The Preseptic Period and Inflammatory Markers in the Prediction of the Course of Sepsis.

BACKGROUND The aim of this study was to find a simple and easily accessible scoring system that could predict the development of sepsis in the preseptic period. MATERIAL AND METHODS The study included 161 patients with a basal sequential organ failure assessment (SOFA) value of 2 or more. The sepsis group (n=83) comprised patients with infection reported in culture results; the control group (n=78) comprised patients not showing evidence of infection in blood, urine, and phlegm cultures; samples were taken on three consecutive days. RESULTS The patients in both groups were divided into subgroups of non-survivor and survivor patients. The preseptic and septic SOFA score, neutrophil lymphocyte ratio (NLR), and procalcitonin (PRC) and lactate (Lac) values were determined to be statistically significantly higher in the sepsis group than in the control group. When the values related to sepsis were examined, a strong relationship was determined between sepsis and SOFA score, PRC values, and Lac values in the preseptic period and a weak relationship with NLR. In the model formed using multiple regression analysis with defined cutoff values for the preseptic and the septic periods, we found that in the septic period, a diagnosis of sepsis could be made with 83.8% accuracy. The diagnostic value of the same parameters evaluated in the preseptic period was 77.9%. CONCLUSIONS The diagnostic value of the combination of Lac, PRC, SOFA, and NLR were found to be similar in the preseptic period as the sepsis period; thus these combined values could safely be used for the early diagnosis of sepsis.

Nigella Sativa Oil Protects the Rat Ovary from Oxidative Injury Due to Ischemia-Reperfusion.

BACKGROUND The aim of this study was to evaluate the effects of Nigella sativa (N. sativa) oil (NSO) on ovarian oxidative damage following ischemia-reperfusion injury, using a rat model of ovarian torsion. MATERIAL AND METHODS Forty-eight female albino Wistar rats were divided into six groups: (Group 1) laparotomy only; (Group 2) intraperitoneal NSO (2 ml/kg), 1 hour following laparotomy; (Group 3) 3 hours of ovarian ischemia; (Group 4) 3 hours of ovarian ischemia followed by 3 hours of reperfusion; (Group 5) 3 hours of ovarian ischemia and 2 ml/kg of NSO 1 hour before laparotomy; (Group 6) 3 hours of reperfusion after 3 hours of ovarian ischemia and 2 ml/mg of NSO 1 hour before laparotomy. RESULTS The antioxidant status, ceruloplasmin level, native thiol, total thiol, and disulfide levels of the control group (Group 1) were significantly increased compared with the ovarian ischemia-reperfusion group treated with NSO (Group 6) (p=0.003, p=0.002, p=0.006, p=0.001 and p=0.003, respectively); these levels in the ovarian ischemia group (Group 3) and ischemia-reperfusion group (Group 4) were statistically similar to those of the ovarian ischemia + NSO group (Group 5) and ovarian ischemia-reperfusion + NSO group (Group 6). CONCLUSIONS In this preliminary rat study, administration of NSO shortly after the onset of ovarian ischemia-reperfusion injury, did not significantly reduce levels of markers of oxidative injury. Further studies are required to evaluate the ovarian changes at the tissue level, and to determine the optimum dose of NSO.

The efficacy of different insulin-sensitizing agents on treatment outcomes in patients with polycystic ovary syndrome who underwent in-vitro fertilization: A retrospective, record-based, comparative study.

INTRODUCTION: It is not clear which metformin or inositol is more effective on IVF results. The aim of this study was to compare the effects of Metformin and Inositol co-treatments on IVF outcomes in Polycystic ovary syndrome patients. METHODS: A retrospective examination was made of the demographic characteristics and the follicular-embryonic development results of PCOS patients applied with an antagonist protocol of ovarian hyperstimulation in the first cycle of IVF with co-treatment of Metformin at 2000 mg/day regularly for 3 months (Metformin co-treatment group, n:35) or Inositol at 4000 mg/day myo-inositol for 3 months (Inositol co-treatment group, n:34) and those not using any co-treatment (FSH only group [control group], n:40). RESULTS: No significant difference was determined between the groups in respect of demographic characteristics. The HOMA-IR scores and hCG day E2 level were significantly higher in the control group than in both co-treatment groups (p = 0.021, p = 0.018, respectively). The M1 oocyte count was significantly lower in the Metformin group than in the Inositol and control groups (p = 0.001). The GVDJ oocyte count was significantly lower in both co-treatment groups than in the control group (p = 0.042). No statistically significant difference was determined between the groups in respect of other follicular and embryological development parameters, implantation, clinical pregnancy, live births and abortus rates. CONCLUSION: Insulin-sensitizing agents may have positive effects on follicular development in PCOS patients applied with IVF.

An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study.

OBJECTIVES: To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changes in treatment strategies and complications according to year. MATERIAL AND METHODS: A retrospective examination was made of 93 patients applied with caesarean hysterectomy with a diagnosis of placenta percreta in 5-year periods of 2005-2009, 2010-2014, and 2015-2019. Demographic characteristics were recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight. Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit (ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirement for massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded. RESULTS: The 93 patients comprised 8 cases in the period 2005-2009, 23 in 2010-2014, and 62 in 2015-2019. The number of previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase was observed in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there was seen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosis of placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterine fundal incision were greatest in the period 2015-2019. CONCLUSIONS: In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomes can be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimal prenatal preparation.

The efficacy of LigaSure™ open instruments in cases of cesarean hysterectomy due to placenta percreta: a retrospective, record-based, comparative study.

OBJECTIVE: The standard treatment for patients with placenta percreta is cesarean hysterectomy that can cause severe bleeding. New-generation vessel sealing systems like LigaSure can cut and seal vascular structures and tissues. The aim of this study was to retrospectively compare hysterectomies performed with traditional instruments and those performed with LigaSure instruments to determine the possible advantages with the latter. MATERIALS AND METHODS: Patients with placenta percreta who underwent elective cesarean hysterectomy by the same surgeon were divided into two groups based on the type of instruments used. Group 1, the standard conventional hysterectomy group, operated with conventional instruments for cutting and tying; and Group 2, the LigaSure hysterectomy group, operated with the new-generation bipolar sealing and cutting instruments. The groups were retrospectively compared for bleeding, operating time, and complications. RESULTS: In Group 2, the operating time, intraoperative and total transfused erythrocyte suspension units, total fluid in the drain, and total hospital stay were lower than in Group 1 (p < .05), as was the need for internal iliac artery ligation (p = .013). The complication rates were similar between the two groups (p > .05). CONCLUSION: The use of LigaSure open instruments in cesarean hysterectomies in patients with placenta percreta may reduce operating times and the amount of bleeding.

A randomized pilot study of electro-acupuncture treatment for hysterosalpingography pain relief and related anxiety.

OBJECTIVE: To investigate the effect of acupuncture on reducing pain and anxiety related to hysterosalpingography (HSG). MATERIALS AND METHODS: A total of 107 patients planned to undergo HSG were randomly separated into 3 groups; the acupuncture group (n=36), intramuscular diclofenac sodium group (n=35), and control group (n=37). In the acupuncture group, electro-acupuncture was applied to specified points for 20 mins before the procedure. In the intramuscular diclofenac sodium group, an intramuscular injection of 75 mg diclofenac sodium was applied 30 mins before the procedure. No analgesics were administered to the patients in the control group before intervention. Pain was evaluated with a Visual Analog scale (VAS) and anxiety with the State-trait Anxiety inventory -state (STAI-S), preoperatively and at specified times postoperatively. RESULTS: The VAS scores at 1 and 5 minutes after HSG were similar in acupuncture group and intramuscular diclofenac sodium group, and significantly lower than in the control group. At 30 mins postoperatively, there was no significant difference between the 3 groups in respect of the VAS scores. The STAI-S scores at 1 hour preoperatively were similar in all the groups (p=0.563). In the comparisons of the STAI-S values at preoperative 5 mins, following acupuncture in acupuncture group and the diclofenac injection in intramuscular diclofenac sodium group, and at postoperative 30 mins, the acupuncture group values were determined to be statistically significantly lower than those of the other groups (p<0.001, p<0.001). CONCLUSION: Acupuncture has similar effects on the reduction of pain as other analgesics and reduces anxiety. It can therefore be used in HSG in suitable clinics.

A comparison in an experimental rat model of the effects on adhesion formation of different hemostatic methods used in abdominopelvic surgery.

OBJECTIVES: To evaluate the effects of different hemostasis methods used in abdominal surgery on the development ofabdominal adhesion. MATERIAL AND METHODS: A total of 48 Wistar albino female rats were separated into six groups; Group 1 - Control group,Group 2 - Hemorrhage group, Group 3 - Electrocoautery group, Group 4 - Gel Spon-P®, Group 5 - PAHACEL®, andGroup 6 - Ankaferd-Blood Stopper®. Adhesions that developed were scored according to the Knightly classification andthe prevalence of adhesions according to the Linsky classification. The total adhesion score was calculated as the total ofthe severity and prevalence scores. RESULTS: The lowest total adhesion values were determined in Group 1 (control) and the highest adhesion values were inGroup 2 (hemorrhage) group in terms of all parameters. The adhesion values in Group 3, where the rats were administeredhemostasis with electrocautery were similar to those of Group 2 (hemorrhage). When the alternative methods were evaluated,the lowest adhesion scores were in Group 6 (Ankaferd-Blood Stopper®). CONCLUSIONS: In cases of minor pelvic or abdominal bleeding, not providing hemostasis or applying hemostasis withelectrocautery can increase the development of intra-abdominal adhesions. The use of alternative hemostatic materialsinstead of electrocautery for hemostasis may reduce the formation of adhesions.

Association of serum N-terminal pro-brain natriuretic peptide levels with the severity of preeclampsia.

OBJECTIVE: To investigate whether serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could be used as a marker to determine the severity of preeclampsia. METHODS: This prospective cohort study included pregnant women with preeclampsia and severe preeclampsia and normotensive pregnant controls admitted between January 2013 and July 2014. Preeclampsia was graded according to the recently revised criteria of the American College of Obstetricians and Gynecologists (ACOG). Serum NT-proBNP levels were compared among the groups. RESULTS: Of the 49 women with preeclampsia, 25 had severe preeclampsia. The controls were 27 normotensive pregnant women admitted during the same period. Serum NT-proBNP levels were significantly higher in the preeclampsia groups than in the control group (p < 0.001). In addition, NT-proBNP levels were significantly higher in the severe preeclampsia group compared with both the preeclampsia group (p < 0.001) and the control group (p < 0.001). CONCLUSION: The ACOG has recently revised the grading of hypertensive diseases of pregnancy and the criteria for severe preeclampsia. In line with these revised guidelines, serum NT-proBNP levels appear to be a useful marker to evaluate the severity of preeclampsia.

Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses.

OBJECTIVE: We aimed to investigate the utility of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte count as biomarkers to distinguish malignant from benign ovarian masses. MATERIAL AND METHODS: We retrospectively reviewed the histopathological results of 185 benign and 33 malignant cases following surgery for an initial diagnosis of adnexal mass and confirmed ovarian masses. Age, cancer antigen 125 (CA-125), white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), mean platelet volume (MPV), platelet distribution width (PDW), NLR, PLR, and lymphocyte counts were compared between groups. RESULTS: The significant diagnostic factors to distinguish malignant from benign disease were age (35.5±22 vs. 62±13 years; p<0.001) and CA-125 levels (16.6±21 vs. 98±366 U/mL; p<0.001). No significant difference was observed in WBC count, Hct, Hb, platelet count, PDW, and MPV between groups. To distinguish malignant from benign masses, lymphocyte count (1.29±0.91 vs. 1.80±0.67×10(3) cells/µL, p<0.001), NLR (4.95±5.36 vs. 3.32±2.72, p=0.024), and PLR (203.41±107.84 vs. 160.75±70.84, p<0.001) were identified as markers. The cutoff values were lymphocyte count of >1500 cells/µL (p<0.001), NLR of 3.4732 (p=0.033), PLR of 161.13 (p<0.001), CA-125 of >40 U/mL (p<0.001), and age of >53 years (p<0.001); their respective sensitivity and specificity were 66.7% and 77.8% [area under the curve (AUC), 0.723±0.055], 68.8% and 54.1% (AUC, 0.624±0.058), 81.8% and 50.8% (AUC, 0.683±0.052), 78.8% and 77.8% (AUC, 0.797±0.057), and 81.8% and 82.2% (AUC, 0.888±0.025). Multiple logistic regression analysis revealed cutoff explanatory and accuracy values of 68.2% and 94.9%, respectively, for lymphocyte count, NLR, PLR, CA-125, and age as independent parameters to distinguish malignant from benign ovarian masses. CONCLUSION: In combination with age and CA-125 levels, NLR, PLR, and lymphocyte count may be helpful to preoperatively distinguish malignant from benign ovarian masses.

The effects of electromagnetic fields on the number of ovarian primordial follicles: An experimental study.

The aim of this study was to evaluate the effect of an electromagnetic field (EMF), generated close to the ovaries, on primordial follicles. A total of 16 rats were used in this study. The study group consisted of rats exposed to an EMF in the abdominal region for 15 min/d for 15 days. Both the study and control group were composed of eight rats. After the treatment period of 15 days, the ovaries of the rats were extracted, and sections of ovarian tissue were taken for histological evaluation. The independent samples t test was used to compare the two groups. In the study group, the means of the right and left ovarian follicle numbers were 34.00 ± 10.20 and 36.00 ± 10.53, respectively. The average total ovarian follicle number was 70.00 ± 19.03. In the control group, the means of the right and left ovarian follicle numbers were 78.50 ± 25.98 and 71.75 ± 29.66, respectively, and the average total ovarian follicle number was 150.25 ± 49.53. The comparisons of the means of the right and left ovarian follicle numbers and the means of the total ovarian follicle numbers between the study and control groups indicated that the study group had significantly fewer follicles (p < 0.001, p = 0.011, and p = 0.002, respectively). This study found a significant decrease in the number of ovarian follicles in rats exposed to an EMF. Further clinical studies are needed to reveal the effects of EMFs on ovarian reserve and infertility.

The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters.

OBJECTIVE: To investigate the relationship between fetal birth weight and maternal hemoglobin concentrations in different trimesters. METHODS: This prospective cross-sectional study comprised 329 women, monitored and delivered between January 2013 and January 2014 in our clinic. Hemoglobin concentrations in all trimesters and all birth weights of the newborns were recorded. Comparisons and correlations were made of the maternal hemoglobin concentrations and birth weights in each trimester. RESULTS: A positive correlation was determined between fetal weight and increased first trimester maternal hemoglobin concentration (p: 0.025). No correlation was found between fetal weights and second and third trimester hemoglobin concentrations (p = 0.287, p = 0.298, respectively). When the effect of independent factors on fetal weight was investigated, it was determined that birth week and first trimester hemoglobin levels were the factors of most influence. CONCLUSIONS: Low hemoglobin concentrations in the first trimester of gestation seem to be associated with low fetal birth weights. Anemia can directly cause poor in utero fetal growth due to inadequate oxygen flow to the placental tissue or it can be an indirect indicator of maternal nutrition deficiency. In both circumstances, this study reveals that treatment of anemia before and in the early stages of pregnancy is directly correlated with better fetal outcomes.

[Seroprevalance Differences of Toxoplasma Between Syrian Refugees Pregnants and Indigenous Turkish Pregnants in Kahramanmaras]. / Kahramanmaras Yöresindeki Yerlesik Türk Gebelerle Suriyeli Mülteci Gebeler Arasinda Toxoplasma Seroprevalans Farkliliklari.

OBJECTIVE: In this study, we aimed to compare the Syrian refugees and resident Turkish pregnant population in terms of Toxoplasma seroprevalence. METHODS: Data acquired from Kahramanmaras Necip Fazil City Hospital Department of Obstetrics and Gynecology between 2012 and 2013 were analyzed retrospectively. Results of 7201 Toxoplasma IgM tests and 4113 Toxoplasma IgG tests were evaluated. RESULTS: For 2012 and 2013 Toxoplasma IgM seropositivity was found in Syrian refugees 4.76% and 4.84% respectively in our study. In the same population Toxoplasma IgG seropositivity rates were 80% and 62.6%, respectively. Toxoplasma IgM seropositivity rates for the native peoples in Turkey in 2012 and 2013 was 1.96% and 2.34%, while in the same population Toxoplasma IgG seropositivity was detected 49.7% and 45.7% respectively. Toxoplasma IgM seropositivity was statistically higher in Syrian refugees for each year (p <0.001 and 0.019, respectively). Toxoplasma IgG seropositivity of Syrian refugees was statistically higher (p <0.001 and <0.001 respectively). CONCLUSION: Since it was found in our study that toxoplasma seropositivity rates of Syrian refugees living in the region of Kahramanmaras were statistically higher than the rates of local inhabitants, we consider that this condition should be taken into account in the follow-ups of Syrian pregnant refugees outnumbering in Kahramanmaras and its vicinity.

Management of hematometrocolpos due to dysfunctional uterine bleeding following progestin use: a case report.

Hematometrocolpos is accumulation of blood in the vagina and uterine cavity due to intra-uterine hemorrhage. A 20-year-old female presented to our clinic with massive menorrhagia at menarche after progestin usage. Hematometrocolpos was detected by transabdominal ultrasonography. She was pale because of heavy bleeding for 5 days and hemoglobin level was measured as 5.1 g/dl. Initial treatment was blood transfusion and medical drug therapy. After resolution of the hematometrocolpos was shown by transabdominal ultrasound 2 days later, the patient, who was stable, was discharged without complication. Obstruction of the female genital outflow tract is rarely seen. Hematocolpos has been reported in elderly women following vaginal occlusion due to radiotherapy, vaginal fibroma and labial synechiae causing infection or inflammatory conditions. The case is presented here because of the successful management of hematometrocolpos due to massive dysfunctional uterine bleeding in a young virgin patient.