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Cagan M, Donmez HG, Fadiloglu E, Beksac MS. Skin disorders in women with poor obstetric history: MTHFR polymorphisms and importance of preconceptional counseling. Curr Med Res Opin 2024; 40:905-909. [PMID: 38557333 DOI: 10.1080/03007995.2024.2337668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES This study focused on the link between skin disorders and Methylenetetrahydrofolate reductase (MTHFR) polymorphisms. METHODS Study cases were taken from a pre-conceptional care program where patients with poor obstetric history were evaluated in terms of systemic disorders including skin diseases. This retrospective cohort (n = 472) consisted of 110 (23.3%) and 362 (76.7%) women with or without skin disorders, respectively. For ease of analysis, the history of skin diseases was classified into seven categories: (1) acne/rosacea/other acneiform disorders; (2) fungal disease; (3) pruritis/xerosis; (4) psoriasis vulgaris; (5) acrochordons and other benign skin growths; (6) urticaria/dermatitis; and (7) viral diseases. RESULTS In this retrospective cohort of 472 women, we explored the impact of MTHFR A1298C and C677T polymorphisms on skin disorders. Despite similar allelic frequencies, our findings revealed a statistically significant association between the presence of MTHFR polymorphisms and skin disorders (p = .027). Subgroup analysis indicated significantly higher rates of MTHFR polymorphisms in patients with psoriasis vulgaris (p = .033) and acrochordons (p = .030), highlighting their potential relevance in specific skin disorder subtypes. CONCLUSIONS The increased prevalence of psoriasis and acrochordons among women with MTHFR deficiency underscores the complex relationship between genetic factors and dermatological health. Our findings emphasized the critical role of MTHFR polymorphisms not only in poor obstetric history but also as significant contributors to skin disorders. This dual association highlights the importance of comprehensive preconception counseling, especially customized for women affected by skin disorders.
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Affiliation(s)
- Murat Cagan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Türkiye
| | - Erdem Fadiloglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
- Department of Obstetrics and Gynecology, Istinye University, Liv Ankara Hospital, Ankara, Türkiye
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Donmez HG, Celik HT, Kayki G, Tanacan A, Cagan M, Yigit S, Yurdakok M, Cakar AN, Beksac MS. Impact of Prematurity on the Buccal Epithelial Cells of the Neonates via Wnt/Beta-Catenin Signaling Pathway and Apoptosis. Am J Perinatol 2024; 41:445-451. [PMID: 34891194 DOI: 10.1055/s-0041-1740348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Understanding the reflections of prematurity is necessary for the management of neonatal complications. We focused on the impact of prematurity and related "maternal risk factors/obstetric complications" on buccal cells of the neonates via evaluation of the Wnt/β-catenin signaling pathway and apoptosis. STUDY DESIGN This study consisted of "early preterm neonates (EPN) (≤34th gestational week [gw]) (n = 36)," "late preterm neonates (LPN) (34th- < 37th gw) (n = 46)," and "term neonates (control) (≥37th gw) (n = 56)." Cohort was also subclassified according to the presence of maternal risk factors, obstetric complications, and neonatal complications. Wnt/β-catenin signaling and caspase-3 activation pathways were studied immunocytochemically. RESULTS Wnt/β-catenin signaling positivity was statistically more frequent at buccal smears of the EPN and LPN groups compared with controls (p < 0.001). The cutoff for gestational age at delivery in receiver operating characteristic curve with the best balance of sensitivity (67.4%) and specificity (67.3%) was 35.8th gw for determining the reduction of Wnt/β-catenin signaling positivity (p < 0.001). The study demonstrated that obstetric complications significantly affected the activity of signaling, while maternal risk factors do not have any effect on Wnt/β-catenin signaling pathway (p = 0.003 and p = 0.828, respectively). This study also demonstrated a significant relationship between Wnt/β-catenin signaling pathway and the presence of neonatal complications (p = 0.015). CONCLUSION Dynamic characteristics of buccal cells are influenced by prematurity and related obstetric and neonatal problems. Buccal smear is a good tool to investigate the impact of prematurity and obstetric problems on perinatal outcome. KEY POINTS · Neonatal buccal cells are affected by prematurity and related obstetric/neonatal problems.. · 35.8th gw is critical for determining the reduction of Wnt/β-catenin signaling positivity.. · Obstetric and neonatal complications significantly related to Wnt/β-catenin signaling activity..
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Hasan Tolga Celik
- Division of Neonatology, Department of Pediatrics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Gozdem Kayki
- Division of Neonatology, Department of Pediatrics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Yigit
- Division of Neonatology, Department of Pediatrics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Murat Yurdakok
- Division of Neonatology, Department of Pediatrics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Ayse Nur Cakar
- Department of Histology, Faculty of Medicine, TOBB University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Gencer EB, Akin HY, Toprak SK, Turasan E, Yousefzadeh M, Yurdakul-Mesutoglu P, Cagan M, Seval MM, Katlan DC, Dalva K, Beksac MS, Beksac M. In vivo and in vitro effects of cord blood hematopoietic stem and progenitor cell (HSPC) expansion using valproic acid and/or nicotinamide. Curr Res Transl Med 2024; 72:103444. [PMID: 38447268 DOI: 10.1016/j.retram.2024.103444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND High self-renewal capacity and most permissive nature of umbilical cord blood (CB) results with successful transplant outcomes but low hematopoietic stem and progenitor cell (HSPC) counts limits wider use. In order to overcome this problem ex vivo expansion with small molecules such as Valproic acid (VPA) or Nicotinamide (NAM) have been shown to be effective. To the best of our knowledge, the combinatory effects of VPA and NAM on HSPC expansion has not been studied earlier. The aim of this study was to analyze ex vivo and in vivo efficacy of VPA and NAM either alone or in combination in terms of expansion and engraftment. METHODS A total of 44 CB units were included in this study. To determine the ex vivo and in vivo efficacy, human CB CD34+ cells were expanded with VPA and/or NAM and colony forming unit (CFU) assay was performed on expanded HSPC. Xenotransplantation was performed simultaneously by intravenous injection of expanded HSPC to NOD-SCID gamma (NSG) mice (n = 22). Significance of the difference between the expansion groups or xenotransplantation models was analyzed using t-test, Mann-Whitney, ANOVA or Kruskal-Wallis tests as appropriate considering the normality of distributions and the number of groups analyzed. RESULTS In vitro CD34+ HSPC expansion fold relative to cytokines-only was significantly higher with VPA compared to NAM [2.23 (1.07-5.59) vs 1.48 (1.00-4.40); p < 0.05]. Synergistic effect of VPA+NAM has achieved a maximum relative expansion fold at 21 days (D21) of incubation [2.95 (1.00-11.94)]. There was no significant difference between VPA and VPA+NAM D21 (p = 0.44). Fold number of colony-forming unit granulocyte-macrophage (CFU-GM) colonies relative to the cytokine-only group was in favor of NAM compared to VPA [1.87 (1.00-3.59) vs 1.00 (1.00-1.81); p < 0.01]. VPA+NAM D21 [1.62 (1.00-2.77)] was also superior against VPA (p < 0.05). There was no significant difference between NAM and VPA+NAM D21. Following human CB34+ CB transplantation (CBT) in the mouse model, fastest in vivo leukocyte recovery was observed with VPA+NAM expanded cells (6 ± 2 days) and the highest levels of human CD45 chimerism was detectable with VPA-expanded CBT (VPA: 5.42 % at day 28; NAM: 2.45 % at day 31; VPA+NAM 1.8 % at day 31). CONCLUSION Our study results suggest using VPA alone, rather than in combination with NAM or NAM alone, to achieve better and faster expansion and engraftment of CB HSPC.
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Affiliation(s)
| | - Hasan Yalim Akin
- Ankara University Faculty of Medicine Cord Blood Bank, Ankara, Turkey; Middle East Technical University, Department of Biochemistry, Ankara, Turkey
| | - Selami Kocak Toprak
- Ankara University Faculty of Medicine Cord Blood Bank, Ankara, Turkey; Ankara University Faculty of Medicine Department of Hematology, Ankara, Turkey
| | - Eylul Turasan
- Ankara University Faculty of Medicine Cord Blood Bank, Ankara, Turkey
| | - Mahsa Yousefzadeh
- Ankara University Faculty of Medicine Cord Blood Bank, Ankara, Turkey; Ankara University Stem Cell Institute, Ankara, Turkey
| | | | - Murat Cagan
- Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Murat Seval
- Ankara University Faculty of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Doruk Cevdi Katlan
- Istanbul Training and Research Hospital Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Klara Dalva
- Ankara University Stem Cell Institute, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey; Istinye University, Ankara Liv Hospital, Obstetrics and Gynecology, Ankara, Turkey
| | - Meral Beksac
- Ankara University Faculty of Medicine Department of Hematology, Ankara, Turkey; Istinye University, Ankara Liv Hospital, Hematology and Stem Cell Transplantation Unit Ankara, Turkey.
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Uzelpasacı E, Ozcakar L, Özgül S, Özyüncü Ö, Beksac MS, Akbayrak T. Significance of Physical Exercise in Pregnancy: Comparison of Short and Long Exercise Programs. Z Geburtshilfe Neonatol 2024. [PMID: 38286413 DOI: 10.1055/a-2231-7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Several musculoskeletal changes occur in pregnancy, particularly in the abdominal region. The aim of this study was to search and compare the effects of long (LEP) and short exercise programs (SEP) in terms of the satisfaction of the needs of pregnant women. METHODS This study consisted of 2 groups: LEP (n=16) and SEP (n=16). Muscle thickness measurements determined by ultrasound, the 6 minute walk test, Pregnancy Physical Activity Questionnaire, Visual Analogue Scale, Oswestry Disability Index, and Short Form-36 Quality of Life Questionnaire were the study variables. Evaluations were done at the 16th (baseline), 24th, and 32nd gestational weeks. The LEP consisted of 20 and the SEP consisted of 9 exercises, which were applied for 16 weeks until the 32nd gestational week. RESULTS Emotional role limitation and pain scores of quality of life, 6 minute walk test, and occupational physical activity were found to be better in the LEP group at the 24th gestational week (p=0.043, p=0.049, p=0.049, p=0.026). At the 32nd gestational week, the 6 minute walk test and occupational physical activity were found to be higher in the LEP group (p=0.006, p=0.017). Additionally, rectus abdominis and bilateral diaphragm muscle thicknesses, "moderate intensity and sports physical activity" and "vitality and emotional well-being" were increased over time with the LEP (p+<+0.05 for all). On the other hand, unilateral diaphragm muscle thickness, sports physical activity level, and vitality were improved with the SEP (p+<+0.05 for all). CONCLUSIONS The SEP and LEP both have beneficial effects in pregnant women. However, the LEP increases physical activity level, functional capacity, and quality of life more than the SEP during the later stages of pregnancy.
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Affiliation(s)
- Esra Uzelpasacı
- Faculty of Gülhane Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | | | - Serap Özgül
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Özgür Özyüncü
- Medical School, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Fadiloglu E, Donmez HG, Beksac K, Beksac MS. Impact of Increased Activated Protein-C Resistance, Decreased Antithrombin III Activity and Hypocomplementemia on the Gestational Outcomes of Pregnancies with MTHFR Polymorphisms. Z Geburtshilfe Neonatol 2023; 227:434-440. [PMID: 37579788 DOI: 10.1055/a-2134-6452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To evaluate the impact of increased Activated Protein C (APC) resistance, decreased antithrombin III activity and hypocomplementemia on the pregnancy outcomes of the patients with methylentetrahydrofolate reductase (MTHFR) polymorphisms. METHODS This study was composed of 83 pregnancies with MTHFR polymorphisms. Increased APC resistance, decreased antithrombin III activity and hypocomplementemia were accepted as risk factors for poor gestational outcome. RESULTS Having at least one risk factor resulted in significantly higher rates of "APGAR score of<7" at the first ten minutes (p=0.009). Composite adverse outcome rate was also higher in patients with at least one of the defined risk factors despite lack of statistical significance (p=0.241). Rate of newborn with an "APGAR score of<7" at first ten minutes was significantly higher at patients with hypocomplementemia (p=0.03). CONCLUSION Hypocomplementemia is a risk factor for poor gestational outcome in pregnancies with MTHFR polymorphisms.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Hacettepe University Faculty of Science, Ankara, Turkey
| | - Kemal Beksac
- Department of General Surgery, Dr. Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Donmez HG, Beksac MS. Association of single nucleotide polymorphisms (4G/5G) of plasminogen activator inhibitor-1 and the risk factors for placenta-related obstetric complications. Blood Coagul Fibrinolysis 2023; 34:396-402. [PMID: 37577872 DOI: 10.1097/mbc.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Placenta-related obstetric complications (PROCs) such as miscarriage, fetal growth restriction, preeclampsia, and preterm birth are the major causes of maternal and fetal morbidity and mortality. The objective of this study was to search the relevance of plasminogen activator inhibitor-1 (PAI-1) polymorphisms and co-morbidities and the risk factors for PROCs such as miscarriage, fetal growth restriction, preeclampsia, and preterm birth. METHOD This retrospective study analyzed the PAI-1 genotype in a cohort of 268 multiparous women with poor obstetric history. Poor obstetric history was defined as the presence of at least one of the PROCs and/or poor gestational outcomes at the previous pregnancy/pregnancies. RESULTS 5G allele frequency was higher than the 4G allele frequency in the cohort (0.767 vs. 0.233). The frequencies of having at least one risk factor are relatively similar among the different PAI-1 genotypes ( P > 0.05). However, the presence of MTHFR polymorphisms (homozygous and compound heterozygous forms of C677T and A1298G) and hereditary thrombophilia (Factor V Leiden and prothrombin G20210A gene mutations, and FXIII deficiency) were found to be associated with PAI 4G/4G ( P = 0.048) and 5G/5G ( P = 0.022) genotypes, respectively. Significant differences were not observed in other risk factors and co-morbidities such as autoimmune disorders, chronic inflammatory diseases, history of venous thromboembolism, carbohydrate metabolism disorders, hyperlipidemia, cardiovascular and cerebrovascular diseases depending on PAI-1 genotypes ( P > 0.05). CONCLUSION MTHFR polymorphisms were found to be associated with PAI 4G/4G genotype, while 5G/5G genotype was observed more frequently in hereditary thrombophilia cases.
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Affiliation(s)
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Sahal G, Donmez HG, Beksac MS. Cervicovaginal Bacillus velezensis Isolate: A Potential Probiotic and an Antagonist Against Candida and Staphylococcus. Curr Microbiol 2023; 80:332. [PMID: 37642756 DOI: 10.1007/s00284-023-03447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
The cervicovaginal microbiota is an essential aspect of women's reproductive and overall health. In this study, we aimed to evaluate the probiotic properties of a cervicovaginal isolate, obtained from a gynecologically healthy woman and assess its antagonistic effect against various microorganisms isolated from the vagina. Cytological examination was performed using Papanicolaou staining, and the isolated microorganism was identified via 16S Ribosomal RNA Gene Sequence Analysis. Probiotic characteristics were evaluated by determining the tolerance of the isolate to low pH, different NaCl concentrations, and bile salts. Bacterial adherence to stainless steel sheets, antibiotic susceptibility, and antimicrobial activity tests were also conducted and analyzed. Antimicrobial tests and antagonistic activities were assessed through disc diffusion assays. The cervicovaginal isolate was identified as B. velezensis ON116948 and was found to be tolerant to low pH, high NaCl and 0.3% bile salts. Additionally, it exhibited adherence. With the exception of amoxicillin/clavulanic acid (AMC) (30 μg) and oxacillin (OX) (1 μg), this isolate was susceptible to all the antibiotics tested. Candida species did not grow on B. velezensis spread media, while B. velezensis was able to grow on C. albicans, C. glabrata, C. tropicalis, S. condimenti and S. epidermidis spread media with growth zones of 13.7 ± 0.6, 13.3 ± 0.6, 14.2 ± 4.4, 10.5 ± 0.5 and 16.0 ± 1.0 (around discs), respectively. Our findings suggest that the cervicovaginal B. velezensis ON116948 isolate exhibits probiotic properties and antagonistic activity. These results provide important insights into the potential use of this isolate as a probiotic for the prevention of vaginal infections.
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Affiliation(s)
- Gulcan Sahal
- Department of Biology (Biotechnology), Faculty of Science, Hacettepe University, Ankara, Turkey.
| | - Hanife Guler Donmez
- Department of Biology (General Biology), Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Cagan M, Donmez HG, Dikmen ZG, Beksac MS. Association of lupus anticoagulants with risk factors for obstetric complications and adverse gestational outcome. Hum Antibodies 2023:HAB230003. [PMID: 37248894 DOI: 10.3233/hab-230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Lupus anticoagulant (LA) may be a cause of poor obstetric outcome. OBJECTIVE To search the association of LA with risk factors for obstetric complications and adverse gestational outcome. METHODS This retrospective cohort was consisted of 2 groups of pregnancies with poor obstetric history; 1) LA (+) gestations (Study Group, n= 20) and 2) LA (-) gestations (Control Group, 78). All patients were admitted to a special antenatal care program and were examined in terms of risk factors for thrombotic events, placenta-related obstetric complications, and poor gestational outcomes. Patients were administered low-dose low-molecular-weight heparin (LMWH), low-dose salicylic acid and low-dose corticosteroid (if necessary) within the framework of a prophylaxis protocol in addition to their already existing medications. RESULTS We have shown that adverse gestational outcome was 1.7-fold more frequent in LA (+) pregnancies with poor obstetric history (p= 0.039, 70% vs. 41%). Higher rates of autoimmune diseases and hereditary thrombophilia were observed among LA (+) patients compared to LA (-) gestations (35% vs. 10.3%, p< 0.012 and 55% vs. 19.2%, p< 0.003, respectively). To identify the effectiveness of low-dose LMWH prophylaxis protocol, we compared gestational outcomes and demonstrated that the miscarriage rate was significantly decreased to half in current pregnancies compared to the previous gestations (73.6% vs. 35%, p= 0.003). CONCLUSIONS Autoimmune diseases and hereditary thrombophilia are more frequent in LA (+) pregnancies, and these women are prone to obstetric problems. Low-dose LMWH and salicylic acid prophylaxis are critical in the management of LA (+) pregnant women.
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Affiliation(s)
- Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Zeliha Gunnur Dikmen
- Department of Medical Biochemistry, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Unal C, Fadiloglu E, Cagan M, Ziyadova G, Kaya E, Tanacan A, Beksac MS. Refusal of the hospitalization: a distressed dilemma in obstetric practice. Ther Adv Reprod Health 2023; 17:26334941231216531. [PMID: 38152477 PMCID: PMC10752054 DOI: 10.1177/26334941231216531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/15/2023] [Indexed: 12/29/2023] Open
Abstract
Background Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns. Objectives We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians' recommendations. Design We have retrospectively evaluated the patients admitted to the 'Obstetric Emergency Outpatient Clinic' and refused hospitalization between 1 January 2019 and 31 December 2019. Methods Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients. Results A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters. Conclusion Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements.
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Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital, Ankara 06100, Turkey
| | - Gunel Ziyadova
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Esra Kaya
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Sekkin Eser M, Ulutas Ugur Y, Tanacan A, Gurbuz Hekimoglu R, Cakar AN, Beksac MS. Evaluation of umbilical cord immune cells in pregnancies with autoimmune disorders and/or methylenetetrahydrofolate reductase polymorphisms. J Perinat Med 2022; 50:910-925. [PMID: 35344642 DOI: 10.1515/jpm-2021-0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate umbilical cord immune cells in pregnancies with autoimmune disorders (AID) and/or methylenetetrahydrofolate reductase (MTHFR) polymorphisms. METHODS Umbilical cords were obtained from seven AID women without MTHFR polymorphisms, eight with AID and MTHFR polymorphisms, nine with MTHFR polymorphisms, and eight with neither. Umbilical cords were assessed immunohistologcally by anti-CD4, anti-CD8, anti-CD14, anti-CD19, anti-CD21, and anti-CD56 antibodies in six umbilical cord zones: 1) arterial wall 2) periarterial zone 3) venous wall 4) perivenous zone 5) intervascular zone, and 6) subamniotic zone. RESULTS AIDs and MTHFR polymorphisms had an effect on the number and composition of CD4+ cells in the venous wall. The presence of a MTHFR polymorphism may affect the number and morphology of CD4+ cells in the subamniotic zone. CD8+ cell distribution is substantially influenced by the presence of maternal risk factors. The co-existence of AID with MTHFR polymorphism has a prominent effect on the number and morphology of CD14+ cells, especially in the arterial wall. CD19+ cells were only observed in the control group in the venous wall, perivenous zone, and intervascular zone. CD21+ cells were only observed in the arterial wall of the control group and the intervascular zone of the AID group with different morphologic features. The number and morphology of CD56+ cells is prominently affected by the presence of maternal risk factors. CONCLUSIONS Umbilical cord stem cell and immune cell composition may be affected by the presence of risk factors like MTHFR polymorphisms and/or AID.
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Affiliation(s)
- Miray Sekkin Eser
- Department of Histology & Embryology, Hacettepe University, Ankara, Turkey
| | - Yesim Ulutas Ugur
- Department of Histology & Embryology, Lokman Hekim University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey.,Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Rumeysa Gurbuz Hekimoglu
- Department of Histology & Embryology, Hacettepe University, Ankara, Turkey.,Department of Histology & Embryology, Bezmialem Vakıf University, İstanbul, Turkey
| | - Ayse Nur Cakar
- Department of Histology & Embryology, Hacettepe University, Ankara, Turkey.,Department of Histology & Embryology, TOBB University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University, Ankara, Turkey
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11
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Beksac K, Donmez HG, Cagan M, Beksac MS. Impact of anti-thyroid peroxidase and anti-thyroglobulin antibodies on the gestational outcome of euthyroid pregnancies: A retrospective study. Hum Antibodies 2022; 30:157-163. [PMID: 35912736 DOI: 10.3233/hab-220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thyroglobulin (anti-TG) and/or thyroid peroxidase (anti-TPO) autoantibodies are associated with higher rates of poor gestational outcomes. OBJECTIVE To demonstrate the impact of anti-TPO and anti-TG autoantibodies on the gestational outcomes of euthyroid pregnant women with a history of poor gestational outcome and thyroid gland disorders. METHODS This retrospective study included totally 75 euthyroid pregnant, 30 of women with high thyroid autoantibodies (Anti-TPO/Thyroglobulin-positive group) and 45 of them without autoantibodies (control group). RESULTS We could not demonstrate significant differences between two groups in terms of risk factors/co-morbidities, obstetric complications, gestational outcomes, and birth data (p> 0.05). However, enhanced miscarriage rates were observed among the Anti-TPO/Thyroglobulin-positive and control groups without significance (36.7% and 17.8% respectively, p= 0.116). High neonatal intensive care unit (NICU) admission rates were found for control and Anti-TPO/Thyroglobulin-positive groups (16.2% and 21.1%, respectively) (p= 0.720). Clinically, we compared the two groups in terms of the existence and the types of goiter (diffuse and nodular), and demonstrated that nodular goiter was statistically more frequent in the control group (40.0% vs. 8.7%, p= 0.015). Alongside, relatively high hereditary thrombophilia and type-2 diabetes mellitus rates were found in the Anti-TPO/Thyroglobulin-positive group (20.0% and 20.0%). CONCLUSION Thyroid autoantibody positivity is likely a risk factor for early pregnancy loss and NICU admission.
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Affiliation(s)
- Kemal Beksac
- Department of General Surgery, Ankara Oncology Hospital, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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12
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Donmez HG, Akgor U, Onder S, Tanacan A, Kuru O, Ozgul N, Usubutun A, Hufbauer M, Akgül B, Beksac MS. Impact of Human Papillomavirus on Wnt/Beta-Catenin Signaling in Morphological Inconspicuous Cervicovaginal Cells. Acta Cytol 2022; 66:409-419. [PMID: 35306501 DOI: 10.1159/000522635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/12/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to identify early changes in the Wnt/beta-catenin signaling pathway in high-risk human papillomavirus (HPV) infected cervicovaginal cells and to correlate these changes with cell proliferation, apoptosis, and autophagic processes. METHODS We evaluated 91 cervicovaginal smears of women with (n = 41) and without (n = 50) HPV-DNA. Smears were stained against beta-catenin, c-myc, secreted frizzled-related protein 4 (sFRP4), cleaved caspase-3, and the autophagy markers Beclin-1 and light chain 3B. In addition, sFRP-1, -2, -3, -4, -5 mRNA levels were determined by quantitative reverse transcription-PCR in primary keratinocytes and FaDu cells expressing HPV16-E6, -E7, or -E6E7. RESULTS Our data indicated that the Wnt/beta-catenin signaling is activated in HPV (+) cervicovaginal cells that can already be detected in cells with no obvious changes in cellular morphology (HPV [+]/cyto [-]). These cells also had significantly higher sFRP4 levels when compared to HPV-negative samples. In primary keratinocytes, sFRP4 was found to be absent and sFRP1 and sFRP2 to be repressed in the presence of HPV16-E6 and E7. Interestingly, sFRP4 is expressed in FaDu cells and can be upregulated in the presence of E6E7. Curiously, SFRP4 expression correlated with an increase in the level of autophagic markers in HPV (+)/cyto (-) smears. CONCLUSION In conclusion, the activation of the Wnt/beta-catenin signaling pathway and upregulation of sFRP4, paralleled by an activation of the autophagic pathway may represent predisposing cellular factors early after HPV infection which need to be further determined in larger study.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
- Institute of Virology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Utku Akgor
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sevgen Onder
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Oguzhan Kuru
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nejat Ozgul
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Martin Hufbauer
- Institute of Virology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Baki Akgül
- Institute of Virology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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13
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Cagan M, Okuducu U, Donmez HG, Beksac MS. Singleton pregnancy losses before gestational week 22 among patients with autoimmune disorders and Methylenetetrahydrofolate reductase polymorphisms. Hum Antibodies 2022; 30:59-65. [PMID: 35001885 DOI: 10.3233/hab-211517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The rates of pregnancy losses (PLs) are increased by maternal risk factors such as autoimmune disorders (AD) and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms. OBJECTIVE To evaluate singleton PLs before gestational week (gw) 22 among patients with AD and MTHFR polymorphisms. METHODS Totally, 1108 singleton pregnancies in 243 women were categorized as: 1) 148 pregnancies in 33 patients with AD, 2) 316 pregnancies in 66 patients with MTHFR polymorphisms, 3) 644 pregnancies in 144 patients with AD +MTHFR polymorphisms. PLs were classified into subgroups: a) Chemical Pregnancy(CP), b) Blighted Ovum(BO), c) gw ⩽ 10, d) gw11-14 e) gw15-22, f) Ectopic Pregnancy(EP), g) Trophoblastic Disease(TD). Obstetric histories were compared using Beksac Obstetrics Index (BOI): [number of living child + (π/10)]/gravida. RESULTS PL rates before gw22 were 39.2% (58/148), 33.2% (105/316), and 36.3% (234/644) in AD, MTHFR, and AD +MTHFR groups, respectively (p= 0.421). The rate of Pre-Prenatal Screening Period fetal losses (CP + BO + gw ⩽ 10 fetal losses + EP + TD) were 84.8%, 75.9%, and 77.8% in AD, MTHFR, and AD +MTHFR, respectively (p= 0.264). Gravidity ⩽ 4 versus those with gravidity ⩾ 5 had statistically significant differences in BOI (p< 0.001). CONCLUSIONS PL rate before gw22 among singleton pregnancies with AD and/or MTHFR polymorphisms was 35.8%. The clinical findings seem to be more complicated in patients with gravidity ⩾ 5.
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Affiliation(s)
- Murat Cagan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ummuhan Okuducu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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14
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Orgul G, Dalva K, Dalva-Aydemir S, Alniacik RG, Donmez HG, Cakar AN, Beksac M, Beksac MS. Significance of inhibitory maternal killer-cell immunoglobulin-like receptor (KIR) and fetal KIR ligand genotype combinations in placenta related obstetric complications. J Reprod Immunol 2021; 148:103425. [PMID: 34607283 DOI: 10.1016/j.jri.2021.103425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/10/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Some maternal killer-cell immunoglobulin-like receptor (KIR) and fetal KIR ligand genotypes are associated with obstetric complications, such as recurrent miscarriage, fetal growth restriction, preeclampsia, and preterm birth. However, how KIR/KIR ligand genotypes affect these placenta-related obstetric complications has not been fully understood. We aimed to demonstrate the association of maternal KIR-fetal KIR ligand genotype combinations with immunological/metabolic risk factor associated placenta-related obstetric complications. This study consisted of three groups of pregnant women: 1) Miscarriage group (n = 30), 2) Complicated Pregnancy (CP) group (n = 30), and 3) Control group (n = 30). The observed maternal genotype frequencies of all inhibitory and activating KIRs were similar in all groups (p > 0.05). However, inhibitory 2DL3 was quite frequent in the miscarriage group (p = 0.052). There was no difference between groups in terms of centromeric and telomeric maternal haplotypes (p > 0.05). The fetal group 1 HLA-C genotype was frequently detected in the miscarriage and CP groups with rates of 83.3 % and 93.3 % respectively, while the observed frequency was 70 % in the control group. The fetal group 2 HLA-C genotype was the same in all groups. The results demonstrated significantly less fetal group 2 HLA-C homozygosity in the CP groups when compared to the control group (p = 0.020). The fetal HLA-Bw4 genotype was detected more frequently in the miscarriage and CP groups (p = 0.028 and p = 0.001, respectively). The inhibitory KIR/KIR ligand genotype combinations of 2DL3-C1 and 3DL1-Bw4 were more frequent in the miscarriage and CP groups (p = 0.045 and p = 0.002, respectively). Enhanced NK cell inhibition may be one of the mechanisms underlying placenta-related obstetric complications.
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Affiliation(s)
- Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Turkey.
| | - Klara Dalva
- Division of Haematology, Department of Internal Medicine, Ankara University, Turkey.
| | | | | | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey.
| | - Ayse Nur Cakar
- Department of Histology and Embryology, TOBB University, Ankara, Turkey.
| | - Meral Beksac
- Division of Haematology, Department of Internal Medicine, Ankara University, Turkey.
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Turkey.
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15
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Tanacan A, Orgul G, Aydin E, Kayki G, Celik HT, Yalcin S, Soyer T, Yigit S, Yurdakok M, Beksac MS. Antenatal management and outcomes of pregnancies with congenital diaphragmatic hernia. J Neonatal Perinatal Med 2021; 13:323-330. [PMID: 31796690 DOI: 10.3233/npm-190266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study is to evaluate the obstetric outcomes of pregnancies with congenital diaphragmatic hernia (CDH). METHODS Fifty one pregnancies prenatally diagnosed with CDH at our institution between January 1, 2002 and August 31, 2018 were retrospectively evaluated. The pregnancies were divided into two groups according to neonatal survival. Demographic features, clinical characteristics and prognostic factors were compared between the neonatal survival (n = 16) and non-survival (n = 28) groups. Cut-off values of fetal lung area to head circumference ratio (LHR), observed/expected LHR (o/e LHR) and observed/expected total fetal lung volume (o/e TFLV) for neonatal survival were calculated. RESULTS Thirty six (70.6%) and fifteen (29.4%) fetuses had left and right sided CDH respectively. Seven patients chose termination of their pregnancies (13.7%). Statistically significant differences were found between survival and non-survival groups in terms of parity, median gestational week at diagnosis, polyhydroamniosis rate, CDH type, stomach position, liver position, median LHR, o/e LHR, o/e TFLV, median 5th minute Apgar score and neonatal operation rate values (p values were 0.03,<0.001, 0.02, 0.006,<0.001, 0.006,<0.001,<0.001,<0.001, 0.04 and <0.001 respectively). According to ROC curve analysis, 1.05 (82% sensitivity, 74% specificity) for LHR, 22.5 (78.6% sensitivity, 73.9% specifity) for o/e LHR and 23.5 (85.7% sensitivity,74.2% specificity) for o/e TFLV were determined to be cut-offs for neonatal survival, respectively, with highest sensitivity and specificity. CONCLUSION Earlier gestational week at diagnosis, right sided CDH, presence of liver herniation, supradiaphragmatic stomach position, lower LHR, o/e LHR and o/e TFLV were associated with decreased rates of neonatal survival.
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Affiliation(s)
- Atakan Tanacan
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe University Hospital, Ankara, Turkey
| | - Gokcen Orgul
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe University Hospital, Ankara, Turkey
| | - Emine Aydin
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe University Hospital, Ankara, Turkey
| | - Gozdem Kayki
- Department of Pediatrics, Division of Neonatology, Hacettepe University Hospital, Ankara, Turkey
| | - Hasan Tolga Celik
- Department of Pediatrics, Division of Neonatology, Hacettepe University Hospital, Ankara, Turkey
| | - Sule Yalcin
- Department of Pediatric Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Sule Yigit
- Department of Pediatrics, Division of Neonatology, Hacettepe University Hospital, Ankara, Turkey
| | - Murat Yurdakok
- Department of Pediatrics, Division of Neonatology, Hacettepe University Hospital, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe University Hospital, Ankara, Turkey
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Beksac MS, Donmez HG. Association of increased C-Reactive Protein and hypocomplementemia with risk factors for thrombosis in women who have susceptibility for poor gestational outcome; importance of preconceptional counseling. Hum Antibodies 2021; 29:249-254. [PMID: 34275896 DOI: 10.3233/hab-210452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study aimed to investigate the association of increased C-Reactive Protein (CRP) and hypocomplementemia with risk factors for thrombosis such as Factor V Leiden (FVLP) and Prothrombin G20210A polymorphisms (PP), increased Activated Protein C Resistance (APCR) and decreased anti-thrombin III (ATIII) activity in women who have metabolic (MTHFR polymorphisms) and immunological risk factors (autoimmune antibody positivity, autoimmune disorders, and chronic inflammatory diseases). All patients (n= 197) were evaluated in terms of risk factors for thrombosis including FVLP, PP, increased APCR, and decreased ATIII activity as well as CRP and complement (C) 3 and C4 levels within a framework of preconceptional care program. Patients with high CRP levels together with hypocomplementemia were included to the study group (n= 13), while women with normal levels of CRP, C3, and C4 were accepted as controls (n= 184). Decreased ATIII activity was found to be statistically more frequent in the study group compared to controls (p= 0.036). There were no significant differences between the study and control groups in terms of the presence of FVLP, PP and increased APCR (p= 0.386, p= 0.462, p= 0.625, respectively). Decreased ATIII activity should be the concern of preconceptional and antenatal care programs in risky patients with increased CRP levels and hypocomplementemia in order to prevent placental inflammation related gestational complications.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
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17
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Donmez HG, Celik HT, Kayki G, Yigit S, Yurdakok M, Cakar AN, Beksac MS. Impact of preterm birth on the cellular characteristics of neonatal buccal cells. Cytopathology 2021; 32:660-670. [PMID: 34033163 DOI: 10.1111/cyt.12992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To demonstrate the impact of preterm birth on the cytological, cytomorphometrical, and nuclear parameters of neonatal buccal smears. METHODS This study consisted of Early Preterm Neonates (EPN; ≤34th gestational week [gw]; n = 36), Late Preterm Neonates (LPN; 34th to <37th gw; n = 46), and Term Neonates (control; ≥37th gw; n = 56). Cytological evaluation and buccal cytome assay were performed using Papanicolaou and Feulgen methods, respectively. RESULTS Cytological evaluation demonstrated that smear background was cleaner (P < .05) and there were less macrophages in the control group (P < .001). Cyto-morphometric analysis showed that the measurements of nuclear diameter, nuclear area, and nucleus-to-cytoplasm ratio were higher in the preterm (EPN and LPN) versus the control groups (P = .016, P < .001, and P < .001, respectively). We also demonstrated that staining intensity of the nucleus and cytoplasm were less intense in the EPN and LPN groups (P < .001). There was no statistically significant difference between the EPN and LPN groups for any parameters (P > .05). Buccal cytome assay showed that nuclear buds were more prevalent in term newborns compared to preterm neonates (P < .001). CONCLUSIONS Morphological and cytological properties of neonatal buccal cells are influenced by preterm birth status, and buccal smears may be used as a tool to detect biological markers of neonatal health problems.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Hasan Tolga Celik
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gozdem Kayki
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Yigit
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Yurdakok
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayse Nur Cakar
- Department of Histology, Faculty of Medicine, TOBB University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Cagan M, Unal C, Urel Demir G, Fadiloglu E, Ozgul RK, Beksac MS. Obstetrical history of a family with combined oxidative phosphorylation deficiency 3 and methylenetetrahydrofolate reductase polymorphisms. Case Reports in Perinatal Medicine 2021. [DOI: 10.1515/crpm-2020-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Recurrent pregnancy loss (RPL) is a devastating complication of pregnancy with various etiologic backgrounds.
Case presentation
We present a case of combined oxidative phosphorylation deficiency 3 (COXPD3) carrier pregnant woman with Methylenetetrahydrofolate reductase (MTHFR) polymorphisms. She had five pregnancy losses and a postpartum death due to COXPD3. The patient was admitted to our clinic for the first time at her seventh pregnancy with oocyte donation. The patient was registered in a special antenatal care program and delivered a healthy baby at term. Her eighth pregnancy was terminated due to COXPD3 which was prenatally diagnosed.
Conclusions
Comprehensive and individualized approaches are necessary in RPL cases to obtain optimal outcomes.
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Affiliation(s)
- Murat Cagan
- Department of Obstetrics and Gynecology , Division of Perinatology, Hacettepe University , Ankara , Turkey
| | - Canan Unal
- Department of Obstetrics and Gynecology , Division of Perinatology, Hacettepe University , Ankara , Turkey
| | - Gizem Urel Demir
- Department of Pediatric Genetics , Hacettepe University , Ankara , Turkey
| | - Erdem Fadiloglu
- Department of Obstetrics and Gynecology , Division of Perinatology, Hacettepe University , Ankara , Turkey
| | - Riza Koksal Ozgul
- Department of Pediatrics , Division Pediatric Metabolism, Hacettepe University , Ankara , Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology , Division of Perinatology, Hacettepe University , Ankara , Turkey
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Beksac MS, Donmez HG. Impact of hydroxychloroquine on the gestational outcomes of pregnant women with immune system problems that necessitate the use of the drug. J Obstet Gynaecol Res 2020; 47:570-575. [PMID: 33146470 DOI: 10.1111/jog.14561] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the impact of hydroxychloroquine (HCQ) on the perinatal outcomes of pregnancies with immune system disorders that necessitate the use of the drug. METHODS This cohort consisted of 202 pregnancies with poor obstetric history and immune system problems. Patients enrolled in special antenatal care program were administered low-dose low-molecular-weight heparin, low-dose salicylic acid and low-dose corticosteroid (prophylaxis protocol) as soon as their pregnancies were confirmed. Pregnancies with systemic lupus erythematosis, Sjogren syndrome and rheumatoid arthritis were additionally administered HCQ 200 mg daily as a part of their routine treatment. Pregnancies using HCQ were included in the study group (n = 39) while the remainders were included in control group (n = 163). We compared the groups in terms of the presence of miscarriage, fetal growth restriction (FGR), preeclampsia and preterm birth, as well as gestational week at birth, birthweight and "APGAR score of <7" at 10th minute. RESULTS Miscarriage rates were 28.2% and 28.2% while preterm birth rates were 16.6% and 28.2% in the control and study groups, respectively (P = 0.215). Preeclampsia and HCQ-related side effects were not detected in the groups. There were also no significant differences between the groups in terms of FGR, gestational day at birth, birthweight and the presence of "APGAR score <7" at 10th minute (P = 0.462, P = 0.064, P = 0.273 and P = 0.627, respectively). CONCLUSION Low-dose low-molecular-weight heparin, low-dose salicylic acid and low-dose corticosteroid prophylaxis together with HCQ seem to be promising in pregnancies with immune system disorders. HCQ seems to be a safe and effective drug in low dosages.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Gynecology and Obstetrics, Hacettepe University, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
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Tanacan A, Eyupoglu M, Fadiloglu E, Zengin HY, Karaagaoglu E, Beksac MS. Use of the 50-g glucose challenge test to predict small-for-gestational-age neonates. J Diabetes 2020; 12:791-797. [PMID: 32469124 DOI: 10.1111/1753-0407.13068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/14/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To determine a cutoff value for the 50-g glucose challenge test (50-g GCT) for the prediction of small-for-gestational-age (SGA) neonates. METHODS This retrospective cohort study was conducted among pregnant women who were screened with the 50-g GCT at Hacettepe University Hospital between 1 January 2016 and 31 March 2019. Patients with 50-g GCT values <74 mg/dL (<10th percentile) served as the study group (n = 244), while patients with 50-g GCT values between 74 to 139 mg/dL served as the control group (n = 3104). Groups were compared in terms of demographic features, clinical characteristics, and obstetric outcomes. Logistic regression analysis was used to determine independent predictors of SGA. Receiver operating characteristic curves were used to assess the performance of 50-g GCT values in predicting SGA. RESULTS Lower birthweight, birthweight percentile, and 5th-minute Apgar values, together with higher rates of SGA, were observed in the study group (P < .001 for all). A 50-g GCT value below the 10th percentile (odds ratio: 3.29, 95% CI: 2.31-4.69, P < .001) was a significant independent factor for SGA. A cutoff value of 89.5 mg/dL (84.9% sensitivity, 85.6% specificity) was determined for SGA. CONCLUSIONS Low 50-g GCT values (<89.5 mg/dL) may be an early indicator for SGA.
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Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mert Eyupoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | | | | | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Tanacan A, Fadiloglu E, Celebioglu ED, Orhan N, Unal C, Celik T, Kalyoncu AF, Beksac MS. The Effect of Asthma Severity on Perinatal Outcomes: A Tertiary Hospital Experience. Z Geburtshilfe Neonatol 2020; 225:333-340. [PMID: 33058100 DOI: 10.1055/a-1264-8207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of asthma severity and disease exacerbation on pregnancy outcomes. MATERIALS AND METHODS Pregnancies were classified into 3 groups as mild (n=195), moderate (n=63), and severe (n=26) according to preconceptional asthma severity. Demographic features, clinical characteristics, and perinatal outcomes were compared between the groups. Delivery characteristics and pregnancy outcomes were also compared between the pregnancies with or without asthma exacerbation (43 and 241 pregnancies, respectively). RESULTS Worsening of symptoms during pregnancy was higher in moderate and severe asthma groups (p<0.001). Rates of spontaneous abortion, fetal structural anomaly, preterm delivery, preeclampsia, fetal growth restriction (FGR), oligohydramnios, gestational diabetes, and intrauterine fetal demise were higher in moderate and severe asthma groups (p-values were < 0.001, 0.01, 0.008, 0.02, 0.01, < 0.001, < 0.001, and 0.007, respectively). Admissions to neonatal intensive care units and neonatal complication rates were higher among moderate and severe asthma groups (p=0.035 and < 0.001). Spontaneous abortion, preterm delivery, preeclampsia, FGR, oligohydramnios, and neonatal complication rates were higher (p<0.001) in the group with exacerbated symptoms. CONCLUSION Moderate to severe asthma before pregnancy and the exacerbation of asthma symptoms during pregnancy may lead to increased rates of perinatal complications.
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Affiliation(s)
- Atakan Tanacan
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Erdem Fadiloglu
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ebru Damadoglu Celebioglu
- Division of Allergic and Immunological Diseases, Department of Chest Disease, Hacettepe Universitesi Tip Fakultesi, Ankara
| | - Nazli Orhan
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Canan Unal
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Tolga Celik
- Division of Neonatology, Department of Pediatrics, Hacettepe Universitesi Tip Fakultesi, Ankara
| | - Ali Fuat Kalyoncu
- Division of Allergic and Immunological Diseases, Department of Chest Disease, Hacettepe Universitesi Tip Fakultesi, Ankara
| | - Mehmet Sinan Beksac
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Fadiloglu E, Karatas E, Tez R, Cagan M, Unal C, Nar M, Tanacan A, Beksac MS. Assessment of Factors Affecting Breastfeeding Performance and Latch Score: A Prospective Cohort Study. Z Geburtshilfe Neonatol 2020; 225:353-360. [PMID: 33022737 DOI: 10.1055/a-1255-3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the risk factors that may affect LATCH scores. MATERIALS AND METHODS We prospectively evaluated the LATCH scores and any relevant risk factors of patients who delivered at our institution during April and May 2020. All examinations were performed by the same physicians during the study period. LATCH scores were determined at initial breastfeeding session, and postnatal days 1 and 2. RESULTS We analyzed 338 patients in this prospective study. Patients with high-risk pregnancies were found to have lower LATCH scores at each measurement (p: 0.002, 0.001, and 0.09, respectively). Skin-to-skin contact immediately after delivery and breastfeeding longer than 20 min in the first session did not improve LATCH scores (p>0.05). Breastfeeding within 30 min after delivery significantly improved LATCH scores at each session (p<0.01 for all). Odds ratios of having a LATCH score lower than 8 was 10.9 (95% CI: 4.22-28.37) for the patients breastfed after more than 30 min, while this ratio was 2.17 (95% CI: 1.34-3.50) and 6.5 (95% CI: 3.46-12.58) for the patients having a high-risk pregnancy and cesarean section, respectively. Furthermore, we also determined a positive statistically significant association between parity and all LATCH scores according to regression analyses (p: 0.005, 0.028, and 0.035 for LATCH scores at initial breastfeeding, postnatal day 1 and 2, respectively) CONCLUSION: High-risk pregnancies, patients who delivered by cesarean section, and patients not attempting to breastfeed within 30 min tend to have lower LATCH scores.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Esra Karatas
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ruya Tez
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Makbule Nar
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
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Cagan M, Tanacan A, Donmez HG, Fadiloglu E, Unal C, Beksac MS. The Effect of Small Size Uterine Fibroids on Pregnancy Outcomes in High-risk Pregnancies. Rev Bras Ginecol Obstet 2020; 42:535-539. [PMID: 32992356 PMCID: PMC10309216 DOI: 10.1055/s-0040-1713913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid. METHODS This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes. RESULTS There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy. CONCLUSION Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safely performed in properly selected cases.
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Affiliation(s)
- Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
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Beksac B, Donmez HG, Cagan M, Unal C, Fadiloglu E, Beksac MS. Acrochordons and autoimmunity: Significance of preconceptional counseling. Hum Antibodies 2020; 28:335-339. [PMID: 32831198 DOI: 10.3233/hab-200426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acrochordons are benign hypertrophic lesions of the skin of which the pathophysiology is unclear. OBJECTIVE This study aimed to examine the association of acrochordons with autoimmune disorders in patients with a poor obstetric history. METHODS This retrospective cohort involved 350 female patients with poor obstetric history who were included in a preconceptional care program to investigate risk factors for obstetric complications. These patients were further investigated for the co-existence of autoimmune disorders (defined by either a diagnosis of autoimmune diseases or autoimmune antibody positivity) and acrochordons. RESULTS An autoimmune disorder was present in 55.7% (195/350) of the patients. The rate of acrochordons was significantly higher in patients with autoimmune disorders (n= 195) compared to the control group (n= 155) (8.21% versus 2.58%, respectively) (p= 0.043). When the autoimmune disease positive (n= 58) and autoimmune antibody-positive (n= 137) groups were separately analyzed, acrochordons were found more frequently in the autoimmune disease group (p= 0.004). However, there was no statistically significant co-occurrence of autoimmune antibody positivity and the presence of skin tags (p= 0.135). CONCLUSION There may be immune system-related biological mechanisms underlying the pathogenesis of acrochordons. Preconceptional counseling is beneficial for women with poor obstetric history and acrochordons.
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Affiliation(s)
- Burcu Beksac
- Department of Dermatovenereology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Tanacan A, Fadiloglu E, Unal C, Beksac MS. Importance of shock index in the evaluation of postpartum hemorrhage cases that necessitate blood transfusion. Women Health 2020; 60:1070-1078. [PMID: 32757719 DOI: 10.1080/03630242.2020.1802638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study aims to determine cutoff values for shock index (SI) to predict the need for transfusion and composite adverse outcomes in postpartum hemorrhage (PPH) cases. One hundred thirty PPH cases (study group) that necessitated blood transfusion were retrospectively compared to a frequency-matched control group (n = 130). Receiver operating characteristic (ROC) curves and decision tree [Classification & Regression Tree (C&RT) and Chi-square Automatic Interaction Detector (CHAID)] were used to identify cutoff values for SI. Cutoff values for postdelivery, peak and delta SI values for the prediction of PPH that required transfusion were 0.9125 (0.815 sensitivity, 0.923 specificity), 0.9145 (0.892 sensitivity, 0.823 specificity) and 0.195 (0.823 sensitivity, 0.885 specificity), while cutoff values for the same SI values in the prediction of composite adverse outcome were 1.315 (0.645 sensitivity, 0.616 specificity), 1.183 (0.613 sensitivity, 0.737 specificity) and 0.487 (0.710 sensitivity, 0.758 specificity). Delta SI was superior to postdelivery and peak SI in the prediction of PPH that required transfusion. Peak SI was superior to postdelivery and delta SI in the prediction of composite adverse outcome. In conclusion, increased postdelivery, peak, and delta SI values were related to adverse outcomes for PPH. SI seems to be a practical and effective method for the objective assessment of postpartum hemorrhage.
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Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University , Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University , Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University , Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University , Ankara, Turkey
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Donmez HG, Sahal G, Akgor U, Cagan M, Ozgul N, Beksac MS. The relationship between the presence of HPV infection and biofilm formation in cervicovaginal smears. Infection 2020; 48:735-740. [PMID: 32623704 DOI: 10.1007/s15010-020-01478-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To demonstrate and understand the association of HPV infection and biofilm formation. METHODS The study consisted of cervicovaginal samples of 72 women who were evaluated at the colposcopy unit. Papanicolaou staining was used for cytological examination while "Crystal Violet Binding" assay was performed to detect biofilm formation. RESULTS HPV-DNA was positive in 55.5% (n = 40) of the patients. The biofilm formation rate was statistically significantly higher in the HPV-positive women (45%) compared to HPV-negative women (21.9%) (P < 0.05). There was a statistically significant relationship between the presence of single HPV and "high-risk HPV" types and biofilm formation (P < 0.05). Biofilm formation was found in 80% of women with abnormal smear demonstrating atypical epithelial cells (P < 0.05). CONCLUSION Biofilm formation is more frequent at the cervicovaginal microbiota of patients with HPV infection. This finding is especially important in cases with atypical epithelial cells at their cervicovaginal smears.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey.
| | - Gulcan Sahal
- Department of Biology, Faculty of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey
| | - Utku Akgor
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Özkan E, Nemutlu E, Beksac MS, Kır S. GC-MS analysis of seven metabolites for the screening of pregnant women with Down Syndrome fetuses. J Pharm Biomed Anal 2020; 188:113427. [PMID: 32683283 DOI: 10.1016/j.jpba.2020.113427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/18/2020] [Accepted: 06/11/2020] [Indexed: 01/14/2023]
Abstract
Down Syndrome is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. Metabolomics is identification and quantification of small-molecule metabolites (molecular weight <1000 Da) in tissues, cells and physiological fluids within a certain period time. Metabolites are intermediate products of various types of biochemical reactions that participate in bonding metabolic pathways. In this study, metabolites such as 2-Hydroxybutyric acid, 3-Hydroxybutyric acid, β-Hydroxyisovaleric acid, Uracil, Glutamic acid, Maltose and Melezitose were chosen as the possible determinants/markers for the prenatal screening of Down Syndrome. Quantitative analysis of the metabolites conducted by GCMS method using 5 % phenyl / 95 % dimethylpolysiloxane (30 m ×0.25 mm, 0.25 μm film thickness) capillary column. The oven temperature was held constant at 60 °C for 1 min and ramped at 10 °C /min to 200 °C then ramped at 30 °C/min to 320 °C and hold for 6 min before cool-down, as helium mobile phase and flow rate of 2.8 mL/min and adding Myristic acid-d27 as an internal standard. Our method was validated by parameters of system suitability, stability, linearity, sensitivity, accuracy, precision, selectivity, robustness and ruggedness. The developed and validated method was applied to plasma samples taken from pregnant women with Down Syndrome (study group) and euploid fetuses (healthy group). The levels of these seven metabolites are statistically different (p < 0.05 for all) between the groups. It can be concluded that these relevant metabolites might be used for the prenatal screening of Down Syndrome.
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Affiliation(s)
- Ece Özkan
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, 06100 Sıhhıye, Ankara, Turkey.
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, 06100 Sıhhıye, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, 06100 Sıhhıye, Ankara, Turkey
| | - Sedef Kır
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, 06100 Sıhhıye, Ankara, Turkey
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Donmez HG, Cagan M, Fadiloglu E, Unal C, Onder SC, Beksac MS. Is bacterial vaginosis associated with autoimmune antibody positivity? Cytopathology 2020; 31:298-302. [PMID: 32358984 DOI: 10.1111/cyt.12846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the association between bacterial vaginosis (BV) and autoimmune antibody positivity. METHOD We evaluated Papanicolaou-stained cervicovaginal smears of 210 patients with poor obstetric history who were admitted to a special preconception counselling programme. Cytological specimens with various types of microorganisms except for BV, epithelial cell abnormalities and other non-neoplastic findings, including inflammation were excluded from the cohort in addition to patients with autoimmune and chronic inflammatory diseases. The remaining study population (n = 121) was divided into two groups of patients with autoimmune antibody positivity (study group, n = 80) and patients without antibody positivity (control group, n = 41). RESULTS The rate of BV was demonstrated to be 13.8% and 2.4% in the study and control groups respectively (P = .042). We also demonstrated that the anti-nuclear antibody was positive in 58.3% of the cases with BV. CONCLUSION BV was found more frequently in patients with autoimmune antibody positivity to a statistically significant degree.
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Affiliation(s)
| | - Murat Cagan
- Department of Gynecology and Obstetrics, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Department of Gynecology and Obstetrics, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Department of Gynecology and Obstetrics, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Sinan Beksac
- Department of Gynecology and Obstetrics, Hacettepe University, Ankara, Turkey
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Tanacan A, Uyanik E, Unal C, Beksac MS. A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes. J Obstet Gynaecol Res 2020; 46:1333-1341. [PMID: 32483902 DOI: 10.1111/jog.14320] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/09/2020] [Accepted: 05/08/2020] [Indexed: 01/30/2023]
Abstract
AIM To determine a cut-off value for systemic immune-inflammation index (SII)(neutrophil × platelet /lymphocyte) in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes (PPROM). METHODS This retrospective cohort study was conducted among singleton pregnancies with PPROM. Cases were divided into two main groups: Group 1) PPROM diagnosed at 24th-28th weeks of gestation and Group 2) PPROM diagnosed at >28th-34th weeks of gestation. Thereafter, main study groups were divided into two subgroups: Subgroup A: pregnancies with favorable neonatal outcomes and Subgroup B: pregnancies with composite adverse neonatal outcomes. Subgroups were compared in terms of demographic features, clinical characteristics, laboratory test results and SII values. Furthermore, cut-off values of SII for the prediction of composite adverse neonatal outcomes were determined for two main groups. A Mann-Whitney U test was conducted to compare the median values and the chi-square test was used to compare categorical variables among the groups. Receiver operating characteristic (ROC) curves were used to assess the performance of SII value in predicting composite adverse neonatal outcomes. RESULTS Significant differences were observed for median platelet and SII values between the subgroups (P < 0.001 for both in group 1 and P = 0.002 and P = 0.005, respectively, in group 2). Cut-off values of 1695.14 109 /L (83.3% sensitivity, 85.7% specificity) and 1430.90 × 109 /L (71.4% sensitivity, 75.7% specificity) for composite adverse neonatal outcomes were determined, respectively in group 1 and 2 according to the ROC curve analysis. CONCLUSION SII may be used as an additional indicator for the prediction of adverse neonatal outcomes in PPROM.
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Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Esra Uyanik
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Tanacan A, Ozgen B, Fadiloglu E, Unal C, Oguz KK, Beksac MS. Prenatal diagnosis of central nervous system abnormalities: Neurosonography versus fetal magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2020; 250:195-202. [PMID: 32460228 DOI: 10.1016/j.ejogrb.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To share our experience in diagnosis of congenital central nervous system (CNS) abnormalities by fetal magnetic resonance imaging (MRI). STUDY DESIGN This study consisted of 110 pregnancies. Neurosonography (NS) findings were compared with MRI results. Anomalies were categorized into 10 groups: 1) Corpus callosum (CC) and cavum septum pellucidum (CSP) anomalies, 2) Neural tube defects (NTD), 3) Posterior fossa anomalies (PFA), 4) Primary ventriculomegaly (PVM), 5) Microcephaly, 6) Macrocephaly, 7) Periventricular leukomalacia (PVL), 8) Craniosynostosis, 9) Intracranial hemorrhage (ICH) and 10) Lumbosacral teratoma. Demographic features, clinical characteristics and perinatal outcomes of the study subjects were evaluated. RESULTS Gestational weeks for NS and for MRI were 25.5 and 26.5 weeks, respectively. Fourteen (12.7%) pregnancies were terminated. PVM (n = 36, 32.7%), CC and CSP anomalies (n = 29, 26.3%), PFA (n = 11, 10%) and NTD (n = 11, 10%) were the most common fetal MRI indications. There were no statistically significant differences between the accuracy of fetal NS and fetal MRI for CC and CSP anomalies, NTDs, PFA and PVM (p = 0.09, 0.43, 0.45 and 0.23, respectively). However, fetal MRI was more accurate for the detection of normal anatomic findings in cases with suspected microcephaly, macrocephaly and craniosynostosis in NS when pooled together (p = 0.007). Furthermore, MRI also seemed to be advantageous in CC & CSP anomalies though it was not validated by statistical measures. No statistically significant difference was found for diagnostic performance of NS and MRI according to gestational week (p = 0.27). CONCLUSION Fetal MRI in addition to NS may improve diagnostic accuracy in pregnancies with congenital CNS abnormalities.
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Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey.
| | - Burce Ozgen
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Beksac MS, Tanacan A, Ozten G, Cakar AN. Low-dose low-molecular-weight heparin prophylaxis against obstetrical complications in pregnancies with metabolic and immunological disorder-associated placental inflammation. J Matern Fetal Neonatal Med 2020; 35:1546-1553. [PMID: 32354247 DOI: 10.1080/14767058.2020.1760834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: We investigated the importance of prophylactic administration of low-dose low-molecular-weight heparin (LMWH) in women with risk factors associated with placental inflammation.Materials and methods: This retrospective cohort study included 300 pregnant women with a singleton pregnancy (30 primigravidas and 270 multigravidas) who received prophylactic low-dose LMWH to prevent placental inflammation. Based on maternal risk factors, patients were categorized into 3 groups as follows: Group 1: Patients with metabolic risk factors for placental inflammation (n = 205), Group 2: Patients with immunological risk factors for placental inflammation (n = 42), Group 3: Patients with metabolic and immunological risk factors for placental inflammation (n = 53). Obstetric histories, demographic features, clinical characteristics, and present pregnancy outcomes were compared between groups. Live birth rates, composite adverse obstetric outcomes, and the Beksac obstetric index were compared between present and previous pregnancies in multigravidas.Results: Pregnancy outcomes were significantly better in the present pregnancy than in previous pregnancies. A significant increase was observed in live birth rates (33.4% vs. 69.9%, 27.5% vs. 60.5%, and 30.1% vs. 69.4% in groups 1, 2, and 3, respectively) and in the Beksac obstetric index (0.32 vs. 0.43, 0.33 vs. 0.47, and 0.38 vs. 0.57 in groups 1, 2, and 3 respectively) (p < .001 for all). A significant decrease in composite adverse pregnancy outcome rates was observed during the present pregnancy (23.5% vs. 100%, 28.9% vs. 100%, and 24.5% vs. 100% in groups 1, 2, and 3, respectively) (p < .001 for all). Live birth and composite adverse obstetric outcome rates were 70% and 33.3%, respectively in primigravidas.Conclusion: Low-dose low-molecular-weight heparin prophylaxis is useful to prevent metabolic and immunological disorders causing placental inflammation, which is the most likely pathophysiological mechanism contributing to various obstetrical complications.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Gonca Ozten
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Ayse Nur Cakar
- Department of Histology and Embryology, TOBB ETU University, Ankara, Turkey
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Recber T, Orgul G, Aydın E, Tanacan A, Nemutlu E, Kır S, Beksac MS. Metabolic infrastructure of pregnant women with methylenetetrahydrofolate reductase polymorphisms: A metabolomic analysis. Biomed Chromatogr 2020; 34:e4842. [PMID: 32267539 DOI: 10.1002/bmc.4842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
Abstract
The aim of this study was to demonstrate the altered metabolic infrastructure of pregnant women with methylenetetrahydrofolate reductase (MTHFR) polymorphisms at first trimester and during delivery. Eight singleton pregnant women with MTHFR polymorphisms were compared with 10 normal pregnant women. Maternal blood samples were obtained twice during their pregnancy period (between the 11th and 14th gestational weeks and during delivery). Metabolomic analysis was performed using GC-MS. The GC-MS based metabolomic profile helped identify 95 metabolites in the plasma samples. In the MTHFR group, the levels of 1-monohexadecanoylglycerol, pyrophosphate, benzoin, and linoleic acid significantly decreased (P ˂ 0.05 for all), whereas the levels of glyceric acid, l-tryptophan, l-alanine, l-proline, norvaline, l-threonine, and myo-inositol significantly increased (P ˂ 0.01 for the first two metabolites, P ˂ 0.05 for the others) at 11-14 gestational weeks. Conversely, the levels of benzoin, 1-monohexadecanoylglycerol, pyruvic acid, l-proline, phosphoric acid, epsilon-caprolactam, and pipecolic acid significantly decreased in the MTHFR group, whereas metabolites such as hexadecanoic acid and 2-hydroxybutyric acid increased significantly in the study group during delivery. An impaired energy metabolism pathway, vitamin B complex disorders, tendency for metabolic acidosis (oxidative stress), and the need for cell/tissue support seem prevalent in pregnancies with MTHFR polymorphisms.
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Affiliation(s)
- Tuba Recber
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Gokcen Orgul
- Division of Perinatology, Medical Faculty, Department of Obstetrics and Gynecology, Hacettepe University Hospital, Ankara, Turkey
| | - Emine Aydın
- Division of Perinatology, Medical Faculty, Department of Obstetrics and Gynecology, Hacettepe University Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Medical Faculty, Department of Obstetrics and Gynecology, Hacettepe University Hospital, Ankara, Turkey
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sedef Kır
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Medical Faculty, Department of Obstetrics and Gynecology, Hacettepe University Hospital, Ankara, Turkey
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Beksac K, Tanacan A, Cagan M, Dönmez HG, Fadiloglu E, Unal C, Beksac MS. Relationship of Cholelithiasis and Urolithiasis with Methylenetetrahydrofolate Reductase Polymorphisms. J INVEST SURG 2020; 34:1104-1107. [PMID: 32228104 DOI: 10.1080/08941939.2020.1742402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM To investigate the relationship of cholelithiasis and urolithiasis with Methylenetetrehydrofolate Reductase (MTHFR) polymorphism(s) in patients with poor obstetric history to search whether they are risk factors for adverse pregnancy outcome. MATERIALS AND METHOD This study is consisted of 94 patients with poor obstetric history. Patients were evaluated in terms of the presence of cholelithiasis and urolithiasis in association with MTHFR polymorphism(s). Additional laboratory tests including homocysteine measurements were also performed. ROC analysis for assessing the performance of blood homocysteine level in predicting the presence of cholelithiasis and urolithiasis were also performed. RESULTS Patients were divided into three groups such as cholelithiasis group (n = 9, 9.6%), urolithiasis group (n = 18, 19.1%) and control group (n = 67, 71.3%). Groups did not differ in term of age and Beksac obstetrics index (BOI) which is "[living child+(π/10)]/gravidity." The rate of the presence of MTHFR polymorphisms were 88.9% (8/9), 88.9% (16/18) and 43.3% (29/67) in cholelithiasis, urolithiasis and control groups respectively. Median homocysteine levels were found to be 13.1, 11.6 and 7.2 micromol/lt for the groups respectively. Statistically significant differences were found for MTHFR polymorphism rates and homocysteine levels (<0.001 for both). According to ROC analysis, 10.9 mcmol/L (88.9% sensitivity, 89.6% specificity) and 9.25 mcmol/L (83.3% sensitivity, 73.1% specificity) were determined to be cutoff values of homocysteine for cholelithiasis and urolithiasis respectively. CONCLUSION More frequent MTHFR polymorphisms are observed in women with a clinical history of gall or renal stones. Thus, screening of these patients may be benefical for the approprate management of their subsequent pregnancies.
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Affiliation(s)
- Kemal Beksac
- Department of General Surgery, Ankara Oncology Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Hacettepe University, Ankara, Turkey
| | | | - Erdem Fadiloglu
- Division of Perinatology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Hacettepe University, Ankara, Turkey
| | - M S Beksac
- Division of Perinatology, Hacettepe University, Ankara, Turkey
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Kasnakoglu BT, Cakar M, Okem ZG, Tanacan A, Fadiloglu E, Orgul G, Beksac MS. Concerns of Pregnant Women in "Prenatal Screening/Diagnosis" Practice and Termination of Pregnancy. Z Geburtshilfe Neonatol 2020; 224:136-142. [PMID: 32157675 DOI: 10.1055/a-1076-1039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP). STUDY DESIGN This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients' feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP. RESULTS Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP. CONCLUSION Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing women's decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.
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Affiliation(s)
- Berna Tari Kasnakoglu
- Department of Business Administration, TOBB Economics and Technology University, Ankara, Turkey
| | - Mehmet Cakar
- Department of Management, Baskent University, Ankara Turkey
| | - Zeynep Guldem Okem
- Department of International Entrepreneurship, TOBB Economics and Technology University, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Erdem Fadiloglu
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Gokcen Orgul
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Unal C, Karatas E, Fadıloglu E, Portakal O, Beksac MS. Comparison of term and preterm labor procalcitonin and leukocyte cell volume, conductivity and light scatter (VCS) parameters in order to demonstrate the impact of inflammation on the triggering mechanisms of preterm uterin contractions. J Obstet Gynaecol Res 2020; 46:694-698. [DOI: 10.1111/jog.14216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
| | - Esra Karatas
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
| | - Erdem Fadıloglu
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
| | - Oytun Portakal
- Department of BiochemistryHacettepe University Ankara Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
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Beksac MS, Korkmaz A, Kasapoglu T, Ozdemir P, Cosgun E, Tanacan A. Antenatal corticosteroids for women at risk of preterm delivery: the "Emperor's New Clothes" tale in medical practice. J Matern Fetal Neonatal Med 2020; 35:705-712. [PMID: 32093542 DOI: 10.1080/14767058.2020.1731455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To introduce the effect of a single course of betamethasone for pregnant women at risk of preterm delivery (PTD).Materials and methods: In this study, a single course of 12 mg Bethamethasone was administered twice in 24 h (between 24-34 gestational weeks) for antenatal corticosteroid prophylaxis. Four hundred ninety-three neonates fulfilled the inclusion criteria and they were categorized (259 singletons, 192 twins and 42 triplets who met the inclusion criteria) into two groups according to the utilization of antenatal corticosteroid as control (n = 202) and study (n = 291) groups. We used respiratory distress syndrome (RDS), congenital pneumonia, intraventricular hemorrhage (IVH), neonatal sepsis, and bronchopulmonary dysplasia (BPD) as primary outcomes for the evaluation of neonatal morbidity.Results: Study and control groups were similar in terms of clinical characteristics. RDS, congenital pneumonia, neonatal sepsis, and BPD rates were significantly higher in the study group (betamethasone) (p = .05, p = .007, 0.003, and 0.004, respectively) between 24-34 gestational weeks (when the neonates of multiple pregnancies were excluded from the analysis, we have demonstrated that congenital pneumonia (p = .033) and neonatal sepsis (p = .030) were still significantly higher in the betamethasone group). The neonates of 24-28 gestational weeks were compared separately and we demonstrated that RDS (p = .012), congenital pneumonia (p = .022), IVH (p = .044), neonatal sepsis (p = .023), and BPD (0.001) were also more frequent in the study group. When the 28-32 gestational week data were compared, IVH (p = .020) and neonatal sepsis (p = .017) were more frequent in the single course betamethasone users. However, we could not demonstrate a significant difference between the control and study groups between 32-34 gestational weeks in terms of the primary neonatal outcomes used in this study.Conclusion: Single course antenatal betamethasone administration may be ineffective on the respiratory complications of preterm and very preterm infants while it may be unfavorable for extremely preterm infants.What is new about the paper, what could add to the current knowledge: Pregnant women at risk for preterm labor must be under intensive antenatal care programs, and if possible, necessary precautions must be undertaken to prevent fetal hypoxia together with etiology specific treatments. This approach might contribute to better perinatal outcomes than just administering antenatal corticosteroid therapy.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Ayse Korkmaz
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Taner Kasapoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Pinar Ozdemir
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Erdal Cosgun
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Fadiloglu E, Unal C, Tanacan A, Portakal O, Beksac MS. 5 Years' Experience of a Tertiary Center with Thrombocytopenic Pregnancies: Gestational Thrombocytopenia, Idiopathic Thrombocytopenic Purpura and Hypertensive Disorders of Pregnancy. Geburtshilfe Frauenheilkd 2020; 80:76-83. [PMID: 31949322 PMCID: PMC6957351 DOI: 10.1055/a-0865-4442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/15/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022] Open
Abstract
Aim
To evaluate thrombocytopenic pregnancies including gestational thrombocytopenia (GT), idiopathic thrombocytopenic purpura (ITP), and hypertensive disorders of pregnancy (HDP).
Materials and Methods
We evaluated the pregnancy outcomes and laboratory findings of 385 patients diagnosed with GT, ITP, or HDP whose thrombocyte levels were < 150 000/µL.
Results
GT, ITP, and HDP were the final diagnoses in 315 (81.8%), 35 (9.1%), and 35 (9.1%) cases, respectively. Patients diagnosed during the 1st trimester and diagnosed with ITP had significantly lower minimal platelet counts during the antenatal period and prior to delivery (p < 0.001; p < 0.001; p < 0.001; p < 0.001). Transfusion of any kind of blood product was given in 9.9% (n = 38) of all cases. Twelve patients had methylprednisolone and/or intravenous immunoglobulin treatments during the antenatal period. All patients who had undergone medical treatment were also found to have ITP. Four out of 385 patients underwent hysterectomy post partum due to refractory hemorrhage. Analysis of newborn platelet levels showed no statistical differences between any of the groups. Despite the lack of statistical significance, the rate of thrombocytopenia in newborns was 50% in patients with severe thrombocytopenia, while rates were 25.6 and 18.1% in patients with moderate and mild thrombocytopenia, respectively.
Conclusion
Thrombocytopenic pregnancies must be carefully evaluated with regard to the severity of thrombocytopenia, gestational period at initial diagnosis, and etiology. In particular, patients with ITP must be evaluated carefully as these patients are more likely to require transfusions and have platelet counts < 50 × 10
3
/µl.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Oytun Portakal
- Department of Clinical Biochemistry, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Beksac MS, Beksac AT, Tanacan A, Mumusoglu S, Katlan D, Celik HT. Antenatal hydronephrosis and fetal urine sampling. Congenit Anom (Kyoto) 2020; 60:4-9. [PMID: 30629771 DOI: 10.1111/cga.12324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/30/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study is to evaluate the significance of renal pelvis aspiration (RPA) in the management of antenatal hydronephrosis (AHN). This study enrolled 15 AHN cases (one twin pregnancy) that necessitated RPA for AHN. Chromosomal abnormalities, gene disorders, and additional life-threatening congenital abnormalities were eliminated prior to intrauterine interventions. Urine analysis were performed for the evaluation of renal function. Normal renal function was observed in six neonates/infants (40%) (group 1), whereas impaired renal function and various type of urinary system anomalies were observed in 9 neonates/infants (60%) (group 2) during the short-term and longitudinal follow-up periods. There were statistically significant differences in the oligohydroamniosis rate, mean fetal urine sodium value, mean fetal urine β2-microglobulin, mean gestational week at birth, and mean birthweight values between the groups (P = 0.007, P < 0.001, P = 0.035, P < 0.001, and P = 0.001, respectively). Renal pelvis aspiration and urine analysis were substantial for the management of AHN in necessary cases. β2-microglobulin and sodium are clinically useful markers to detect the presence of severe renal damage due to obstructive uropathy and thus, important adjuvants in the proper selection of fetuses for further antenatal interventions.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Sezcan Mumusoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Doruk Katlan
- Department of Obstetrics and Gynecology, Süleymaniye Research and Training Hospital, Istanbul, Turkey
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Fadiloglu E, Unal C, Tanacan A, Cagan M, Beksac MS. Effect of hypocomplementemia on perinatal outcomes of pregnancies with autoimmune disorders. Hum Antibodies 2020; 28:179-184. [PMID: 32116241 DOI: 10.3233/hab-200401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To demonstrate the effect of preconceptional complement levels on perinatal outcomes of pregnancies with autoimmune disorders. METHODS Pregnant women with autoimmune disorders (autoimmune disease and/or autoimmune antibody positivity) who were screened for complement levels (C3 and C4) prior to their pregnancies were enrolled in a special antenatal care program. These patients were administered low-dose low-molecular-weight heparin (enoxaparine, 1 × 2000 Anti-XA IU/0.2 mL/day), low-dose salysilic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1 × 4 mg/day orally) as soon as their pregnancies were confirmed according to the institutional protocol. We have compared hypo- and normocomplement pregnancies with autoimmune disorders in terms of their obstetric and perinatal outcomes. We have also used Beksac Obstetric Index (BOI) which is "[living child + (π/10)]/gravidity" for the comparison of their previous obstetric histories. RESULTS Obstetric and neonatal outcomes showed no significant difference between hypocomplement patients (n= 38) and control group (n= 157) (p> 0.05). "Composite obstetric and perinatal adverse outcome" rates were 26.2% and 27.3% in study and control groups, respectively (p> 0.05). BOI was significantly lower in hypocomplement patients (p: 0.002). Then, we have classified hypocomplement patients into 3 subgroups according to the type of complement (C3, C4 or both). Comparison inbetween these groups revealed no statistical significance in any of the analyzed parameters (p> 0.05). CONCLUSION Low complement levels in pregnant women with autoimmune disorders may be associated with gestational problems and poor obstetric history. Immunomodulatory treatment modalities such as ours may be beneficial for improving the obstetric and neonatal outcomes.
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Okem ZG, Orgul G, Kasnakoglu BT, Cakar M, Beksac MS. Budget impact of incorporating non-invasive prenatal testing in prenatal screening for Down syndrome in Turkey. Health Policy and Technology 2019. [DOI: 10.1016/j.hlpt.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Unal C, Fadiloglu E, Tanacan A, Zaim OC, Beksac MS. Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey. Int J Rheum Dis 2019; 23:101-105. [PMID: 31713329 DOI: 10.1111/1756-185x.13746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS). METHODS This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease-related medical treatment during pregnancy, as drug free, single medication or multiple medication. RESULTS Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty-three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P = .162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P = .267 and P = .297, respectively). CONCLUSION In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia.
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Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Onur Can Zaim
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Tanacan A, Beksac MS. Spontaneous pregnancies in patients with at least one failed IVF cycle after the management of autoimmune disorders, hereditary thrombophilia, and methylation disorders. JBRA Assist Reprod 2019; 23:361-366. [PMID: 31173496 PMCID: PMC6798589 DOI: 10.5935/1518-0557.20190034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aimed to describe the impact on achieving spontaneous pregnancy of
treating patients with at least one failed in-vitro fertilization (IVF)
cycle for autoimmune disorders, hereditary thrombophilia, and methylation
disorders. Methods: Fifty-three patients who met the enrollment criteria seen between January
2007 and October 2017 were included in this retrospective cohort study. The
patients were retrospectively assessed for the presence of hereditary
thrombophilia, methylenetetrahydrofolate reductase (MTHFR) polymorphisms,
serum vitamin B12/folate/homocysteine levels, and autoimmune antibody
positivity. The required data were extracted from the institutional patient
database. Statistical analyses were performed on Statistical Package for the
Social Sciences (SPSS.22®). The Kolmogorov-Smirnov test
was used to evaluate the distribution of the data, and since the data did
not following a normal distribution, proportions and median
(minimum-maximum) values were used. Results: The 53 patients included in the study had singleton pregnancies. The
distribution of autoantibodies was as follows: thyroid peroxidase (n=17);
antithyroglobulin (n=11); double-stranded DNA (n=4); antinuclear (n=8);
anti-smooth muscle (n=1); and anticardiolipin IgG and IgM (n=1). Autoimmune
diseases included Hashimoto's thyroiditis (n=23); SLE (n=7); Behcet's
disease (n=1); Sjogren's syndrome (n=1); ulcerative colitis (n=1); and
anti-phospholipid antibody syndrome (n=1). Ten patients had heterozygous
Factor V Leiden thrombophilia; two had homozygous Factor 5 Leiden
thrombophilia; and three had the prothrombin 20210A heterozygous mutation.
Twenty-eight patients were positive for autoantibodies and hereditary
thrombophilia and/or MTHFR polymorphisms. Conclusions: Evaluation and management of hereditary thrombophilia, MTHFR gene
polymorphisms, and/or autoimmune conditions may be beneficial for patients
with unexplained infertility.
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Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Donmez HG, Beksac MS. Comparison of cytological and immunocytochemical methods for detecting apoptotic epithelial cells in cervicovaginal smears. Diagn Cytopathol 2019; 47:1277-1282. [PMID: 31576675 DOI: 10.1002/dc.24316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/28/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several methods have been applied to detect death cells in tissue, cell culture, and fluid samples. We aimed to compare the cytological and immunocytochemical methods for detecting apoptotic cells in cervicovaginal smears. METHODS Cervicovaginal smears were taken from 102 women for various gynecological complaints. The slides were stained using the Papanicolaou (Pap)-staining method for cytological evaluation. Cleaved caspase 3 (CC3) antibody was used to detect apoptosis by immunocytochemically, and H-Score was used for the evaluation. In Pap-stained smears, apoptosis was detected and evaluated using our new scoring system by the examination of morphological changes of epithelial cells such as apoptotic bodies, blebbing, karyopyknosis, karyorrhexis, and karyolysis. We used Kappa analysis to understand whether there is an agreement between cytological and immunocytochemical methods for detecting apoptotic cells. RESULTS Cytological and immunocytochemical methods showed similarities at a moderate level (κ = 0.482, P < .001). The cytological and immunocytochemical scores were also similar to each other at a fair level (κ = 0.373, P < .001). Pap smears had a sensitivity of 64.40% (95% CI: 50.12-76.01), specificity of 86.04% (95% CI: 72.65-94.83), positive likelihood ratio of 4.62, negative likelihood ratio of 0.41, positive predictive value of 86.36%, negative predictive value of 63.79%, and overall probability of 73.53% compared to immunocytochemical staining. CONCLUSIONS Our results demonstrate that Pap smear and cytological scores alone were not good enough to identify apoptosis compared to the immunocytochemical studies. However, because of its high specificity, it may still be an adequate method to detect apoptotic cells.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Beksac AT, Orgul G, Tanacan A, Uckan H, Sancak B, Portakal O, Beksac MS. Uropathogens and Gestational Outcomes of Urinary Tract Infections in Pregnancies that Necessitate Hospitalization. Curr Urol 2019; 13:70-73. [PMID: 31768172 PMCID: PMC6873071 DOI: 10.1159/000499290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim is to identify uropathogens that cause urinary tract infections (UTIs) that necessitate hospitalization, and analyze outcomes of gestational UTIs. METHODS This study consisted of 30 pregnant women who necessitate hospitalization because of UTI (7.8% of gestational UTIs during the same period of time). UTI that necessitates hospitalization is defined as clinical complaints, urination problems, urine analysis and culture positivity, fever and uterine discomfort. Patients with at least two positive cultures (≥ 100,000 cfu/ml) were included to this study. Antimicrobial susceptibility tests were obtained in all cases in order to determine antimicrobial resistance and to choose the ideal antibiotics for treatment. RESULTS In our study, we have found that Escherichia coli is the most common microorganism (56.7%). Enterococcus faecalis (13.3%) and Klebsiella pneumonia (10%) were other frequently observed microorganisms. In this series, mean gestational week at birth was 35 weeks 5 days (range 23-40 weeks). Mean birthweight was 2,656 g (range 500-3,700 g). Twenty-three cases (76.7%) were hospitalized before 37th gestational week and preterm delivery rate was 56.3%. Maternal risk factors and coexisting diseases were detected in 11 (36.7%) patients as follows: diabetes mellitus in 4, thrombophilia in 3, thyroid disorders in 3 and hydroureteronephrosis in 1 case. Cesarean section rate was 65.2%. CONCLUSIONS Knowing uropathogens of patient population is beneficial in the management of patients and better planning of future medical treatments. Preterm labor seems to be an important complication in pregnancies with UTIs going together with fever and urination problems.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Hasan Uckan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Banu Sancak
- Department of Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oytun Portakal
- Department of Clinical Biochemistry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
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Gurbuz RH, Atilla P, Orgul G, Tanacan A, Dolgun A, Cakar AN, Beksac MS. Impaired Placentation and Early Pregnancy Loss in Patients with MTHFR Polymorphisms and Type-1 Diabetes Mellitus. Fetal Pediatr Pathol 2019; 38:376-386. [PMID: 30955395 DOI: 10.1080/15513815.2019.1600623] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: To evaluate the impact of type-1 diabetes mellitus (DM) and methylenetetrahydrofolate reductase (MTHFR) polymorphisms on impaired placentation leading to early pregnancy loss. Methods: Miscarriage materials were obtained from eight pregnant women with type-1 DM without MTHFR polymorphism, eight with MTHFR polymorphisms without type-1 DM, and eight controls with neither DM nor MTHFR polymorphisms. Insulin-like growth factor-1 (IGF-1), leukemia inhibitory factor (LIF), and Beclin-1 expression were assessed to evaluate placentation. Results: Cytoplasmic LIF, IGF-1, and Beclin-1 expression were decreased in the superficial and glandular epithelial cells of the decidua in both study groups. LIF expression was increased in interstitial trophoblasts in the MTHFR group. IGF-1 expression was decreased in the decidual cells and interstitial trophoblasts in both study groups, while the decrease in stromal cells was noted only in type-1 DM group. Beclin-1 expression was increased in interstitial and villous trophoblasts in both study groups. Conclusion: The expression of IGF-1, LIF, and Beclin-1 are altered in both the decidua and the trophoblasts in pregnancies of women with type-1 DM and MTHFR polymorphisms, compared to normal pregnancies undergoing (elective) terminations.
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Affiliation(s)
- Rumeysa Hekimoglu Gurbuz
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Pergin Atilla
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Gokcen Orgul
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Anil Dolgun
- College of Science, Engineering and Health, Lecturer of Statistics, RMIT University , Melbourne , Australia
| | - Ayse Nur Cakar
- Department of Histogy and Embryology, TOBB University Faculty of Medicine , Ankara , Turkey
| | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine , Ankara , Turkey
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Unal C, Ozkara HA, Tanacan A, Fadiloglu E, Lay I, Topçu M, Cakar AN, Beksac MS. Prenatal enzymatic diagnosis of lysosomal storage diseases using cultured amniotic cells, uncultured chorionic villus samples, and fetal blood cells: Hacettepe experience. Prenat Diagn 2019; 39:1080-1085. [PMID: 31411753 DOI: 10.1002/pd.5547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/25/2019] [Accepted: 08/05/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | | | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Incilay Lay
- Department of Medical Biochemistry, Hacettepe University, Ankara, Turkey
| | - Meral Topçu
- Division of Pediatric Neurology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Ayse Nur Cakar
- Department of Histology and Embryology, TOBB University of Economics and Technology, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Tanacan A, Beksac MS, Orgul G, Duru S, Sener B, Karaagaoglu E. Impact of extractable nuclear antigen, anti-double stranded DNA, antiphospholipid antibody, and anticardiolipin antibody positivity on obstetrical complications and pregnancy outcomes. Hum Antibodies 2019; 27:135-141. [PMID: 30856108 DOI: 10.3233/hab-180359] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extractable nuclear antigen (ENA) and anti-double stranded DNA (anti-dsDNA) positivity and related diseases like systemic lupus erythematosus, Sjögren syndrome, and other autoimmune diseases are known to be associated with obstetrical complications and poor perinatal outcomes. OBJECTIVE To demonstrate the importance of ENA, anti-dsDNA, antiphospholipid (APL), and anticardiolipin (ACL) antibody positivity on pregnancy outcomes. METHODS Ninety one pregnant women with known ENA, anti-dsDNA, APL IgG and IgM, and ACL IgG and IgM antibody positivity were retrospectively compared with 91 randomly selected pregnant woman in terms of obstetrical complications and pregnancy outcomes. Beksac Obstetrics Index-pregnancy (BOIp), calculated as (number of children + (π/10))/gravidity in the current pregnancy, was used to compare the risk level between groups. RESULTS Significant differences were found in the median maternal age, gravidity, number of previous miscarriages, and BOIp between the groups (p= 0.04, p< 0.001, p< 0.001, and p< 0.001, respectively). Significant differences were also found between the study and control groups in the median gestational age at birth, birth weight, and APGAR1 score (p< 0.001 for all). Similarly, significant differences were found between groups in the rates of intra-uterine growth restriction, oligohydramnios, and gestational hypertension (p< 0.001, p= 0.05, and p= 0.05, respectively). There were 3 (3.3%) stillbirths in the study group and none in the control group (p= 0.123). CONCLUSION We evaluated the impact of anti-dsDNA, ENA, APL, and ACL antibody positivity, which may cause immunologic inflammation at placenta and thereby affect pregnancy outcomes.
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Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Sinem Duru
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Burcin Sener
- Department of Clinical Biochemistry, Hacettepe University, Ankara, Turkey
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Aktoz F, Ozyuncu O, Tanacan A, Fadiloglu E, Unal C, Soyer T, Celik T, Beksac MS. Gestational Outcomes of Pregnancies with Prenatally Detected Gastroschisis and Omphalocele. Fetal Pediatr Pathol 2019; 38:282-289. [PMID: 30892123 DOI: 10.1080/15513815.2019.1585501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: To evaluate and compare the outcomes of pregnancies with prenatally detected gastroschisis and omphalocele. Materials and Methods: We retrospectively evaluated prenatally detected gastroschisis and omphalocele cases. Cases were compared in terms of maternal demographic and clinical characteristics as well as pregnancy and neonatal outcomes. Results: This study consisted of 17 gastroschisis and 30 omphalocele cases. Only one case with gastroschisis was terminated due to additional severe limb deformities. Seventeen out of 30 cases of omphalocele were terminated for various reasons (56.7%). All patients with gastroschisis had surgical repair, while 8 out of 13 omphalocele cases had surgery. One patient with an omphalocele died after surgery due to sepsis. Six cases of gastroschisis also died in the neonatal period due to various reasons (6/16, 37.5%). Conclusion: Additional genetic disorders are more frequent in those with omphalocele cases, and they are more frequently terminated during gestation that the gastroschisis fetuses.
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Affiliation(s)
- Fatih Aktoz
- a Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital , Ankara , Turkey
| | - Ozgur Ozyuncu
- a Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital , Ankara , Turkey
| | - Atakan Tanacan
- a Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital , Ankara , Turkey
| | - Erdem Fadiloglu
- a Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital , Ankara , Turkey
| | - Canan Unal
- a Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital , Ankara , Turkey
| | - Tutku Soyer
- b Department of Pediatric Surgery, Hacettepe University Hospital , Ankara , Turkey
| | - Tolga Celik
- c Division of Neonatology, Department of Pediatrics, Hacettepe University Hospital , Ankara , Turkey
| | - Mehmet Sinan Beksac
- a Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital , Ankara , Turkey
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Fadiloglu E, Beksac MS. Reply to the Letter to the Editor: methodological issues on the clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large-for-gestational-age (LGA) fetuses in non-diabetic pregnancies. J Perinat Med 2019; 47:575-576. [PMID: 31017873 DOI: 10.1515/jpm-2019-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey, Tel.: +90 5464750175
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Fadiloglu E, Tanacan A, Unal C, Aydin Hakli D, Beksac MS. Clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies. J Perinat Med 2019; 47:534-538. [PMID: 30817306 DOI: 10.1515/jpm-2018-0373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/24/2019] [Indexed: 11/15/2022]
Abstract
Objective To demonstrate clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies. Methods We retrospectively evaluated 75-g GTT screening results of 356 pregnancies without prompt diagnosis of gestational diabetes mellitus (GDM) between January 2013 and December 2017. Newborns with a birthweight greater than the 90th percentile were evaluated as LGA. Pregnancies with LGA and non-LGA fetuses were compared by demographic and historical factors - maternal age, gravidity, parity, birthweight, birthweek, GTT results and birthweight percentiles - via Student's t-test. Multiple linear regression using the backward elimination method was performed to define the correlation between parameters and LGA (P-value of <0.20 was identified as the threshold). Receiver operator characteristics (ROC) curve analysis was performed for further analysis. Results The cohort was consisted of 45 (12.6%) and 311 (87.4%) pregnancies with LGA and non-LGA fetuses, respectively. Maternal age and 2nd-h GTT results were found to be significantly higher in patients with LGA newborns (P<0.001 and P=0.016, respectively). Fasting glucose levels and GTT 1st-h results were also higher (P=0.112, P=0.065). The coefficient of multiple determination (R2) was 0.055 by multiple linear regression analysis. Accordingly, GTT 2nd-h result and maternal age were statistically significant and contributed to the explanation of LGA, although the R2 value was not that much higher (P=0.016; P=0.001). Maternal age and GTT 2nd-h results were found to be associated with LGA fetuses with area under the curve (AUC) values of 0.662 and 0.608 according to ROC curve analysis. Conclusion Maternal age and 75-g GTT 2nd-h results were significantly higher in gestations with LGA newborns without GDM.
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Affiliation(s)
- Erdem Fadiloglu
- Hacettepe University, Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey, Tel.: +90 5464750175
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
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