Fatma Nur Aksakal

Melatonin improves the oocyte and the embryo in IVF patients with sleep disturbances, but does not improve the sleeping problems

PurposeWe aimed to analyse the in vitro fertilization-embryo transfer (IVF-ET) outcomes of the patients with sleep disturbances who were administered melatonin.MethodsA total of 60 patients with sleep disturbances were divided into two groups. The study group (group A, n = 30) had underwent the IVF-ET with melatonin administration and the control group (group B, n = 30) without melatonin. Sleeping status after melatonin administration and the IVF outcomes were compared between the two groups.ResultsSleeping status change was not significant (p > 0.05). The mean number of the retrieved oocytes, the mean MII oocyte counts, the G1 embryo ratio were significantly higher in the melatonin administered group (group A) than that the non-administered group (group B); p = 0.0001; p = 0.0001; p < 0.05 respectively.ConclusionIVF patients with sleep disorders may benefit from melatonin administration in improving the oocyte and the embryo quality, but the sleeping problem itself may not be fixed.

Tetanus immunization in pregnant women. Serum levels of antitetanus antibodies at time of delivery

The objective of this study was to determine the tetanus immunity status of pregnant women at the time of delivery according to tetanus toxoid (TT) vaccination coverage during their most pregnancy. The serum anti-tetanus antibody levels of 493 mothers who had live births at a hospital in Ankara were determined by enzyme-linked immunosorbent assay (ELISA). Protected women were defined as those with serum antibody levels ≥ 0.6 IU/ml. Overall, 69.0% of mothers had protective tetanus antibody titers at the time of delivery. The rates of protection for mothers who had received no vaccination, one TT dose, or two TT doses during pregnancy were 46.4, 93.5, and 95.6%, respectively. Vaccinating every pregnant woman with at least one dose of TT would be an affordable and effective way to protect against neonatal tetanus, and would be a step toward eliminating the deaths that continue to occur due to this preventable disease in Turkey.

Ultrasonographic measurement of the femoral cartilage thickness in patients with polycystic ovary syndrome

OBJECTIVE To compare the femoral cartilage thickness values of polycystic ovary syndrome (PCOS) patients with those of age-matched, healthy women and to find out whether cartilage thickness changes with the clinical parameters. DESIGN A cross-sectional controlled study. SETTING A secondary care center and a tertiary care center. PATIENT(S) Thirty-three women with PCOS (mean age: 23.7 ± 3.5 years; 66 knees) and 30 healthy control women matched for age and body mass index (mean age: 24.8 ± 4.2 years; 60 knees). INTERVENTION(S) Measurement of knee cartage thickness of infertile PCOS patients. MAIN OUTCOME MEASURE(S) The thickness of femoral articular cartilage measured with an ultrasound with a linear probe (7-12 MHz) as well as three midpoint measurements taken from each knee: the lateral condyle, intercondylar area, and medial condyle. RESULT(S) The demographic and clinical features of the PCOS patients, the laboratory evaluations, and the endometrial thickness values were recorded, and the three midpoint measurements were taken from each knee. The PCOS patients had thicker cartilage values than the control group at all measurement sites. There was no correlation between the clinical parameters and the cartilage thickness values of PCOS patients. CONCLUSION(S) Our findings support the possible favorable effects of estrogen and androgens in PCOS patients. However, our data cannot determine whether PCOS patients have less risk of developing osteoarthritis later in life because they also have higher BMI values. The possible long-term changes in cartilage thickness in PCOS patients require further study.

Bordetella pertussis Seroprevalence Among Vaccinated School Children in Ankara, Turkey

Pertussis is an acute infectious disease caused by Bordetella pertussis occurring world wide [1]. It is highly contagious in the early catarrhal stage and the secondary attack rate can increase up to 80–90% with household contact [1, 2]. Antibodies against pertussis toxin (PT) have been correlated with clinical protection against pertussis in humans [3]. Pertussis affects susceptible individuals of every age and is especially severe in children [1, 2]. Adolescents and adults are important reservoirs for B. pertussis and are frequent sources of infection for infants in particular [1, 4, 5]. In Turkey, infants are vaccinated with whole cell pertussis as a triple vaccine including Tetanus and Diphteria at the second, third, and fourth months with a booster at 18 months of age according to the national vaccination schedule. No pertussis vaccination is given afterward. Neither immunity nor vaccination protects against the disease long-term and it has been reported that the number of pertussis cases in adolescents and adults has been increasing since the 1990s [4, 6–13]. Pertussis is a notable disease in Turkey and continues to be one of the important childhood infections [14]. The National Standard Diagnosis and Surveillance Guide is put into use since January 1st, 2005, and cases are started to be reported as probable cases or definite cases from all health facilities [15]. Due to the new surveillance system, the number of clinically confirmed cases were 200 and laboratory confirmed cases were 72 with an overall incidence of 0.01/1,000,000 population [16]. The low number of cases reported may likely to be due to the low awareness of the clinicians both in diagnosis and in reporting. Laboratory verification is not usually obtained because of not including the disease in their prediagnosis list or lack of required laboratory infrastructure. In this study, we aimed to determine the pertussis seroprevalance rate in four dosage vaccinated school children aged 6–14 years through the assessment of anti PT IgG antibodies.

Immunogenicity of a Haemophilus influenzae type b–tetanus conjugate vaccine when administered separately or in combined vaccines for primary immunization in two consecutive national schedules in Turkey☆

BACKGROUND In Turkey, the Haemophilus influenzae type b-tetanus toxoid conjugate vaccine (Hib) was replaced by the combined diphtheria-tetanus-acellular pertussis and inactivated polio vaccine (DTaP-IPV/Hib) in 2008. This shift to the new schedule created different cohorts of vaccinated children as a consequence of the different schedules used. We evaluated the immunogenicity of the Hib vaccine in infants vaccinated with these different schedules. METHODS Three groups of children were evaluated: group 1 comprised 145 infants vaccinated with diphtheria, tetanus, and whole cell pertussis (DTwP), oral polio vaccine (OPV), and Hib vaccines simultaneously at separate sites; group 2 comprised 204 infants vaccinated with the DTaP-IPV/Hib combined vaccine; group 3 comprised 100 infants vaccinated with a mixed schedule of DTwP, OPV, and Hib for the first one or two doses, followed by DTaP-IPV/Hib vaccine to complete the series. RESULTS Anti-polyribosylribitol phosphate (anti-PRP) titers ≥0.15μg/ml were similar in groups 1, 2, and 3. However, in group 1, who received all the vaccines at separate sites, ≥ l.0μg/ml long-lasting antibody titers and anti-PRP geometric mean titers were higher (p=0.001). CONCLUSION This study showed that even one dose administered in combination with other vaccines in a primary series decreased the level of anti-PRP.

Associations between obesity and the radiographic phenotype in knee osteoarthritis

BACKGROUND/AIM Investigation of the association between obesity and the distinction of radiographic patterns in knee osteoarthritis. MATERIALS AND METHODS Seven hundred and thirty-four women underwent weight-bearing antero-posterior knee radiography. Osteophytes and joint space narrowing (JSN) were graded according to the OARSI atlas. Each subject was assigned to one of the following groups with respect to the maximum score: osteophyte-dominant, indeterminate, JSN-dominant, and radiographically normal. RESULTS Obese patients had a significantly more frequent osteophyte-dominant pattern compared to nonobese subjects (74.5% and 38%, respectively, P < 0.001). Logistic regression analysis demonstrated that obesity had a stronger association with an osteophyte-dominant pattern compared to a JSN-dominant pattern (OR and 95% CI = 7.16 (3.15-16.26) and 1.63 (0.96-2.78), respectively). Age had a very weak effect on the distinction to an osteophyte-dominant pattern and no effect on JSN dominance (OR and 95% CI = 1.1 (1.06-1.15) and 1.02 (0.99-1.05), respectively). CONCLUSION There might be an association between obesity and the radiographic phenotype in patients with knee osteoarthritis. The findings suggest that the association between obesity and the osteophyte formation is stronger than that of JSN.

Ovarian Cyst Formation Following Gonadotropin-Releasing Hormone-Agonist Administration Decreases the Oocyte Quality in IVF Cycles

OBJECTIVE The gonadotropin-releasing hormone-agonist (GnRH-a) treatment during in vitro fertilization (IVF) sometimes causes a functional ovarian cyst during the administration period before gonadotropin stimulation, as an undesired event. The aim of this study was to analyze the effect of these cysts on the IVF outcomes. MATERIAL AND METHODS Out of 981 IVF cycles, 78 with ovarian cysts were retrospectively analyzed with respect to the demographic characteristics, hormonal outcomes, and fertilization, implantation and clinical pregnancy rates. RESULTS The metaphase II oocyte ratio, fertilization rate and percentage of high quality embryos (grade 1) were significantly higher in the cyst-negative group (p<0.0001; p<0.0001; p≤0.05). These same three parameters were also significantly higher in the cyst-aspirated group (p<0.01; p<0.05; p<0.05). Cyst diameters of the aspiration group were significantly higher (p<0.05). No statistically significant differences in implantation and clinical pregnancy rates were determined between the groups. CONCLUSION An ovarian cyst formation during the GnRH-a suppression period negatively affects oocyte quality. Cyst aspiration before gonadotropin stimulation does not improve the IVF outcome.