The Use of Thiol/Disulfide as a Novel Marker in Premature Ovarian Failure.

The study aimed to compare the dynamic thiol/disulfide homeostasis between patients with premature ovarian failure (POF) and healthy women. A total of 77 women, 40 POF and 37 healthy controls, were recruited from a university hospital between December 2013 and June 2015. Blood samples were taken from patients to evaluate follicle stimulating hormone (FSH), luteinizing hormone, estradiol and thiol/disulfide levels. A new, fully automated method was used to measure plasma thiol, total thiol and disulfide levels. Disulfide levels, disulfide/native thiol and disulfide/total thiol ratios were significantly increased, native thiol/total thiol levels were significantly decreased in POF patients compared to controls (p < 0.001). FSH was negatively correlated with native thiol and native thiol/total thiol levels and positively with disulfide, disulfide/native thiol, and disulfide/total thiol levels. This is the first study demonstrating the thiol/disulfide homeostasis in women with POF and may help us understanding the pathophysiology.

A guide on how to build a novel home-made part task training simulator for cervical cerclage training.

Cervical cerclage is a experience demanding procedure and which is difficult for most of the residents and maternal fetal medicine fellows to have the first experience on real patients. In this study we presented an in-expensive and easy to build model for cervical cerclage training.

Evaluation of preventive effect of shilajit on radiation-induced apoptosis on ovaries.

PURPOSE: Canc er is the second leading cause of death in children in developed countries and most of childhood malignancies can be treated with chemo-radiotherapy. Although radiation therapy is a successful treatment modality in cancer patients, it has various adverse effects. Especially the gonads are very sensitive and prone to radiation-related damage. Radiation impairs the ovaries by triggering apoptosis of follicular cells and chromosomal damage and oxidative stress. Shilajit, a traditional medicinal agent in India, Russia, and other parts of the world, contains various antioxidant agents and has ovogenic effects. To evaluate the ability of shilajit to prevent radiation-induced ovarian damage. METHODS: Forty Wistar albino female rats were divided into four groups as: Control group, shilajit group, radiation only group, and radiation + shilajit group. Four days after radiation exposure, the rats were sacrificed and the ovaries were removed and evaluated immuno-histopathologically. RESULTS: There was a statistically significant difference in follicle counts (primordial, primary, preantral, antral, and atretic follicles) between the groups (p < 0.001). Almost all follicles at all stages were atretic in the radiation only group whereas normal-looking primordial follicles were detected in the radiation + shilajit group. In radiation + shilajit group, p53, Bax and caspase 3 expression was less intense than that in the radiation only group follicles. CONCLUSION: This is the first reported study evaluating the effects of shilajit on radiation-related ovarian damage prevention. Shilajit decreased the expression of p53, Bax, and caspase 3, thereby blocking the apoptotic pathways. Shilajit was found to be especially protective of primordial follicles.

Comparison of the predictive value of plateletcrit with various other blood parameters in gestational diabetes development.

Gestational diabetes is the most encountered metabolic disease in pregnancy and affects both the mother and fetus adversely. Low-grade subchronic inflammation is associated with gestational diabetes development. Platelets (PLT) play role in blood coagulation and inflammatory process. We aimed to compare the various platelet indices in patients with GDM and healthy pregnant controls and to determine whether PLT indices are useful in Gestational diabetes diagnosis. The present study was performed at the Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology. Statistically significant relationships with plateletcrit, mean platelet volume, and platelet distribution width and patients with GDM were found (p < 0.001). Plateletcrit had higher sensitivity and specificity than other platelet indices. Although plateletcrit is a largely unknown or an underestimated parameter in complete blood count, it gives more precise information than platelet count and mean platelet volume. Platelet-related indices and their determination are inexpensive and routinely ordered markers, the significance of which is often ignored. They may be useful in screening for gestational diabetes as an adjunct to oral glucose tolerance test.

Does anticoagulant therapy improve adverse pregnancy outcomes in patients with history of recurrent pregnancy loss?

OBJECTIVES: Recurrent pregnancy loss (RPL) is a serious problem in the reproductive age women. We aimed to study the role of anticoagulant therapy on pregnancy complications and perinatal outcomes in pregnant patients with histories of RPL. MATERIAL AND METHODS: One hundred fifty-three pregnants, with RPL history and thrombophilia positivity, were grouped into two as 89 treated with anticoagulant therapy and 64 non-treated. Treated and untreated groups were compared for pregnancy complications, delivery weeks, abortion rates, fetal birth weights, APGAR scores, live birth rates, and newborn intensive care admission rates. RESULTS: Of the total 153 pregnant patients (63%) 97 developed pregnancy complications; 55 (56.7%) were in the untreated group and 42 (43.3%) were in the treated group, which was statistically significant (p = 0.003). The differences in pregnancy complications were produced by differences in the numbers of IUFDs and anembryonic fetuses among the groups. The average neonatal birth weights of infants whose mothers had taken LMWH + ASA were significantly higher (p=0.011). The prematurely delivered infants were admitted to the neonatal intensive care unit (NICU), and the NICU requirements were not statistically different between the groups (p = 0.446). However, live birth rates were significantly higher in the treated group than in the untreated group (p = 0.001). CONCLUSIONS: Anticoagulant therapy improves pregnancy complications and live birth rates in patients with RPL and hereditary thrombophilia.

Cholecalciferol (vitamin D3) prevents postoperative adhesion formation by inactivating the nuclear factor kappa B pathway: a randomized experimental study.

BACKGROUND: Postoperative peritoneal adhesions are major complications of abdomino-pelvic surgeries. We aim to investigate the preventive and therapeutic effects of cholecalciferol (vitamin D3) supplementation on postoperative peritoneal adhesion (PPA) in a rat model. MATERIALS AND METHODS: This randomized, controlled, single blinded animal study was performed in university laboratory. Thirty-two female Wistar albino rats were randomly separated into four equal groups as, group 1: (21-d vitamin-D treatment group), group 2: (21-d corn oil group), group 3: (14-d vitamin-D treatment group), and group 4: (control group). Uterine horns were traumatized with bipolar cautery for adhesion formation process. On postoperative day 14, all the animals were sacrificed and evaluated for adhesions. Adhesion extent, severity, degree, and total adhesion scores were evaluated macroscopically. Histopathologically, adhesions were evaluated for inflammation, fibrosis, and NFκB (nuclear factor kappa b) staining. RESULTS: On postoperative day 14, we found lesser peritoneal adhesion severity, degree, extent, and total adhesion scores with vitamin-D administration compared with control and corn oil-treated groups; the difference was statistically significant (P < 0.001). Histopathologic adhesion scores of inflammation and fibrosis were statistically different among the four groups (P < 0.001). NFκB staining was markedly increased in control and vehicle groups. The NFκB staining scores were statistically different between the groups (P < 0.001). The intensity of NFκB staining was lower in both vitamin 14 and 21-d vitamin-D groups. CONCLUSIONS: Vitamin D as a supplement and as a therapeutic medicine decreases the formation of PPA in an animal model. In future studies, the association of vitamin D deficiency and PPA should be studied. In addition, vitamin D should be investigated in future clinical studies for the prevention of PPAs.

A novel preoperative scoring system for predicting endometrial cancer in patients with complex atypical endometrial hyperplasia and accuracy of frozen section pathological examination in this context: a multicenter study.

OBJECTIVE: To estimate the accuracy of frozen pathological analysis in patients preoperatively diagnosed with endometrial atypical complex hyperplasia (ACH) and to develop a model predicting the probability of the presence of endometrial carcinoma in ACH. METHODS: Patients (n = 128) who underwent total hysterectomies because of diagnoses of ACH were evaluated at four tertiary centers. RESULTS: Diagnoses made using frozen sections and permanent sections were in good agreement (ĸ = 0.61, p < 0.0001). A useful scoring system combining weighted risk factors derived from a regression model is as follows: (2 × age ≥50 years) + (3 × BMI ≥30) + (2 × menopausal status) + (2 × diabetes comorbidity) + (3 × endometrial thickness >12 mm). The AUC of this score was 0.793, and the score afforded 80.9% sensitivity, 70.3% specificity, a 75.3% positive predictive value, and a 76.4% negative predictive value, when a score of 5 was used as a cutoff. CONCLUSIONS: Patients with ACH should be evaluated by gynecological oncologists and intraoperative frozen section analysis should be performed by pathologists specializing in the evaluation of gynecological malignancies, because ACH is closely associated with endometrial cancer (EC). Our novel preoperative scoring system may aid in the detection of patients at increased risk of EC and thus guide general gynecologists.

Pycnogenol prevents peritoneal adhesions.

PURPOSE: This study tested the ability of pycnogenol, an extract from the bark of the French maritime pine (Pinus pinaster), to prevent intra-abdominal adhesions. METHODS: Thirty female Wistar albino rats were separated randomly into three equal groups: Group (1) the control group, which underwent surgery, but was given no drug; Group (2) given 10 mg/kg of pycnogenol dissolved in normal saline intraperitoneally for 10 days after surgery; and Group (3) given 0.1 mL of normal saline for 10 days intraperitoneally after surgery. On post-operative day 10, all of the animals were killed and any adhesions were evaluated macroscopically and histopathologically. RESULTS: The macroscopic adhesion scores (mean ± SD) for Groups 1, 2, and 3 were 2.5 ± 0.53, 0.60 ± 0.70, and 2.0 ± 0.82, respectively. The macroscopic adhesion score was significantly lower in Group 2 than in Groups 1 and 3 (p < 0.001). All three components of the histopathological evaluation (inflammation, fibrosis, and neovascularization) were significantly lower in Group 2 than in Groups 1 or 3 (p < 0.001, p < 0.001, and p = 0.004, respectively). CONCLUSIONS: Pycnogenol was found to be effective at preventing surgery-related adhesions in an animal model.

Effect of Nigella sativa oil on postoperative peritoneal adhesion formation.

AIM: We aim to evaluate the effect of Nigella sativa oil (NSO) on postoperative peritoneal adhesion formation in female rats. This experimental study is the first on the prevention of postoperative adhesion formation by NSO. METHODS: Twenty-four Wistar albino female rats were randomly assigned to three groups of eight rats each. Rats in group 1 were each injected i.p. with 1 mL of NSO. In group 2, an adhesion model was created with no injection of NSO. In group 3, an adhesion model was created and the area was covered with 1 mL of NSO. The rats were killed on postoperative day 8, and the severity of adhesions was evaluated macroscopically and histopathologically. RESULTS: There was a statistically significant difference in adhesion scores between group 2 (control) and group 3 (NSO-treated) (P = 0.003). Statistically significant differences in angiogenesis, fibrosis and inflammation were observed between the control and Nigella sativa groups (P = 0.002, P = 0.001 and P = 0.004, respectively). CONCLUSION: Covering peritoneal surfaces with NSO after peritoneal trauma is effective in decreasing peritoneal adhesion formation.

Labor induction in term premature rupture of membranes: comparison between oxytocin and dinoprostone followed 6 hours later by oxytocin.

OBJECTIVE: The aim of this randomized study was to compare 2 protocols for inducing labor in women with premature rupture of membranes (PROM) at term. STUDY DESIGN: Women with PROM and a Bishop score ≤5 were randomly assigned to receive either an intravenous oxytocin infusion (n = 223) or a dinoprostone pessary followed 6 hours later by an intravenous oxytocin infusion (n = 227). RESULTS: Vaginal delivery within 24 hours of labor induction increased significantly with sustained-released dinoprostone followed by oxytocin infusion (78.5% vs 63.3%; relative risk, 1.23; 95% confidence interval, 1.09-1.39; P = .001). Maternal and neonatal outcomes were similar between the groups. CONCLUSION: Sustained-released dinoprostone followed 6 hours later by an oxytocin infusion in term women with PROM was associated with a higher rate of vaginal delivery within 24 hours, and no difference in maternal-neonatal complications was observed compared with oxytocin infusion alone.

Postmenopausal tuberculosis endometritis.

Tuberculosis remains a global health problem, primarily in developing countries with inadequate health services. A significant portion of tuberculosis in these settings is extrapulmonary, including tuberculosis of the genitourinary tract. Patients with genital tuberculosis are usually young women detected during work up for infertility. After menopause, tuberculosis of the endometrium is a rare possibility probably because of the decreased vascularity of the tissues. We present a case of endometrial tuberculosis with postmenopausal vaginal bleeding.

Are the women with Sjögren's Syndrome satisfied with their sexual activity?

OBJECTIVE: Females with Sjögren's Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. METHODS: Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. RESULTS: The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p<0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p<0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p<0.001). Life quality scores were significantly lower in patients with SS than the controls (p<0.001). Vaginal dryness was negatively correlated with FSFI total (r=-0.312, p=0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r=0.449, p=0.002, r=0.371, p=0.011, r=0.299, p=0.043, respectively). CONCLUSIONS: Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management.

Premenstrual syndrome and life quality in Turkish health science students.

BACKGROUND/AIM: The purpose of the present study was to investigate the incidence of PMS, risk factors affecting PMS symptoms, and life quality in health science students. MATERIALS AND METHODS: A total of 608 volunteer female students studying at the health campus of a state university in Turkey were included in the study. The participants were asked to fill out questionnaires on sociodemographic data, PMS symptoms, and SF-36 life quality tests. RESULTS: The overall frequency of PMS among participants was 84.5%. The average PMS and general health SF scores were 118.34 ± 37.3 and 20.03 ± 3.72, respectively. Students who had irregular breakfast, drank ≥2 cups of coffee/day, and consumed alcohol or fast food had higher PMS scores. Irregular menstruation and family history increased PMS scores and decreased life quality (P < 0.05). The life quality of the students significantly decreased as the severity of PMS increased (P < 0.001). CONCLUSION: Low body mass index, family history, irregular menstruation, bad eating habits such as fast food consumption and irregular breakfasts, and coffee and alcohol consumption increased PMS risk significantly. In order to improve their life quality, students should be informed about the symptoms, risk factors, and management options of PMS.

Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse?

OBJECTIVES: Pelvic organ prolapse (POP) is an important problem for women with multifactorial etiology. This study aims to determine the role of hypertension (HT) and diabetes mellitus (DM) in POP. STUDY DESIGN: The study included 586 women admitted to Bulent Ecevit University Hospital between September 2013 and April 2015 for hysterectomy, comprising 186 patients with POP and 400 patients without. The demographic characteristics, age, body mass index (BMI), obstetrical history, type of delivery, associated medical diseases, and benign gynecological diseases were recorded. HT, DM, or both together were particularly considered as coexisting medical diseases. RESULTS: Median gravida, parity, and live birth numbers were significantly higher in POP patients (4 vs. 3, 3 vs. 2, and 3 vs. 2 respectively, p<0.001). POP patients were more obese than POP-absent patients (p<0.001). Vaginal history of birth increased POP frequency to 25.8% with statistical significance (p<0.001). There was no significant difference between groups regarding coexisting endometritis, endometrial polyp, endometriosis, endometrial hyperplasia (p>0.05). There was a significant difference between groups regarding comorbid diseases (p<0.001). Logistic regression analysis for risk factors of POP revealed age, BMI, vaginal parturition, and co-morbidity with HT+DM together significantly increased POP risk (p<0.05). HT+DM together significantly increased risks with OR of 1.9 (1.1-3.16). CONCLUSIONS: In addition to multiple factors increasing POP risk, comorbidities as HT+DM together should be considered as risk factors. Patients with these comorbidities should be encouraged to change their lifestyles to prevent POP.

Can Plateletcrit be a Marker for Recurrent Pregnancy Loss?

AIM: To determine the utility of platelet (PLT) indices for the prediction of recurrent pregnancy loss (RPL). METHODS: In all, 208 patients who experienced 2 or more first trimester spontaneous abortions and 95 controls who had no abortions were studied. The hematological markers, including plateletcrit (PCT) and neutrophil (Neu) to lymphocyte (Lym) ratio (NLR), were measured. Thrombophilia genetic tests for factor V Leiden mutation, prothrombin G202I0A mutation, and methylenetetrahydrofolate reductase C677 T and A1298C mutations were performed. RESULTS: The PLT count, PCT, white blood cell count, red cell distribution width (RDW), Lym and Neu count, and NLR were significantly higher in patients with RPL than in controls. The RDW, PLT, and PCT values were higher in the low-risk group, whereas mean PLT volume values were lower than the high-risk group values. CONCLUSION: Plateletcrit is a low-cost, widely available marker for prediction of RPL in patients with a history of at least 1 abortus.

Is Xanthine oxidase activity in polycystic ovary syndrome associated with inflammatory and cardiovascular risk factors?

The aim of this study is to examine women with polycystic ovary syndrome (PCOS) to determine the relationship between xanthine oxidase (XO) and oxidative stress, inflammatory status, and various clinical and biochemical parameters. In this cross-sectional study a total of 83 women including 45 PCOS patients and 38 healthy women were enrolled. We collected blood samples for XO and superoxide dismutase (SOD) activity, hormone levels, cholesterol values, and inflammatory markers. Body mass index (BMI) , waist-to-hip ratio (WHR), and blood pressure were assessed. Blood samples were taken for hormonal levels, cholesterol levels, fasting plasma glucose (FPG), fasting plasma insulin (FPI), homeostatic model assessment-insulin resistance (HOMA-IR) index, quantitative insulin sensitivity check index (QUICKI), C-reactive protein (CRP), white blood cell and neutrophil counts, XO and SOD activities. The basal hormone levels, triglyceride (TG) levels, TG/HDL-C (high density lipoprotein-cholesterol) ratios FPG, FPI and HOMA-IR levels were higher in PCOS patients compared to controls (p<0.05). Platelet and plateletcrit (PCT) values, CRP, and XO activity were significantly increased, however SOD activity was decreased in PCOS patients (p<0.001). XO activity was positively correlated with LH/FSH and TG/HDL ratios, CRP, PCT, FPG, FPI, and HOMA-IR, and negatively correlated with QUICKI levels. In conclusion, XO is a useful marker to assess oxidative stress in PCOS patients. Positive correlations between XO and inflammatory markers and cardiovascular disease risk factors suggest that XO plays an important role in the pathogenesis of PCOS and its metabolic complications.

Borderline ovarian tumors: clinical characteristics, management, and outcomes - a multicenter study.

BACKGROUND: The optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs. METHODS: A retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS. RESULTS: In total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7-1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8-1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8-1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7-1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage ≥ IC was not an independent prognostic factor for DFS or OS. CONCLUSIONS: Patients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.

Bromelain: a natural proteolytic for intra-abdominal adhesion prevention.

INTRODUCTION: Peritoneal adhesions are pathological fibrous connections between peritoneal surfaces resulting from incomplete peritoneal repair. Adhesions cause various health problems ranging from pelvic pain and bowel obstruction to infertility. To date, no effective agent exists for intra-abdominal adhesion prevention. Bromelain is the crude extract of the pineapple and it has fibrinolytic, antithrombotic, and anti-inflammatory properties. Bromelain has been shown to be effective for removing necrotic tissues and has been found to be effective for treating various wounds, inflammatory conditions, and thrombotic pathologies. In the present study, we evaluated bromelain as a novel agent for preventing intra-abdominal adhesions. METHODS: Group 1 (control group): Adhesions were produced by cecal abrasion method, and no treatment was applied. Group 2 (i.p. bromelain-treated group): After adhesion formation, 10 mg/kg/BW of bromelain dissolved in 1 mL saline solution was applied intraperitoneally for 10 days. Group 3 (i.p. saline-treated group): After adhesion formation, 1 mL saline solution was applied intraperitoneally for 10 days. On postoperative day 10, all animals were sacrificed. RESULTS: All 30 rats survived surgery. Throughout the follow-up period, no complications were observed. Statistically significant differences were found between the groups with regards to macroscopic adhesion scores, inflammation, fibrosis and neo-vascularization (p < 0.001, <0.001, p = 0.001, p = 0.002, respectively). Macroscopic and histopathologic (inflammation, fibrosis, neo-vascularization) adhesion scores were lowest in the bromelain-treated group. CONCLUSION: Bromelain, acting through its barrier, anti-inflammatory, antioxidant, and proteolytic effects and without increasing bleeding tendency or having any adverse effects on wound healing, may be a suitable agent for intra-abdominal adhesion prevention.

Adjuvant treatment modalities, prognostic predictors and outcomes of uterine carcinosarcomas.

PURPOSE: The purpose of this study is to evaluate the clinicopathological characteristics, treatment, and prognosis of uterine carcinosarcoma (UC). MATERIALS AND METHODS: A retrospective review of three cancer registry databases in Turkey was conducted for identification of patients diagnosed with UC between January 1, 1996, and December 31, 2012. We collected clinicopathological data in order to evaluate factors important in disease- free survival (DFS) and overall survival (OS). RESULTS: A total of 66 patients with UC with a median age of 65.0 years were included in the analysis. The median survival time of all patients was 37.5 months and the 5-year OS rate was 59.1%. In early stage patients (I-II) who received adjuvant chemotherapy (CT) with radiation therapy (RT), the median DFS and OS was 44 months and 55 months, respectively, compared to 34.5 months and 36 months, respectively, in patients who received adjuvant RT or CT alone (hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.7 to 3.1 for DFS; p=0.23 and HR, 2.2; 95% CI, 0.9 to 5.3 for OS; p=0.03). In advanced stage patients (III-IV), the median DFS and OS of patients receiving adjuvant RT with CT was 25 months and 38 months, respectively, compared to 23.5 months and 24.5 months, respectively, in patients receiving adjuvant RT or CT alone (HR, 3.1; 95% CI, 0.6 to 16.0 for DFS; p=0.03); (HR, 3.3; 95% CI, 0.7 to 15.0 for OS; p=0.01). In multivariate analysis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage and suboptimal surgery showed significant association with poor OS. CONCLUSION: In patients with early or advanced stage UC, adjuvant CT with RT is associated with improved DFS and OS, as compared to CT or RT alone.