Servet Hacivelioglu

The protective effect of quercetin on IMA levels and apoptosis in experimental ovarian ischemia-reperfusion injury.

OBJECTIVE To investigate the protective effect of quercetin (QE), an anti-inflammatory and anti-oxidant agent, on torsion-detorsion induced histopathological changes and blood IMA levels in experimental ovarian ischemia-reperfusion (IR) injury. STUDY DESIGN Twenty-four female Wistar rats were randomly divided into four groups in this study (n=6). Group I, (sham operation); Group II, torsion-detorsion plus saline (IR); Group III, torsion-detorsion plus solvent (dimethylsulfoxide: DMSO, IR+DMSO); Group IV, torsion-detorsion plus 15 mg/kg/bw quercetin (IR+QE) injected intraperitoneally 30 min prior to detorsion. After 3h of reperfusion, the right ovaries were removed surgically. The ovary tissue samples were fixed in 10% formalin solution for histopathological and immunohistochemical examination. Blood samples were obtained at the end of the procedures for each group of animals. RESULTS Ovarian sections in Groups II and III showed higher follicular cell degeneration, hemorrhage, vascular congestion and edema when compared with Group I. Administration of quercetin in rats significantly prevented degenerative changes in the ovary. Significantly less histopathological changes were found in Group IV compared with Groups II and III. Caspase-3 and TUNEL positive cells were detected in the ovarian surface, follicle epithelium, and stromal cells in all experimental groups, and there was a significant increase in Groups II and III compared with Group I (P<0.05). Treatment with quercetin decreased the number of caspase-3 and TUNEL positive cells. IR increased the ischemia modified albumin (IMA) levels in comparison to the sham group (1.06 ± 0.10 ABSU and 0.92 ± 0.08 ABSU, P<0.05). Quercetin administration before IR reduced the levels of IMA (0.93 ± 0.08 ABSU, P<0.05). CONCLUSION Administration of quercetin is effective in preventing tissue damage induced by IR injury in ovaries.

Acne severity and the Global Acne Grading System in polycystic ovary syndrome

To evaluate the association between acne, quantified by the Global Acne Grading System (GAGS), and abnormal clinical and laboratory markers of androgen excess in patients with polycystic ovary syndrome (PCOS).

The effect of anaesthesia technique on maternal and cord blood ischaemia-modified albumin levels during caesarean section: A randomized controlled study

Objective Ischaemia-modified albumin (IMA) is an early marker for various ischaemic events, including cardiac ischaemia. This study determined variations in IMA levels during caesarean section, performed under general anaesthesia or with combined spinal epidural anaesthesia. Methods Full-term, healthy pregnant women were allocated to undergo caesarean section, using either general anaesthesia or combined spinal epidural anaesthesia. IMA and albumin levels were measured in maternal serum samples taken immediately prior to caesarean section and 30 min into the procedure, as well as from serum taken from cord blood after double clamping. Results At total of 51 healthy pregnant women underwent either general anaesthesia (n = 28) or combined spinal epidural anaesthesia (n = 23). Within-group analysis of the general anaesthesia group showed that both IMA levels and IMA/albumin ratios were significantly higher at 30 min of surgery compared with the immediate preoperative period. Conclusions Lower IMA levels in the combined spinal epidural anaesthesia group may have been due to improved balancing of oxidative stress during caesarean section. Further research on IMA levels during caesarean section should take into account the method of anaesthesia used.

Sleep disturbance among women with chronic pelvic pain

To investigate the effect of chronic pelvic pain (CPP), a debilitating condition, on sleep quality.

Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery

Abstract Objective: Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST). Methods: Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation. Results: Out of the patients with no SG (n = 11), mild SG (n = 10) and severe SG (n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively (p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively (p = 0.561). Conclusions: To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation.

Does Omegaven have beneficial effects on a rat model of ovarian ischemia/reperfusion?

OBJECTIVE The beneficial effects of omega-3 fatty acids on an intestinal ischemia/reperfusion (I/R) model was shown previously. Therefore, we aimed to examine the potential beneficial effects of parenteral omega-3 fatty acids, a safe and inexpensive product, on a rat model of ovarian I/R. STUDY DESIGN A group of 39 rats was divided into six groups. Group 1 (Sham Group; n=6) underwent two laparotomies with a 3-h interval and their ovaries were removed 3h later. Group 2 (torsion-detorsion Group; n=7) had their ovaries torsioned clockwise and fixed at 720°; 3h later a detorsion operation was done and after another 3h, their ovaries were removed. Group 3 (n=7) and Group 4 (n=7) received the same treatment as Group 2; however, half an hour prior to detorsion, these rats received Omegaven at 1mL/kg and 5mL/kg, respectively. Group 5 (n=6) and Group 6 (n=6) received the same treatment as Group 1; however, half an hour prior to the second laparotomy, these rats received Omegaven at 1mL/kg and 5mL/kg, respectively. One ovary from each rat was evaluated histologically by hematoxylin and eosin (H&E) staining and the other ovary was homogenized and evaluated for total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI). RESULTS While we failed to show any significant relationship among groups in oxidative parameters, there was a significant worsening in the torsion-detorsion group in histological evaluation. High Omegaven doses, but not low doses, improved tissue injury scores of torsioned and detorsioned ovaries to the levels observed in the control group. CONCLUSION Omegaven improves the detrimental effects of ovarian I/R when used in sufficient doses. Its effects and dose adjustment on women with ovarian torsion must be investigated by further studies.

Can the addition of a paracervical block to systemic or local analgesics improve the pain perceived by the patient during hysterosalpingography

The aim of the present study was to investigate whether the addition of a paracervical block to local intrauterine anaesthesia or the use of an intramuscular non-steroidal anti-inflammatory drug was effective for pain control during and at 30 min after hysterosalpingography (HSG). A total of 120 patients undergoing hysterosalpingography were randomised into four groups. Patients received intramuscular dexketoprofen trometamol with or without a paracervical block or intracavitary lidocaine instillation with or without paracervical block. The primary outcome was the overall pain score from the four stages of the procedure. The lowest pain scores were observed in the patients receiving dexketoprofen trometamol with a paracervical block, whereas the highest pain scores were observed in patients with intracavitary lidocaine instillation without a paracervical block (p = 0.021). No beneficial effect was found when a paracervical block (PCB) was added to either systemic or local analgesics. The combination of intramuscular dexketoprofen and a paracervical block with plain lidocaine produced the best pain relief during the three specified steps and at up to 30 min after the HSG procedure.

The relationship between subclinical cardiovascular disease and lipocalin-2 levels in women with PCOS

OBJECTIVE In this study we aimed to investigate the relationship between lipocalin-2 (LCN2) levels and cardiovascular risk in patients with polycystic ovary syndrome (PCOS). STUDY DESIGN Fifty patients with PCOS and 44 healthy women as controls were enrolled in the study. Laboratory and echocardiographic examinations were performed between the second and fifth days of the menstrual cycle. Serum LCN2 levels were measured with an enzyme-linked immunosorbent assay (ELISA) method. RESULTS Serum LCN2 levels were significantly lower in PCOS patients (75.8 [51.4-131.2] ng/ml vs. 85.3 [56.7-138.5] ng/ml, p=0.038). Carotid intima-media thickness (CIMT) was increased in patients with PCOS compared to controls (0.61±0.13mm vs. 0.50±0.07mm, p=0.001). Aortic strain was lower in patients with PCOS. Aortic stiffness (β index) was significantly increased and distensibility was decreased in PCOS patients compared to control subjects. Serum LCN2 levels and the presence of PCOS were associated with CIMT in Spearman correlation analysis (p=0.05 and p<0.001) in all participants. There was no statistically significant relationship between LCN2 levels and CIMT in patients with PCOS (p=0.238). CONCLUSION In the present study, we found that LCN2 levels were low in women with PCOS. Although our patients with PCOS had elevated cardiac risk, there was no correlation between LCN2 levels and early findings of atherosclerosis.

Comparison of olive oil and lanolin in the prevention of sore nipples in nursing mothers.

Sore nipple is a frequently encountered problem among lactating women. This problem might cause severe pain and might end up with discontinuation of suckling. An effective method to prevent sore nipples have not been defined yet. Olive oil is an easily accessible and relatively cheap substance. Although it had been used for sore nipples in the Mediterranean countries for many years, the usage of olive oil in the management of sore nipples has not been discussed in the literature yet. We aimed to define a new, safe, effective, and cheap modality for preventing sore nipples. We conducted the study on the patients who were delivered in our clinic between February 2012 and June 2012. Ethical committee approval and the written consent of patients were obtained. An education on breastfeeding was given to all patients by the same nurse. Patients’ nipples were examined to evaluate if both of them were suitable for suckling or not. Patients who did not give consent, could not breastfeed in the first 24 hours, had a difference between nipples that might affect suckling, had contraindication for breastfeeding, did not have sore nipples with their previous babies, and had an allergy to either olive oil or lanolin were excluded. Patients were requested to put olive oil on one nipple and lanolin on the other one before suckling and breastfed the baby without cleaning the ointment. They were asked to use the same ointment to the same nipple every time until the end of the study. They were advised to use one of the modalities for both nipples if they were satisfied with the modality. They were also advised to record the time they chose the modality if a selection was done. After a month, patients were evaluated once more. They were asked about satisfaction from the modalities, their choice if there was, and the pain during the suckling. Data were analyzed with the SPSS version 11.5 software program (SPSS, Inc., Chicago, IL). A value of p < 0.05 was defined as statistical significance. The mean age of the 31 patients included to our study was 27.84 – 6.33 years. Among the study group 64.5% of them were primiparous, and 51.6% of them were delivered by cesarean section. Education levels of patients were evaluated: nine (29%) of them graduated from a primary school, 17 (54.9%) of them graduated from a secondary school, and five (16.1%) of them graduated from a university. From the study group, 15 patients (48.4%) lived in an urban area with a downtown, and 16 (51.6%) of them lived in rural areas. In total, 18 (58.1%) patients preferred olive oil, five (16.1%) preferred lanolin, three (9.7%) continued to use both modalities, and five (16.1%) of them gave up both methods at the end of 1 month ( p < 0.001). Although nine (29%) patients decided to choose one of the methods in the first week of the delivery, the rest made their choice after 1 week. Of the ones who had decided in the first week of delivery, eight (89%) patients chose olive oil, and one of them gave up both methods. When a regression analysis was done for age, education levels, gravidas, parities, pain during suckling, delivery route, and method choice, we found a significant relationship only between the pain during suckling and the choice of method. As it is well established, breastmilk is the ideal nutrition for a newborn. In a population-based study that examined the breastfeeding rate and patterns among 3,161 infants younger than 6 months, it was found that 22.8% of mothers experienced sore nipples. Unfortunately, sore nipple might cause breastfeeding cessation. When Mohammadzadeh et al. compared hind milk rubbing after suckling and lanolin usage three times a day with the control group, they concluded that there was no difference among groups in terms of clinical manifestations of sore nipples. Tachev et al. concluded that highly purified lanolin (Lansinoh ; Lansinoh Laboratories, Alexandria, VA) was suitable for both preventing and treating sore nipples. Melli et al. recommended peppermint gel for sore nipples compared with placebo and lanolin. Olive oil has strong antioxidant and antimicrobial properties, and it had been used for wound healing for a long time. It is also known that even parenteral usage of olive oil for newborns is safe. So it is well tolerated by the babies and the families. To our knowledge this is the first article that evaluates the satisfaction of lactating women with olive oil for preventing sore nipples in the English literature. Using the contralateral nipple of the patient as a control group is the major factor that strengthens our study. In this way we eliminated many factors that might affect our results.

Does pregnancy-induced hypertension affect the electrophysiology of the heart?

Pregnancy-induced hypertension (PIHT) increases both maternal and neonatal mortality and morbidity in pregnant women. We sought to investigate the electrocardiographic findings in pregnant women with PIHT. Seventeen pregnant women (29.4 ± 5 years) with PIHT and 24 pregnant women (27.3 ± 6.1 years) with normal blood pressure (control group) were included in the study. A 12-lead surface electrocardiogram was used to evaluate the electrocardiographic parameters. Pregnant women with PIHT had higher blood pressure (p = 0.001). The Tp-e interval was longer in PIHT pregnant women at 83.5 ± 7.8 ms versus 75.8 ± 8.4 ms in the control group (p = 0.007). The Tp-e/QTc ratio was higher in pregnant women with PIHT than that in healthy controls (0.19 ± 0.02 vs. 0.18 ± 0.02, respectively). This study demonstrated that Pd, QTd and the P wave durations were similar in the PIHT pregnant women and control group, but the Tp-e and Tp-e/QTc ratio were higher in pregnant women with PIHT than in normotensive pregnant women.