Aim: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women during the reproductive ages. The purpose of this study was to investigate the chronotype and sleep quality of PCOS patients.Methods: Volunteering nulliparous participants who were diagnosed with PCOS and a convenience sample of healthy controls without accompanying chronic medical conditions who presented to the Bezmialem University gynecology outpatient clinic were enrolled in the study. Participants were asked to fill out the Turkish versions of Morningness Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality index Questionnaire (PSQIQ). Results: There were 111 participants in the PCOS group and 108 participants in the healthy control group. Both groups were similar in age (p=0.24) and body mass index (p=0.9). The prevalance of hirsutism (mFG ≥8) was 33.3% among PCOS patients. Subjective sleep quality (<0.001), sleep latency (<0.001), habitual sleep efficiency (0.003), utilization of sleep medication (0.03) and daytime dysfunction (<0.001) scores were significantly different between the groups. In the PCOS group, MEQ score was inversely correlated with the mFG score and fT levels. There was a negative correlation between MEQ-mFG (r=-0.59, p<0.001).Conclusion: PCOS patients were more prone to eveningness chronotype and had worse sleep quality compared to controls. Furthermore PCOS patients with hirsutism were more evening oriented and had more difficulty falling asleep compared to those without hyperandrogenism.
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Aim: Survivin is an “inhibitor of apoptosis” protein. Survivin expression is a poor prognostic factor in a variety of solid tumors. In thisclinicopathological study, we aimed to investigate survivin immunostaining of leiomyomas, leiomyoma variants, STUMP (Uterinesmooth muscle tumor of uncertain malignant potential)’s and LMS (leiomyosarcoma). Our second objective was to investigatewhether survivin immunoreactivity in STUMP and LMS may play a role in determining recurrence.Material and Methods: Consecutive 119 specimens of leiomyoma, leiomyoma variants, STUMP and LMS from the pathology archivesof Bezmialem Medical Faculty and Cerrahpasa Medical Faculty were selected. Clinicopathologic characteristics were analyzed andspecimens were stained with survivin and Ki-67. The percentage and staining intensity of immunoreactive cells were examined.Additionally, we analyzed whether survivin intensity and expression might be a predictor of LMS recurrence.Results: The patients in the LMS group were older (p< 0.001). All LMS and all STUMP specimens were stained with survivin. Survivinstaining and Ki-67 staining were highest in the LMS and STUMP groups. Survivin staining was 14.2 ± 6.7 % in the LMS group, 11.2±10.4 % in the STUMP group, 1.85 ± 1.9 % in the leiomyoma group and 1.4 ± 0.2 % in the leiomyoma variant group (p<0.001). Survivinstaining intensity was 1.2 ± 0.6 in the LMS group, 0.9 ± 0.2 in the STUMP group, 0.8 ± 0.4 in the leiomyoma group and 0.9 ± 0.3 in theleiomyoma variant group ( p=0.025). Both survivin staining percentage and staining intensity correlated with the Ki-67 proliferationindex. In the LMS cases that showed recurrence survivin staining was 16% while in the cases that did not reoccur survivin stainingwas 2% (p<0.001).Conclusion: The antiapoptotic marker “survivin” has not been studied before for smooth muscle tumors of the uterus. Utilizingsurvivin in conjuncture with histologic features and Ki-67 can also help to determine malignancy potential and LMS recurrence.
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Aim: To assess the risk factors associated with high rate of insufficient endometrial sampling on endometrial biopsy in postmenopausal women.Methods: Data were retrieved from the records of 522 consecutive patients who underwent endometrial sampling. Logistic regression analyses were performed to determine various factors associated with scanty endometrial biopsy. The exclusion criteria included patient refusal, uncertain menopausal status, cervical carcinoma detected after sampling and unavailable records.Results: The sample was insufficient for a definitive diagnosis in 143 (25.9%) patients. Out of these, 53 cases were investigated with invasive procedures. Further histopathological examination revealed that five (9.4%) patients had uterine malignancy. Based on the multivariate analysis, time since the onset of menopause [Odds ratio (OR)=1.044, 95% confidence interval (CI)=1.000-1.090, p=0.049] was significantly associated with insufficient endometrial biopsy in cases with a endometrial thickness of >12 mm on ultrasonography (OR=0.624, 95% CI=0.472-0.824, p=0.001). The use of dilation and curettage technique (OR=0.662, 95% CI=0.522-0.841, p=0.001) decreased the risk of insufficient sampling on endometrial biopsy.Conclusion: Time since the onset of menopause and the thickness of endometrium were significant independent factors associated with insufficient sample. Using Karman cannula for endometrial aspiration may not be a reliable method in the evaluation of postmenopausal women. An insufficient endometrial sample does not rule out endometrial carcinoma, therefore, a further histopathological examination is recommended.
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AmaçYinelenen servikal serklaj, literatürde primer serklaj sütürünün başarısız olduğu durumlar için tanımlanan tedavi seçeneklerinden biridir. Ancak yenidoğan için daha belirgin olan serklaj uygulamasının enfeksiyöz komplikasyonları görülebilir. Çalışmamızda, uzamış gebelikten faydalanmak adına karşılaşılan şiddetli akut maternal morbidite olgusunu sunduk.OlguDikoryonik diamniyotik gebeliği olan 27 yaşında ve 23+5 gebelik haftasındaki nullipar hasta, “ağrı” ve “vajinal kanama” ile acil kliniğimize başvurdu. Olguya, gebeliğinin 18. haftasında hastanemizde kısa servikal uzunluk (14 mm) ile endike Shirodkar serklajı uygulandı. “Membran sarkması” şikayetiyle başvurduğu bir başka kurumda hastaya 23+3 haftada yinelenen serklaj uygulandı. Koryoamniyonit şüphesiyle hastaya gebeliğin sonlandırılması önerildi. Gebeliğin sonlandırılmasının ardından kardiyak arrest gelişti. İki dakikalık resüsitasyon sonrasında sinüs ritmi elde edildi. Hasta yoğum bakım ünitesine sevk edildi.SonuçYinelenen serklajın rolü tartışmalıdır. Uzamış gebeliğin terapötik faydasından yararlanabilmek için, serklaj sütürü uygulamasından önce altta yatan intrauterin enfeksiyon ihtimalini elemek için tüm çaba sarf edilmelidir.
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Objective: The first objective of this study was to investigate the relationship between gestational diabetes mellitus (GDM) and gestational weight gain (WG), waist circumference (WC), prepregnancy, and gestational body mass index (BMI). The second aim of our study was to assess the ability of WG, WC, prepregnancy, and gestational BMI with special reference to their cut-off points on predicting the risk of GDM in pregnant women in Turkey.Materials and Methods: A total of 261 women who underwent screening for GDM with the 75-g glucose tolerance test (GTT) between 24th and 28th gestational weeks were included. According to the 75-g oral GTT results, women were classified into two groups: the GDM group and non-GDM group. The data collected included age, parity, plasma glucose level for fasting, 1- and 2-h tests, WC, prepregnancy and gestational BMI, prepregnancy weight, WG during pregnancy, gestational age at birth, and birth weight.Results: WC at 20-24 weeks of gestation, prepregnancy BMI, and gestational BMI had a predictive capacity for GDM. According to our results, optimal cut-off points for the best predictive value of GDM were WC of 100 cm with a sensitivity of 84% and specificity of 70%, prepregnancy BMI of 25 kg/m2 with a sensitivity of 81.8% and specificity of 76%, and gestational BMI of 28.3 kg/m2 with a sensitivity of 75% and specificity of 77.4%.Conclusion: The measurement of prepregnancy BMI, gestational BMI, and WC may be useful in predicting the risk of GDM. Pregnant women with increased prepregnancy BMI, gestational BMI, and WC measurements may be susceptible to the development of GDM.
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Objectives: The aim of this study was to investigate whether first trimester combined screening for major fetaltrisomies is influenced by assisted reproduction techniques (ART) from blastocyst transfer, with or withoutcryopreservation.Methods: This study is a retrospective analysis involving 115 singleton pregnancies with euploid fetusesrecruited between January 2017 and December 2017. Sixty-five women conceived with fresh blastocysts fromin vitro fertilization (IVF) cycles (fresh-blasto), 50 with frozen-thawed blastocysts. All cases underwentultrasound assessment at 11+0 - 13+6 weeks with measurements of crown rump length, nuchal translucency(NT) , free beta-human chorionic gonadotrophin (free β-hCG) and pregnancy-associated plasma protein A(PAPP-A) concentrations.Results: Baseline characteristics and pregnancy outcomes did not differ substantially among the study groups.The NT was not significantly different in the frozen-thawed -blasto compared to the fresh-blasto group (p =0.741). The free β-hCG levels was not significantly different in frozen-thawed-blasto group compared to freshblasto group (p = 0.495). The two groups showed no significant difference in the PAPP-A levels (p = 0,139).The median delta crown rump length was also not significantly different among the two groups (p = 0.758).Conclusions: In ART pregnancies from blastocyst transfer, with or without cryopreservation, the NTmeasurement, free β-hCG concentration and PAPP-A levels did not show any significant difference. Thesefeatures are apparently unrelated to the outcome of pregnancy and may be due to alterations or delays inembryogenesis or placentation with potential relevance for the screening test performance.
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