Nermin Akdemir

Increased Serum Asymmetric Dimethylarginine Levels in Primary Dysmenorrhea

Background: Primary dysmenorrhea is a common disorder among young women, and uterine ischemia plays an important role in pelvic pain. Asymmetric dimethylarginine (ADMA) is accepted as a strong marker of endothelial dysfunction. Objective: To investigate the role of ADMA in primary dysmenorrhea. Methods: Thirty-three patients with primary dysmenorrhea and 29 healthy controls were evaluated in a hospital outpatient clinic-based study. Secondary causes of dysmenorrhea had been ruled out in each patient. LDL cholesterol, triglycerides measured and body mass index were also calculated. Blood samples for determination of ADMA concentration were drawn on the 3rd day of menses in each woman. Groups were compared for statistically significant difference by Mann-Whitney U test. Results: Groups did not differ in age or hormone levels. ADMA level was higher in women with dysmenorrhea compared to healthy controls (Mann-Whitney U test, Z = –2.24, p = 0.025). ADMA levels showed positive correlation with age and erythrocyte sedimentation rate in the first group (Spearman’s rho = 0.360, p = 0.040, and r = 0.379, p = 0.029, respectively). Although erythrocyte sedimentation rate and C-reactive protein (CRP) were positively correlated, no significant correlations were found between high-sensitivity CRP and ADMA level in the first group (Spearman’s rho = 0.048, p = 0.749). Conclusion: ADMA concentrations are elevated in primary dysmenorrhea compared to healthy controls. This suggests that endothelial dysfunction plays a role in primary dysmenorrhea.

Effect of reperfusion therapy on index of myocardial performance in acute myocardial infarction: thrombolytics versus primary angioplasty

It is known that primary angioplasty is more effective than thrombolytic therapy for the treatment of ST-segment elevation acute myocardial infarction. The aim of the present study is to compare the effects of the two strategies on the left ventricular functions using the Tei index (a combined myocardial performance index). Of 81 patients (11 female, mean age 52.7 ± 11.9 years, and 70 male, mean age 54.8 ± 11.5 years) matching the selection criteria, 41 patients were treated by primary percutaneous transluminal coronary angioplasty and stenting (group A, 41 patients) and 40 patients were treated by thrombolytic agents (streptokinase) (group B, 40 patients). All patients underwent a complete two-dimensional transthoracic echocardiographic and Doppler study in the left lateral decubitus position from multiple windows. There was no significant difference between the two groups in isovolumetric contraction time and ejection time. Isovolumetric relaxation time was 95.2 ± 18.4 in group A and 116.2 ± 28.1 in group B (P = 0.001) and the Tei index was 0.51 ± 0.12 in group A and 0.59 ± 0.16 in group B (P = 0.019). Isovolumetric relaxation time and Tei index were significantly higher in group B. Primary angioplasty is superior to thrombolytic therapy as assessed by the Tei index even in the first 3 h, with no apparent change in systolic function.

Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy: A silent epidemic.

Abstract Chronic postsurgical pain (CPSP) is an important clinic problem. It is assessed that prevalence of chronic pain extends to 30% but it is contended that there are various risk factors. We aimed to evaluate the prevalence of chronic pain after hysterectomy, risk factors of chronicity, neuropathic features of pain, and sensorial alterations at surgery area. Between years 2012 and 2015, 16 to 65 ages old patients that electively undergone total abdominal hysterectomy bilateral salpingo-oophorectomy and passed minimum 3 months after surgery were included to study. Visual analog scale (VAS) and Douleur Neuropathique 4-questionnaire (DN-4) surveys were used to evaluate pain symptoms, algometry device was used for evaluating abdominal pressure threshold and Von Frey Filament was used for sensorial alterations. Ninety-three of 165 eligible patients were included to study. As the groups were compared by demographic data, no difference was obtained (P > 0.05). There was no difference between groups regarding patient and surgery attributes (P > 0.05). Most frequently performed incision type was Pfannenstiel. Neuropathic symptoms were observed in 90 patients (96.8%). Sensorial alterations as hypoesthesia and hyperesthesia were detected around abdominal scar in 18 patients (19.4%) with pinprick test. Neuropathic symptoms should not be ignored in studies evaluating CPSP and a standard methodology should be designed for studies in this topic.

Electrocardiographic Findings in Patients With Primary Dysmenorrhea

Introduction:Primary dysmenorrhea (PD), which is characterized by painful menstrual cycles, is one of the common clinical problems in young adult women. The aim of this study was to investigate the risk of cardiac arrhythmias in PD patients by using the electrocardiographic (ECG) parameters. Methods:Forty patients diagnosed with PD and 30 age-matched normal controls were included in this study. ECGs were performed by using 12-leads with 10 mV amplitude and 25 mm/sec velocity. P and QT waves were manually marked along the isoelectric line. P maximum, P minimum, QT maximum and QT minimum were measured on the surface 12-leads ECG, and the P wave and QT dispersions were calculated. Results:There was not any significant correlation of P wave dispersion and QT dispersion between the age, sex, body mass index, hemoglobin, fasting blood glucose or any other laboratory parameters. P wave dispersion was significantly longer in the PD group than the control group (61.4 ± 19 msec versus 57 ± 14 msec, P = 0.01). The P minimum duration was significantly shorter in the PD group compared with the control group (36 ± 16 msec versus 41 ± 9 msec, P = 0.03). QT dispersion was significantly higher in the PD group compared with normal controls (76 ± 23 msec versus 58 ± 16 msec, P = 0.02). Conclusion:These results show that PD can be associated with cardiac arrhythmias, especially atrial fibrillation, by increasing P wave dispersion and ventricular arrhythmia risk because of an increased QT interval.

Thyroid dysfunction in hyperemesis gravidarum: a study in Turkish pregnant women.

OBJECTIVE In this study we investigate the possible relation of thyroid dysfunction and thyroid antibodies to hyperemesis gravidarum. MATERIAL AND METHODS Thirty-seven patients with hyperemesis gravidarum and 33 healthy controls have been included in this study. RESULTS Thyroid dysfunction was significantly more common than in controls (38% vs 6%, p=0.002). Thyroglobulin antibodies were also significantly more common in patients with hyperemesis gravidarum than controls (54 IU/mL vs. 14 IU/mL, p=0.03). CONCLUSION Hyperemesis gravidarum can be a risk factor for postpartum thyroid dysfunction. Thyroid antibodies must be checked in the hyperemesis population in an endemic goitre region and/or iodine replacement regions.

Isolated Renal Vein Thrombosis Associated With MTHFR-1298 and PAI-1 4G Gene Mutations

Isolated renal vein thrombosis is very rare without the presence of nephrotic syndrome. It is more common in the newborns and infants. Whereas major risk factors in adults are the procoagulant states such as protein C or S deficiency, factor V Leiden mutation, primary or secondary antiphospholipid syndrome, severe hypothyroidism, and trauma. Here, we report a case of isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. It should be noted that the presence of MTHFR-1298 and PAI-1 4G gene mutations together might be one of the examples of genetic mutation combinations that increase the likelihood of a thrombotic event.

Evaluation of the level of thiol-disulphide homeostasis in patients with mild and severe preeclampsia

• We assessed thiol-disulphide balance with a new colorimetric method recently developed by Erel & Neselioglu.

Sakarya Bölgesindeki Adölesan Gebeliklerin İncelenmesi

Makale / Article Akdemir ve Ark. Sakarya’da Adölesan Gebelikler Sakaryamj 2014;4(1):18-21 19 Giriş: Erken veya ileri yaşta gebelikler düşük doğum ağırlıklı bebek doğurma ve prematürite gibi kötü doğum sonuçlarıyla sonlanabilmektedir. Erken yaşta gebelikler büyük bir toplum sorunudur. Çoğu gelişmiş ülkeler adölesan gebelikleri azaltmak için çeşitli sağlık politikaları üretmektedir. İleri yaş gebelik sonuçları adölesan gebelik sonuçlarıyla karşılaştırıldığında önemsenmeyecek düzeydedir çünkü adölesanlara göre yüksek sosyoekonomik düzeye sahiplerdir. Bazı araştırmacılara göre ileri yaş anneler adölesan annelere göre daha az düşük doğum ağırlıklı bebek veya prematürite riskine sahiplerdir. Düşük doğum ağırlıklı bebek ve prematürite için risk faktörleri arasında hipertansiyon, astım, plasenta previa, ve aşırı kilo alımı vardır. Otuz beş yaş ve üzeri ilk gebeliği olan kadınlarda gestasyonel diyabet, plasenta previa, gebeliğine bağlı hipertansiyon ve sezeryanla doğum gereksinimi gibi riskler sağlıklı gebelere oranla daha fazladır. Aynı zamanda ileri yaş annelerde hipertansiyon, diyabetes mellitus ve diğer kronik hastalıklar sıkça görülür. Adolesanlar, genel toplumda nüfusun %20 -25’ini oluşturmakta ve bu adolesanların %85’i gelişmekte olan ülkelerde yaşamaktadır. Adolesan dönem bireyin biyolojik, psikolojik ve sosyal değişimlerinin gerçekleştiği, Dünya Sağlık Örgütünün tanımıyla 10-19 yaşları arasındaki dönemi kapsamaktadır. Adölesan gebeler ise gebeliği boyunca kötü maternal kilo alımı, yetersiz prenatal bakım, gebeliğine bağlı hipertansiyon ve preeklampsi için yüksek risk faktörüne sahiplerdir. Bu çalışmamızda eğitim ve araştırma hastanemize başvuran adolesan gebelerin gebelik sonuçlarını ve komplikasyonların analizini yapmayı amaçladık. Materyal ve Metod 2010-2012 yılları arasında Sakarya Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde doğum yapan tüm hasta dosyaları incelendi. 1019 yaş gebelikler adölesan gebelik olarak kabul edildi. Tüm doğum verileri, adölesan gebeler ve kontrol (20-35 yaş) grubu olarak gebeler retrospektif olarak incelendi. Bu yıllar içerisinde toplam doğum sayısı yaklaşık 1700 olup 77 tane adölesan gebenin doğumu gerçekleştiği saptandı. Kontrol grubu ve adölesan grupta hastaların demografik, klinik ve sonuç bilgileri incelendi. Anneye ait verilerden; maternal yaş, sosyoekonomik düzey, hastaneye yatış gereksinimi, gravida, parite, gebelik komplikasyonları, doğum şekli, doğum komplikasyonları ve bebeğe ait; canlı doğum, ölü doğum, doğum ağırlığı, APGAR skoru, yenidoğan yoğun bakım gereksinimi, neonatal morbidite ve mortalite verileri değerlendirildi. 2500 gram ve altında olan yenidoğanlar düşük doğum ağırlıklı olarak kabul edildi. APGAR skorunun 7’nin altında olması kötü olarak değerlendirildi. İstatististik Sürekli değişkenler için tanımlayıcı istatistikler ortalama ve standart sapma olarak ifade edilirken, kategorik değişkenler sayı ve yüzde olarak ifade edilmiştir. Kategorik değişkenler için yüzde değerlerin karşılaştırılmasında Chi-Kare testi kullanılmış ve istatistik anlamlılık düzeyi <0.05 olarak alınmıştır. Hesaplamalar için SPSS (ver: 18) istatistik paket programı kullanılmıştır. Bulgular Çalışma grubunda 20-35 yaş arası gebe sayısı 1220 olup 77 gebe adölesan dönemdeydi. Adölesan grupta doğan %44 erkek çocuk, %56 kız çocuk varken, kontrol gurubnda %47 erkek ve %53 kız çocuk mevcut olup her 2 grup arasında anlamlı fark yoktu (p= 0.7). Adölesan grupta doğan çocukların Tablo 1: Demografik özellikler Adölesan Grup, n:77 Kontrol Grubu, n: 1220 P Yaş(yıl) 18 (15-19) 26.8 (20-35) 0.0001 Parite 0.09(0-1) 1.99(1-5) 0.0001 Gebelik Süresi(Hafta) 38(24.5-41) 39.7(29-41.5) 0.001

The comparison of hyaluronic acid vaginal tablets in the treatment of atrophic vaginitis

We read the study titled ‘‘The comparison of hyaluronic acid vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial’’ by Dr. Murat Ekin et al. published in Arch Gynecol Obstet (2011) 283:539–543 with interest. It is reported in the study that hyaluronic acid-containing vaginal tablets can be effective as an alternative treatment agent for the treatment of atrophic vaginitis in post-menopausal women who cannot use local estrogen. There are some issues which attracted our attention in the material methodology part. It is reported in Table 3, where pre-treatment epithelial atrophy levels of the groups are compared, that about 1/4 (23.8%) of the women in the hyaluronic acid vaginal tablet group (group 2) had severe epithelial atrophy, while none of the cases included in the estradiol vaginal tablet group had severe epithelial atrophy. The authors showed in the table that a statistically significant difference (p 0.012) occurred in the epithelial atrophy signs of the groups in the basal examination. Similar proportional differences between the two groups are manifest in Table 4 where vaginal pH evaluation results are presented as well. Although it is indicated in the title that the study is a randomized trial, there is no explanatory information about the method by which the patients allocated to study and control groups were randomized. The fact that the groups were not homogeneous in terms of vaginal epithelial atrophy signs before treatment suggests a failure of proper randomization in the allocation to study and control groups. The bias in the patient allocation at the beginning of the treatment will affect the evaluation of the treatment outcomes in the study and control group patients who are already small in number. In other words, the results may be expected to favor the group receiving estrogen, which had a better basal condition. We believe that we can make a better evaluation of the study results, if the authors would illuminate the aforementioned issues.

Pulse wave velocity and myocardial performance index in premature ovarian insufficiency

Abstract Objective. Epidemiological studies suggest that women with loss of ovarian function at early ages may be especially burdened by cardiovascular disease (CVD). In this study, we aimed to evaluate pulse wave velocity (PWV) and myocardial performance index (MPI) in patients with premature ovarian insufficiency (POI). Design. We enrolled 51 female patients (mean age 38.9 ± 6.7 years) with POI and 49 healthy subjects (mean age 36.8 ± 5.2 years). All participants underwent a detailed echocardiographic examination and PWV measurement, which is basically the velocity of pulse wave travelling from carotid to femoral artery. Results. Both groups were similar with regard to age, body mass index (BMI) and left ventricular ejection fraction. When diastolic functions were assessed, patients with POI had higher mean E/E’ratio (9.3 ± 1.9 vs. 7.6 ± 1.6, p < 0.001). POI patients have impaired MPI (0.9 ± 0.5 vs. 0.5 ± 0.2, p < 0.001) comparing to healthy controls but PWV measurements did not differ between two groups (5.7 ± 0.8 vs. 5.6 ± 0.6 m/s, p = 0.48). Conclusions. This study showed POI patients might have impaired global left ventricular functions comparing to age matched healthy controls and this might reflect the effects of premature lack of estrogen (E) on women’s cardiovascular (CV) system.