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    Assessment of oxidative stress markers in cord blood of newborns to patients with oxytocin-induced labor
    (Wiley, 2017) Karacor, Talip; Sak, Sibel; Basaranoglu, Serdar; Peker, Nurullah; Agacayak, Elif; Sak, Muhammet Erdal; Turgut, Abdulkadir
    Aim: We aimed to measure the extent of oxidative stress experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth and to compare the effects of induced labor on fetalwell-being. Methods: Sixty-four healthy pregnant women referring to the Department of Gynecology and Obstetrics, Dicle University Medical Faculty between October 2010 and May 2011 were included in this comparative study. Pregnant women undergoing induced labor by oxytocin were group 1 and those without labor induction were group 2. Post-partum Apgar score was calculated at 1 and 5 min and measurements of weight and height of the neonateswere carried out. After the fetal cordwas clamped, 5 cm(3) blood was drawn into a plain tube without anticoagulant. The samples were centrifuged at 5000 r.p.m. for 5 min. Separated sera were transferred to Eppendorf tubes and were stored at -80 C degrees until the analysis time. Results: The complete blood counts and biochemistry results indicated that there were no statistically significant differences in regards to diseases between the two groups. Nitric oxide and asymmetrical dimethylarginine values of the two groups were not significantly different; however, there were statistically significant differences in the malondialdehyde, paraoxonase, total antioxidative status, and total oxidative status values of the two groups (respectively, P = 0.005, P = 0.006, P = 0.008, and P = 0.007). Conclusion: We observed that oxytocin-induced labor increases stress markers but does not affect Apgar scores. Oxidative stress in pregnant women may trigger antioxidative mechanisms. Prospective studies in larger cohorts are needed to better understand the impact of oxytocin-induced labor on pregnant women and neonates.
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    Bilateral hypogastric artery ligation: A tertiary center experience
    (Harran Üniversitesi Tıp Fakültesi, 2019) Peker, Nurullah; Yavuz, Mustafa; Aydın, Edip; Ege, Serhat; Bademkıran, Muhammet Hanifi; Turan, Gökçe; Karaçor, Talip; Gül, Talip
    Background: The aim of this study was to evaluate the obstetric characteristics and maternal outcomes of patients undergoing bilateral hypogastric artery ligation (BHGAL) for primary postpartum hemorrhage (PPH). Materials and Methods: Digital records and hospital archives of patients who underwent BHGAL in the postpartum period after vaginal delivery (VD) or during or after cesarean section (C/S) in a tertiary center between May 2005 and May 2018 were reviewed retrospectively. Demographic characteristics, parity, gestational week, duration of operation, hospitalisation time, estimated blood loss, laboratory values, transfused blood volume, previous C/S history, and intensive care requirement of the patients were evaluated. The efficacy of BHGAL in controlling bleeding, indications, concomitant surgeries, and intraoperative and postoperative complications were evaluated. Results: There were 276.008 deliveries in our hospital in the specified period. Of the patients with PPH, 41 patients underwent BHGAL after VD and 19 patients underwent BHGAL during or after C/S. In 25 of 28 patients with PPH due to atony, bleeding was controlled by BHGAL, while 3 patients underwent hysterectomy together with BHGAL. While the effectiveness of BHGAL in uterine atony was 89.2%, the success rate was 33.3% when all cases were considered. The most common cause of indication for BHGAL was atony and disseminated intravascular coagulation (DIC) was the most common complication in patients undergoing BHGAL. Iliac vein injury was detected in one patient due to the procedure itself. Conclusions: BHGAL is more effective on controlling PPH due to atony compared to the control of other PPH causes. Most of the complications in these patients are not related to the procedure but are due to the complications of PPH. Therefore, BHGAL continues to be a life-saving method when applied by centers with adequate surgical knowledge and equipment.
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    Can clomiphene citrate resistance be predicted by RDW-CV levels in infertile women with PCOS?
    (Wolters Kluwer Medknow Publications, 2019) Peker, Nurullah; Ege, Serhat; Bademkiran, Muhammet Hanifi; Aydin, Edip; Karacor, Talip; Obut, Mehmet; Arac, Esref
    Objective: To identify whether red blood cell distribution width coefficient of variation (RDW-CV) and mean platelet volume (MPV) levels can predict clomiphene citrate resistance (CC-R) in infertile, anovulatory females with polycystic ovarian syndrome (PCOS). Methods: A total of 89 infertile patients who were admitted to a tertiary center diagnosed with non-obese PCOS were included in this study. The patients were divided into two groups: the first group comprised 53 non-obese patients with PCOS and CC-R, and the second group included 36 non-obese patients with PCOS and CC-S. RDW-CV, RDW-SD, and MPV values, along with routine whole blood count parameters were compared between the groups. Results: RDW-CV values were found to be significantly higher in the patients with CC-R compared to those with CC-S (P < 0.05). The sensitivity, specificity, positive, and negative predictive values were found to be 69%, 58.1%, 34.5%, and 12.5%, respectively, at an RDW-CV level of 12.85. The odds ratio was calculated as 3.077 (95% CI 1.245-7.603) in terms of the cut-off point. Conclusion: We think that RDW-CV which is a marker of inflammation is a simple, cheap, and accessible marker for the prediction of CC resistance.
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    A comparison between a combination of letrozole and clomiphene citrate versus gonadotropins for ovulation induction in infertile patients with clomiphene citrate - A resistant polycystic ovary syndrome-A retrospective study
    (Via Medica, 2020) Ege, Serhat; Bademkıran, Muhammed Hanifi; Peker, Nurullah; Tahaoǧlu, Ali Emre; Çaça, Fatma Nur Hançer; Özçelik, Serap Mutlu
    Objectives: The aim of this study was to compare a combination treatment with CC plus letrozole versus gonadotropins in CC-resistant polycystic ovary syndrome (PCOS) patients with regard to ovulation and clinical pregnancy rate. Material and methods: One hundred sixteen CC-resistant infertile PCOS patients were evaluated retrospectively. The patients were divided into two groups. Group 1 (n = 73) received CC plus letrozole, and Group 2 (n = 43) received gonadotropins. Results: The ovulation rate in Group 1 was 65/73 (89%), the pregnancy rate was 13/73 (18%), the twin foetuses rate was 1/73 (1.3%) and the miscarriage rate was 2/73 (2.7%). In Group 2, the ovulation rate was 41/43 (95%), and the pregnancy rate was 8/43 (19%) the rate of the twin foetuses was 1/43 (2.3%) and the miscarriage rate was 1/43 (2.3%). There was no statistically significant difference in the ovulation (p = 0.25), pregnancy (p = 0.91), twin foetuses (p = 0.89) and miscarriage p = 0.89) rates between two groups. Conclusions: This new drug combination suggests that it may be a lower cost, lower risk alternative treatment that increases the rate of ovulation. Larger randomized clinical trials are needed to provide information on live birth rates of this combination.
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    Comparison of histomorphological findings of cardinal ligament in patients with and without uterine prolapse
    (İnönü Üniversitesi Tıp Fakültesi, 2020) Peker, Nurullah; Kırıcı, Pınar; Kaya, Şeyhmus; Yıldırım, Ayhan; Karaçor, Talip
    Aim: This study aimed to investigate histomorphological changes in cardinal ligaments between patients with and without uterine prolapse. Material and Methods: This study included 30 patients who underwent vaginal hysterectomy for POP-Q stage 4 uterine prolapse (Group 1) and 30 patients who underwent abdominal hysterectomy for benign reasons except uterine prolapse (Group 2) at a tertiary center hospital. Demographic data, parity, uterine weight, and histomorphological findings of cardinal ligaments were compared between the two groups. Results: Age and parity were significantly higher unlike uterine weight was lower in Group 1. In histomorphological findings of cardinal ligaments, vessel wall thickness, peripheral nerve thickness and the number of cells in the connective tissue stroma counted in 1 mm2 area were statistically significantly higher in Group 1. While the presence of extravasated erythrocytes was greater in Group 1, no significant difference was found between the two groups in terms of inflammation. Conclusion: It is obvious that some histomorphological changes are formed in the cardinal ligaments of patients with uterine prolapse due to pressure on the uterus. We believe that the increase in the number of extravasated erythrocytes and the thickness of the vascular wall and peripheral nerve should be supported by further studies.
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    Comparison of serum and salivary alpha-fetoprotein levels in pregnancies complicated with neural tube defects
    (Yerküre Tanıtım & Yayıncılık Hizmetleri A.Ş., 2020) Karaçor, Talip; Bülbül, Mehmet; Nacar, Mehmet Can; Kırıcı, Pınar; Önderci, Muhittin; Peker, Nurullah; Sak, Sibel
    Objective: To compare the serum and salivary values of alpha-fetoprotein (AFP) used in screening neural tube defects (NTD) during pregnancy. To investigate whether saliva can be used instead of serum in NTD screening. Method: The study was conducted between May 2018 - November 2019 at Adıyaman University. The study included 41 pregnant women complicated by NTD and 44 healthy pregnant women. Three ml venous blood and 2 ml saliva samples were taken from both groups. Serum and saliva samples were not diluted. AFP concentration was measured at 450 nm by using commercially available enzyme-linked immunoassay. The intra‐ , and inter- test assay coefficients (CVs) of the kit were <8% and <10%, respectively. SPSS 21 program was used for data analysis. Mann-Whitney Test was used for the analysis of continuously changing parameters. The correlation coefficient was calculated by Spearman test. A p value of less than 0.05 was accepted for statistical significance. Results: When serum and salivary AFP values were compared between the two groups, the AFP values were found to be higher in both NTD group samples (p<0.001, p<0.001). In both groups, correlation analysis for serum and salivary AFP values showed a strong positive correlation (r=0.730, p<0.001). When the cut-off value for serum AFP is taken as 0.26, NTD can be determined with 100% sensitivity and 90% specificity (AUC: 0.932, p<0.001). When the cut-off value for salivary AFP is taken as 0.034, it can detect NTD with 95% sensitivity and 92% specificity (AUC: 1.00, p<0.001). Conclusion: Salivary and serum AFP values showed strong positive correlation between themselves. We believe that saliva can be used in NTD screening performed by AFP measurement.
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    Comparison of ultrasound-guided drainage with other available treatment modalities for, treatment of tubo-ovarian abscess
    (Türkiye Klinikleri Yayınevi, 2018) Aydın, Edip; Peker, Nurullah; Bademkıran, M. Hanifi; İçen, Mehmet Sait; Gül, Talip
    Objective: The present study aimed at the retrospective evaluation of the medicalrecords of patients treated for tubo-ovarian abscess (TOA) at our clinic and investigation of the efficacyof USG-guided drainage compared with that of other available treatment modalities. Materialand Methods: Medical records of 100 patients with TOA, who were treated and followed up atthe Department of Gynecology and Obstetrics, School of Medicine, Dicle University between January2009 and April 2015, were reviewed retrospectively. Details such as demographic data, risk factors,clinical and laboratory findings, treatment modalities used, and complications observed wererecorded for each patient. Results: The mean age of the patients was 36.46±11.6 years. Of the 100patients, 10 were menopausal women. Pelvic pain was the most common complaint in all patients(100%). The history of intrauterine or intra-abdominal intervention within six months was themost common risk factor (60.5% patients) for the development of TOA. Of the patients, 25% reportedfever (≥38 °C), 55% had leukocytosis, 85% had high sedimentation rate, and 92% had highCRP levels. The development of leukocytosis was not observed to be associated with the treatmentmodality used (p > 0.05). Of the patients, 38% underwent only medical treatment, 47% underwentmedical treatment followed by surgery, and 15% underwent medical treatment followed by USGguideddrainage. All 34 (72.3%) patients who had undergone surgical treatment required fertilitypreservingsurgery. Intraoperative bowel injury (6.3% patients) and wound site infection (8.5%patients) were among the common complications reported in patients undergoing surgical treatment.The mean duration of hospital stay was 7.9±6 days. The longest mean duration of hospital stay(10.5±3.9 days) was observed in the patients who had undergone USG-guided drainage. Conclusion:Broad-spectrum antibiotic therapy, the first step of treatment in patients with TOA, increasesthe size of abscess. In addition, a significant number of patients with bilateral abscesses require additionalintervention (surgery). Our findings suggest that USG-guided drainage should be consideredonly in patients not responding to medical treatment and not consenting to undergo surgicaltreatment.
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    Could moesin be a new marker for indicating progression in endometrial cancer?
    (Dove Medical Press Ltd., 2022) Ağaçayak, Elif; Keleş, Ayşenur; Değer, Uğur; Özçelik, Mehmet Şirin; Peker, Nurullah; Gündüz, Reyhan; Akkuş, Murat; Büyükbayram, Hüseyin
    Aim: This study aims to determine an important parameter in progression from pre-invasive lesions of endometrium to endometrial cancer and also evaluate the effect of this parameter on the progression of endometrial cancer. Material and Method: In our study,30 patients with normal endometrial tissue (group 1), 56 patients who had endometrial hyperplasia without atypia (group 2), 36 patients who had endometrial hyperplasia with atypia (group 3), and 63 patients with endometrial cancer (group 4) were included. Age, parity, body-mass index, systemic diseases, and tumor markers of patients were evaluated. Expression levels of Ezrin, Radixin, and Moesin proteins were immunohistochemically evaluated in terms of frequency, intensity, and score value. Results: When we compared hyperplasia cases with or without atypia; frequency, and score value of ezrin expression and frequency, intensity, and score value of moesin expression was significantly higher in patients who had hyperplasia with atypia (p:0.000 p:0.001 p:0.003, p:0.032 p: 0.035 p:0.015 p:0.005, respectively). It was observed that the frequency and score value of moesin expression were significantly higher in patients with endometrial cancer when compared with patients who had hyperplasia with atypia (p:0.003 p:0.045). The frequency of moesin expression was significantly higher in patients who had postoperative mortality (p:0.030 p:0.039). Conclusion: Increased frequency of moesin expression in the preoperative period in patients with atypical hyperplasia should alert the surgeon in terms of malignancy. If the frequency of moesin expression increases in cases with endometrial cancer, the patient should be followed closely in terms of progression in the postoperative period.
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    Covid-19 plasentalarında beclin-1 ve HMGB-1 protein ekspresyonlarının immunohistokimyasal değerlendirilmesi
    (Dicle Üniversitesi, Sağlık Bilimleri Enstitüsü, 2024) Peker, Nurullah; Akkuş, Murat
    Amaç: Bu tezin amacı COVID-19 gebe hastaların plasentalarında Beclin-1 bağışıklık hücresi ile bağışıklıkta yer alan HMGB-1 antikorlarının, otofaji, inflamasyon ve hücre ölümü açısından ekspresyonlarını mikroskobik olarak incelemektir. Gereç ve Yöntem: Çalışmada materyal olarak kullanılan plasentalar Kadın Hastalıkları/Doğum servisindeki yatan hastalardan elde edilerek, COVID-19 tanısı konmuş, 20 gebe kadın ve 20 normal gebe hastanın plasentaları incelenmiştir. Her iki grupta da 18-49 yaş aralığındaki kadınlar araştırılmış olup, COVID-19 semptomları olan nefes darlığı, öksürük ve boğaz ağrısı semptomlarına ek olarak PCR testi COVID-19 virüsü için (+) hastalardan alınan plasentalar incelenmiştir. Bulgular: Covid-19 grubunun plasental yapılarının histolojik kesitlerinde kök villusların membran yapısının belirgin olarak bozulduğu ve inflamatuar alanlar oluşturduğu izlenirken, bu bulgulara paralel şekilde maternal bölgede koryonik villusların özellikle bağlantı bölgeleri olan sinsityal köprülerde incelmeler meydana geldiği ve koryonik villüslarda sinsityal düğümlerin genişlediği görüldü. Covid-19 grubuna ait plasenta görüntülerinde Beclin-1 ekspresyonlarının sinsityal düğümlerde önemli biçimde pozitif ekspresyon verdiği izlenirken, intervillöz alandaki bazı lökositer yapılarda ve hiyelanize alanlarda yine ekspresyonların pozitif olduğu izlendi. Sonuç: Gebelikte bulaşan COVID-19 enfeksiyonunun gebelerdeki plasenta dokularında histopatolojik değişikliklere sebep olduğu görülmüştür.
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    Diyarbakır ilindeki gebe kadınlarda Toksoplazma, Rubella ve Sitomegalovirus seroprevalansı
    (Dicle Üniversitesi Tıp Fakültesi, 2019) Obut, Mehmet; Doğan, Yasemin; Bademkıran, Muhammed Hanifi; Akgöl, Sedat; Kahveci, Bekir; Peker, Nurullah; Uzundere, Osman; Kaçar, Cem Kıvılcım; Özbek, Erdal; Gül, Talip
    Amaç: Bu çalışmada; gebelerde, Toxoplasma gondii, Rubella virüs ve Cytomegalovirus infeksiyonlarının bölgemizdeki seroprevalanslarının belirlemesi amaçlanmıştır. Yöntemler: Bu çalışmada hastanemize Eylül 2016 ile Haziran 2018 tarihleri arasında kadın hastalıkları ve doğum polikliniklerine ilk prenatal vizite gelen 18-45 yaş arası gebeler dahil edildi. Bu hastalardan Toxoplasma gondii, Rubella ve Cytomegalovirus virüs serolojisi çalışılanların test sonuçları retrospektif olarak incelendi. Bulgular: Toxoplasma gondii antikorları açısından 8175 hastanın 2853’ inde (%34,9) anti toksoplazma gondii IgG antikorları, 91’ inde (%1,1) anti Toxoplasma gondii IgM antikorları pozitif olarak saptandı. Cytomegalovirus antikorları açısından 2797 hastanın 2775’ inde (%99,2) anti Cytomegalovirus IgG, 20’ sinde (%0,7) anti Cytomegalovirus IgM pozitif olarak saptandı. Rubella virüs antikorları açısından 8158 hastanın 7677’ sinde (%94,1) anti Rubellavirus IgG, 5’ inde (%0,1) anti Rubellavirus IgM pozitif olarak saptandı. Sonuç: Bu çalışmada hastanemize başvuran gebelerin çoğunun toksoplazma seronegatif (%65,1) olduğu tespit edildi. Rubella seroprevalansı (%94,1) Türkiye verileri ile uyumludur. Gebelerin Cytomegalovirus seroprevalansı için seropozitiflik oranı (%99,2) dünya verileri ile uyumludur.
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    Does detection of follicle rupture affect success in intrauterine insemination cycles? A tertiary center experience
    (Kare Publishing, 2023) Abide, Çiğdem Yayla; Devranoğlu, Belgin; Peker, Nurullah; Çöğendez, Ebru; Kumru, Pınar
    Objective: The aim of this study is to investigate the effect of intrauterine insemination (IUI) performed simultaneously with ultrasound detected follicular rupture during biological reproduction window on pregnancy rates in patients with unexplained infertility undergoing ovulation induction (OI) cycles with gonadotropins. Material and Methods: Three-hundred and twenty-five patients with unexplained infertility were included in this prospective cohort study, who received recombinant follicular stimulating hormone (75–150 IU/day) or Human Menopausal Gonadotropin starting from the 2nd to 3rd days of the cycle. IUI was carried out with ultrasonographic monitoring of the follicles. The presence of free fluid within the Douglas pouch, detection of corpus luteum, and/or loss of the dominant follicle was interpreted as follicular rupture. Pregnancy rates with or without follicular rupture were compared after 14 days. Results: Among those with follicular rupture, the time between administration of recombinant hCG and IUI was significantly longer as compared to those without follicular rupture (p<0.001). β hCG was positive at 14 days after IUI in 19.01% (31/163) and 13.92% (22/158) of the cases with or without follicular rupture, respectively. The difference in pregnancy rates was not significant (p=0.219). Conclusion: IUI simultaneously performed with ultrasound-detected follicular rupture in OI cycles with gonadotropins does not increase pregnancy rate.
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    Does ischaemia-modified albumin level predict clomiphene citrate resistant polycystic ovary syndrome patients?
    (Taylor & Francis Inc, 2021) Ege, Serhat; Bademkiran, Muhammet Hanifi; Peker, Nurullah; Erdem, Selami; Koceroglu, Rusen; Erel, Ozcan
    This study aims to examine the role of ischaemic-modified albumin (IMA) in predicting clomiphene citrate (CC) resistance in patients with CC-resistant and CC-sensitive infertile polycystic ovary syndrome (PCOS). Sixty women patients admitted to the infertility clinic were evaluated. The patients were divided into two groups. Group 1 comprised 30 infertile PCOS patients with CC resistance; group 2 was the control group comprising 30 infertile PCOS patients with CC sensitivity. Serum IMA levels of PCOS patients with CC resistance were significantly higher than CC sensitivity patients (p < .001). The independent variables BMI and age effects were adjusted according to the logistic regression method with groups. Significant differences were observed between the two groups in the levels of IMA (p = .0005), HOMA-IR (p = .0045), insulin (p = .022), free testosterone (p = .0001) and total testosterone (p = .03) values. By using ROC curve analysis for IMA between study and control groups, cut off point of IMA was calculated as 0.505 U/mL, sensitivity was 80% and specificity was 63%. The area under the curve was 0.926. This shows us that more oxidative stress (OS) occurs in the CC-resistant group. As a reflection of OS in the follicular endocrine, microenvironment may be linked with impaired oocyte developmental competence and embryo quality in association with increased IMA, free testosterone, total testosterone, insulin and HOMA-IR levels.Impact statement What is already known on this subject?In previous studies, IMA was compared between PCOS and control groups. In this study, serum IMA levels were measured in infertile PCOS patients resistant to CC for the first time. What the results of this study add?Serum IMA levels were significantly higher in resistant infertile PCOS patients compared to the control group. This shows us that more OS occurs in the CC-resistant group. What the implications are of these findings for clinical practice and/or further research?IMA will be a guide for PCOS management in patients with CC-resistant PCOS.
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    The effect of a levonorgestrel-releasing intrauterine device on female sexual function
    (Taylor & Francis Inc, 2021) Turan, Gokce; Bahat, Pinar Yalcin; Cetin, Berna Aslan; Peker, Nurullah
    This study aimed to evaluate the effect of a levonorgestrel-releasing intrauterine system (LNG-IUS) on the sexual function of women. Participants who had abnormal uterine bleeding (AUB) complaints with LNG-IUSs were included (study registration: Kanuni Sultan Suleyman Training and Research Hospital, 2018/10/34). The demographic data of all participants were recorded. The female sexual function index (FSFI) questionnaire was used to participants before the insertion of LNG-IUSs and 6 months after its insertion. FSFI scores were calculated at both timepoints and were compared. The total FSFI score after LNG-IUS insertion was significantly higher than the total FSFI score application (p < .001). The scores of the desire, arousal, lubrication, orgasm, satisfaction and pain categories significantly increased after LNG-IUS compared to those before LNG-IUS. As a result, the present study demonstrated that after LNG-IUS insertion, these women had higher FSFI scores.Impact Statement What is already known on this subject?There are many publications in the literature comparing the effects of LNG-IUSs, IUSs, OCs and other contraceptive methods on female sexuality. However, there are markedly few studies that compare sexual function before and after LNG-IUS insertion. What do the results of this study add?The total FSFI score after LNG-IUS insertion was significantly higher than the total FSFI score before the insertion (p< .001). The scores of the desire, arousal, lubrication, orgasm, satisfaction and pain categories significantly increased after LNG-IUS insertion compared to those before the application. The number of participants with FSFI scores >= 26.5 before LNG-IUS insertion was 17 (12.5%), and this number increased to 71 (52.5%) after the application What are the implications of these findings for clinical practice and/or further research?This study contributes to the literature because there are few researches that compare sexual function before and after LNG-IUS insertion. As a result of our study, sexual dysfunction decreased after LNG-IUS, and the scores increased in all sub-groups together with the total FSFI scores.
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    The effect of clomiphene citrate on oxidative stress parameters in polycystic ovarian syndrome
    (Taylor & Francis Inc, 2021) Peker, Nurullah; Turan, Gokce; Ege, Serhat; Bademkiran, Muhammet Hanifi; Karacor, Talip; Erel, Ozcan
    This study aimed to examine the possible association between the oxidative stress parameters and clomiphene citrate resistance in polycystic ovary syndrome. The demographic data, hormone profiles and oxidant and antioxidant values of 50 clomiphene citrate-resistant polycystic ovary syndrome patients (Group 1), 32 clomiphene citrate-sensitive polycystic ovary syndrome patients (Group 2) and 87 non-polycystic ovary syndrome patients (Group 3) were compared. The average age, follicle-stimulating hormone, oestradiol, thyroid-stimulating hormone and prolactin values of the three groups were found to be homogeneous. Ferroxidase, catalase and myeloperoxidase levels were determined to be lower in the clomiphene citrate-resistant group compared to clomiphene citrate-sensitive and non-polycystic ovary syndrome groups (p < .001). As a result, Polycystic ovary syndrome patients with clomiphene resistance had lower antioxidant (catalase and ferroxidase) levels compared to those who were sensitive to clomiphene and who did not have polycystic ovary syndrome. The myeloperoxidase levels also demonstrated the same trend, which might be due to a compensation mechanism.Impact Statement What is already known on this subject? In the literature, there are many studies evaluating the association between PCOS and oxidative stress. No research related to antioxidants in clomiphene citrate-sensitive and clomiphene citrate-resistant PCOS patients was found in the relevant literature. What do the results of this study add? In this study, the antioxidants catalase and ferroxidase were found to be lower in PCOS women compared to non-PCOS; however, they were the lowest in clomiphene citrate-resistant PCOS women. Interestingly, myeloperoxidase, which is a part of oxidative stress, was also found to be higher in the non-PCOS group.
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    The effect of surgical procedure on surgical outcomes in patients undergoing emergency peripartum hysterectomy: a retrospective
    (Taylor & Francis, 2021) Bülbül, Mehmet; Karaçor, Talip; Peker, Nurullah; Nacar, Mehmet Can; Okutucu, Gülcan
    Objective To investigate the effect of surgical procedure on the operation's results in patients undergoing emergency peripartum hysterectomy (EPH). Methods The records of patients who underwent EPH due to postpartum hemorrhage between 2010 and 2020 in two tertiary centers with a high crude delivery rate were retrospectively analyzed. Surgical data were compared according to the EPH type. Results During the study period, 115,709 births occurred in these two centers. EPH was administered for 181 (1.6%) of these patients. Sixty-seven (37%) of the EPH cases involved subtotal EPH (SEPH), and 114 (63%) were total EPH (TEPH). Surgical time (107.3 +/- 17.6 vs. 134.2 +/- 32.3 min, p < 0.001), erythrocyte transfusion count (2.6 +/- 1.3 vs. 4.3 +/- 6.2, p < 0.001), ureter injury (0.0 vs. 7.9%), bladder injury (1.5 vs. 28.1%), disseminated intravascular coagulation (1.5 vs. 9.6%), need for relaparotomy (4.5 vs. 14%), and intensive care unit admission (19.4 vs. 52.6%) were found to be higher in the TEPH group compared to the SEPH group (p < 0.05). In addition, the total length of hospitalization was longer in the TEPH group (4.5 +/- 2.3 vs. 6.1 +/- 4.6 day, p = 0.011). Conclusion According to the results, if the bleeding in peripartum hemorrhage requiring EPH can be controlled with SEPH, attempting to remove the cervix completely may be associated with increased surgical time, blood transfusion need, and surgical complications.
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    The effect of vaginal bleeding and non-spesific pelvic pain on pregnancy outcomes in subchorionichematomas cases
    (Via Medica, 2019) Karaçor, Talip; Bülbül, Mehmet; Nacar, Mehmet Can; Kırıcı, Pınar; Peker, Nurullah; Ağaçayak, Elif
    bjectives: To determine the clinical differences and factors affecting early pregnancy outcome in the first and early second trimester subchorionic hematoma cases. Material and methods: This study involved with the retrospective analysis and evaluation of 81 cases diagnosed with subchorionic hematoma. The patients were grouped according to the gestational periods, symptoms at the time of admission, ratio of surrounding hematoma to the gestational sac, and whether there was a pregnancy loss. The groups were compared according to the clinical features and pregnancy outcomes. Results: The ratio of surrounding hematoma to the gestational sac in the group with pregnancy loss was significantly higher (p = 0.002). When the cut-off value was 35.5%, it could determine the possibility of a complication in pregnancy with 70% sensitivity and 75% specificity. Nonspecific pelvic pain were significantly higher in the pregnancy loss group than in the other group. Logistic regression analysis was performed to determine the effect of these two parameters on the pregnancy outcome. Although the presence of non-specific pelvic pain is more in the group with pregnancy loss; there was no effect of on pregnancy outcome (p = 0.141). The risk of pregnancy loss increased 4.5 fold if the ratio of ScH to gestational sac was above 35% (p = 0.027). Conclusions: In the cases of subchorionic hematoma, we concluded that when the ratio of surrounding hematoma to the gestational sac increased and when it was accompanied by nonspecific pelvic pain, the hospitalization period of the patients increased and the ratio of pregnancy loss was higher.
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    Effects of cerclage suture type on pregnancy and neonatal results: Mersilene suture & prolene suture
    (İnönü Üniversitesi Tıp Fakültesi, 2022) Değer, Uğur; Çavuş, Yunus; Turan, Gökçe; Peker, Nurullah
    Aim: The aim of this study is to compare pregnancy and neonatal results with regards to the thickness of the suture material used in the transvaginal cerclage operation. Materials and Methods: Patients who were subject to transvaginal cervical cerclage due to cervical insufficiency were evaluated in a secondary care center between 2103 and 2021 retrospectively. The demographic data, cerclage indications (ultrasound induced, prophylactic, or physical examination induced), number of pregnancy weeks at cerclage, type of cerclage suture (prolene, mersilene), type of cerclage (McDonald, Shirodkar), total pregnancy weeks, delivery method (cesarean (C/S), normal spontaneous vaginal delivery) of each patient were recorded. Additionally, birth weight, 1st and 5th minute APGAR scores, and neonatal intensive care unit (NICU) requirements were recorded as neonatal parameters. Patients were divided into two groups with regard to the type of cerclage suture (mersilene or prolene) and maternal, neonatal and pregnancy results were compared between these groups. Results: The study included 151 patients in total. Prolene sutures were used for 69 of the patients (45.7%) and mersilene sutures for 82 patients (54.3%) Cerclage was applied for 18 patients (11.9%) depending on the ultrasound findings, 121 patients (80.1%) depending on emergency and 12 patients (7.9%) depending on history. Gravida increased significantly in the prolene suture group (p=0.021). Pregnancy week was found to be significantly lower in the mersilene suture group [32.5 w (15-40)] compared to the prolene suture group [37.0 w (15-41)] [37.0 w (15-41)](p<0.001). Ratios of birthing below 34 weeks and 37 weeks for the mersilene suture group were found as 57.3% and 80.5%, and for the prolene suture group 11.6% and 40.6% respectively, and a statistically significant difference was observed (p<0.001). Fetal weight, 1st and 5th minute APGAR scores in the mersilene suture group were significantly lower (p<0.05). Ratios of newborn intensive care requirements and preterm premature rupture of membranes (PPROM) in the mersilene suture group were found to be significantly higher compared to the prolene suture group (p=0.016, p<0.001 respectively). Conclusion: Although mersilene suture is more preferred, its supply is not always possible in emergency situations. Therefore, the prolene suture should be kept in mind as an even stronger cerclage suture option.
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    Ektopik Gebelik Olgularinda Gebelik Haftasina Göre Tedavi Yaklaşimlarinin Retrospektif Değerlendirilmesi
    (2017) Tunç, Senem Yaman; Sak, Sibel; Peker, Nurullah; Gül, Talip; Başaranoğlu, Serdar; Karaçor, Talip
    Çalışmamızda tersiyer bir merkezde ektopik gebelik (EG) tanılı hastalarda tanıya giden adımlar ve tedavi yöntemleri irdelendi. Son adet tarihine (SAT) göre gebelik haftasının tedavi yöntemleriyle ilişkisi değerlendirildi.Gereç ve Yöntem: Çalışmamızda 2011-2014 tarihleri arasında, üçüncü basamak olan kliniğimizde EG tanısı ile tedavi edilen 192 olgu tanısal yöntemlerine ve tedavi seçeneklerine göre değerlendirildi.Bulgular: EG insidansı 30.8/1000 olarak bulundu. Tek doz metotreksat (MTX) tedavisinin başarı oranı % 69.8, iki doz MTX ile birlikte medikal tedavinin başarı oranı ise % 87.5 olarak bulundu. Cerrahi uygulanan hastalarda en sık cerrahi prosedürün (% 54) salpenjektomi olduğu tespit edildi. 37 hastada (% 19.2) ise izlem tedavisi yeterli oldu. Tedavi şekilleri ile belirli parametreler karşılaştırıldığında; geliş ?-hCG seviyesinin yüksek olması, fetal kardiyak atımın (FKA) pozitif olması, batında serbest mayi olması, kitle boyutunun büyük olması ve SAT' a göre gebelik haftasının büyük olması ile cerrahi tedaviye gidiş arasında istatistiksel olarak anlamlı fark olduğu saptandı (p<0,05).Sonuç: Erken dönemde tanı alan EG' de, SAT' a göre gebelik haftası küçük olan hastaların daha çok izlem ve medikal tedavi ile, daha geç dönemde tespit edilen hastalarda ise cerrahi tedaviye gidişin yüksek olduğu izlendi.
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    Evaluation and Management of Patients with Hematoma After Gynecologic and Obstetric Surgery
    (2021) Uzundere, Osman; Ege, Serhat; Kahveci, Bekir; Budak, Mehmet Sukru; Kahveci, Gaye; Peker, Nurullah; Sucu, Mete
    OBJECTIVE: Postoperative hematoma following abdominal surgery is relatively rare and mainly depends on the type of surgery. Specific treatment including surgery or interventional radiology is sometimes necessary. The aim of this study is to evaluate the cases of postoperative hematoma after gynecologic and obstetric surgery.STUDY DESIGN: This is a retrospective cohort study of 30 patients with hematoma developed after gynecologic and obstetric surgery. We included the patients who hospitalized with the diagnosis of a postoperative hematoma between June 2017 and April 2019 at Gazi Yasargil Training and ResearchHospital of Health Sciences University. Hematomas occurring after endoscopic surgery and episiotomywere not included. The diagnosed cases were divided into three groups as wound hematoma, rectussheath hematoma and intra-abdominal hematoma (intraperitoneal and retroperitoneal). All cases wereassessed by patient demographics and clinical findings, hematoma of characteristics, treatment methods and results.RESULTS: A total of 30 patients were included in the study with a mean age of 33.0±8.6 years.Incidence of hematoma account for 0.2%. The mean c-reactive protein was 37.9±47.4 mg/dL at admission and 14.6±25.8 mg/dL at discharge, respectively. The decrease was statistically significant (p <0.001). The mean hemoglobin was 10.6±2.1 g/dL at admission and 10.7±1.5 g/dL at discharge. Feverwas detected in 7 (23.3%) patients. Only 12 patients (40%) were followed up by observation and symptom management. In 10 (33.3%) patients, antibiotics were included in the treatment due to infection. Inaddition, 4 patients (13.3%) had relaparotomy, 5 patients (16.7%) underwent percutaneous radiologicaldrainage and 8 (26.7%) received blood transfusion. The mean time of resorption of the hematoma was4.6 ± 2.0 days. The evaluation of the hematoma locations revealed that 14 patients (46.7%) had woundhematoma, 7 patients (23.3%) had rectus sheath hematoma (Type I: 2 cases, type II: 3 cases, type III:2 cases), 8 patients (26.7%) had pelvic hematoma and 2 patients (6.7%) had a retroperitonealhematoma. The mean hematoma size was 68.1±15.18 mm.CONCLUSIONS: In cases of hematoma resistant to antibiotic treatment and non-resorbable hematoma,we can consider percutaneous catheter drainage as an alternative to surgical intervention
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    Evaluation of catalase, myeloperoxidase and ferroxidase values in pregnant women with hyperemesis gravidarum
    (Via Medica, 2019) Ege, Serhat; Bademkıran, Muhammed Hanifi; Peker, Nurullah; Erdem, Selami; Bağlı, İhsan; Köçeroǧlu, Ruşen; Kahveci, Bekir; Yıldızhan, Recep; Erel, Özcan; Araç, Eşref
    Objectives: To investigate maternal serum catalase, myeloperoxidase and ferroxidase levels in pregnant women with Hyperemesis Gravidarum and to compare the results with healthy pregnancies. Material and methods: In this study, 60 female patients admitted to the Health Sciences University, Gazi Yasargil Training and Research Hospital, Gynecology and Obstetrics Department were evaluated. The patients were divided into two groups: Group 1 included 30 pregnant women with hyperemesis gravidarum; Group 2 included 30 healthy pregnant women. Pregnancies over 14 weeks were excluded from the study. Results: The laboratory and laboratory characteristics of both groups are shown in Table 1. No significant differences were found between the groups in terms of the maternal age, gestational age, gravidity, parity, fasting glucose level, and BMI. The maternal blood CAT levels were significantly higher in the HG group (219.6 ± 111.3 kU/L) when compared to the control group (71.5 ± 52.5 kU/L) (p < 0.001). The maternal blood MPO levels were lower in the control group (121.5 ± 36.3 U/L) than in the study group (90.9 ± 56.4 U/L) (p = 0.016). However, the ferroxidase levels were similar between the two groups. The independent variables BMI, age, parity, gravidity and gestational week effects were adjusted according to the logistic regression method with groups. Significant differences were observed between the two groups in the levels of CAT (0.001), MPO (0.005) values. Conclusions: This study suggests that antioxidants in response to oxidative stress gave different reactions with different mechanisms; Also, we believe that insufficient food intake suppresses the immune system and this has an important role on antioxidants.