Characteristics of suicidal attacks in pregnancy; a multicenter study

BACKGROUND

Maternal death, fetal death and suicidal attack (SA), each one of these topics are an important public health problem. A suicide attack attempt during pregnancy includes all these important issues together and requires additional attention. Some factors may show regional differences such as suicidal method, distribution of attempts according to the gestational week and the most common preferred drugs. The predetermination of these variables may allow taking preventive measures and advantages can be gains on maternal-fetal health.

METHODS

The data of pregnant women who were admitted to 3 different university hospital emergency departments in same city between 2015 and 2020 after a SA was investigated. SAs features and distribution of attacks based on variables such as age, gravidity and gestational week etc. was recorded. In addition, obstetric/non-obstetric injuries and pregnancy outcomes was also analyzed.

RESULTS

The mean age of 78 cases was 26.9 ± 6.4 (17-44) years. SAs were detected most frequently in the 1st trimester (42.3%) and at least in the 3rd trimester (20.5%). The most preferred SA method (89.7%) was high-dose drug intake. The most commonly preferred drugs were paracetamol, iron/folic acid replacement therapy drugs and antidepressants.

CONCLUSIONS

Pregnant women are at risk of SA, especially in the first trimester. Contrary to popular belief, 75% of pregnant women who have SA do not have a known psychiatric disease diagnosis before. Therefore, psychiatric evaluation should be a part of routine pregnancy follow-up examination, especially in the first trimester. In this way, pregnant women which have increased risk factors for SA such as alcohol addiction, unwanted pregnancy, and depressive mood can be detected early. In this special patient group, the most commonly SA method is high-dose drug intake. Knowing the high dose treatments for frequently used drugs such as paracetamol by emergency physicians and obstetricians, educating medical staff about treatments can save additional time for mother and fetus and can be a life saver approach.

Investigation of body image perception, self-esteem, and self-confidence in female-to-male transsexuals before and after sex reassignment surgery

PURPOSE

The study was aimed at investigatting the changes in body image perception, self-esteem, and self-confidence of female-to-male transsexuals (FtM) after sex reassignment surgery (SRS).

DESIGN AND METHODS

The quasi-experimental study was conducted with the female individuals who undergo FtM SRS between May 2018 and May 2019. The study data were collected using the Personal Information Form, Body Image Scale, Coopersmith Self-Esteem Inventory, and Self-Confidence Scale.

FINDINGS

It was observed that the patients' postoperative body image perception, self-esteem, and self-confidence improved. As their postoperative body image perception was higher than was their preoperative body image perception, their postoperative self-esteem and self-confidence levels were also higher. In addition, as their self-esteem increased, so did their self-confidence.

PRACTICE IMPLICATIONS

It was found that the patients' postoperative body image perception, self-esteem, and self-confidence improved.

Laparoscopic view of endosalpingiosis in a woman with dermoid cyst and endometriosis

Endosalpingiosis is, like endometriosis, the presence of cystic masses outside of the salpinx which contains fallopian tube epithelium. Endosalpingiosis can be seen on the surface of ovaries, tubal serosa, uterine serosa, myometrium, and also in the bladder. The main clinical features of endosalpingiosis are pelvic pain, adnexal mass which mimics cancer, and urinary symptoms. Herein, we present a surgical video of endosalpingiosis in a woman with endometriosis and a dermoid cyst.

Pipelle endometrial sampling success rates in Kazakhstani settings: results from a prospective cohort analysis

The aim of this study was to evaluate the feasibility of Pipelle endometrial sampling and to explore factors influencing Pipelle success rate in the clinical settings of Kazakhstan. This prospective analysis included 87 patients who had undergone Pipelle biopsy due to medical indications for endometrial sampling. We analysed physician and patient-related factors potentially influencing the success rate of this method. Pipelle endometrial biopsy overall success rate was 82.76%. The indications for the procedure and patients' age were key factors influencing Pipelle sampling success (p < .001). The success rate was the highest in the group with abnormal uterine bleeding as a biopsy indication in the reproductive age group (93.19%; p < .001).Pipelle biopsy was found to be an acceptable option for endometrial sampling in our clinical setting; at the same time, physicians should consider the potential influencing factors on its success rate like indications for the procedure, BMI and patients' age as well as their menopausal status. In order to provide precise future directions, there is a need to study a larger number of patients.IMPACT STATEMENTWhat is already known on this subject? Compared to dilation and curettage sampling conducted in the operation room, Pipelle endometrial sampling is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting.What do the results of this study add? This is the first prospective data analysis about Pipelle endometrial sampling in Kazakhstani population.What are the implications of these findings for clinical practice and/or further research? Enabling the timely diagnosis of current endometrial pathology, Pipelle endometrial sampling approach may have an important impact on healthcare safety and efficiency, and improve overall treatment outcomes and the quality of life of Kazakhstani population if used consistently.

Quality of Life and Perceived Social Support Before and After Sex Reassignment Surgery

This study aimed to explore the pre- and postoperative differences in quality of life and perceived social support of Female-to-Male transsexual patients who underwent mastectomy and complete hysterectomy. Sixty-three Female-to-Male female individuals who underwent complete hysterectomy and mastectomy between November 2019 and November 2020 were included in this study. Data were collected using the Personal Information Form, Multidimensional Scale of Perceived Social Support, and the World Health Organization Quality of Life Scale Short Form. The pre- and postoperative perceived social support mean scores of patients were 57.2 ± 9.0 and 74.9 ± 7.3, respectively. The pre- and postoperative quality of life mean scores of patients were 76.9 ± 8.3 and 107.8 ± 10.1, respectively. There were statistically significant differences between the measurements (p < .05). In addition, the patients whose education level was primary school, whose income was less than their expenditure, whose father was a primary school graduate, whose family had a strict family opinion on sexuality, whose family had a traditional view, and who had a high body mass index were found to have higher postoperative social support perceptions and quality of life. The patients' postoperative quality of life and perceived social support improved after sex reassignment surgery.

Investigating Pelvic Floor Muscle Strength in Women of Reproductive Age and Factors Affecting It

This descriptive study was designed to investigate the pelvic floor muscle strength (PFMS) of women aged 18 to 49 years and to examine the factors that may have an effect on PFMS. The study was conducted on 258 women who visited a gynecology outpatient clinic between January 2019 and January 2020, who met the research criteria, and who agreed to participate in the study. The data were collected using the Sociodemographic Characteristics Information Form. The Modified Oxford Scale (MOS) and a perineometer were used to evaluate the PFMS of the women. The mean PFMS value measured using the perineometer was 31.56 ± 12.17 cmH₂O (moderate pressure). The PFMS values were 20.00 to 29.9 cmH₂O (weak pressure) and 30.00 to 39.9 cmH₂O (moderate pressure) in 23.6% of the women, respectively. The PFMS values measured with MOS were of grade 3 strength (moderate pressure) in 23.6% of the women and grade 2 strength (weak pressure) in 23.3%. A statistically significant strong correlation was found between the perineometer measurement and the women's MOS values. Moreover, a statistically significant difference was found between the PFMS values measured with the perineometer, MOS scores, and women's age groups, educational status, marital status, employment status, income status, persistent cough, use of nicotine, alcohol and coffee consumptions, chronic constipation, history of frequent urinary tract infections, regular exercise, body mass index, history of pregnancy, mode of delivery, use of episiotomy at birth, perineal rupture at birth, use of forceps vacuum at birth, multiple pregnancies, delivery of a baby weighing ≥4,000 g, treatment during pregnancy, hysterectomy, menopause, frequency of sexual intercourse, and pain during sexual intercourse (p < .05). We conclude that most of the women in the study had weak to moderate PFMS, that the evaluation of PFMS with the MOS positively overlapped with the perineometric measurements, and that a number of sociodemographic and obstetric variables act as risk factors that affect PFMS. The PFMS of all women should be assessed as part of their routine gynecological examinations.

The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy

We aimed to investigate the effects of chewing gum on bowel activity and postoperative pain in patients undergoing laparoscopic hysterectomy. Patients were randomised into two groups (n = 58, study; n = 51, control). In the study group, patients started chewing sugarless gum every 2 h for 15 min, beginning at the second postoperative hour. The control group did not chew gum, and they received standard postoperative care. Both groups were compared primarily in terms of the amount of time until the first bowel movement, the time of the first passage of flatus and the time of first defaecation. The amount of time until the first bowel movement, the time of the first passage of flatus and the time of the first defaecation were found to be significantly shorter in the chewing gum group (p < .001). The amount of postoperative analgesics that were needed and VAS scores at 6-hours and 24-hours postoperatively, were found to be lower in the study group than in the control group (p < .001). Chewing gum was found to have beneficial effects on bowel motility and postoperative pain in patients undergoing laparoscopic hysterectomy. This affordable and simple method could be recommended to patients after total laparoscopic hysterectomy.Impact statementWhat is already known on this subject? Postoperative gastrointestinal dysfunction remains a source of morbidity and the major determinant of length of stay after abdominal operation. The mechanism of enhanced recovery from postoperative gastrointestinal dysfunction with the help of chewing gum is believed to be the cephalic-vagal stimulation of digestion which increases the promotability of neural and humoral factors that act on different parts of the gastrointestinal tract.What do the results of this study add? The findings of previous randomised controlled studies have been inconsistent regarding the effect of chewing gum on postoperative bowel function following abdominal gynecological surgery. In this randomised prospective study, we found that chewing gum early in the postoperative period after total laparoscopic hysterectomy hastened time to bowel motility and flatus. To our knowledge this is the first study of the impact of chewing gum on bowel motility after total laparoscopic hysterectomy.What are the implications of these findings for clinical practice and/or further research? Chewing gum early in the postoperative period following laparoscopic hysterectomy hastens time to bowel motility and flatus. The use of chewing gum is a simple and cheap strategy for promoting the recovery of gastrointestinal functions.

Effectiveness of a one-day laparoscopic suture course

We aimed to determine the effectiveness of a one-day course on laparoscopic suturing skills development by performing a prospective study with obstetrics and gynaecology specialists. The course consisted of a theoretical portion describing the suturing technique basics and a practical portion consisting of box trainer suturing. Before and after the course, each trainee was given 10 min to introduce the suture material into the abdomen, properly position the needle using a needle holder, pass the suture through premarked points on the silicone pads and tie an intracorporeal knot. The procedures were video recorded and evaluated after the course. The results showed that there were statistically significant reductions in the needle holding, suture passing and knot tying times after completing the course. Overall, the one-day course was an effective training programme for improving a surgeon's laparoscopic suturing skills. IMPACT STATEMENT What is already known on this subject? Currently, many countries have centres that provide laparoscopic training as part of the medical residency education. However, a standardised training programme has not been implemented worldwide. What do the results of this study add? In this study, we pointed out the effectiveness of a one-day laparoscopic suturing course. A one-day suturing course is easy to implement, cheap and effective. What are the implications of these findings for clinical practice and/or further research? A one-day suturing course should be implemented worldwide, especially in those countries lacking sufficient financial resources to provide laparoscopic training as part of the medical residency programme.

Tadalafil attenuates ischemic damage as well as reperfusion injury in the rat ovary

Objective:

Tadalafil is a selective phosphodiesterase type-5 inhibitor with a long half-life. It has a dual function in ischaemic and re-perfused tissues, i.e. vasodilatation and anti-oxidant effects. These features of tadalafil distinguish it from other anti-oxidants. We investigated the dual effect of tadalafil on ischaemia and reperfusion injury in the rat ovary.

Material and Methods:

We established five study groups. Group 1 (n=6): sham-operated; group 2 (n=6): torsion; group 3 (n=6): torsion and Tadalafil; group 4 (n=6): torsion/de-torsion; and group 5 (n=6): torsion/de-torsion and tadalafil. Ovarian samples were harvested from animals and evaluated in terms of histopathologic changes, tissue malondialdehyde (MDA) concentrations, lactate production, and plasma cyclic guanosine monophosphate (cGMP).

Results:

Follicular degeneration, oedema, haemorrhage, and inflammatory cells were significantly decreased in group 5 in comparison with group 4. Group 2 and group 3 were compared in terms of vascular congestion and haemorrhage; these parameters were significantly decreased in group 3. In addition, significantly decreased MDA and lactate concentrations were observed in group 5 in comparison with group 4. Increased cGMP concentrations were detected in group 3 and group 5.

Conclusion:

We conclude that tadalafil might be useful in protecting the ovary against ischaemia and reperfusion injury. In the evet of ovarian torsion, it will provide a greater therapeutic effect than only performing de-torsion of the ovary or using other anti-oxidant agents.

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligament fixation (SSLF), and iliococcygeus fixation due to apical prolapse. Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgery performed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeus fixations. Patients' short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed. Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in the SSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter in the iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period, no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominal sacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332). Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedures were not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-related morbidity.

Uterine rupture in pregnancy after robotic myomectomy

Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. A gravida 2 para 1 woman aged 40 years who was 33-34 weeks pregnant presented to our clinic with serious abdominal pain, nausea and vomiting that had begun 6 hours previously. Her past surgical history included a robotic myomectomy 2 years ago in our unit. Obstetric ultrasonography revealed a 33-week fetus without a heartbeat whereupon she underwent emergency laparotomy and we found a 4 cm rupture on the anterior wall of the uterus. Uterine rupture should always be kept in mind, especially in patients with history of uterine surgery.

Intracranial foreign body (bullet) during pregnancy

Intracranial foreign bodies during pregnancy is a very rare condition, however its maternal and fetal outcomes are very crucial with regard to morbidity and mortality. Furthermore wounding by firearms is still a public health problem particularly in our country. Intracranial foreign bodies during pregnancy is high risk pregnancy and must be managed with care and multidisciplinary approach. During this course and labour avoiding the increase in intracranial pressure is the most important key point. In this case report we present the follow-up and outcome of a patient with bullet in brain after intracranial injury caused by firearm.