Hüseyin Aksoy

Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding?

BACKGROUND An easy, reproducible and simple marker is needed to estimate phase of endometrial pathologic lesions such as hyperplasia and endometrial cancer and distinguish from pathologically normal results. We here aimed to clarify associations among neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. MATERIALS AND METHODS Patients (n=161) who were admitted with abnormal uterine bleeding and the presence of endometrial cells on cervical cytology or thick endometrium were investigated. The study constituted of three groups according to pathologic diagnosis. Group 1 included endometrial precancerous lesions like hyperplasia (n=63), group 2 included endometrial cancerous lesions (n=38) and group 3 was a pathologically normal group (n=60). Blood samples were obtained just before the curettage procedure and the NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count; similarly, PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. RESULTS The white blood cell count was significantly higher in patients with cancer than in those with hyperplasia (p=0.005). The platelet count and neutrophil to lymphocyte ratio were significantly higher in patients with cancer than in control patients, but there was significantly no difference between patients with hyperplasia and other groups (p=0.001 and p=0.025 respectively). PLR was significantly lower in control subjects than in other groups (p<0.001), but there was no significant difference between patients with hyperplasia and those with cancer. CONCLUSIONS PLR was significantly lower in control subjects than in other groups. Thus both hyperplasia and cancer may be differentiated from pathologically normal patients by using PLR. White blood cell count was significantly higher in patients with cancer than in those with hyperplasia and pathologically normal patients. Therefore white blood cell count may be used for discriminate hyperplasia to cancer. By using multiple inflammation parameters, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients.

Depression levels in patients with hyperemesis gravidarum: a prospective case–control study

Hyperemesis gravidarum (HG) is a condition characterized by severe, intractable nausea and vomiting in early pregnancy. It affects about 0.3–2% of all pregnancies and is thought that HG is a multifactorial disease resulting from the combination of various unrelated conditions such as genetic, hormonal and psychiatric. Although there are studies investigating the relationship between anxiety, depression and HG; however, none have sufficiently clarified this link. The aim of this prospective case–control study was to investigate the possible relationship between depression and HG and compare the prevalence of depression disorders in pregnant women with and without HG.A prospective case–control study was performed at our tertiary referral centre between December 2013 and July 2014. The study group consisted of 78 pregnant women with HG and the control group consisted of 82 healthy pregnant women who never had experienced any nausea and vomiting. No study participants had any pre-pregnancy history of any psychiatric disorder including depression. Structured Clinical Interview for Diagnostic (SCID-I) and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) was used to evaluate symptoms of depression. Beck Depression Inventory (BDI) was administered to patients during the psychiatric interview and was evaluated by the same psychiatrist.The mean BDI scores in HG study and healthy control groups were 18.97 ± 9.85 and 6.36 ± 5.61, respectively (p < 0.001). Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression.In conclusion, the findings of this study indicated that psychological distress associated with HG was a direct consequence rather than a cause of HG. Therefore, patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions.

Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomised controlled trial.

Objective Fear of pain during intrauterine device (IUD) insertion can be a barrier to widespread use of this safe and highly effective contraceptive method. Our objective was to determine the effectiveness of topical 10% lidocaine spray for pain control during IUD insertion. Methods A total of 200 subjects with the request for IUD insertion were included in the study. The patients were randomly divided into two groups: lidocaine spray (n=100) and placebo (n=100). The pain experienced during the procedure was measured immediately after insertion by a standard Visual Analogue Scale (VAS) administered by a separate researcher with maintenance of allocation concealment. Results The mean pain score during the procedure was 1.01±1.20 in the lidocaine spray group and 3.23±1.60 in the placebo spray group (p<0.001). Lidocaine spray treatment significantly lowered the overall procedural pain score compared with placebo. Conclusions Significant pain reduction during IUD insertion can be achieved by using 10% lidocaine spray alone. Lidocaine spray can be accepted as a non-invasive, easy to apply and more comfortable local anaesthetic method for IUD insertion. Trial registration number NCT02020551.

Evaluation of endometrial precancerous lesions in postmenopausal obese women--a high risk group?

AIM To evaluate precancerous lesions such as hyperplasia and endometrial polyps in obese postmenopausal women. MATERIALS AND METHODS Women who were referred with abnormal uterine bleeding in postmenopausal period or the presence of endometrial cells on cervical cytology in our department were investigated. Anthropometric measurements such as height, weight, body mass index, waist/hip ratio and endometrial thickness were compared between a precancerous lesion (hyperplasia and endometrial polyp) group and a pathologically normal group. RESULTS We detected statistically significant thickening of endometrium in patients with precancerous lesions. Moreover patients with precancerous lesions had higher body mass index than the pathologically normal group. CONCLUSIONS We found elevated precancerous lesion rates in overweight and obese women in the postmenopausal period, of interest given that the prevalence of obesity is increasing in most parts of the world. Although screening for endometrial cancer is not recommended for the general population, in high-risk populations like obese postmenopausal women, it may be very important.

Evaluation of the macula, retinal nerve fiber layer and choroid in preeclampsia, healthy pregnant and healthy non-pregnant women using spectral-domain optical coherence tomography.

Objective: To evaluate the macular, retinal nerve fiber layer (RNFL) and choroidal thickness alterations by using spectral-domain optical coherence tomography (SD-OCT) in preeclampsia and compare with healthy pregnant and healthy non-pregnant controls. Method: The study population included healthy pregnant control group (n: 25), healthy non-pregnant control group (n: 26) and study group with preeclampsia (n: 27). Retinal thickness parameters were measured by SD-OCT. Results: There was a statistically significant difference among all of the groups for choroidal thickness (p < 0.001). Choroidal thickness in preeclamptic women was significantly thinner than healthy pregnant women. The most thick choroid layer was detected in healthy pregnant group, and also the most thin choroidal thickness was detected in healthy non-pregnant group (p < 0.001). Macular central subfield and foveal center thickness were significantly thinner in preeclamptic study and healthy pregnant groups than healthy non-pregnant group (p < 0.001). However, there was no statistically significant difference between preeclamptic study group and healthy pregnant group for both macular central subfield and foveal center thickness. Average of RNFL thickness was significantly thicker in healthy pregnant group than healthy non-pregnant group (p = 0.004). Conclusions: This study revealed that choroidal thickness measured using SD-OCT increased in women with preeclampsia and healthy pregnant women but the increase in choroidal thickness in preeclampsia was lower than the healthy pregnant controls. This lower rise in choroidal thickness can be generally attributed to the markedly increased systemic vascular vasospasm secondary to preeclampsia.

Influence of maternal body mass index on sonographic fetal weight estimation prior to scheduled delivery.

To investigate the possible effect of maternal obesity on the accuracy of sonographically estimated fetal weight in the third‐trimester shortly before induction of labor and to compare the accuracy of the estimation between normal weight, overweight, and class I, class II and class III obese groups.

Comparison of lidocaine spray and paracervical block application for pain relief during first-trimester surgical abortion: A randomised, double-blind, placebo-controlled trial

Surgical abortion is one of the most frequently performed gynaecological procedures and its associated pain has always been a problem in gynaecology. Here we studied the analgesic efficacy of lidocaine spray and paracervical block (PCB) in patients undergoing first-trimester surgical abortion. A randomised double-blind placebo-controlled study was conducted on 108 women requesting pregnancy termination. The subjects were randomly assigned into four groups: Group 1 (PCB plus lidocaine spray) (n=27), Group 2 (PCB) (n=27), Group 3 (lidocaine spray) (n=27) and Group 4 (placebo) (n=27). Intra-procedural and post-procedural pain scores were measured with a standard visual analogue scale (VAS). The median VAS scores during procedure in placebo, lidocaine spray, PCB plus lidocaine spray and PCB groups were 8 (7–9), 5 (4–8), 4 (3–4) and 5 (3–5), respectively. The most effective method of pain relief during first-trimester abortion can be achieved through a combined use of PCB plus lidocaine spray. Therefore, lidocaine spray is a non-invasive complementary anaesthetic method versus traditional PCB for first-trimester surgical abortion.

Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study

OBJECTIVE We aimed to compare the effect of general and spinal anesthesia on maternal blood loss in elective cesarean section (CS). MATERIAL AND METHODS This was a prospective randomized study and included 418 healthy pregnant women with a term uncomplicated singleton pregnancy between 37 and 41 weeks of gestation. The study participants were randomly divided into two groups: the general anesthesia group and spinal anesthesia group. CSs were all performed using the same surgical technique, and within the groups, the same anesthetic procedures were used (either general or spinal). The primary outcome for this study was operative blood loss. Hemoglobin and hematocrit concentrations were compared between the two groups. RESULTS The preoperative hemoglobin and hematocrit levels were similar in the both groups (p=0.08 and p=0.239, respectively). Significantly lower operative blood loss was achieved using spinal anesthesia versus general anesthesia during elective CS. The differences between preoperative and postoperative blood values for both the study groups were statistically significant (p<0.001). CONCLUSION This study demonstrates that spinal anesthesia is associated with a lower risk of operative blood loss than general anesthesia in low risk patients undergoing elective CS.

Utilization of Emergency Service of Obstetrics and Gynecology: A Cross-Sectional Analysis of a Training Hospital

Background Overutilization and inappropriate use of emergency departments (EDs) by patients with non-urgent health problems has become a major concern worldwide. This study aims to describe the characteristics of obstetric and gynecologic patients admitted to the Department of Emergency Obstetric and Gynecology. Methods A retrospective and cross-sectional study was designed at our Emergency Service of Obstetrics and Gynecology of Kayseri Education and Research Hospital of Medicine between January 1 and December 31, 2013. A total of 30,853 patients applying to emergency service were retrospectively analyzed from the admission charts, patient files and hospital automation system. Patients were assessed in terms of demographic features, presentation times, complaints, admission type (with own facilities, with consultation or with ambulance), diagnoses (urgent or non-ergent), discharge rates, clinical admission, rejection rate of examination, and rejection rate of hospitalization. Results A total of 30,853 patients were analyzed retrospectively. The mean age of patients was 27.69 ± 8.44 years; 51% of patients were between 20 and 29 years old. The categories of patients in urgent and non-urgent were 69% and 31% respectively. Most common presentation time period was between 19:00 and 21:00. Labor pain, pain and bleeding during pregnency, routine antenatal control, pelvic pain and menstrual irregularity were the most common complaints. Labor pain with the rate of 21% was the most common cause of ED admission. All patients who presented with labor pain were hospitalized. Patients hospitalized for labor constituted 56% of all hospitalized patients. Among patients, 62% were treated on an outpatient basis and 38% were hospitalized. Of patients, 3.54% refused to hospitalization. The cases using the ambulance to admission constituted 1.07% of all ED patients. Of these patients who have used ambulance 3.65% refused to the patient examination. Conclusions To improve the obstetric and gynecologic emergency medical care in Turkey, demographic properties and other characteristics of patients should be analyzed in detail. Detailed analysis of the data contributes to the further design and perspective of the EDs.

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial.

Background & objectives: Patients frequently experience pain of moderate to severe degree during gynaecologic procedures. This prospective, randomized, placebo-controlled trial was aimed to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure. Methods: A total of 144 mutiparous women were randomly allocated to one of the six groups. The first group (control group) consisted of 22 participants and they did not receive any treatment. The second group had 26 participants receiving oral 25 mg dexketoprofen trometamol. The 23 participants of the third group received two puff lidocaine sprays on cervical mucosa. The forth group consisted of 25 participants receiving 100 mg pethidine. In the fifth group, the 23 participants received 1000 mg intravenous paracetamol and the sixth group consisted of 25 participants receiving diclofenac sodium. Results: Pethidine was the best choice for reducing pain score during curettage procedure (t2:intra-operative). All analgesic procedures were significantly effective in reducing pain during postoperative period (t3). Significant pain reduction was achieved for both intra- and postoperative period by using analgesics. Interpretation & conclusions: The results of our study showed that lidocaine puffs provided the best pain relief than the other analgesics used. Therefore, lidocaine may be considered as the first choice analgesic in fractional curettage (NCT ID: 01993589).