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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only Investigation of childhood pneumonia with thoracic ultrasound: a comparison between X-ray and ultrasound(Lippincott Williams and Wilkins, 2023) Buz Yaşar, Ayşenur; Tarhan, Merve; Atalay, Basak; Girit, Saniye; N/A; School of Medicine; Koç University HospitalChildhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q1: 8 and Q3: 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different (P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment (κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia. © Wolters Kluwer Health, Inc. All rights reserved.Publication Metadata only Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas(Taylor & Francis Inc, 2018) Boza, Ayşen; Aksu, Sertan; Arslan, Tonguç; Urman, Cumhur Bülent; Ata, Mustafa Barış; Taşkıran, Çağatay; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 12147; 182910; 134190The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. IMPACT STATEMENT What is already known on this subject: When the myoma is symptomatic, compressing the endometrium, does not show serosal protrusion and is not amenable to hysteroscopic resection, laparoscopic surgery may become challenging. What do the results of this study add: The use of intraoperative endoscopic ultrasound under these circumstances may facilitate the procedure by accurate identification of the myoma and correct placement of the serosal incision. What are the implications of these findings for clinical practice and/or further research: Intraoperative ultrasound should be more oftenly used to accurately locate deep intramural myomas to the end of making laparoscopy feasible and possibly decreasing recurrence by facilitating removal of otherwise unidentifiable disease.Publication Metadata only Relations between second-trimester aneuploidy screening results and prediction of labour induction success in term pregnancies(2021) Karakoç, Gökhan; Eroğlu, Hasan; Çakır, Caner; Yavuz, And; Yücel, Aykan; N/A; Turğal, Mert; Doctor; N/A; Koç University Hospital; N/AWe aimed to assess whether the second-trimester maternal serum markers could be used for the prediction of labour induction success. This prospective study enrolled women planned labour induction at term. Women were assigned to one of two groups: vaginal prostaglandin or balloon dilatation. All patients were evaluated for Bishop score, maternal serum oestriol, human chorionic gonadotropin and progesterone at the time of second-aneuploidy screening. The total successful rate for induction of labour was 63.9% in both groups. Maternal serum oestriol multiple of median (MoM) values were significantly lower among the caesarean section group compared to the vaginal delivery group (p < .001). A MoM value of 0.74 for oestriol was associated with a sensitivity of 75.9%, specificity of 41.0%, a positive predictive value of 76.6% and a negative predictive value of 58.0% for a successful induction of labour. Oestriol had a good performance in the prediction of successful induction of labour at term.Publication Metadata only Perinatal and neonatal outcomes of women with very early preterm premature rupture of membranes treated via serial transabdominal amnioinfusion and expectant management: experience of a tertiary referral center in Turkey(Wiley, 2022) Melekoglu, Rauf; N/A; Çelik, Ebru; Faculty Member; School of Medicine; 116631Aim We compared the outcomes of serial transabdominal amnioinfusion and expectant management on the perinatal and neonatal outcomes of pregnancies complicated with very early preterm premature rupture of membranes (PPROM). Methods We retrospectively reviewed the records of patients with very early PPROM admitted to the University of Inonu School of Medicine from 2014 to 2019. All such patients received comprehensive counseling on the possible prognoses; all were offered pregnancy termination, expectant management, and serial transabdominal infusion. Results Sixty-three women met the inclusion criteria; 36 were assigned to the expectant management group and 27 were assigned to the amnioinfusion group. The median delivery latency and the gestational age at delivery were significantly higher in the amnioinfusion than the expectant management group [35 (11-90), 14 (7-48), p < 0.001; 27.6 (22.1-34.0), 22.3 (19.0-26.5), p < 0.001, respectively]. Serial transabdominal amnioinfusion was associated with significantly less neonatal mortality than expectant management (29.6 vs 83.3%, p < 0.001). Multivariate binary logistic regression showed that the odds of neonatal mortality were 6.12 times higher among neonates in the expectant management group compared to that of the serial transabdominal amnioinfusion group after adjusting for potential confounders. Severe neonatal morbidities were significantly more common in the expectant management group than in the amnioinfusion group (p = 0.011). Conclusion The present study has demonstrated a significant positive effect of serial transabdominal amnioinfusion procedure on latency period and neonatal morbidity and mortality in pregnant women complicated with very early PPROM.Publication Metadata only A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre(Taylor & Francis, 2014) Kutuk, M. S.; Ozgun, M. T.; Uludag, S.; Dolanbay, M.; Tas, M.; Terzioğlu, Ayşecan; Faculty Member; School of Nursing; 177870The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers' education to change this attitude should be implemented.Publication Metadata only A pioneering study: oral clarithromycin treatment for feeding intolerance in very low birth weight preterm infants(Taylor and Francis Ltd, 2018) Sancak, Selim; Tuten, Abdulhamit; Arman, Didem; Karatekin, Guner; Ovali, Fahri; N/A; Gürsoy, Tuğba; Faculty Member; School of Medicine; 214691Purpose: To examine the prokinetic effect of clarithromycin in very low birth weight (VLBW) preterm infants. Materials and methods: VLBW preterm infants who have not achieved half of the full enteral feeding in the second week of life were enrolled in the study. The infants enrolled in the study were randomized. Twenty infants received oral clarithromycin (7.5 mg/kg, twice a day) and 20 control infants did not receive any treatment. Results: Full enteral feeding was attained earlier in the clarithromycin group than in the control group [7 (6-9) versus 9 (9-11) days, respectively; p<.001]. Duration of parenteral nutrition and number of withheld feeds were significantly lower in the clarithromycin group (p = .013 and p<.001, respectively). Parenteral nutrition-associated cholestasis (n = 1 versus 3, p = .1) and length of hospital stay (50 versus 59 median days, p = .1) tend to be lower in the clarithromycin group without any statistical significance. We observed no adverse effect of clarithromycin therapy. Conclusions: Clarithromycin treatment in VLBW preterm infants resulted in better toleration of enteral feeding. Larger randomized controlled trials are needed to establish routine use of clarithromycin in the treatment of feeding intolerance.Publication Metadata only Vaginal progesterone gel for luteal support after cleavage stage embryo transfer once or twice a day?(Sci Printers & Publ Inc, 2017) Çelik, Serdar; Alper, Ebru; Balaban, Başak; Urman, Cumhur Bülent; Yakın, Kayhan; Ata, Mustafa Barış; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 12147; 106822; 182910Objective: To determine whether twice daily dosing of progesterone vaginal gel (PVG) is better for luteal phase support (LPS) than once daily dosing. Study Design: Retrospective study including 456 women aged <= 42 years who underwent assisted reproductive technology with long GnRH agonist protocol. Blastocyst transfers and difficult embryo transfers were excluded. LPS was started with 90 mg PVG once daily on the evening of oocyte retrieval and continued until negative pregnancy test or 10th week of pregnancy in both groups. PVG dosage was doubled on the day of embryo transfer in the twice-daily group. Results: Age, duration of infertility, and number of oocytes collected were similar. Numbers of embryos transferred were 2.9 and 2.8 in the once-daily and twice-daily groups, respectively (p=0.04). Embryo implantation (23.96% vs. 27.95%) and clinical pregnancy (50.9% vs. 56.5%) rates favored twice-daily dosage; however, differences were statistically nonsignificant, and the study had 20% power to demonstrate significance. When our results were pooled with a prior trial comparing once and twice daily dosing, twice daily dosing seemed to significantly increase clinical pregnancy rate (rate ratio: 1.18, 95% CI 1.01-1.38). Conclusion: Trends favoring twice daily dosing are encouraging findings and require further investigation.Publication Metadata only Sexual dysfunction in women with human papilloma virus infection in the turkish population(Taylor & Francis, 2019) Mercan, Sibel; Sur, Haydar; Kilciksiz, Can Misel; Apaydin, Zuhal; Ayhan, Cem; N/A; Mercan, Ramazan; Durmaz Çetin, Birsen; Kaçar, Anıl Şafak; Ata, Mustafa Barış; Faculty Member; Faculty Member; PhD Student; Faculty Member; School of Medicine; School of Medicine; Graduate School of Health Sciences; School of Medicine; 125526; 111719; N/A; 182910Human papilloma virus infection (HPV) is the most common sexually transmitted disease. It may increase the risk of several cancers, including those of the cervix, vulva, vagina, head and neck. HPV is usually transmitted during sexual intercourse; there are limited data about sexual dysfunction (SD) after infection with this virus. We aimed to measure the incidence of SD in women with HPV. In this study, we evaluated 67 HPV-infected female patients and 66 healthy controls. The Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Socio Demographic Form were used for evaluation. Gynaecologists and psychiatrists evaluated the participants. Women with HPV were found to have significantly higher Arizona Sexual Experience Scale (ASEX) total scores and ASEX sub scores than the control group in the domains of sexual desire, arousal, genital response, orgasmic experience and their satisfaction from orgasm (p.05). The study group shows a statistically significant difference in the Beck Depression Inventory (BDI), but Beck Anxiety Inventory (BAI) scores show no significant differences between the experimental and control groups. Our study shows that HPV positivity in female patients is associated with a significant impairment in sexual function and that this impairment is not related to depression or anxiety.Impact statementWhat is already known on this subject? There are only a few studies concerned with sexual dysfunction in HPV patients. These studies have methodological problems, as they do not rule out the effect of depression on sexual dysfunction. It is very difficult to perform studies on sexual dysfunction and sexually transmitted diseases, because both physicians and patients are reluctant to talk about sexual problems. In the present study, only 6 out of 15 physicians accepted to contribute to the study. Although the physicians gave a questionnaire to more than 400 patients, only 133 of them completed that questionnaire. The most important difficulties in this study was to find enough patients.What do the results of this study add? Depression and sexual dysfunction are frequently seen in HPV patients. Although depression is one of the most common causes of sexual dysfunction, an HPV infection may lead to sexual dysfunction even in the patients without depression.What are the implications of these findings for clinical practice and/or further research? HPV infections may be associated with mental health problems and sexual dysfunction. The gynaecologists and other clinicians working with HPV patients should also evaluate patients psychologically and refer patients to psychiatry if required. The psychiatric problems associated with an HPV infection do not only impair sexual functions, but also may lead to difficulties in social life.Publication Metadata only Letter from a young female physician, candidate(Galenos Yayincilik, 2018) Bilir, Esra; Researcher; School of Medicine; N/AN/APublication Metadata only The role of ovarian reserve markers in prediction of clinical pregnancy(Taylor & Francis Inc, 2017) Zebitay, Ali G.; Çetin, Orkun; Verit, Fatma F.; Keskin, Seda; Sakar, M. Nafi; İlhan, Gülşah; Şahmay, Sezai; N/A; Karahüseyinoğlu, Serçin; Faculty Member; School of Medicine; 110772To evaluate the role of ovarian reserve markers in the prediction of clinical pregnancy and embryo transfer accomplishment among poor responder IVF applicants. 304 female poor responder IVF applicants were included in this prospective cohort study conducted at the IVF-unit. Antral follicle count, FSH, LH, E2, AMH and IVF outcomes were compared in pregnant and non-pregnant groups as well as in ET vs. non-ET groups. The number of retrieved oocytes was significantly correlated positively with AMH and AFC, and negatively with FSH and age. Quartiles of FSH and AFC were similar to the rate of pregnancy. Quartiles of AMH (<25%/25-75% and <25%/>75%) were statistically significant. Mean serum levels for AMH were significantly lower in the non-ET group. Our findings seem to indicate that day 3 AMH values can predict ET accomplishment with a sensitivity of 96% and a specificity of 35%. Quartiles of AMH <25% (<0.21ng/mL) can predict the IVF results among poor responder IVF applicants.Impact statementVarious cut-off values have been determined for day 3 serum AMH values. These values help to determine the groups that are expected to give normal, high or low response to stimulation and decide the treatment options.In contrast to other groups of patients, poor responders cannot reach the embryo transfer stage for several reasons. These are; absence of a mature oocyte after oocyte pick-up, fertilisation failure without male factor or poor embryo quality.In the present study; a cut-off value of 0.33ng/mL for the prediction of ET accomplishment in poor responder patients was determined with a sensitivity of 96%. Additionally, clinical pregnancy could not be achieved under the value of 0.21ng/mL day 3 AMH values.It is important to clarify the embryo transfer success of poor responder patients prior to expected treatment success. Pre-treatment counselling for these patients would lessen the disappointment that may develop after treatment. The cost-effectiveness of treatments below these AMH values can be determined by further studies.
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