Investigation of cesarean sections at Konya Training and Research Hospital Obstetrics and Gynecology Department between 2010 and 2015

Objective: Analysis of the annual distribution of cesarean sections and indications between 2010 and 2015 in our clinic. Material and methods: Medical records of 10,437 cesarean section patients from a total number of 24,283 deliveries performed at Department of Obstetrics and Gynecology between 2010–2015 were evaluated retrospectively. The indications for Cesarean section were analyzed and compared based on years. Results: The lowest cesarean section rate was 18.67% in 2011 and the highest rate was 24.5% in 2013, and the annual rates were close to each other in this 6-year period (p > 0.05). History of uterine surgery was the indication with the highest rate of 49.52%, while fetal distress was the second most frequent with 12.53%; presentation anomalies were observed as the most frequent third indication with 7.55%, and umbilical cord prolapse was the least frequent indication with 0.33%. Conclusions: Patient education about normal delivery and providing means for pain control during normal delivery, improvement in physical conditions of the clinics, frequent and regular training of the assisting staff with obstetrics physicians are important to diminish the rates of primary cesarean sections. In addition, a normal delivery after a previous cesarean section must be encouraged

Serum progranulin levels are elevated in infertile women with obesity

Introduction: The aim of the present study was to investigate the changes in serum progranulin and sex hormone levels in infertile women with obesity. Material and methods: A total of 171 infertile women who had fertility desire were included in this cross-sectional study. The initial assessment included measurements of weight, height, waist circumference, and hip circumference to calculate body mass index (BMI) and waist/hip ratio. All participants were categorised into two groups in accordance with BMI as a control group ( < 30 kg/m2, n = 135) and a study group (≥ 30 kg/m2, n = 36). After anthropometric measurements, venous blood samples were taken for analyses of oestradiol and follicle stimulating hormone (FSH), luteinising hormone, total testosterone (TT), 17-hydroxyprogesterone, dehydroepiandrosterone sulphate, anti-Müllerian hormone, and progranulin. Results: The present study demonstrated that the overweight women had higher FSH levels (p < 0.01). Elevated TT levels were detected in obese women (p < 0.05). Progranulin concentrations were higher in the study group than in the control group (p < 0.05). Regression analysis demonstrated that there was a relationship between the serum progranulin concentrations and BMI (p < 0.05). Conclusions: Our findings support that the elevated progranulin levels are associated with obesity in infertile women. Therefore, infertile and obese patients may benefit if their serum progranulin levels decrease. Further studies are needed to elucidate this issue

Diagnostic value of CA 19-9 in pregnancies complicated by spinal neural tube defects: a preliminary study

Objectives: Various physiological and pathological conditions can induce significant variations in plasma concentrations of tumor markers, such as CA 19-9, which is present in the serum and amniotic fluid of pregnant women. Herein, we aimed to determine the clinical importance of maternal serum CA 19-9 levels in the diagnosis of neural tube defects (NTDs). Material and methods: A total of 100 women were included in this controlled cross-sectional study. Thirty-three patients whose pregnancies were complicated by isolated meningocele or meningomyelocele constituted the study group, whereas 33 normal, healthy pregnant women constituted the control group, and 34 age- and body mass index (BMI)-matched non-pregnant women were chosen for the validation group. Results: The mean maternal serum CA 19-9 levels were 17.2 ± 17.0 IU/mL, 7.1 ± 5.9 IU/mL, and 4.7 ± 3.6 IU/mL in the study, control, and validation groups, respectively (p < 0.001). ROC analyses showed that elevated CA 19-9 values may predict NTDs (p < 0.001). The cut-off value for CA 19-9 was found to be 9.6 IU/mL at 70% (51%–84%, 95% CI) sensitivity and 84% (74%–92%, 95% CI) specificity. Conclusions: CA 19-9 may be a promising noninvasive marker for NTDs. Further studies are needed to reveal the clinical applicability and diagnostic potential of maternal serum CA 19-9 levels in the identification of NTDs

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Endometrial Örnekleme ve Histopatoloji Sonuçlarının Değerlendirilmesi; 4.247 Olgunun Analizi

WOS:000399175500010PubMed ID: 28416932Amaç: Bu çalışmada kliniğimizde endometrial örnekleme yapılan olgularda endikasyonlar ile histopatolojik sonuçlar arasındaki ilişkinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Kliniğimizde Ocak 2010 - Ekim 2016 yılları arasında başvuran ve obstetrik dışı jinekolojik endikasyonlar nedeni ile endometrial örnekleme yapılan 4,247 olgunun verileri Kadın Hastalıkları ve Doğum Kliniği ve Patoloji Kliniği arşiv kayıtlarından retrospektif olarak taranarak değerlendirildi. Bulgular: Olguların yaş ortalaması 46,88,22 olup en sık endikasyon menometroraji-menoraji (%70,66) iken en az servikal polip (%1,34) idi. Endometriyal biyopsi sonucu proliferatif-sekretuar endometriyum (%63,62) en sık atipili basit hiperplazi (%1,13) en az histopatolojik sonuç olarak tespit edildi. Endometriyum kanseri postmenaposal kanama ya da endometriyal kalınlık grubunda daha fazla oranda gözlendi (%23,11). Biyopsi yapılan olguların %52,18%'ne histerektomi ameliyatı yapılmıştı. Histerektomi sonucu proliferatif-sekretuar endometriyum (%59,52) en sık atipili basit hiperplazi (%1,13) en az histopatolojik sonuç olarak tespit edildi.Sonuç: Postmenapozal kanama ya da endometrial kalınlık artışı olan olgularda endometriyal değerlendirmeyi takiben örnekleme yapılması uygunken, çalışmamız sonuçlarına göre diğer endikasyonlarda rutin olarak endometrial biyopsi tercih edilmemelidirObjective: This study aimed to investigate the relationship between indications and histopathological results in patients undergoing endometrial sampling.Materials and Methods: Data of 4,247 patients undergoing endometrial sampling due to non-obstetric gynecological causes between January 2010 and October 2016 were retrospectively evaluated using the archives of the Gynecology and Obstetrics Clinic of Konya Training and Research Hospital.Results: The mean age of patients was 46.8 8.22 years; the most common indication was menometrorrhagia/menorrhagia (70.66%), and the least common indication was cervical polyp (1.34%). The most common histopathological result was proliferative-secretory endometrium (63.62%); simple hyperplasia with atypia (0.56%) was determined to be the least common result. Endometrial cancer was observed more frequently in the post-menopausal bleeding and increased endometrial thickness group (23.11%). Of patients in whom biopsy was performed, 52.18% had undergone hysterectomy, as a result of which proliferative–secretory endometrium was most commonly (59.52%) and simple hyperplasia with atypia least commonly found as the histopathological diagnosis.Conclusion: Although sampling should be performed following endometrial evaluation in patients with postmenopausal bleeding or increased endometrial thickness, according to the results of our study, routine endometrial biopsy should not be preferred in the other indication

Primary Hyperparathyroidism Presenting with Hyperemesis Gravidarum; a Case Report and Literature Review

Gebelikte oldukça nadir görülen primer hiperparatiroidizm (HPT), hiperemezis gravidarumkliniği ile karışabilmektedir. Daha önce bir sezaryen doğumu ve bir de düşüğü olmak üzere 15 haftalık üçüncü gebeliği olan 26 yaşındaki olgu kliniğimize dirençli kusma şikâyeti ile sevk edilmişti.Yapılan tetkikler sonucunda HPT tanısı konulan olguda paratiroid adenomu saptandı. Kalsiyumdüzeyleri 12 mg/dL’nin üzerinde seyreden olguya cerrahi paratiroidektomi yapıldı ve obstetrik izlemlerinde 35. gebelik haftasında antihipertansif tedaviye dirençli preeklampsi gelişmesi üzerine sezaryen ile 2.550 g ağırlığında sağlıklı bir kız bebek doğurtuldu. Anne ve fetüs için ciddi morbiditeve mortaliteye neden olabilen primer HPT'de erken tanı, uygun medikal ve cerrahi tedavi ile olumlumaternal ve fetal sonuçlar alınabilmektedir.Primary hyperparathyroidism (HPT), which is very rare in pregnancy, may be confusedwith hyperemesis gravidarum. A 26-years-old patient with a third pregnancy of fifteen weeks, previously with a cesarean birth and one abortion, was referred to our clinic with a resistant vomiting complaint. As a result of the examinations, parathyroid adenoma was detected in the patientwith HPT diagnosis. Surgical parathyroidectomy was performed in patients with calcium levelshigher than 12 mg/dL and a healthy girl was born with cesarean section on the occurence of antihypertensive treatment-resistant preeclampsia on 35th gestational week in obstetric follow-ups.Primary HPT, which can cause serious morbidity and mortality for the mother and the fetus, mayhave positive maternal and fetal outcomes with early diagnosis, appropriate medical and surgicaltreatment

Innervation degree of vaginal epithelium and immünohistochemical analysis of subepithelium connective tissue in women with pelvic organ prolapse

Bu çalışmanın amacı pelvik organ prolapsusu olan kadınlarda vajinal epitelin innervasyon derecesini belirlemek ve subepitelyal konnektif dokuyu immünohistokimyasal yöntem kullanarak incelemektir. Aralık 2005 ile Ağustos 2007 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum bölümüne başvuran prolapsusu olan hastalar çalışma, olmayanlar ise kontrol grubunu oluşturacak şekilde iki grup olarak düzenlendi. Vajen ön duvarı Aa noktasına uyan alandan fasyayı kapsayacak şekilde alınan biyopsi materyalleri, Aktin ve Protein Gen Product 9.5 ile immünohistokimyasal yöntem kullanılarak boyandı ve fotomikroskop (Carl-Zeiss; seri no:000262) ve çözümleyici program (KS300) aracılığı ile beş büyük büyütme alanında kasa olan submukozal derinlik, sinir çap ve sayısı değerlendirildi. Hastalar prolapsus seviyesi Evre-0 ve 1 olan yani prolapsusu olmayan ve Evre > 2 olan yani prolapsusu olan hastalar olmak üzere iki gruba ayrıldı. İki grup yaş, Body Mass Indeks, parite, vajinal doğum, müdahaleli doğum (epizyotomi), sezaryan, menopozal durum ve süre, Pelvik Organ Prolapsus-Kuantifikasyon sistemindeki en distal noktaların dağılımı, Pelvik Organ Prolapsus-Kuantifikasyon noktalarının himene olan ortalama uzaklığı, histolojik paremetrelerin (kasa olan submukozal derinlik, sinir sayısı ve çapı) farkları ve demografik özellikler ile histolojik paremetreler arasındaki ilişki açısından incelendiler. İstatiksel analiz için Student-t testi, Ki-Kare testi, Pearson Korelasyon Analizi ve Kovaryans Analizi kullanıldı. Prolapsuslu hastalar, prolapsusu olmayanlara göre daha ileri yaşlarda olup, doğum sayıları daha fazla ve tamamında normal vajinal doğum, bununla birlikte çoğunluğunda da epizyotomi öyküsü mevcuttu. Prolapsus hastalarında Body Mass Index daha düşüktü. Prolapsuslu hastalar çoğunlukla postmenopozal dönemde idi ve bu süre prolapsusu olmayanlara göre daha uzundu. Prolapsus oluşumunun önlenmesi açısından Hormon Replasman Tedavisi kullanımı fayda sağlamadığı görüldü. Kontrol grubunu oluşturan hastaların Pelvik Organ Prolapsus-Quantifikasyon sistemindeki en distal noktaları, en fazla arka kompartmanda iken, çalışma grubunu oluşturan hastalarda ise en distal noktaların ön ve apikal kompartmanda olduğu saptandı. Histolojik inceleme paremetreleri (kasa olan submukozal derinlik, sinir sayısı ve çapı) açısından gruplar karşılaştırıldığında ise, prolapsus grubunda istatiksel olarak sinir çapı daha küçük, sinir sayısı daha az ve kas dokusuna olan submukozal derinlik de anlamlı olarak daha geniş idi. Demografik özellikler ile histolojik paremetreler arasındaki ilişki açısından karşılaştırıldığında, doğum sayısı ile sinir çap ve sayısı arasında negatif korelasyon olduğu, yaş arttıkça vajinal duvar kalınlığının, sinir çap ve sayısının azaldığı, postmenopozal süre uzadıkça da vajinal duvar sinir sayısının azaldığı tespit edildi.The aim of this study is to determine innervation degree of vaginal epithelium in women with pelvic organ prolapse and to investigate subepithelium connective tissue using immunohistochemistry method. Between December 2005 and August 2007, patients who applied to Trakya University, Faculty of Medicine, Departmant of Obstetrics and Gyneacology, were prepared with prolapse as study group, without prolapse as control group. The biopsy material taken from anterior vaginal wall Aa point area including fascia, was painted with Actin and Protein Gene Product 9.5 by using immunohistochemistrical method and submucosal depth into the muscle, the number and diameter of the nerves was evaulated by photomicroscop (Carl-Zeiss; serial number: 000262) and analytic programme (KS 300). Patients were divided into two groups as with prolapse, Stage > 2 and without prolapse, Stage 0 and 1. Two groups were investigated in view of age, Body Mass Index, parity, vaginal delivery, operative delivery (episiotomy), cesearean section, menopausel situation and period, distrubution of the most distant points in the Pelvic Organ Prolapse-Quantification system, average distance of the Pelvic Organ Prolapse-Quantification points to hymen, the differences of histological parameters (submucosal depth into the muscle, the number and diameter the of nerves), the relationship between the demographical features and histologycal parameters. Student-t test, Chi-square test, Pearson correlation test for analysis, Covarians analysis were used for statistical analysis. The patients with prolapse, with more parity, all breeded by vaginal delivery and most undergone episiotomy, were older than the ones without prolapse. Body Mass Index was lower in patients with prolapse. Most of the patients with prolapse were in postmenopausal period and this period was longer than the ones without prolapse. It was determined that Hormon Replacement Treatment was useless for preventing prolapse development. It was found that while the most distant points in the Pelvic Organ Prolapse-Quantification system of the patients in the control group were mostly in the posterior compartment, they were in the anterior and the apical compartments of patients in the study group. The groups were compared in view of hystological paremeters including submucosal depth into the muscle, the number and diameter of the nerves. The diameter of the nerves was lower, the number of them was fewer and submucosal depth into the muscle was larger in the prolapse group statistically. When the groups were compared according to their relationship between the demographical features and histologycal parameters, it was determined that there was negative correlation between parity and the number and diameter of the nerves. Moreover, it was found that vaginal wall thickness got thinner and the number and diameter of the nerves got smaller by aging. On the other hand, as menopausal period got longer, the number of the nerves on vaginal wall decreased

Laparoskopik histerektominin klinik sonuçları: Tek merkez deneyimi

Purpose: The aim of this study was to evaluate the clinicalresults of laparoscopic hysterectomy (LH).Materials and Methods: In this retrospective study, theoriginal files of 511 patients who underwent LH betweenJanuary 2010 and December 2016 were analyzed. Thefollowing parameters were recorded and assessedaccording to the years studied: mean age, body mass index(BMI), parity, indications for surgery, uterine weight,operation duration, blood loss, duration of hospitalization,analgesic needs, and intra- and post-operativecomplications.Results: The lowest LH rate was 10.14% in 2012, and thehighest rate was 47.73% in 2016. Uterine myoma (31.51%)and menometrorrhagia (25.63%) resistant to medicaltreatment were the most common indications. There wereno differences in terms of age, BMI, parity, blood loss,analgesic requirements, uterus weight, previous intraabdominalsurgery rate, laparoscopy to laparatomyconversion rate, and intra- or post-operative complicationsduring the period assessed. However, operation time andhospital stay durations were significantly reduced after thefirst 3 years.Conclusion: An emphasis on endoscopy training forgynecological surgeons, along with technological advancesand the use of surgical techniques, has improvedpostoperative LH recovery, and the length of the requiredhospital stay has become shorter. LH should be thepreferred surgical option in hysterectomy indications, as itis effective and safe for the patient.Amaç: Bu çalışmanın amacı laparoskopik histerektominin(LH) klinik sonuçlarını değerlendirmektir.Gereç ve Yöntem: Bu retrospektif çalışmada, Ocak 2010ile Aralık 2016 arasında LH uygulanan 511 hastanın orijinaldosyaları incelendi. Yaş ortalamaları, vücut kitle indeksi(VKİ), doğum sayısı, ameliyat endikasyonları, uterusağırlığı, operasyon süresi, kan kaybı, hastanede kalmasüresi, analjezik ihtiyaçları, intraoperatif veya postoperatifkomplikasyonlar kaydedildi ve yıllara göre değerlendirildi.Bulgular: En düşük LH oranı %10.14 ile 2012 yılında, enyüksek oran %47.73 ile 2016 yılında idi. Medikal tedaviyedirençli uterin myom (%31.51) ve menometroraji (%25.63)en sık görülen endikasyonlardı. Değerlendirilen süreiçerisinde yaş, VKİ, doğum sayısı, kan kaybı, analjezikgereksinimi, uterus ağırlığı, önceden karın içi cerrahioperasyon geçirme oranı, laparoskopiden laparatomiyedönüşüm oranı, intraoperatif veya postoperatifkomplikasyonlar açısından fark yoktu. Ancak ameliyatsüresi ve hastanede kalış süresi ilk 3 yıldan sonra önemliölçüde azalmıştı.Sonuç: Jinekolojik cerrahlar için endoskopi eğitimine,teknolojik gelişmelere ve cerrahi tekniklerin kullanımınaverilen önem LH sonrası iyileşmeyi geliştirmiş vehastanede kalış süresini kısaltmıştır. LH hasta için etkin vegüvenli olduğundan histerektomi endikasyonlarında tercihedilen cerrahi seçenek olmalıdır