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    Factors Affecting ICU Stay and Length of Stay in the ICU in Patients with HELLP Syndrome in a Tertiary Referral Hospital
    (Hindawi Ltd, 2022) Agacayak, Elif; Bugday, Rezan; Peker, Nurullah; Deger, Ugur; Kavak, Gonul Olmez; Evsen, Mehmet Siddik; Gul, Talip
    Objective. The study aimed to compare patients with HELLP syndrome who require intensive care and who do not require intensive care and evaluate the factors affecting the length of stay in the intensive care unit. Methods. Patients were divided into two groups as follows: requiring intensive care (group 1) and not requiring intensive care (group 2). The data of both groups were compared in terms of demographic characteristics, transfusion amounts, length of stay in the intensive care unit, maternal complications, and mortality. Results. 14032 births in a tertiary center between 2011 and 2018 were evaluated in this study. During the study period, 342 patients were diagnosed with HELLP, and 32 (9.4%) of these were followed up in the intensive care unit. The length of stay in the intensive care unit was determined as 8.1 (7.2) days on average. Fresh frozen plasma, erythrocyte suspension, apheresis, and random thrombocyte transfusion were observed to be significantly more in group 1 patients. In the regression analysis, the most effective factor was found to be erythrocyte suspension and the length of stay in the intensive care unit was significantly longer in patients who had erythrocyte suspension transfusion. The receiver operating characteristic curve showed that the area under the curve value for erythrocyte transfusion was 70.6%. When the cutoff value of erythrocyte suspension was 450 (95% CI: 365-681) ml, the sensitivity was 43.8% and the specificity was 91.6%. Conclusion. We think that physicians should be careful that maternal morbidity and mortality may increase as the need for erythrocyte suspension transfusion increases in patients with HELLP syndrome. Minimum transfusion to hemodynamically stable patients can be more suitable in terms of morbidity and mortality in managing patients with HELLP syndrome requiring erythrocyte suspension transfusion. Precautions and measures should be taken in this regard.
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    Investigation of the Effects of Carvacrol on Experimental Ischemia/Reperfusion Model of Rat Ovaries by Immunohistochemistry
    (Sci Printers & Publ Inc, 2020) Peker, Nurullah; Deger, Ugur; Asir, Firat
    OBJECTIVE: Ovarian torsion is a gynecologic problem that presents as acute lower abdominal pain. As a result, blood flow to the ovaries decreases and ischemia develops. Many medications have been used to treat ovarian torsion, including carvacrol. We conducted an experimental ischemia/reperfusion (torsion-detorsion) model using rats to observe the effects of carvacrol on ovarian torsion by immunohistochemical study. STUDY DESIGN: Thirty-two female Wistar rats were randomly categorized into 4 groups (8 rats per group): control group, ischemia group, ischemia/reperfusion group, and ischemia/reperfusion + carvacrol-treated group. Ischemia was created by sealing the left ovaries for 3 hours, followed by 3-hour reperfusion. For the ischemia/reperfusion + carvacrol-treated group, 100 mg/kg carvacrol was administered orally in 2 mL 0.9% NaCl after the reperfusion. All animals were sacrificed, and ovarian tissues were dissected for routine paraffin wax embedding tissue protocol. RESULTS: Control groups showed normal ovarian histological structures. In the ischemia group, hyperplastic granulosa cell vascular dilation, severe hemorrhage, and inflammation were observed. The ischemia/reperfusion group showed edema, inflammation, congestion, degenerated follicles, and cells with pyknotic nuclei. In the ischemia/reperfusion + carvacrol group, degenerative changes and vascular pathologies were decreased in ovarian tissues. Endothelin-1 (ET-1) was expressed in degenerated follicles and vascular endothelial cells in the ischemia and ischemia/reperfusion group. Expression of ET-1 was decreased in follicular cells but negative in stromal and luteal cells in the ischemia/reperfusion + carvacrol group. ADAMTS-5 expression was positive in degenerated follicles, apoptotic cells, and inflammatory cells in the ischemia and ischemia/reperfusion groups. In the ischemia/reperfusion + carvacrol group, corona cells and a few inflammatory cells around vessels showed positive ADAMTS-5 expression. CONCLUSION: ET-1 can induce angiogenic development with the decrease of degenerative development and inflammation in the carvacrol group. ADAMTS-5 molecule may be a marker of cellular structure and extracellular matrix development in different stages of development of ovarian cells and follicles in ischemia and oxygen deficiency caused by ischemia reperfusion.