36 research outputs found
Serial progesterone levels more accurately predict the time of ovulation in subfertile women: a prospective cohort study
No full textPurpose: To predict ovulation in subfertile women using serial follicular growth (FG) and serum hormone measures (estradiol (E2), luteinizing hormone (LH), and progesterone (P) levels) in mathematical models. Methods: This was a prospective observational study of 116 subfertile women aged between 18 and 40 years. FG was assessed by serial transvaginal ultrasonography starting from cycle days 8–12, depending on cycle length. Once the dominant follicle reached 15–16 mm, hormone levels were assessed daily. The primary outcome measure was ovulation (Ov), with a serum LH level ≥15 IU/l defining the start of the LH surge (the day prior to ovulation) and a serum P level >1 μg/ml concurrent with a drop in serum E2 levels indicating Ov. To determine Ov, mathematical models were generated using FG, LH, E2, and P measurements. Results: A mathematical model was constructed using exponential regression to relate days until and after ovulation with P levels. The Ov(P) model was found to be superior to the Ov(LH) model in the prediction of Ov, with high R2 and low RMSE values of 0.9983 and 0.2454, respectively. In the range of [−2, 2] days, the net accuracy of the Ov(P) model was 63.0%, while with an allowed one-day error, the accuracy was 99.6%. Conclusion: Serum P levels display a highly predictable linear curve in natural cycles, which enables the prediction of ovulation. The Ov(P) model can be independently used to schedule embryo transfer in natural frozen-thaw cycles and could therefore replace the Ov(LH) model in clinical practice
Designing for a Pro-Active Ministry of Justice and Security: A strategy to move towards actionability in response to Harmful and Immoral Online Behaviour
No full text‘Wicked problems’ like Harmful and Immoral Online Behaviour is a complex social phenomenon which the Ministry of Justice and Security feel increasing urgency for. However, because such a phenomenon is complex and fast-paced it is hard to respond to.Since 2018 Directie X has started to draw attention to Harmful and Immoral Online Behaviour within the Ministry of Justice and Security. But the (potential) stakeholders found the complexity too high to take ownership and action. The current process is a way of working which has been initiated to respond to wicked problems like’ ‘Harmful and Immoral Online Behaviour’. Unfortunately this way of working results in the problem being moved around the Ministry as ‘un-opened boxes’. From interviews, observations, and collaborating with the current process themes emerged surrounding the way of working. Themes are aspects which hinder ‘opening the boxes’.This project suggests a strategy for the Ministry of Justice and Security to transition towards an alternative way of working which focuses on actionability to be able to effectively respond to wicked problems like Harmful and Immoral Online Behaviour. Strategic Product Desig
Detection of the Ovulation Time via Hormone Levels in the Peripheral Blood of the Subfertile Women with Regular Menstrual Cycle
No full textOBJECTIVE: In order to detect the ovulatory disorders, ovulation physiology is needed to be fully understood, and the cut-off values related to the changes in hormone levels are to be defined. This study aimed to define the cut-off values showing the ovulation with serial evaluation of serum hormone levels of progesterone (P), estradiol (E2), and luteinizing hormone (LH), besides ultrasonographic assessments of the subfertile women having regular menstrual cycle.MATERIALS AND METHODS: In this prospective observational study, 50 subfertile women aged between 18-40, having regular menstruation with a cycle length between 24-38 days, and women accepting blood tests with full attendance to the follow-up visits are included. All participants are provided informed consent. Patients who are fully attended the follow-ups with no ovulation are excluded. Participants are invited for transvaginal ultrasonographic examination (TVUE) and peripheral blood test on the second day of the menstruation and two days prior to the estimated ovulation day, and after the ovulation in order to detect the corpus luteum. During the evaluation, and the analysis of the data, follicle size, E2, LH, P, and endometrial thickness are taken into account.RESULTS: 50 participants with mean age 31.3±4.2 years underwent serial TVUE, and serial analysis of hormone levels in blood. Mean cycle length was 28.8±1.6 days, and the mean follicle size on the ovulation day was measured as 18.6±1.5 mm in size. The effect of P levels on determining the ovulation day was investigated. It was observed that the data shows an exponential trend, hence an exponential regression was carried out to construct the mathematical model which relates days until and after ovulation with the P levels. The fit was performed on the average of the daily P levels of each patient. The R2, the sum of squared estimate of errors (SSE), and root-mean-square error (RMSE) values of the constructed model was evaluated as 0.99, 0.61, and 0.35, respectively, which show that the model is highly sufficient in estimating the P levels. P levels were measured as 0.57±0.19 ug/L two days prior to the ovulation, 0.79±0.20 ug/L one day prior to the ovulation, 1.31±0.31ug/L on the ovulation day, 2.10±0.48 the day after the ovulation, 4.45±2.36 ug/L two days after the ovulation, and 12.91±6.01 ug/L on the 5th day after the ovulation which can be scheduled for the blastocyst transfer for the natural frozen thaw cycles.CONCLUSIONS: Progesterone has a particular increasing pattern in menstrual cycle which enables the prediction of the ovulation day in order to schedule the embryo transfer day in natural frozen thaw cycles.IMPACT STATEMENT: This model may be utilized to determine the ovulation day of patient directly from the P levels, which would assist the physicians in assigning appointments accordingly and avoid unnecessary appointments.</p
Vulvar granular cell tumor
No full textGranular cell tumors (GCTs) are rare and approximately half of the all lesions arise from head and neck, especially from the tongue. However, they are rarely seen in the vulva. They can occur in patients of any age, but peak age incidence is in the fourth to sixth decades. They generally occur as small, slow growing, and skin-colored nodule. GCTs are usually benign, but malignant cases were reported. Recurrence can be seen in benign tumors with clear margins, but rates increase with positive margins. The treatment is complete surgical excision. We report a case of benign GCT of the vulva. A 41-year-old patient presented with vulvar mass, and biopsy was consisted with GCT
Do ovarian reserve markers predict the subsequent pregnancy outcomes in women with recurrent pregnancy loss?
No full textAbstract
Objective(s):
Chromosomal abnormalities are more commonly seen in embryos with decreased oocyte quality. Therefore aneuploidy due to diminished ovarian reserve may be one of the causative reasons of RPL. We investigated the relationship between ovarian reserve markers especially serum antimullerian hormone (AMH) level and antral follicle count (AFC) and recurrent pregnancy loss (RPL).
Materials and methods:
This prospective cross-sectional clinical trial including 88 women with RPL and 84 age-matched women without RPL.
Results:
There were statistically significant differences in body mass index, live birth number, menstrual cycle length, AFC and serum AMH level between groups. There was no statistically significant difference between groups regarding age, menstrual cycle regularity and serum follicle stimulating hormone (FSH) and estradiol (E2) levels. The percentage of women with levels of AMH<1 was 21.4% in the RPL group and 11.4% in the control group. AFC <7 in both ovaries was lower in the RPL group when compared with the control group (73.8% vs 44.3%, respectively).
Conclusion(s):
Serum AMH levels and AFC can be assessed in patients with RPL as a part of the work up parameters. Lower Serum AMH levels and AFC especially may predict the quantity of oocytes that may be consequently be related with RPL.</jats:sec
Population health and status of epidemiology: WHO European Region I
No full textBackground This article of the International Epidemiological Association commissioned paper series stocktakes the population health and status of epidemiology in 21 of the 53 countries of the WHO European Region. By United Nations geographical classification, these countries belong to Eastern Europe, Western Asia and South-Central Asia. Methods Published data were used to describe population health indicators and risk factors. Epidemiological training and research was assessed based on author knowledge, information searches and E-mail survey of experts. Bibliometric analyses determined epidemiological publication outputs. Results Between-country differences in life expectancy, amount and profile of disease burden and prevalence of risk factors are marked. Epidemiological training is affected by ongoing structural reforms of educational systems. Training is advanced in Israel and several Eastern European countries. Epidemiological research is mainly university-based in most countries, but predominantly conducted by governmental research institutes in several countries of the former Soviet Union. Funding is generally external and limited, partially due to competition from and prioritization of biomedical research. Multiple relevant professional societies exist, especially in Poland, the Czech Republic and Hungary. Few of the region's 39 epidemiological academic journals have international currency. The number of epidemiological publications per population is highest for Israel and lowest for South-Central Asian countries. Conclusions Epidemiological capacity will continue to be heterogeneous across the region and depend more on countries' individual historical, social, political and economic conditions and contexts than their epidemiologists' successive efforts. National and international research funding, and within- and between-country collaborations should be enhanced, especially for South-Central Asian countries
Al-Wujuh wa Al-Nazair in the Qur’an and its place in tafsir
No full textVücûh-Nezâir ilmi, tefsir ilminin bir alt dalı veya ulûmü’l-Kur’ân’ın bir bölümü olarak ifade edilen, Kur’ân’daki lafızların farklı bağlamlarda kazandıkları anlamları ve bu anlamlara işaret eden âyet örneklerini inceleyen, bu yönüyle de Kur’ân’ın Kur’ân’la/âyetin âyetle tefsirinin en erken örnekler olarak kabul edilen bir ilimdir. Tarihten günümüze Vücûh-Nezâir kavramlarına dar farklı tanımlar yapılmıştır. Ancak bu tanımlar, ilk dönem müelliflerinin maksadını tam olarak yansıtmadığı gibi ilgili kavramları muhtevasının dışına taşımış, özellikle de son dönem Vücûh-Nezâir anlayışında, konunun nezâir boyutu çok farklı bir anlama bürünmüştür. Çalışmanın ilk bölümünde; Vücûh-Nezâr kelimelerinin tarihsel süreçte geçirdiği anlam değişiklikleri, terimleşme süreci ve kavramsal çerçevesi ele alınmış, Vücûh-Nezâir ilminin tanımı, ilmin müessisi ve ilk müellifi Mukâtil b. Süleymân (öl. 150/767) ve onun izinden giden âlimlerin bu ilimden maksatlarını ortaya koyacak şekilde oluşturulmaya çalışılmıştır. İkinci bölümde, ilmin doğuşu ve temel kaynakları araştırılmış, Mukâtil’in el-Vücûh ve’n-Nezâir adlı eser başta olmak üzere sekiz kaynak incelenmiştir. Üçüncü bölümde, Vücûh-Nezâir ilmiyle ilişkili kavramlar -eşbâh, müşterek, mütevâtı’, müterâdf, ezdâd, çokanlamlılık, eşanlamlılık, semantik- benzerlikler ve farklılıkları bakımından analiz edilmiştir. Son bölümde ise bu ilmin tefsirdeki yeri ve önemi ele alınmış, müfessirler üzerindeki etkisi araştırılmıştır. Mukâtil’in eseri temel alınarak seçilen yirmi bir lafız, “rivâyet, dirâyet, mezhebî, fıkhî, ictmâî, şârî ve ilmî tefsirler” olmak üzere yedi farklı tefsir grubundan yirmi bir tefsirde incelenmiştir. Sonuç olarak Mukâtil’ den günümüze kadar beş farklı tanımın yapıldığı görülmüş, bu ilmin Hz. Peygamber (s.a.s.), sahâbe ve tâbîn dönemlerinde var olduğuna dair rivâyetler tespit edilmiştir. Ayrıca Vücûh-Nezâir ilminin Kur’ânî bir ilim olduğu ve lügavî kavramlarla karıştırılmaması gerektiği vurgulanmıştır. Vücûh-Nezâir ilminin tefsirlere yansıması ve müfessirlerin yorumlarına etkisinin bazı yerlerde doğrudan, bazı yerlerde se dolaylı olduğu tespit edilmiştir.The Science of Wujūh and Nazāʾir is a discipline that examines the different meanings that Qur'anic terms acquire in various contexts and provides verse examples that indicate these meanings. In this respect, it is considered one of the earliest examples of the interpretation of the Qur'an through the Qur'an or the interpretation of a verse by another verse. Throughout history, different definitions have been made regarding the science of Wujūh and Nazāʾir. However, these definitions neither fully reflect the intent of early authors nor accurately represent the relevant concepts, often leading to an expansion beyond their original scope. Particularly in recent understandings of Wujūh and Nazāʾir, the concept of Nazāʾir has taken on a significantly different meaning. In the first section of this study, the semantic changes that the terms Wujūh and Nazāʾir have undergone throughout history, their process of becoming technical terms, and their conceptual framework are examined in detail. The definition of the science of Wujūh and Nazāʾir, its founder, and its first author Muqātil b. Sulaymān (d. 150/767), along with the objectives of later scholars following his approach, have been explored. The second section investigates the origins and primary sources of this discipline, analyzing eight sources, with a particular focus on Muqātil’s work al-Wujūh wa al-Nazāʾir. The third section examines related concepts such as Ashbāh (similar words), Mushtarak (homonymous terms), Mutawātiʾ (univocal terms), Mutarādif (synonyms), Aḍdād (antonyms), polysemy, synonymy, and semantics, analyzing their similarities and differences. The final section discusses the role and significance of this discipline in Qur’anic exegesis (tafsīr) and explores its influence on exegetes. Based on Muqātil’s work, 21 Qur'anic terms were selected and analyzed in 21 different tafsīr works from seven distinct exegetical approaches: narrative (riwāyah), rational (dirāyah), sectarian (madhhabī), juridical (fiqhī), social (ijtimāʿī/sociological), esoteric/mystical (ishārī/Sufi), and scientific (ʿilmī) tafsīrs. As a result, it has been determined that five different definitions of this discipline have emerged since Muqātil’s time. Furthermore, reports suggesting that the science of Wujūh and Nazāʾir existed during the time of the Prophet (peace be upon him), his companions (ṣaḥābah), and the generation following them (tābiʿūn) have been identified. Additionally, it has been emphasized that Wujūh and Nazāʾir is a Qur’anic science and should not be confused with linguistic concepts. The study has also found that the influence of Wujūh and Nazāʾir on tafsīr and exegetical interpretations is sometimes direct and, in other cases, indirect
The efficiency of the uterocervical angle in the prediction of second-trimester pregnancy terminations in multiparous women
No full textThe role of ADAMTS-2, collagen type-1, TIMP-3 and papilin levels of uterosacral and cardinal ligaments in the etiopathogenesis of pelvic organ prolapse among women without stress urinary incontinence
No full textObjective(s): To investigate the potential role of 'a disintegrin-like and metalloproteinase with thrombospondin type motifs-2 (ADAMTS-2), collagen type-1, tissue inhibitor of metalloproteinases-3 (TIMP-3) and papilin' levels in the uterosacral ligament (USL) and cardinal ligament (CL) of the uterus on the etiopathogenesis of pelvic organ prolapse (POP) among postmenopausal women without stress urinary incontinence (SUI). Study design: A total of 45 postmenopausal women, 22 diagnosed as POP stage III-IV and 23 age- and body mass index (BMI)-matched controls referred for hysterectomy due to POP or benign gynecological disease, respectively, were recruited prospectively for our study. The biopsies of the USL and CL were obtained during hysterectomy. ADAMTS-2, collagen type-1, TIMP-3 and papilin levels were determined by enzyme-linked immunosorbent assay (ELISA) method after tissue homogenization. We excluded patients who smoked or presented with SUI. Results: There were no differences in terms of demographic features including age, BMI, obesity, duration of menopause, gravidity, parity, delivery modes and family history for POP between the POP and non-POP groups. Significant differences in the levels of ADAMTS-2, collagen type-1, TIMP-3 and papilin of USL were noted among the groups. Females with POP had lower levels of ADAMTS-2, collagen type-1, TIMP-3 and papilin in the USL compared to non-POP females. All investigated markers in the CL were also decreased in the POP group, but this relationship was not statistically significant. When age, duration of menopause, gravidity, parity and obesity were taken as covariates, only the USL papilin levels were negatively predictive for the development of POP. Conclusion(s): ADAMTS-2, collagen type-1, TIMP-3 and papilin levels of the USL play essential roles in the etiopathogenesis of POP among postmenopausal women without SUI. Moreover, significantly decreased USL papilin levels in females with POP suggest the importance of the USL and the impact of papilin on the development of POP. (C) 2018 Elsevier B.V. All rights reserved
Combination of myasthenia gravis and HELLP Syndrome in pregnancy: case report and literature review
No full textMyasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction. Preeclampsia/HELLP Syndrome is a potentially life-threatening pregnancy complication. The combination of HELLP Syndrome and MG is challenging because the preferred treatment regimens for both conditions generally contradict each other. Our aim is to describe the management options when these two diseases occur simultaneously. We present a case in which a woman with an established diagnosis of MG developed HELLP Syndrome at 31 weeks gestation. Magnesium sulfate prophylaxis was not utilized because of the patient’s MG diagnosis. A cesarean delivery was performed. Reported cases with combined diagnoses of MG and preeclampsia/HELLP Syndrome are reviewed and adjustments to treatment plans are discussed. Management of such patients should be done with a multidisciplinary approach in advanced medical centers with careful consideration of the medications used
