Önder Ercan

Modified Ferriman–Gallwey hirsutism score and androgen levels in Turkish women

OBJECTIVE(S) To evaluate a modified Ferriman-Gallwey (mFG) scoring system and serum total testosterone (tT) and dehydroepiandrosterone sulfate (DHEAS) levels, in women with polycystic ovary syndrome (PCOS) and in control subjects. STUDY DESIGN Women with any gynecological problem who presented to the Kahramanmaras Sutcuimam University Medical Faculty Gynecology and Obstetric Outpatient Clinic in the Mediterranean region of Turkey were assessed prospectively. Oligo-anovulation, clinical and biochemical hyperandrogenism, and PCO appearance on ultrasound that met the 2003 Rotterdam Consensus Criteria were used for PCOS diagnosis. Group 1 consisted of 43 cases with a diagnosis of PCOS and group 2 (control group) consisted of 75 age and BMI matched control subjects without PCOS. RESULTS In groups 1 and 2, clinical hyperandrogenism (hirsutism) appearance ratio was 86.0% (37/43) and 18.0% (15/75) (p < 0.001); while biochemical hyperandrogenism (high serum tT or DHEAS level) was 65.1% (28/43) and 36% (27/75) (p < 0.05), respectively. In groups 1 and 2, mean serum tT levels were 115.2 and 73.4 ng/dL (p < 0.001), mean serum DHEAS levels were 256.1 and 177.7 ng/dL (p < 0.001), and mean hirsutism scores were 11.2 and 5.5 (p < 0.001), respectively. Serum mean tT, DHEAS and hirsutism scores for group 1 were significantly higher than those of group 2 (<0.001). No correlation was observed between BMI and the hirsutism scores or the biochemical hyperandrogenism in both groups. CONCLUSION(S) In our study, mean serum androgen levels and hirsutism ratio in the PCOS group were higher than the control group. These values were also substantially higher than those previously published in the literature.

Changes in Copper, Zinc, and Malondialdehyde Levels and Superoxide Dismutase Activities in Pre-Eclamptic Pregnancies.

Background Preeclampsia (PE) is a hypertensive disorder that occurs in 2% to 8% of pregnancies. Although numerous studies have investigated the etiology and pathophysiology of preeclampsia, the precise pathological mechanisms remain poorly understood. Hence, in the present study malondialdehyde (MDA) levels and SOD expression, and Cu and Zn concentrations and ratios were correlated with birth weights in pregnant women with and without PE, and in non-pregnant females of reproductive age. Material/Methods Malondialdehyde (MDA) levels and superoxide dismutase (SOD) activities were determined spectrophotometrically, and Cu and Zn levels were determined using atomic absorption spectrometry in serum from 42 non-pregnant women (NP), 40 healthy pregnant women (HP), and 38 pre-eclamptic pregnant (PE) women. Subsequently, Cu/Zn ratios were calculated and associations with birth weights were analyzed using Spearman correlations. Results Cu, Zn, and MDA levels and Cu/Zn ratios were significantly higher in the PE group than in the HP and NP groups, and were significantly higher in the HP than in the NP group (p<0.001 and p<0.001; respectively). In contrast, serum Zn and SOD levels were significantly lower in the PE group than in HP and NP groups, and were significantly lower in the HP group than in the NP group (p<0.001 and p<0.001; respectively). However, only Cu and Zn levels were significantly associated with fetal birth weights (r=−0.433, p<0.001). Conclusions Serum Cu/Zn ratios may reflect vascular complications of PE, and the ensuing increases in lipid peroxidation may play important pathogenic roles.

Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia?

OBJECTIVE To evaluate the relationship of neutrophil/lymphocyte ratio (NLR) with proteinuria and blood pressure level in patients with pre-eclampsia and to investigate whether or not NLR has a role in predicting the severity of pre-eclampsia. STUDY DESIGN The study comprised 30 healthy pregnant females (Group 1), 37 females with mild pre-eclampsia (Group 2) and 40 with severe pre-eclampsia (Group 3). All the study participants were statistically compared in respect of demographic data, proteinuria levels, and blood pressure levels. RESULT Age, body mass index, and gestational weeks were similar in all the groups. Maternal NLR was determined to be significantly high in the pre-eclamptic patients (Groups 2 and 3) compared to the healthy pregnant patients (Group 1) (p=0.017). NLR was significantly higher in the severe pre-eclampsia group than in the mild pre-eclampsia group (p=0.032). A significant positive correlation was determined in correlation analysis between NLR and proteinuria (p=0.013, r=0.319). There was also a significant and positive correlation between NLR and systolic/diastolic arterial pressure (p=0.007, r=0.285; p=0.044, r=0.213, respectively). CONCLUSION In conclusion, while NLR was determined as significantly high in patients with pre-eclampsia, to be able to use this in the classification of the severity of pre-eclampsia, there is a need for further studies on a more extensive population.

Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy

To compare vaginal length and sexual function after total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH), and vaginal hysterectomy (VH).

Hormonal treatment for severe hydronephrosis caused by bladder endometriosis.

The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydronephrosis and bladder endometriosis was determined in the etiology. After the patient was pathologically diagnosed, Levonorgestrel-Releasing Intrauterine System (LNG-IUS) was administered to the uterine cavity. At the 12-month follow-up, endometriosis was not observed in the cystoscopy and symptoms had completely regressed. Hydronephrosis may be observed after exposure of the ureter, and silent renal function loss may develop in patients suffering from endometriosis with bladder involvement. For patients with moderate or severe hydronephrosis associated with bladder endometriosis, LNG-IUS application may be separately and successfully used after conservative surgery.

Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses

OBJECTIVE We aimed to investigate the utility of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte count as biomarkers to distinguish malignant from benign ovarian masses. MATERIAL AND METHODS We retrospectively reviewed the histopathological results of 185 benign and 33 malignant cases following surgery for an initial diagnosis of adnexal mass and confirmed ovarian masses. Age, cancer antigen 125 (CA-125), white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), mean platelet volume (MPV), platelet distribution width (PDW), NLR, PLR, and lymphocyte counts were compared between groups. RESULTS The significant diagnostic factors to distinguish malignant from benign disease were age (35.5±22 vs. 62±13 years; p<0.001) and CA-125 levels (16.6±21 vs. 98±366 U/mL; p<0.001). No significant difference was observed in WBC count, Hct, Hb, platelet count, PDW, and MPV between groups. To distinguish malignant from benign masses, lymphocyte count (1.29±0.91 vs. 1.80±0.67×10(3) cells/μL, p<0.001), NLR (4.95±5.36 vs. 3.32±2.72, p=0.024), and PLR (203.41±107.84 vs. 160.75±70.84, p<0.001) were identified as markers. The cutoff values were lymphocyte count of >1500 cells/μL (p<0.001), NLR of 3.4732 (p=0.033), PLR of 161.13 (p<0.001), CA-125 of >40 U/mL (p<0.001), and age of >53 years (p<0.001); their respective sensitivity and specificity were 66.7% and 77.8% [area under the curve (AUC), 0.723±0.055], 68.8% and 54.1% (AUC, 0.624±0.058), 81.8% and 50.8% (AUC, 0.683±0.052), 78.8% and 77.8% (AUC, 0.797±0.057), and 81.8% and 82.2% (AUC, 0.888±0.025). Multiple logistic regression analysis revealed cutoff explanatory and accuracy values of 68.2% and 94.9%, respectively, for lymphocyte count, NLR, PLR, CA-125, and age as independent parameters to distinguish malignant from benign ovarian masses. CONCLUSION In combination with age and CA-125 levels, NLR, PLR, and lymphocyte count may be helpful to preoperatively distinguish malignant from benign ovarian masses.

The evaluation of Nesfatin-1 levels in patients with and without intrauterine growth restriction

Abstract Objective: To evaluate Nesfatin-1 levels in patients with and without intrauterine growth restriction and to analyze the correlation between Nesfatin-1 levels and fetal birth weights. Methods: This study comprised a total of 81 cases; 41 patients with IUGR and 40 healthy cases. Demographic data, pregnancy weeks, fetal birth weights and Nesfatin-1 levels were all recorded. The Nesfatin-1 levels were compared between the groups and the correlation between fetal birth weights and Nesfatin-1 levels was analyzed. Results: No statistical significant difference was determined between the groups in terms of demographic data (p > 0.05). Average birth weights were determined as 3420 ± 259 g in the control group and 2041 ± 350 g in the IUGR group, which was found to be statistically unequal (p = 0.001). The average Nesfatin levels in the control group were 0.069 ± 0.011 and 0.094 ± 0.042 in the IUGR group. This difference was statistically unequal (p = 0.001). While no correlation was determined between Nesfatin levels and fetal birthweights in the control group (r = −0.034 versus p = 0.836), in the IUGR group and when all the cases were evaluated together, a statistically moderately significant negative correlation was determined (r = −0.469, p = 0.002 and r = −0.251, p = 0.024, respectively). Conclusions: Although intrauterine growth is a multifactorial process, the effect mechanism has not yet been established. The results of this study offer some indications about the possible effect of Nesfatin 1 on fetal growth.

Comparison of solifenacin and fesoterodine in treatment of overactive bladder

Objectives: To compare the use of solifenacin and fesoterodine in treatment of overactive bladder (OAB). Methods: This prospective study was conducted on patients diagnosed with OAB who presenting to the Department of Obstetrics and Gynecology and Urology, School of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey between October 2013 and August 2014. Patients were randomized into 2 groups. Group 1 (n=60) received 5 mg solifenacin per day, while Group 2 (n=59) received 4 mg fesoterodine per day. All the patients’ OAB symptom scores (OABSS) in weeks 0, 4, and 12 were recorded. In addition, treatment costs and side effects of the drugs were evaluated. Results: Average OABSS (score 1) was determined as: 9.5 ± 2.8 for Group 1 and 10.7 ± 1.8 for Group 2 at week 0; 2.2 ± 1.2 (Group 1) and 2.4 ± 1.3 (Group 2) at week 4 (score 2); and 1.3 ± 0.5 for Group 1 and 1.3 ± 0.6 for Group 2 at week 12 (score 3). In addition, no statistically significant difference was found between the scores (p=0.062 (score 1), p=0.464 (score 2), and p=0.527 (score 3). The discontinuation rate of medication due to its side effects was 0 (0%) for Group 1, and 6 (10.2%) for Group 2. Intragroup changes in the scores 1-2, 1-3, and 2-3 values was statistically significant in both groups (p<0.001). Conclusion: No significant difference was found between the OABSS of these 2 drugs. However, discontinuation of drugs due to side effects was more frequent in fesoterodine.

The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters

Abstract Objective: To investigate the relationship between fetal birth weight and maternal hemoglobin concentrations in different trimesters. Methods: This prospective cross-sectional study comprised 329 women, monitored and delivered between January 2013 and January 2014 in our clinic. Hemoglobin concentrations in all trimesters and all birth weights of the newborns were recorded. Comparisons and correlations were made of the maternal hemoglobin concentrations and birth weights in each trimester. Results: A positive correlation was determined between fetal weight and increased first trimester maternal hemoglobin concentration (p: 0.025). No correlation was found between fetal weights and second and third trimester hemoglobin concentrations (p = 0.287, p = 0.298, respectively). When the effect of independent factors on fetal weight was investigated, it was determined that birth week and first trimester hemoglobin levels were the factors of most influence. Conclusions: Low hemoglobin concentrations in the first trimester of gestation seem to be associated with low fetal birth weights. Anemia can directly cause poor in utero fetal growth due to inadequate oxygen flow to the placental tissue or it can be an indirect indicator of maternal nutrition deficiency. In both circumstances, this study reveals that treatment of anemia before and in the early stages of pregnancy is directly correlated with better fetal outcomes.

Parietal peritoneal closure versus non-closure at caesarean section: which technique is feasible to perform?

Abstract Objective: To evaluate short-term effects of closure versus non-closure of the parietal peritoneum at caesarean section. Methods: A randomized controlled study of women undergoing caesarean section was conducted at the obstetrics department of a research and education hospital between October 2010 and May 2011. Patients were randomly assigned to have closure of parietal peritoneal layer (Group I, n = 55), and non-closure of parietal peritoneal layer (Control, Group II, n = 55). Intra-operative and post-operative outcomes were compared between the groups. Results: Groups were similar for baseline characteristics. Although there was statistically significant difference between Group 1 and Group 2 in terms of time to oral intake and mobilization time [12 (8–12) versus 8 (8–10) h; p < 0.001; 12 (8–12) versus 8 (8–10) h; p < 0.001]; the other variables, such as drop in hemoglobin concentration, estimate of blood loss, intra-operative additional sutures, operating time and time to passage of flatus [1.13 ± 0.86 versus 1.41 ± 0.82 g/dL; 487.9 ± 217.01 versus 544.87 ± 237.64 mL; 0 (0–1) versus 0 (0–1); 30.8 ± 7.63 versus 31.6 ± 10.38 h; 18.2 ± 6.04 versus 18.2 ± 4.23 h, p > 0.05] were not statistically different between Group 1 and Group 2. Conclusions: Closure of the parietal peritoneum has no benefit over non-closure of parietal peritoneum and non-closure is associated with rapid post-operative recovery.