The importance of bone density and anatomical structure in superior semicircular canal dehiscence.

OBJECTIVE: This study investigates the importance of bone density, surface area, and diameter of anatomical structures of the superior semicircular canal (SSC), lateral semicircular canal (LSC), posterior semicircular canal (PSC), utricle, and saccule in patients diagnosed with superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: The bone density, surface area, and diameter of SSC, LSC, PSC, utricle, and saccule were measured and compared between the SSCD group and control group. Fifteen ears in the SSCD group and 60 ears in the control group were evaluated. Additionally, within the SSCD group, the dehiscent and healthy sides were evaluated independently. RESULTS: SSC's bone density was significantly lower in the SSCD group compared to the control group (p = 0.008). No significant differences were found in surface area and diameter between the groups (p > 0.05). While most of the anatomical structures showed no significant difference in bone density between dehiscent and healthy ears (p > 0.05), SSC bone density was significantly lower in affected ears (p = 0.000) in SSCD group. CONCLUSION: Based on the data obtained in this study, bone density and anatomical structure may be useful in patients diagnosed with SSCD.

Impact of Isthmocele on Assisted Reproductive Treatment Outcomes: An Age-matched Retrospective Study.

STUDY OBJECTIVE: To evaluate whether the presence of an ultrasonographic visible isthmocele has an impact on the chance of pregnancy in women undergoing embryo transfer. DESIGN: Age-matched retrospective study. SETTING: Private-assisted reproductive center. PATIENTS: The study included a total of 150 patients with a history of cesarean delivery with 75 isthmocele cases and 75 controls. All patients underwent embryo transfer from January 2017 through June 2018. The diagnosis of isthmocele was based on transvaginal ultrasound assessment. Isthmocele was defined as an anechoic indentation on the previous cesarean scar at the midsagittal plane, with a depth of >1 mm. INTERVENTIONS: Embryo transfer. MEASUREMENTS AND MAIN RESULTS: The groups were similar in patient and treatment characteristics. The live birth rate was 44% in the isthmocele group and 46.7% in the control group (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.47-1.71; p = .743). The clinical pregnancy rates were 49.3% and 50.7%, respectively (OR, 0.94; 95% CI, 0.50-1.79; p = .870). The miscarriage rate was greater in the isthmocele group (8%) than in the control group (4%); however, it did not reach statistical significance (OR, 2.09; 95% CI, 0.50-8.67; p = .302). The multiple pregnancy rate was similar between the groups (8% vs 5.3%, respectively; OR, 1.54; 95% CI, 0.41-5.70; p = .513). The groups were also similar in ectopic pregnancy rates (p = .560). These outcomes remained similar when adjusted for potential confounders on the regression analysis. CONCLUSION: Isthmocele does not seem to have a significant impact on the chance of pregnancy in assisted reproductive treatment settings. However, the embryo transfer procedure may be more difficult in the presence of an isthmocele.

Evaluation of the diagnostic performance of the Xpert® MTB/RIF assay in pulmonary and extrapulmonary samples.

INTRODUCTION: This study aimed to evaluate the performance of the Xpert MTB/RIF assay in the identification of M. tuberculosis in pulmonary and extrapulmonary clinical samples by taking the results of the BACTEC MGIT 960TB culture system as a reference. MATERIALS AND METHODS: A total of 11,341 specimens sent to Sivas Cumhuriyet University Application and Research Hospital Tuberculosis Laboratory for microbiological examination with suspicion of tuberculosis infection between January 2013 and December 2019 were examined, and 6847 clinical specimens that underwent culture (BACTEC MGIT 960TB), Xpert MTB/RIF and AFB (Acid-fast bacilli) testing were selected and included in our study. Of the samples included in the study, 5096 samples were pulmonary, and 1751 were extrapulmonary samples. RESULT: In our study, sensitivity, specificity, PPV and NPV values of Xpert MTB/ RIF and AFB were calculated by taking TB culture test as reference test. The sensitivity of the Xpert MTB/RIF assay was calculated as 96.1%, specificity as 99.7%, positive predictive value (PPV) as 88.2%, and negative predictive value (NPV) as 99.9%. These values for pulmonary samples were determined as 98.3%, 99.7%, 89.9%, and 99.9%, respectively. For extrapulmonary samples, the sensitivity of the assay was found as 89.4%, specificity as 99.5%, PPV as 82.9%, and NPV as 99.7%. The sensitivity and PPV values for AFBpositive samples were found to be 99.0% and 97.1%, respectively. For AFB negative samples, the sensitivity, specificity, PPV, and NPV values were determined as 90.5%, 99.7%, 73.8%, and 99.9%, respectively. CONCLUSIONS: A large number of clinical samples were studied with the Xpert MTB/RIF test in our study. It can be a guide in determining the performance of the test under the conditions of our country. Especially in the diagnosis of extrapulmonary TB, the effectiveness of the Xpert MTB/RIF assay has not been certainly proven in countries having a moderate prevalence of TB, such as Turkey. In most of the published studies, only a small part of the samples is extrapulmonary samples. So, our study provides valuable results in terms of evaluating a large number of extrapulmonary samples.

Preimplantation genetic testing for aneuploidy in severe male factor infertility.

RESEARCH QUESTION: Does the use of preimplantation genetic testing for aneuploidies (PGT-A) improve outcomes in couples with severe male factor infertility (SMFI)? DESIGN: This retrospective cohort study included SMFI cases that underwent blastocyst transfer with/without PGT-A. Inclusion criteria were SMFI (azoospermia and sperm count <1 million/ml), women aged 25-39 years, single vitrified-warmed blastocyst transfer, and no intracavitary pathologies. Patients were divided into PGT-A and non-PGT-A groups. The primary outcome was live birth rate (live birth of an infant after 24 weeks of gestation); secondary outcomes were implantation and clinical pregnancy rates. RESULTS: The study included 266 SMFI cases (90 and 176 in the PGT-A and non-PGT-A groups, respectively). Men and women in the PGT-A group were significantly older than those in the non-PGT-A group. The groups did not differ in terms of male factor categories, sperm collection methods or additional female factors. Live birth rates in the PGT-A and non-PGT-A groups were 55.6% and 51.1%, respectively (odds ratio [OR] 1.19, 95% confidence interval [CI] 0.71-1.98, P = 0.495). The implantation rates were 65.6% and 64.2%, respectively (OR 1.06, 95% CI 0.62-1.80, P = 0.827). The clinical pregnancy rates were 62.2% and 58.0%, respectively (OR 1.19, 95% CI 0.71-2.01, P = 0.502). The use of PGT-A was not an independent factor for live birth (aOR 1.33, 95% CI 0.66-2.70, P = 0.421). Advanced age in women was the only independent factor associated with live birth (aOR 0.46, 95% CI 0.22-0.96, P = 0.041). CONCLUSIONS: The use of PGT-A does not seem to be an independent factor associated with live birth per transfer in couples with SMFI.

Frozen blastocyst transfer improves the chance of live birth in women with endometrioma.

Purpose: The existing literature is scarce regarding outcomes of fresh vs frozen embryo blastocyst transfers in women with endometrioma. The goal of the study was to compare outcomes between fresh and frozen blastocyst transfers (fresh-BT vs. frozen-BT) in endometrioma-affected women. Materials and methods: This study included 315 endometrioma-affected women aged between 20 and 39 years who underwent blastocyst transfer. Primary outcome was live birth rate (an alive birth after 24 completed weeks gestation). Results: The study groups did not differ in terms of patient characteristics and treatment variables. The live birth rate was 40.7% in fresh-BT group and 56.1% in frozen-BT group (OR:1.86, 95% CI:1.18-2.92 p = .007). The approach of frozen embryo transfer was an independent factor of live birth (adjusted OR:1.83, 95% CI:1.16-2.90, p = .009). Conclusion: The approach of frozen blastocyst transfer increases the chance of live birth in endometrioma-affected patients compared with fresh blastocyst transfer. Thus, a frozen embryo transfer may be the choice of strategy in these patients.

[Klebsiella pneumoniae Infections in the Intensive Care Unit: Risk Factors Related to Carbapenem Resistance and Patient Mortality]. / Yogun Bakim Ünitesinde Gelisen Klebsiella pneumoniae Enfeksiyonlari: Karbapenem Direnci ve Hasta Mortalitesi ile Ilgili Risk Faktörleri.

Klebsiella pneumoniae is the cause of complicated and difficult-to-treat nosocomial infections such as sepsis, urinary tract infection, catheter related infections, pneumonia and surgical site infections in intensive care units. The biggest problem in infections with K.pneumoniae is that treatment options are limited due to multiple antibiotic resistance and consequently the increased morbidity and mortality. The widespread and improper use of carbapenems can lead to epidemics that are difficult to control, especially in intensive care units because of the acquired resistance to this group of antibiotics. Outbreaks and sporadic cases caused by carbapenem resistant K.pneumoniae (CRKP) species have been reported all over the world in recent years with increased frequency. The aim of this study was to determine the risk factors related to carbepenem resistance and mortality caused by K.pneumoniae infections in a university hospital anesthesia intensive care unit. The study was conducted between January 1st, 2016, and December 31st, 2018. Retrospective data were obtained from the patient and laboratory-based surveillance records. Adult patients (≥ 18 years) with K.pneumoniae growth in the blood, urine, abscess and tracheal aspirate samples collected 48 hours after admission to the intensive care unit were considered as the relevant infection locus-related agent and treated with antibacterial therapy. Clinical samples collected from patients were inoculated onto 5% sheep blood and eosin-methylene-blue (EMB) agar except the blood samples. Blood samples were cultured in blood culture bottles and incubated in an automated system. Gram staining was performed for the samples showing growth signal within five days and then inoculated onto 5% sheep blood and EMB agar media and were incubated for 18-24 hours at 35.5-37°C. Identification of the isolates was performed using Bruker IVD MALDI Biotyper 2.3 (Bruker Daltonik GmbH, Bremen, Almanya) based on "matrix-assisted laser desorption/ionization time-of-mass spectrometry (MALDI-TOF MS)". K.pneumoniae isolates were identified by obtaining reliability scores of 2.0 and above in the study. Antibiotic susceptibility tests were performed with Phoenix 100 (BD, New Jersey, ABD) automated system. Interpretations were made according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Combination disk diffusion test and polymerase chain reaction based tests were used to show the presence of carbapenemase in CRKP isolates. A total of 88 patients with K.pneumoniae infection were included in the study. The mean age of the patients was 74 ± 15 (range= 21-93) years and 60.2% were female. CRKP was detected in 32 patients (36.4%) and carbapenem-sensitive K.pneumoniae (CSKP) was detected in 56 patients. The presence of OXA-48 was found to be 68.8% in the carbapenem screening test performed by combination disc method in patients with CRKP. Multivariate logistic regression analysis showed that previous use of colistin [Odds ratio (OR)= 19.108; 95% confidence interval (CI)= 2.027-180.133; p= 0.010] and aminoglycoside (OR= 12.189; 95% CI= 1.256-118.334; p= 0.031) was an independent risk factor in terms of CRCP among the patients with K.pneumoniae infection. The 28-day mortality rates were 71.9% in the CRKP group (23/32) and 37.5% in the CSKP group (21/56). Presence of CRKP in terms of 28-day mortality (OR= 5.146; 95% CI= 1.839-14.398; p= 0.002) was an independent risk factor. The data obtained in this study will guide for conducting effective and continuous surveillance studies and implementing rational antibiotic programs to prevent the increase in CRKP.

The impact of serum oestradiol concentration prior to progesterone administration on live birth rate in single vitrified-warmed blastocyst transfer cycles.

RESEARCH QUESTION: Can serum oestradiol concentrations on the day of progesterone initiation predict live birth rates in single, autologous vitrified-warmed blastocyst transfers following artificial endometrial preparation? DESIGN: This retrospective study included the first transfers of 468 patients with unexplained or tubal factor infertility who underwent freeze-all cycles using single, top-quality blastocysts after artificial endometrial preparation from January 2015 to January 2018. Patients were stratified into four groups based on serum oestradiol concentration percentiles on the day of progesterone initiation: Group 1 (<25th percentile), Group 2 (25-50th percentile), Group 3 (51-75th percentile) and Group 4 (>75th percentile). The primary outcome was live birth rate. The secondary outcomes were implantation, clinical pregnancy and multiple pregnancy rates. Receiver operating characteristic (ROC) curves were generated to evaluate serum oestradiol concentrations in predicting implantation, clinical pregnancy and live birth. RESULTS: Similar live birth rates of 51.6%, 55.1%, 54.9% and 56.4% for Groups 1, 2, 3 and 4, respectively, were found. The groups also showed similar implantation and clinical pregnancy rates. ROC analysis revealed that serum oestradiol concentrations on the day of progesterone initiation were not predictive for implantation (area under the curve [AUC] 0.490, 95% CI 0.445-0.554), clinical pregnancy (AUC 0.507, 95% CI 0.453-0.561) or live birth (AUC 0.514, 95% CI 0.461-0.566). CONCLUSIONS: Serum oestradiol concentration monitoring just prior to progesterone administration does not appear to be predictive for live birth rates in good prognosis patients undergoing single, autologous vitrified-warmed blastocyst transfer after artificial endometrial preparation. Therefore, the current practice of monitoring serum oestradiol concentration is not supported by this study.

Comparison of daily vaginal progesterone gel plus weekly intramuscular progesterone with daily intramuscular progesterone for luteal phase support in single, autologous euploid frozen-thawed embryo transfers.

PURPOSE: To compare outcomes between daily intramuscular progesterone (IMP) and daily vaginal progesterone (VP) gel plus weekly intramuscular hydroxyprogesterone caproate (IMHPC) for luteal phase support (LPS) in single, autologous euploid frozen-thawed blastocyst transfers (FBTs) following artificial endometrial preparation (EP). METHODS: The retrospective cohort study included 767 single, autologous FBTs from 731 patients between January 2015 and March 2018. LPS was performed either with IMP (100 mg/day) or with VP gel (90 mg, twice daily) plus IMHPC (250 mg/week). Oral estrogen was prescribed in combination of both regimes. Oral estrogen was discontinued following the visualization of fetal cardiac activity on ultrasound and progesterone at 10 weeks of gestation. The primary outcome was live birth rate. The secondary outcomes included implantation, clinical pregnancy, and multiple pregnancy rates. RESULTS: Patient characteristics did not differ in LPS regimes. Of 767 FBTs, 608 had IMP (100 mg/day) for LPS and 159 had VP gel (90 mg, twice daily) plus IMHPC (250 mg/week) for LPS. The live birth rate was 51.8% and 50.3%, respectively (p = 0.737, OR 0.94, 95%CI 0.66-1.33). The implantation rate was 62.7% and 64.2%, respectively (p = 0.730, OR 1.06, 95%CI 0.74-1.53). The clinical pregnancy rates were also similar in both groups (59.5% vs. 61.6%, respectively, p = 0.631, OR 1.09, 95%CI 0.76-1.56). CONCLUSIONS: We did not observe significant differences in the rates of live birth, implantation, and clinical pregnancy between daily IMP and daily VP gel plus weekly IMHPC for LPS in single, autologous euploid FBTs after artificial EP.

Implications of circulating irisin and Fabp4 levels in patients with polycystic ovary syndrome.

The aim of the study was to evaluate the fatty acid-binding protein-4 (FABP4) and irisin concentrations in women with polycystic ovary syndrome (PCOS). Forty-nine women with PCOS, diagnosed according to Rotterdam criteria and 39 healthy women matched for body mass index (BMI) and age. Serum irisin and plasma FABP4 concentrations were measured in both groups. The association of irisin and FABP4 concentrations with metabolic parameters were also tested. Women with PCOS had significantly lower mean serum irisin concentrations than control subjects (158.5 ± 123.3 versus 222.9 ± 152.2 ng/ml, p < 0.05). Concentrations of FABP4 in PCOS and control groups were not significantly different (10.5 ± 4.4 versus 10.9 ± 4.2 ng/ml, p > 0.05). FABP4 concentrations were correlated with BMI, waist-hip ratio (WHR) and HOMA-IR (r = 0.57, p = 0.001; r = 0.26, p = 0.03; r = 0.26, p = 0.03, respectively). No associations between irisin and all the others parameters except serum levels of LH were found. Serum irisin concentrations of women with PCOS were lower compared to the controls. Moreover, there were no difference in plasma FABP4 concentrations between women with PCOS and controls.

[Investigation of carbapenemases in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains isolated in 2014 in Turkey]. / Türkiye'de 2014 yili içinde izole edilen karbapeneme dirençli Escherichia coli ve Klebsiella pneumoniae izolatlarinda karbapenemaz varliginin arastirilmasi.

Carbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.

Rotavirus and adenovirus gastroenteritis: time series analysis.

BACKGROUND: This study investigated the effects of changes in weather conditions (monthly average temperature, monthly minimum temperature, monthly average humidity) on rotavirus and adenovirus gastroenteritis frequency and whether there was a seasonal correlation. METHODS: Between 2006 and 2012, 4702 fecal samples were taken from patients ≤ 5 years of age with acute gastroenteritis; these samples were analyzed in terms of rotavirus group A and adenovirus serotype 40-41 antigens using time-series and negative binomial regression analysis. RESULTS: Rotavirus antigens were found in 797 samples (17.0%), adenovirus antigens in 113 samples (2.4%), and rotavirus and adenovirus antigens together in 16 samples (0.3%). There was a seasonal change in rotavirus gastroenteritis (P < 0.001), and a 1°C decrease in average temperature increased the ratio of rotavirus cases in those with diarrhea by 0.523%. In addition, compared with data from other years, the number of patients was lower in the first month of 2008 and in the second month of 2012, when the temperature was below -20°C (monthly minimum temperature). There was no statistically significant relationship between adenovirus infection and change in weather conditions. CONCLUSION: Various factors such as change in weather conditions, as well as the population's sensitivity and associated changes in activity, play a role in the spread of rotavirus infection.

Alterations of ionized and total magnesium levels in pregnant women with gestational diabetes mellitus.

BACKGROUND/AIMS: The aim of this prospective study was to determine ionized and total magnesium (Mg) levels in pregnant subjects with and without gestational diabetes mellitus (GDM). METHODS: Eighty-five women, 26-28 weeks pregnant, were recruited for routine oral glucose tolerance tests (OGTT); 45 had normal OGTT results and 40 were diagnosed with GDM. Electrolyte levels, including ionized and total Mg, were analyzed. RESULTS: Gestational age and BMI were similar between the two groups (p = 0.800, p = 0.025). Multivitamin use was higher in the control group (p = 0.036). Fasting blood glucose was higher in the GDM group (p < 0.001). The median total Mg levels were 1.9 mg/dl (range 1.6-2.2) in the control group and 1.8 mg/dl (range 1.2-2.1) in the GDM group (p < 0.001). The median ionized Mg levels were 0.5 mmol/l (range 0.4-0.6) in the control group and 0.4 mmol/l (range 0.4-0.5) in the GDM group (p < 0.001). CONCLUSION: Our study revealed a relationship between low total and ionized Mg levels and GDM, as in type 2 diabetes mellitus (DM). The literature regarding type 2 DM and our findings suggest that Mg is the key ion in the pathophysiology of GDM. Low-dose Mg supplementation was not related to GDM; however, pharmacological doses in the various stages of pregnancy could be beneficial and should be investigated.

Omentin and chemerin and their association with obesity in women with polycystic ovary syndrome.

We aimed to investigate whether overweight/obesity is associated with omentin and chemerin. The study group consisted of 81 women with Polycystic ovarian syndrome (PCOS) (41 lean, BMI < 25 kg/m² and 40 overweight or obese, BMI > 25 kg/m²) and 61 healthy subjects (31 lean, BMI < 25 kg/m² and 30 overweight or obese, BMI > 25 kg/m²; control group). The clinical, endocrine, metabolic parameters, plasma omentin and chemerin levels were measured in patients and compared to control. In all subjects with PCOS (n = 80), serum chemerin levels were higher compared with those of the controls (n = 58) (7.71 ± 1.78 ng/mL versus 6.94 ± 0.82 ng/mL, p = 0.003). However, serum omentin levels were not significantly different between the PCOS subjects and the controls (1.55 ± 0.43 ng/mL versus 1.69 ± 0.37 ng/mL, p = 0.056). The mean chemerin concentrations were significantly elevated in the obese PCOS group compared with the obese control subjects (8.98 ± 1.45 ng/mL versus 7.02 ± 0.67 ng/mL, p = 0.000) and the nonobese PCOS group compared with the obese control subjects (6.57 ± 1.17 ng/mL versus 7.02 ± 0.67 ng/mL, p = 0.000). In conclusion, fat mass seems to be the main determinant factor of increased chemerin and decreased omentin in women with PCOS.

Favorable outcomes for both mother and baby are possible in pregnant women with Crimean-Congo hemorrhagic fever disease: a case series and literature review.

To assess the impact of Crimean-Congo hemorrhagic fever (CCHF) infection during pregnancy on maternal and fetal outcomes, we present the clinical and laboratory findings and outcomes of 5 pregnant women with CCHF infection as well as fetal outcomes. We also reviewed previously reported cases with CCHF infection in pregnant women. All pregnant women with CCHF infection who had been hospitalized between August 2007 and September 2011 were included. The gestational ages at the time of CCHF infection were 8, 18, 20, 21 and 32 weeks. CCHF infection was acquired during the 1st trimester in only 1 case and resulted in spontaneous abortion. The other 4 pregnant women completely recovered, all reached a healthy full-term gestation and 4 term babies were born. All infants had normal birth weight and were found to be healthy on their first examination and follow-up. In the literature concerning CCHF infection in pregnancy, 8 published articles including case reports or case series and 1 poster presentation including 1 case could be accessed. In conclusion, there is a risk of vertical transmission of CCHF infection, and infections acquired early in gestation had a poor prognosis for the fetus.

Fascia Lata-Fat Island Graft in Septal Perforation Repair.

Objective: To measure the success of the fascia lata-fat island graft technique in septal perforation repair as measured by nasal endoscopic examination. Background: This study presents the results of using fascia lata-fat island, a different graft technique, for the repair of septal perforations, offering an alternative to this challenging procedure. Methods: This retrospective study assesses nasal septal perforation repair using the fascia lata-fat island graft technique performed by a single surgeon. Inclusion criteria involved completing 12-month follow-ups within a 3-year review period. Success rates were calculated and evaluated alongside patient characteristics. Results: The median (range) age of the 25 patients included in the study was 34 (25-45) years and 72.0% were men. The septal perforation size of all patients was >2 cm and the etiological cause in all of them was previous septal surgery. All patients were followed for 12 months. The perforation was completely closed in 23 of 25 patients (92%). Conclusion: Using a different graft with an open rhinoplasty approach, we achieved a high success rate in patients with large septal perforations, followed for 1 month with nasal stenting and an average follow-up duration of 12 months.

Assessment of impaired glucose tolerance prevalence with hemoglobin A1c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study.

STUDY QUESTION: What is the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and controls in a Turkish population? SUMMARY ANSWER: The total prevalence of glucose abnormalities in PCOS patients was 16.3% [impaired glucose tolerance (IGT) 14.3%; type 2 diabetes mellitus (T2DM) 2%] and was higher than in healthy subjects (IGT 8.5%; T2DM 0%, respectively). WHAT IS KNOWN ALREADY: One of the most common markers of chronic glycemia is hemoglobin Alc (HbA1c). However, little is known about whether the use of HbA1c results in diagnosis of more cases of glucose intolerance in the PCOS population than the oral glucose tolerance test (OGTT) alone. STUDY DESIGN, SIZE, DURATION: This was a prospective study, including 252 women with PCOS and 117 control women without PCOS. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was carried out in the gynecological outpatient department of Namik Kemal University Hospital, Turkey, between 2010 and 2012. Women with PCOS (n = 252) were diagnosed according to Rotterdam criteria. The control group included 117 women (aged 17-45 years) who were selected randomly. BMI of participants ranged between 15.6 and 47.9 kg/m(2). MAIN RESULTS AND THE ROLE OF CHANCE: Patients with PCOS were comparable to controls in terms of age (24.8 versus 25.9 years, respectively) and had higher BMI (26.1 versus 24.9 kg/m(2), respectively). Of 252 patients with PCOS, 41 had glucose intolerance (IGT 14.3%; T2DM 2%) when compared with 10 of the 117 control patients (IGT 8.5%; T2DM 0%; odds ratios = 2.08; P = 0.045) during the OGTT. When an HbA1c value ≥ 5.6% was used to divide the total population, the prevalence of abnormal glucose metabolism was 7.9% in the patients with PCOS, below the value detected in the control patients (8.5%), which showed that 20 of 41 patients with abnormal glucose tolerance would not have been diagnosed, if the HbA1c alone had been used. When compared with the OGTT results, HbA1c provided 52.4% sensitivity, 74.4% specificity, 67.1% positive and 60.9% negative predictive values with a threshold value of 5.6% in abnormal glucose tolerance. The receiver operating characteristic analysis suggested a threshold value of 5.35% in HbA1c (75.6% sensitivity and 52.6% specificity) for the prediction of abnormal glucose tolerance. LIMITATIONS, REASONS FOR CAUTION: This study did not involve weight-matched healthy subjects, which may cause a difference in prevalence of abnormal glucose metabolism between the groups, and the results are limited to an unselected population of patients who have the full PCOS phenotype. In addition, the incidence of T2DM among the first-degree relatives and 2-h insulin levels could not be reported in full. WIDER IMPLICATIONS OF THE FINDINGS: Further investigation of the efficacy of HbA1c for the prediction of abnormal glucose tolerance should be undertaken in long-term prospective studies and in different geographic populations. At present, the only way to reliably detect abnormal glucose metabolism in Turkish women with PCOS appears to be using the OGTT. STUDY FUNDING/COMPETING INTEREST(S): No financial support. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: Not applicable.

Decreased ovarian reserve in female Sprague-Dawley rats induced by isotretinoin (retinoic acid) exposure.

Isotretinoin is a retinoid widely used for the treatment of severe nodulocystic acne. Although it has broad side effects, there is no well-designed study about its effects on the ovary. This study investigated possible toxic effects of isotretinoin on female gonads. A total of 30 female rats were randomly divided into three equal groups according to the dose of isotretinoin they were administered: 0 mg/kg/day (group 1), 7.5 mg/kg/day (group 2) or 15 mg/kg/day (group 3). Thirty days after the treatment, the effects of isotretinoin on the ovaries were evaluated with serum anti-Müllerian hormone (AMH) concentrations, apoptosis by TUNEL assay and immunohistochemical observations by proliferating cell nuclear antigen (PCNA). The percentage of atretic follicles was calculated for each stage of folliculogenesis. The serum AMH concentrations were found to be lower in both isotretinoin groups. The percentage of atretic follicles in both isotretinoin groups was higher than the control. The number of PCNA-positive granulosa cells was decreased in the isotretinoin groups. The number of ovarian follicles with apoptotic granulosa cells was increased in the experimental groups. These data are the first to identify that exposure of isotretinoin may be responsible for decreased ovarian reserve and toxic effects on rat ovaries.

The relationship between copper, homocysteine and early vascular disease in lean women with polycystic ovary syndrome.

This study investigates copper (Cu) levels and vascular dysfunction in lean women with polycystic ovary syndrome (PCOS). 44 subjects with PCOS, diagnosed according to Rotterdam criteria, and 42 healthy subjects matched for body mass index and age. Comparison of serum Cu, homocysteine, carotid intima-media thickness (CIMT), brachial artery flow mediated dilation (FMD) was carried out between PCOS patients and the control group. Clinical study was done in Namik Kemal University School of Medicine. The CIMT and concentration of Cu in PCOS patients was significantly higher than the healthy controls. FMD levels in PCOS patients were significantly lower than those in controls. In PCOS patients, CIMT was correlated with estrogen and Cu levels. However, FMD was correlated with age and Cu levels. Among these contributing factors, Cu levels were correlated with a change in CIMT and FMD. CIMT and FMD in PCOS patients were related to Cu levels as well as several cardiovascular risk factors. Thus, increased Cu levels may be responsible for the increased risk of early vascular disease in women with PCOS.

Cytotoxic, Antioxidant, Antibiofilm, and Antimicrobial Activities of Mushroom Species from Turkey.

Mushrooms, which have been collected to meet the nutritional needs of the world for many years, have gained medical importance thanks to the bioactive compounds they produce. Thanks to studies carried out to determine mushroom diversity, the number of species identified is increasing year by year. Accordingly, in recent years, studies conducted to determine the biological activities of metabolites produced by fungi have been increasing. The present study was conducted to determine the cytotoxic, antioxidant, antibiofilm and antimicrobial activities of the seven different mushroom species (Craterellus cornucopioides, Hymenopellis radicata, Lepista nuda, Pisolithus arhizus, Ramaria flava, Schizophyllum commune, and Tricholoma ustale) collected from Tokat and Yozgat regions located in northern and central Turkey. Laboratory studies have demonstrated that mushrooms used in this study have different degrees of antibiofilm, antimicrobial, antioxidant and cytotoxic activities. At the end of the study, it is determined that C. cornucopioides and L. nuda species have the highest antimicrobial activity. In addition, mushroom species have biofilm inhibitory effects on indicator microorganisms at varying degrees ranging between 20.7 and 96.3%. As a result of antioxidant activity studies, it was determined that T. ustale has the highest free radical scavenging effect and P. arhizus, which has the highest polyphenol content, has the highest reducing power. Finally, it is determined that, among the mushrooms used in the present study, H. radicata showed higher selectivity on the MDA-MB-231 breast cancer cell line than on the normal cell line tested, while C. cornucopioides showed higher selectivity on the MCF-7 breast cancer cell line.

An assessment of the effects of adenoid hypertrophy on mucociliary clearance and nasal cytology in children.

AIM/OBJECTIVE: The aim of this study was to demonstrate the benefits of the systematic use of nasal cytology and mucociliary clearance in the diagnostic workup of nasal disorders in children with adenoid hypertrophy (AH) to reach a well-defined diagnosis, establish a rational therapeutic approach, avert from complications, and develop the patient's life quality. MATERIALS/METHODS: In this prospective study, a total of 61 pediatric patients (aged 5-12 years) were evaluated. The case group consisted of 31 children with AH symptoms, while the control group comprised 30 children without AH symptoms.Exclusions included previous adenoidectomy/adenotonsillectomy, cardiovascular/neurological diseases, acute/allergic rhinitis, genetic disorders (e.g., Down syndrome), and immunodeficiency. The control group consisted of children without nasal obstruction symptoms and without AH, who admitted for various reasons. Medical history, examinations, fiberoptic nasopharyngoscopy, cephalometric evaluations, AST, and nasal cytology were conducted. RESULTS: At the end of the study, a significant increase in the mucociliary clearance time was observed in the group with AH compared to the control group (p < 0.05). Although AH may disrupt MCC, there is no correlation between the size of the hypertrophy and MCC time.When the distribution of cells in the nasal cytology is evaluated, no difference was detected between the AH group and control groups. CONCLUSION: Nasal mucociliary clearance has been found to be decreased, particularly in the presence of significant AH.