The Female Genital Mutilation/Cutting Experience in Somali Women: Their Wishes, Knowledge and Attitude.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a common sociocultural practice in many communities in Africa. Unfortunately, what females are forced to accept because they are helpless, in order to be an individual in social life and in the country they live in, is an important health issue that is not only harmful to the human body but also against human rights. OBJECTIVES: This study aimed to investigate the wishes, knowledge and attitude of Somali women regarding FMG/C. METHODS: From 16 regions of Somalia, 356 women were randomly selected. A structured and interviewer-administered questionnaire was used to collect data. RESULTS: Except for one, all women participating in the survey were circumcised. A significant proportion of women embraced the continuation of FGM/C (52%) and 54.2% of them were satisfied with being FMG/C. Their knowledge, attitude, and practices were shaped by their religion and traditions. However, the proportion of those who wanted to stop FGM/C was 91%. CONCLUSIONS: Further efforts and research from different countries, cultures, beliefs, organizations, and individuals focusing on knowledge, awareness, legalization, and the opinions of lay and religious individuals, particularly including women's rights activists, and women with FGM/C, are needed to stop FGM/C, also known as female circumcision.

The importance of uterosacral ligament anatomy in overactive bladder: A preliminary study.

OBJECTIVE: To evaluate whether uterosacral ligament (USL) thickness measured using magnetic resonance imaging (MRI) was associated with overactive bladder (OAB) in otherwise healthy women. MATERIALS AND METHODS: The study comprised 27 women with OAB and 27 healthy women (control group) who were followed up at the Obstetrics and Gynecology Department of a tertiary referral center. All subjects were evaluated using pelvic MRI to determine the transverse USL thickness. These measurements were compared between the two groups. p values less than 0.05 were considered statistically significant. RESULTS: The mean age of women in the OAB and control groups were 43.88±9.36 years and 39.92±5.36 years, respectively. The mean body mass index in the OAB group was 29.77±4.82 kg/m2 and 27.49±3.44 kg/m2 in the control group. In the comparison of Pelvic Organ Prolapse Quantification system stages between the groups, no statistically significant relationship was determined. In the OAB group, the mean right USL thickness was 2.04±0.34 mm, and the mean left USL was 2.04±0.52 mm. In the control group, the mean right USL thickness was 2.17±0.47 mm, and the mean left USL was 2.09±0.51 mm. There were no statistically significant differences in terms of USL thickness between the OAB and control groups (p>0.05). CONCLUSION: No previous studies have been identified in the literature that have investigated the relationship between USL thicknesses and urinary incontinence. In the present study, no significant relationship could be demonstrated between right and left USL thicknesses of the OAB and control groups. This was a preliminary study, and further research with larger sample sizes is required to reach a final conclusion.

The distribution of cancer cases in Somalia.

OBJECTIVE: The aim of this study was to investigate the frequency and distribution of cancer cases in a defined time period in Somalia. MATERIALS AND METHODS: A total of 403 cancer cases were diagnosed between January 01, 2016 and March 01, 2017 in the Department of Pathology at the Somalia Mogadishu-Turkey Education and Research Hospital or the Department of Oncology at Uniso Hospital, Somalia University. Data on cancer type, patient age, and gender were obtained from pathology reports and hospital records. RESULTS: Female patients totaled 49.6% (n = 200) and 50.4% of patients were male (n = 203). The youngest patient was 18 years of age, the oldest was 97, and the average age was 53.4 years. The 10 most common types of cancer were esophageal (n = 130, 32.3%), non-Hodgkin lymphoma (n = 35, 8.7%), liver (n = 26, 6.5%), breast (n = 24, 6.0%), skin (n = 17, 4.2%), thyroid (n = 13, 3.2%), brain (n = 12, 3.0%), bone (n = 11, 2.7%), colorectal (n = 11, 2.7%), and soft tissue (n = 11, 2.7%). The most common site of cancer in both males and females was the esophagus. CONCLUSION: These results show a high incidence of esophageal cancer in Somalia, and strongly suggest that environmental risk factors and nutritional habits have a strong impact in this population. Serious and extensive research on the etiology of esophageal cancer is required.

The outcomes of intestinal resection during debulking surgery for ovarian cancer.

OBJECTIVE: To evaluate the clinical and surgical outcomes of intestinal resection during primary debulking surgery for ovarian cancer. MATERIAL AND METHODS: This retrospective study was conducted at Zekai Tahir Burak Women's Health Training and Research Hospital between 2009 and 2013. The patients who underwent intestinal resection during debulking surgery for stage 3 ovarian cancer were included in the analysis. Data regarding patient age, body mass index, tumor histology, disease stage, the site of intestinal resection, all postoperative complications, duration of intensive care unit admission and hospital stay were collected and analyzed. RESULTS: A total of 22 patients with a mean age of 53.4 years were included in the study. Optimal cytoreduction was achieved in 14 (63%) patients. Transverse colectomy was the most common type of intestinal resection (63%). The most common postoperative complication was transfusion of blood products (63%). No postoperative mortality was observed. CONCLUSION: Intestinal resection is a crucial part of debulking surgery for advanced ovarian cancer, with acceptable complication rates. Despite the limited number of patients, the results obtained from the present study are comparable with previous reports.

Is there any relationship between low PAPP-A levels and measures of umbilical vein and placental thickness during first trimester of pregnancy?

OBJECTIVE: Low pregnancy-associated plasma protein A (PAPP-A) level is associated with adverse perinatal outcomes. The purpose of this study was to evaluate relationship between umbilical cord diameter (UCD), umbilical vein and artery diameters (UVD, UAD), placental thickness, and PAPP-A level at gestational age of between 11 and 14 weeks. METHODS: UCD, UVD, UAD, and placental thickness of 246 women were assessed during ultrasound examination at between 11 and 14 weeks of gestation, as well as measurement of nuchal translucency (NT) and crown-rump length (CRL). Patients were divided into 2 groups according to PAPP-A percentile. Group 1 comprised 23 patients who had low PAPP-A (<0.44 multiple of medians [MoM], <10th percentile) and Group 2 was made up of 223 patients with PAPP-A of >0.44 MoM, >10th percentile. Calipers used for measurement were placed inner edge to inner edge of echogenic boundaries of the vessel. Largest sections of all vessels (UV and both arteries) were evaluated. Thickest part of the placenta was used for placental thickness measurement. RESULTS: Narrow UCD (<4.5±0.6 mm) was associated with low PAPP-A level (p=0.02). There was no significant difference in UVD, UAD, or placental thickness between groups. There was no significant difference in gestational age, CRL, or NT between groups. Fetal birth weight was significantly lower in Group 1 (p=0.03). CONCLUSION: Closer attention to women with low-risk, healthy pregnancies and low PAPP-A level in first trimester screening results is recommended. They should be routinely screened for background medical risk factors and umbilical cord morphology in first trimester scan.

Evaluation of quality of life and cost-effectiveness of definitive surgery and the levonorgestrel intrauterine system as treatment options for heavy menstrual bleeding.

BACKGROUND/AIM: This study aimed to compare the levonorgestrel intrauterine system (LNG-IUS) with abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) as first-line treatments for heavy menstrual bleeding (HMB). MATERIALS AND METHODS: Ninety-eight patients aged 20-55 years who complained of regular heavy menstrual bleeding were enrolled in the study. The TAH group included 29 patients, the LNG-IUS group included 34, and the TLH group included 35. These groups were compared in terms of quality of life and the cost-effectiveness of the selected methods. Quality of life was assessed using the 36-Item Short Form (SF-36), and cost-effectiveness was assessed according to the current cost of each approach. RESULTS: The quality of life parameters, with the exception of mental health, improved significantly in the LNG-IUS, TAH, and TLH groups. The mean costs of the LNG-IUS, TAH, and TLH procedures were $99.15 ± 4.90, $538.82 ± 193.00 and $1617.05 ± 258.44, respectively (P < 0.05). Overall, LNG-IUS was the most cost-effective treatment option. CONCLUSION: The outcome measures of the SF-36 revealed that after 6 months, these treatments were equal in terms of quality of life, except for mental health. LNG-IUS was the most cost-effective approach.

Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section.

PURPOSE OF INVESTIGATION: We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity. MATERIALS AND METHODS: We analyzed intra-abdominal adhesions of 672 patients. RESULTS: Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively. CONCLUSIONS: Emergency operations and adhesions increased complications.

The role of mean platelet volume and platelet distribution width in the prediction of placental abruption.

We determined the role of mean platelet volume (MPV) and platelet distribution width (PDW) in the prediction of placental abruption (PA) prior to caesarean section. Data obtained between January 2011 and July 2014 from patients (n = 33) with PA and healthy control subjects (n = 67) matched for age- and gestation-stage were analysed. Pre-operative and post-operative MPV and PDW were significantly different between the PA and control groups when cut-off values for MPV were set at 9.23; sensitivity at 87.8% and specificity at 46.2%; positive predictive value (PPV) at 48.3%; and negative predictive value (NPV) at 90.0%. When the cut-off value for PDW was set at 18.5, the sensitivity was 100% and specificity 71.6%, PPV 40.7% and NPV 59.3% for the prediction of PA. MPV and PDW levels were significantly higher in cases of PA. These results suggest that clinical evaluation of MPV and PDW displays reasonable sensitivity and specificity as a marker of PA, prompting the need for more research in this area of clinical study.

Can different geographic conditions affect the formation of striae gravidarum? A multicentric study.

AIM: Striae gravidarum (SG) is a most common physiological skin change that many pregnant women experience during pregnancy. We investigated the effects of geographic conditions and altitude on the formation of SG. MATERIAL AND METHODS: A total of 508 nulliparous women with singleton gestation were included in the study from three different geographic locations. The first city is located in the mountainous area at an altitude of approximately 1900 m (approximately 6233 ft). The second city is located on a plain in the middle of the country at an altitude of 900 m (approximately 2952 ft). The third city is located by the seaside (altitude 26 m, 85 ft). Twelve variables were recorded for each woman in the prepartum period, and striae were scored using the numerical scoring system of Atwal et al. RESULTS: We found that striae formation was significantly more common in higher areas. According to the regression analyses, when the third region, located at sea level, was taken as a reference point, the appearance of SG was 2.1- and 1.8-fold more common in the first region (altitude 1900 m) and the second region (altitude 900 m), respectively (P = 0.020). CONCLUSION: To the best of our knowledge, this study is the first to evaluate the effect of environmental factors on SG formation. Moreover, our study group is one of the largest in the published work. Environmental factors can affect the formation of striae gravidarum. Further studies with different ethnic groups are needed.

Surgical Staging of Early Stage Endometrial Cancer: Comparison Between Laparotomy and Laparoscopy.

BACKGROUND: The aim of the present study was to compare the laparotomy (LT) and laparoscopy (LS) in patients who undergone surgical staging for early stage endometrium cancer. METHODS: Retrospective data were collected and analyzed for amount of intraoperative bleeding, complication rates, total resected and laterality specific number of lymph nodes and duration of operation in patients operated with either LT or LS. RESULTS: Seventy-nine stage I endometrium cancer patients were found to be eligible for the trial purposes: 58 (73.4%) treated by LT and 21 (26.6%) treated by LS. The number of lymph nodes was similar in LT (8.9 ± 5.3) and LS (9.2 ± 4.8) (P = 0.8). In LT group, there was no difference in the number of lymph nodes between the right and left sides (10 ± 5.8 and 8.7 ± 4.8 respectively, P = 0.19); in LS group, the number of lymph nodes resected from the right side was higher than the left side (9.8 ± 5 and 7 ± 3.5 respectively, P = 0.039). The amount of intraoperative bleeding and hospitalization period were significantly higher in LT group. Seventy-nine patients had a median follow-up of 30 months. The two groups were similar for disease-free survival (P = 0.46, log rank test). CONCLUSIONS: There was no significant difference between the two methods in terms of number of total resected lymph nodes. In early stage endometrial carcinoma, LS has provided adequate staging and similar survival rates with LT.