A comprehensive assessment of redox balance in small for gestational age newborns and their mothers.

OBJECTIVE: The objective of this study was to assess oxidative stress in small for gestational age (SGA) newborns and their mothers by evaluating intra- and extracellular thiol homeostasis and the quantification of major oxidants and antioxidants. METHODS: A total of 75 mothers and their 75 newborns (43 SGA) were enrolled in this study. Thiol-disulfide homeostasis, serum myeloperoxidase, catalase, total oxidant, and antioxidant status were analyzed. Additionally, erythrocytic glutathione (GSH) homeostasis was measured. RESULTS: Although native and total thiol levels were decreased, disulfide levels were increased in SGA groups. Additionally, myeloperoxidase activity and total oxidant status levels were significantly elevated whereas total antioxidant status levels and enzymatic antioxidant systems were diminished in SGA groups. Similarly, intra-erythrocytic GSH homeostasis was shifted in favor of oxidants in SGA groups. CONCLUSION: Our results demonstrate that insufficient antioxidant systems in mothers and a robust source of oxidative stress in SGA might contribute to the pathophysiology of SGA births.

COVID-19 Severity among Healthcare Workers: Overweight Male Physicians at Risk.

We performed a prospective longitudinal cohort study in two healthcare settings. In total, 909 HCWs out of 3982 (23.35%) were diagnosed with COVID-19 before the vaccination era. Eighty-five per cent of COVID-19 positive HCWs (n = 774) were asymptomatic or mild, and 15% were moderate or severe. The mean age of the infected HCWs in the moderate or severe group was higher than the mild or asymptomatic group (35.4 vs. 31.3 years, p < 0.001). Thirty-two per cent of HCWs were male and the rate of male gender was more frequent in the moderate/severe group (p = 0.009). The rate of those who have cardiovascular diseases (p = 0.003) and diabetes mellitus (p = 0.044) were significantly higher among the HCWs with moderate or severe COVID-19. In multivariate analysis, male gender (OR:1.65, CI:1.11−2.46, p = 0.013), BMI > 30 (OR: 1.9, CI: 1.09−3.51, p = 0.024), and being physician (OR: 2.56, CI:1.45−4.52, p = 0.001) were found to be associated with moderate or severe COVID-19.

Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures

Objective: To evaluate the attitudes of medical students and professionals towards female genital cosmetic procedures (FGCPs) in terms of medical justification, applicability in practical life, ethical concerns, patient autonomy, and the clinical/social/psychological benefits-harms of these procedures. Materials and Methods: A semi-structured questionnaire providing information about the attitudes of medical students and specialists (n=623) towards FGCPs including G-spot amplification, clitoral hood reduction, vaginoplasty, labia majora augmentation/reduction, labia minora augmentation/reduction, hymenoplasty, laser procedures, vulvar/perianal bleaching, and liposculpture, was completed by a target population and evaluated statistically. Results: Participants stated that FGCPs could be performed only upon patient request and there could rarely be a medical indication for their performance (p<0.05). Nearly half (44.5%) of the participants regarded hymenoplasty as controversial in terms of ethical issues, and 44.6% of participants do so for G-spot amplification. Over half (54.5%) of the participants agreed on the positive effect of FGCPs on improving the quality of life, 55.4% on improving self-esteem, and 54.1% on improving sexual functions of women. About half (49.3%) of respondents thought that the advertising and encouragement of FGCPs should be forbidden and 47% were indecisive about whether FGCPs constituted genital mutilation. Conclusion: The majority of the participants declared that FGCPs could be performed only upon patient request and improve self-esteem, quality of life, and sexual functions. The most controversial procedures in terms of ethics were hymenoplasty and G-spot amplification. Detailed guidelines for the protection of both patients and physicians are needed because the recommendations on FGCPs are insufficient to define the boundaries of medical justification, genital mutilation, advertising, and ethical concerns.

Can preoperative complete blood count parameters be used in the diagnosis of patients with adnexal torsion: a case-control study.

OBJECTIVE: To determine whether there is a relationship between complete blood count parameters at adnexal torsion and to investigate the clinical utility of these parameters in preoperative diagnosis. METHODS: The retrospective, case-control study was conducted at a tertiary care hospital in Turkey and comprised data of patients who underwent adnexal torsion surgery from 2007 to 2017. Medical records of healthy controls who underwent various gynaecological surgeries during the period were used as the control group. Demographic characteristics and preoperative complete blood count parameters were retrieved from the medical records, and factors influencing adnexal torsion diagnosis were evaluated. Data was analysed using SPSS 21. RESULTS: Of the 296 subjects, 73(24.7%) were adnexal torsion cases and 223(75.3%) were controls. Demographic characteristics did not differ between the groups (p>0.05). Leukocytosis was present in 38(52%) cases. Mean white blood cell, neutrophil, and platelet counts and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were significantly higher, and mean platelet volume was significantly lower in the cases compared to controls (p<0.05). Logistic regression analysis identified an independent association between a low mean platelet volume and adnexal torsion (p<0.05). The optimal cutoff value was 10.35fL, with 77.4% sensitivity and 74.2% specificity. CONCLUSIONS: There was found to be a significant relationship between adnexal torsion and certain parameters of the complete blood count. Low mean platelet volume could be considered a useful additional tool for the preoperative diagnosis.

Accuracy of sonographic fetal weight estimation in full-term singleton pregnant women.

OBJECTIVES: To investigate the factors which might influence the sonographic fetal weight estimation (SFWE) accuracy. METHODS: This prospective study was conducted among 949 singleton term pregnant women who delivered at a tertiary center, from January 2017 to December 2017. All participants' maternal (i.e. parity, age, body mass index and gestational weight gain during pregnancy), fetal sonographic (i.e. fetal presentation, amniotic fluid index, localization of placenta and estimated fetal weight) and neonatal (birth weight and gender) characteristics were recorded. A p<0.05 was considered significant. RESULTS: The mean absolute percent error (APE) values of SFWE was 8.2±6.5 percent, and overall failure ratio (APE >10%) was 33%. In failure group, primiparous woman and cephalic presentation fetus were significantly more common compared to accuracy group (55.9% vs.44.8%; p=0.001 and 98% vs. 95.2%; p=0.03, respectively). In contrast, the mean neonatal birth weight (NBW) value was significantly lower in failure group compared to success group (3250±565 gr vs. 3404±410 gr; p=0.001). The correlation between SFWE and NBW was linear, however negative, and significant (p=0.001). Logistic regression analysis revealed that primiparous woman, cephalic presentation fetus and <3300 gr NBW were independent risk factors for the SFWE failure (relative risks were 1.6, 2.8 and 2.4 respectively, p<0.05). CONCLUSION: SFWE has a high correlation with NBW, however it's accuracy is still unsatisfactory, and depend on many unpredictable and inconsistent factors.

Is postmenopausal endometrial fluid collection alone a risk factor for endometrial cancer?

OBJECTIVE: To determine the usefulness of single-layer, ultrasonographic measurement of endometrial fluid collection (EFC) volume to predict endometrial pathology in asymptomatic postmenopausal patients. METHODS: One hundred fifty asymptomatic postmenopausal women were analysed retrospectively from January 2012 to December 2016. After patients with endometrial hyperplasia/neoplasia were included in Group-I, and those with insufficient tissue, endometrial atrophy, or endometritis were included in Group-II; Groups one and two were compared with respect to primary (correlations between endometrial thickness and EFC volume) and secondary (correlations between demographic characteristics and EFC volume) outcomes. RESULTS: There was no correlation between EFC volume and single-layer endometrial thickness (P = 0.36). Likewise, demographic characteristics were not related to EFC (P > 0.05). However, both EFC volume and single-layer endometrial thickness were thicker in Group-I compared to Group-II (4.8 ± 1.9 mm vs. 3.7 ± 2.5 mm; and 5.7 ± 9.4 mm vs. 2.7 ± 2.5 mm, respectively) (P values were < 0.05). CONCLUSION: Although a cutoff value for endometrial thickness and EFC volume could not be recommended based on our study findings, it should be noted that 2% is a clinically significant rate of malignancy. Thus, postmenopausal patients with EFC should be evaluated for endometrial sampling.

Coexisting Primary Ovarian and Omental Hydatid Disease Mimicking an Ovarian Neoplasm: A Case Report.

Hydatid disease is a parasitic infection that most commonly affects the liver and lungs, although the disease can arise in any part of the body. Cysts may mimic many benign and malignant conditions. The diagnosis cannot be confirmed preoperatively in all cases. A 44-yr-old menopausal woman was admitted to the department of gynecology with complaints of abdominal distention. A fixed abdominopelvic mass was identified. Radiology revealed a 20-cm mass with branched septations and solid components. CA-125 level was 55 kU/L, and Risk of Malignancy Index-2 score was 880. These findings suggested the presence of an ovarian neoplasm, and laparotomy was performed. Cystic masses measuring 22 cm and 4 cm, originating from the omentum majus and left ovary, respectively, were found during surgery. Frozen-section analysis revealed hydatid disease. Infracolic omentectomy and total abdominal hysterectomy with bilateral salpingo-oopherectomy were performed. Results of a serum Echinococcus hemagglutination test performed immediately after surgery were negative. The patient was prescribed albendazole for 6 mo and discharged on the third postoperative day with no complaints. The incidence of hydatid disease in the female reproductive system is very rare; however, clinicians must be aware of this disease and take necessary precautions while operating because any spillage may lead to anaphylactic shock and increased risk of recurrence.

Soluble urokinase-type plasminogen activator receptor (suPAR) and interleukin-6 levels in hyperemesis gravidarum.

BACKGROUND: The aim was to compare serum soluble urokinase-type plasminogen activator receptor (suPAR) levels as well as interleukin-6 levels (IL-6) in pregnant women with hyperemesis gravidarum (HG) and asymptomatic pregnant women. METHODS: Our study population consists of voluntary first trimester-pregnant women who applied to the outpatient clinic of the department of obstetrics and gynecology of Ankara Ataturk Training and Research Hospital. Between February and May 2016, 60 pregnant women were included in our prospective study. Serum suPAR and IL-6 levels were evaluated with the ELISA method. Twenty-nine pregnant women with HG and 31 asymptomatic pregnant women were included in the study. RESULTS: Serum suPAR level in the HG group was measured as 0.36 ± 0.56 ng/ml, whereas this level in the healthy pregnant control group was measured as 0.15 ± 0.15 ng/ml (p < 0.05). The interleukin-6 level in the HG group was 5.69 ± 2.16 pg/ml, whereas in the control group it was measured as 3.88 ± 0.28 pg/ml (p < 0.05). CONCLUSION: Serum suPAR and IL-6 levels proved to be high in the HG group. It is likely that suPAR could play a role in the etiopathogenesis of hyperemesis gravidarum.

The prognostic significance of preoperative serum cancer antigen 15-3 levels in endometrial carcinomas.

OBJECTIVES: To determine the associations between serum cancer antigen 15-3 levels and prognostic factors in patients with endometrial carcinomas. Additionally, we investigated the clinical utility of serum cancer antigen 15-3 levels in the selection of low-risk patients with endometrioid type, tumor size less than 2 cm, myometrial invasion ≤50%, and histological grade 1-2. Methods: Ninety-six patients, who were surgically staged at  Ankara Yildirim Beyazit University, Ankara, Turkey, between 2007 and 2016, were retrospectively analyzed. Demographic, clinical, and surgical characteristics were retrieved from the patients' hospital records. A p less than 0.05 was considered significant. Results: Fifteen patients had advanced (≥Stage II) disease, 14 patients had Type 2 histology, 20 patients had Grade 3 tumors, 23 patients had lymphovascular space invasion, and 10 patients had positive lymph node involvement. Serum cancer antigen 15-3 levels were significantly higher in patients with advanced (≥Stage II) disease, Type 2 histology, Grade 3 tumors, lymphovascular space invasion, and positive lymph node involvement (p less than 0.05). Serum cancer antigen 15-3 levels were also significantly correlated with tumor size (p=0.006). Serum cancer antigen 15-3 levels were significantly lower (95% confidence interval: 0.57-0.79; p=0.03) in low-risk patients compared to other endometrial carcinoma patients. A cutoff of 25.0 IU/mL was used to identify high-risk patients with a specificity of 100%. Conclusion: Serum cancer antigen 15-3 levels significantly correlated with prognostic factors and were a useful diagnostic tool for endometrial carcinomas.

Single-dose methotrexate for the treatment of ectopic pregnancy: Our experience from 2010 to 2015.

OBJECTIVE: To evaluate the success of systemic single-dose methotrexate (MTX) treatment in patients with ectopic pregnancy (EP) and to investigate factors related to treatment success. METHODS: This retrospective study had been performed in Yildirim Beyazit University between January 2010 and December 2015. Demographic and clinical characteristics, ultrasonografic findings, pretreatment serum ß-human chorionic gonadotropin (ß-hCG) and progesterone levels of 58 patients with EP were retrieved from hospital records retrospectively. The patients were grouped according to MTX treatment success (response vs. failure). RESULTS: Single-dose MTX-treatment was successful in 72.4% (42/58) of patients. The mean pretreatment ß-hCG level was significantly lower in responders than in failures (2080 ± 2322 vs. 5707 ± 3885 IU/L, p = 0.001), and 2678 IU/L was the most suitable cutoff to predict success (75% sensitivity, 73.8% specificity). Moreover, failure rate was 8.45 times more in group of patients whose ß-hCG values were determined above the cutoff. The presence of fetal cardiac activity adversely affected treatment success (odds ratio = 12, p = 0.004). Treatment success was not affected by past history of ectopic pregnancy, thickness of endometrium, progesterone value or presences of pseudosac and free pelvic fluid. CONCLUSION: The success rate of single dose MTX in this study was 72.8 %, and we found that failure rate of MTX treatment was 8.45 times more in group of patients whose initial serum ß-hCG values were above 2678 IU/L and 12 times more in patients with fetal cardiac activity.

The relationship between first-trimester pregnancy-associated plasma protein-A levels and intrapartum fetal distress development.

OBJECTIVE: To investigate the relationship between the development of intrapartum fetal distress and serum pregnancy-associated plasma protein-A (PAPP-A) levels measured during first-trimester aneuploidy screening tests. MATERIAL AND METHODS: This retrospective study included 283 uncomplicated pregnancies that resulted in full-term live births via spontaneous labor or with the induction by oxytocin. Cases were divided into two groups based on whether their first-trimester PAPP-A multiple of the median (MoM) levels were ≤0.5 (Group 1, n=75) or >0.5 (Group 2, n=208). As primary end points, the rate of cesarean section (C/S), the rate of C/S due to fetal distress, and the umbilical artery blood pH values in cases of C/S for fetal distress were compared between the two groups. Statistical analyses were performed using the Chi-square test and independent samples t-test. P≤0.05 were considered statistically significant. RESULTS: The mean gestational age at birth and the birth weights were significantly lower in Group 1 than in Group 2 (p=0.002 and p=0.007, respectively). Although the rate of C/S was similar between the groups (p=0.823), the rate of C/S due to fetal distress was significantly higher in Group 1 than in Group 2 (68.4% vs. 42%, respectively; p=0.050) and the mean umbilical artery blood pH value for C/S deliveries indicated by fetal distress was lower (p=0.048) in Group 1 than in Group 2. When the mode of delivery was analyzed according to the application of labor induction, both the C/S delivery rates (31.6% in Group 1 and 31.7% in Group 2; p=0.992) and C/S delivery rates due to fetal distress (66.7% in Group 1 and 46.2% in Group 2; p=0.405) were similar in both groups. CONCLUSION: Low PAPP-A levels (≤0.5 MoM) in the first trimester are associated with the risk of intrapartum fetal distress development and the likelihood of C/S for fetal distress. Nonetheless, this risk is not affected by labor induction.

Vaginoplasty Using Human Amniotic Membranes A Report of Five Patients.

OBJECTIVE: To present our experiences with an innovative surgical approach for vaginal agenesis that uses amnion as the allograft to create a functional neovagina. STUDY DESIGN: This study involved 5 patients with diagnosed vaginal agenesis. One patient had karyotype 46,XY and was diagnosed with complete androgen insensitivity syn- drome, whereas the others had karyotype 46,XX and were diagnosed with Mayer-Rokitansky-Kiister-Hauser syndrome. All patients underwent Mclndoe vagino- plasty using amnion and were followed up at 2 weeks, 3 months, 6 months, and 12 months postsurgery. Functionality of the neovagina was assessed by Rosen Female Sexual Function Index (FSFI) questionnaire. RESULTS: At the 12-month follow-up 1 patient report- ed. an inability to use the vaginal dilator effectively; for the other 4 patients the mean depth of the neovagina was 9.5 cm and the mean width was 3.5 cm. The mean overall FSFI score was 28.3. CONCLUSION: McIndoe vaginoplasty is a simple, safe, and quick operative method that results in a ftnctional vagina. The amnion is a suitable material to apply to the surface of the neovagina because it is readily avail- able and does not have any associated immune reiection problems or costs.

Maternal serum 25(OH)D levels in the third trimester of pregnancy during the winter season.

OBJECTIVE: To measure serum 25(OH)D levels of pregnant women in the last trimester during the winter season and to determine the factors affecting their serum levels. METHODS: In all, 79 pregnant women in the third trimester were examined between November 2008 and March 2009. Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels were measured. Maternal age, education, socioeconomic status (SES), nutrition, dressing habits, and level of sunlight exposure were determined and their correlation with serum 25(OH)D levels were statistically compared. RESULTS: The mean serum 25(OH)D level of the study group was 11.95 ± 7.20 ng/ml, and the prevalence of severe vitamin D deficiency [25(OH)D < 10 ng/ml] in pregnant women was 45.6%. No association was detected between severe vitamin D deficiency and maternal age, gravidity, skin phototype, benefiting from ultraviolet index, and educational status of the cases. Also in patients who used multivitamin supplements and good SES, 25(OH)D levels were significantly higher (p=0.046, p=0.025, respectively). CONCLUSIONS: This study showed a remarkable high rate of vitamin D deficiency in pregnant women during the winter season and we have found high levels of vitamin D in patients supplemented with multivitamins and in ones with good SES.