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Yeniocak AS, Tercan C, Dagdeviren E, Arabacı O, Genc EE. Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy. Arch Gynecol Obstet 2024; 309:2047-2055. [PMID: 38488896 DOI: 10.1007/s00404-024-07458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. METHODS Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. RESULTS Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5 cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10 mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. CONCLUSION Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.
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Affiliation(s)
- Ali Selcuk Yeniocak
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Emrah Dagdeviren
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Onur Arabacı
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Emine Elif Genc
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Tercan C, Sivas MC, Aktoz F. The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study. Arch Gynecol Obstet 2024; 309:1027-1033. [PMID: 38184803 DOI: 10.1007/s00404-023-07335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE 2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. METHODS In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. RESULTS The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). CONCLUSION In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.
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Affiliation(s)
- Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Mustafa Can Sivas
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey
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Aktoz F, Tercan C, Vurgun E, Gelir BD, Polat I, Yucel B. Evaluation of Perinatal and Neonatal Outcomes of Syrian Refugees Compared to Turkish Population: A Snapshot During the COVID-19 Pandemic. J Immigr Minor Health 2023; 25:522-528. [PMID: 36952151 PMCID: PMC10034225 DOI: 10.1007/s10903-023-01470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The perinatal and neonatal outcomes of Syrian refugees during the coronavirus disease 2019 (COVID-19) pandemic are unknown. Therefore, in this study, we aimed to evaluate these outcomes. METHODS Turkish (n = 303) and Syrian refugees (n = 303) who delivered in our hospital between June 1, 2020 and December 31, 2020 were included in the study. Demographic, perinatal, and neonatal data were obtained by retrospectively evaluating hospital records. RESULTS Adolescent pregnancy was more common in Syrian refugees (p < 0.001). The rates of antenatal visits, performed combined test, triple test, quadruple test, fetal anatomy ultrasound, and glucose tolerance test were lower in all refugees (p < 0.01). Furthermore, there was no difference in the mode of delivery, Hb after delivery, gestational age, birth weight, Apgar score, stillbirth, and fetal anomaly (p > 0.05 for all). CONCLUSION Despite poorer antenatal care during the COVID-19 pandemic, Syrian refugee pregnant women had similar perinatal and neonatal outcomes compared with the Turkish pregnant population.
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Affiliation(s)
- Fatih Aktoz
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Eren Vurgun
- Department of Medical Biochemistry, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Busra Deniz Gelir
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ibrahim Polat
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Burak Yucel
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Tercan C, Kokanali MK, Aktoz F, Aksakal OS. The role of maximal urethral closure pressure in predicting the outcomes of trans-obturator tape operation. Eur J Obstet Gynecol Reprod Biol 2023; 282:128-132. [PMID: 36709705 DOI: 10.1016/j.ejogrb.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the role of preoperative maximal urethral closure pressure (MUCP) in predicting postoperative outcomes of trans-obturator tape (TOT) operation. STUDY DESIGN 82 patients who underwent TOT surgery due to urodynamically proven stress urinary incontinence were retrospectively analyzed. Preoperative and 6th month postoperative results of cough stress tests (CST), Turkish validated Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) quality of life (QOL) questionnaires were recorded. Patients who had negative CST and more than 50% improvement in the QOL questionnaires in the postoperative evaluation were classified as cured. RESULTS 14 (17.1 %) patients had MUCP ≤ 20 cmH2O, 68 (83 %) patients had MUCP > 20 cmH2O. The postoperative IIQ-7 and UDI-6 QOL scores were significantly improved compared to preoperative values in both MUCP ≤ 20 cmH2O and MUCP > 20 cmH2O groups. However, cure rate was lower in the MUCP ≤ 20 cmH2O group than in MUCP > 20 cmH2O group (35.7 % vs 83.8 %, respectively). Preoperative MUCP measurement and urethral mobility assessment were found to be independent factors associated with surgical outcome. A preoperative MUCP ≥ 28.5 cmH2O could predict surgical success after TOT with 92.6 % sensitivity and 85.7 % specificity. CONCLUSIONS TOT is a reliable method that has a high efficacy in the surgical treatment of stress urinary incontinence in short-term. Patients with low MUCP can also benefit from TOT. However, the success rate of TOT surgery decreases in the presence of low MUCP and absence of hypermobile urethra.
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Affiliation(s)
- Can Tercan
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey; Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | | | - Fatih Aktoz
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Orhan Seyfi Aksakal
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
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Aktoz F, Tercan C, Dagdeviren E, Kaya C. Comparison of laparoscopic hysterectomy videos on YouTube and WebSurg platforms in terms of educational reliability and quality. J Gynecol Obstet Hum Reprod 2022; 51:102435. [DOI: 10.1016/j.jogoh.2022.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
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Aktoz F, Tercan C, Cigdem B, Vurgun E. Preoperative and Postoperative Complete Blood Cell Counts and Prediction of Surgical Site Infection After Cesarean Delivery: A Retrospective Case-Control Study. Wound Manag Prev 2022. [DOI: 10.25270/wmp.2022.9.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Cesarean delivery (CD) is the most frequently performed surgery. Surgical site infection (SSI) is a common complication after CD. PURPOSE: To evaluate the role of complete blood count parameters in predicting the development of SSI after CD. METHODS: Patients who were hospitalized because of SSI after CD were included in the SSI group (n = 48). A control group (n = 45) was formed with healthy postpartum women who had also undergone CD. Preoperative and postoperative hemoglobin (Hb), white blood cell count (WBC), neutrophil count, lymphocyte count, platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were recorded. RESULTS: WBC, neutrophil count, and NLR levels increased while Hb, PLT, and lymphocyte count levels decreased after CD in both the SSI and control groups. PLR increased after CD in the SSI group but remained stable in the control group. However, the difference in PLR could not predict SSI after CD. CONCLUSION: Complete blood count parameters were not useful to predict SSI after CD. Larger prospective studies are needed.
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Aktoz F, Tercan C, Cigdem B, Vurgun E. Preoperative and postoperative complete blood cell counts and prediction of surgical site infection after cesarean delivery: a retrospective case-control study. Wound Manag Prev 2022; 68:19-23. [PMID: 36112797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cesarean delivery (CD) is the most frequently performed surgery. Surgical site infection (SSI) is a common complication after CD. PURPOSE To evaluate the role of complete blood count parameters in predicting the development of SSI after CD. METHODS Patients who were hospitalized because of SSI after CD were included in the SSI group (n = 48). A control group (n = 45) was formed with healthy postpartum women who had also undergone CD. Preoperative and postoperative hemoglobin (Hb), white blood cell count (WBC), neutrophil count, lymphocyte count, platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were recorded. RESULTS WBC, neutrophil count, and NLR levels increased while Hb, PLT, and lymphocyte count levels decreased after CD in both the SSI and control groups. PLR increased after CD in the SSI group but remained stable in the control group. However, the difference in PLR could not predict SSI after CD. CONCLUSION Complete blood count parameters were not useful to predict SSI after CD. Larger prospective studies are needed.
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Affiliation(s)
- Fatih Aktoz
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Busra Cigdem
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Eren Vurgun
- Department of Medical Biochemistry, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Aktoz F, Tercan C, Vurgun E, Aslancan R, Ürün H, Yücel B, Dursun S. What are the advantages of clock position method to determine fetal heart axis for inexperienced resident physicians? A comparative study. J Turk Ger Gynecol Assoc 2022; 23:95-98. [PMID: 35642358 PMCID: PMC9160999 DOI: 10.4274/jtgga.galenos.2022.2021-12-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Residency training programs are challenging for young physicians with heavy workloads. Although ultrasonography (USG) is an imaging method that is frequently used in obstetrics practice, some basic USG skills can be acquired late in this intensive learning process. Likewise determining the fetal heart axis is an elementary evaluation but can turn into a challenging and time-consuming process, especially for inexperienced clinicians. Material and Methods Pregnant women between 20 and 37 weeks of gestation were recruited. Two observers assessed the axis of fetal heart by standard, Bronshtein and clock position methods. Fetal heart axis evaluation times were compared. Inter-observer and intra-observer agreements of the three methods were measured. One factor learning rates were calculated. Results A total of 31 pregnant patients between the ages of 18 and 40 years were included in the study. Fetal heart axis evaluation time by the clock position method was shorter than the Bronshtein and standard method in both observers. Furthermore diagnostic accuracy for both observers was 100% with the clock position method, while this fell to 100% in observer-1 and 96.8% in observer-2 using the Bronshtein method. The clock position method was learned faster than either of the other methods. Conclusion Clock position method is an easy and feasible method for inexperienced resident physicians in terms of learning and application to determine the fetal heart axis. The advantages of this method increase when patient numbers are higher.
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Affiliation(s)
- Fatih Aktoz
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Can Tercan
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Eren Vurgun
- Clinic of Medical Biochemistry, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
| | - Reyhan Aslancan
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Hanife Ürün
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Burak Yücel
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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