A new conservative treatment approach to vesicovaginal fistula cases: a case report and mini-review of the literature

EINLEITUNG

Eine vesikovaginale Fistel (VVF) ist ein anormaler Weg zwischen der Blase und der Vagina, der es ermöglicht, dass Urin kontinuierlich unbeabsichtigt in die Vagina abfließt. Die Operation ist die am häufigsten bevorzugte Methode zur Behandlung von Frauen, jedoch wird die chirurgische Option für einige Patienten aufgrund der Patientennachfrage und der Kostenanalyse nicht gewählt. Außerdem kann nach einer chirurgischen VVF-Reparatur eine Restharninkontinenz beobachtet werden. In diesem Zustand werden konservative Behandlungsmethoden versucht. Der Erfolg dieser Methoden bleibt jedoch begrenzt. In diesem Sinne ist die Notwendigkeit für ein neues Behandlungsmodell entstanden.

FALLBERICHT

Wir haben einen neuen Ansatz getestet, einschließlich der Injektion von plättchenreichem Plasma in den Fistelgang, und es hat eine kürzere Erholungszeit von 10 Tagen bewirkt, wenn nur die Katheterisierung und die anticholinerge Anwendung berücksichtigt wurden.

SCHLUSSFOLGERUNG

Plättchenreiches Plasma kann vesikovaginale Fisteln behandeln, es hätte die Schließzeit verkürzen können und die Erfolgsrate der Operation erhöhen können, wenn es vor der Operation angewendet wird.

Early Prediction of Gestational Diabetes Mellitus Using Placental Strain Elastography and Subcutaneous Adipose Tissue Thickness

AIM

The aim of this study is to investigate the efficacy of placental strain ratio values measured by real-time sonoelastography and maternal subcutaneous adipose tissue thickness measured by two-dimensional ultrasonography in predicting gestational diabetes mellitus in the first trimester.

MATERIALS AND METHODS

The population of the study consisted of the first 210 consecutive singleton pregnant women who applied for routine first-trimester screening between the 11th and 14th week of gestation.B-mode subcutaneous adipose tissue thickness sonography and real-time placental strain elastography scanning were performed.All patients underwent 75 g oral glucose tolerance test between the 24th and 28th week of gestation. American Diabetes Association criteria were used in the diagnosis of gestational diabetes mellitus.

RESULTS

It was observed that body mass index (p<0.001), first-trimester fasting blood sugar (p<0.001), subcutaneous adipose tissue thickness (p<0.001), and placental strain ratio value (p<0.001) affected the development of gestational diabetes mellitus statistically. The multivariate analysis shown that subcutaneous adipose tissue thickness (odds ratio=1.271, 95% CI=1.142-1.416, p<0.001) and placental strain ratio value (odds ratio=3.664, 95% CI=1.927-6.969, p<0.001) were the independent risk factors affecting the development of gestational diabetes mellitus.

CONCLUSIONS

The findings of this study indicated a positive correlation between 75 g oral glucose tolerance test application and first trimester subcutaneous adipose tissue thickness and placental strain ratio. Using the cut-off values of>11.5 mm for subcutaneous adipose tissue and>0.986 for placental strain ratio, the development of gestational diabetes mellitus may be predicted in the early weeks of pregnancy.

Evaluation of Spreadable Kefir Produced from Different Milks in Terms of Some Quality Criteria

Kefir, which has many beneficial effects on health, is one of the most consumed fermented milk products worldwide. It is important to increase consumption of the fermented product for public health. In this study, it was aimed to increase the beneficial effects of kefir on public health. Therefore, kefirs produced from different types of milk (cow, buffalo, sheep, and goat) were concentrated, and obtained spreadable kefir samples were investigated in terms of their microbiological characteristic (lactic bacilli, lactic cocci, yeasts and moulds, total bacteria, and coliform bacteria), benzoic acid content, physicochemical properties (fat, total solid, ash content, acidity, pH, syneresis, viscosity, colour, and rheological properties), and sensory characteristic. It was determined that APC, lactic bacilli, lactic cocci, and yeast counts of the concentrated kefir samples changed between 6.90 and 8.64, 6.89 and 8.61, 7.42 and 8.72, and 2.17 and 5.39 log CFU/g, respectively, during storage. Mould and coliform bacteria were not detected in the samples. The concentrated kefir samples contained benzoic acid in the range of 18.30-119.58 mg/L. Results from this study showed that type of milk caused differences on APC, lactic bacilli, lactic cocci and yeast count, total solids, ash, fat, acidity, pH, syneresis, colour, viscosity and rheological parameters, and benzoic acid content. In addition, milk type affected sensory properties of the kefirs. Concentrated kefirs produced from cow and buffalo milk were the most liked by panellists. Finally, it was determined that concentrated kefir was favoured as a new product by most of the panellists.

Could real-time sonoelastography-measured placental strain ratio (PSR) value be a soft marker for the diagnosis of intrahepatic cholestasis of pregnancy?: A case-control study and short reviews

Diagnosis of intrahepatic cholestasis of pregnancy (ICP) is often decided upon with typical pruritus supported by elevated serum bile acid levels. However, there is confusion regarding the absolute reference range for serum bile acid. To confirm the utility of Placental Strain Ratio (PSR) measurement as a marker for the diagnosis of ICP and to reveal the extent to which it is correlated with serum bile acid concentration. A case-control study was conducted. The case group included 29 patients who were admitted to our hospital in the second or third trimester of pregnancy with typical itching and were clinically diagnosed with ICP with >10 mmol/L serum bile acid. The first 45 pregnant women were assigned to a control group. Real-time tissue elastography software was used for ultrasound assessment of all pregnant placentas. Software was used to estimate the SR values. Biochemical liver function parameters, hemograms, serum bile acid levels, and SR values were compared between these groups. PSR was found to predict the development of cholestasis with poor discrimination (area under the curve [AUC] = 0.524; 95% CI = 0.399-0.646). The optimal threshold value with the best sensitivity and specificity rates was calculated to be 0.46 PSR. ICP developed significantly more frequently in the low PSR group than in the high PSR group (60% vs 29.3%, P = .05, odds ratios [OR] = 0.276, 95% CI = 0.069-1.105). No correlation was found between the PSR and bile acid levels (rho = -0.029, P = .816). PSR values can support the diagnosis of ICP, predict serum bile acid levels, and can be used as soft markers.

[Evaluation of Malassezia furfur Biofilm Formation on Polypropylene Membrane]

The Malassezia yeast species colonize on the skin immediately after birth and could be found on the healthy skin flora for life. Although they are more frequently involved in the etiology of common skin infections in the community, particularly Malassezia furfur could cause life-threatening infections such as fungemia. Detection of biofilm during the colonization of these yeasts on the skin is an important criterion for its virulence. Since they are lipophilic yeasts, commonly used biofilm detection methods are not applicable to the Malassezia strains. The aim of the study was to describe the growth and measurement of M.furfur isolates on a polypropylene membrane to demonstrate their biofilm-forming capacities. Twenty-seven M.furfur strains colonized in the newborns were included in the study. Basically, sterile polypropylene membranes were placed on different polysorbates (tween 20, 40, and 80) which were spread on Sabouraud dextrose agar. Ten µl saline suspension of M.furfur was dropped on the polypropylene membrane and incubated in standard growth conditions for three days. Later, the visible colony was removed gently by washing with running water and the biofilm structure formed on the membrane was stained with safranin. The stained biofilm was photographed. Performing image analysis, the values obtained against background activity were digitized according to the specified protocol. Moreover, XTT reduction test was performed and the measured metabolic activity results were compared with the safranin-stained biofilm data. The safranin hydrolysis of the strains was measured spectrometrically. Twenty-five (92.6%) of the strains included in the study were stained with safranin, which indicated the presence of biofilm on the polypropylene membrane. The strains grown with tween 20 and tween 80 formed a higher biofilm layer density than those supplied with tween 40. Isolates with low and high biofilm-forming capacity were clearly separated by tween 20 (p< 0.05). XTT activity was detected in 26 (96.3%) isolates. No correlation was found between biofilm density obtained by the described method and XTT reduction. It was observed that hydrolysis of safranin did not affect the biofilm evaluation method. In this study, it was shown that as a result of sufficient diffusion through hydrophobic membranes, polysorbate-based growth factors could maintain measurement of the biofilm layer formed by lipophilic M.furfur strains. The best grouping properties for M.furfur were obtained with tween 20 which could determine low and high level of biofilm formation. Image analysis was used with high performance for this method. As conclusion, the utilization of different hydrophobic membranes and dyes would lead to the development of new techniques for the application in other lipophilic yeasts.

Determination of Elemental Contents and Microbiological and Chemical Properties of Çökelek Cheeses Consumed in Turkey

The Çökelek samples what 30 different were collected from randomly local bazaars to investigate heavy metal contaminant and mineral levels and some physicochemical and microbiological properties of samples. While the Pb was identified in 6 of the 30 samples, the As was only found in 4 of the samples. The mean major and trace element contents of Çökelek samples were ordered as Na > P > Ca > K > Mg and Al > Zn > Ni > Cu, respectively. The physicochemical properties indicated a high deviation among samples. The mean total solids, ash, salt, fat, protein waters soluble nitrogen contents, and sample ripening index were 29.83%, 1.88%, 0.68%, 4.31%, 19.84%, 0.33%, and 1.79%, respectively. The mean total aerobic mesophilic bacteria (TAMB) count of Çökelek samples was found as 8.26 log CFU g^-1. The coliform bacteria and yeast-mold counts were detected in 11 and 27 of 30 samples, respectively. The mean coliform and yeast-mold counts were 1.82 log CFU g^-1 and 7.11 log CFU g^-1, respectively. Traditional cheeses are not mentioned in legal laws such as the Turkish Food Codex. So, there is no legal limit and standard production processes. This situation is a problem in terms of traditional cheese quality. For this reason, traditional cheese should perform further studied, and determine the legal limits.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders

OBJECTIVE

We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa.

METHODS

The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements).

RESULTS

Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814-0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770-0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) CONCLUSION: Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

Antioxidant Activity, Physiochemical and Sensory Characteristics of Ice Cream Incorporated with Sloe Berry (Prunus spinosa L.)

The aim of this study was to determine the influence of sloe berry (SB) addition at different ratios on the physical, chemical, antioxidant, colour and sensory properties and mineral contents of ice creams. The increment of SB led to the an increase of titratable acidity, overrun, viscosity and ash values, first dripping and complete melting times; in contrast, it decreased the total solid, pH and fat values. Mn and Zn values were affected significantly (P < 0.05) by the addition of SB but other element levels were not affected. L* and b* values decreased significantly in all samples as compared with control sample, while a*, H°, C* and ∆E* increased significantly with addition of SB. Antioxidant activity was the highest in the sample containing 15 % SB (w/w) among ice cream samples. The ice cream samples containing 15 % SB had higher score than the control sample in terms of colour and appearance, gumming structure and general acceptability.

Cryptococcus neoformans Recovered From Olive Trees (Olea europaea) in Turkey Reveal Allopatry With African and South American Lineages

Cryptococcus species are life-threatening human fungal pathogens that cause cryptococcal meningoencephalitis in both immunocompromised and healthy hosts. The natural environmental niches of Cryptococcus include pigeon (Columba livia) guano, soil, and a variety of tree species such as Eucalyptus camaldulensis, Ceratonia siliqua, Platanus orientalis, and Pinus spp. Genetic and genomic studies of extensive sample collections have provided insights into the population distribution and composition of different Cryptococcus species in geographic regions around the world. However, few such studies examined Cryptococcus in Turkey. We sampled 388 Olea europaea (olive) and 132 E. camaldulensis trees from seven locations in coastal and inland areas of the Aegean region of Anatolian Turkey in September 2016 to investigate the distribution and genetic diversity present in the natural Cryptococcus population. We isolated 84 Cryptococcus neoformans strains (83 MATα and 1 MAT a) and 3 Cryptococcus deneoformans strains (all MATα) from 87 (22.4% of surveyed) O. europaea trees; a total of 32 C. neoformans strains were isolated from 32 (24.2%) of the E. camaldulensis trees, all of which were MATα. A statistically significant difference was observed in the frequency of C. neoformans isolation between coastal and inland areas (P < 0.05). Interestingly, the MAT a C. neoformans isolate was fertile in laboratory crosses with VNI and VNB MATα tester strains and produced robust hyphae, basidia, and basidiospores, thus suggesting potential sexual reproduction in the natural population. Sequencing analyses of the URA5 gene identified at least five different genotypes among the isolates. Population genetics and genomic analyses revealed that most of the isolates in Turkey belong to the VNBII lineage of C. neoformans, which is predominantly found in southern Africa; these isolates are part of a distinct minor clade within VNBII that includes several isolates from Zambia and Brazil. Our study provides insights into the geographic distribution of different C. neoformans lineages in the Mediterranean region and highlights the need for wider geographic sampling to gain a better understanding of the natural habitats, migration, epidemiology, and evolution of this important human fungal pathogen.

[Isolation of Cryptococcus neoformans from a chesnut tree (Castanea sativa), Denizli, Turkey]

Cryptococcus neoformans is a basidiomycetous encapsulated yeast that can cause life-threatening infections in immunosuppressed humans and animals. C.neoformans/Cryptococcus gattii infections are considered to be acquired via inhalation of aerosolized particles from the environment. Avian guano, decaying tree hollows and soil are known as environmental niches. In recent years, colonization of the woody structures of different trees such as Eucalyptus camaldulensis, Tamarix hispida, Platanus orientalis and Punica granatum has been reported in the environmental study of the western Anatolian region. Based on the results of previous studies, our country may have intensive Cryptococcus colonization niches in the western regions. The aim of this study was to investigate the presence of the colonization of C.neoformans niche in chestnut (Castanea spp.) trees on higher altitudes. In the study, the colonization of C.neoformans was screened on chestnut trees (Castanea spp.) in Aydın-Ödemiş-Denizli geographical area. This area consists of mountainous terrain between the fertile plain formed by two major rivers.This region is one of the widespreading areas of chestnut farming in Anatolia. Two hundred and fourteen chestnut trees that had deep fissures or trunk hollows were screened during mid-summer 2017. A swabbing technique was used, and all samples were cultured on Staib agar medium containing biphenyl and antibiotics. Cultures were checked for ten days for suspicious brown colonies. Suspicious yeast colonies were tested for the identification of pathogenic Cryptococcus by conventional methods and canavanine-glycine-bromothymol agar reactions. ITS 1-4 primers were used for strain PCR tests. We determined the mating type and serotypes by PCR analysis of the STE20 genes using STE20 (Aa), STE20 (Aα), STE20 (Da), and STE20 (Dα) primers. V8 agar medium was used for mating cultivation. Only one (0.47%) strain of C.neoformans was isolated from 214 screened trees. This strain was confirmed by ITS 1-4 sequencing. The serotype A MATα mating type was observed. Basidium, basidiospores and clamp connections in hyphal structure were noted with MATα mating on V8 agar medium. In this study, the first C.neoformans isolate from a chestnut tree (Castanea sativa) was determined from Denizli region. Further studies of distribution of human pathogenic Cryptococcus will be helpful to determine the risk areas for the living organisms in our region.

[Prediction of the species distribution of Cryptococcus neoformans throughout Turkey]

Cryptococcus neoformans is a human pathogenic yeast that causes life-threatening infections especially in immunosuppressed patients. The environmental isolation of C.neoformans from Turkey was reported as early as 2004, although this was mostly from Eucalyptus camaldulensis colonization. Successful isolations were also reported from pomegranate (Punica granatum), oriental plane (Platanus orientalis), pine tree (Pinaceae), chestnut (Castanea sativa) and salt cedar (Tamarix hispida). The investigation of the relationship between the bioclimatic factors affecting the environmental isolation sites and the colonization of pathogens is a frequently used method. With this method, detailed risk maps can be generated in which environmental colonization can be estimated. The aim of this study was to use the high-resolution bioclimatic and previously-isolated yeasts' coordinates to create a valid model for the occurrence of C.neoformans in Turkey and provide insight into ecological processes. A machine learning approach using presence-only data software, maximum entropy (MaxEnt), was used to for the prediction of C.neoformans distribution. Climatic data and environmental bioclimatic variables from WorldClim were downloaded as 30 seconds spatial resolutions. The correlation between different Turkey bioclimatic layers were analyzed with ENMTools and similar layers were discarded. Forty-one different coordinates representing C.neoformans isolation points were used to generate a predictive map. The area under the curve and the omission rate were used to validate the model. Meanwhile, Jackknife tests were applied to enumerate the contribution of different environmental variables, and then to predict the final model. Maps were created using QGIS mapping software. In this study, we have shown that the coastal region of Anatolia, which is geographically located in the Northeastern Mediterranean Basin, as well as the entire Aegean region, carry an extremely high risk for the colonization of C.neoformans. Other areas which have not previously been reported for the isolation of C.neoformans were predicted to be potential colonization hotspots, including the western part of Ataturk Dam, the Amik Plain and the Bakırçay and Gediz valleys. The maximum temperature of the warmest month, the mean temperature of the warmest quarter and the precipitation of the coldest quarter were the most important factors influencing the model's predictions. It was determined that the humidity in the environment affected the colonization especially in November. In conclusion, we produced a C.neoformans colonization risk map of Turkey for the first time. Obtaining more regional data will facilitate the identification of the regions having similar risk. This approach is useful for the clinical prediagnosis of cryptococcosis cases, which may be more common in places with environmental niches.

Is the management of Rh-Rh incompatibility with noninvasive fetal Rh genotyping for targeted prophylaxis cost-effective in the Turkish population?

Background/aim: The aim of this study was to assess unnecessary immunization rates and compare the cost-effectiveness of targeted prophylaxis with fetal Rh genotyping with that of traditional management of Rh-Rh incompatibility in a virtual economic model. Materials and methods: This retrospective data analysis was conducted at two tertiary centers between 2011 and 2015. The data of 1135 pregnant women were analyzed. The main outcome measure was to determine the unnecessary immunization rate among the whole Rh-Rh incompatibility group. The second outcome measure was to compare the cost-effectiveness of universal immunization with that of targeted prophylaxis with fetal Rh genotyping in a virtual economic model. Results: Average cost per patient was found as $259.20 with universal prophylaxis and the total cost was $177,344, whereas if targeted prophylaxis had been applied to these patients the total cost would have been $263,392 and cost per patient would have been $385. Universal prophylaxis was more cost-effective than targeted prophylaxis in terms of both total cost and cost per patient (P < 0.0001). Conclusion: Unless the cost of noninvasive fetal Rh genotyping is reduced, a universal approach of anti-D immune globulin prophylaxis is more cost-effective than noninvasive determination of fetal Rh genotyping with targeted prophylaxis.

Prevalence and Comparing of Some Microbiological Properties, Somatic Cell Count and Antibiotic Residue of Organic and Conventional Raw Milk Produced in Turkey

The aim of this study was to investigate the effects of production systems and milk collection periods on the somatic cell count (SCC), some microbiological properties, total aerobic mesophilic bacteria (TAMB), coliform, Staphylococcus aureus (S. aureus), yeast and mould) and antibiotic residue of milk; in Turkey. Milk samples were collected from 9 conventional farms and 9 organic farms during one year time, at six different months (December 2013 to October 2014), and all farms were selected from the same geographical locations. All organically managed farms had organic production certificates given by the Republic of Turkey Ministry of Food, Agriculture and Livestock. The count of TAMB, coliform, and coagulase positive S. aureus were affected by production systems at the level of p<0.01; yeast and mold, and somatic cell count (SCC) were affected at the level of p<0.05. But, differences according to months were statistically significant only on TAMB (p<0.01) and coliform (p<0.05) counts. The general means of TAMB, coliform and yeast and mould counts of the organic milk (OM) were significantly lower (p<0.05), while the general means of SCC and coagulase positive S. aureus count of the OM was significantly higher (p<0.05) compared to conventional milk (CM). Antibiotic residue was determined in one of the CM sample and in two of the OM samples. Our study is the first research that compared conventional and organic milk in Turkey. This study indicated that the microbiological quality of OM was the higher in terms of TAMB, coliform and yeast and mould, whereas was the lower in relation to SCC and coagulase positive S. aureus counts. But, the quality of both milk types should be improved.

Changes in Some Quality Properties of Kefir during Storage and Inhibition Effect of Water Soluble Extracts on Angiotensin-I Converting Enzyme Purified by Human Plasma

Angiotensin converting enzyme (ACE)-inhibitory activity in water soluble extracts (WSEs) of kefir was investigated. Kefir was produced traditionally using kefir grains and stored at refrigerated temperature for 20 days. During storage period (on 1, 5, 10, 15 and 20 days) in vitro ACE-inhibitory activity in WSEs was determined. ACE was purified from human plasma to determine kinetic parameters. Purified ACE had a specific activity of 20.75 EU.mg−1, a yield of 16.6% with a factor of 22100. The inhibition effects of kefir on ACE increased at 15 storage days than other storage days. Some microbiological and physicochemical characteristics of kefir were also studied. Counts of presumptive LAB on M-17 and presumptive LAB on MRS in the kefir were about 108 CFU.ml−1 throughout the storage period. Yeast counts were lower than lactic acid bacteria counts and the average of the counts was approximately 106 log CFU.ml−1. Storage period had a significant effect (P < 0.05) on titratable acidity and pH values. On the contrary, it had no significant effect (P > 0.05) on viscosity and serum separation values of kefir.

Effect of thermosonication on physicochemical, microbiological and sensorial characteristics of ayran during storage

The aim of the study was to determine whether thermosonication extends the shelf life of ayran, an acidic milk drink. The effect of thermosonication at different temperatures (60, 70 and 80 °C) and times (1, 3 and 5 min) on the physicochemical and microbiological characteristics, and sensorial properties of ayran during storage were investigated. According to the results, thermosonication applied at 60 °C decreased lower the bacteria counts, although the Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus counts decreased as the temperature and time increased. The yeast and mold levels in samples treated with thermosonication were <1 log CFU mL(-1) during storage period. The ayran samples had non-Newtonian behavior, and the consistency coefficients of the thermosonicated samples were significantly higher than that of the heat-treated samples. Regarding serum separation, the most effective thermosonication treatment was applied at 70 °C for 3 min. The sensory properties of the thermosonicated samples were better than the thermal-treated samples after storage.