Optimization studies on laccase activity of Proteus mirabilis isolated from treatment sludge of textile industry factories : Optimization of laccase activity of Proteus mirabilis.

Laccase is an exothermic enzyme with copper in its structure and has an important role in biodegradation by providing oxidation of phenolic compounds and aromatic amines and decomposing lignin. The aim of this study is to reach maximum laccase enzyme activity with minimum cost and energy through optimization studies of Proteusmirabilis isolated from treatment sludge of a textile factory. In order to increase the laccase enzyme activities of the isolates, medium and culture conditions were optimized with the study of carbon (Glucose, Fructose, Sodium Acetate, Carboxymethylcellulose, Xylose) and nitrogen sources (Potassium nitrate, Yeast Extract, Peptone From Soybean, Bacteriological Peptone), incubation time, pH, temperature and Copper(II) sulfate concentration then according to the results obtained. Response Surface Method (RSM) was performed on six different variables with three level. According to the data obtained from the RSM, the maximum laccase enzyme activity is reached at pH 7.77, temperature 30.03oC, 0.5 g/L CuSO4, 0.5 g/L fructose and 0.082 g/L yeast extract conditions. After all, the laccase activity increased 2.7 times. As a result, laccase activity of P. mirabilis can be increased by optimization studies. The information obtained as a result of the literature studies is that the laccase enzymes produced in laboratory and industrial scale are costly and their amounts are low. This study is important in terms of obtaining more laccase activity from P.mirabilis with less cost and energy.

Evaluation of adherence to levothyroxine and out-of-range thyroid-stimulating hormone levels in pregnant women with primary hypothyroidism.

PURPOSE: Adherence to levothyroxine (LT4) and attaining thyroid-stimulating hormone (TSH) goal in pregnancy has not been well-defined yet. We aimed to investigate adherence to LT4, success to reach TSH goal, and association between them in pregnant women with primary hypothyroidism. MATERIALS AND METHODS: Eight-item Morisky Medication Adherence Scale (MMAS-8) was applied in third trimester in pregnant women with primary hypothyroidism (Hashimoto's thyroiditis, surgical hypothyroidism or iodine deficiency) whom LT4 was given for at least 3 months. Those with chronic illness or thyroid cancer were excluded. We grouped the patients according to MMAS-8 score (<6, low adherence vs ≥6, medium/high adherence), and TSH measurement in third trimester (in-range vs out-of-range). RESULTS: Of total (n = 85), 57.64% (n = 49) had medium/high adherence to LT4, and 41.17% (n = 35) out-of-range TSH, but no association was found among them (P = .937). LT4 initiation in pregestational period, surgical hypothyroidism, high LT4 dose in second/third trimester and alternate-day dosing were associated with medium/high adherence. Age, number of visits, and less time between ingestion of LT4 and breakfast were associated with medium/high adherence. LT4 dose in second trimester and dose increment at the beginning of pregnancy were positively associated with in-range TSH. CONCLUSION: Non-adherence and treatment failure are frequent in LT4-treated pregnant women. Adherence seems not to be associated with treatment success. Regular follow-up may improve adherence. Our study is the first to analyse both treatment success and adherence to LT4 in pregnancy.

Determination of optimization parameters based on the Box-Behnken design for cloud point extraction of quinoline yellow using Brij 58 and application of this method to real samples.

Quinoline yellow (E104) dye is a food additive and generally used in cosmetics and drugs. In this work, polyethylene glycol hexa decyl ether (Brij 58) was used for the spectrophotometric determination of quinoline yellow (QY) in food and drug samples after cloud point extraction (CPE). Some parameters such as extraction temperature and time, pH, centrifuge speed, Brij 58 (surfactant) concentration, and Na2SO4 concentration were optimized using Box-Behnken design. The limit of detection (LOD) of this method was 0.0019 µg mL-1 for QY while the relative standard deviation (RSD) at low concentration levels (0.03 µg mL-1) was 1.32% (n = 5). Findings indicated that, this novel CPE method can be used quickly for the reproducible, selective and sensitive determination of QY dye in ordinary analysis.

Comparative study of low-dose versus standard single-dose methotrexate: A novel approach for medical treatment of ectopic pregnancy.

AIM: Methotrexate (MTX) treatment at a dose of 50 mg/m2 of body surface area (BSA) is an effective and widely used treatment method in ectopic pregnancy. However, there is a limited number of studies investigating lower MTX doses. In this study, we aimed to investigate the efficacy of lower MTX doses in the treatment of ectopic pregnancy. METHODS: This retrospective study included a total of 112 patients who were hospitalized due to ectopic pregnancy and administered single-dose MTX. The patients were divided into three groups according to the dose given as 22-40 mg/m2 of BSA (n = 17), 41-49 mg/m2 of BSA (n = 81) and ≥ 50 mg/m2 of BSA (n = 14). Data including demographic characteristics of the patients, previous history of ectopic pregnancy, previous gynecological surgeries, the use of in vitro fertilization techniques, ultrasonographic findings, beta-human chorionic gonadotropin hormone (ß-hCG) levels, pre-treatment endometrial sampling, MTX doses applied, and the need for a surgical intervention during follow-up were retrieved from the hospital records. RESULTS: Of the patients, 16.96% (n = 19) were operated at the end of treatment, irrespective of the pre-treatment ß-hCG levels with a success rate of 83% (n = 93). Fourteen (12.5%) of the patients received the second dose of MTX. The overall success rate was 89.2% in patients with a ß-hCG level of ≤5000 mIU/mL. CONCLUSION: This study shows that lower MTX doses than 50 mg/m2 , which has been considered standard treatment and widely used in the treatment of ectopic pregnancy for nearly three decades, are effective with similar success rates.

The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy.

We aimed to investigate the effects of chewing gum on bowel activity and postoperative pain in patients undergoing laparoscopic hysterectomy. Patients were randomised into two groups (n = 58, study; n = 51, control). In the study group, patients started chewing sugarless gum every 2 h for 15 min, beginning at the second postoperative hour. The control group did not chew gum, and they received standard postoperative care. Both groups were compared primarily in terms of the amount of time until the first bowel movement, the time of the first passage of flatus and the time of first defaecation. The amount of time until the first bowel movement, the time of the first passage of flatus and the time of the first defaecation were found to be significantly shorter in the chewing gum group (p < .001). The amount of postoperative analgesics that were needed and VAS scores at 6-hours and 24-hours postoperatively, were found to be lower in the study group than in the control group (p < .001). Chewing gum was found to have beneficial effects on bowel motility and postoperative pain in patients undergoing laparoscopic hysterectomy. This affordable and simple method could be recommended to patients after total laparoscopic hysterectomy.Impact statementWhat is already known on this subject? Postoperative gastrointestinal dysfunction remains a source of morbidity and the major determinant of length of stay after abdominal operation. The mechanism of enhanced recovery from postoperative gastrointestinal dysfunction with the help of chewing gum is believed to be the cephalic-vagal stimulation of digestion which increases the promotability of neural and humoral factors that act on different parts of the gastrointestinal tract.What do the results of this study add? The findings of previous randomised controlled studies have been inconsistent regarding the effect of chewing gum on postoperative bowel function following abdominal gynecological surgery. In this randomised prospective study, we found that chewing gum early in the postoperative period after total laparoscopic hysterectomy hastened time to bowel motility and flatus. To our knowledge this is the first study of the impact of chewing gum on bowel motility after total laparoscopic hysterectomy.What are the implications of these findings for clinical practice and/or further research? Chewing gum early in the postoperative period following laparoscopic hysterectomy hastens time to bowel motility and flatus. The use of chewing gum is a simple and cheap strategy for promoting the recovery of gastrointestinal functions.

Intraoperative superior hypogastric plexus block during cesarean section: a new technique for pain relief.

Background: With increasing cesarean section rates all around the world, postoperative pain management is an important issue for all women. Good postoperative pain management helps to shorten the recovery period of the mother, improve the mother's feeling of well-being, enable good breastfeeding, and provide optimum maternal-neonatal bonding.Objective: To evaluate the efficacy of intraoperative superior hypogastric plexus block (SHPB) during cesarean section and describe the technique.Study design: This was a prospective quasi-experimental study that was conducted with 69 pregnant women at HSU. Kocaeli Derince Training and Research Hospital Obstetrics and Gynecology Clinics between 15 March 2018 and 15 August 2018. The case group included 34 healthy pregnant women who received SHPB (SHPB+) for postoperative pain relief during cesarean section under general anesthesia, and the control group included 35 healthy pregnant women who did not receive SHPB during cesarean section with general anesthesia (SHPB-). Postoperative 1st hour, 6th hour, 12th hour, 24th hour, and 48th hour visual analog scale (VAS) scores, the amount of analgesics used for pain relief, and the time of the postoperative first gas extraction were assessed.Results: The SHPB (+) group had lower 1st hour VAS scores than the SHPB (-) group (p < .001). The mean postoperative 1st hour VAS score of the SHPB (+) group was 4.74 ± 1.44, and was 6.80 ± 2.08 for the SHPB (-) group. There were no differences in postoperative 6th hour, 12th hour, 24th hour, and 48th hour VAS scores between the groups. When the SHPB (+) and SHPB (-) groups were compared for postoperative analgesic use and for the first postoperative gas extraction time, the SHPB (+) group had lower analgesic use (p < .001), and the SHPB (-) group had earlier gas extraction. The mean analgesic use in the SHPB (+) group was 2.29 ± 1.11 and it was 4 ± 0.84 in SHPB (-) group. The mean gas extraction time for the SHPB (-) group was 18.03 ± 7.2 h, and was 24.56 ± 8.56 h for the SHPB (+) group (p = .001).Conclusion: SHPB performed intraoperatively in cesarean section procedures with general anesthesia is a simple, easy approach to perform during open surgery with direct vision. SHPB helps postoperative pain management extensively with low postoperative VAS scores and low analgesic requirement.

Adenomyosis and urinary system symptoms.

OBJECTIVE: This study aims to investigate the presence and incidence of overactive bladder (OAB) syndrome in patients diagnosed with adenomyosis and to evaluate the impacts of urinary symptoms on the quality of life of the patients. MATERIALS AND METHODS: A total of 108 individuals including 50 patients with adenomyosis and 58 controls who were admitted to the Obstetrics and Gynecology Department of Bursa, Cekirge State Hospital and Derince Training and Research Hospital between April 2015 and December 2015 were included. The Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to evaluate symptoms. RESULTS: Irritative urinary symptoms such as nocturia and frequency were seen more frequently in the adenomyosis group (p = 0.001 and p = 0.035). Overactive bladder symptoms were more common in the adenomyosis group (p = 0.0001). CONCLUSION: Our study showed that symptoms of urinary tract symptoms are common in patients with adenomyosis, which adversely affect the quality of life.

Evaluation of hearing and cochlear function by audiometric testing in patients with hyperemesis gravidarum.

INTRODUCTION: The aim of this study was to investigate cochlear functions in patients with hyperemesis gravidarum (HG). METHODS: Twenty-nine HG patients (58 ears) and 31 healthy control subjects (62 ears) were included. Audiometry testings at 250 and 500 Hz and 1, 2, 4, 8, 10, 12, 14, 16 kHz were performed to the patients and controls. RESULTS: Mean age of patients with HG was 26,5 ± 4,4 years and the mean age of control group was 28,0 ± 4,2 years. At the time of the tests mean gestational age of the HG group and controls were 9 and 11 weeks respectively. No differences were observed between the groups in tympanic membrane status, or other otolaringological evaluations. No significant differences were observed in audiometric tests at any frequencies between the groups (p values for all > 0.05). CONCLUSION: There was not a difference between pregnant cases with HG and cases with normal pregnancy in terms of audimetric tests. Cochlear functions are not affected remarkably in women with HG.

Prenatal screening tests may be a warning for the partial molar pregnancy? case report.

Prenatal screening tests are frequently requested for chromosomal abnormalities. Placental pathologies in early pregnancy may be overlooked, especially in partial molar pregnancy. We are reporting an incorrect preliminary diagnosed case with an increased risk of Down syndrome in her first-trimester screening test due to partial molar pregnancy.

Assessment of the relationship of basal serum anti-mullerian hormone levels with oocyte quality and pregnancy outcomes in patients undergoing ICSI.

BACKGROUND: Anti-Mullerian hormone (AMH) is constantly secreted during menstrual cycles and may offer several advantages over traditional biomarkers of ovarian reserve. OBJECTIVE: To assess the relationship of anti-Mullerian hormone (AMH) values, which are used to evaluate ovary reserves, with oocyte and embryo quality and with ART outcomes in patients undergoing intra-cytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: This cross sectional study was performed using 50 women undergoing ICSI in IVF center of Zeynep Kamil Women's and Children's Hospital, Istanbul, Turkey. All patients received the long protocol. Follicle-stimulating hormone, luteinizing hormone, estradiol, and AMH levels were measured and antral follicle counts were obtained on the 3(rd) day of menstruation. A cut-off value based on the number of oocytes was determined for AMH, and women were evaluated after being divided into two groups as bad responders and good responders, according to their AMH levels. RESULTS: Twelve (27.3%) women were in bad responders group and 32 (72.7%) women were in good responders group. AMH measurements were statistically significantly different between the two groups (p<0.01). Based on this significance, the researchers used ROC analysis to estimate a cut-off point for AMH. The researchers detected the good responders with an AMH level 1.90 or above, with 87.50% sensitivity, 66.67% specificity, 87.50% positive prediction, and 66.67% negative prediction (AUC=0.777, p<0.01). CONCLUSION: Basal AMH levels can be used as an indicator to determine the ovarian response in women undergoing ICSI. AMH can be used to predict the number of mature oocytes that can be collected during treatment and the number of oocytes that can be fertilized. However, AMH is not a valuable tool to evaluate oocyte quality, the development of high-quality embryos, or pregnancy conception.

Hearing loss: an unknown complication of pre-eclampsia?

AIM: The aim of this study was to determine whether pre-eclampsia is a risk factor for cochlear damage and sensorineural hearing impairment. MATERIAL AND METHODS: This prospective case-control study consisted of 33 patients with pre-eclampsia and 32 normotensive pregnant patients as controls. All of the subjects underwent otoscopic examinations - pure tone audiometry (0.25-16 kHz) and transient evoked otoacoustic emission (1-4 kHz) tests - during their third trimester of pregnancy. RESULTS: The mean ages of the patients with pre-eclampsia and the control subjects were 29.6 ± 5.7 and 28.6 ± 5.3 years, respectively. The baseline demographic characteristics, including age, gravidity, parity number, and gestational week, were similar between the two patient groups. Hearing thresholds in the right ear at 1, 4, 8, and 10 kHz and in the left ear at 8 and 10 kHz were significantly higher in the patients with pre-eclampsia compared to the control subjects. The degree of systolic blood pressure measured at the time of diagnosis had a deteriorating effect on hearing at 8, 10, and 12 kHz in the right ear and at 10 kHz in the left ear. CONCLUSIONS: Pre-eclampsia is a potential risk factor for cochlear damage and sensorineural hearing loss. Further studies that include routine audiological examinations are needed in these patients.

Estimating the causes of traffic accidents using logistic regression and discriminant analysis.

Factors that affect traffic accidents have been analysed in various ways. In this study, we use the methods of logistic regression and discriminant analysis to determine the damages due to injury and non-injury accidents in the Eskisehir Province. Data were obtained from the accident reports of the General Directorate of Security in Eskisehir; 2552 traffic accidents between January and December 2009 were investigated regarding whether they resulted in injury. According to the results, the effects of traffic accidents were reflected in the variables. These results provide a wealth of information that may aid future measures toward the prevention of undesired results.

Rudimentary horn pregnancy in the first trimester; importance of ultrasound and clinical suspicion in early diagnosis: A case report.

We aimed to present 7-8 weeks rudimentary horn pregnancy detected preoperatively. A 37-year-old woman, gravida 3, para 2, at 7-8 weeks' gestation referred to our clinic with a complaint of abdominal pain. The patient was primarily infertile, and she had unicornuate uterus detected during infertility investigation. Due to abnormal ultrasonographic image, rudimentary horn pregnancy was considered. Accurate diagnosis was made by laparoscopy, and rudimentary horn excision was performed. Prerupture diagnosis is very difficult in rudimentary horn pregnancies. The key role in preoperative diagnosis is suspicion. Ultrasonographic examination and clinical suspicion are sufficient in most cases.

Predictive factors influencing pregnancy rates after intrauterine insemination.

BACKGROUND: So far, many studies investigated factors that affect pregnancy rates after intrauterine insemination (IUI). Various investigators have not agreed on the nature and ranking of these criteria. OBJECTIVE: The aim of this study was to assess the predictive factors for pregnancy rate after controlled ovarian hyperstimulation (COH)/ IUI. MATERIALS AND METHODS: Retrospective study of all patients undergoing IUI at Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital from January 2006 to December 2009. In total 980 IUI cycles in 569 couples were analyzed. All women in the study underwent ovarian stimulation using gonadotropin and IUI was performed 36 h after triggering ovulation. The primary outcome measure was clinical pregnancy rates. Predictive factors evaluated were female age, body mass index (BMI), duration of infertility, type of infertility, follicle stimulating hormone (FSH) level and estradiol (E2) on third day of the cycle, number of preovulatory follicles, endometrial thichness, total motil sperm (TMS) count, and ratio of progressive motile sperm. RESULTS: The overall clinical pregnancy rate was 4.7%. Among the predictive factors after multivariate logistic regression analysis level of BMI (<25 kg/m²), number of preovulatory follicles (≥2), level of FSH (<9.4 IU/L), level of E2 (<80 pg/ml) and the ratio of progressive motile sperm (>50%) significantly influenced the clinical pregnancy rate. CONCLUSION: Level of BMI, FSH, estradiol, number of preovulatory follicles and the ratio of progressive motile sperm may determine IUI procedure as optimum treatment model.