Vajinal Pesser Kullanan Hastalarda Vajen Kültür Sonuçlarının Değerlendirilmesi: Araştırma Makalesi

Abstract Introduction: Although surgery is the main treatment in cases with uterine prolapse, the use of vaginal pessary is an important alternative in cases where surgery cannot be performed due to comorbid diseases and patient avoidance of surgery.  With the use of pessaries, the pelvic organs are held in place and a significant improvement in the patient's quality of life is achieved. Objective: Obviosly Usage of vaginal pessaries cause to vaginal infection. The aim of this study to determine solutions of the problems that patients may encounter and better evaluate this situation in the light of vaginal culture results taken from patients. Method: 22 patients who applied to Gynecology and Obstetrics outpatient clinics and used vaginal pessaries due to pelvic organ prolapse for various reasons were included in the study. Previous vaginal culture results due to infection were evaluated retrospectively in the patients who are using pessaries. The cases were examined in terms of age, gravida, parity, height, weight, BMI, existing complaint, comorbidity, reason for not being able to undergo surgery, shape and degree of pelvic organ prolapse, whether it was accompanied by incontinence, and pathological findings using ultrasonography. Results: During sterile speculum examination of the patients with vaginal discharge due to pessary use intense leukorrhea was detected in just 1 patient (4%) and 9 patient (40.9%) had minimal leukorrhea. Although the patient had a complaint, no evidence of infection was detected in 12 of the patients (54.5%) during the examination. The vaginal culture results shows that 7 of 22 patients (31%) were reported as "no growth". Normal flora elements grew in 12 of them (54%). Pathogenic microorganisms were observed in only 3 (13.6%) patients.The causative microorganism Echechia coli was observed in 2 of the patients with growth in vaginal culture, and Enterococcus faecealis was observed in 1.   Conclusion: As a result of this study, it is seen that local antibiotics used prophylactically and local estrogen given to prevent tissue damage provide adequate treatment in patients using vaginal pessaries, but it is more valuable to show the presence of infection by vaginal examination rather than culture to improve the quality of life of patients Özet Giriş: Uterin prolapsus görülen olgularda esas tedavi cerrahi olmasına rağmen, komorbid hastalıklar, hastanın cerrahiden kaçınması gibi nedenlerle cerrahi yapılamayan olgularda vajinal pesser kullanımı önemli bir alternatiftir.  Pesser kullanımı ile pelvik organlar yerinde tutulmakta ve hastanın yaşam kalitesinde önemli ölçüde bir düzelme sağlanmaktadır. Amaç: Vajinal pesser kullanan hastaların vajinal enfeksiyona maruz kalacağı aşikardır. Bu durumu daha iyi değerlendirmek ve hastaların karşılaşacağı sorunların çözümüne ışık tutmak adına hastalardan alınan vajinal kültür sonuçlarının değerlendirilmesini amaçlanmıştır.   Yöntem: Araştırmaya Kadın hastalıkları ve Doğum polikliniklerine başvuran çeşitli pelvik organ prolapsusu nedenleri ile vajinal pesser kulanan 22 hasta dahil edildi. Olguların yaş, gravida, parite, boy, kilo, bmı, mevcut şikayet, ek hastalık, cerrahi yapılamama nedeni, Pelvik organ prolapsus şekli ve derecesi, inkontinansın eşlik edip etmediği ve ultrasonografi ile patolojik bulgular açısından incelemesi yapıldı. Bulgular: Pesser kullanımı nedeni ile vajinal akıntısı olan hastaların steril spekulum muayenesinde sadece 1’inde(%4) yoğun lökore tespit edilirken; 9’unda (%40,9) minimal lökore mevcuttu. Hasta şikayeti olmasına rağmen muayene sırasında hastaların 12’sinde(%54,5) enfeksiyon lehine bulgu saptanmadı. Alınan vajinal kültür sonuçlarında 22 hastanın 7’sinin (%31) kültür sonucu “üreme yok” şeklinde raporlanırken 12’sinde (%54) normal flora elemanları ürediği raporlandı. Sadece 3 (%13,6) hastada ise patojen mikroorganizma gözlendi. Vajinal kültürde üreme olan hastaların 2’sinde etken mikroorganizma Echechia coli, 1’inde ise Enterococcus faecealis gözlendi. Sonuç: Bu çalışmanın sonucunda vajinal pesser kullanan hastalarda profilaktik olarak kullanılan lokal antibiyotik ve doku hasarını önlemek için verilen lokal östrojenin yeterli tedaviyi sağladığı, ancak hastaların hayat kalitesinin artırılması için kültürden ziyade vajinal muayene ile enfeksiyon varlığının gösterilmesinin daha kıymetli olduğu görülmektedir

Serum concentrations of heavy metals in women with endometrial polyps

Endometrial polyps are one of the common reasons of abnormal uterine bleeding in women. Industrialisation, urbanisation and increased air pollution cause increased heavy metal exposure. Heavy metals that have oestrogenic effects in human body are named as metalloestrogens. The aim of this study was to investigate the serum metalloestrogen levels such as copper (Cu), zinc (Zn), aluminium (Al), lead (Pb), nickel (Ni) and Cu/Zn ratio and their possible relationship with the occurrence of endometrial polyps. Eighty women with abnormal uterine bleeding were divided into two groups: 40 women diagnosed with endometrial polyp (study group) and 40 women without endometrial polyp (control group). Ages, body mass indices, smoking behaviours, drinking water choices, chronic diseases and intrauterine device histories were noted for all patients. Blood levels of Cu, Zn, Al, Pb, Ni and Cu/Zn ratio were analysed by inductively coupled plasma-mass spectrometry method for both groups. No statistically significant differences were observed in terms of serum median levels of Cu and Pb between the study and the control groups. The serum median levels of Zn, Ni and Al were found to be statistically lower in the study group when compared with the control group. The Cu/Zn ratio was statistically higher in the study group. High Cu/Zn ratio, as a biomarker of oxidative stress, suggests the role of oxidative stress in etiopathogenesis of endometrial polyps.IMPACT STATEMENT What is already known on this subject? Studies demonstrate that oestrogen and progesterone play an important role in pathogenesis of endometrial polyps. Inorganic heavy metal ions that bind and activate oestrogen receptors are referred to as ‘metalloestrogens’. Apart from toxic effects, metalloestrogens have been linked to the aetiology of oestrogen-dependent diseases such as breast and endometrium cancer and endometriosis. However, serum levels of heavy metals were not investigated in a large group of endometrial polyp patients. What do the results of this study add? This is the first study investigating the serum levels of heavy metals in a large group of endometrial polyp patients. We did not observe any increased serum levels of heavy metals in endometrial polyp patients. Our results might suggest that oestrogenic heavy metal exposure has no role in the appearance of endometrial polyps. However, increased Cu/Zn ratio due to low serum levels zinc suggests oxidative stress might play a role in endometrial polyps. What are the implications of these findings for clinical practice and/or further research? Further research of heavy metals in endometrial polyps with simultaneous blood and tissue samples could show the precise effect of environmental exposure of metalloestrogens in aetiopathogenesis of endometrial polyps