Nurses' Knowledge and Opinions on HPV Vaccination: a Cross-Sectional Study from Istanbul.

Implementing a HPV vaccination program is currently under evaluation by the Turkish health ministry. For screening and vaccination programs to be successful, the cooperation of nurses is essential. We aimed to evaluate (1) basic knowledge of nurses and nursing interns regarding HPV infection and cervical cancer, (2) their attitudes towards smear testing and HPV vaccination, and (3) their viewpoint on vaccination of school age children. This cross-sectional study was undertaken at Bezmialem Vakif University. The survey was designed to assess knowledge about HPV infection, Pap smear testing, cervical cancer, HPV vaccine, attitudes towards HPV vaccination, and school-based vaccination programs. Validity content was determined by expert gynecologists, and a pilot study was performed on 10 nurses. A total of 550 questionnaires were handed out; 499 were completed. Our response rate was 90.7%. Fifty-nine participants answered all the knowledge questions correctly. The calculated knowledge score of the female participants was 6.99 ± 2.22, the male participants was 5.89 ± 2.92. Female participants were more knowledgeable (p < 0.0001). Out of the 353 female participants, 18.6% (n = 66) had undergone smear testing. There were 20 (5.6%) female and 6 (4%) male participants who were vaccinated against HPV. The leading answer for not having a HPV vaccine was "I'm not at risk for a HPV infection" (n = 106, 34.9%). There was a statistical relationship between "HPV knowledge score" and answering "Yes" to "Do you want your children/future children to be vaccinated? (p = 0.001) and "Do you think including the vaccine in the Turkish immunization program is necessary?" (p = 0.001). Nurses in our cohort seem to have satisfactory basic knowledge regarding HPV infection; however, their viewpoints on vaccination were not favorable. Strategies and intervention materials for HPV vaccination will be necessary if a national immunization program will be initiated.

Survivin Expression in Simple Endometrial Polyps and Tamoxifen-associated Endometrial Polyps.

Endometrial polyps are benign pathologies originating as localized overgrowths of basal endometrium. Risk factors include endogenous and exogenous estrogen excess and tamoxifen (TAM) exposure. Our main objective was to investigate the role of an apoptosis-inhibiting protein, survivin, in endometrial polyps. We performed a cross-sectional, analytical study; our samples were obtained from the archives of the Department of Pathology. Sixty samples were included, comprising 20 TAM polyps, 20 simple endometrial polyps, and 20 cases of simple endometrial hyperplasia without atypia not associated with TAM use. Immunohistochemical staining with rabbit monoclonal anti-human survivin, clone EP 119, was performed. Survivin staining score was highest in the endometrial polyp group and lowest in the TAM polyp group (P<0.001). There was no correlation between survivin staining score and the age of patient (r=0.09), TAM exposure (r=-0.02), nor endometrial thickness (r=0.25). Endometrial polyps are frequently associated with TAM. The low expression of the antiapoptotic marker survivin in TAM polyps but high expression in other polypoid endometrium illustrates that different mechanisms are responsible in the pathogenesis of endometrial polyps. It is possible that there is a direct effect of TAM on apoptosis or indirect effect through a progesterone-related mechanism.

Amniotic fluid "sludge"; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery.

INTRODUCTION: The aim of our study is to determine prevalence and clinical significance of the presence of amniotic fluid "sludge" among asymptomatic patients at high-risk for spontaneous preterm delivery, prospectively. MATERIAL AND METHODS: In our study, 99 patients at high risk for spontaneous preterm delivery were evaluated for the presence of amniotic fluid sludge with transvaginal ultrasonography at 20-22, 26-28, and 32-34 gestational weeks, prospectively; between August 2009 and October 2010 in Hacettepe University Hospital. And, these patients were followed up for their delivery weeks and pregnancy outcomes. We defined the high-risk group as the patients possessing one or more of the followings; a history of spontaneous preterm delivery, recent urinary tract infections, polyhydramnios, uterine leiomyomas, müllerian duct anomalies, and history of cone biyopsy or LEEP. Patients with multiple gestations, placenta previa, fetal anomalies, or symptoms of preterm labor at first examination were excluded. We have obtained ethical board approval from Hacettepe University (16.07.2009-HEK/No:09-141-59). RESULTS: The prevalence of amniotic fluid sludge in the study population was 19,6% (18/92). The rates of spontaneous preterm delivery at <37 weeks of gestation were 66,7% (12/18), within the patients with sludge and 27,0% (20/74) within the patients without sludge. Patients with sludge had a higher rate of spontaneous preterm delivery (p = 0.002). A higher proportion of neonates born to patients with amniotic fluid sludge had a neonatal morbidity (50% (9/18) vs. 24,3% (18/74), p = 0.044) and died in the perinatal period, (p = 0,013) than those born to patients without sludge. When we combined sludge and cervical lenght (CL) (<25 mm) and used it as a screening test to identify women at risk for preterm delivery; it catched more women with preterm delivery, (p = 0.000). While sensitivity of sludge was 37,5%, and sensitivity of CL was 34%, sensitivity of "sludge positive or CL ≤25 mm" was 56% for preterm birth (PTB) in high-risk group. CONCLUSIONS: The prevalence of amniotic fluid sludge is 19,6% and "sludge" is an independent risk factor for spontaneous preterm delivery among asymptomatic patients at high-risk for spontaneous preterm delivery. PTB is by far the leading cause of infant mortality, and prevention of PTB has been an elusive goal. When sludge added to screening, we can catch more PTB.

Dental health dispositions of pregnant women: A survey from a hospital clinic in Istanbul.

Dental hygienic habits should be maintained in pregnancy despite challenges. We aimed to study the dental attitudes and habits of pregnant women. The patients attending our hospital clinic were invited to fill out a structured questionnaire categorised into three major domains: (1) general oral hygiene status, (2) dental habits, and (3) dental attandence both during pregnancy and prior to pregnancy. Four hundred and seventy four women agreed to participate. Mean age of participants was 28 (18-43). While 184 (38%) women reported brushing twice a day, only 98 (20%) women claimed using floss and or mouth rinse. Fifty-nine (12.4%) women had a dental visit in their current pregnancy and 24 (5.1%) received professional treatment. Obstetric care givers should convey the importance of dental care to their patients. We suggest that dental health should be improved antenatally, and be assessed in detail by dental health care providers. Impact Statement Poor oral health conditions have shown to be associated with an increased risk of adverse pregnancy outcomes, especially in low-income countries and regions. There is escalating evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene. Our results showed that dental hygienic practices of pregnant women are disconcerting in Turkey. The need for inter-professional collaboration among obstetric healthcare providers and dental specialistis is crucial for conveying to women the importance of dental care in pregnancy and beyond.

A rat hysteropexy model for evaluating adhesion formation and comparison of two different structured meshes.

INTRODUCTION AND HYPOTHESIS: Peritonization of mesh during sacrohysteropexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking, and peritonization may not be completely possible in a laparoscopic hysteropexy procedure. Our main objective was to describe a basic experimental rat sacrohysteropexy model. We hypothesized that even when peritoneal closure was omitted, using composite mesh would result in less adhesions to the viscera. METHODS: Twenty in-bred female virgin Wistar Hannover rats were used in this study. Standardized hysteropexy procedure and adhesion model is described step by step with two different mesh materials: polypropylene and a composite polyester. Mesh was anchored between the posterior cervix and anterior longitudinal ligament of the lumbar vertebrae. Macroscopic adhesion scores and histopathological tissue reaction was investigated. RESULTS: Macroscopically, the surface area involved in adhesions was similar between groups. However, adhesions in the polypropylene group were more dense, required sharp dissection for lysis, and yielded higher total macroscopic adhesion scores (p < 0.001). Histologically, a more pronounced host inflammatory response was encountered in the polyester group (p < 0.001). CONCLUSIONS: We describe a rat hysteropexy model and a previously established uterine adhesion model. Adhesion scores in the composite mesh group were lower, and bowel involvement was not seen. Our findings are promising, and further research investigating antiadhesive composite mesh use for hysterosacropexy would be appropriate, especially when peritoneal closure is omitted.

Uterine tumors resembling ovarian sex cord-stromal tumors: synchronous uterine tumors resembling ovarian sex cord-stromal tumors and ovarian sex cord tumor.

Uterine tumors resembling ovarian sex cord-stromal tumors (UTROSCTs) are very rare. In this article, we present 3 cases that manifest classical histomorphological features alongside diverse immunohistochemical findings. As a distinctive finding, one of the patients had UTROSCT in the uterus and an ovarian sex cord tumor, called granulosa cell tumor, in the left ovary, simultaneously. Problems in diagnosing such pathologic condition generally arise because of the variable histologic picture of UTROSCT and may cause problems for general and other nongynecologic surgical pathologists. Immunohistochemically, these tumors express different markers that indicate their polyphenotypic origins.