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The study aimed to investigate the effect of metformin treatment on leukocyte telomere length (LTL) and the relationship of LTL with C-reactive protein (CRP), homocysteine, albumin, complete blood count, and HOMA-IR values in patients with polycystic ovary syndrome (PCOS).A prospective case-control study consisting of 30 women with PCOS and 30 healthy women without PCOS was performed. The relationship between clinical and laboratory parameters and LTL was analyzed. PCOS patients were treated with metformin (850 mg/day) for three months. Before treatment (BT) and after treatment (AT), each patient's LTL was evaluated and compared with the control group.In the comparison between PCOS and control groups, the difference was significant for LTL, age, body mass index (BMI), and CRP (p = 0.002; p 0.001; p = 0.001; p = 0.01, respectively). In PCOS patients, the difference between BT and AT, LTL was not statistically significant (BT: 6.06 ± 2.12; AT: 6.30 ± 1.93; p = 0.623; 95% C.I: - 1.22-0.74); however, the difference for weight was significant (BT: 83.78 ± 15.31; AT: 80.62 ± 15.40; p = 0.02; 95% CI: 1.34-4.99). The logistic regression model established by BMI (group 1: 21-24, group 2: 24-29, group 3: 29-34, group 4: 34), age, and RDW, which predicted the PCOS group by affecting the LTL level, was statistically significant (p 0.001/PPV = 96.3%; NPV = 88.5%). Each unit reduction in telomere length increased women's probability of PCOS by 0.4 times (p = 0.013; OR = 0.419, 95% CI: 0.211-0.835).Although statistically insignificant, LTL increased after metformin use in PCOS patients, and the mean weight loss reduction was statistically significant. Telomere shortening increased the likelihood of PCOS 0.4 times.

Introduction Factor XIII deficiency is an extremely rare type among bleeding diathesis. In factor XIII deficiency, normal results of coagulation screening tests are expected. It usually does not cause spontaneous bleeding. Apart from bleeding diathesis, it may cause delayed wound healing and recurrent spontaneous abortions in women. Here, we present a 32-year-old case with severe congenital factor XIII deficiency who had an uncomplicated pregnancy and birth with regular replacement therapies. Case report A 32-year-old patient with severe congenital factor XIII deficiency, who had a history of spontaneous abortion at the 11th week of her first pregnancy, applied to our center with a request for childbirth. It was learned that the factor XIII levels of the patient could not be measured, that she was using plasma-derived FXIII concentrate at a dose of 25 units/kg every time once a month, and in cases where this could not be obtained, 5 units/kg cryoprecipitate was given instead. After the completion of the pre-pregnancy assessments, starting 3 months before the planned pregnancy and continuing for the whole pregnancy and for 3 months after birth, 25 units/kg plasma-derived concentrate at a dose of 25 units/kg was applied each time and every two weeks, and in cases where this could not be provided, the follow-up was continued by applying cryoprecipitate at a dose of 5 units / kg instead. During this whole process, FXIII levels ranged between 70% and 100%. The patient, who developed an abortion risk due to decidual bleeding in the first trimester, was hospitalized and an additional 25 units / kg plasma-derived FXIII concentrate was administered and a parenteral dose of 30 mg / kg tranexamic acid was applied until the signs of decidual bleeding disappeared. An additional 50 units/kg dose of plasma-derived FXIII concentrate was administered to the patient 30 minutes before birth who had a planned delivery by cesarean section at 38 weeks of gestation, and 30 mg/kg parenteral tranexamic acid was administered for 7 days following the delivery. FXIII level was detected 50% in the child of a healthy, 3500-g born boy. The patient and her baby, who are in the first year after birth, are followed up without any complications, and prophylactic plasma-derived FXIII concentrate or cryoprecipitate is administered to the patient once a month. Discussion and Conclusion Inherited bleeding diathesis lead to an increased risk of bleeding and abortion in obstetric patients. Factor XIII deficiency is an extremely rare type among them. FXIII has a role in angiogenesis as well as hemostasis. Therefore, wound healing and tissue repair are impaired in Factor XIII deficiency. The risk of premature separation of the placenta, miscarriage especially in the first trimester, and postpartum uterine bleeding are increased in FXIII deficiency. Tranexamic acid can be used safely in obstetric patients with bleeding diathesis. It may be possible to ensure that patients with factor XIII deficiency have an uncomplicated pregnancy and delivery with regular follow-ups, regular prophylactic factor preparations, plasma replacements if they are not found, and in cases of bleeding, with additional doses of factor preparations or plasma replacement applications with tranexamic acid.

With the impact of globalization,management knowledge, especially in the field of public administration, hasseen new changes in public administration with the emergence of new publicmanagement understanding. As a result of these changes, a brand new conceptemerged under the name of electronic state. In the development of this concept,the widespread use of internet in the frame of globalization and theproportionate effect of the slowness of the bureaucracy in the publicinstitutions has been increased. In this study, I will examine the concept ofe-democracy which develops under the e-government and its sub-subject dependingon the new concept of public administration emerged with globalization., Küreselleşmenin etkisiyle yönetimbilimi, özellikle kamu yönetimi alanında yeni arayışlar sonucu ortaya çıkanyeni kamu yönetimi anlayışı ile kamu yönetiminde büyük değişimlergörülmektedir. Bu değişimlerin sonucunda elektronik devlet adı altında yepyenibir kavram ortaya çıkmıştır. Bu kavramın gelişiminde küreselleşme çerçevesindeinternet kullanımının yaygınlaşması ve buna doğru orantılı şekilde kamukurumlarında ki bürokrasinin yavaşlığının insanlar üzerinde yarattığı olumsuzetkilerin artmasını öncelikli olmuştur. Bu çalışma da küreselleşmeyle birlikteortaya çıkan yeni kamu yönetimi anlayışına bağlı olarak e-devlet ve bunun altbaşlığında gelişen e-demokrasi kavramını inceleyeceğim.

Küreselleşmenin etkisiyle yönetim bilimi, özellikle kamu yönetimi alanında yeni arayışlar sonucu ortaya çıkan yeni kamu yönetimi anlayışı ile kamu yönetiminde büyük değişimler görülmektedir. Bu değişimlerin sonucunda elektronik devlet adı altında yepyeni bir kavram ortaya çıkmıştır. Bu kavramın gelişiminde küreselleşme çerçevesinde internet kullanımının yaygınlaşması ve buna doğru orantılı şekilde kamu kurumlarında ki bürokrasinin yavaşlığının insanlar üzerinde yarattığı olumsuz etkilerin artmasını öncelikli olmuştur. Bu çalışma da küreselleşmeyle birlikte ortaya çıkan yeni kamu yönetimi anlayışına bağlı olarak e-devlet ve bunun alt başlığında gelişen e-demokrasi kavramını inceleyeceğim.

OBJECTIVE: Neural tube defects are congenital malformations those mostly causing life-long morbidities. They are prevented by the periconseptional folic acid usage and prenatal diagnostic methods. MATERIALS-METHODS: Pregnants from Afyonkarahisar and neighbourhood cities applied to our hospital and determined NTD, were investigated. RESULTS: In our obstetrics clinic 1403 delivery were made and 43 of them had fetus with NTD. Among these fetuses 41.3% had meningomyelocel, 17.4% had meningocel, 21.7% had encephalocel, 8.7% had unencephali and 4.3% had iniencephali. CONCLUSION: Incidence of NTD is high in our region and geographic region, nutrition and other socioeconomic factors may be related to the high incidence. Education of the mother and periconceptional folic acid usage may reduce teh incidence of NTD.

OBJECTIVE: In this study our aim was to investigate the factors affecting the nausea and vomiting of pregnancy (NVP) and behaviours those done by the pregnants to reduce the sense of NVP. MATERIALS-METHODS: Ninety-six pregnants smaller than 14 weeks pregnancy whom applied to our obstetrics clinic were taken in to the study. Twenty-six of them had no NVP and 70 of them had NVP. A questionnaire including sociodemographic factors, obstetric features and factors increasing and decreasing the sense of nausea and vomiting was fulfilled. Rhode’s scoring system was used for determining the degree of NVP. Kruskal Wallis test, χ2 test and Pearson corelation analysis were done for statistical analysis. P< 0.05 was considered significant. RESULTS: There was no NVP in the 27.1% of the pregnants by Rhode’s scoring system, 30.2% had mild, 42.7% had moderate NVP. Age, gestational week, gravidy, parity, abortus, number of the live child, occupational status, education and income level were not different statistically between the groups. There was a positive correlation between NVP and fatigue (p< 0.05). Pregnants those had NVP symptoms preferred resting and sleeping more than others to reduce the symptoms. CONCLUSION: NVP is an important health problem that adversly affect the social and family life of women. Doctors should pay attention to this important health problem and should made pregnants and their family conscious of the affected factors

AIM: Obstructive sleep apnea syndrome (OSAS) chracterized by snoring, witnessed apnea and sleepiness in daytime. Snoring is frequent in pregnant women than non pregnancies. To our knowledge there is only one study about the relationship between pregnancy and OSAS in our country. So we decided to investigate the frequency of OSAS symptoms, habitual snoring, risk factors and systemic diseases in pregnant women. MATERIALS-METHODS: Fifty-four women with habitual snoring were suggested to take polysomnography. Thirty-four of them accepted to take polysomnography in Sleep Laboratury of the Pulmonary Clinics. RESULTS: Mean age of the pregnancies were 27.4±5.3 (min17-max55), 103 (25.8) of them had snoring sometimes, 54 (13.4%) had habitual snoring. Age, neck circumference, body mass index, systolic and diastolic blood pressure were significantly higher in snoring pregnant women. Frequency of habitual snoring was significantly higher in third trimester than first and second trimester. Systemic diseases accompanying pregnancy with habitual snoring were preeclampsia, gestational diabetes and cardiac diseases. These were higher in snoring pregnant women. Habitual snoring increased the risk of diabetes 5 times, preeclamsia 9 times, cardiovascular disease 12 times in our study. Four patients (11.8%) of 34 women those were made polysomnography, had apnea-hypoapnea index ≥5 and evaluated as OSAS. CONCLUSION: OSAS symptoms were higher in pregnant women. OSAS is related with pregnancy associated systemic diseases so all pregnant women should be evaluated for OSAS symptoms and should be made polysomnography if necessary