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The matrix metalloproteinase-9 (MMP-9) and neutrophil gelatinase associated lipocalin (NGAL) are shown to increase in an inflammatory situation. Based on our previous reports that NGAL can be detected in the urine of children with urinary tract infection (UTI), we also asked whether MMP-9/NGAL complex could be detected in the urine of children with UTI. This multicenter, prospective study was conducted between October 2009 and October 2010. Seventy-one patients with symptomatic culture proven UTI, 37 asymptomatic children with contaminated urine and 37 healthy children were recruited. Mean uMMP-9/NGAL/Cr levels were significantly higher in the UTI group than in the control group ( p < 0.0001). According to ROC analysis, the optimal cut-off level was 0.08 ng/mg to predict UTI. Using a cut-off value, sensitivity and specificity were 98.6 and 97.3%, respectively. The mean levels of uMMP-9/NGAL/cr in the UTI group were also significantly higher than those in the contamination group ( p < 0.0001). There was no statistically significant difference between contamination group and the control group ( p = 0.21). The mean uMMP-9/NGAL/Cr in the UTI group were significantly higher before treatment than after treatment ( p < 0.0001). The area under the curve was 0.997 (SE: 0.002, 95% CI: 0.993 to 1.001) for uMMP-9/NGAL/Cr. Urinary MMP-9/NGAL/Cr level was also correlated with positive urine nitrite test, positive urine leukocyte esterase reaction and renal scarring ( p = 0.0001, p = 0.0001, p = 0.04, respectively) whereas was not correlated to leukocytosis and positive CRP level in serum. Urine MMP-9/NGAL/cr can be used as a diagnostic biomarker for UTI in children. Identification of NGAL-MMP-9/cr levels in the urine of suspected UTI patients may also be useful to differentiate between contamination and infection and for monitoring of treatment response in children. [ABSTRACT FROM AUTHOR]

Background Vasectomy is well accepted in some countries, but uncommonly used in others. The failure of family planning programmes may be the result of men failing to play a role in contraception. This study was carried out to determine the attitudes of women and men regarding male and female sterilisation. Study design Women of reproductive age (17-35 years old; n = 1211) and their husbands (n = 1174) were enrolled in this study. Information was collected from the participants via face-to-face interviews using a questionnaire. Results In our study, 61.4% of women would agree to their husbands' undergoing a vasectomy but only 3.7% of husbands agreed to it. Most (92.7%) men said they would agree to their wives' undergoing a sterilisation and 83.1% of women would agree to tubal occlusion. Only 2% knew anyone who had been sterilised. Nearly a fifth of women thought vasectomy could lead to impotence. Conclusion The prejudices against vasectomy are probably due to misinformation. Female sterilisation, however, is widely accepted by both participants. Family planning programmes organised equally for women and men, supported also by mass media could improve access to convenient and effective contraception. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine associated ultrasonographic findings, chromosome abnormalities and the prognostic factors of cystic hygromas in live-born infants. Methods: We reported a series of 57 cystic hygroma cases, who were diagnosed in the first and the second trimester of pregnancy by means of the ultrasonographic morphology of cystic hygroma, associated structural abnormalities, karyotype analysis and the autopsy findings. Survivors were followed for their fetal outcome and prognosis. Results: There were 57 new cases of cystic hygroma among 8,155 screenings (0.7%). 35 of the cases (61.4%) were nonseptated and 22 of the cases (38.6%) were septated cystic hygroma. Chromosomal abnormalities were found in 23 of the cases (40.3%). The most common abnormality in nonseptated cystic hygroma was trisomy 21 (8 cases, 25%) and in septated cystic hygroma was Turner syndrome (4 cases, 21.1%). The most common associated structural malformations were cardiac abnormalities (in 7 cases, 20%) in nonseptated cystic hygroma cases and nonimmune hydrops (in 12 cases, 54.5%) in septated cystic hygroma cases. Overall survival was poor; only one case of septated cystic hygroma with axillary location and seven cases of nonseptated cystic hygroma, of whom two died in the neonatal period, were alive (10.5%). This study had 80% power to detect 0.03% difference in diagnosis cystic hygroma (alpha = 0.05, beta = 0.80). Conclusion: Fetuses with cystic hygroma are at high risk for adverse outcome. Prenatal diagnosis with invasive procedures should be done in order to inform the parents in detail. Axillary location of the hygroma and the depth of invasion had prognostic importance. [ABSTRACT FROM AUTHOR]

Background: At least 90% of all ectopic pregnancies are located in the Fallopian tubes. Rupture rates differ according to localization of the ectopic masses. Isthmic ectopic pregnancies are more likely to rupture than ampullary ectopic pregnancies. Cornual pregnancies are capable of reaching further weeks of gestation. Abdominal ectopic pregnancies may even reach full-term, which is a very rare situation. Case: This article presents a case of an advanced unruptured tubal ectopic pregnancy reaching beyond the first trimester. A 36-year-old woman, gravida 4, para 2, curetage 1 was admitted to the emergency department of the Kanuni Sultan Suleyman Training and Research Hospital, in Istanbul, Turkey. She had severe abdominal pain and was admitted with clinical findings of a ruptured ectopic pregnancy. At exploration, an unruptured tubal ectopic pregnancy of 13 weeks and 3 days' duration was observed in the patient's right Fallopian tube during the operation. There was a fetus inside this Fallopian tube, with isolated tubal torsion. A right salpingectomy was performed. Results: This patient's postoperative recovery was uneventful, and she was discharged on the 3rd postoperative day. Conclusions: Localization of any pregnancy should be determined cautiously in order not to miss rare ectopic pregnancies and in order to decrease maternal morbidity and mortality. (J GYNECOL SURG 31:296) [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate perinatal outcome in pregnancies complicated by TRAP sequence. Methods: The perinatal outcomes of 15 TRAP sequence pregnancies referred to Kanuni Sultan Suleyman Research and Teaching Hospital, Turkey, were evaluated. Six cases were treated conservatively. Alcohol ablation and bipolar coagulation were performed in 5 and 4 cases, respectively. Results: In 12 cases, there were signs of fetal compromise and acardiac/pump twin abdominal circumference ratio of more than 50%. In 3 cases without intervention, the ratio was less than 50%. Three of the 6 pregnancies treated conservatively resulted in intrauterine death of the pump twin. Alcohol ablation was successful in 3 cases, with delivery of live fetuses at 36–38weeks, whereas intrauterine death occurred in 1 case and abortion occurred in 1 case. In 2 of the cases involving bipolar cord coagulation, live birth occurred at 39weeks; preterm premature rupture of membranes and abortion occurred at 18weeks in 1 case, and pregnancy was terminated in 1 case because of ventriculomegaly. Conclusion: Conservative therapy is suitable for mild cases of TRAP sequence in which the pump twin dominates. If there are signs of pump twin compromise, alcohol ablation and bipolar cord coagulation can be performed successfully. [Copyright &y& Elsevier]

Glycogen storage diseases (GSDs) are clinically and genetically heterogeneous disorders that disturb glycogen synthesis or utilization. Although it is one of the oldest inherited metabolic disorders, new genetic methods and long-time patient follow-ups provide us with unique insight into the genotype-phenotype correlations. The aim of this study was to share the phenotypic features and molecular diagnostic results that include new pathogenic variants in our GSD cases. Twenty-six GSD patients were evaluated retrospectively. Demographic data, initial laboratory and imaging features, and current findings of the patients were recorded. Molecular analysis results were classified as novel or previously defined variants. Novel variants were analyzed with pathogenicity prediction tools according to American College of Medical Genetics and Genomics (ACGM) criteria. Twelve novel and rare variants in six different genes were associated with the disease. Hearing impairment in two patients with GSD I, early peripheral neuropathy after liver transplantation in one patient with GSD IV, epilepsy and neuromotor retardation in three patients with GSD IXA were determined. We characterized a heterogeneous group of all diagnosed GSDs over a 5-year period in our institution, and identified novel variants and new clinical findings. It is still difficult to establish a genotype-phenotype correlation in GSDs.

Background: Until September 1, 2016, Turkey hosted around 2.7 million Syrian refugees. However, data investigating the pregnancy health concerning the refugees are still limited., Aim: In the present study, we aimed to compare the delivery characteristics and short-term obstetric outcomes in Turkish women and Syrian refugees., Subjects and Methods: The study included 1556 singleton pregnancies which comprised 940 Turkish women and 616 Syrian women between January 2016 and January 2017. The groups were compared for demographic data, obstetric features, and pregnancy outcomes., Results: There were significant differences between Turkish women and the refugees in terms of preterm (18.94% vs. 11.00%, P = 0.003) and post-term delivery rates (11.49% vs. 2.91%, P < 0.001), caesarian delivery rates (33.4% vs. 23.95%, P = 0.002), newborn weights <1000 g (2.55% vs. 0.97%, P = 0.006) and >4000 g (5.32% vs. 3.24%, P = 0.006), pre-eclampsia (5.32% vs. 1.62%, P = 0.009), HELLP (1.28% vs. 0.00%, P = 0.046), and placental anomalies (1.91% vs. 0.00%, P = 0.014), respectively. Being a Turkish resident (P = 0.015) was an important risk factor for the development of unfavorable pregnancy outcomes. Moreover, maternal education of at least 12 years (P = 0.028) and receiving a regular antenatal visit at a tertiary center (P = 0.031) were preventative for the development of unfavorable pregnancy outcomes. Adverse pregnancy outcomes were less prevalent in Syrian refugees compared to that in the Turkish residents which was likely due to the contribution of maternal education and regular antenatal visits which were higher in Syrian refugees., Conclusions: We suggest that providing adequate education particularly for women in undeveloped countries and facilitating access to the tertiary hospitals have the potential to reduce unfavorable pregnancy outcomes in immigrant women., Competing Interests: None

Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis. Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA). Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively. Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.

Breast cancer (BC) is the most frequent cause of cancer death in women throughout the world. Thus, it is necessary to establish sensitive screening, diagnosis and treatment methods for BC. Heat shock protein 70 (HSP70) is an important cellular stress response protein that protects cells from apoptosis. Recent studies have shown that serum HSP70 levels may provide clinically important information in various types of cancer. HSP70 is also overexpressed in BC, which is known to be associated with cancer progression, apoptosis and cell proliferation. However, the serum level of HSP70 and its diagnostic and prognostic potential in BC have not been investigated yet. The aim of this study was to determine the usefulness of serum HSP70 level as a diagnostic test and its predictive value in patients with BC. This prospective study consisted of 45 female patients diagnosed with BC and 16 healthy women who were matched for age and body mass index (BMI). Enzyme-linked immunosorbent assay (ELISA) technique was used to measure the serum level of HSP70. The serum level of HSP70 was significantly higher in patients with BC than in the healthy control group (5.98 ± 2.05 vs. 1.49 ± 0.47 ng/ml, p = 0.001). HSP70 level > 2.41 ng/ml was the best cutoff value to predict BC (97.78% sensitivity and 93.75% specificity). This study shows that HSP70 can be used as an adjunct to other diagnostic tests for BC and may be helpful for identifying patients at increased risk of BC.

Aims: Endothelin-1 (ET-1) contributes to renal fibrogenesis in several manners such as increasing collagen synthesis in mesangium, decreasing extracellular matrix (ECM) degradation by mesangial cells and stimulating mesangial contraction. The aim of our study was to investigate whether urine level of ET-1 (uET-1) could represent a useful biomarker of renal scarring and if so, to determine the optimal cutoff level for uET-1 to predict a renal scar., Methods: 44 children with renal scarring and 32 children without renal scarring were enrolled in the study. Urine ET-1 was measured by enzyme-linked immunosorbent assay., Results: Mean uET-1 level was significantly higher in the scar group than in controls (2.75 ± 1.35 fmol/ml vs. 0.68 ± 0.41 fmol/ml, p = 0.001). The optimal cut-off level was 1.064 fmol/ml for uET-1 to predict renal scarring. Using this cut-off point, sensitivity and specificity were 97.73% and 93.91%, respectively. AUC was found 0.975 (95% CI 0.917 - 0.996) for uET-1. Mean urine Endothelin-1/Creatinine ratio (uET-1/Cr) was also significantly higher in the scar group than in the control group (4.04 ± 2.29 fmol/mg Cr vs. 1.09 ± 0.67 fmol/mg Cr, p = 0.0001). Using 1.67 fmol/mgCr as optimal cut-off level, sensitivity and specificity were 95.45% and 84.09%, respectively. AUC was 0.945 (95% CI 0.875 - 0.982) for uET-1/Cr., Conclusion: Our study suggests that both uET-1 and uET-1/Cr can be used for prediction of renal scarring in children with normal renal function. Measuring urine level of ET-1 can help us to avoid unnecessary DMSA studies if the patient's uET-1 level is found to be under the determined cut-off point.

Aim: To compare the effectiveness of the Pfannenstiel-Kerr method (PKM) or modified Misgav-Ladach method (MMLM) in previous cesarean sections (C/Ss)., Methods: Hundred and fifteen gravidas were included with previous one C/S, using either a PKM or MMLM. Demographic characteristics, operative outcomes, surgical complications, and neonatal outcomes were compared in two groups., Results: The mean operative time (18.0 ± 3.5 vs. 23.5 ± 5.7 min; p < 0.0001) and mean extraction time (90.1 ± 41.2 vs. 208.1 ± 79.1 s; p < 0.0001) were significantly shorter in the MMLM group than the PKM group. Postoperative recovery (mobilization, normalization of bowel function, need for analgesics, time to oral feeding, and intra-operative blood loss) was similar between the MMLM and PKM groups., Conclusion: The MMLM appears to be a faster alternative to PKM for previous C/Ss, with similar results as in previous studies with primary CSs.

Objective: The aim of our study is to determine whether the serum human chorionic gonadotropin (hCG) level is helpful in the differential diagnosis and in the clinical management and follow-up of preeclampsia, superimposed preeclampsia, and chronic hypertension during the third trimester., Material and Methods: Eighty hypertensive pregnant patients, who had been hospitalized, and 25 normotensive pregnant patients, who attended the outpatient perinatology clinic in Zeynep Kamil Women and Pediatric Diseases Education and Research Hospital between June 2001 and September 2001 were enrolled in the study. These patients were evaluated in five groups: mild preeclamptic, severe preeclamptic, superimposed preeclamptic, chronic hypertensive, and normotensive groups. The geometric means of hCG levels of these groups were compared with each other and cutoff levels for differential diagnosis were determined., Results: The geometric mean of hCG levels was established as 17,361.31 mIU/mL in the mild preeclamptic group, 49,817.59 mIU/mL in the severe preeclamptic group, 41,101.09 mIU/mL in the superimposed preeclamptic group, 12,558.57 mIU/mL in the chronic hypertensive group, and 9647.98 mIU/mL in the normotensive group. When the geometric mean of the severe preeclamptic group was compared with the results of the normotensive patients, mild preeclamptic patients, chronic hypertensive patients, and superimposed preeclamptic patients, the mean hCG value of severe preeclamptic group was statistically significantly higher than all of the other groups (p < 0.001) except for the latter. The geometric mean of hCG levels of severe preeclamptic patients was compared with the geometric mean of hCG levels of superimposed preeclamptic patients (p > 0.05). The geometric mean of hCG levels in the chronic hypertensive group was lower than that of the superimposed preeclamptic group and the difference was statistically significant (p < 0.001). The geometric mean of hCG levels of the chronic hypertensive group was not significantly different from the results of the mild preeclamptic group and the normotensive group. There was, however, a statistically significant difference between the geometric means of hCG levels of mild preeclamptic patients and normotensive group (p < 0.001). The cutoff value of hCG was determined as 25,000 mIU/mL in differentiation of chronic hypertension from the severe preeclampsia, as 20,000 mIU/mL in differentiation of chronic hypertension from the superimposed preeclampsia, and as 30,000 mIU/mL in differentiation of severe preeclampsia from mild preeclampsia., Conclusion: The maternal serum hCG level is a useful laboratory tool when managing and treating hypertensive disorders that complicate pregnancy. The serum hCG level is especially significant in severe preeclampsia and superimposed preeclampsia. Therefore, a high serum hCG level can be a helpful marker in the diagnosis and clinical management by preventing possible complications resulting from severe and superimposed preeclampsia.