Sumeyra Tatar

Mid-pregnancy vitamin D levels and postpartum depression.

OBJECTIVES Postpartum depression (PPD) is a common disorder that affects 10-15% of postpartum women, and it can have negative effects on both the mother and newborn. Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression. The aim of this prospective study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 (25(OH)D3), a reliable measurement of vitamin D, during mid-pregnancy. STUDY DESIGN The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital, Sifa University. In order to better evaluate a possible effect between vitamin D levels and PPD, individuals with characteristics that put them at risk for developing PPD were excluded from the study. Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group. Serum 25(OH)D3 concentrations ≤20ng/mL (50nmol/L) were classified as a mild deficiency and those ≤10ng/mL (25nmol/L) were classified as a severe deficiency. Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD 1 week, 6 weeks, and 6 months after delivery. A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods. A logistic regression analysis was used to determine the independent effects of vitamin D on PPD. RESULTS Six hundred and eighty-seven pregnant women were included in this study. After excluding women due to PPD risk factors (in two stages), 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum. Eleven percent of our study group had severe vitamin D deficiency and 40.3% had mild vitamin D deficiency. The frequency of PPD was 21.6% at the 1st week, 23.2% at 6th week, and 23.7% at the 6th month. There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores, which is indicative of PPD for all three follow-up periods (p=0.003, p=0.004 and p<0.001, respectively). In addition, there was a significant negative correlation between vitamin D levels and EDPS at all three time points (r=-0.2, -0.2, -0.3, respectively). CONCLUSIONS Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD. More extensive studies are required to be carried out on this subject.

Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma

OBJECTIVE To evaluate whether a preoperative serum CA-125 level in patients with endometrial carcinoma can provide additional information in determining the stage of disease, and which cutoff value is optimal in this respect. STUDY DESIGN Retrospective chart review of 147 women with pathologically proven endometrial carcinoma who were treated between January 1999 and May 2009. The associations of preoperative CA-125 levels with the tumor stage, histologic type and grade, and the lymph node positivity were examined. To determine the values of cutoff point levels for serum tumor marker CA-125, the levels of 20 IU/ml and 35 IU/ml were compared. RESULTS High CA-125 levels significantly correlated with advanced stage and lymph node metastases. The ROC curve determined that the best cutoff value was 20 U/ml. The sensitivity and specificity of a CA-125 cutoff level of 20 U/ml were 75% and 69.51%, respectively, with a positive predictive value of 80.6% and negative predictive value of 84.9%. CONCLUSION The current study suggests that measurement of preoperative CA-125 is a clinically useful test in endometrial carcinoma patients. CA-125 appears to be a significant independent predictor of the advanced stage of the disease as well as lymph node metastases. The results complement a growing body of literature that supports the relationship between CA-125 level and stage of disease but more studies are needed to establish the appropriate cutoff level for serum CA-125 in this respect.

Impact of Prognostic Factors on Survival Rates in Patients with Ovarian Carcinoma

PURPOSE The aim of the present study was to invesitigate the impact of significant clinico-pathological prognostic factors on survival rates and to identify factors predictive of poor outcome in patients with ovarian carcinoma. MATERIALS AND METHODS A retrospective chart review of 74 women with pathologically proven ovarian carcinoma who were treated between January 2006 and April 2011 was performed. Patients were investigated with respect to survival to find the possible effects of age, gravida, parity, menstruel condition, pre-operative Ca-125, treatment period, cytologic washings, presence of ascites, tumor histology, stage and grade, maximal tumor diameter, adjuvan chemotherapy and cytoreductive success. Also 55 ovarian carcinoma patients were investigated with respect to prognostic factors for early 2-year survival. RESULTS The two-year survival rate was 69% and the 5-year survival rate was 25.5% for the whole study population. Significant factors for 2-year survival were preoperative CA-125 level, malignant cytology and FIGO clinical stage. Significant factors for 5-year survival were age, preoperative CA-125 level, residual tumor, lymph node metastases, histologic type of tumor, malignant cytology and FIGO clinical stage. Logistic regression revealed that independent prognostic factors of 5-year survival were patient age, lymph node metastasis and malignant cytology. CONCLUSIONS We consider quality registries with prospectively collected data to be one important tool in monitoring treatment effects in population-based cancer research.

Uterine closure with unlocked suture in cesarean section: Safety and Quality

Objective: Comparing locked and unlocked uterine closure techniques in terms of bleeding control and uterine incision healing. Methods: The patients undergoing cesarean section in Sifa University Hospital between May - October 2012 were accepted to this prospective controlled study. Primarily, safety was evaluated. The hemoglobin count (HC) and serum creatine kinase (CK) levels of the patients in the locked (n = 47) and unlocked (n = 35) groups were measured just before and 24 hours after operation. Hemoglobin deficit, increase in CK and the additional hemostatic sutures were compared. Secondly, uterine scar healing was evaluated three months later. Scar thickness, niche and percentage of thinning of the scar region of the locked (n = 27) and unlocked (n = 32) groups were calculated and compared. Results: The hemoglobin deficit was similar in two groups. CK rise was less in the unlocked group but it was not significant (P = 0.082). Unlocked group needed more additional sutures (P = 0.016). The thickness of the niche and the percentage of thinning of the scar region were significantly less in the unlocked group (P= 0.002, P=0.000). Conclusions: Unlocked uterine closure technique is safe and has less damage to the myometrium.

Vitamin D deficiency in pregnancy may affect fetal thymus development

OBJECTIVES The aim of our study was to evaluate the association of vitamin D deficiency (VDD) during pregnancy with thymus size in full-term fetuses. MATERIAL AND METHODS In this prospective study, we evaluated mid-pregnancy serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations. The fetal thymus size was measured by ultrasound in the third trimester. Neonatal 25(OH)D3 levels were evaluated by umbilical cord blood sampling. Correlation of maternal and neonatal vitamin D levels and association between thymus size and both, maternal and neonatal vitamin D concentrations were investigated. RESULTS Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers and 10 (13.1%) new-borns. A strong correlation between mid-pregnancy maternal and neonatal 25(OH)D3 concentration (r = 0.8, p < 0.001) was found. A significant linear correlation was observed between both, maternal and neonatal 25(OH)D3 concentrations and thymus perimeter length (r = 0.45, p = 0.04 and r = 0.43, p < 0.01, respectively). Both, maternal and fetal VDDs were associated with decreased thymus perimeter (p = 0.04, p = 0.03). CONCLUSIONS Vitamin D deficiency during pregnancy may be associated with smaller fetal thymus. Our data suggest that VDD in pregnancy may lead to systemic inflammatory response in the fetus.

Asymptomatic cervical diverticulum: An unusual case

Herein is presented the case report of a patient who had secondary infertility. Hysterosalpingography (HSG) and subsequent diagnostic hysteroscopy revealed an asymptomatic cervical diverticulum. In vitro fertilization (IVF) was suggested for infertility due to bilateral tubal occlusion. We also informed the patient that her diverticulum does not require surgical intervention due to the absence of symptoms.

Chromosomal abnormalities and polymorphisms among couples with recurrent in vitro fertilization (IVF) failure

Aim: The present study aims to evaluate chromosomal structure among couples with a history of recurrent in vitro fertilization (IVF) failure undergoing assisted reproduction treatment. Materials and Methods: Chromosomal structure analysis was conducted on peripheral blood samples from couples with an indication of recurrent IVF failure at the Genetic Diagnosis Center Cytogenetics Laboratory between 2007 and 2012. All data were investigated retrospectively. Results: Abnormal chromosome organization was observed in 39 (15.8%) females and in four (1.7%) males. Moreover, chromosomal polymorphism was detected in 15 (6%) females and 28 (12%) males. Almost all chromosomal abnormalities were associated with sex chromosomes. Conclusion: Highly abnormal chromosome organization was observed in couples with recurrent IVF failures. Preimplantation genetic diagnosis should be offered to these patients to evaluate the likelihood of treatment success and the establishment of a healthy pregnancy.

Cesarean section and ovarian cystectomy in the patient with factor XI deficiency

Factor XI (F XI) deficiency is a rare bleeding disorder with an autosomal inheritance and generally asymptomatic. However, the incidence of primary post-partum hemorrhage and secondary post-partum hemorrhage in F XI deficiency were reported as 16% and 24%, respectively. A 35-year-old primigravida woman diagnosed with F XI deficiency was examined by the maternal-fetal medicine service of our hospital at 37 weeks 5 days′ gestation. Her blood levels of F XI and activated partial thromboplastin time were %2 and 116 s, respectively at pre-partum period. We made fresh frozen plasma (FFP) replacement 1 day before surgery and we continued transfusions until post-operative 6 th day. The most challenging problems we encountered were hypervolemia and electrolyte imbalance. The management of F XI deficiency necessitates careful consideration and replacement with FFP is believed to be the main approach.