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Yayın Bone turnover and maternal 25(OH) vitamin D3 levels during pregnancy and the postpartum period: should routine vitamin D supplementation be increased in pregnant women?(ELSEVIER SCIENCE BV, 2011) Haliloglu, Berna; Ilter, Erdin; Aksungar, Fehime Benli; Celik, Aygen; Coksuer, Hakan; Gunduz, Tonguc; Yucel, Erdal; Ozekici, UmitObjective: To investigate the relationship between 25(OH) vitamin D3 levels and maternal bone turnover during pregnancy and lactation. Study design: Thirty pregnant women and 30 healthy non-pregnant controls were included the study. The pregnant women were examined in the 12th, 25th and 32nd gestational weeks and 6 weeks after delivery. The controls were examined once. Serum concentrations of 25(OH) vitamin D3, parathyroid hormone (PTH), cross-linked C-terminal telopeptide of type I collagen (CTX), calcium, and phosphate were measured. Results: In the 32nd week and the postpartum period, 25(OH) vitamin D3 deficiency rates were 13.3% and 333%, respectively. Serum 25(OH) vitamin 03 levels were below the detection limit in 10% and 33%, respectively, of the same subjects. In the control group, rates of 25(OH) vitamin D3 deficiency and "below detection limit" were 30% and 23%, respectively. While 25(OH) vitamin 03 and CTX levels were not correlated to each other in the first trimester, a negative correlation was found in the 2nd and 3rd trimesters and the postpartum period between 25(OH) vitamin 03 and CTX levels (r = -0.472, p = 0.048; r = -0.893, p < 0.0001, r = -0.881, p < 0.001, respectively). No correlation between 25(OH) vitamin D3 and CTX levels was found in controls. Conclusion: We consider that 25(OH) vitamin D3 supplementation of women could both decrease maternal bone resorption and lead to enhanced bone mass in offspring during later life. Since women are prone to 25(OH) vitamin D3 insufficiency, we suggest higher doses of 25(OH) vitamin D3 should be given to pregnant subjects. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Yayın Comparison of conventional and liquid-based cytology: do the diagnostic benefits outweigh the financial aspect?(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2012) Ilter, Erdin; Midi, Ahmet; Haliloglu, Berna; Celik, Alrgen; Yener, Arzu Nee; Ulu, Ipek; Bozkurt, Hayriye Serpil; Ozekici, UmitAim: We aimed to compare the efficiency of conventional cytology (CC) and new liquid-based cytology (LBC) techniques in the assessment and the accuracy of Pap smears reported as abnormal by histological examinations. Materials and methods: A total of 3488 women who were undergoing routine cervical screening (1308 CC and 2180 LBC) were included in the initial screening. The results were assessed as either satisfactory or unsatisfactory. Satisfactory results were subdivided as negative, atypical squamous cells of undetermined significance (ASCUS), atypical squamous cells for which high-grade lesions could not be excluded (ASC-H), low-grade squamous intraepithelial lesion (LGSIL), high-grade squamous intraepithelial lesion (HGSIL), and cancer. Results: These data show that the rate of unsatisfactory results for the LBC technique (0.05%) was lower than for the CC group (0.5%). Except for ASCUS and cancer cytology, all other atypical cytology results were diagnosed more frequently with CC than with LBC. The rates of detected ASC-H and HGSIL were higher with CC than LBC, and the difference was statistically significant (P <0.05). Conclusion: LBC has higher satisfaction rates than CC. LBC also detected more true-abnormal cases when compared with CC. The residual specimens from the LBC technique can be used to detect human papillomavirus DNA through immunocytochemistry, if needed. However, the benefits of LBC do not seem to justify the cost. It seems that CC should be the first choice for developing countries with lower incomes.Yayın Comparison of uterine artery blood flow with levonorgestrel intrauterine system and copper intrauterine device(ELSEVIER SCIENCE INC, 2011) Haliloglu, Berna; Celik, Aygen; Ilter, Erdin; Bozkurt, Serpil; Ozekici, UmitBackground: As a contraceptive method, we investigated whether the levonorgestrel-releasing intrauterine system (LNG-IUS) has any effect on uterine artery blood flow when compared with copper intrauterine device (IUD). Study Design: Sixty women with copper IUD and 60 women with LNG-IUS were included in the study. The age, gravidity, parity, body mass index (HMI) and menstrual flow pattern using a pictorial chart were recorded. All women were assessed by ultrasonography at the preinsertion period and 1 year after insertion. The pulsatility and resistance indices (PI and RI, respectively) of the uterine artery and endometrial thickness were evaluated in the preinsertion and postinsertion periods. Results: In copper IUD users, preinsertion and postinsertion ultrasonographic assessments were not significantly different. However, postinsertion RI was significantly higher compared with preinsertion RI in LNG-IUS users (p=.001). The PI was also increased 1 year after insertion, but it did not reach statistically significant levels (p=.08). Endometrial thickness was also significantly decreased in the postinsertion period in women with LNG-IUS (p=.04). Conclusion: The significant increase in uterine artery RI in LNG-IUS users 1 year after insertion might be due to its local progestational effects. It might also indicate the mechanism of the LNG-IUS in reducing menstrual blood flow. (C) 2011 Elsevier Inc. All rights reserved.Yayın Does urinary incontinence subtype affect sexual function?(ELSEVIER SCIENCE BV, 2011) Coksuer, Hakan; Ercan, Cihangir Mutlu; Haliloglu, Berna; Yucel, Mehmet; Cam, Cetin; Kabaca, Canan; Karateke, AtesObjective: Urinary incontinence (UI) may affect a woman's physical and psychological well-being in different aspects. The aim of this study was to compare the effects of urinary stress incontinence (USI), detrusor overactivity (DO) and mixed urinary incontinence (MUI) on sexual function. Study design: One-hundred and seventy urinary incontinent, sexually active women were included in this cross-sectional study. After urodynamic evaluation, participants were divided into three subgroups as USI (n = 61), DO (n = 55) and MUI (n = 54). Patients were matched according to age, parity and body mass index (BMI), rendering the sample size to 41 patients in each group. Turkish version short form of the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) was filled out by each of the participants. Totally, 52 patients were excluded from the study (47 could not be matched and 5 incomplete questionnaire). Demographic characteristics of the participants, total and three domain scores of PISQ-12 were compared among three UI subgroups. Results: The study group was consisted of 38 (32.2%) DO, 41(34.7%) USI and 39(33.1%) MUI patients. Demographic characteristics of the patients were similar in three subgroups. Patients with a diagnosis of MUI had significantly lower mean PISQ-12 scores than the ones with USI and DO whereas patients with USI had lower mean PISQ-12 scores than patients with DO. Conclusion: Although urinary stress incontinence effects sexual function more than detrusor overactivity in terms of PISQ-12 scores, mixed urinary incontinence has the greatest impact on sexual function when compared with urinary stress incontinence and detrusor overactivity. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Yayın Effects of Hyperandrogenism on Tear Function and Tear Drainage in Patients with Polycystic Ovary Syndrome(SCI PRINTERS & PUBL INC, 2011) Coksuer, Hakan; Ozcura, Fatih; Oghan, Fatih; Haliloglu, Berna; Karatas, SerapOBJECTIVE: Polycys tic ovary syndrome (PCOS) is an endocrinopathy characterized by chronic anovulation and hyperandrogenism. Hormonal changes can affect ocular surface and tear functions. We evaluated dry eye symptoms, clinical tear film alterations, and tear clearance in patients with PCOS. STUDY DESIGN: Thirty-five women with PCOS and 22 healthy individuals were enrolled in the study. An ocular surface disease index (OSDI) questionnaire was administered, and after the routine ophthalmologic examination tear film breakup time (TB UT) and Schirmer tests were performed. Tear clearance was assessed via fluorescein dye disappearance test (FDDT). RESULTS: No difference was observed in Schirmer test between the groups, however OSDI scores were significantly higher (p=0.01) and TBUT was significantly lower (p=0.01) in PCOS patients than in the control women. FDDTs were not different between the PCOS and control subjects. CONCLUSION: Our findings suggest that patients diagnosed with PCOS should be advised to obtain an ophthalmic examination, especially for dry eye. (J Reprod Med 2011;56:65-70)Yayın Evaluation of carotid wall thickness and vertebro-basilar system insufficiency in patients with obese polycystic ovary syndrome(WILEY, 2011) Coksuer, Hakan; Koplay, Mustafa; Oghan, Fatih; Haliloglu, Berna; Keskin, NadiAim: To investigate the risk of cardiovascular disease by measuring carotid intima-media thickness (CIMT) and to evaluate the diameters and blood flow volume of vertebral arteries using Doppler ultrasound and the possible contribution of hyperandrogenemia that exists in these patients. Material and Methods: We prospectively studied 64 Caucasian women aged 18-35 years (31 with polycystic ovary syndrome [PCOS] and 33 healthy controls). Patients were classified according to body mass index into obese (BMI > 27 kg/m(2)). All subjects were examined with ultrasound to measure CIMT and blood flow volume and diameters of vertebral arteries. Results: A significant difference between the two groups in CIMT (0.51 +/- 0.08 vs 0.39 +/- 0.02 mm, P < 0.001) and diameters of vertebral arteries (right, 3.03 +/- 0.37 vs 3.44 +/- 0.68 mm and left, 2.94 +/- 0.34 vs 3.33 +/- 0.63 mm, P < 0.05) were found, respectively. Right-left and total flow volumes of the vertebral arteries (VA) were significantly lower in the PCOS group than in the control group (P <= 0.001). Compared to the control group, diameters of right and left VA decreased (P < 0.05). Conclusion: The results of this study suggest that hyperandrogenemia in obese PCOS patients affects carotid and vertebro-basilar system arteries wall thickness. Pre-atherosclerotic vascular impairment with androgen excess should determine early examination of vertebro-basilar system with ultrasound. All patients with PCOS must be routinely examined using color Doppler ultrasound to measure CIMT carotid and vertebro-basilar arteries, and diameters and blood flow volume of vertebral arteries.Yayın Fluid intake and voiding parameters in asymptomatic Turkish women(SPRINGER LONDON LTD, 2012) Haliloglu, Berna; Peker, Hakan; Ilter, Erdin; Celik, Aygen; Kucukasci, Meryem; Bozkurt, SerpilFor an accurate evaluation of bladder diaries, we aim to investigate normal urinary habits and determining factors on functional bladder capacity, frequency, and 24-h volume in the bladder diaries of asymptomatic women. One-hundred and fifteen asymptomatic women who recorded a 24-h bladder diary were included in the study. Linear regression analyses were used to explore associations between diary values and patient characteristics. Total number of voids was related to age, body mass index, total voided volume, total fluid intake, total diuresis rate, and maximum fluid intake in one go. Maximum, average, and minimum volumes per void were found to be related to body mass index, total voided volume, total fluid intake, total diuresis rate, and maximum fluid intake. When we used multiple regression analysis, only maximum fluid intake was found to be related to the total number of voids, maximum, average, and minimum volumes per void. Maximum fluid intake rather than total voided volume seems to be an important determinant factor for total number of voids and functional bladder capacity.Yayın Intestinal vaginoplasty: seven years' experience of a tertiary center(ELSEVIER SCIENCE INC, 2010) Karateke, Ates; Haliloglu, Berna; Parlak, Onur; Cam, Cetin; Coksuer, HakanObjective: To investigate the long-term effects of intestinal vaginoplasty in cases with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Design: Prospective study. Setting: Division of Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, at a women's and children disease education and research hospital. Patient(s): Between 2003 and 2009, 29 patients with MRKH syndrome underwent intestinal vaginoplasty. Intervention(s): Two of the patients were treated with ileal and 27 with sigmoid vaginoplasty. Main Outcome Measure(s): The age, marital status, associated anomalies, method used for bowel transposition (isoperistaltic/antiperistaltic), type of abdominal incision, and intra-and postoperative complications were evaluated. Result(s): One of the patients for whom ileal vaginoplasty was performed had 40 cm ileal necrosis requiring bilateral ileostomy for 2 months. Introital stenosis was detected in 15 cases (79%) who were unmarried, while none of the married cases had introital stenosis. However, all patients responded to finger-dilatation. All married patients were sexually satisfied after operation. An intraluminal abscess developed in the proximal segment of the neovagina owing to stricture occurring above abdominoperineal tunnel 2 years after operation. In another patient who had a rudimentary uterine horn, hematometra developed 3 years after operation and treated with resection. Conclusion(s): In our experience, sigmoid vaginoplasty seems to be a favorable procedure which provides excellent long-term results for the patients with vaginal agenesis. (Fertil Steril (R) 2010;94:2312-5. (C) 2010 by American Society for Reproductive Medicine.)Yayın Negative correlation between D-dimer and homocysteine levels during pregnancy and the postpartum period a prospective study(ELSEVIER SCIENCE BV, 2010) Haliloglu, Berna; Aksungar, Fehime Benli; Celik, Aygen; Ilter, Erdin; Coksuer, Hakan; Ozekici, UmitObjective There have been conflicting data about the role of increased levels of homocysteine (Hcy) on haemostatic system We aim to investigate prospectively the relation between serum Hcy levels and changes in haemostatic system in pregnancy and postpartum period Study design Sixty-eight healthy pregnant women were included in the study Blood samples were obtained in the 11th gestational week 25th gestational week 32nd gestational week and postpartum 4th week The haemoglobin levels white blood cell count (WBC) platelet count activated partial thromboplastin time (aPTI-) prothrombin time (PT) fibrinogen D-dimer Hcy vitamin B12 and folate levels were measured Results Serum Hcy levels were negatively correlated with D-dimer levels (r = -0 57 p < 0 0001) The highest levels of D-dimer (1046 62 +/- 322 01 ng/ml) were achieved in the third trimester and the lowest levels of serum Hcy (4 45 +/- 123 mmol/1) were detected in the same trimester In postpartum fourth week D dimer levels were decreased to normal levels (238 27 +/- 198 59 ng/ml) while the serum Hcy levels were reached to the highest levels (7 99 +/- 1 36 mmol/1) Conclusion The negative correlation between Hcy and D-dimer levels may be a compensatory mechanism to maintain the normal haemostatic balance in pregnancy Hence possible advantage of low Hcy levels in pregnancy may be to prevent undesired thrombosis (C) 2010 Elsevier Ireland Ltd All rights reservedYayın Primary omental pregnancy: case report(2011) Haliloglu, Berna; Çelik, Aygen; Ilter, Erdin; Küçükaşçı, Meryem; Yener, Neşe; Manukyan, Manuk Norayık; Bozkurt, Serpil; Özekici, ÜmitPrimary omental pregnancy is an extremely rare type of ectopic pregnancy. It can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present a case in which a 27-year-old woman admitted to emergency department with severe abdominal pain. There was no gestational sac in the endometrium, however, marked free fluid and normal ovaries were demonstrated in transvaginal ultrasound. She was diagnosed as ruptured ectopic pregnancy and laparotomy was carried out. In exploration, bilateral tubes and ovaries were intact. An omental pregnancy was detected and partial omentectomy was performed. Histopathologic evidence of neovascularization confirmed the diagnosis of "primary omental pregnancy". The primary omental pregnancy should be considered in the cases with diffuse hemorrhage and normal appearance of bilateral tubes and ovaries in exploration. Copyright © 2011 by Türkiye Klinikleri.Yayın Relationship between bone mineral density, bone turnover markers and homocysteine, folate and vitamin B12 levels in postmenopausal women(SPRINGER HEIDELBERG, 2010) Haliloglu, Berna; Aksungar, Fehime Benli; Ilter, Erdin; Peker, Hakan; Akin, Figen Temelli; Ozekici, UmitWe aimed to investigate whether levels of homocysteine (Hcy), folate, and vitamin B12 are related to bone turnover markers and bone mineral density (BMD) in postmenopausal women. One hundred and twenty postmenopausal women were divided into three groups: osteoporotic, osteopenic and normal, according to the BMD measurements. The age, weight, body mass index (BMI), years since menopause (YSM), gravidity, parity, bone turnover markers [type I collagen C-telopeptides (CTx) and bone-specific alkaline phosphatase (BAP)], serum Hcy, parathyroid hormone (PTH), vitamin B12, folate, calcium and magnesium levels were compared with each other. Twenty-five women had osteoporotic, 42 women had osteopenic, and 53 had normal BMD values. After adjusting for confounding factors, serum Hcy levels were significantly higher in osteoporotic women [adj OR = 38.95 (1.474-1029.88) p = 0.02]. The age, YSM, PTH, CTx and BAP levels were related to serum Hcy in all women (beta = 0.523, p = 0.0001; beta = 0.446, p = 0.001; beta = 0.295, p = 0.005; beta = 0.239, p = 0.026; beta = 0.451, p = 0.001, respectively). Our data showed that vitamin B12, folate and Hcy levels were not related with BMD in postmenopausal women. We think that one of the underlying mechanisms of increased Hcy levels and osteoporosis may be a mechanistic link which cannot detected by BMD or biochemical markers.Yayın Relationship between bone mineral density, bone turnover markers and homocysteine, folate and vitamin B12 levels in postmenopausal women (vol 281, pg 663, 2010)(Springer Heidelberg, 2010) Haliloglu, Berna; Aksungar, Fehime Benli; Ilter, Erdin; Peker, Hakan; Akin, Figen Temelli; Mutlu, Nilgün; Özekici, Umit[Abstract Not Available]Yayın Serotonin dilemma in postmenopausal women: Is it low or high?(ELSEVIER IRELAND LTD, 2008) Haliloglu, Berna; Aksungar, Fehime Berth; Ilter, Erdin; Akin, Figen Temelli; Mutlu, Nilgun; Peker, Hakan; Ozden, SelcukObjective: In this study, we have studied with premenopausal (PM), naturally menopausal (NM) and surgically induced menopausal (SM) women in order to investigate the differences in serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), follicle stimulating hormone (FSH) and estradiol (E2) levels on serum serotonin levels. Methods: Forty premenopausal (36.7 +/- 3.5 years), 40 naturally menopausal (54.2 +/- 8.4 years) and 38 surgically induced menopausal (55.4 +/- 11.2 years) women were included in the study. None of the subjects were using antidepressants or hormone replacement therapy. In NM and SM, years since menopause (YSM) were 3.16 +/- 1.58 and 3.36 +/- 1.89, respectively. Cortisol, DHEA-S, FSH and E2 levels were determined by immunochemiluminisence while serotonin levels were determined by HPLC. Results: Serum serotonin levels in NM women were higher than the other two groups [144.23 +/- 45.29 mu g/L vs 61.35 +/- 37.72 mu g/L in SM women and 98.74 +/- 50.29 mu g/L in PM women]. E2 and DHEA-S were positively correlated, while FSH and cortisol were negatively correlated with serotonin in NM and SM. There was no significant correlation between serotonin and age or YSM. In the PM group, there was no significant correlation between serotonin and the hormones. Conclusion: In conclusion, increased serotonin levels in naturally menopausal women may be a compensatory mechanism to decreased E2 levels as it is postulated that there is strong interaction between E2 and the serotoninergic system. (C) 2008 Elsevier Ireland Ltd. All rights reserved.Yayın Subjective versus objective measurement of surgical outcomes of treatment of female stress urinary incontinence: it is not just black and white(SPRINGER LONDON LTD, 2010) Haliloglu, Berna; Rizk, Diaa E. E.…Yayın Women's Knowledge of Pap Smear Test and Human Papillomavirus Acceptance of HPV Vaccination to Themselves and Their Daughters in an Islamic Society(LIPPINCOTT WILLIAMS & WILKINS, 2010) Ilter, Erdin; Celik, Aygen; Haliloglu, Berna; Unlugedik, Elif; Midi, Ahmet; Gunduz, Tonguc; Ozekici, UmitObjective: Cancer of cervix uteri is the second most common cancer among women, and it has been shown to be caused by human papillomavirus (HPV) infection in more than 99% of cases. We surveyed Muslim Turkish women, who mostly accept talking about sex as a taboo, to examine their knowledge about Papanicolaou (Pap) smear test, HPV, HPV vaccine, and their attitude toward vaccination to themselves and their daughters. Methods: We surveyed 525 women aged between 19 and 53 years to examine their knowledge about cervical cancer screening Pap smear test, HPV, HPV vaccine, and their attitude toward vaccination to themselves and their daughters with a questionnaire that is consisted of 5 parts with a total of 31 items. Results: The knowledge of cervical screening was high (70%), and 51% of the subjects were at least once had a Pap smear test, but most respondents (56%) had never heard of HPV. For most women, recommendations from health workers (67%) were the major influences in deciding to get vaccinated. Conclusions: The importance of successful introduction on the vaccine by the drug providers and health care professionals in Turkey was shown in this present study with a high rate of awareness of cervical cancer vaccine. "Early-age vaccination knowledge" before any sexual contact is probably due to the correct education of mothers by health care professionals. The professionals should be educated and trained about HPV, vaccination, and its relation with cervical cancer to increase the knowledge about it.
