaluated prospectively. Serial fetal ultrasonography follow-ups with 3-day intervals were performed beginning on the admission day. The FTTD was recorded on every ultrasonographic examination. Cord blood TNF-α and IL-6 values were measured after delivery. RESULTS: FTTD was decreased below 5% according to nomograms compared to the initial measurement in 45% of all PPROM cases. Decreased FTTD had a sensitivity of 100%, specificity of 73%, positive predictive value of 55%, and negative predictive value of 100% in predicting early neonatal sepsis. Cord blood TNF-α had a sensitivity of 80% and specificity of 90%, whereas IL-6 had a sensitivity of 90% and specificity of 63.3% in predicting early neonatal sepsis. CONCLUSIONS: Assessment of the decrease in FTTD by serial ultrasonographic examinations is a promising 'prenatal' method for the early detection of early neonatal sepsis.

Is there any effect of insulin resistance on male reproductive system?

OBJECTIVES: To investigate the possible effect of insulin resistance (IR) on male reproductive system via evaluation of semen analysis, male sex hormones and serum lipid profiles, and testicular volumes. METHODS: After the exclusions, a total of 80 male patients were enrolled in this prospective study. Body Mass Index (BMI), Testicular volume, semen samples, serum hormone/lipid profiles, high sensitive C-Reactive Protein (hsCRP) were obtained from all the subjects. RESULTS: The patients were divided into two groups as study and control according to the presence of IR. There were no statistical differences in terms of age, marriage period, testicular volume, serum levels of hormone and lipid profiles and BMI between the groups. There were no relationship between homeostasis model assessment of insulin resistance (HOMA-IR) and semen volume (r = -0.10, p = 0.37), total sperm count (r = -0.09, p = 0.39), motility (r = -0.15, p = 0.16) and morphology (r = -0.14, p = 0.19). However, HOMA-IR was closely associated with hsCRP levels (r = 0.94, p < 0.0001). CONCLUSIONS: Despite of the documented strong inverse relationships between Diabetes Mellitus (DM) and male/female fertility, and also between IR and female infertility via ovarian functions as in polycystic ovary syndrome, to our knowledge, there is no report about any influence of IR on male fertility. DM and metabolic syndrome (MetS) have negative influence on fertility. Thus, IR may be accused of causing detrimental effect on male infertility due to hyperinsulinemic state and being one of the components for MetS. Interestingly, due to our preliminary results, we do not found any inverse correlation between IR and male reproductive functions.

The Evaluation of Adropin and Autotaxin as Potential Markers of Endothelial Dysfunction in Preeclampsia.

Endothelial dysfunction (ED) plays a prominent role in the pathogenesis of preeclampsia (PE). There is a need for non-invasive methods to assess endothelial function in preeclamptic patients. In the present study, adropin, autotaxin (ATX), and lysophosphatidic acid (LPA) were evaluated as indicators of ED. Patients diagnosed with PE and healthy pregnant women (n = 42 for each group) were compared. After measuring flow-mediated dilation (FMD), the participants were stratified as ED (+) or ED (-) based on a cut-off value of 6.5%. The PE patients were divided as early/late onset PE and severe/mild PE. Adropin, ATX, and LPA levels were measured, and their relevance to ED was evaluated. Student t, Mann-Whitney U, or ANOVA tests were used for statistics, as appropriate. Adropin levels were diminished in the ED (+) group, whereas ATX and LPA levels were increased. The decrease in adropin levels was more pronounced in severe PE, showing a positive correlation with the FMD. In the logistic regression model, adropin was the only parameter that was an independent variable for the FMD test (P < .001). Adropin measurements in serum may be of value for disease follow-up in patients with PE.

The prevalence of metabolic syndrome in clomiphene citrate resistant polycystic ovary syndrome.

OBJECTIVE: To investigate the prevalence of metabolic syndrome in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients. METHODS: 58 CC resistant PCOS patients, 52 CC responders, 53 fertile PCOS and 53 age and body mass index-matched normoandrogenic ovulatory fertile women were evaluated for metabolic syndrome. RESULTS: Metabolic syndrome prevalence was 41.4% in CC resistants, in 23.1% of CC responders, in 11.3% of PCOS fertiles and 0% of controls (p < 0.0001). Waist circumference (WC) > 88 cm was 44.8%, systolic blood pressure (BP) ≥ 130 mmHg and diastolic BP ≥85 mmHg were 27.6%, TG (triglyceride) ≥150 mg/dL was 36.2%, HDL(high density lipoprotein) < 50 mg/dL was 63.8%, fasting glucose levels ≥ 100 mg/dL was 20.7% in CC resistant PCOS women. There were positive associations between CC resistance and WC >88 cm, BP ≥ 130 ≥ 85 mmHg, TG ≥ 150 mg/dL, HDL < 50 mg/dL, fasting glucose ≥ 100 mg/dL, and presence of metabolic syndrome (p < 0.05, for all). Moreover, WC > 88 cm, and HDL < 50 mg/dL were independent variables that were associated by CC resistance by multivariate regression analysis. CONCLUSIONS: CC resistant PCOS patients have high prevalence of metabolic syndrome. These women have an increased risk of future cardiovascular disease.

Increased insulin resistance and C-reactive protein in women with complete hydatidiform mole.

OBJECTIVE: To evaluate (i) insulin resistance and C-reactive protein (CRP) levels in women with complete hydatidiform mole (CHM) and (ii) whether there were any correlations between these parameters and CHM. METHODS: Thirty-two women with CHM and 30 healthy pregnant women were enrolled in the study. Fasting serum glucose and insulin levels, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) and C-reactive protein (CRP) were measured. Insulin resistance was calculated by the homeostasis model assessment ratio (HOMA-IR). RESULTS: Fasting glucose, insulin, HOMA-IR, CRP, and TG levels were higher, and HDL was lower among patients with CHM compared with healthy pregnant group (p < 0.05 for all). There were positive associations between CHM status and glucose, insulin, HOMA-IR, CRP, TG levels and had a negative correlation with HDL (p < 0.05 for all). The receiver operating characteristic curve (ROC) analysis value for HOMA-IR in CHM was 0.96 (95% confidence interval (CI) = 0.92-1.00), sensitivity = 94%, and specificity = 87%. The area under ROC curve value for CRP was 0.72 (95% confidence interval (CI) = 0.58-0.84), sensitivity = 82%, and specificity = 60% in CHM. CONCLUSIONS: Insulin resistance and CRP were found to be higher among patients with CHM. These parameters were also closely associated with CHM. Further studies are needed to investigate the nature of this link in this group.

May platelet count be a predictor of low-risk persistent gestational trophoblastic disease?

PURPOSE: The aim of this paper was to determine whether platelet count could be used as an early marker to predict low-risk persistent trophoblastic disease (PTD) from complete hydatidiform mole (CHM). METHODS: This study included 27 PTD, 30 CHM, and 30 healthy pregnant women. All patients were evaluated with respect to age, gestational age, parity, BMI, and platelet count. All women had low-risk disease using FIGO and WHO scoring systems. RESULTS: There were no significant differences in terms of age, gestational age, parity, BMI between the groups (P > 0.05, for all). Platelet levels were lower in patients with low-risk PTD compared with CHM and healthy pregnant group (P = 0.001 and P < 0.0001, respectively). Platelet levels were also found to be lower in patients with CHM than in healthy pregnancies (P = 0.006). There was a negative relationship between platelet count and low-risk PTD (r = 0.47, P < 0.0001) in the study. The receiver operating characteristic curve analysis revealed a high diagnostic value for platelet count with respect to low-risk PTD with an area under curve of 0.80 (95% confidence interval = 0.89-0.90), sensitivity = 77% and specificity = 75%. CONCLUSION: Platelet count was significantly decreased in low-risk PTD compared with CHM and healthy pregnant controls. Platelet count can be used as a reliable marker for the early detection of low-risk PTD.

Can Short Anogenital Distance Cause Chronic Prostatitis?

Chronic prostatitis/Chronic pelvic pain syndromes (CP/CPPS) are a widespread pathology with unknown etiology without a proved treatment algorithm. Neurologic, endocrine and immune systems, and oxidative stress, infections are ranked in the physiopathology. Anogenital distance (AGD) as a marker for the degree of antenatal exposure of androgens that link to some disorders of androgen-sensitive tissues especially of urogenital system. In this study, we aimed a construct a hypothesis that improper development of perineum and pelvic bottom due to the insufficient embryologic androgen exposure, which can be detected by reduced AGD, can form histologic/clinic CP in adulthood through the physical forces that resulted in stretched prostate via chronic hypoxia induced oxidative stress and failed immune mechanisms. AGD, unlike the previous published ones, suggested as a real physical scale to detect narrowed pelvic bottom other than an endocrine related biomarker.

Are women with small endometriomas who undergo intracytoplasmic sperm injection at an elevated risk for adverse pregnancy, obstetric, and neonatal outcomes?

OBJECTIVE: The aim of the study was to investigate pregnancy, obstetric, and neonatal outcomes in women with small (<4 cm) unilateral endometriomas. METHODS: This retrospective study included 177 patients: 91 patients with small endometriomas and 86 controls with unexplained or tubal factor infertility who were treated at the Süleymaniye Gynecology and Maternity Training and Research Hospital Infertility Unit between January 2010 and July 2015. The groups were matched with regards to demographic characteristics such as age, body mass index, and infertility duration. All of the women in this study conceived via intracytoplasmic sperm injection. We compared pregnancy, obstetric, and neonatal outcomes between these groups. RESULTS: Women with endometriomas had a higher biochemical pregnancy rate, but lower clinical pregnancy and live birth rates than women with unexplained and tubal factor infertility (p<0.05 for all). However no significant differences were found in terms of obstetric and neonatal complications between the two groups (p>0.05 for all). CONCLUSION: In this study, we found that women with endometriomas less than 4 cm were more prone to early pregnancy complications. We also showed that this group did not have any increased risks of late pregnancy, obstetric, and neonatal complications.