Aylin Ayrim

Comparison of the analgesic effects of oral tramadol and naproxen sodium on pain relief during IUD insertion.

OBJECTIVE To compare the analgesic efficacy of oral tramadol and naproxen sodium on pain during insertion of an intrauterine device (IUD). DESIGN Randomized, double-blinded, clinical trial (Canadian Task Force classification I). SETTING University-affiliated hospital. Single-center. PATIENTS One hundred three patients scheduled for insertion of an IUD. INTERVENTIONS Patients were randomly assigned to receive oral tramadol 50 mg capsules (n = 35) or naproxen sodium 550 mg tablets (n = 34) or placebo (n = 34) 1 hour before insertion of the IUD. After insertion of the IUD, pain intensity was evaluated using a visual analog scale (VAS, 0-10). Adverse effects, patient satisfaction with the medication, and preference for using it during future insertions were also recorded. MEASUREMENTS AND MAIN RESULTS The VAS scores were significantly different during IUD insertion among the 3 groups (p = .001). Pain scores in the tramadol group were significantly lower than in the naproxen group (p = .003), and the scores in the naproxen group was significantly lower than in the control group (p = .001). Patient satisfaction with the medication and preference for its future use were significantly lower in the control group than in the other 2 groups (p = .001). CONCLUSION Prophylactic analgesia using 50 mg tramadol and 550 mg naproxen, delivered orally, can be used to relieve pain during IUD insertion. However, tramadol capsules were found to be more effective than naproxen tablets.

Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids

OBJECTIVES: The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS: A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS: Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm2, respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1%) and control (43.3%) groups. Bone fracture was identified in four patients with asthma (8.6%) and in six patients from the control group (10%). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS: There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.

Breastfeeding Throughout Pregnancy in Turkish Women

INTRODUCTION Around the world, as well as in Turkey, women breastfeed their infants as long as possible. There is, however, a strong cultural taboo against continuing breastfeeding while having a new pregnancy. The aim of this study was to evaluate the outcome of pregnancies occurring during the lactation period and to determine whether lactation throughout the pregnancy had any adverse effects. This is the first study in Turkey to provide data on the association between the practice of lactation throughout pregnancy and outcome. SUBJECTS AND METHODS One hundred sixty-five multiparous women with singleton pregnancies who were ≥ 18 years of age, breastfeeding the previous child, and did not have systemic disease were included. Forty-five of the 165 pregnant women continued lactating, whereas 120 did not. We compared weight gain during pregnancy, hemoglobin level alterations, pregnancy complications, neonatal weight, and Apgar scores between the two groups. RESULTS Lactating pregnant women gained less weight than the nonlactating group, and the decreased level of hemoglobin during pregnancy was significant in the lactating group. Between the two groups, there was no statistically significant difference in hyperemesis gravidarum, threatened abortion, preeclampsia, premature labor and birth, neonatal weight, or Apgar scores. CONCLUSIONS Breastfeeding during pregnancy is not harmful, and health professionals should not advise weaning if overlapping occurs and should observe mother, infant, and fetus closely for negative effects, and if a negative effect occurs they should take precautions.

The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: A prospective study

Abstract Objective To compare vaginal microflora and cervical cytology before and after insertion of a copper-containing intrauterine device (Cu-IUD) or a levonorgestrel releasing-intrauterine system (LNG-IUS). Methods Between April 2009 and February 2011, all women requesting insertion of an intrauterine contraceptive for family planning or noncontraceptive indications were enrolled. One hundred and eight Cu-IUDs and 42 LNG-IUSs were placed. Cervical cytological and vaginal microbiological findings before insertion and after 12 months were recorded. Results With regard to cervical cytology, nonspecific inflammatory changes became more frequent (but not significantly so; p = 0.062) after one year of use of a Cu-IUD, whereas their prevalence remained unchanged among women fitted with a LNG-IUS. Colonisation by Candida spp. and mycoplasma infections were diagnosed significantly more often after one year of use of the Cu-IUD than at baseline. During the study period, women wearing a Cu-IUD complained significantly more frequently of vaginal discharge, pelvic pain, and increased menstrual flow. Conclusion Use of a Cu-IUD – but not that of a LNG-IUS – was associated with an alteration of the vaginal flora and showed a trend towards a higher frequency of nonspecific inflammatory changes affecting cervical cytology.

Prenatal diagnosis and follow-up of giant sacrococcygeal teratoma

Sacrococcygeal teratoma is a non-organ-specific soft tissue lesion composed of extragonadal tissues located in the pericoccygeal region. Sacrococcygeal tumor, a germ cell tumor, is quite rare in the general population; however, it is the most common congenital tumor in newborns. The incidence for this tumor is estimated to be 1:40,000 live births [1]. Although it has a benign histological character, it has a relatively high mortality rate (>50%) among patients diagnosed prenatally [2]. We hereby, present a patient who presented to our department with an estimated gestational age of 32 weeks, whose fetus was observed to have a sacrococcygeal teratoma measuring 20 cm by ultrasound (US) and fetal magnetic resonance imaging (MRI) evaluations. A 23-year-old primigravid woman presented to our department for antenatal follow-up at the 32 gestationalweek. She stated that she had been followed-up regularly in another medical center throughout previous gestational weeks. A solid lesion with solid cyctic components with a size of 20 cm 18 cm located in the sacrococcygeal region of the fetus was detected on ultrasonic examination of the patient. Her amniotic index was measured as 210 mm and placentomegaly was noted. We confirmed the gestational age consistentwith32weeksof gestation. Furthermore, a detailed investigation was performed to affirm clear diagnosis. Color Doppler sonography designated that the mass was not well vascularized, and there was no evidence of fetal hydrops. Fetal echocardiographic examination was normal. Fetal MRI investigation revealed a solid lesion measuring 20 cm 17 cm with a hypointense peripheral margin extending through the pelvic and anal region, involving diffuse cyctic areas. Its main component was located at the right side of the fetus. The lesion primarily suggested the diagnosis of Type I sacrococcygeal teratoma (Fig. 1). The patient was hospitalized and monitored with serial US and external fetal monitoring. There was no designated