Folic acid-modified methotrexate-conjugated gold nanoparticles as nano-sized trojans for drug delivery to folate receptor-positive cancer cells.

Methotrexate (MTX), an analog of folic acid (FA), is a drug widely used in cancer treatment. To prevent its potential toxicity and enhance therapeutic efficacy, targeted drug delivery systems, especially nanotechnology-folate platforms, are a central strategy. Gold nanoparticles (AuNPs) are promising candidates to be used as drug delivery systems because of their small particle sizes and their inertness for the body. In this study, glutathione (GSH)-coated FA-modified spherical AuNPs (5.6 nm) were successfully synthesized, and the anticancer activity of novel MTX-loaded (MTX/Au-GSH-FA) NPs (11 nm) was examined. Dynamic light scattering (DLS) and transmission electron microscopy (TEM) results showed that MTX/AuNPs possess spherical morphology, nanoscaled particle size, narrow size distribution, and good stability. In vitro studies showed that cytotoxicity of MTX/Au-GSH-FA to folate receptor-positive (FR+) human brain (U-87 MG) and cervical (HeLa) cancer cells enhanced significantly (∼3 and ∼10 fold, respectively) compared to free MTX while there was no significant effect in FR-negative human cell lines A549 (lung carcinoma), PC3 (prostate carcinoma), HEK-293 (healthy embryonic kidney). Moreover, the receptor specificity of the conjugate was shown by fluorescent microscopic imaging. In conclusion, these results indicate that the synthesized novel MTX/Au-GSH-FA NP complex seems to be a good candidate for effective and targeted delivery in FR+ cancer therapy.

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.

Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section.

PURPOSE OF INVESTIGATION: We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity. MATERIALS AND METHODS: We analyzed intra-abdominal adhesions of 672 patients. RESULTS: Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively. CONCLUSIONS: Emergency operations and adhesions increased complications.

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.

The role of mean platelet volume and platelet distribution width in the prediction of placental abruption.

We determined the role of mean platelet volume (MPV) and platelet distribution width (PDW) in the prediction of placental abruption (PA) prior to caesarean section. Data obtained between January 2011 and July 2014 from patients (n = 33) with PA and healthy control subjects (n = 67) matched for age- and gestation-stage were analysed. Pre-operative and post-operative MPV and PDW were significantly different between the PA and control groups when cut-off values for MPV were set at 9.23; sensitivity at 87.8% and specificity at 46.2%; positive predictive value (PPV) at 48.3%; and negative predictive value (NPV) at 90.0%. When the cut-off value for PDW was set at 18.5, the sensitivity was 100% and specificity 71.6%, PPV 40.7% and NPV 59.3% for the prediction of PA. MPV and PDW levels were significantly higher in cases of PA. These results suggest that clinical evaluation of MPV and PDW displays reasonable sensitivity and specificity as a marker of PA, prompting the need for more research in this area of clinical study.

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.

Ramadan fasting and pregnancy: implications for fetal development in summer season.

AIMS: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women. METHODS: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July-7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan. RESULTS: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05). CONCLUSION: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.

Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection.

BACKGROUND: To compare the effect of the GnRH antagonist/letrozole/gonadotropin protocol with the microdose GnRH agonist flare-up protocol in poor ovarian responders for intracytoplasmic sperm injection. MATERIALS AND METHODS: One hundred twenty-one consecutive patients suspected of having or with a history of poor ovarian response between January 2009 and June 2010, who were undergoing ICSI were enrolled. The microdose flareup (MF) protocol was used in 79 patients and the estradiol + progesterone/letrozole + gonadotropin and GnRH antagonist (EP/ALG) protocol was used in 42 patients. RESULTS: Age of the patients, duration of infertility, basal FSH, the total gonadotropin consumption, duration of stimulation, E2 level on the day of hCG administration, the number of embryo transferred, the fertilization rate, implantation rate, clinical pregnancy rate and the live birth rate were not statistically different (p > 0.05). Only the number of oocytes retrieved was significantly higher in the EP/LGA group (1.7 ± 0.7 versus 2.6 ± 0.6). CONCLUSION: The EP/LGA protocol has no significant improvement against the microdose flare-up protocol in poor responder patients.

Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage?

OBJECTIVE: This study evaluated the clinical outcomes and safety of treating caesarean scar pregnancy (CSP) by means of suction curettage followed when required by Foley tamponade, with or without methotrexate (MTX) therapy preceding the curettage. METHODS: Twenty-five patients with CSP were identified between August 2008 and April 2012. The first team of doctors treated Group A patients (n = 11) with systemic MTX followed by dilatation and suction curettage whereas the second team of doctors carried out only a suction curettage on women of Group B (n = 14). If uncontrolled vaginal bleeding occurred in either group during or after the operation, a Foley catheter, guided by real time transabdominal ultrasound, was placed in the uterine cavity against the site where the CSP had been implanted. RESULTS: Clinical outcomes in the two groups - including mean estimated blood loss, major complication rate, and hospital length of stay - were comparable. Surgeons used Foley catheter balloons for tamponade in six of the 11 patients in Group A and in seven of the 14 patients in Group B. Treatment was successful in ten of 11 cases in group A and 13 of 14 cases in group B. Group B's mean duration of treatment (2.36 ± 0.49 days) was significantly shorter than that of Group A (14.45 ± 4.96 days; p < 0.001). CONCLUSION: Suction curettage, followed when needed by Foley catheter tamponade, is an effective treatment for CSP.

Protective Effects of Intranasally Administrated Oxytocin-Loaded Nanoparticles on Pentylenetetrazole-Kindling Epilepsy in Terms of Seizure Severity, Memory, Neurogenesis, and Neuronal Damage.

Pentylenetetrazole (PTZ)-induced kindling is an animal model for studying human temporal lobe epilepsy (TLE), which is characterized by alterations of hippocampal neurons and memory. Although the intranasal (IN) administration of oxytocin (OT) has limited efficiency, nanoparticles (NPs) are a promising candidate to deliver OT to the brain. However, there are very limited data on epilepsy research about oxytocin-loaded nanoparticles (NP-OTs). The aim of this study is to investigate the effects of IN administration of chronic NP-OTs on the hippocampus of PTZ-induced male epileptic rats in terms of seizure severity, memory, neurogenesis, and neuronal damage. Saline/OT/NP-OTs were administrated to both control (Ctrl) and PTZ groups intranasally. Consequently, saline and PTZ were injected, respectively, 25 times every 48 h. Then, seizure severity (score and latency) was calculated for the PTZ groups. A spatial working memory evaluation test (SWMET) was performed after the last injection. Hippocampus histopathology, neurogenesis, and apoptosis were demonstrated. Serum total antioxidant status (TAS) and total oxidant status (TOS) levels and the oxidative stress index (OSI) were measured. We showed that OTs and NP-OTs prevented the kindling development and had positive effects on seizure severity. SWMET-related behaviors were also recovered in the PTZ + NP-OT group. A significant increase of neurogenesis and decrease of apoptosis in the hippocampus of the PTZ + NP-OT group were observed, while OTs and NP-OTs had protective effects against PTZ-induced damage to hippocampal neurons. Our results indicate that the chronic administration of NP-OTs may have positive effects on hippocampal damage via increasing neurogenesis and decreasing apoptosis and seizure severity.

The importance of uterosacral ligament anatomy in overactive bladder: A preliminary study.

OBJECTIVE: To evaluate whether uterosacral ligament (USL) thickness measured using magnetic resonance imaging (MRI) was associated with overactive bladder (OAB) in otherwise healthy women. MATERIALS AND METHODS: The study comprised 27 women with OAB and 27 healthy women (control group) who were followed up at the Obstetrics and Gynecology Department of a tertiary referral center. All subjects were evaluated using pelvic MRI to determine the transverse USL thickness. These measurements were compared between the two groups. p values less than 0.05 were considered statistically significant. RESULTS: The mean age of women in the OAB and control groups were 43.88±9.36 years and 39.92±5.36 years, respectively. The mean body mass index in the OAB group was 29.77±4.82 kg/m2 and 27.49±3.44 kg/m2 in the control group. In the comparison of Pelvic Organ Prolapse Quantification system stages between the groups, no statistically significant relationship was determined. In the OAB group, the mean right USL thickness was 2.04±0.34 mm, and the mean left USL was 2.04±0.52 mm. In the control group, the mean right USL thickness was 2.17±0.47 mm, and the mean left USL was 2.09±0.51 mm. There were no statistically significant differences in terms of USL thickness between the OAB and control groups (p>0.05). CONCLUSION: No previous studies have been identified in the literature that have investigated the relationship between USL thicknesses and urinary incontinence. In the present study, no significant relationship could be demonstrated between right and left USL thicknesses of the OAB and control groups. This was a preliminary study, and further research with larger sample sizes is required to reach a final conclusion.

Anti-Müllerian hormone levels during hormonal contraception in women with polycystic ovary syndrome.

OBJECTIVE: The use of oral contraceptive (OC) pills alters the characteristic features of polycystic ovary syndrome (PCOS) complicating the diagnosis of this disease. Anti-Müllerian hormone (AMH) levels are high in PCOS patients and are stable throughout the menstrual cycle in healthy subjects. This study examined the influence of hormonal suppression with OC therapy on the serum AMH levels in women with PCOS and with normal menstrual cycles. STUDY DESIGN: Thirty women with PCOS and 15 women with normal menstrual cycles were enrolled in this prospective study. Serum was collected from the subjects during the early follicular phase of the menstrual cycle and after the sixth cycle of oral contraceptive therapy, and stored frozen until assayed. The effect of OC therapy on the serum AMH, estradiol (E(2)), luteinizing hormone (LH), follicle-stimulating hormone (FSH), free testosterone, total testosterone, and dehydroepiandrosterone sulfate (DHEA-S) levels was studied. In addition, ovarian volume and follicle count were assessed. RESULTS: The serum AMH levels in PCOS patients were significantly higher than in healthy women at baseline (+/-S.D.; 5.49+/-2.26 and 1.93+/-0.51 ng/ml, respectively; p=0.001). After six cycles of OC therapy, no significant changes in the AMH levels were observed in either the PCOS patients or normally cycling women. Ultrasound showed significant reductions in ovarian volume and follicle number and size at 6 months in both groups. CONCLUSION: Although significant reductions were observed in ovarian volume and follicle number, 6 months of contraceptive therapy did not change the serum AMH concentration in either group. AMH may be considered a new marker in PCOS patients who are already on contraceptive treatment.

Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery.

OBJECTIVE: To compare cervical length measurements at 10-14 and 20-24 weeks gestation in asymptomatic women with singleton pregnancies and to assess the measurements as a predictor of preterm delivery. STUDY DESIGN: In this prospective study, cervical length was measured in 152 asymptomatic women with singleton pregnancies using transvaginal ultrasonography at 10-14 and 20-24 weeks gestation. The primary outcome measure was spontaneous preterm delivery before 35 weeks of gestation. The mean cervical length was calculated at both stages, and lengths were compared between the term and preterm groups. RESULTS: The rate of spontaneous preterm deliveries was 10.5%. The mean cervical length at 10-14 and 20-24 weeks was 40.5 and 37.1mm, respectively. The cervical length at 10-14 weeks was not significantly different between those who delivered at term (40.9 mm) and those who delivered preterm (38.6 mm). By contrast, the cervical length at 20-24 weeks was significantly shorter in the group that had preterm deliveries (28.4 mm) than in those who had term deliveries (37.8 mm) (P < 0.001). The cervical shortening was more apparent in the group that delivered prematurely (from 38.6 to 28.4 mm) than in that which delivered at term (from 40.9 to 37.8 mm). CONCLUSION: Cervical length measurement used to predict preterm delivery was found to be more predictive at 20-24 weeks. Cervical length measurement at 10-14 weeks was not reliable for predicting preterm delivery. The mean cervical length tapered gradually from the first to the second scan, and the more rapid cervical shortening was found to be associated with increased risk for preterm delivery.

Two successive pregnancies after ursodeoxycholic acid therapy in a previously infertile woman with antimitochondrial antibody-negative primary biliary cirrhosis.

OBJECTIVE: To describe the benefit of ursodeoxycholic acid (UDCA) for the initiation and completion of a successful pregnancy in a previously infertile woman with primary biliary cirrhosis. DESIGN: Case report. SETTING: A university hospital with relevant departments. PATIENT(S): A 29-year-old woman with primary biliary cirrhosis and failure to conceive for 6 years. INTERVENTION(S): Establishment of diagnosis with a liver biopsy, pretreatment of patient with UDCA before conception, and continuation of UDCA after first trimester until term. UDCA was used in the second pregnancy again after the first trimester. MAIN OUTCOME MEASURE(S): Achievement of a safe conception and full-term pregnancy. RESULT(S): Two consecutive successful pregnancies, a healthy 3,250-g male infant and a healthy 3,000-g female infant. The second conception occurred in a period without the use of UDCA, implicating a latent beneficial effect of either UDCA or the previous pregnancy via some possible immune mechanism. CONCLUSION(S): Ursodeoxycholic acid could help achieve conception in infertile women with primary biliary cirrhosis. The use of UDCA after the first trimester is shown to be safe in two consecutive pregnancies. Although it cannot be conclusive, the unintentional use of UDCA in the first 20 days after conception did not result in any teratogenicity in the first child.

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination.

INTRODUCTION: Intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) was applied to selected infertile patients to determine the effect of gonadotropin-releasing hormone (GnRH) antagonists in IUI cycles, in which recombinant follicle-stimulating hormone (rFSH) had been used for COH. METHODS: This study was conducted between April 1, 2009 and June 10, 2009, and involved a total of 108 patients. These patients had primary or secondary infertility, which resulted in an indication for IUI, and they each received two cycles of ovarian stimulation treatment with clomiphene citrate. The patients were randomised into two groups--patients in group A received rFSH + GnRH antagonist (n = 45), while those in group B received only rFSH (n = 63). RESULTS: The mean age of the patients was 31.84 ± 3.73 years and the mean body mass index (BMI) was 24.40 ± 1.88 kg/m(2). The mean age and BMI of the patients in groups A and B were not significantly different. There was no significant difference in the mean total rFSH dose administered (988.33 IU in group A and 871.83 IU in group B). When compared to group B, the mean number of follicles that were > 16 mm on the human chorionic gonadotropin (HCG) trigger day was significantly higher in group A (1.58 and 1.86, respectively; p < 0.05). When the two groups were compared, there were no statistically significant differences in the number of cancelled cycles due to premature luteinisation (none in group A vs. two in group B) and the rate of clinical pregnancy (8.9% in group A vs. 7.9% in group B). CONCLUSION: No significant improvement in the clinical pregnancy rates was observed when GnRH antagonists were used in COH + IUI cycles, despite the significant increase in the number of follicles that were > 16 mm on HCG trigger day.

Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoing in vitro fertilization/intracytoplasmic sperm injection treatment cycles: A randomized controlled study.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during assisted reproductive technology protocols. The aim of this study was to evaluate the role of dopamine agonist as a preventive strategy of OHSS in women at high risk in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles. METHODS: Seventy women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included. The study group received 0.5 mg of cabergoline for 8 days from the day of human chorionic gonadotropin administration in comparison to those who undergo no treatment for the prevention of OHSS. The reduction of the incidence of OHSS was the primary outcome. RESULTS: The actual incidence of OHSS was 8.33% in the cabergoline group and 20.58% in the control group. Thus, the incidence of OHSS was significantly reduced, by almost 60%, in the cabergoline group in comparison with the control group (relative ratios: 0.4, 95% confidence interval: 0.18-0.79). CONCLUSION: Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment. However, the effects of cabergoline on important outcomes, namely, live birth, miscarriage, and congenital abnormalities are still uncertain.

Neither early nor late for becoming pregnant: Comparison of the perinatal outcomes of adolescent, reproductive age, and advanced maternal age pregnancies.

OBJECTIVE: To compare perinatal and short-term neonatal outcomes of adolescent, reproductive age, and advanced maternal age (AMA) pregnancies in a low-income region of Istanbul. MATERIALS AND METHODS: Three hundred six adolescents, 301 reproductive age, and 303 AMA pregnant women who delivered in Süleymaniye Education and Research Hospital between January 1st 2007, and January 31st 2015, were recruited to the study population. The clinical, obstetric and short-term neonatal outcomes of the women were analyzed retrospectively. RESULTS: Adolescent and AMA pregnancies were associated with severe adverse perinatal and short-term neonatal outcomes compared with reproductive-age women. Adolescent and AMA pregnancies had quite similar risks in obstetric outcomes. Adolescent pregnancies were related with severe adverse short-term neonatal outcomes when compared with advanced maternal age pregnancies. CONCLUSION: Adolescent and AMA pregnancies should be defined as high-risk pregnancies. Our research indicated that healthcare providers such as obstetricians, midwives, and family physicians should be alert in these populations.

A case of primary Addison's disease with hyperemesis gravidarum and successful pregnancy.

We followed up a pregnant woman with Addison's disease diagnosed before conception. She presented with hyperemesis gravidarum. Throughout pregnancy, she received prednisone and the basic disease did not deteriorate during pregnancy. She was delivered by caesarean section due to breech presentation. The fetal prognosis was good.

Knowledge levels of adolescent girls about human papilloma virus and its vaccine.

AIM: The aim of our study was to evaluate the level of knowledge of the adolescent girls who presented to our clinic about human papilloma virus (HPV) infection and HPV vaccine. MATERIAL AND METHODS: Five hundred and one adolescent girls aged between 13 and 18 years who presented to the gynecology outpatient clinic between March 2012 and March 2013 were asked to answer the questions of the questionnaire about HPV and HPV vaccine. The "Participant Information Form" and "HPV Information Assessment Form" were used by examination of the related literature by the investigators. The data obtained were entered into the computer using the SPSS 16.5 program and evaluated. Descriptive statistics were shown with mean, standard deviation, number and percentage values. RESULTS: The mean age of 501 subjects who were included into the study was 15.92 years. 390 subjects (77.8%) who were included in the study had no information about HPV. 111 subjects (22.2%) stated that they heard of HPV before or had information about HPV. The mean age of the subjects who had information about human papilloma virus was found to be 16.52 years. The mean age of 390 subjects (77.8%) who had no information about human papilloma virus was 15.75 years. It was found that only one of the subjects (0.9%) was vaccinated with HPV vaccine. When the subjects who did not wish to be vaccinated were asked for the reason, 40.9% stated that the reason was inadequate information, 26.4% stated that the reason was high cost, 16.4% stated that the reason was the fact that they did not consider themselves at risk and 16.4% stated that the reason was the fact that they were afraid of side effects. CONCLUSIONS: In our study, it was found that the adolescent girls who constituted our study group had insufficient information about HPV and HPV vaccine. Verbal, written and visual communication tools and internet should be used intensively and efficiently for the objective of introducing HPV vaccine and teaching the precautions related with prevention of cervix cancer in terms of public health. Primarily pediatrician and gynecologists and family physicians who give service for the adolescence age group should be supported to develop appropriate attitudes and behaviors related with HPV vaccine and infection.