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Cystathionine beta-synthase deficiency (CBSD) is the most prevalent inherited disorder of homocysteine metabolism in the transsulphuration pathway. Research have suggested oxidative stress and inflammation as candidate pathogenic mechanisms in CBSD. This study aims to evaluate mitochondrial dysfunction and oxidative stress biomarkers in cystathionine beta-synthase deficiency (CBSD) patients, which may aid in understanding the pathogenesis of CBSD and improving treatment. The study group comprised 23 patients with a diagnosis of CBSD and healthy controls. We analysed serum levels of NAD+ and NADH by fluorometric assay, FGF-21 and GDF-15 by ELISA, mitochondrial DAMPs by real time qRT-PCR, total homocysteine levels in plasma by enzymatic test and compared the results in CBSD group with healthy controls. In patient group, a positive correlation was found between the total homocysteine level and both GDF-15 and NAD+/NADH levels. Furthermore, there was a negative correlation between total homocysteine levels and both total NAD++NADH and NADH levels. The alterations in NAD+, FGF-21, GDF-15 levels, and NAD+/NADH ratio in patients suggest that oxidative damage coexists with mitochondrial dysfunction in CBSD. Assessment of oxidative damage and addition of anti-oxidant therapy together with mitochondrial support may have additional benefits in reducing long-term morbidity in CBSD patients. [ABSTRACT FROM AUTHOR]

The epigenetic features contribute to variations in host susceptibility to SARS-CoV-2 infection and severity of symptoms. This study aimed to evaluate the relationship between the relative expression of microRNAs (miRNAs) and the severity of the disease in COVID-19 patients. The miRNA profiles were monitored during the different stages of the disease course using reverse transcription–quantitative polymerase chain reaction (RT-qPCR). The expression levels of the selected 11 miRNAs were measured in the blood samples collected from 73 patients (moderate, n = 37; severe, n = 25; critically ill, n = 11, a total of 219 longitudinal samples) on hospitalization day and days 7 and 21. Expression changes were expressed as "fold change" compared to healthy controls (n = 10). Our study found that several miRNAs differed according to disease severity, with the miR-155-5p the most strongly upregulated (p = 0.0001). A statistically significant negative correlation was observed between the expression of miR-155-5p and its target gene, the suppressor of cytokine signaling 1 (SOCS1). The relative expression of miR-155-5p was significantly increased and SOCS1 was significantly decreased with the disease progression (r = −0.805 p = 0.0001, r = −0.940 p = 0.0001, r = −0.933 p = 0.0001 for admission, day 7, and day 21, respectively). The overexpression of miR-155-5p has significantly increased inflammatory cytokine production and promoted COVID-19 progression. We speculated that microRNA-155 facilitates immune inflammation via targeting SOCS1, thus establishing its association with disease prognosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the changes in cervical collagen during the first trimester of pregnancy and to evaluate the collagen deficit in cases with a previous diagnosis of cervical insufficiency (CI).Materials and Methods: Cervical punch biopsies were obtained from 66 patients divided into three groups: patients with recurrent abortions due to CI (CI group; n = 8); first-trimester abortion group (study group; n = 37), subdivided into three groups according their gestational week (<7, 7-9 and 9-12 weeks), and patients with cervical biopsy due to gynecologic reasons (control group; n = 12). Collagen quantity was determined by a biochemical method that measured the levels of hydroxyproline (HOP) in dry cervix tissue.Results: The HOP concentrations were significantly higher at lower gestational ages (p = 0.001). Collagen quantity was lowest in the CI group compared with other groups (p < 0.001).Conclusion: This study shows collagen component of cervix decreases as pregnancy advances through the first trimester. Cervical collagen concentration is lower in women with a history of CI compared to controls who has not a history of CI. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to compare the diagnostic performance of the line probe assay (LPA) with conventional multiplex polymerase chain reaction (PCR) for Streptococcus pneumoniae as well as real-time PCR for Neisseria meningitidis and Haemophilus influenzae type b (Hib) in cerebrospinal fluid (CSF) samples from children during the multicenter national surveillance of bacterial meningitis between the years 2006 and 2009 in Turkey. Results: During the study period 1460 subjects were enrolled and among them 841 (57%) met the criteria for probable bacterial meningitis. The mean age of subjects was 51 ± 47 months (range, 1-212 months). We performed the line probe assay in 751 (89%) CSF samples of 841 probable bacterial meningitis cases, of whom 431 (57%) were negative, 127 (17%) were positive for S. pneumoniae, 53 (7%) were positive for H. influenzae type b, and 41 (5%) were positive for N. meningitidis. The LPA was positive in 19 of 23 (82%) S. pneumoniae samples, 4 of 6 (67%) N. meningitidis samples and 2 of 2 (100%) Hib samples in CSF culture-positive cases. The specificity of the LPA for all of S. pneumoniae, H. influenzae type b, and N. meningitidis was 88% (95% CI: 85-91%), when using the standard PCR as a reference. The specificity of LPA for each of S. pneumoniae, H. influenzae type b, and N. meningitidis was 93% (95% CI: 89-95%), 96% (95% CI: 94-98%), and 99% (95% CI: 97-99%), respectively. For all of S. pneumoniae, H. influenzae type b and N. meningitidis the sensitivity of the LPA was 76% (95% CI: 70-82%) and for each of S. pneumoniae, H. influenzae type b and N. meningitidis was 72% (95% CI:63-79%), 88% (95% CI: 73-95%), and 81% (95% CI:67-92%), respectively. Conclusions: The LPA assay can be used to detect common bacterial meningitis pathogens in CSF samples, but the assay requires further improvement. [ABSTRACT FROM AUTHOR]

Introduction: In this study we aimed to detect paraoxonase 1 (PON-1) activity in iron deficiency anemia (IDA) and to compare it with healthy controls by observing the change after iron therapy.Material and Methods: In this study, 50 adult patients with IDA and 40 healthy subjects were enrolled. All patients were analyzed at the beginning and after treatment according to laboratory assessments.Results: Mean paraoxonase and arylesterase activities in the iron deficiency anemia group were significantly lower than mean activities of the control group (102.4 ±19.2 U/l and 163.3 ±13.68 U/l, respectively and 157.3 ±26.4 U/l and 256.1 ±24.6 U/l, respectively; p = 0.0001 for both). Paraoxonase and arylesterase activities significantly increased after treatment for IDA (143.2 ±13.9 and 197.6 ±27.9 U/l, respectively, p = 0.0001). Mean activities after treatment with iron were significantly lower than mean activities in the control group (p = 0.002; p = 0.0001 respectively).Conclusions: Paraoxonase and arylesterase activities in patients with IDA significantly increased after treatment with iron therapy. In adults IDA may also be one of the factors associated with increased risk of atherosclerosis. [ABSTRACT FROM AUTHOR]

Insidious progressive renal damage caused by type 1 diabetes mellitus (T1DM) begins in childhood before it becomes manifest in adult ages. Heat shock proteins (HSPs) regulate the cell response to any hazardous factors to prevent cell structure. The aim of the study is to determine whether urine levels of HSPs increase in diabetic children with time and indicate a progressive renal injury in T1DM. Thirty-three patients with T1DM and 24 healthy children were enrolled in the study. Renal function was normal in all patients. Urine levels of HSP27, HSP40, HSP60, HSP70, and HSP90 were measured by enzyme-linked immunosorbent assay at two consecutive years (2012 and 2013). The results were evaluated as urine HSP/creatinine ratios (uHSP/Cr). Mean urine HSP27/Cr, HSP40/Cr, HSP60/Cr, HSP70/Cr, HSP90/Cr in patient group were significantly higher than in controls in 2012 (uHSP27/Cr 460.12 ± 217.64 versus 270.02 ± 136.83 pg/mgCr; uHSP40/Cr 180.89 ± 118.59 versus 99.44 ± 62.49 pg/mgCr; uHSP60/Cr 114.40 ± 64.91 versus 70.50 ± 43.70 pg/mgCr; uHSP70/Cr 41.17 ± 28.42 versus 16.47 ± 7.32 pg/mgCr; uHSP90/Cr 175.64 ± 102.22 versus 107.61 ± 75.85 pg/mgCr) (p < 0.05). In 2013, uHSP70/Cr level increased significantly (51.08 ± 27.72 pg/mgCr;p = 0.001), whereas uHSP60/Cr level decreased and uHSP27/Cr, uHSP40/Cr, uHSP90/Cr levels remained stable (p > 0.05). Area under the curve (AUC) for uHSP70/Cr (0.957) was significantly higher than the others. Using a cutoff 22.59 pg/mgCr for uHSP70/Cr to predict of diabetic damage, sensitivity and specificity were 85% and 96%, respectively. Our results suggest that uHSP70/Cr increases over time and may indicate early phases of progressive kidney damage in diabetic children. [ABSTRACT FROM AUTHOR]

ObjectivesParaoxonase-1 (PON1) is a high-density lipoprotein-associated enzyme implicated in the pathogenesis of atherosclerosis by protecting lipoproteins against peroxidation. PON1 has two genetic polymorphisms both due to amino acid substitution, one involving glutamine and arginine at position 192 and the other leucine and methionine at position 55. Recent reports suggest that nephrolithiasis and atherosclerosis share a number of risk factors. Our study aimed to compare the effects of PON1 192, PON1 55 polymorphisms, and PON1 activity in patients with urolithiasis and controls.Materials and methodsPON1’s arylesterase/paraoxonase activities and phenotype were determined in 158 stone forming cases (Group 1) and 138 non-stone forming controls (Group 2). The PON1 192 and PON1 55 polymorphisms were studied by polymerase chain reaction/restriction fragment length polymorphism.ResultsParaoxonase activity was significantly lower in Group 1 than Group 2 (112 ± 31.8 vs. 208 ± 53.1 IU/L) (p < 0.001). The PON1 L55M polymorphism was significantly higher in Group 1. The “M” allele coding for PON1 was higher in Group 1 (p < 0.001). PON1 192 RR homozygotes had significantly higher PON1 activity than QR and QQ genotypes among all the patients (p < 0.001).ConclusionThe results of our study demonstrate that the PON1 55 gene “M” allele is associated with renal stone disease. Individuals possessing the “M” allele have a higher incidence of urolithiasis. The results of this study provide genetic evidence that the PON1 gene may play a role in stone formation. PON1 genotype determination may provide a tool to identify individuals who are at risk of urolithiasis. [ABSTRACT FROM AUTHOR]

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 preeclampsia (PE) patients between 24 and 34 weeks gestation, 166 were diagnosed with mild PE and 324 were diagnosed with severe PE. Patients were divided into four groups (no notch, a unilateral notch, bilateral notches and double notches). Results: Bilateral and double notches were predictive of shorter follow-up times, adverse laboratory outcomes, HELLP syndrome, prematurity, neonatal intensive care unit admission and perinatal mortality. Conclusion: Double notches represent progressive deterioration in the uterine artery and are predictive of adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Benign cystic mesothelioma (BCM) is a rare tumor of unknown origin, most frequently encountered in women of reproductive age and with unknown etiology. Most patients have a history of previous pelvic operation, endometriosis, or pelvic inflammatory disease. Preoperative diagnosis is difficult. We report the cases of three patients, with one case complicated by pregnancy, and discuss the diagnostic evaluation and treatment of this rare disease. Complete surgical resection is recommended if feasible. However, recurrent disease is not uncommon. Clinical positive effects of different adjuvant medical treatments are also discussed. [ABSTRACT FROM AUTHOR]

Objective. Mirror syndrome (Ballantyne's syndrome) refers to the association of fetal hydrops and maternal preeclampsia. The aim of this study was to determine the relation and incidence between fetal hydrops and preeclampsia in our clinic. Methods. A retrospective review of patients associated with fetal hydrops and findings with preeclampsia was used. Seventy-five cases with single pregnancy and diagnoses with nonimmune hydrops fetalis were found. According to the data 4 cases were found related with preeclampsia. Results. Mirror syndrome is rarely encountered and underdiagnosed. We found a frequency of 5.3%% (4 cases in 75 affected pregnancies) for single non-immune hydrops cases in which maternal hypertension occurred. Fetal outcome is depending on etiology and prognosis is mainly very low. Maternal symptoms and laboratory findings are resolving after intrauterine fetal death or delivery. Conclusion. Hydrops fetalis must be considered as a potential risk factor for preeclampsia. It is important that this clinical condition has a potential of about 5%% for proceeding preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: Macrophage migration inhibitory factor (MIF) is a pleiotropic proinflammatory cytokine that plays an important role in several disease including sepsis, pneumonia, diabetes, rheumatoid arthritis, inflammatory bowel disease and cancer. In this study, our aim was to examine the levels of macrophage migration inhibitory factor in children with renal scarring due to recurrent urinary tract infection Material and Methods: Eighty eight children with renal scarring due to recurrent urinary tract infection were included. Dimercaptosuccinic acid (DMSA) scintigraphy revealed renal scarring in 44 of them. Macrophage migration inhibitory factor were analyzed by ELISA from the urine samples in both groups. Results: Urine MIF levels were statistically significantly high in renal scar group than without scar group (p<0.001). the average levels of urine MIF in scar group was 331.14±256.20 (254,85) than those in patients without scar 195.30±298,68 (111,55) MIF/creatinine levels were not statistically significant between groups (p>0.05). Conclusion: In patient with renal scarring, for using urine MIF levels as a biochemical marker, more prospective studies are needed on this subject. Key words: Urinary tract infection, renal scarring, macrophage migration inhibitory factor. [ABSTRACT FROM AUTHOR]

im: To compare the effectiveness of the Pfannenstiel-Kerr method (PKM) or modified Misgav-Ladach method (MMLM) in previous cesarean sections (C/Ss). Methods: Hundred and fifteen gravidas were included with previous one C/S, using either a PKM or MMLM. Demographic characteristics, operative outcomes, surgical complications, and neonatal outcomes were compared in two groups. Results: The mean operative time (18.0 ± 3.5 vs. 23.5 ± 5.7 min; p < 0.0001) and mean extraction time (90.1 ± 41.2 vs. 208.1 ± 79.1 s; p < 0.0001) were significantly shorter in the MMLM group than the PKM group. Postoperative recovery (mobilization, normalization of bowel function, need for analgesics, time to oral feeding, and intra-operative blood loss) was similar between the MMLM and PKM groups. Conclusion: The MMLM appears to be a faster alternative to PKM for previous C/Ss, with similar results as in previous studies with primary CSs. [ABSTRACT FROM AUTHOR]

Turner syndrome is associated with a higher frequency of heart defects detected prenatally when compared to postnatal reports. The most common heart defects detected prenatally are hypoplastic left heart syndrome and coarctation of the aorta. We report a case involving a fetus at 16 gestational weeks with a septated cystic hygroma located on the neck and head, an interventricular septal mass, a hypoplastic left ventricle due to aortic stenosis, mitral stenosis, and a hypoplastic aortic arch with a karyotype of mos 45, X, [47 cells]/47, XXX [3 cells]. The autopsy findings confirmed our prenatal diagnosis with a final diagnosis of Turner syndrome and congenital cardiac vascular malformation. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the impact of one abnormal fetus in a twin pregnancy, to compare impact of chorionicity and clinical outcome of intervention and expectant management. Thirty-seven dichorionic (DC) twins and 18 monochorionic (MC) twins complicated with one malformed fetus were evaluated for gestational age, birthweight and perinatal outcome. Six hundred and forty-two twin pregnancies were evaluated in the database. The control groups consisted of 429 DC and 86 MC twins without anomalous fetus. Mean birthweight and gestational age at birth for DC control group were (n = 429; 2137g and 34.71 weeks), DC study group, n = 37; 2117g (p = .338) and 33.97 weeks (p = .311), and DC study group with major malformations, n = 30; 2019g (p = .289) and 33.3 weeks (p = .01), and showed only significance for gestational age. There was no statistical significance between MC control group, n = 86; 2097g and 34.93 weeks, and MC study group, n = 18; 2237g (p = .338), and 34.42 weeks (p = .502). Because of limited data, the preliminary evaluation for expectant management and intervention, and survival of at least one normal fetus showed no impact. We conclude that, although, all DC twin pregnancies have a risk for preterm delivery, DC twins complicated with major malformation of one twin, have a lower mean gestational age at birth. Preliminary results for intervention does not improve fetal outcome for DC and MC twins and needs further evaluation with greater studies of impact or review. [ABSTRACT FROM AUTHOR]

Aim: To study the outcome of cases of incidental adnexal masses detected during cesarean section. Methods: A total of 126 093 live births and 39 115 cesarean deliveries performed between 2002 and 2008 were retrospectively evaluated and cases with additional adnexal masses and surgical interventions were included in the study. Histopathologic assessment and related outcomes were examined. Results: One hundred and nineteen patients had incidental adnexal masses at the time of cesarean delivery; the incidence of adnexal masses was 1/329. The most common histopathologic diagnoses were mature cystic teratoma (32%) and functional cysts (26%). Six cases (5%) were bilateral. The mean cyst size was 6.4 cm; two of the masses were malignant. Conclusion: Incidental masses detected at the time of cesarean section should be extirpated in order to exclude the possibility of malignancy and to avoid additional surgical procedures following cesarean section. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate prognosis of type of ventricular septal defects and coexistence of associated cardiac and extracardiac defects. Methods: 120 prenatal diagnosed pregnancies associated with ventricular septal pathology were retrospective evaluated and divided into four groups as atrioventricular septal defects, perimembranous septal defects, muscular septal defects and univentricular formation. Each group were divided afterwards again into four groups as isolated defect, co-existing extracardiac defect, septal defect with extracardiac defect and septal defect with co-existing cardiac and extracardiac defect. Postnatal follow-up was done until 8 months of life, at least. Results: Median gestational age at diagnosis was 26.3 weeks, 47 cases were diagnosed before 24 weeks. After dispersion of septal defects there was a statistical significance of p=0.0089 between groups. Of 31 cases with atrioventricular septal defects, only one case survived (3.2%) and there was a high association with extracardiac defects and abnormal karyotype (p=0.002). 69 cases with perimembranous ventricular septal defects were diagnosed and 24 cases (34.8%) survived, with significance for abnormal karyotype (p=0.039). Of 18 cases born with muscular septal defects 12 cases (66.7%) stay alive. We had two cases with univentricular structure; both cases decided for termination of pregnancy. Conclusion: The more complicated and severe pathology, the worsen prognosis. Individualized counseling is the most important point in decision making together with families. [ABSTRACT FROM AUTHOR]

Objective: To assess the indications and distribution of cases decided for termination of pregnancy and reasons delaying to third trimester termination. Methods: Retrospective study of cases between 2002 and 2006 in the hospital council. Cases were divided in two groups as early termination (<23 weeks of gestation) and late termination (greater than or equal to 23 weeks of gestation). All pregnant women who underwent termination were classified according related systemic pathology and chorionicity. Reasons delaying to third trimester termination were evaluated in four groups. Results: During this five year period 1.449 complicated pregnancies were counseled and in 713 cases termination was offered. Of 677 cases (94.95%) with termination, 412 cases (60.09%) had early and 265 cases (39.91%) late termination. The most seen indications were central nervous system abnormalities (51.7%), chromosomal abnormalities (11.7%), and urogenital abnormalities (8.4%). The main reason in delaying termination was failure of screening by ultrasound (65.6%). Conclusion: Systematic screening for fetal anomalies is the main step for prevention of affected pregnancies. Information given to parents for TOP is important, but the decision for TOP is influenced by many factors. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to determine prenatal follow up and clinical outcome in fetuses born with cystic hygroma. Methods: A series of 64 cystic hygroma patients, who were diagnosed in the first and the second trimester of pregnancy, was enrolled. Associated structural abnormalities, karyotype analysis and pregnancy outcome were studied. Survivors were followed for their fetal outcome and prognosis. Results: There were 64 new cases of cystic hygroma in 8524 subjects screened (0.75%). Thirty-nine (60.9%) were of non-septated and 25 (39.1%) were of septated cystic hygroma. Chromosomal abnormalities were present in 25 (39.1%). The most common abnormality in non-septated cystic hygroma was trisomy 21 (10, 27.8%), and that in septated cystic hygroma was Turner syndrome (5, 23.8%). Associated structural malformations are common in cystic hygroma and overall survival was poor. Nine of the present infants were live-born and were subsequently followed up. Two had cardiac pathology and died after cardiac operation, two others were diagnosed with axillary cystic hygroma, had an excellent prognosis and responded well to treatment, and another two had cranial findings with mild neurological sequel. Only three cases had, at birth and in the follow-up period, no complications. Conclusion: Cystic hygroma is highly correlated with adverse perinatal outcome. Prenatal diagnosis and invasive procedures are vital for counselling with close follow-up after delivery for appropriate medical support. A multidisciplinary approach is strictly recommended in live-born children. [ABSTRACT FROM AUTHOR]

We report a case of mucinous adenocarcinoma arising from mature cystic teratoma (MCT) of the ovary ascertained incidentally during pregnancy. An ovarian adnexal mass was seen in a 38-year-old pregnant woman during cesarean section. Oophorectomy revealed a mucinous adenocarcinoma arising from MCT with additional capsule invasion. Following this, staging procedures were applied. The patient was staged as IC and adjuvant chemotherapy was applied. She has remained disease-free for over 24 months. To our knowledge, this is a case of mucinous adenocarcinoma arising from MCT and the third case of malignant transformation from MCT in pregnancy in English literature. [ABSTRACT FROM AUTHOR]

The Brenner tumor is an uncommon ovarian tumor in pregnancy with only three previous cases in the English published reports. A 35-year-old woman delivered abdominally because of distress symptoms and a Brenner tumor was resected incidentally. Histological examination revealed a tumor composed of epithelial nests and areas of stromal luteinization. The patient was treated conservatively. Brenner tumor should be considered in the differential diagnosis of adnexal masses during pregnancy. These tumors are mainly benign and show typical luteinization associated with the hormonal milieu in pregnancy. [ABSTRACT FROM AUTHOR]

To determine the risk factors causing re-laparotomy and the indications, management and outcomes of re-laparotomy after a cesarean section. We had, during the study period of January 2002 to January 2007, 28,799 cesarean sections and 35 cases with re-laparotomy. We studied the patients’ age, parity, indications for cesarean section and indications for re-laparotomy, time interval after cesarean section to reopening of the abdomen, type of surgery, need for blood transfusion and span of hospital stay. The incidence of re-laparotomy was 0.12%. Cases with placental abruption and previous cesarean ≥3 had a higher risk for re-laparotomy. Procedures that were performed at re-laparotomy were drainage and resuturing of hematomas ( n = 8), resuturing of uterus and securing hemostasis with stitches ( n = 10), bladder repair ( n = 1), herniation repair ( n = 1), total abdominal hysterectomy ( n = 2), subtotal abdominal hysterectomy ( n = 5), and draining and resuturing of broad ligament, parametrium, abdominal wound, and cutaneus and subcutaneous tissue due to infection and abscess formation ( n = 8). Two cases required admission into the intensive care unit. We had one case with maternal mortality. Majority of the complications were revealed at an early period and these were hemorrhagic cases mostly. Although the rate of re-laparotomy after cesarean section is low, several actions must be undertaken to decrease the need for re-laparotomy. In particular, cases with placental abruption and previous cesarean ≥3 are with higher risk for re-laparotomy and have a 15-fold risk for re-laparotomy after cesarean section. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine prenatal diagnosis of double-outlet right ventricle (DORV)-associated anomalies and prognosis of each case. Medical records were reviewed of fetuses with DORV who had fetal echocardiography at our institution from 2002 to 2006. Pre- and postnatal diagnosis and outcome were compared and evaluated. Twenty-one fetuses were diagnosed with DORV. The pregnancy was terminated in seven cases. Three cases had chromosomal abnormalities; three cases, hypoplastic left ventricle; and one case, encephalocele. Accurate prenatal diagnosis of the ventricular septal defect, outflow obstruction, and great artery relationship was achieved in 14 of 16 cases (87.5%). Only 2 of 13 live-born cases survived beyond 6 months. The overall prognosis for fetuses with DORV is poor. DORV is found in fetuses with a huge spectrum of associated cardiac and extracardiac anomalies. Careful assessment by fetal echocardiography can determine important anatomic details with adequate correctness for precise counseling. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine prenatal diagnosis of double-outlet right ventricle (DORV)-associated anomalies and prognosis of each case. Medical records were reviewed of fetuses with DORV who had fetal echocardiography at our institution from 2002 to 2006. Pre- and postnatal diagnosis and outcome were compared and evaluated. Twenty-one fetuses were diagnosed with DORV. The pregnancy was terminated in seven cases. Three cases had chromosomal abnormalities; three cases, hypoplastic left ventricle; and one case, encephalocele. Accurate prenatal diagnosis of the ventricular septal defect, outflow obstruction, and great artery relationship was achieved in 14 of 16 cases (87.5%). Only 2 of 13 live-born cases survived beyond 6 months. The overall prognosis for fetuses with DORV is poor. DORV is found in fetuses with a huge spectrum of associated cardiac and extracardiac anomalies. Careful assessment by fetal echocardiography can determine important anatomic details with adequate correctness for precise counseling. [ABSTRACT FROM AUTHOR]

A case of intrahepatic arteriovenous malformation connected with umbilical, hepatic, portal, and arterial systems in a fetus diagnosed at 36 weeks of gestation is presented. Prenatal color Doppler ultrasonography in the fetal liver demonstrated complicated vascular connections fed by arterial and portal branches. Postnatal color Doppler, power Doppler, 3D power Doppler, abdominal multidetector computed tomography (MDCT), and angiography CT verified the prenatal diagnoses. Extended right hepatectomy was performed successfully on postnatal day 19. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine associated ultrasonographic findings, chromosome abnormalities and the prognostic factors of cystic hygromas in live-born infants. Methods: We reported a series of 57 cystic hygroma cases, who were diagnosed in the first and the second trimester of pregnancy by means of the ultrasonographic morphology of cystic hygroma, associated structural abnormalities, karyotype analysis and the autopsy findings. Survivors were followed for their fetal outcome and prognosis. Results: There were 57 new cases of cystic hygroma among 8,155 screenings (0.7%). 35 of the cases (61.4%) were nonseptated and 22 of the cases (38.6%) were septated cystic hygroma. Chromosomal abnormalities were found in 23 of the cases (40.3%). The most common abnormality in nonseptated cystic hygroma was trisomy 21 (8 cases, 25%) and in septated cystic hygroma was Turner syndrome (4 cases, 21.1%). The most common associated structural malformations were cardiac abnormalities (in 7 cases, 20%) in nonseptated cystic hygroma cases and nonimmune hydrops (in 12 cases, 54.5%) in septated cystic hygroma cases. Overall survival was poor; only one case of septated cystic hygroma with axillary location and seven cases of nonseptated cystic hygroma, of whom two died in the neonatal period, were alive (10.5%). This study had 80% power to detect 0.03% difference in diagnosis cystic hygroma (alpha = 0.05, beta = 0.80). Conclusion: Fetuses with cystic hygroma are at high risk for adverse outcome. Prenatal diagnosis with invasive procedures should be done in order to inform the parents in detail. Axillary location of the hygroma and the depth of invasion had prognostic importance. [ABSTRACT FROM AUTHOR]

Carbamazepine (CBZ) intoxication is an important issue in acute poisoning practice. Highly protein-bound, CBZ is not removed efficiently through conventional hemodialysis. We describe the use of continuous venovenous hemodiafiltration (CVVHDF) in a 2-year-old boy who developed general tonic clonic seizure and respiratory depression due to controlled-release formula of CBZ overdose (peak drug level of >20 μg·ml−1, therapeutic range: 5–10 μg·ml−1). Serum CBZ concentrations fell to 0.25 μg·ml−1 at the end of hemodiafiltration. The patient recovered rapidly and was discharged from hospital 4 days from the time of ingestion with no complications or neurologic impairment. [ABSTRACT FROM AUTHOR]

Objective: The cervical tissue consists mainly of an extracellular matrix rich in collagen; important fort the biomechanical properties. During normal gestation, the biomechanical strength of the cervix is determined by the collagen concentration. This study demonstrates the differences and changes of cervical collagen in first trimester abortions and its relation with age and parity. Methods: Cervical punch biopsies were obtained from 59 patients divided into two groups: first trimester abortion group (study group; n=45), and patients with cervical biopsy due to gynecologic reasons (control group; n=14). According to their gestational weeks, 45 first trimester pregnant women (median age=28.2) were divided into 3 groups (<7 weeks, 7-9 weeks, >9 weeks). Biochemical testing was performed and collagen quantity (as μg OH-prolin/mg dry weight) was determined. Hydroxyproline was measured in cervix tissue by the method of Switzer. Finally, the results of collagen and its relation with age and parity were investigated. Results: Collagen quantity was lower in the first trimester pregnant women group (13.06±4.17 μg OH-prolin/mg tissue) (p=0.0001) compared with the control group (24.48±12.87). Moreover, when data were adjusted for gestational weeks, no difference in collagen quantity was found between <7 weeks and control groups (17.01 ± 1.11 μg OH-prolin/mg tissue) (p= 0.047). However the collagen quantities of 7-9 weeks (12.07±3.85 μg OH-prolin/mg tissue) and >9 weeks (11.16± 4.39 μg OH-prolin/mg tissue) groups were statistically lower compared with the control group (p=0.0001). Furthermore, the results of first trimester pregnancy group were evaluated for age and parity. Lineer regression analyses shows that collagen increases with age and decreases with parity. Conclusions: Our study shows that, the collagen content of cervix started to decrease as early as first trimester of gestation. We observed that, from the beginning of 7th gestational week, cervical collagen starts to decrease. In accordance with the literature knowledge, collagen quantity increases with age and with regard to parity. [ABSTRACT FROM AUTHOR]

An abstract of the article "Cervical collagen and hydroxy-prolin ratios in patients with cervical insufficiency," by A. Gedikbasi, A. Gedikbasi, O. Arslan, M. Giris, S. Dogru-Abbasoglu, A. Tekirdag, and H. Aslan is presented.

An abstract of the conference paper "Spontaneous management of TRAP sequence due to fetal umbilical knot," by A. Gedikbasi and colleagues is presented.

Objectives: The aim of this study was to evaluate the relationship between the cervix and the threat of preterm labor in singleton pregnancies between gestational weeks less than 37 and greater than 37 weeks in correlation with utero‐cervical angle (UCA) and cervical length (CL) measurements. Materials and Methods: We conducted a prospective cohort study with UCA and CL measurements in patients with threatened preterm labor (TPL). Primary outcome was differences in UCA and CL measurements in relationship to maternal characteristics and perinatal outcome between groups. Secondary outcome evaluated measurement results and influencing factors for delivery within 7 days, between 1 and 4 weeks and beyond 4 weeks. Results: Overall 152 patients were divided into as study/preterm group (<37 weeks; n = 56) and the control/term group (≥37 weeks; n = 96). Mean gestational age at admission was similar in both groups (30.98 ± 2.83 vs. 30.36 ± 2.63 weeks, p = 0.149) with similar CL (33.9 ± 6.34 vs. 32.02 ± 8.88 mm, p = 0.132), but wider UCA in the preterm group (81.65 ± 16.81° vs. 99.21 ± 22.33°, p < 0.001). Multivariate logistic regression analysis for preterm delivery was significant for nulliparity and UCA measurement. The factor for delivering before 37 gestational weeks within 7 days was the gestational week at admission (p = 0.046). UCA and CL measurements were statistically significant for distinguishing patients for delivery within 7 days and beyond 4 weeks (p = 0.001 for CL and p = 0.0001 for UCA). NPV was found 92.5, 92.2, and 92.3 for UCA >105°, CL ≤30 mm, and Bishop score >3, respectively. Conclusion: Combined measurement of TV UCA and CL represents stronger predictors for sPTB ultrasonographically, demonstrating the uterocervical sub‐segment maturation before the active onset of labor. [ABSTRACT FROM AUTHOR]

Maternal hyperoxygenation (MH) has been studied as a diagnostic tool to evaluate pulmonary vasculature and as a treatment option to improve the growth of fetal left heart in fetuses with left‐sided cardiac defects. Chronic maternal hyperoxygenation (CMH) therapy leads to an improvement in fetal pulmonary blood flow resulting in an enhanced venous return to the left heart with increased gestational age. With this manipulation it is anticipated to augment blood flow directed remodeling of the left heart structures and to improve left heart growth spanning from the mitral valve to the aortic isthmus. However, there are concerns about CMH therapy with regard to fetal complications with growth restriction and fetal brain development. Now, with two successful cases we try to discuss this fetal treatment option and related concerns. [ABSTRACT FROM AUTHOR]

Background: The family of heat shock proteins (HSPs) contains several members that regulate the cell response to any hazardous factors to protect protein structure. Theaimof the studywasto determinewhetherserumlevels of HSPsincrease in children with IgA nephropathy/Immunoglobulin A - associated vasculitis nephritis (IgAN/IgAVN) and to assess their relationship with the prognostic factors. Patients and Methods: Twenty - nine patients with IgAN/IgAVN, 41 patients with idiopathic nephrotic syndrome (INS) as a patient control group, and 24 healthy controls were enrolled in the study. Renal function was normal in all participants. Serum levels of HSP27, HSP40, HSP60, HSP70, and HSP90 were measured using an enzyme - linked immunosorbent assay (ELISA). Results: Median serum levels of HSP27, HSP40, HSP60, HSP70 and HSP90 were significantly higher in the IgAN/IgAVN group than in the INS group and controls (P < 0.05). Among these HSPs, only HSP60 had no overlap between patients and controls. Serum HSP40, HSP60, HSP70 levels were significantly higher in the patients with INS than in controls (P< 0.05), whereas HSP27 and HSP90 were not different. HSP27 was significantly higher in patients with proteinuria in the IgAN/IgAVN group than in patients with no proteinuria (P = 0.045). None of these HSPs was related to the presence of crescent and severity of proteinuria in the IgAN/IgAVN group. Conclusions: Our results demonstrated that serum levels of HSP27, 40, 60, 70, 90 increased in the patients with IgAN/IgAVN considering HSPs might have a role in pathogenesis of the disease. Among these HSPs, HSP60 was a prominent marker because it had no overlap between patients and controls. Explaining the role of these HSPs in IgAN/IgAVN may pave the way for future treatment. [ABSTRACT FROM AUTHOR]

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 pre-eclampsia patients between 24 and 34 weeks gestation, 166 were diagnosed with mild pre-eclampsia and 324 were diagnosed with severe pre-eclampsia. Patients with complete data were divided into four groups as patients with no notch (n:58), a unilateral notch (n:93), bilateral notches (n:252) and double notches (n:39). Results: Bilateral and double notches were predictive of shorter follow-up times, adverse laboratory outcomes (mean 24 h proteinuria, AST, LDH levels) and HELLP syndrome, need for magnesium sulphate treatment, higher systolic and diastolic blood pressure. Conclusion: Bilateral notches and especially double notches represent progressive deterioration in the uterine artery and are predictive of adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 pre-eclampsia patients between 24 and 34 weeks gestation, 166 were diagnosed with mild pre-eclampsia and 324 were diagnosed with severe pre-eclampsia. Patients with complete fetal data were divided into four groups as patients with no notch (n:53), a unilateral notch (n:78), bilateral notches (n:219) and double notches (n:39). Results: Bilateral and double notches were predictive for prematurity, lower 1st minute Apgar scores, higher need for neonatal intensive care unit admission, and perinatal mortality. Conclusion: Double notches represent progressive deterioration in the uterine artery and are predictive of adverse fetal outcomes. [ABSTRACT FROM AUTHOR]

Background: Placenta percreta is a life-threatening condition that places patients at risk of massive bleeding. It necessitates very complicated surgery and can result in mortality. Caesarean hysterectomy is the accepted procedure worldwide; however, recent studies discussing conservative treatment with segmental resections have been published. Foetal extraction and segmental resection can be performed through the same incision (single uterine incision) or through two different incisions (double uterine incision). In this study, we aimed to evaluate the effectiveness and results of the double incision technique.Methods: Twenty-two patients with a diagnosis of placenta percreta who underwent conservative surgery were included. Segmental resection was performed via single incision in ten patients and double incision in twelve patients.Results: There was no difference between the patients who underwent segmental resection via single and double incision in terms of age, gravida, number of previous caesarean deliveries, gestational age at delivery, or rate of elective surgeries. The operation time, transfusion requirement, intensive care unit admission, total hospitalization and success of conservative surgery were comparable between the groups.Conclusions: Based on the outcomes of our study, double uterine incision allows for the safe extraction of the foetus during uterus-preserving surgery in patients with placenta percreta without worsening the results compared to single uterine incision.Trial Registration: NCT02702024 , Date of registration: February 26, 2016, retrospectively registered. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Outcomes of second-trimester pregnancy terminations in prior Cesarean section: comparing of two regimens," by A. Gedikbasi and colleuges are presented.

An abstract of the conference paper "Preeclampsia due to fetal nonimmune hydrops: mirror syndrome and review of literature," by A. Gedikbasi, K. Oztarhan and Z. Gunenc is presented.

Background The most frequent cause of cancer deaths throughout the world is breast cancer (BC). Therefore, preventing, diagnosing and treating BC has gained importance. S100 protein probably plays an important role in carcinogenesis, cancer development, and metastasis. In this study, we aimed at diagnostic and clinic-pathological importance of serum levels of S100A9 and S100A12 with known cytokine-like pro-inflammatory effects in BC. Material and method Serum samples were collected with BC and the control group consisting of healthy individuals. All the samples were analyzed with enzyme-linked immunosorbent assay for serum S100A9 and S100A12 levels before starting the systemic chemotherapy. Clinicopathological characteristics of BC and other blood parameters were compared in relation with serum S100A9 and S100A12 levels. Results While the serum S100A9 levels were found significantly higher as compared to healthy individuals (190.85 ± 32.29 and 92.72 ± 54, respectively) ( p = 0.001), it was observed that there were no differences in S100A12 (120.50 ± 15.78 and 112.21 ± 10.46, respectively) ( p = 0.056) levels. As regards the subgroup analysis in BC patients, no statistically significant results were found in body mass index (BMI), smoking, menopause status, histopathologic type, grade, and biological subtype of BC, tumor size, presence of lymph node metastases, lymphovascular invasion (LVI), perineural invasion (PNI) and stage. As regards the blood parameters and serum S100 A9, while only statistically significant results were found with anemia (209.05 ± 33.12 and 181.75 ± 28.21, respectively) ( p = 0.005), no statistically significant results were found with leukocytosis, thrombocytosis and tumor markers. Conclusion In this study, while we found the level of S100A9, which has a potential cytokine-like function in inflammation, significantly higher, we could not find any increase in S100A12 level. Therefore, it is possible that S100A9 can play a key role in inflammation-related BC. Despite of there are no significance relationship between S100A9 and S100A12 clinicopathological features of BC, the determination of S100A9 levels contributes to diagnosis the of BC patients. In future, we suggest that serum S100A9 is investigated as a diagnostic tool even the target marker in BC to suppress inflammation in treatment. [ABSTRACT FROM AUTHOR]

Purpose: Here we aimed to evaluate the incidence of obstetric anal sphincter injuries in spontaneous primigravid deliveries with mediolateral episiotomy beyond 36 gestational weeks. Methods: We performed a prospective, randomized controlled study including 201 primigravid women that delivered vaginally. Anal sphincter anatomy and integrity was evaluated before hospital discharge in all cases with transvaginal sonography (5-9 MHz) (Siemens Sonoline G50 and Voluson 730 Expert). The vaginal ultrasound probe is placed in the fourchette of the vaginal introitus to obtain the transverse section of the anal sphincter. Results: In the cases with sphincter defect, mean gestational week and second stage of labor were prolonged significantly ( p = 0.039 and p < 0.0001, respectively). The mean perineal body distance in cases with sphincter injury, as detected by sonography, 2.18 ± 0.33 cm, is compared to 2.31 ± 2.43 cm in cases without injury. There was a significant difference between the two groups ( p = 0.0142). Shoulder dystocia was significantly higher in cases with sphincter injury, compared to cases without injury ( p = 0.011). No clinical findings were reported in 11.5 % of cases (Sonography findings 1A∓, 1B∓) and 3.5 % of cases had clinical and sonographic findings (Sonography findings 2A∓, 2B∓). 'Occult tears' were considered as those cases not detected clinically, but detected by sonography (11.5 % of all cases). Two months after examination, a moderate incontinence (Wexner continence scale) was found in 71.5 % of cases with overt sphincter tear, which was significantly different to the non-overt sphincter tear group. Multiple logistic regression analyses for sphincter injuries identified prolonged second stage of labor and shoulder dystocia as two independent risk factors. Conclusion: Here, we found that only a portion of anal sphincter injuries can be detected after physical examination, with many of cases of 'occult tears' escaping notice. These cases of occult anal sphincter injury are detectable by sonography with transperineal use of a vaginal probe. Based on these findings, we propose that this technique is convenient for obstetric, gynecologic and proctologic evaluation of sphincter anatomy. [ABSTRACT FROM AUTHOR]

Objective: Alström syndrome (ALMS) is a rare autosomal recessive genetic disorder that is caused by homozygous or compound heterozygous mutation in the ALMS1 gene. Dilated cardiomyopathy (DCM) is one of the well-recognized features of the syndrome ranging from sudden-onset infantile DCM to adult-onset cardiomyopathy, sometimes of the restrictive hypertrophic form with a poor prognosis. We aimed to evaluate severe cardiomyopathy in Alström syndrome in infancy and display susceptible specific mutations of the disease, which may be linked to severe DCM. Secondarily we reviewed published mutations in ALMS1 with cardiomyopathies in the literature.Method: We represent new mutagenic alleles related to severe cardiomyopathy and cardiac outcome in this patient cohort. We evaluated echocardiographic studies of nine Turkish patients diagnosed with Alström syndrome (between 2014 and 2020, at age two weeks to twenty years). Thus, we examined the cardiac manifestations of a single-centre prospective series of nine children with specific ALMS mutations and multisystem involvement. All patients underwent genetic and biochemical testing, electrocardiograms, and echocardiographic imaging to evaluate systolic strain with speckle tracking.Results: Four of the patients died from cardiomyopathy. Three patients (including three of the four fatalities) with the same mutation (c.7911dupC [p.Asn2638Glnfs*24]) had cardiomyopathy with intra-familial variability in the severity of cardiomyopathy. Global longitudinal strain, a measure of systolic contractile function, was abnormal in all patients that can be measured.Conclusion: Cardiac function in ALMS patients with infantile cardiomyopathy appears to have different clinical spectrums depending on the mutagenic allele. The c.7911dupC (p. Asn2638Glnfs*24) mutation can be related to severe cardiomyopathy. Parents can be informed and consulted about the progression of severe cardiomyopathy in a child carrying this mutagenic allele. [ABSTRACT FROM AUTHOR]

We sought to compare maternal and neonatal risk factors in cases with previable premature rupture of membranes (pPPROM, between 14-24 weeks) for optimal counselling. Therefore, 192 pregnancies of 485 cases which met selection criteria and agreed to follow-up were retrospectively analysed. Mean gestational age at pPPROM was 20.45 weeks. Live births occurred in 171 cases, but 67 (39.2%) of them died in the neonatal period (neonatal death group) and 104 cases (60.8%) constituted surviving neonate group. Of the surviving neonates, 37 (33.7%) experienced at least one complication. Most seen maternal complications were chorioamnionitis (24.48%) and placental abruption (8.33%). Although amniotic fluid volume, length of pPPROM period, completing antibiotherapy and CRP values were significant, amniotic fluid volume and length of pPPROM showed also significance for multivariate regression analysis for maternal risk factors. Risk factors for birth were gestational age at pPPROM, gestational age at birth, new-born weight at birth, 1st and 5th minute Apgar scores, umbilical cord pH value and need for neonatal resuscitation. Furthermore, development of respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and retinopathy of premature were additional risk factors for neonate. Of them, gestational age at birth, new-born weight at birth, respiratory distress syndrome and retinopathy of prematurity were also significant in multivariate regression analysis. What is already known on this subject? Management of previable premature rupture of membranes is controversial and there is no definite consensus on the approach. The factor that best predicts neonatal survival is the gestational age at birth (Deutsch et al. 2010). What do the results of this study add? Appropriate counselling for pPPROM cases is important especially during antenatal period (maternal factors) and postpartum period (neonatal factors). Maternal infection risk is increased with an increased latency period of PPROM. As the gestational age at birth increases, the survival rate increases and neonatal complication rates decrease. Other important determinants of neonatal survival and well-being are the presence of oligo-anhydramnios and latency period of previable PPROM to delivery. What are the implications of these findings for clinical practice and/or further research? Counselling the patient with previable PPROM about pregnancy complications and paediatric outcome is challenging because of the small size, different gestational age ranges, and retrospective nature of the multiple studies on this subject. The most important feature of our study was the relatively high number of patients compared to other series. Thus, we can counsel pregnant women with PPROM prior to 24 weeks of gestation about the maternal antenatal factors and neonatal postnatal factors with related outcomes and help make an informed decision regarding termination or conservative follow-up. Nevertheless, there is a need for larger multicentric prospective studies to validate our data and to establish the prognosis of previable PPROM for both mother and foetus. [ABSTRACT FROM AUTHOR]

Placental mesenchymal dysplasia (PMD) is a rare placental abnormality characterised by placentomegaly and grape-like vesicles resembling partial mole by ultrasonography, but in contrast to partial mole can co-exist with a viable fetus. Although the karyotype is normal, the fetus is at increased risk for intrauterine growth restriction, intrauterine fetal demise or perinatal death and Beckwith-Wiedemann syndrome. Prenatal diagnosis is difficult and the final diagnosis is usually achieved by postpartum histological examination of the placenta. We present two recent cases of placental mesenchymal dysplasia with poor obstetric outcome. One fetus presented with reduced growth parameters, while the other fetus showed hepatosplenomegaly and early hydropic changes that appear to be associated with Beckwith-Wiedemann syndrome. In this report, the clinico-pathological features of two cases of PMD are discussed and the differentiation from a partial mole is highlighted. This study also supports the utility of cytogenetic ploidy analysis and p57KIP2 protein staining in the evaluation of pregnancies with PMD. [ABSTRACT FROM AUTHOR]

Objective: To compare cytogenetic data of first-trimester missed abortions in intracytoplasmic sperm injection (ICSI) for non-male factor-mediated and spontaneous pregnancies. Methods: Using karyotype analysis, we conducted a retrospective cohort trial of missed abortions following ICSI for non-male factor and spontaneous pregnancies. Patients experienced missed abortions during the first 12 weeks of pregnancy. Dilation and curettage procedure was performed followed by cytogenetic evaluations. Two patient groups were created: ICSI ( n = 71) and spontaneous pregnancies ( n = 81). At least 20 GTG-banded metaphases were analyzed in each case for cytogenetic analyses. Statistical analyses were performed using NCSS 2007 Statistical Program software. The significance level and confidence interval for all analyses were set to p < 0.05 and a 95% confidence interval, respectively. Results: A total of 49.3% (75/152) of the miscarriages were cytogenetically abnormal among the patients. We detected cytogenetically abnormalities in 47.9% (34/71) of the ICSI group and 50.6% (41/81) of the control group, which were not statistically significant differences (p=NS). The sex chromosome abnormalities were similar between the ICSI and control groups (p=NS). The most prevalent abnormalities that were observed in the ICSI and control groups with first-trimester pregnancy loss were trisomy ( n = 42; 27.6%), Turner syndrome (45, X0, n = 13; 8.6%), triploidy ( n = 13; 8.6%), 48 chromosomes ( n = 5; 3.3%), and mixed chromosomal abnormalities ( n = 3; 1.2%). In addition, the karyotypes were similar between the ICSI and control groups (p=NS). We observed increases in fetal aneuploidy rates with increased maternal age (<30 years = 23.9% vs. 31-34 years = 37.0% vs. 35-39 years = 82.9% vs. >39 years = 90.9%). However, the observed increases in fetal aneuploidy rates were not statistically significant (p=NS). Conclusion: The aneuploidy rates and sex chromosome anomalies following ICSI for non-male factor were similar to those following natural conception. [ABSTRACT FROM AUTHOR]

The matrix metalloproteinase-9 (MMP-9) and neutrophil gelatinase associated lipocalin (NGAL) are shown to increase in an inflammatory situation. Based on our previous reports that NGAL can be detected in the urine of children with urinary tract infection (UTI), we also asked whether MMP-9/NGAL complex could be detected in the urine of children with UTI. This multicenter, prospective study was conducted between October 2009 and October 2010. Seventy-one patients with symptomatic culture proven UTI, 37 asymptomatic children with contaminated urine and 37 healthy children were recruited. Mean uMMP-9/NGAL/Cr levels were significantly higher in the UTI group than in the control group ( p < 0.0001). According to ROC analysis, the optimal cut-off level was 0.08 ng/mg to predict UTI. Using a cut-off value, sensitivity and specificity were 98.6 and 97.3%, respectively. The mean levels of uMMP-9/NGAL/cr in the UTI group were also significantly higher than those in the contamination group ( p < 0.0001). There was no statistically significant difference between contamination group and the control group ( p = 0.21). The mean uMMP-9/NGAL/Cr in the UTI group were significantly higher before treatment than after treatment ( p < 0.0001). The area under the curve was 0.997 (SE: 0.002, 95% CI: 0.993 to 1.001) for uMMP-9/NGAL/Cr. Urinary MMP-9/NGAL/Cr level was also correlated with positive urine nitrite test, positive urine leukocyte esterase reaction and renal scarring ( p = 0.0001, p = 0.0001, p = 0.04, respectively) whereas was not correlated to leukocytosis and positive CRP level in serum. Urine MMP-9/NGAL/cr can be used as a diagnostic biomarker for UTI in children. Identification of NGAL-MMP-9/cr levels in the urine of suspected UTI patients may also be useful to differentiate between contamination and infection and for monitoring of treatment response in children. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women. Methods: Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS. Results: Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively. Conclusions: As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the serum adiponectin levels together with metabolic and hormonal parameters among teenage girls at the early onset of polycystic ovary syndrome (PCOS) and hyperandrogenism with controls. Design: Prospective study. Settings: Education and research hospital, outpatient gynecological endocrinology clinic. Participants: Four hundred seventy-nine teenage girls from a school of nursing were interviewed for the signs and symptoms of PCOS. Among them, 42 cases who had a definitive diagnosis of PCOS with hyperandrogenism based on Rotterdam diagnostic criteria were recruited for the study and other causes of hyperandrogenemia had been excluded. The controls were recruited from regularly cycling healthy teenage girls from the same high school of nursing; none of those who agreed to join the study met any of the diagnostic criteria for PCOS (n = 44). Interventions: Cases were selected as group I: PCOS with body mass index (BMI) <25 kg/m2 (n = 20), group II: PCOS with BMI >25 kg/m2 (n = 22), group III: Controls with BMI <25 kg/m2 (n = 21) and group IV: Controls with BMI >25 kg/m2 (n = 23). Serum adiponectin, metabolic and hormonal parameters were compared in PCOS patients with BMI matched controls. Main Outcome Measures: Difference of serum adiponectin levels, metabolic and hormonal parameters between teenage girls with PCOS and controls. Results: Serum adiponectin levels were not significantly different in group I and group II. Serum adiponectin levels were significantly decreased in group I and group II compared with both control groups (III and IV). Conclusion: Serum adiponectin levels were lower in teenage girls with PCOS and this reduction was independent from BMI. [Copyright &y& Elsevier]

We aimed to compare the accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) for uterine pathologies among infertile women. A total of 346 patients were selected for operative hysteroscopy, following SIS after TVS. SİS was performed with a Cook Soft 500 IVF catheter. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated to compare the accuracy of TVS, SIS and hysteroscopy for uterine abnormalities. SIS showed a sensitivity of 87%, specificity of 100% and PPV of 100% for endometrial hyperplasia, and a sensitivity and NPV of 100% for polypoid lesions. For submucosal myoma SIS showed a sensitivity of 99% with PPV of 96%. Hysteroscopy had a sensitivity, specificity, PPV and NPV of 98%, 83%, 96% and 91%, respectively for overall uterine pathologies. Finally, SIS seems to be superior to TVS, for uterine pathologies, with respect to hysteroscopy as the gold standard. [ABSTRACT FROM AUTHOR]

Macrophage migration inhibitory factor (MIF) plays an essential pathophysiological role in inflammatory reactions. The aim of this study was to investigate the clinical utility of urine MIF (uMIF) level in predicting urinary tract infections (UTI). This multicenter, prospective study was conducted over a 1-year period between March 2008 and March 2009. Sixty patients with symptomatic culture-proven UTI and 29 healthy children were recruited. Urine MIF was measured by enzyme-linked immunosorbent assay. The mean MIF level was found to be significantly higher in the UTI group than in the control group (1082.82 vs. 211.45 pg/ml, p = 0.0001). Receiver operating characteristic (ROC) analysis revealed that the optimal cut-off uMIF level was 295 pg/ml for uMIF to predict UTI. The sensitivity and specificity of this cut-off level were 91.7% and 69%, respectively. Mean uMIF/creatinine (Cr) was also significantly higher in the UTI group than in the control group (2400.69 vs. 267.56 pg/mgCr, p = 0.0001). At a cut-off of 815 pg/mgCr for uMIF/Cr, the sensitivity and specificity were 95 and 79%, respectively. The area under curve (AUC) was 0.848 (standard error 0.040, 95% confidence interval 0.756–0.915) for uMIF and 0.889 (0.034, 0.805–0.946) for uMIF/Cr. Urine MIF/Cr was significantly higher in the patients with a positive leukocyte esterase reaction in the urine ( p = 0.047), leukocytosis ( p = 0.0001) and positive C-reactive protein level in serum ( p = 0.003). The uMIF level was not related to leukocytosis, positive CRP level in serum and leukocyte esterase reaction in the urine. Neither uMIF nor uMIF/Cr were correlated to the positive urine nitrite test, pyuria, urine pH and specific gravity ( p > 0.05). These results suggest that urine MIF and uMIF/Cr can be used for the early prediction of UTI in children. [ABSTRACT FROM AUTHOR]

Background Vasectomy is well accepted in some countries, but uncommonly used in others. The failure of family planning programmes may be the result of men failing to play a role in contraception. This study was carried out to determine the attitudes of women and men regarding male and female sterilisation. Study design Women of reproductive age (17-35 years old; n = 1211) and their husbands (n = 1174) were enrolled in this study. Information was collected from the participants via face-to-face interviews using a questionnaire. Results In our study, 61.4% of women would agree to their husbands' undergoing a vasectomy but only 3.7% of husbands agreed to it. Most (92.7%) men said they would agree to their wives' undergoing a sterilisation and 83.1% of women would agree to tubal occlusion. Only 2% knew anyone who had been sterilised. Nearly a fifth of women thought vasectomy could lead to impotence. Conclusion The prejudices against vasectomy are probably due to misinformation. Female sterilisation, however, is widely accepted by both participants. Family planning programmes organised equally for women and men, supported also by mass media could improve access to convenient and effective contraception. [ABSTRACT FROM AUTHOR]