Cihan Togrul

Roles of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios in the Early Diagnosis of Malignant Ovarian Masses

BACKGROUND The present study aimed to investigate the utility and importance of the various parameters of complete blood count panel for benign-malignant differentiation of adnexal masses. MATERIALS AND METHODS This retrospective study involved 316 patients with documented benign and 253 patients with malignant adnexal masses who underwent primary surgical treatment at a tertiary referral center. Prior to the study, all benign and malignant cases were compared within their own groups and then the benign and malignant cases were compared to each other. For all cases, cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), neutrophil, lymphocyte, platelet and CA-125 parameters, and the results were compared in regards to the groups. RESULTS NLR, PLR, neutrophil, CA-125, and platelet values were higher in the malignant compared to the benign cases (p<0.01). The lymphocyte value was lower in the malignant cases (p<0.01). No significant differences were found for basophils and eosinophils (p > 0.05). For CA-125, the sensitivity, specificity, PPV and NPV for all cases were 78%, 62%, 62% and 78%, respectively. For NLR, they were 65.6%, 72.1%, 65.3%, and 72.3%, and for PLR, 48%, 81%, 67%, and 66%. Additionally, the sensitivity and specificity were 55% and 77% for CA-125, 66% and 58% for NLR, and 61% and 58% for PLR in early malignant cases. CONCLUSIONS NLR and PLR appear to be useful methods that can be applied together with CA-125 due to the relatively high sensitivity values for the malign-benign differentiation of ovarian masses. Although the specificity of these parameters is lower than CA-125, especially in cases with early malignant ovarian pathology, their sensitivity being higher is promising for the early diagnosis of ovarian cancer. It can be used to detect ovarian malignancies in the early stages, and it will increase the treatment options and improve survival rates.

A survey on human papillomavirus awareness and acceptance of vaccination among nursing students in a tertiary hospital in Ankara, Turkey

OBJECTIVE The purpose of this study was to assess the awareness and knowledge regarding human papillomavirus (HPV), HPV related conditions and HPV vaccine among nursing students, and to identify their attitudes towards HPV vaccination. MATERIALS AND METHODS The study was carried out at a tertiary Womens Health Care Center in Ankara, Turkey. Self-administered questionnaires were filled out individually by the nursing students and by a control group including similar aged women. Data regarding demographic information, knowledge and awareness about HPV infection and HPV vaccine, attitudes towards vaccination, acceptance of HPV vaccine and assessment of HPV vaccination attitudes of the nurses with respect to the gender of their children was assessed and recorded. RESULTS A total of 752 participants was included in the analysis. Five hundred and twenty (69.14%) of the participants were nursing students and the rest (n=232; 30.8%) were control group. The mean ages of the nursing students and the control group were 19.4 (16-27) and 19.4 (16-25) years, respectively. Majority of the nursing students knew the causal relationship between HPV and cervical cancer. Seventy-eight percent of the nursing students and 22.4% of the control group stated that they had heard of HPV vaccine. While the rate of the willingness to be vaccinated was 33.7% in the nursing student group, it was only 13.4% in the control group. CONCLUSION The awareness and knowledge about HPV, its relation with cervical cancer and prevention of cervical cancer by HPV vaccine were favorable among nursing students at a tertiary hospital in Ankara, Turkey. However, although aware of the theoretical implications, they did not seem to apply it to practice, such as not having regular gynecologic examinations and Pap smears. Thus, further studies are needed to evaluate the factors that affect practical applications of health care professionals responsible for providing health education to the public.

Sperm-Associated Antigen 9 is a Promising marker for Early Diagnosis of Endometrial Cancer

BACKGROUND Sperm-associated antigen 9 (SPAG9) has been recently proposed as a novel biomarker for early diagnosis of several human tumors, including ovarian, cervical and breast cancers. Its clinical value remains to be clarified for endometrial cancer (EC). In this study, we investigated the utility of serum SPAG9 levels in diagnosis of EC and its association with important clinicopathological parameters. MATERIALS AND METHODS This cross-sectional study was performed at a tertiary womens referral center in Ankara, Turkey. Preoperative serum samples were collected from patients surgically treated for endometrial cancer between June 2012-April 2013. Similar aged women with a biopsy proven benign endometrium were used as controls. Serum SPAG9 levels were measured with an enzyme-linked immunosorbent assay (ELISA) method and assessed for links with clinicopathological factors. Receiver operating characteristic (ROC) curve analysis was performed to assess power of SPAG9 levels for EC prediction. P values less than 0.05 were considered statistically significant. RESULTS A total of 63 women with EC and 27 with benign endometrium were included in the study. Mean age in the EC group was 58.7±1.1. Median SPAG9 levels in the EC and control groups were 18.3 (range, 12.7-53.8) and 14.1 (range, 4.3-65.3), respectively (p<0.001). A cut-off value of 17 ng/ml for SPAG9 predicted presence of malignant endometrium with 74% sensitivity and 83% specificity [Area under curve (AUC)=0.82, p<0.001]. SPAG9 levels did not demonstrate any significant association with histological type, FIGO stage, tumor grade, size, myometrial invasion, lymphovascular space invasion, cervical involvement, adnexal involvement, peritoneal cytology or lymph node status (all p>0.05). CONCLUSIONS Testing for SPAG9 may be useful for early detection of EC in asymptomatic high-risk women. Its role in post-treatment follow-up and early detection of recurrence should be assessed in future trials.

Cost and effectiveness comparison of immediate colposcopy versus human papillomavirus DNA testing in management of atypical squamous cells of undetermined significance in Turkish women.

BACKGROUND A small but significant proportion of cases with atypical squamous cells of undetermined significance (ASCUS) may harbour CIN 2-3, or even invasive carcinoma. Although immediate colposcopy, HPV-DNA testing or expectant management are three recommended options in ASCUS triage, a consensus does not currently exist on which one of these approaches is the most efficient. In this study, we aimed to compare the performance and cost of immediate colposcopy and colposcopy based on the human papillomavirus (HPV) testing for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN) in women with ASCUS. MATERIALS AND METHODS Records of 594 women with an index Papanicolaou smear showing ASCUS were retrospectively analyzed. Women in the immediate colposcopy arm were referred directly to colposcopy (immediate colposcopy group, n=255) and those in the HPV triage arm were proceeded to colposcopy if the high-risk HPV (hrHPV) test was positive (HPV triage group, n=339). High grade CIN (CIN2+) detection rate and treatment costs were compared between the groups. RESULTS The detected rate of CIN2+ was higher in the HPV triage group compared to immediate colposcopy group (8% vs. 1.6%, p=0.011). In the HPV triage group, the total cost, cost per patient, and the cost for detecting one case of high grade CIN were higher than the immediate colposcopy group (p<0.001). CONCLUSIONS In women with ASCUS cytology, HPV DNA testing followed by colposcopy is more costly than immediate colposcopy, but this approach is associated with a higher rate of CIN2+ detection. This findings suggest that HPV DNA testing combined with cervical cytology could reduce the referral rate to colposcopy.

Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia

To investigate the risk factors potentially associated with high‐risk human papillomavirus (HPV) persistence in women undergoing cold‐knife conization (CKC) for treatment of high‐grade cervical intraepithelial neoplasia (CIN).

Dose dependent protective effects of vardenafil on ischemia–reperfusion injury with biochemical and histopathologic evaluation in rat ovary

PURPOSE The purpose of the study is to evaluate the effect of vardenafil on the histopathology and biochemical parameters in reducing damage in experimental ovarian ischemia and ischemia/reperfusion injury in a rat model and to compare the effect of two different doses of vardenafil. METHODS Forty-two rats with experimental ovarian torsion. Group-I: sham; Group-II: ovarian ischemia; Group-III: 2 hours of ischemia followed by a 2-hour reperfusion. Group-IV: two hours before the sham operation, rats received 1mg/kg vardenafil; Group V and VI: A 2-hour period of ovarian ischemia was applied, in which rats were treated with intraperitoneal vardenafil 1 and 2mg/kg dose, after 1.5 hours of ovarian ischemia. After 2 hours of reperfusion, the ovaries on the right side were removed for examination. The ovarian ischemia/reperfusion injury was evaluated by calculating total antioxidant status, total oxidant status and oxidative stress index; and histopathologic examination of all ovarian rat tissue. RESULTS The histologic findings in vardenafil treatment groups were statistically significant decreased edema and follicle degeneration, with vascular congestion, hemorrhage and follicle degeneration being dose-dependent. There were no statistically significant changes in the biochemical parameters. CONCLUSIONS According to histopathological examination, low and high dose vardenafil is effective in attenuating ischemia-reperfusion induced ovary injury.

Effect of pre-procedural state-trait anxiety on pain perception and discomfort in women undergoing colposcopy for cervical cytological abnormalities.

BACKGROUND Colposcopy is the gold standard procedure for evaluating cervical cytological abnormalities. Although it is essentially a minimally invasive intervention, referral for colposcopy may cause significant distress on patients. In this study, we aimed to determine if pre-procedural anxiety levels have a significant association with procedure related pain and discomfort in women undergoing colposcopy for evaluation of abnormal cervical cytology. We also assessed the impact of various clinical factors on anxiety, pain and discomfort in these patients. MATERIALS AND METHODS This prospective study was performed at the Gynecologic Oncology Department of Zekai Tahir Burak Womens Health Education and Research Hospital in Ankara, Turkey between January and June 2013. After taking informed consent, State-Trait Anxiety Inventory (STAI) form and a 14-item questionnaire were filled for women who were admitted to our outpatient colposcopy unit for evaluation of abnormal cervical cytology. STAI scores were calculated for each participant. Immediately after the procedure, visual analog scale (VAS) scores for procedure-related pain and discomfort were obtained. Associations between STAI and VAS scores were investigated using correlation analyses. The effect of various contributing factors on anxiety, pain and discomfort were evaluated with linear regression analysis. The p values less than 0.05 were considered statistically significant. RESULTS A total of 222 women met the inclusion criteria within the study period. Mean patient age was 38.5±9.6. Median state and trait anxiety scores were 47 and 46, respectively. Median VAS scores for pain and discomfort were 4 for both variables. State anxiety had a significant correlation with procedure related discomfort (p=0.02). Colposcopy related pain VAS scores were significantly affected by state anxiety level, marital status and prior gynecological examination (p<0.05). Colposcopy related discomfort VAS scores were significantly affected by state anxiety level, marital status, prior gynecological examination and educational status. CONCLUSIONS Additional measures should be implemented in women that carry higher risk for experiencing pain and discomfort. Social, cultural and lifestyle issues may also affect womens experiences during colposcopy, therefore further studies are needed to define specific determining factors in various populations.

Adnexal masses encountered during cesarean delivery

To outline and discuss the clinical features and outcomes of adnexal masses that were treated during cesarean delivery at a tertiary referral hospital located in Ankara, Turkey.

Is there a role for kisspeptin in pathogenesis of polycystic ovary syndrome

Abstract Aim: To investigate association of kisspeptin levels in infertile women with different ovarian reserve patterns. Materials and methods: In this prospective cross-sectional study, 157 participants were recruited. The women were divided into three groups: (i) adequate ovarian reserve (AOR) (n = 57), (ii) high ovarian reserve (PCOS) (n = 60), (iii) diminished ovarian reserve (DOR) (n = 40). Weight, height, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist/hip ratio (WHR) were measured. The blood samples were analyzed for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), 17-hydroxy progesterone (17OHP), dehydroepiandrosterone sulfate (DHEAS), antimullerian hormone (AMH), kisspeptin measurements. Results: FSH concentration was higher and AMH concentration was lower in DOR group (p < .001, p < .001, respectively). The mean LH, TT and DHEAS levels were higher in PCOS group (p = .001, p < .00 and p = .003, respectively). The 17OHP level did not differ among the groups (p = .15). Women with PCOS possessed the highest kisspeptin level (p = .01). The kisspeptin level was negatively correlated with FSH level (r = −0.18, p = .02) and positively correlated with TT and DHEAS levels (r = 0.17, p = .02 and r = 0.23, p = .003, respectively). Conclusions: Women with PCOS had increased serum kisspeptin levels. Kisspeptin concentrations were negatively correlated with serum FSH and positively correlated with serum TT and DHEAS levels.

The impact of inherited thrombophilia on first trimester combined aneuploidy screening test parameters

Abstract Objective: To determine whether inherited thrombophilia affects components of first trimester combined aneuploidy screening test. Method: A case–control study was performed between January 1st and December 31st 2011, at a tertiary referral hospital. Singleton pregnancies with inherited thrombophilia that underwent first trimester (11–13+6 week) combined aneuploidy screening test were included in the study. Pregnancy associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (fbHCG) and fetal nuchal translucency (NT) were compared between the study group and controls. Results: Within the study period, 15 881 women with singleton pregnancies had a combined first trimester aneuploidy screening test at our institution. Among these, 207 women met the inclusion criteria. A control group that comprised 625 women with similar gestational age was generated, using a 1:3 ratio. PAPP-A levels were significantly higher, whereas fbHCG levels and fetal NT measurements were lower in women with inherited thrombophilia (p < 0.001). Conclusion: Our study suggested that PAPP-A, free b-HCG and NT MoM levels display alterations in women with inherited thrombophilia. Future trials are needed to assess the need for readjustment of risk in these patients.