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Öğe Novel method for trisomy 21 screening in the first trimester of pregnancy: fetal brain angle(Walter De Gruyter Gmbh, 2022) Karsli, Mehmet Fatih; Cakmak, Bulent; Sen, CihatObjectives The present study was performed to examine the utility of a new first trimester marker called the brain angle (BA) in screening for trisomy 21. We postulate that differences in the midbrain anatomy between euploid fetuses and those that are affected by trisomy 21 are reflected in changes in BA measurements. Methods In fetuses at 11(+0)-13(+6) weeks of gestations, which were at high risk for trisomy 21, the angle was measured between the line crossing the thalamus and mesencephalon cranial border tangentially and the line crossing the brainstem lower limit. This angle was compared between fetuses with trisomy 21 (based on karyotyping) and those with a normal karyotype. Results Trisomy 21 was detected in 45 (8%) of 560 fetuses. Receiver operating characteristic analysis showed that, at BA >= 94 degrees, the sensitivity and specificity for determining trisomy 21 were 97.8% (95% CI=88.2-99.9%) and 100% (95% CI=99.2-100%), respectively. Conclusions Fetal BA appears to be a promising new first trimester marker in screening for trisomy 21.Öğe Obstructive sleep apnea syndrome is associated with maternal complications in pregnant women(Via Medica, 2021) Sag, Ismail; Cakmak, Bulent; Ustunyurt, EminObjectives: This study was performed to evaluate the relationship between obstructive sleep apnea syndrome and pregnancy complications. Material and methods: A total of 500 women (18-45 years) who had delivered (vaginal delivery or caesarean section) between January 2017 and March 2017 in our clinic were included in the study. Patients at high risk for obstructive sleep apnea syndrome were identified using the Stop Bang questionnaire. Based on the results of the questionnaire, pregnancy complications were compared between high-risk pregnant women (Group 1) and low-risk pregnant women (Group 2). Results: Age, body mass index, smoking rate, and the rate of systemic disease (e.g., diabetes and/or hypertension) were higher in Group 1 than in Group 2 (p < 0.05). Rates of preeclampsia, gestational diabetes, preterm labor, premature rupture of the membranes, and cesarean section were significantly higher in Group 1 than in Group 2 (p < 0.05). Conclusions:Obstructive sleep apnea syndrome is associated with a higher rate of maternal complications among pregnant women. Affected patients should be carefully monitored.Öğe Perceived Stress and Accompanying Low Urine pH Are in Relation to Bladder Pain Syndrome(Galenos Yayincilik, 2021) Cihan, Ahmet; Cihan, Esra; Cakmak, BulentObjective: The clinical relevance of low urine pH and perceived stress levels in patients with bladder pain syndrome (BPS) has not yet been clarified. In this study, we hypothesised that urine pH and perceived stress levels may differ in patients with BPS and that they may be related to each other. Materials and Methods: A prospective case control study was conducted to test the hypothesis. Patients aged >18 years who were newly diagnosed with BPS were included in the patient group. The control group consisted of healthy volunteers aged >18 years. The 10-item Perceived Stress scale (PSS-10), spot urine pH measurements, Interstitial Cystitis Symptom index (ICSI), Interstitial Cystitis Problem index (ICPI), visual analogue scale for pain (VAS-Pain) and quality-of-life (QOL) scores were evaluated. Independent samples t-test and multivariate regression with path analysis were performed. Results: The study evaluated 84 patients with BPS and 86 healthy participants. The mean spot urine pH, PSS-10, ICSI, ICPI, VAS-Pain and QOL scores were different between the patient group and control group. Spot urine pH level (p=0.01, odds ratio (OR)=0.31) and PSS-10 scores (p=0.01, OR=1.1) remained significant predictors of BPS in the multivariate analysis. Lower urine pH and higher perceived stress levels were associated with worse ICSI, ICPI, VAS-Pain and QOL scores. Conclusion: Acidic urine pH and high perceived stress levels are associated with the presence of BPS. Perceived stress is independent from low urine pH, as they each relate to BPS symptoms in a bidirectional manner.Öğe Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial(K Faisal Spec Hosp Res Centre, 2021) Gulucu, Selim; Cakmak, BulentBACKGROUND: Abnormal uterine bleeding (AUB) affects approximately 14% to 25% of women of reproductive age. The most common use of office hysteroscopy is to evaluate pathologies related to AUB and reproductive health, but office hysteroscopy can also be used for the diagnosis and treatment of other intrauterine pathologies. OBJECTIVE: Investigate the effects of the temperature of the distension fluid on pain severity in patients undergoing diagnostic office hysteroscopy due to AUB. DESIGN: Randomized controlled clinical trial. SETTING: Tertiary care center in Turkey. PATIENTS AND METHODS: One hundred perimenopausal patients with AUB were randomly allocated according to the temperature of the distension fluid used in office hysteroscopy (37 degrees C or 25 degrees C). Pain intensity was assessed using a visual analog scale (VAS). Six VAS measurements were compared over the course of the hysteroscopy: pre-treatment (VAS-1), at vaginal entry (VAS-2), at the cervical ostium transition (VAS-3), while in the cavity (VAS-4), at the end of the procedure (VAS-5), and 30 minutes after the end of the procedure (VAS-6). MAIN OUTCOME MEASURES: VAS SAMPLE SIZE: Fifty in each group enrolled, one drop out. RESULTS: The VAS-3, VAS-4, and VAS-5 scores were significantly lower for patients in the warm fluid group than in the room temperature group (P<.05), whereas the VAS-1, VAS-2, and VAS-6 scores were similar in both groups. CONCLUSION: The application of warm distension fluid in office hysteroscopy reduces pain severity compared with the application of an unheated fluid. LIMITATIONS: The main limitations of the study were that a subgroup analysis could not be performed due to an insufficient number of cases, and we were unable to evaluate vasovagal symptoms.
