Наукові праці. Кафедра акушерства та гінекології № 3
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Publication Tocilizumab is effective in preventing ovarian injury induced by ischemia- reperfusion in rats(Academia Brasileira de Ciências, 2023-05-15) Uzel, Kemine; Lakhno, Igor; Turkler, Can; Kuzucu, Mehmet; Naz, Gulce Yazici; Mammadov, Renad; Suleyman, Bahadir Ahadir; Kale, Ahmet; Suleyman, HalisOvarian torsion can be defined as the bending of the ovaries on the supporting ligament, disrupting both venous and arterial blood circulation. Insufficient blood flow causes ovarian tissue hypoxia and leads to ischemia. This study aimed to investigate whether tocilizumab has a protective effect on ischemia-reperfusion injury due to ovarian torsion in rats. Eighteen female Wistar albino rats were divided into three equal groups (Sham (SG), ischemia-reperfusion (OIR), and ischemia-reperfusion+tocilizumab (OIRT)). Degeneration, necrosis, vascular dilatation/congestion, interstitial edema, hemorrhage, and polymorphonuclear lymphocyte (PMNL) infiltration scores were significantly different between the groups (p=0.001 for all parameters). Moreover, the OIRT group had a significant improvement in these criteria compared to the OIR group (p<0.05). Additionally, there was a considerable difference between OIRT and OIR groups in the number of primordial, developing, and atretic follicles groups (p<0.05), while there was no difference in the number of corpus luteum (p=0.052). Stress markers or cytokines, such as MDA, tGSH, NF-κB, TNF-α, IL-1β, and IL-6, were significantly different between groups (p<0.05). Furthermore, a significant improvement was found in the measured variables when the OIRT group was compared with the OIR group (p<0.05). Tocilizumab may be an alternative option for treating ischemia-reperfusion injury due to ovarian torsion.Publication Dysautonomia involvement in maternal cardiac arrhythmia(Balkan Medical Union, 2022-03-08) Lakhno, Igor; Kniazkova, Iryna; Lakhno, Olga; Uzel, KemineIntroduction. The role of autonomic imbalance in maternal cardiac arrhythmia (CA) is still debatable. The objective of the study was to assess the relationship between maternal autonomic tone and CA in pregnant women. Materials and methods. The cross-sectional study was carried out among pregnant women admitted to Kharkiv Municipal Perinatal Center between 1 December 2015 and 31 July 2020. 117 patients at 28-36 weeks of gestation were enrolled. 20 of them had sinus rhythm and were included in Group I (control). In Group II, 55 pregnant women with CA and cardiovascular comorbidity were observed. 42 patients with idiopathic CA were monitored in Group III. The daily electrocardiogram and heart rate variability (HRV) were obtained. The density of ectopic beats (DEB) was defined as the percentage of ectopic to total beats. Results. The investigation of the HRV revealed heterogeneity in the groups of study. The enhanced sympathetic activity was determined in women with CA and structural heart disease. Pregnant women with idiopathic CA demonstrated a parasympathetic pattern of autonomic nervous regulation. The revealed relations between DEB and sympathetic or parasympathetic regulation demonstrate an increased sympathetic tone in patients with structural heart disease. In women with idiopathic CA, parasympathetic regulation played a significant role in the scenario of cardiac ectopy. Conclusions. The idiopathic CA could be the result of abnormally elevated parasympathetic regulation in the second half of pregnancy.Publication Comparison of the effects of testosterone on pre- and posthysterectomy findings in transgender Individuals(Japan University of Health Sciences & Japan International Cultural Exchange Foundation, 2021-08-15) Uzel, Kemine; Lakhno, Igor; Eminli, ItibarObjective: This study aimed to investigate the effect of testosterone on complications and blood parameters in transgender individuals undergoing hysterectomy. Methods: This case-control study was carried out by examining the files and records in the hospital automation system of individuals who underwent laparoscopic hysterectomy and oophorectomy for a female to male transgender change in our hospital. To achieve normal male physiologic testosterone levels, transgender individuals (n = 12) were given intramuscular testosterone esters for two years before surgery. The drug dose was initially administered every three weeks, then adjusted according to the patients response. The control group (n=20) was selected from women who underwent hysterectomy and oophorectomy in the same hospital and study period. Results: When the research and control groups were compared concerning blood values, there was no significant difference in preoperative white blood cell (Z = 0.262, p = 0.795), neutrophil (Z = 0.384, p = 0.704), and lymphocyte levels (Z = 0.481, p = 0.634). However, a significant difference was found in the postoperative levels of the same measurements (Z = 2.457, p = 0.020; Z= 7.310, p = < 0.001; and Z = 6.586, p < 0.001, respectively). Regarding preoperative and postoperative measurements, leukocyte and neutrophil levels increased, while lymphocyte and hemoglobin levels decreased in both groups (p < 0.001). Besides, the study group had higher creatinine levels than the control group (Z = 3.817, p = 0.001). Conclusion: Testosterone has anti-inflammatory effects. Additionally, it substantially influences hemoglobin. Thus, testosterone can be considered as an option in selected cases. However, it's potentially harmful effect on the kidneys should always be kept in mind.Publication Gestational trophoblastic diseases-diagnosis and risk factors: A case series(ScopeMed Publishing, 2019-07-04) Uzel, Kemine; Basol, Gulfem; Kale, Ahmet; Lakhno, IgorAim of study: The aim of our study is to investigate the role of the age, gravida, parity, blood group in the development of GTD also significance of the b-hCG levels and pelvic ultrasonography in diagnosis and treatment of this patients. Comparisons of GTD incidence between Turkey and different regions of the world. Materials and Metods: This retrospective study included 1813 patients which underwent vacuum aspiration from 2010 to2018 years in Derince Training and Research Hospital, Kocaeli, Turkey. Files of 18 patients compatible with GTD in pathology were retrospectively scanned. Result: As a result of the study, the average age of patients were27.06, pathology results were found in 14 patients (77,7%) partial mol, in 2 patients (11,1%) complete mol, invasive mol in 1 patient (5,6%) and choriocarcinoma in 1 patient (5,6%). In these cases, 1 case of lung metastasis and 3 patients received chemotherapy treatment. There was no mortality associated with the disease during follow-up. Conclusion: The calculated GTD incidence was 1,5 per 1000 births. Radiologist plays a main role in the first diagnosis of GTD and basis disease management and early finding of its complications. Although serum b- hCG is a useful biochemical marker for GTD. Ultrasound is the initial line radiological examination in approving the diagnosis of GTD in a case suspected on the basis of clinical detections and b- hCG levels. We believe that diagnosis, adequate treatment and follow-up will make easy the cure of GTD and the incidence can be calculated more exacly by performing wide community-based studies.Publication The role of endometrial thicknesses as risk factor in endometrial pathologies(ScopeMed Publishing, 2021-04-15) Uzel, Kemine; Lakhno, IgorAim: This study aimed to investigate the role of endometrial thickness in endometrial pathologies and compare transvaginal ultrasonography (TvUSG) and histopathological results in pre-and post-menopausal women with abnormal uterine bleeding. Methods: We retrospectively reviewed the records of 1882 women with abnormal uterine bleeding between 2018 and 2020. After exclusions, the final study population consisted of 1088 women. The primary variable was the endometrial thickness. Secondary variables examined were final diagnosis, age, gravidity, parity, and menopausal status. Results: Results for 653 women (60.0%) with normal endometrium, 26 women (2.4%) with endometrial carcinoma, and 409 women (37.6%) with other endometrial pathology were analyzed. The mean endometrial thickness of the women with normal endometrium was 11.38±5.80 mm (range: 3-45 mm), while the mean endometrial thickness of the women with other endometrial pathology and endometrial carcinoma were 12.27±5.15 mm (range: 3-33 mm), and 17.24±7.19 mm (range: 5-33 mm), respectively. A statistically significant difference was detected between the groups concerning endometrial thickness (F=15.464, p<0.001). On the other hand, logistic regression analysis was used to identify the risk factors for endometrial carcinoma. Age (p=0.003) and endometrial thickness (p=0.002) were the risk factors in predicting endometrial carcinoma. Conclusion: Women admitted to the hospital with pre-menopausal or post-menopausal bleeding should undergo a detailed gynaecological examination, and the endometrium should be evaluated with TvUSG. If an increased endometrial thickness is detected, an endometrial biopsy should be performed. Even TvUSG is not a definitive diagnostic method; it is a non-invasive, cost-effective, and guiding technique for endometrial pathologies.Publication Comparison of pre- and postoperative techniques in the assessment of histological tumor grading in patients with endometrial carcinoma: a descriptive cross-sectional study(Medical Communications Sp. z o.o., 2019-12-31) Uzel, Kemine; Lakhno, IgorIntroduction: This study aimed to compare histological grades in patients with endometrial cancer assessed by pre- and postoperative techniques. Methods: We retrospectively reviewed the records of 43 patients operated on for endometrial cancer between 2012 and 2019. The primary dependent variables included histological grade assessed by preoperative probe curettage and postoperative analysis of surgical specimens. The independent variables included age, surgery type (laparoscopy or laparotomy), pre- and postoperative hemoglobin levels, and the length of hospital stay. Results: The mean age was 62.14 ± 9.14 years, and the length of hospitalization time was 6.51 ± 3.46 days. The mean values of pre- and postoperative hemoglobin levels were 12.44 ± 1.51 mg/dL and 10.91 ± 1.28 mg/dL, respectively. According to the grading results of probe curettage, grade 1, 2, and 3 tumors were found in 21 (48.8%), 19 (44.2%), and 3 (7.0%) patients, whereas the paraffin sections revealed grade 1, 2, and 3 in 12 (27.9%), 22 (51.2%), and 9 (20.9%) patients, respectively. There was a fair but statistically significant agreement between the pre- and postoperative grading (kappa = 0.365, p = 0.001). Discussion: This study confirms literature reports that preoperative histological tumor grade fairly predicts final histological results. Caution is warranted when making clinical decisions solely based on probe curettage. Further improvements in preoperative diagnostic techniques in endometrial cancer are needed.Publication A mortal case of coronavirus disease in a pregnant diabetic woman. Clinical case(Trilist, 2020-05-13) Uzel, Kemine; Lakhno, IgorPregnant women are very susceptible to coronavirus infection. Gestational diabetes mellitus is severe comorbidity and a serious risk factor for lethal outcomes. We report a mortal case of coronavirus disease (COVID-19) associated with bilateral pneumonia and systemic inflammatory response syndrome in a pregnant woman with gestational diabetes mellitus. Patient was admitted to the hospital at 31 weeks of gestation with COVID-19 bilateral pneumonia. Anti-inflammatory, antiviral, antibacterial and immunomodulatory treatment was started. She received per os favipiravir 200 mg, azithromycin 500 mg, enfluvir 75 mg, plaquenil 200 mg, and ceftriaxone 1 g intravenously, piperacillin 4.5 g intravenously, methylprednisolone 40 mg intramuscular, enoxaparin 0.6 subcutaneously. The doses of insulin were changed. But maternal status became worse in several hours. Oxygen saturation dropped to 80%. Patient was intubated and connected to the artificial lung ventilator. The cesarean was performed. The preterm born baby with early neonatal sepsis diseased the next day. The treatment could not counteract an inflammatory storm. Despite intensive resuscitation, the woman diseased. The fatal case of COVID-19 was associated with coexisted gestational diabetes mellitus and late admission to the hospital. The COVID-19 patients with gestational diabetes mellitus are at higher risk of severe pneumonia, systemic inflammatory response and carbohydrate metabolism decompensation. Oxidative stress caused by bilateral pneumonia initiated the chain of tissue injury-related reactions. The fat tissue is an additional source of free radicals and proinflammatory cytokines. Progression of the proinflammatory scenario enhanced multiple organ failure. We have found signs of acute pulmonary, hepatic, and renal insufficiency. The unresponsiveness to treatment contributed to systemic inflammatory response and maternal deterioration. Further investigations are necessary to improve outcomes in COVID-19 during pregnancy.Publication Spontaneous pregnancy, macrosomia and cephalopelvic disproportion in diffuse adenomyosis: a case report(Balkan Medical Union, 2021-03-16) Lakhno, Igor; Uzel, KemineIntroduction. Adenomyosis increases obstetrical and perinatal complications. Case presentation. We present a rare case of spontaneous pregnancy, large fetus, and cephalopelvic disproportion in a woman with diffuse adenomyosis. No biophysical or biochemical markers of failed placentation were detected during pregnancy. However, delivery was complicated by cephalopelvic disproportion. A male baby of 4350 g in weight, 59 cm in length, with a head circumference of 38 cm and Apgar score of 8 to 9 was delivered via Caesarean. The spontaneous conception and the absence of chronic placental insufficiency were unusual presentations in this case. Conclusions. The fact of complete cervical dilation and cephalopelvic disproportion in diffuse adenomyosis is of great interest. The presented clinical case is a ground for the continuation of the studies in the field of fetal outcome and uterine contractile activity in adenomyosis.Publication Effect of B-Lynch Suture: Bleeding Control and Asherman's Syndrome(Jaypee Brothers, 2021-03-16) Uzel, Kemine; Lakhno, IgorAim and objective: The study was aimed to investigate possible complications such as intrauterine synechiae following the B-Lynch suture, which was used to control postpartum hemorrhage (PPH). Materials and methods: Our study included 36 patients, which underwent B-Lynch suture due to PPH from 2013 to 2015. Results: Asherman's syndrome was found in 3 (8.3%) of 36 patients who participated in the study. Two patients with Asherman's syndrome had a history of placenta accreta and one patient placenta previa. Conclusion: Compared to procedures that require experiences such as hysterectomy or internal iliac artery ligation, B-Lynch suture is a high-level PPH approach that preserves fertility potential with preventing complications.Publication PCR positivity and D-dimer levels in pregnant women with COVID-19(IMR Press, 2020-10-15) Uzel, Kemine; Lakhno, IgorBackground: Every day brings us new data on COVID-19, which has come to affect all the dynamics of the society, and increasingly more scientific literature becomes available on the topic. However, research information about its effects on particular groups, e.g., pregnant women, is still very limited. Aims: This study was aimed to investigate D-dimer levels in pregnant women admitted to the hospital with suspected COVID-19. Study Design: This descriptive cross-sectional study was carried out among pregnant women admitted to our hospital between 1 April 2020 and 31 May 2020 with suspected COVID-19. The data about patients was obtained from patient records and the hospital automation system. Methods: The primary outcome variable of the study was the D-dimer levels. Secondary outcome variables were the presence/absence of cough, shortness of breath, headache, fever, weakness, proteinuria, diarrhoea, haematuria, loss of taste, hypertension, and gestational diabetes mellitus. Results: Data for 64 pregnant women were analyzed. Thirty-three (51.5%) of them had a positive polymerase chain reaction (PCR) results, and thirty-one (48.5%) had negative ones. The mean age of the participants was 26.33 ± 5.15 years. Of the pregnant women, 51.6% (n = 33) were PCR (+) for COVID-19, and 48.5% (n = 31) were PCR (-). The mean age of the participants was 26.33 ± 5.15 years. Headache occurred significantly more often in PCR (+) pregnant women than in PCR (-) ones (χ2 = 4.201, p = 0.040). A statistically significant difference was found when the groups were compared in regard to the presence of the fever symptom (χ2 = 5.036, p = 0.025). When PCR (+) and PCR (-) pregnant women were compared, a statistically significant difference was found in the D-dimer levels (Z = 2.896, p = 0.004). A logistic regression model with PCR positivity as the dependent variables and headache, fever, and D-dimer levels as independent ones revealed a Nagelkerke R2 of 26.8%, and relatively high sensitivity (87.9%) and specificity (59.1%) values in predicting PCR positivity. Conclusion: This research is the first study to have suggested a model for predicting PCR positivity in women suspected of having the COVID-19 disease, which can speed up decision-making in regard to pregnant women with COVID-19.