Premarital screening of 466 Mediterranean women for serum ferritin, vitamin B12, and folate concentrations

Background/aim: Iron, folate, and vitamin B12 serum levels are closely related with dietary habits and have an essential role in the healthy development of a fetus. We aimed to investigate hemoglobin, ferritin, folate, and vitamin B12 levels in preconceptional women in an area where a plant-based diet referred to as Mediterranean cuisine is commonly used. Materials and methods: The study population included 466 women between the ages of 18 and 45 years admitted for thalassemia screening. Sociodemographic variables and history of menometrorrhagia, pica, and dietary habits were collected. Serum vitamin B12, folate, ferritin, and hemoglobin levels were measured. Ferritin of <12 μg/L, vitamin B12 of <200 pg/mL, and folate of <4 ng/mL were accepted as deficiencies. Hemoglobin level of <12 g/dL was classified as anemia. Results: Polymenorrhea was present in 11.7% and hypermenorrhea in 24.8% of women. Anemia was detected in 24.9% and thalassemia trait in 3.0% of women. Low ferritin levels were observed in 46.1%, vitamin B12 in 21.6%, and folate in 3.4% of women. In the group with low vitamin B12, decreased meat consumption was more prevalent (27.5% vs. 16.9%; P = 0.019). Conclusion: Vitamin B12 and iron are the main micronutrients depleted in our community. This necessitates implementing a public health program for women consuming a Mediterranean diet. © TÜBİTA

The relation of CD3, CD4, CD8 and PD-1 expression with tumor type and prognosis in epithelial ovarian cancers

Objectives: Ovarian cancer is a heterogeneous disease, where chronic inflammation plays a key role in carcinogenesis. In this study, it is aimed to analyze the relationship with prognosis and chemotherapy response to clinicopathologicalnvariables in epithelial ovarian cancers such as proliferation of PD-1 +, CD8 +, CD4 +, CD3 + T-lymphocytes infiltrating the tumor and tumor stroma.Material and methods: Seventy-six cases diagnosed with primary epithelial ovarian tumor from biopsy or surgical resection materials were included in the study. Immunreactivity of CD3, CD4, CD8, PD1 was evaluated immunohistochemically in lymphocytes in tumor infiltrating lymphocytes and stromal lymphocytes.Results: Seventeen (22.4%) of the cases were Type I, 59 (77.6%) of them were Type II ovarian carcinoma. PD-1 positivity was observed in stromal and intraepithelial lymphocytes in 22 (28.9%) of 76 cases. In the presence of PD-1 + T-lymphocytes that infiltrate tumor and stroma, disease-free survival are shorter (p = 0.037). The presence of stromal CD4 + and CD8 + T-lymphocytes was more common in late stage patients (p = 0.012, p = 0.036; respectively). The disease-free and overall survival rate was statistically significantly shorter in the presence of CD8 + T lymphocytes (p = 0.009, p = 0.003; respectively).Conclusions: CD3, CD4 and CD8 may contribute to PD-1 mediated tumor control. Anti PD-1 therapy may be an alternative to chemotherapy in PD-1 positive patients. Identifying patients who do not respond to chemotherapy through PD-1 expression prior to immunotherapy will help develop potential personalized immunotherapy

Caesarean scar endometriosis: Analysis of three cases in our clinic

Scar endometriosis is a disease of abdominal wall and generally develops after obstetric or gynecological operations. After caesarean section, prevalence is reported to be between 0.03-0.4% whereas, this increases as high as 5.08% after second trimester hysterotomy. Preoperative diagnosis of scar endometriosis is difficult because scar endometriosis are similar to some pathologies including abcess, lipoma, hematoma, incisional hernia, desmoid tumor, sarcoma, lymphoma and primer or metastatic carcinoma. Menstruation related mass and pain with a palpable subcutaneous lesion in patients with a history of obstetric or gynecological surgery should raise the suspicion of scar endometriosis after exclusion of other pathologies. In this article, we reviewed three cases of scar endometriosis and ultrasonographic and magnetic resonance imaging features of mass with regard to the current literature perspective. Copyright © 2015 by Türkiye Klinikleri

A rare and unexpected case of retained foetal bone after an unsafe abortion

Unsafe abortion is one of the most neglected healthcare problems in developing countries. One of the rare complications of unsafe abortion is retained foetal bone. Prevalence of disease is around 0.15% among patients undergoing diagnostic hysteroscopy. Patients have no specific symptoms. Case reports have focused on subfertility, abnormal uterine bleeding, lower abdominal pain, abnormal vaginal discharge, dyspareunia, dysmenorrhoea and spontaneous passage of bony fragments. Retained foetal bone fragments may cause acute pelvic inflammatory disease in rare cases regardless of the time interval after abortion. This condition can also present as recurrent vagitinis or endometritis refractory to ampirical antimicrobial treatment. In such cases, foreign body in uterine cavity should be kept in mind. Such patients should primarily be evaluated by ultrasonography which has substantial clinical importance in differential diagnosis of these cases. We present a case of misdiagnosed retained foetal bone complicated with recurrent vaginal discharge and acute pelvic inflammatory disease. © 2015, Pakistan Medical Association. All rights reserved

Public Health Rep

19883147490PMCnull650

Validation of Turkish version of Premenstrual Symptoms Impact Survey™ (PMSIS™) for assessing status of premenstrual syndrome in women of reproductive age

Objective: We aimed to evaluate the reliability and validity of a Turkish adaptation of the Premenstrual Symptoms Impact Survey™ (PMSIS™), a six-question health survey that measures the impact of symptoms of premenstrual syndrome (PMS) on an individual’s functional health and well-being. Methods: The PMSIS™ was independently translated into Turkish and its adaptation to Turkish language was performed via back-translation. The reliability and validity of the PMSIS™ were examined with 63 women of reproductive age, found healthy during annual wellwoman gynecologic examination. Premenstrual Syndrome Scale (PMSS), a Turkish questionnaire, was administered to assess the concurrent validity of the PMSIS™. For the assessment of survey data, the content validity, test-retest reliability, Cronbach’s alpha, concurrent validity, and construct validity tests were used. Results: The content validity index of the Turkish version of PMSIS™ was found as high (91%). After reliability analyses, the intra-class correlation coefficient between the PMSIS™ scores at the first and second assessments was 0.70, showing a good agreement between test and retest values; and the Cronbach’s alpha coefficient was 0.89, indicating adequate and high internal consistency. Regarding the concurrent validity, the Pearson's correlation coefficient between the PMSIS™ (first assessment) and PMSS scores was 0.70. Regarding the construct validity, factor analysis revealed that one dimension was found; and factor loading of items ranged from 0.74 t0 0.84 and total variant of scale was expressed as 65.1%. The PMSIS™ had a good concurrent and construct validities. Conclusions: The Turkish version of PMSIS™ has good reliability and validity properties. It is a reliable, consistent, and valid instrument to assess the status of PMS in women of reproductive age and the outcome of PMS treatment in Turkish population. © 2015, Cukurova University, Faculty of Medicine. All rights reserved

Evaluation of sexual functions and quality of life in female patients after hysterectomy for benign symptomatic diseases

Objective: To evaluate selected quality of life parameters among sexually active patients who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) for benign symptomatic disease. Materials and Methods: Fifty-six TAH-BSO patients (20 menopausal + 36 premenopausalhysterectomized women) were evaluated between September 2017 and May 2018 using the FSFI, ASEX and SF-36 scores with individual interviews before and six months after TAH + BSO surgery. Results: The preoperative and postoperative period scores from three different validated questionnaires were found to be significantly different for all patients. Scores in the postoperative periods were better in all patients. Also, scores in the preoperative and postoperative periods were higher among premenopausal patients than menopausal patients. Conclusion: Our results showed that sexual function and quality of life improved in all patients who underwent TAH-BSO for benign symptomatic disease. Also, menopausal status is very important. ©2020 Koşar Can et al. Published by IMR Press

Evaluation of 902 Total Abdominal Hysterectomies Performed for Benign Reasons

OBJECTIVE: Hysterectomy is the most frequently performed major surgery and is the most common major abdominal operation following cesarean section. The most common indication is uterine leiomyoma. The objective of this study is to evaluate the abdominal hysterectomy indications, intraoperative and postoperative complications and surgical morbidity. STUDY DESIGN: Demographic information, surgical indications, intraoperative and postoperative complications, hospitalization periods and clinical follow-up information of the patients who underwent abdominal hysterectomy at Hacettepe University Hospital, Department of Obstetrics and Gynecology between 2000 and 2004 were retrieved from patients’ files and follow-up forms. Statistical evaluations were performed using SPSS 10.0 for Windows program and p<0.05 values were considered as statistically significant. RESULTS: Among 902 patients in whom abdominal hysterectomy was performed the mean age was 47.9 (range: 30-77), and the most common hysterectomy indication was uterine leiomyoma (n=552, 61.2%). While abdominal hysterectomy alone was performed in only 87 patients (9.6%), bilateral salphingo-oophorectomy was added in 746 patients (82.7%) and unilateral salphingo-oophorectomy was performed in 69 patients (7.7%) together with hysterectomy. Among patients in whom bilateral salphingooophorectomy was performed, 569 (76.3%) were in pre-menopausal period. In 119 patients (13.2%) an additional surgical intervention was applied during operation. Burch procedure and appendectomy were performed in 5.5% and 3.8% of patients, respectively. Mean operation time was 1.21 hours and mean hospitalization period was 6.28 days. Intraoperative complication rate was 0.6% and visceral organ injury was the most commonly seen complication. Postoperative complications were seen in 17.1% of the patients and the most frequent postoperative complications were febrile morbidity and wound infection (10.1% and 4.3%, respectively). Preoperative and postoperative mean hemoglobin values were 11.9 and 10.3 gr/dL, respectively, and 7.5% of the patients received erythrocyte transfusion postoperatively. No operation related deaths were observed during the study period. CONCLUSION: Abdominal hysterectomy, the most frequently performed operation of gynecology clinics, is an effective treatment modality in relieving symptoms and increasing quality of life with relatively lower complication rates. However, its morbidity and complications is agreed to be higher when compared with those of vaginal hysterectomy. Therefore, vaginal approach should always be preferred if possible. When abdominal route is mandatory, an appropriate antibiotic prophylaxis should be used to decrease the rate of febrile morbidity which is the most commonly seen postoperative complication

Does apical prolapse in addition to early stage anterior prolapse have any effect on lower urinary tract symptoms?

OBJECTIVE: To investigate whether apical prolapse in addition to early-stage anterior prolapse has any effect on lower urinary tract symptoms (LUTS). METHODS: Patients with early-stage pelvic organ prolapse (POP) were retrospectively analyzed at the urogynecology unit of a tertiary referral center. Cases with posterior POP were excluded, and the remaining women were distributed across four main groups: (1) no determinable anterior and/or apical POP (control); (2) isolated anterior POP; (3) anterior + apical POP; and (4) isolated apical POP. Each LUTS symptom in these groups was recorded. Women with isolated anterior POP and women with anterior + apical POP were then compared to define the additional effects of apical prolapse on LUTS. In order to asses; symptoms of urgency, urinary incontinence, stress urinary incontinence, frequency, abnormal emptying, hesitancy, interrupted stream, nocturia, post-micturition dribble, and dysuria were noted and Incontinence Impact Questionnaire (IIQ-7), and domains of Urinary Distress Inventory (UDI-6) were compared between the groups. RESULTS: Of the 225 patients, 66 were excluded from the analysis due to accompanying posterior compartment defect. There was no statistically significant difference for age, systemic disease history, or smoking status between the groups (p > 0.05). However, history of traumatic vaginal delivery was significantly lower in the control group than in the other groups (p = 0.039). The prevalence of hesitancy and interrupted stream were found to be significantly higher in the anterior + apical POP group than in the isolated POP group (p<0.05). Obstructive subscale of the Urinary Distress Inventory was higher both in the isolated anterior POP and anterior + apical POP groups than the control group (p<0.05). CONCLUSION: The current study demonstrates that even minimal loss of apical support accompanying anterior prolapse exacerbates LUTS