Abdulkadir Turgut

The Biochemical and Histologic Effects of Adnexal Torsion and Early Surgical Intervention to Unwind Detorsion on Ovarian Reserve An Experimental Study

Objective: The aim of the present study was to determine to what extent ovarian reserves are affected by ischemia–reperfusion injury, evaluating the number of growing follicles and the serum levels of the ovarian hormones. Study Design: Thirty female fertile adult Wistar albino rats, weighing 200 to 220 g, were previously numbered to randomization, and then randomly divided into 3 equal groups (n = 10): sham, torsion, and detorsion groups. In torsion and detorsion groups, bilateral adnexal torsion (3-hour ischemia) was carried out. Bilateral adnexal detorsion (3-hour reperfusion) was performed in the detorsion group. Results: The mean number of preantral and small antral follicles in detorsion group were lower than those of the sham group (P < .01). After torsion, anti-Müllerian hormone (AMH), estradiol, and inhibin B levels decreased significantly compared to the preoperative and postoperative periods (P = .003, P = .032, and P = .014, respectively). In detorsion group, only AMH levels were found to decrease significantly following the 3-hour ischemia and 3-hour reperfusion (P < .05). Conclusion: After adnexal torsion, a significant decrease in ovarian reserve has been detected for the first time in this study. Additionally, the results of this study suggest that conservative surgery alone is insufficient to protect ovarian reserve.

Prolidase, matrix metalloproteinases 1 and 13 activity, oxidative-antioxidative status as a marker of preterm premature rupture of membranes and chorioamnionitis in maternal vaginal washing fluids.

Objective: Etiology of premature preterm rupture of membranes (PPROM) is not yet completely known and chorioamnionitis is one of the most important complications of its. We aimed to evaluate whether prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in vaginal washing fluid (VWF) were associated with etiology of PPROM and whether these markers could be used to predict chorioamnionitis in PPROM. Study Design: This prospective case control study enrolled fifty pregnant women with PPROM and 50 healthy pregnant women. The VWF samples were taken at the time of admission in the PPROM group and patients were followed for chorioamnionitis. Prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in VWF were assayed. Results: VWF levels of prolidase, matrix metalloproteinases 1-13 (p< 0.001), oxidative stress parameters, total oxidative stress (TOS) (p < 0.001) and oxidative stress index (OSI) (p = 0.002), and hs-CRP (p = 0.045) were significantly higher in the PPROM group than in the controls. Antioxidative status parameters, levels of paroxanase (PON-1) (p < 0.001) and total antioxidant capacity (TAC) (p < 0.001), were significantly lower in the PPROM group than in the controls. Mean VWF levels of prolidase (p < 0.001), metalloproteinases (p<0.05), and oxidative-antioxidative status parameters (p<0.05) were significantly different in women with versus women without chorioamnionitis in the PPROM group. Prolidase, MMP-13, TOS, TAC, and PON-1 were found as important predictors for chorioamnionitis in the PPROM group by the multivariate logistic regression analysis. When the ROC curve analysis for prolidase, MMP-13, TOS, TAC, and PON-1 were performed, all of them were statistically significant for area under the curve (areas under the curve were 0.94, 0.90, 0.80, 0.25, and 0.19, respectively). Conclusions: This study showed that collagen turnover mediators, especially prolidase, and increased oxidative stress are significantly associated with PPROM. Also, chorioamnionitis can be predicted with prolidase, MMP-13, TOS, TAC, and PON-1 in PPROM patients.

Evaluation of the protective effects of CoQ₁₀ on ovarian I/R injury: an experimental study.

Background: The aim of this study was to investigate the protective effects of coenzyme Q10 (CoQ10) on ovarian ischemia/reperfusion injury in an experimental rat adnexal torsion model. Methods: 48 female adult Wistar albino rats, weighing 220-250 g, were randomly equally divided into six groups (n = 8): sham, torsion, detorsion, sham+CoQ10, torsion+CoQ10, and detorsion+CoQ10 groups. Bilateral adnexal torsion was performed for 3 h in all groups, except the sham and sham+CoQ10 groups. Bilateral adnexal detorsion was performed on the detorsion and detorsion+CoQ10 groups. CoQ10 was injected intraperitoneally 30 min before the sham operation, torsion, and detorsion. Results: The torsion and detorsion groups had significantly higher histologic evaluation scores, as well as higher MDA levels, TOS values, and oxidative stress index values than the sham group. A strong correlation between total histologic evaluation scores for ischemia/reperfusion injury and the oxidative stress index was found. The mean oxidant marker levels and histopathologic scores for the ovarian tissue significantly decreased after using CoQ10, which is a potent antioxidant. Conclusions: Conservative surgery (detorsion) was found to provide inadequate protection to ovarian tissue. The results of this study suggest that CoQ10 could be useful for the protection of ovarian tissue before conservative surgery.

Levels of Neopterin and other Inflammatory Markers in Obese and Non-Obese Patients with Polycystic Ovary Syndrome

Background We aimed to measure the levels of inflammatory markers and neopterin in obese and non-obese patients with PCOS by using 2 separate control groups with matching body mass index (BMI). Material/Methods A total of 60 women of reproductive age with (n=30) and without (n=30) PCOS were included in this study. Based on their BMI, patients with PCOS were divided into 2 groups as obese (n=15) and non-obese (n=15) PCOS groups. In addition, 2 BMI-matched control groups were formed. Neopterin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (N/L ratio), and vitamin B12 were assessed by complete blood count. Results No significant difference was found between patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and CRP levels. However, N/L ratio levels were significantly higher (p 0.045) and vitamin B12 levels were significantly lower (p 0.033) in patients with PCOS compared to control subjects. No statistically significant difference was found between obese and non-obese patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and N/L ratio levels. However, CRP levels were significantly higher in obese patients with PCOS compared to obese control subjects (p 0.007). Conclusions It can be concluded that inflammatory activity is increased in patients with PCOS, can lead to an increased risk for atherosclerosis, and this increase is not caused by obesity but rather by the polycystic ovary syndrome itself. However, studies with larger sample sizes are needed in this area.

Increased psychological trauma and decreased desire to have children after a complicated pregnancy.

OBJECTIVE Information about fertility desire and psychological sequelae after high-risk pregnancies are scarce in the literature. The aim of the present study is to investigate the psychological effects of high-risk pregnancies. MATERIAL AND METHODS The patients who had a history of severe preeclampsia, eclampsia or major hemorrhage during the peripartum period were enrolled as the study group and compared with the control subjects with respect to fear about new pregnancy, anxiety/ depression and post-traumatic stress disorder (PTSD) scores. The study was carried out by submitting a questionnaire form to the participants. Numbers of planned children before and after the last delivery were evaluated in both groups. RESULTS Fear about a new pregnancy was found to be significantly higher in the study group compared with the controls. There were no statistically significant difference between the two groups in terms of anxiety and depression. In terms of re-experience and avoidance in PTSD was significantly higher in the study group, however no significant difference was found for hyper-arousal. CONCLUSION Fear regarding new pregnancy is high and planning more children is decreased after high-risk pregnancies and PTSD symptom scores were higher after high-risk pregnancies.

A case of cerebral sinus venous thrombosis resulting in mortality in severe preeclamptic pregnant woman.

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality.

Platelet profile in patients with gestational diabetes: a retrospective study.

OBJECTIVE To assess and compare alterations in the morphology and function of platelets occurring in gestational diabetes and healthy pregnancies. MATERIAL AND METHODS A retrospective study was performed of 77 pregnant women: 42 cases with gestational diabetes and 35 healthy controls. The two groups were compared in terms of demographics and platelet parameters derived from complete blood counts. RESULTS The mean platelet volume (p=0.001) and HbA1c (p<0.001) were significantly increased in the patients with gestational diabetes. The mean platelet volume was well correlated with the platelet distribution width (rs=0.404, p<0.001) and the platelet count (rs=0.355, p=0.002). CONCLUSION The mean platelet volume and other platelet parameters may significantly aid the identification of diabetic pregnants at risk for vascular complications. The role and possible clinical relevance of these changes during diabetic pregnancy need to be investigated in further studies.

Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity?

Abstract Objective: The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity. Methods: MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files. Results: The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture. Conclusions: According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Protective effects of honokiol on ischemia/reperfusion injury of rat ovary: an experimental study

Aim The purpose of this study was to investigate the protective effect of honokiol on experimental ischemia/reperfusion injury of rat ovary. Materials and methods A total of 40 female Wistar albino rats were used in this study. The rats were divided into five groups as follows: sham (Group I), torsion (Group II), torsion + detorsion (Group III), torsion + detorsion + saline (Group IV), and torsion + detorsion + honokiol (Group V). Bilateral adnexa in all the rats except for those in the sham group were exposed to torsion for 3 hours. The rats in Group IV were administered saline, whereas the rats in Group V were administered honokiol by intraperitoneal route 30 minutes before detorsion. Tissue and plasma concentrations of malondialdehyde and nitric oxide were determined. Ovarian tissue was histologically evaluated. Data analyses were performed by means of Kruskal–Wallis test and Mann–Whitney U-test (Bonferroni correction) in SPSS 15.0 (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL, USA). Results The torsion and detorsion groups had higher scores in vascular congestion, hemorrhage, and inflammatory cell infiltration compared with the sham group (P<0.005). In addition, total histopathological scores were significantly higher in the torsion and detorsion groups compared with the sham group (P<0.005). A significant reduction was observed in hemorrhage, inflammatory cell infiltration, and cellular degeneration scores, of all histopathological scores, in the honokiol group (P<0.005). Ovarian tissue concentrations of malondialdehyde were significantly higher in the torsion and detorsion groups compared with the sham and honokiol groups (P<0.005). Ovarian tissue concentrations of nitric oxide, on the other hand, were significantly higher in the torsion group compared with the sham, saline, and honokiol groups (P<0.005). Conclusion Honokiol has a beneficial effect on ovarian torsion-related ischemia/reperfusion injury.

Maternal plasma prolidase, matrix metalloproteinases 1 and 13, and oxidative stress levels in pregnancies complicated by preterm premature rupture of the membranes and chorioamnionitis

OBJECTIVE This study aimed to investigate the role of various biochemical markers in preterm premature rupture of membranes (PPROM) and in prediction of chorioamnionitis in patients with PPROM. MATERIAL AND METHODS This case-control study included a total of 100 pregnant women at 26-34 gestational weeks. Of these women, 50 were healthy and 50 had PPROM. The biochemical markers in the maternal plasma including prolidase, matrix metalloproteinase (MMP) 1 and 13, total oxidative status (TOS), total antioxidant capacity (TAC), glutathione peroxidase (GPx), catalase (CAT), paraoxonase-1 (PON-1), tumor necrosis factor alpha (TNF-α), and high sensitive C-reactive protein (hs-CRP) were assayed. These levels were compared between the PPROM and control groups and between women with or without chorioamnionitis in the PPROM group. RESULTS Compared to the control group, the levels of prolidase, MMP-13, and TOS were significantly higher (p values <0.001, 0.020, and 0.035, respectively) and those of TAC and PON-1 were significantly lower in the maternal plasma of the PPROM group (p values=0.012 and <0.001, respectively). The plasma prolidase and TOS levels were significantly higher (p values=0.033 and 0.005, respectively) and the plasma TAC and PON-1 levels were significantly lower in women with chorioamnionitis as compared with the corresponding values in women without chorioamnionitis in the PPROM group (p values =0.041 and 0.048, respectively). The multivariate logistic regression analysis observed that prolidase, TAC, and PON-1 were important markers for the presence of PPROM and prolidase and TOS were important markers for predicting chorioamnionitis. CONCLUSION This study suggested that maternal plasma prolidase, TAC, and PON-1 may be useful for the diagnosis of PPROM, and prolidase and TOS may be used to predict chorioamnionitis in patients with PPROM.