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Kose E.A.,Kirikkale University | Kose E.A.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Honca M.,Kecioren Teaching and Medical Research Hospital | Dal D.,Marmara University | And 2 more authors.
Journal of Clinical Anesthesia | Year: 2013

AbstractStudy Objective To compare the efficacy and safety of ketamine 0.25 mg/kg with ketamine 0.5 mg/kg to prevent shivering in patients undergoing Cesarean delivery. Design Prospective, randomized, double-blinded, placebo-controlled study. Setting Operating rooms and postoperative recovery rooms. Patients 120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia. Measurements Patient characteristics, anesthetic and surgical details, Apgar scores at 1 and 5 minutes, and side effects of the study drugs were recorded. Heart rate, mean arterial pressure, oxygen saturation via pulse oximetry, tympanic temperature, severity of shivering, and degree of sedation were recorded before intrathecal injection and thereafter every 5 minutes. Patients were randomized to three groups: saline (Group C, n=30), intravenous (IV) ketamine 0.25 mg/kg (Group K-0.25, n=30), or IV ketamine 0.5 mg/kg (Group K-0.5, n=30). Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective. Main Results The number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C (P = 0.001, P = 0.001, respectively). The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group. Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10, 20, 30, and 40 minutes after spinal anesthesia. Conclusions Prophylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia. © 2013 Elsevier Inc.

Bingol B.,Istanbul Science University | Abike F.,Medicana International Ankara Hospital | Gedikbasi A.,Istanbul Bakirkoy Maternity and Children Diseases Hospital | Tapisiz O.L.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Gunenc Z.,Istanbul Alman Hospital
Journal of Assisted Reproduction and Genetics | Year: 2012

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. © 2011 LSpringer Science+Business Media, LLC.

Dundar B.,Bursa Yuksek Ihtisas Education and Research Hospital | Dilbaz B.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Karadag B.,Ankara Teaching and Research Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2016

Objective: A wide spectrum of emotions are experienced during abortion, including anxiety, sadness and grief, guilt, pessimism about future pregnancies, disturbed self-perception and loss of confidence in intimate relationships. This study aimed to compare the short-term effects of legal voluntary termination of pregnancy with uterine evacuation for medical reasons on female sexual function. Study design: The study group was comprised of 50 patients admitted to the Family Planning Clinic for legal voluntary termination of pregnancy <10 weeks of gestation, and the control group was comprised of 50 patients who underwent manual vacuum aspiration of the products of conception for medical reasons (e.g. inevitable abortion, incomplete abortion, fetal abnormality and teratogenic drug use). Female sexual function in the two groups was evaluated using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). GRISS scores immediately before and 3 months after termination of pregnancy were compared within each group and between the two groups. Results: Mean total GRISS scores before and after termination of pregnancy were 5.33 and 8.12 in the study group, and 6.02 and 6.4 in the control group, respectively (p < 0.05). The increase in GRISS scores for both groups indicated deterioration in sexual function (p = 0.000 and p = 0.016, respectively). Three months after termination of pregnancy, the total GRISS score was significantly higher in the study group compared with the control group (8.12 vs 6.4, p < 0.05). Conclusion: Female sexual dysfunction is a complicated concept that is affected by multiple factors over a woman's lifetime. It is important to consider female sexual function as a part of reproductive health, with a close relationship with contraception. As such, patients should receive counselling about sexual function and contraception as part of comprehensive abortion care. © 2016 Elsevier Ireland Ltd. All rights reserved.

PubMed | Etlik Zubeyde Hanim Womens Health Education and Research Hospital, Ulucanlar Eye Research and Training Hospital and Ankara Numune Training and Research Hospital
Type: | Journal: International ophthalmology | Year: 2016

The purpose of the study is to assess the changes in the long-term effects of prostaglandin analogues (PGAs) on intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). Data of POAG patients treated with latanoprost (0.005%), travoprost (0.004%), or bimatoprost (0.03%) as the first line treatment for 5years or more were retrospectively evaluated. Baseline ophthalmic assessment values were recorded together with the IOP at the 6th month, 1st year, and then annually. The 79 patients included 33 (41.8%) men and 46 (58.2%) women. There were 34 (43.0%) patients using latanoprost (0.005%), 23 (29.1%) patients using bimatoprost (0.03%), and 22 (27.8%) patients using travoprost (0.004%). There was no difference between the groups in terms of age, gender, or baseline IOP levels. IOP levels at the 6th month were significantly lower than baseline IOP levels in all groups (p<0.01, Friedman test). The IOP decrease was maintained after the 6th month in all three group with no statistically significant difference compared to the 6th month IOP value (p>0.05, Friedman test) and no statistically significant difference between the groups during follow-up (Kruskal-Wallis test, p>0.05). IOP reductions with PGAs were adequate and stable in the 5-year follow-up period with no decrease in effectiveness over time.

PubMed | Etlik Zubeyde Hanim Womens Health Education and Research Hospital, Silopi State Hospital, Food Republic and Ankara Education and Research Hospital
Type: Journal Article | Journal: Taiwanese journal of obstetrics & gynecology | Year: 2016

Endometriosis is a chronic inflammatory disease pathologically defined as the presence of endometrial-like tissue outside the uterine cavity. It is one of the most important diseases affecting women of reproductive age. The process of endometriotic implant growth is mediated by many complex interactions of immunologic, hormonal, genetic, and environmental mediators. Vitamin C (ascorbic acid), besides playing a role in preventing invasion and metastasis, is an antioxidant having anti-inflammatory and -angiogenic effects. In this study, we aimed to investigate the effect of vitamin C on the prevention and regression of endometriotic implants in a rat model of endometriosis.This was a prospective, comparative, experimental animal study. After endometriotic implants were induced simultaneously, rats were divided into three groups. Group A was given 500mg/kg of intravenous vitamin C every 2days, starting immediately after implantation (n=11). All rats had a second operation 21days after the initial one and had the lesion volumes measured. Group B was given 500mg/kg of intravenous vitamin C every 2days, starting 21days after this operation (n=11). All rats were sacrificed 21days after the third operation. Implant volume, weight measurements, and histopathological evaluation of the lesions were carried out. Group A received vitamin C throughout the study, while Group C (n=11) was not given any medication. The findings in the three groups were compared.At the second laparotomy after the induction, Group A had the smallest implant volume with a statistically significant difference compared to Group B (p=0.012). The end-of-study volumes of endometriotic implants of group B were significantly smaller than the first volumes (p<0.05).Intravenous vitamin C treatment might have a suppressive effect on the prevention of endometriotic implant induction and regression of endometriotic implant volumes.

Sengul O.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Ferah I.,Atatürk University | Polat B.,Atatürk University | Halici Z.,Atatürk University | And 4 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2013

Objective: To investigate the role of endothelin receptors in ovarian ischaemia/reperfusion (I/R) injury in rats using the endothelin receptor antagonist bosentan. Study design: Group 1: sham operation; Group 2: sham operation and bosentan 60 mg/kg; Group 3: bilateral ovarian ischaemia; Group 4: 3-h period of ischaemia followed by 3 h of reperfusion; Groups 5 and 6: bosentan 30 and 60 mg/kg, respectively, with bilateral ovarian ischaemia applied 30 min later; the bilateral ovaries were removed after 3 h of ischaemia; Groups 7 and 8: 3 h of bilateral ovarian ischaemia was applied, with bosentan 30 and 60 mg/kg, respectively, administered 2.5 h after the induction of ischaemia; following the 3-h period of ischaemia, 3 h of reperfusion was applied, after which the ovaries were removed. Results: Ischaemia and I/R decreased superoxide dismutase (SOD)activity and the level of glutathione (GSH) in ovarian tissue, but increased the level of malondialdehyde (MDA) significantly compared with the sham operation group. Bosentan 30 and 60 mg/kg before ischaemia and I/R decreased the MDA level and increased SOD activity and the GSH level in the experimental groups. The serum levels of the inflammatory cytokines interleukin (IL)-1β, IL-6 and tumour necrosis factor-α were also measured in the I/R injury model in rat ovaries. The levels of these cytokines were significantly higher in the ischaemia and I/R groups compared with the sham operation and sham operation plus bosentan groups. The histopathological findings also demonstrated the protective role of bosentan against I/R-induced injury in rat ovaries. Conclusion: Administration of bosentan protects the ovaries against oxidative damage and I/R-induced injury. Crown Copyright © 2013 Published by Elsevier Ireland Ltd. All rights reserved.

Kahyaoglu I.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Kayikcioglu F.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Kinay T.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Mollamahmutoglu L.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital
Journal of Obstetrics and Gynaecology Research | Year: 2014

Aim The aim of this study was to evaluate the relation between abdominal scar characteristics and the severity of intra-abdominal adhesions with repeat cesarean deliveries. Methods A total of 208 women with at least one previous cesarean delivery at or beyond 37 weeks of gestation who were admitted for repeat cesarean delivery were enrolled in this study. Scars were categorized as depressed, flat or elevated according to their appearance, and hyperpigmented or the same color as the surrounding skin according to their pigmentation status. Intraoperative adhesions were graded according to the modified Nair's classification and categorized as no adhesion, filmy or dense adhesions. Results No significant difference was found between women with or without adhesions regarding age, body mass index, gestational week at delivery, number of previous cesarean deliveries or the duration since the last cesarean delivery. Women with depressed scars had more intra-abdominal adhesions than women with flat or elevated abdominal scars (P = 0.013). There was no significant difference in the incidence of hyperpigmented and non-pigmented scars between women with or without adhesions (39.4% vs 41.3% and 60.6% vs 58.7%, respectively) (P > 0.05). Scar width was significantly larger in patients with intra-abdominal adhesions than in patients without adhesions (3.6 ± 1.1 vs 3.2 ± 0.9) (P = 0.003), whereas scar length did not differ significantly (15.2 ± 1.3 vs 15.1 ± 2.1) (P > 0.005). Conclusion There is a relation between depressed abdominal scars and intra-abdominal adhesions, whereas pigmentation status does not differ between women with or without adhesions. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Ensari T.A.,Etlik Zubeyde Hanim Womens Health Education and Research Hospital | Pal L.,Yale University
Current Opinion in Endocrinology, Diabetes and Obesity | Year: 2015

Purpose of review: Menopause management has undergone an eventful journey over the past decade; some dogmas got refuted, some new hypotheses took life, and the review is timely and relevant to the practice of clinical medicine in 2015. Recent findings: The field stepped out of an era of absolutes into times of patient centeredness and an individualized perspective. Summary: The onus now is to tailor management to address patient's needs while keeping in perspective individualized symptom burden and risks that may be unique to each aging woman. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

PubMed | Etlik Zubeyde Hanim Womens Health Education and Research Hospital and Ankara University
Type: Journal Article | Journal: The journal of sexual medicine | Year: 2017

Erectile dysfunction (ED) worsens in men with diabetes. Human umbilical cord blood (HUCB), because of its widespread availability and low immunogenicity, is a valuable source for stem cell-based therapies.To determine the effect of intracavernous injection of HUCB mononuclear cells (MNCs) on ED in rats with diabetes induced by streptozotocin.Thirty adult male Sprague-Dawley rats were equally divided into three groups: (i) control, (ii) diabetes induced by streptozotocin (35 mg/kg intravenously for 8 weeks), and (iii) diabetic rats treated with MNCs (110The ratio of intracavernosal pressure to mean arterial pressure ratio; the protein expression of endothelial and neuronal markers, such as von Willebrand factor, neuronal nitric oxide synthase, hypoxia-inducible factor-1, and vascular endothelium growth factor; and the relative area of smooth muscle to collagen using western blotting and Masson trichrome staining were determined.Diabetic rats demonstrated a significantly decreased ratio of intracavernosal pressure to mean arterial pressure (0.26 0.04; P < .01) and treatment with MNCs restored erectile function in diabetic rats (0.67 0.05) compared with control rats (0.56 0.02). In bath studies, neurogenic relaxant and contractile responses were significantly decreased in diabetic cavernosal tissues, which were restored by treatment. The ratio of smooth muscle to collagen was partly recovered by treatment, whereas von Willebrand factor levels were not altered in any group. Neuronal nitric oxide synthase and vascular endothelium growth factor levels were decreased, which were not restored by treatment. Increased hypoxia-inducible factor-1 protein expression in the diabetic group was completely normalized in MNC-treated diabetic samples.These results suggest that HUCB-MNC treatment can enhance the recovery of erectile function and promote numerous activities such the contribution of the hypoxia-inducible factor-1 and von Willebrand factor pathway to the neurogenic erectile response of diabetic rats. HUCB-MNCs in the healing process could involve an adaptive regenerative response and appear to be a potential candidate for cell-based therapy in ED of men with diabetes. It is evident that HUCB could provide a realistic therapeutic modality for the treatment of diabetic ED.

PubMed | Etlik Zubeyde Hanim Womens Health Education and Research Hospital
Type: Journal Article | Journal: The journal of obstetrics and gynaecology research | Year: 2016

Our aim was to evaluate the obstetric outcomes of isolated oligohydramnios during the early-term, full-term, and late-term periods, and to determine the optimal timing of delivery.A retrospective study was performed at a tertiary center. Isolated oligohydramnios cases were divided into early-term, full-term, and late-term groups. Evaluated outcomes were fetal birthweight, 5-min Apgar score<7, meconium-stained amniotic fluid, neonatal intensive care unit admission, transient tachypnea of newborn (TTN), requirement of ventilator, newborn jaundice, mode of delivery, induction of labor, and undiagnosed small-for-gestational-age fetus before delivery. Composite outcome was defined as perinatal outcomes taken together (neonatal intensive care unit admission, TTN, requirement of ventilator, and newborn jaundice).The study period included 1213 cases of term isolated oligohydramnios. Within this cohort there were 347 early-term, 781 full-term and 85 late-term patients. The cesarean rate and the rate of newborn jaundice were higher in early-term cases (37.8% and 3.5%, respectively) than in full-term cases (30.1% and 0.9%, respectively). Meconium-stained amniotic fluid was higher in late-term than full-term cases. Timing of delivery did not affect occurrence of TTN, 5-min Apgar score<7, ventilator requirement, or composite outcome. In total, 15-17% of isolated oligohydramnios cases involved undetected small-for-gestational-age fetuses.As this study was not a randomized controlled trial, a decisive conclusion may not be possible. However, until well-designed controlled studies are conducted, expectant management may be appropriate up to the full-term period and induction of labor may be appropriate management when the full-term period is reached.

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