Biochemiczne markery pierwszego trymestru w ciąży bliźniaczej

Objective: Our aim was to investigate the first trimester serum markers and nuchal translucency (NT) measurements in twin pregnancies in our population. Materials and methods: We reviewed the results of all double tests that were performed in our hospital over a three-year period. Out of them, we selected all twins and compared them with a group of three times as many singleton controls. NT measurements and the first trimester serum markers from 49 twin pregnancies were compared to those of 147 pregnant women with normal singleton pregnancy. Results: There were no statistically significant differences in age, gestational age and maternal weight between the two groups (p>0.05). We found similar NT measurements in the two groups. The median MoM of Pregnancy- Associated Plasma Protein A (PAPP-A) and fβ-hCG levels in twins were statistically significantly higher than those in singleton pregnancies. Twelve percent of the twins (12.2 %) were the result of assisted reproduction technologies. IVF versus naturally conceived pregnancies showed similar MoM of PAPP-A (2.2 vs. 1.2, respectively) and fβ-hCG (Mann-Whitney U; p = 0.195 and p = 0.958). Conclusions: Our study revealed that median PAPP-A and fβ-hCG levels for twins were less than twice those of singleton values.Cel pracy: Celem naszego badania było zbadanie surowiczych markerów pierwszego trymestru oraz przezierności karkowej (NT) w ciążach bliźniaczych w naszej populacji. Metoda: Przeanalizowano wyniki wszystkich testów podwójnych wykonanych w naszym szpitalu w ciągu trzech lat. Wyodrębniono grupę ciąż bliźniaczych (n=49) i porównano ją z trzy razy większą grupą kontrolną prawidłowych ciąż pojedynczych (n=147). Wyniki: Nie znaleziono istotnych statystycznie różnic w wieku, wieku ciążowym i masie ciała ciężarnych pomiędzy grupami (p>0,05). Stwierdzono podobne wyniki pomiaru NT w obu badanych grupach. Mediana MoM białka PAPP-A i poziom fβ-hCGw ciążach bliźniaczych był istotnie wyższy niż w ciążach pojedynczych. Dwanaście procent ciąż bliźniaczych było efektem technik wspomaganego rozrodu. Ciąże w wyniku IVF oraz ciąże spontaniczne wykazywały się podobnych wynikiem MoM białka PAPP-A (2,2 vs. 1,2 odpowiednio) i fβ-hCG (Mann-Whitney U; p=0,195 i p=0,958). Wnioski: Średni poziom białka PAPP-A i fβ-hCG dla ciąż bliźniaczych był mniej niż dwa razy większy niż dla pojedynczych ciąż

Ovulation induction and controlled ovarian hyperstimulation: A global perspectİve

Bir yıllık korunmasız ilişkiye rağmen gebeliğin oluşmaması olarak tanımlanan ve çiftlerin yaklaşık %15ini etkileyen infertilite, medikal bir problem olduğu kadar sosyal ve ekonomik yönden de önemli bir yük olarak karşımıza çıkmaktadır. İnfertilite tedavisinde kullanılan ilaçlarda özellikle son 20 yılda gözlenen hızlı gelişim ovulasyon indüksiyonu ve kontrollü ovaryan hiperstimülasyon protokollerine yeni ajanların katılıp, gerek maliyet gerekse hasta dostu yaklaşım açısından klinisyenlere farklı seçenekler sunmaya olanak sağlamıştır. Aşağıdaki derlemede, ovulasyon indüksiyonu ve kontrollü ovaryan hiperstimülasyon protokolleri özetlenecek ve literatürdeki yeni gelişmeler sunulacaktır.Infertility which is defined as inability to conceive in one year after unprotected regular intercourse, is a common medical but also a serious economic and social problem affecting almost 15% of the couples. The tremendous growth in medical industry in the last 20 years led to the development of new agents to join in ovulation induction and controlled ovarian hyperstimulation protocols and enables the clinician to develop new protocols which are more cost effective and patient friendly. In this review, we will summarize the ovulation induction and controlled ovarian hyperstimulation protocols and present the new literature

Male Infertility: Causes and Current Developments in Diagnostic Work-Up

Male factor infertility gained importance during the last two decades in the infertility work-up and necessitates the revision of basal semen analysis parameters. Diagnostic evaluation of the male begins with a detailed history, physical examination and a semen analysis. Hormonal and genetic evaluation is done if indicated. The expeditious progress in the assisted reproductive techniques, highlight the importance of genetic testing in the evaluation of the male patient and in cases like azoospermia in which the prognosis may change the treatment protocol

H. pylori infection and antral nodular gastritis in children

Objectives: The aim of the study was to determine the prevalence of antral nodularity and establish its association with Helicobacter pylori infection in children. Methods: A total of 358 children (mean age: 10.35±3.15 years, M/F:0.95) who had upper gastrointestinal endoscopy were evaluated retrospectively in terms of clinical, endoscopic and histological findings. The association between antral nodularity and H. pylori infection was determined. Results: Antral nodularity was observed in 158 (44.1%) patients. H. pylori was detected in 138 (83.4%) of those patients with antral nodularity. Infected children with H. pylori compared to non-infected group were older (p= 0.0001). The antral nodularity was observed significantly higher in H. pylori-positive patients than in H. pylori-negative cases (p=0.0001). The sensitivity was 52%, specificity 78%, positive predictive value 87% and negative predictive value was 37%. Lymphoid follicle and aggregates formation was observed higher in patients with antral nodularity than patients without (p=0.0001 and p=0.017, respectively). Statistically significant difference was observed between antral nodularity and the grades of H.pylori density (p=0.0001). Conclusions: Children with antral nodularity were more likely to have H. pylori gastritis compared to children without. The parameters associated significantly with antral nodularity were older age, H. pylori infection and H. pylori density

Recurrent Postpartum Eosinophilic Pneumonia Presenting as Acute Respiratory Distress Syndrome

Eosinophilic pneumonia (EP) is a rare disease of the lung. We aimed to present atypical course of two EP cases. They were admitted to our hospital because of acute respiratory distress syndrome (ARDS) in postpartum period. Eosinophilia was detected in bronchoscopic broncho-alveolar lavage and laboratory examination. In these cases, no spesific cause for eosinophilic pneumonia was determined and steroid treatment was started. After the treatment, the patients were in full recovery which were confirmed by clinical and radiological investigations, readmitted to our clinic with relapses of ARDS. The patients have received regular treatment for 1 year. Our cases were neither fitting the classic definitions of acute eosinophilic pneumonia nor chronic eosinophilic pneumonia. Therefore, we wanted to contribute additional data in the literature by sharing these interesting cases

A Successful Pregnancy by Utilization of Gradually Increasing Low Dose Gonadotrophin Stimulation in a Modified Natural Cycle in Vitro Fertilization Procedure: Case Report

The modified natural cycle in vitro fertilization (MNC-IVF) treatment can be a promising method for poor responder patients especially in young patients with poor ovarian reserve. A 34-year-old primary infertile woman presented with a history of poor ovarian response and cycle cancellation following controlled ovarian hyperstimulation during an IVF-ET procedure two months ago. During MNC-IVF treatment with intracytoplasmic sperm injection (ICSI), gradually increasing doses of hMG for three days (totally 675 IU) have been administered accompanied by daily 0,25 mg cetrorelix. Following ovulation triggering, one oocyte was picked up and a good quality (grade 1) embryo was transferred on day 2. A clinical pregnancy was established with ultrasonography on sixth weeks of gestation. Acceptable pregnancy rates per embryo transfer, low medication cost, relatively low risk of complications and higher patient acceptability are the main advantages of MNC-IVF treatment as a feasible treatment option especially for poor responder patients

Serum Ischemia Modified Albumin Levels in Infertile Couples Underwent in Vitro Fertilization

OBJECTIVE: Ischemia-modified albumin (IMA) is a novel biomarker for diagnosis of distinct disease states including infectious diseases, coronary atherosclerotic disease, hypoxic fetal distress and diabetes mellitus. In vitro fertilization (IVF) is a medical process by which an egg is fertilized by sperm outside the body with varible success rates. It is important for the clinician to assess which women will get pregnant after IVF procedure. In this context we aimed to analyse the possible role of IMA in infertile couples underwent IVF. STUDY DESINGN: The study group comprised 30 patients with IVF failure, 27 patients with a successful IVF cycle and 34 fertile controls. IVF failure is defined as IVF that does not result in a pregnancy. A rapid, spectrophotometric Albumin Cobalt Binding (ACB) test was used to determine serum IMA levels and results were presented by absorbance units (ABSU). RESULTS: Serum IMA levels were 0.27 (0.07-0.58), 0.35(0.08-0.88), and 0.37(0.06-1.07) ABSU for patients with IVF cycle failure, successful IVF cycle and controls respectively. No statistically significant difference was observed between study participants. CONCLUSION: Our results showed that ischemia modified albumin did not provide enough sensitivity or specificity to determine IVF success