Uludağ Üniversitesi Tıp Fakültesi Dergisi / Journal of Uludag University Medical Faculty

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Additional daily ıntramuscular progesterone for luteal phase support does not ımprove live birth rates of programmed frozen-thawed embryo transfer cycles
(Bursa Uludağ Üniversitesi, 2024-06-01) Aslan, Kiper; Kasapoğlu, Işıl; Akkok, Tuğba; Çakır, Cihan; Avcı, Berrin; Uncu, Gürkan; ASLAN, MÜNİR KİPER; KASAPOĞLU, IŞIL; AKKÖK, TUĞBA; ÇAKIR, CİHAN; AVCI, BERRİN; UNCU, GÜRKAN
This retrospective cohort study aims to investigate whether additional daily intramuscular progesterone (IMP) for luteal phase support improves live birth rates of programmed frozen-thawed embryo transfer (FET) cycles. The study was conducted at a tertiary level university hospital assisted reproductive technology (ART) center between January 2014 and Jan 2021. Six hundred four infertile patients with single-day 5-6 frozen-thawed blastocyst embryo transfer were enrolled in the study. All patients received either 8% micronized vaginal gel or vaginal progesterone capsules for luteal phase support. Intramuscular progesterone was added to vaginal progesterone depending on the in vitro fertilization (IVF) specialist’s choice. Luteal phase support (LPS) was started 6 days before transfer in frozen-thawed cycles and continued until the end of the first trimester. Cycles were compared depending on vaginal progesterone types (8% gel vs. capsule) and the presence of intramuscular progesterone. The primary outcome was the live birth rate. A total of 604 FET cycles were enrolled. Using 8% micronized progesterone or progesterone capsules did not change the live birth rates (24% vs. 25.9%). As the main result, intramuscular progesterone support with vaginal progesterone compared with only vaginal progesterone did not improve the live birth results (22% vs. 24%). In conclusion, this study demonstrated that routine IMP progesterone given in combination with vaginal progesterone does not improve ART outcomes. This combination may be beneficial in a selective population with a monitored luteal phase. Using any form of vaginal progesterone alone is adequate for LPS.
Altındağ ilçesindeki bir ilköğretim okulunun çevre sağlığı yönünden değerlendirilmesi
(Uludağ Üniversitesi, 2006-05-30) Temel, Fehminaz; Akın, Levent; Vaizoğlu, Songül Acar; Kara, Özgür; Kara, Asil; Halas, Aasım Misbah; Gurunaidu, Samy Subramaniam
Altındağ İlçesindeki bir ilköğretim okulunda, okul çevre sağlığı açısından mevcut durumun saptanması, okulun Türk Standartları Enstitü sü 12014 sayılı standardına uygunluk durumunun değerlendirilmesi ve okul sınırları içinde Elektromanyetik alan (EMA) düzeylerinin, sınıflarda aydınlanma düzeyinin ölçülmesi amaçlanmıştır. Durum saptaması olan bu araştırmanın verileri, Nisan 2005 tarihinde, 1996’da kabul edilen Türk Standardı 12014 Okul Çevre Sağlığı Standardı (TS 12014 OÇSS) ve Türk Standardı 9518 (TS 9518) dikkate alınarak hazırlanan bilgi formuyla toplanmıştır. Aydınlanma düzeyi ölçümleri TES 1332 digital Light-meter ile, EMA ölçümü ise Bileşke Manye tik Alan Ölçen Gaussmetre (Triaxial ELF Magnetic Field meter) ile yapılmıştır. Sınıflarda ortalama öğrenci sayısı 35,8’dir. Sınıfların öğrenci başına düşen ortalama alan 1,34 m²/kişi, ortalama sınıf hacmi 3,7 m³/kişi bulunmuştur. Pencerelerin zeminden yüksekliği tüm sınıflarda 1,2 metrenin altındadır. Kızlar tuvaletinde lavabo ve kabin başına düşen öğrenci sayısı 48’dir. Erkekler tuvaletinde ise lavabo ve kabin başına düşen öğrenci sayısı 32’dir. Erkek ve kız öğrenciler için tuvaletlerdeki kabin ve pisuar sayısı yetersizdir. Okulda revir, mut fak ve yemekhane bulunmamaktadır. 25 sınıfta yapılan ölçümlerde ortalama aydınlanma 810 + 618 lüks, kütüphanede yapılan ölçümler sonucu ortalama değer 399 lüks bulunmuştur. Kapıya en yakın sıra grubunun ilk sırasında ortalama aydınlanma değeri 195 ± 118 lüks bulunmuştur. Sınıflarda önerilen en düşük aydınlanma değeri 200 lüks ve üzeridir. Sınıflar, kütüphane, idari odalar, bahçe ve koridorların tamamında EMA ortalaması, önerilen standart değer olan 2 mG’un altındadır. Bu çalışma sonucunda okul çevre sağlığı açısından bazı çevre sağlığı standartlarına uyulmadığı saptanmıştır. Okuldaki bu eksikliklerin giderilmesi ve yeni yapılacak okullarda okul çevre sağlığı göz önünde bulundurularak uluslararası standartlara uyulması önerilmektedir.
Capgras syndrome accompanying schizophrenia: An adolescent case report
(Bursa Uludağ Üniversitesi, 2024-07-25) Eroğlu, Mehtap; Yok
In Capgras syndrome, the patient believes that the original person or objects have been replaced by identical ones (fakes). The syndrome rarely occurs in its pure form. It often accompanies psychotic illness and organic pathology. Capgras syndrome can occur in all age groups and is more common in women. In this article, the case of a 16-year-old female patient who applied to the hospital with complaints of aggression, harming her environment and wanting to have a DNA test will be presented. During her first admission examination, she was found to have Capgras delusions, and she was hospitalized and monitored in a psychiatric clinic. The patient, who was followed up with a diagnosis of early-onset psychotic disorder, was determined to be a case of CS accompanying Schizophrenia. Early-onset Schizophrenia is already a rare condition, and the onset of CS at this age is uncommon. Our case is valuable as it shows that CS, a rare condition, can also be seen in adolescence.
Evaluation of the use of ıntraoperative neuronavigation in the surgery of brain tumors: single center experience and retrospective analysis of 172 cases
(Bursa Uludağ Üniversitesi, 2024-08-27) Türkkan, Alper; Bekar, Ahmet; BEKAR, AHMET
Neuronavigation systems are computer-assisted procedures that use preoperative imaging data to ensure accurate anatomical orientation and safe resection during surgery. Despite their widespread use in neurosurgery, evidence of their effectiveness and reliability remains limited. This study aimed to examine the need for neuronavigation systems in patients with intracranial tumors, their relationship with tumor location and size, and their limitations. A retrospective analysis was conducted on 172 patients with intracranial tumors who underwent surgery using neuronavigation systems at our clinic between January 2021 and October 2023. Patients were classified based on tumor size into two groups: those with tumors <3 cm and those with tumors ≥ 3 cm. Further classification was done according to tumor locations such as supratentorial, infratentorial, and skull base, as well as based on superficial and deep-seated tumor locations. The need for neuronavigation systems was assessed using a scoring scale ranging from 0 to 2 assigned during surgery. Of the patients, 49.4% were male and 50.6% were female, with a mean age of 52.9 ± 16.2 years (range 2–80 years). The mean total score for neuronavigation system use was significantly higher in patients with tumors <3 cm and those with deep-seated tumors (p = 0.003). The need for neuronavigation was less in infratentorial tumors. Identifying anatomical and vascular structures during surgery was the surgical stage with the greatest need for neuronavigation use (n=172, 100%). Multivariate binary logistic regression analysis revealed that tumor size ≥3 cm and superficial location were risk factors determining the need for neuronavigation systems. İdentifying anatomical and vascular structures in supratentorial and deep-seated tumors, and evaluating surgical resection in tumors <3 cm are the areas where the use of neuronavigation systems is necessary.
Genotyping apolipoprotein E (APOE) Isoforms with sequence-specific-primer (SSP)-PCR in early onset alzheimer’s disease patients: A rapid and revised methodology
(Bursa Uludağ Üniversitesi, 2024-06-03) Eryılmaz, Işıl Ezgi; Bakar, Mustafa; Egeli, Ünal; Çeçener, Gülşah; ERYILMAZ, IŞIL EZGİ; BAKAR, HACI MUSTAFA; EGELİ, ÜNAL; ÇEÇENER, GÜLŞAH
Alzheimer's disease (AD) is a neurodegenerative disorder that causes progressive damage to brain cells, leading to impairment in cognitive functions. The Apolipoprotein E (APOE) variants play a significant role in the genetic basis of AD, especially late-onset AD (LOAD), and increase the disease risk at an earlier age. Although controversial, some studies reveal the association between APOE genotype and early-onset AD (EOAD) regardless of family history. Therefore, diagnostic laboratories widely perform routine tests to determine the APOE genotype. In the present study, we implemented a revised methodology for the Sequence-Specific-Primer-PCR (SSP-PCR) test for rapid APOE genotyping in 67 EOAD patients. Then, the findings were validated using automatic sequencing with newly designed primers for the related region of the APOE. We state clearly that the applicability of the SSP-PCR method was improved when the primer concentrations of control genes were increased 2-fold, as we reported. All data obtained from SSP-PCR were consistent with Sanger sequencing confirmations. Based on the genotyping results, the four different APOE genotypes were detected: E2/E4, E3/E3, E3/E4, and E4/E4. The frequencies were 1.5% (n=1) for E2/E4, 76.1% (n=51) for E3/E3, 16.4% (n=11) for E3/E4, and 6% (n=4) for E4/E4. In the study group, 23.9% (n=16) of the patients had homozygous or heterozygous APOE E4. However, we detected no significant association between the clinical features and the APOE genotype. As a result, this method is reliable, cost-effective, and rapid for performing genotyping analysis of the APOE for routine tests and research studies with larger EOAD cohorts.
Investigation of the immunoexpression of SVIP and UPR pathway proteins in ovarian adenocarcinoma cell line OVCAR-3
(Bursa Uludağ Üniversitesi, 2024-09-03) Alimoğulları, Ebru; Kartal, Bahar; Yok
Ovarian cancer is the deadliest gynecological cancer. The endoplasmic reticulum (ER), a vital cell organelle, is involved in the folding, synthesis, and modification of a wide range of soluble and insoluble proteins. ER stress initiates the unfolded protein response (UPR), an evolutionary conserved cell stress mechanism. The UPR is mediated by three ER transmembrane sensors: IRE1, ATF6, and PERK. An inhibitor of ERAD is a small VCP/p97-interacting protein (SVIP). The study aimed to investigate the relationship between SVIP and the ER stress protein markers in the human ovarian cancer cell line OVCAR-3. The SVIP and GRP78, PERK, ATF4 immunoexpression levels were analyzed. Furthermore, employing immunofluorescence, the colocalization of three ER sensors and SVIP was ascertained. The immunoexpression of SVIP and GRP78, ATF4, and PERK were shown in the OVCAR-3 cell line. Additionally, immunofluorescence results showed the colocalization of SVIP and UPR-related proteins in the cytoplasm of OVCAR-3 cells. In conclusion, we demonstrated the cellular localization of SVIP and the proteins involved in the UPR pathway. However, further studies are needed to determine the relation between SVIP and these proteins in cancer cells.
Protective effect of mesenchymal stem cells and melatonin on testicular torsion-ınduced infertility
(Bursa Uludağ Üniversitesi, 2024-06-25) Neşet, Gül; Çil, Nazlı; Mete, Gülçin Abban; Yok
We aimed to explore the effects of systemic melatonin and intratesticular Adipose tissue-derived mesenchymal stem cells (AdMSCs) administration on rats with acute unilateral testicular torsion. Rats were randomized into Sham group (S) (n=8), torsion/detorsion group (T/D by torsion of right testis with rotated 720° counter clockwise for 3 h, then detorsion) (n=8), Melatonin group given 25 mg/kg after torsion/detorsion (M) (n=8), Adipose tissue-derived mesenchymal stem cell-treated group after torsion/detorsion (MSC) (n=8), Adipose tissue-derived mesenchymal stem cell-treated group with melatonin after torsion/detorsion (MSC+M) (n=8). We measured MDA, Testosterone, FSH and LH levels, performed histopathological analyses in testicles, and identified SOX, VASA and Caspas-3 reactions immunohistochemically. Testosterone, FSH, LH values did not yield any significant difference between the groups. While the Johnson score in the right testis remained the lowest in T/D, the highest score was noted in the S. The T/D manifested some degenerative seminiferous tubules, abnormal spermatogenesis and maturation arrest. The degenerative appearance monitored in M, MSC and MSC+M groups persisted in some tubules, while markedly reduced degeneration was observed in some other tubules. The highest Caspase-3 expression in T/D, whereas SOX-9 expression remained significantly higher in the treatment groups. Another aspect deserving attention is that MSC were characterized by low VASA expression. Our experimental trial suggests that the torsion-induced degeneration in testicular tissue was ameliorated in all the treatment groups. Although MSC, MSC+M and M administrations decreased the torsion-induced degeneration in the testicular tissue, these treatments did not prove to be superior to each other.
Relationship between health literacy level and contraceptive method preferences: Intrauterine device vs. elective curettage
(Bursa Uludağ Üniversitesi, 2024-06-20) Ocakoğlu, Sakine Rahimli; Atak, Zeliha; Ocakoğlu, Gökhan; Demirci, Hakan; OCAKOĞLU, GÖKHAN
Providing reproductive health services is essential to a healthcare system. Reproductive health is an important component of the World Health Organization, indicating that women and men have the right to information and access to safe and effective contraceptive methods. Unfortunately, not all individuals are aware of the reliable contraceptive methods currently available today; this is the main factor leading to unwanted pregnancy, which is terminated with Elective Curettage. The present study aims to compare the Health Literacy (HL) levels of patients who use intrauterine devices (IUD) for contraception with those who underwent Elective Curettage (E&C) to terminate unwanted pregnancies. This cross-sectional study was conducted with 467 participants who applied to the Family Planning Department to terminate unintended pregnancy with E&C (n=59) and those who used an IUD for contraception (n=408). The study shows no differences between the groups according to the HL level determined for the overall HL scale. However, the "Health Promotion" subscale's median score was higher in the E&C group (p=0.002). The logistic regression analysis showed that the tendency of unemployed women to prefer E&C was 11.15 times more than that of employed women. Moreover, those with a history of curettage were 4.95 times more likely to prefer the E&C method. In conclusion, "Health Promotion" is related to the ability to evaluate the health warnings of the environment. It can be interpreted that the environment influences women's E&C preferences. The frequent occurrence of E&C in unemployed women must also be examined in a sociocultural context.
The effect of the gonadotropin dose increment during controlled ovarian hyperstimulation on live birth rates of POSEIDON group 3-4 patients
(Bursa Uludağ Üniversitesi, 2024-06-12) Aslan, Kiper; Kasapoğlu, Işıl; Mesut, Çağatay; Gürbüz, Tansu Bahar; Çakır, Cihan; Avcı, Berrin; Uncu, Gürkan; ASLAN, MÜNİR KİPER; KASAPOĞLU, IŞIL; MESUT, ÖMER ÇAĞATAY; GÜRBÜZ, TANSU BAHAR; ÇAKIR, CİHAN; AVCI, BERRİN; UNCU, GÜRKAN
This retrospective study seeks to explore whether modifying the gonadotropin dose in cases of poor ovarian response during controlled ovarian hyperstimulation contributes to improved live birth rates in Poseidon Group 3-4 patients. The study took place at a tertiary level university. The electronic database spanning 2012-2021 was scrutinized to identify patients with diminished ovarian reserve (DOR) who underwent intra-cytoplasmic sperm injection – embryo transfer (ICSI-ET). Diminished ovarian reserve was determined using the POSEIDON criteria. Patients were categorized into two groups based on whether dose adjustment was implemented during the initial ultrasound assessment in controlled ovarian hyperstimulation (COH). There were 188 patients in the dose adjustment (DA) group and 310 patients in the fixed-dose (FD) group. The demographic parameters were similar between the groups. The started gonadotropin dose was similar in both groups (300 IU). The median dose adjustment on the first control was +75 IU in the DA group. The follicle output rates, follicle to oocyte indexes, and the embryology parameters were comparable between the groups. The positive pregnancy rate was 19.7% (36/188) in the DA group vs. 19.1% (61/310) in the FD Group (p=0.4). The primary outcome of the study; live birth rates were 12% in the DA group vs. 9% in the FD group, and the results were statistically similar (p=0.3). Our research revealed that adjusting the gonadotropin dose in cases of inadequate ovarian response during COH results in comparable live birth rates to those observed in the fixed-dose group. For patients exhibiting an inadequate response, dose adjustment may be deemed necessary.
Treatment strategies for unknown anatomic pathology ventriculus terminalis case series: single center experience
(Bursa Uludağ Üniversitesi, 2024-08-06) Özmarasalı, Ali İmran; Yağubov, Fakhraddin; Eser, Pınar; Doğan, Şeref; YAGUBOV, FAKHRADDIN; Eser, Pınar; DOĞAN, ŞEREF
The ventriculus terminalis is a cavity in the conus medullaris, bounded by ependymal cells, associated with the central canal. It is an anatomical structure that is very rare in adults, with a limited number of surgical cases that have been reported in the literature. In children, it is regarded as a normal congenital variation, known to regress before five years of age, and very few symptomatic cases have been reported in both pediatric and adult populations. It is often asymptomatic in adults and is detected incidentally. Although potentially nonsignificant individually, symptoms can range from nonspecific low back pain to sphincter dysfunction and focal neurologic deficits. Our purpose is to discuss our management strategy in comparison to the existing literature. A retrospective review was conducted of all adult patients (aged 17 years and older) diagnosed with ventriculus terminalis who were referred to the hospital between 2010 and 2020. Clinical classification was made according to the classification defined by Batista. In addition, Ganau's classification was also used. Five patients were included in the study. The majority of these patients (n=4, 80%) were symptomatic at the time of diagnosis, with nonspecific back pain being the most common symptom (n=3, (60%). None of the patients required neurosurgical intervention during the follow-up period of 21.6±8.9 months, as there was no clinical deterioration observed. Ventriculus terminalis is a rare pathology that may develop de novo in adults, often remaining undiagnosed until the cyst enlarges, and can manifest with a wide spectrum of symptoms. When identified, it requires careful management, involving surgery when necessary and a conservative approach when appropriate.

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