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Öğe Cytomegalovirus (CMV) screening results in pregnant women admitted to a tertiary center in the Middle Anatolia(Refik Saydam National Public Health Agency (RSNPHA), 2019) Kan, Özgür; Koçak, ÖzgürObjective: Human cytomegalovirus (CMV) is a common cause of mother-to-child infection that may lead to severe long-term sequelae in affected infants and is the most common non-genetic cause of hearing loss. CMV prevalence is reported to be higher in developing countries and seroprevalence varies between countries and even regions. The aim of this study was to evaluate the seroprevalence of CMV in pregnant women who applied to regional reference hospital and to investigate the efficacy of antenatal CMV screening. Methods: A total of 3362 patients admitted to a university hospital pregnant outpatient clinic between January 2016 and September 2018 were included in the study. After serological examination, avidity test was performed in cases with results suggestive of active infection. Amniocentesis was recommended to patients with low avidity and these patients were evaluated by Polymerase Chain Reaction (PCR) method. Results: The frequency of CMV immunglobulin (Ig) G and M seropositivity rates were 96.40% and 1.75%, respectively. According to avidity test results of patients with CMV infection; low, intermediate and high avidity levels were found in 10 (20.83%), 3(6.25%) and 35 (72.91%) patients, respectively. PCR analysis results showed primary infection in 3 of the cases with low avidity. Only one infant had signs of congenital CMV infection at the time of birth. Conclusion: Although routine CMV screening in pregnancy is not recommended due to lack of adequate studies on the validity of treatment and costeffectiveness, serological examination may be beneficial especially in risky groups in developing countries. Further studies on vaccination and anti-viral therapy may provide more comprehensive information about the necessity and efficacy of screening.Öğe Efficacy of striae gravidarum extension and localization on predicting intraperitoneal adhesion risk(Wiley, 2019) Kan, Özgür; Görkem, Ümit; Alkılıç, Ayşegül; Çetin, MustafaAim To evaluate the diagnostic value of striae gravidarum (SG) presence and localization in predicting the intraperitoneal adhesion (IPA) risk in pregnant women with a history of at least one previous cesarean delivery (CD). Methods A total of 100 pregnant women with repeated CD were included in this prospective observational study. Patients were divided into three groups according to severity of SG with Davey scoring system. Intraoperative adhesion severity and extension were evaluated by using Nair classification system. Moreover, operation duration and neonatal outcomes were analyzed. Results Demographic features were comparable between the groups. Adhesion scores were significantly higher in mild and severe SG groups (for mild SG: 1.93 +/- 0.99, for severe SG: 2.81 +/- 0.88 and for no SG: 1.4 +/- 0.57; P < 0.001). Analysis revealed a positive correlation between IPA and severity of SG (P < 0.001). There was a correlation between increased striae density and adhesion severity especially in the right and left upper quadrants of the abdomen (for right quadrant: r = 0.515, P < 0.001; for left quadrant: r = 0.359, P = 0.005). Conclusion Our results suggest that preoperative evaluation of SG severity and extend particularly in upper quadrants is a feasible option to predict IPA risk in patients with repeated CD.Öğe Evaluation of the frequency of human papillomavirus (HPV) in women admitted to cancer early diagnosis and screening training centers (KETEM) and analysis of HPV genotypes(Refik Saydam National Public Health Agency (RSNPHA), 2019) Kan, Özgür; Görkem, Ümit; Barış, Ahmet; Koçak, Özgür; Toğrul, Cihan; Yıldırım, EnginObjective: CCervical cancer is one of the most common gynecologic cancers among women in Turkey. Human papillomavirus genotypes (HPV) are strongly associated with cervical malignancies, and the distribution of HPV genotypes varies regionally. Data on prevalence are limited due to the lack of population based epidemiological studies on HPV distribution. The purpose of the study was to assess HPV positivity rates, detect high- risk HPV types in Corum and obtain HPV mapping of Turkey. Methods: A total of 33.649 patients who applied to Cancer Early Diagnosis, Screening and Training Centers (KETEM) between August 2014 and January 2018 were included in this study. Prior to the study, permission was obtained from the ethics committee of the university. Cervical swab samples were collected for HPV-DNA examination and polymeraze chain reaction (PCR) method used to detect HPV DNA. Genotyping was performed in HPV DNA positive samples. In addition, cytologic examination results were also recorded in patients with HPV positives. Results: HPV DNA positivity was found in 3.29% of the patients. HPV DNA was positive in 1108 cases, The highest risk subtypes for cervical cancer, Type 16 and 18, were 14.69% and 1.17%, respectively. When cytological results of HPV DNA positive women were examined; 66.52% of the patients had no precancerous lesion and infection-related cytology results were observed in 41.34% of these patients. The most frequent cytologic abnormal result was LGSIL with 8.21%. Conclusion: HPV typing studies are increasingly important in cervical cancer screening. Considering the regional differences and the heterogeneity of the studies, the results of the Ministry of Health's screening program in 2019 will guide the assessment of the prevalence. By mapping HPV genotypes and evaluating advanced data across all country, appropriate vaccination and prevention policies can be developed. © 2019, Refik Saydam National Public Health Agency (RSNPHA).Öğe Geçirilmiş Sezaryen Olgularında Skar Özelliklerinin İntraperitoneal Adezyonlar İle İlişkisi(2019) Kan, Özgür; Aykılıç, AyşegülAmaç: Sezaryen ile doğum oranlarının artması adezyon formasyonu ilişkili komplikasyonlarda artıa neden olmaktadır. Morbidite ve mortalite ilişkili bu komplikasyonları preoperati öngörebilmek, perinatal sonuç- larda belirgin iyileşme sağlayabilir. Çalışmanın amacı geçirilmiş sezaryen öyküsü olan olgularda skar özellikleri ile intraperitoneal adezyonlar arasındaki ilişkinin değerlendirilmesidir. Materyal ve metot: Prospekti olarak planlanan bu çalışmaya, üniversite hastanesinde, geçirilmiş sezaryen endikasyonu ile elekti sezaryen ile doğum yapacak ve dahil edilme kriterlerini karşılayan toplam 101 hasta dahil edilmişti. Sezaryen skar özellikleri (pigmentasyon, cilt ile ilişkisi) preoperati not edilmişti. Takiben intraperitoneal adezyon varlığına göre hastalar iki gruba ayrılmış ve perinatal sonuçlar değerlendirilmişti. Bulgular: Gruplar arasında yaş, vücut kitle indeksi (VKİ) ve gravida sayıları anlamlı fark izlenmemişti (p?0.05). İntraperitoneal adezyon olan hastalarda hiperpigmente skar varlığı anlamlı olarak daha yüksek bulunmuştur (%43 vs %15, p?l0.001). Çevre cilt ile skar ilişkisi eleve, aynı düzlemde ve deprese olarak sınıflandırıldığında, gruplar arasında skar yüksekliği açısından fark saptanmamıştı (p=0.21). Sonuç: Skar özelliklerinin değerlendirilmesi, sezaryen sonrası bağ doku iyileşmesini prati ve objekti şekilde yansıtabilir. Ek olarak, bağ dokusu iyileşmesinin başka bir sonucu olan adezyon formasyonu gelişimini öngörmede etkili olabileceği düşünülmektedir. Özellikle pigmentasyon artıının preoperati değerlendirilmesi ile batı içi yapışıklıklar hakkında bilgi sahibi olunabilir.Öğe Impact of anxiety levels on difficulty of intrauterine insemination and treatment outcomes(Wiley, 2020) Kan, Özgür; Görkem, Ümit; Başer, Emre; Alkılıç, AyşegülAim The objective of this study was to determine the effect of anxiety on intrauterine insemination (IUI) results in couples with unexplained infertility. Second, the relationship between difficulty level of IUI procedure and anxiety were investigated. Methods A total of 100 women undergoing first IUI treatment were enrolled into this prospective cross-sectional study. Participants were asked to complete the Beck Anxiety Inventory (BAI) before the IUI procedure and classified into two groups according to the anxiety score (minimal anxiety; BAI score <8,n= 73 and mild-to-moderate anxiety; BAI score >= 8,n= 27). Cervical condition was evaluated with speculum and presence of congenital anomalies, extensive leucorrhea or polypoid lesions were classified as unfavorable cervix. All of the patients were evaluated for difficulty of IUI and asked to state the severity of their pain with a visual analog scale after the procedure. Clinical pregnancy rates were also analyzed. Results There was no statistically significant difference between the groups in terms of pregnancy rates (12.3% vs 14.8%,P= 0.743). visual analog scale score was significantly higher in mild-to-moderate anxiety group (P= 0.002). Anxiety levels were higher in patients with difficult IUI (10.5 vs 4.3,P < 0.001). In multivariate analysis, higher BAI scores (odds ratio: 1.1, 95% confidence interval: 1.0-1.2,P= 0.01) and unfavorable cervical condition (odds ratio: 3.6, 95% confidence interval: 1.2-10.7,P= 0.01) emerged as independent predictors for difficulty of IUI. Conclusion Evaluation of anxiety before IUI might help to predict difficulty of IUI and related pain. Although anxiety increases the difficulty of IUI, it does not affect pregnancy outcomes of the treatment.Öğe Is the Concentration of Cadmium, Lead, Mercury, and Selenium Related to Preterm Birth?(Humana Press Inc., 2019) Yıldırım, Engin; Derici, Mehmet Kürşat; Demir, Emre; Apaydın, Hakan; Koçak, Özgür; Kan, Özgür; Görkem, ÜmitEnvironmental pollution and exposure of people to heavy metals cause many bad obstetric outcomes. Our aim is to demonstrate the role of cadmium (Cd), lead (Pb), mercury (Hg), and selenium (Se) in preterm labor etiology with a case-control study. In this study, between November 2017 and April 2018, preterm delivery mothers and term delivery mothers were compared in Çorum, Turkey. All deliveries were performed with cesarean sections and there were 30 mothers in the control group and 20 in the study group. The maternal blood, maternal urine, umbilical cord blood, and heavy metal levels in the amnion fluid in both groups were studied. Graphite furnace atomic absorption spectrometry was used to determine the blood concentration of Cd, Pb, Hg, and Se. We found lower levels of selenium in blood and urine of preterm delivery mothers and umbilical cord and amnion fluids of preterm infants (p < 0.01). We found a statistically significant positive correlation at selenium levels between mother’s blood and umbilical cord blood (r (50) = 0.896, p < 0.001) and between maternal urine and amniotic fluid (r (50) = 0.841, p < 0.001). We have not found a similar correlation between mother and fetus of other metals (p > 0.05). We found that selenium levels were lower in mothers who were preterm birth in the light of the data in our study. We could not determine the positive or negative correlation of Cd, Pb, and Hg levels in blood, urine, and amniotic fluid samples with preterm birth. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.Öğe Kisspeptin and hematologic parameters as predictive biomarkers for first-trimester abortions(Logos Medical Publishing, 2021) Görkem, Ümit; Kan, Özgür; Bostancı, Mehmet Ömer; Taşkıran, Deniz; İnal, Hasan AliObjective: Spontaneous abortion is the most common complication of early pregnancy, affecting up to 20% of recognized pregnancies. Kisspeptin is predominantly released by placental syncytiotrophoblasts, and regulates their placental invasion into the uterine matrices. We aimed to establish an association of serum kisspeptin levels with pregnancy outcomes during the early gestational stage of the first trimester. Method: In this prospective study, 90 pregnant women in their 7 to 8 6/7 gestational weeks were classified into three groups: (i) The control group, consisting of healthy pregnant women (n=30), (ii) the threatened abortion group (n=30), and (iii) the spontaneous abortion group (n=30). The maternal serum samples were analyzed for complete blood count parameters and kisspeptin levels. Results: There was no statistical difference regarding body mass index (BMI) and gestational age (p=0.370). Regarding detailed obstetric notations, including gravida, parity, abortion, and living children, socioeconomic levels, and employment rates, all study groups were comparable (p>0.05, for all). No significant association was found regarding the biochemical parameters of complete blood count, including neutrophil, lymphocyte, and platelet concentrations, as well as neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) (p>0.05, for all). The median serum kisspeptin levels of the study groups did not differ between the groups (p=0.153). Correlation analysis revealed no significant relationship between serum kisspeptin levels and other study parameters in any study groups (p>0.05, for all) Conclusions: We found no statistically significant relationship between serum kisspeptin concentrations and pregnancy outcomes in the early gestational stage of the first trimester, and serum kisspeptin concentrations did not seem to be a reliable marker to distinguish abortion status from viable pregnancy. © Istanbul Medeniyet University Faculty of Medicine.Öğe Recurrent Case of a Rare and Devastating Entity: Harlequin Ichthyosis(2019) Alkılıç, Ayşegül; Kan, Özgür; Aydın, Elif Nazlı ÇetindağHarlequin ichthyosis (HI) is a rare and severe form of congenital ichthyosis caused by truncating mutations in the ABCA12 gene. Although it has many distinctive signs on perinatal sonography such as short limbs, wide gaping mouth, joint contractures, edema of the hands and feet and cloudy amniotic fluids, it usually can not be diagnosed until birth. Herein, we report a case of recurrent HI, which remained undiagnosed until labor at 38 weeks of gestational age. A multiparous woman presented to hospital at 38th weeks of gestation. There were no personal or family history. Vaginal delivery was performed and a 3300 gram baby was delivered. The body of the neonate was covered with thick, armor like skin, have generalized edema and erythematous fissures, scanty hair, everted eyelids with exposed swollen conjunctiva, open mouth were noted at the first examination. Newborn was diagnosed to be having Harlequin ichthyosis and was given to neonatal intensive care unit (NICU) for supportive care and additional examination. Genetic counseling is important and should be recommended to affected families. With the growing technology electron microscopes, invasive prenatal diagnostic tools and 3D sonography may reveal suggestive features of the disease. In addition, new treatment regimens, experienced and competent NICU facilities may increase survival rates.Öğe Results of the Toxoplasmosis Screening in 9311 Pregnant Women in a Tertiary Center in Turkey(2020) Koçak, Özgür; Kan, ÖzgürIntroduction: Toxoplasma gondii is an important parasite that can cause permanent sequelae to the fetus when infected during pregnancy in humans. Although the frequency of this parasite varies widely between countries, it is known that it is common in our country. The aim of this study was to determine the seroprevalence of toxoplasma in pregnant women admitted to a tertiary hospital in central Anatolia and to evaluate the pregnancy outcomes together with seroprevalence. Materials and Methods: A total of 9311 patients admitted to a tertiary hospital between January 2016 and December 2018 were included into the study. After serological examination, avidity test was performed in cases suggestive of acute infection. Amniocentesis was recommended to be performed by Polimeraze Chain Reaction (PCR) in patients with low avidity. Results: The frequency of Toxoplasma immunoglobulin (Ig) G and M seropositivity rates were 20.3% and 0.28%, respectively. Low avidity was found in approximately 27% of the patients with IgM positivity, and only 15.4% had low avidity by confirmatory test. One patient could not be reached during follow-up. PCR was performed in 4 patients whose low avidity value was confirmed by re-tests and all of their PCR results were reported negative. No cases of congenital toxoplasmosis were detected during the 3 years in our clinic. Conclusion: The inclusion of toxoplasma in routine screening programme is still controversial and differs between countries. Screening in areas with a high rate of toxoplasma, such as in our country, may be rational. If infection is detected, treatment may be recommended because it may reduce the transmission to the fetus.Öğe The effect of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on predicting rupture risk in tubal ectopic pregnancies(S. Karger AG, 2019) Kan, Özgür; Gemici, Ali; Alkılıç, Ayşegül; Çetindağ, Elif Nazlı; Çakır, Caner; Dur, Rıza; Altay, MetinBackground: Consecutive measurements of ?-hCG levels and sonographic evaluation of adnexae are critical for choosing the optimal management in ampullar tubal ectopic pregnancies (EP). To select suitable patients for conservative approach, there is a need for an affordable and reliable marker for determining rupture risk. Evaluation of systemic inflammatory markers in combination with serum ?-hCG levels and ultrasound might help to decide the appropriate treatment option. Objective: The purpose of the present study was to evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the rupture risk in ampullar tubal EPs and to compare with intraoperative findings. Methods: A total of 142 patients who underwent surgery for tubal EP were included. Seventy-two patients were in the intraoperatively diagnosed tubal rupture group and 70 patients without rupture findings were included in the control group. Both groups were compared for inflammation markers, ?-hCG levels, and sonographic findings. Results: Both NLR and PLR levels were found to be significantly higher in the tubal rupture group (4.62 ± 3.13 vs. 2.67 ± 1.43, 162.94 ± 63.61 vs. 115.84 ± 41.15, p < 0.01, respectively). According to the receiver operating characteristic analysis performed for the diagnostic performance of tubal diameter measurement, ?-hCG, NLR, and PLR levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.01). Conclusion: Systemic inflammatory markers are feasible and affordable tools for predicting tubal rupture risk in ampullar EPs and might be useful for determining surgery decision especially in low resource settings. © 2019 S. Karger AG, Basel.Öğe The effect of transobturator tape surgery on female sexual functions: A systematic review(2020) Yıldırım, Engin; Büyükkayacı Duman, Nuriye; Görkem, Ümit; Kan, ÖzgürOBJECTIVE: Stress urinary incontinence is one of the diseases that change the quality of life of women. Although there are various medical and surgical treatment modalities exist, transobturator tape surgery is one of the current options with the least complication rates. The aim of this systematic review was to evaluate sexual functional results after the transobturator tape procedure. STUDY DESIGN: Data were taken from those cohort, case-control and cross-sectional studies that were done with human subjects in full texts, were written in the English language. RESULTS:A total of 24 clinical trials were evaluated. The most frequently administered scales were the female sexual function index and The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12. In total, 8 clinical studies employed female sexual function index whereas 8 clinical studies administered Prolapse/Urinary Incontinence Sexual Questionnaire -12. 4 of these studies tried to understand women’s sexual functions through questions determined by the researchers (N/A). 2 of the other studies used the Sexual Impact Questionnaire and a visual analogue scale, 1 study used Nine Questions on Sexual Functioning (NSF-9) and 1 study used International Consultation on Incontinence Questionnaire Vaginal Symptoms Module (ICIQ-VS). It was found that transobturator tape surgery that is performed for incontinence produces positive results on both sexual functions and urinary functions. CONCLUSION: Maintaining urinary continence is detected to directly be correlated with sexual functions. It is of high importance that before initiating surgical treatments, clinicians should give the patients a detailed medical examination in terms of both urinary and sexual functions.Öğe The effects of serum granulin levels on anthropometric measures and glucose metabolism in infertile women with different ovarian reserve status(Via Medica, 2019) Kan, Özgür; Görkem, ÜmitIntroduction: Granulin (GRN) is an adipokine with proinflammatory features, which plays important role in glucose metabolism and insulin resistance pathogenesis. It has been reported that granulin precursors were localised in developing follides in animal studies. The purpose of this study was to evaluate the association of granulin levels with anthropometric features, glucose metabolism, and ovarian reserve. Material and methods: A total of 109 infertile women were induded in this cross-sectional, prospective study, who attended a tertiary clinic. All participants were categorised into diminished ovarian reserve (DOR) and normal ovarian reserve groups (NOR), in accordance with Bologna criteria. The demographic characteristics, including age, BMI, waist-hip circumferences, and biochemical parameters, were recorded. Serum granulin level was determined by enzyme-linked immunosorbent assay. Results: No significant difference was observed in the GRN levels (p = 0.229) between the groups. There was a positive correlation between GRN levels and BMI, WC, HC, and 75 g oral glucose tolerance values in NOR group (p < 0.01, p < 0.05, p < 0.01, and p < 0.05, respectively). Conclusions: Our results suggest that granulin is associated with anthropometric features in infertile patients and might be an important indicator of obesity and impaired glucose metabolism. Elevated levels of granulin may have a diabetogenic effect and predispose women to high glucose levels.Öğe The impact of adding hp-hMG in r-FSH started GnRH antagonist cycles on ART outcome(Taylor and Francis Ltd, 2019) Kan, Özgür; Şimşir, Coşkun; Atabekoğlu, Cem Somer; Sönmezer, MuratWhile luteinizing hormone (LH) activity is believed to play a role in follicle maturation, human chorionic gonadotropin (hCG) might play an important role in implantation process. We aimed to investigate whether addition of human menopausal gonadotropin (hMG) in recombinant-follicle-stimulating hormone (r-FSH) started GnRH antagonist controlled ovarian hyperstimulation (COH) cycles might enhance implantation rate and improve in vitro fertilization (IVF) success. A total of 246 patients undergoing GnRH antagonist IVF cycles were analyzed. One hundred and twenty-three cycles (%50) were treated with only r-FSH and 123 cycles were treated with r-FSH plus hp-hMG combination. Total gonadotropin doses, total number of oocytes retrieved, metaphase 2 (MII) oocytes, top quality embryos, fertilization and implantation rates, clinical pregnancy rates (CPRs) and ovarian hyperstimulation syndrome (OHSS) rates were compared between the groups. Both groups were comparable in terms of demographic details and baseline characteristics. Peak estradiol and progesterone levels in hCG trigger day, number of retrieved oocytes and top quality embryo counts, fertilization rates were similar between the groups. In r-FSH + hp-hMG group, significantly higher implantation rates (35.3% vs 24.3%, p=.017), CPRs (51.2% vs 35.8%, p=.015) and lower OHSS rates (1.6% vs 7.4%, p =.03) were observed respectively compared to r-FSH only treated patients. In conclusion, addition of hp-hMG on the day of antagonist initiation might increase CPRs. A better endometrial receptivity associated with higher implantation rates might be achieved due to hCG component in hp-hMG. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
