Mehmet Yılmaz

The molecular mechanisms differentiating early-onset preeclampsia (EO-PE) from late-onset preeclampsia (LO-PE) remain unclear. High Mobility Group Box 1 (HMGB1), a pro-inflammatory cytokine involved in immune responses and oxidative stress, has emerged as a potential contributor to PE pathogenesis. Our aim was to investigate expression of HMGB1 in the placentas of EO- and LO-PE patients by immunohistochemical methods and in silico analysis. This experimental case-control study included 20 EO-PE, 20 LO-PE, and 20 normotensive control pregnant women. Placental samples underwent immunohistochemical staining to determine HMGB1 expression levels, which were analyzed semiquantitatively using ImageJ software. Bioinformatic analysis utilizing STRING and Cytoscape identified HMGB1-associated protein networks and pathways relevant to PE. Clinical and biochemical parameters were statistically analyzed. HMGB1 expression was significantly elevated in placentas from EO-PE patients compared to both LO-PE and control groups (p < 0.05). Histopathological assessment indicated severe structural disruptions in EO-PE placentas, including increased fibrin deposition, vascular degeneration, and higher incidence of apoptotic cells. Bioinformatics revealed significant interactions of HMGB1 with cytokine signaling pathways (IL-4, IL-13, IL-10) and platelet-related pathways (platelet activation and aggregation). Clinically, EO-PE patients exhibited higher systemic inflammatory markers (CRP, WBC, NLR) and greater biochemical evidence of multi-organ dysfunction. This study identifies significantly increased HMGB1 placental expression predominantly in EO-PE, supporting its role in heightened inflammation and endothelial dysfunction characteristic of this subgroup, suggesting its potential as a biomarker and therapeutic target specifically for EO-PE.

Background: Our study aims to investigate whether there is a relationship by measuring the total oxidant/antioxidant load with the thiol/disulfide method in patients with unexplained infertility. Methods: A total of 82 participants were enrolled, consisting of 41 women with unexplained infertility and 41 fertile controls matched for age and body mass index (BMI). Hormonal profiles, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyroid-stimulating hormone (TSH), and prolactin, were assessed using the chemiluminescence immunoassay method. Thiol/disulfide homeostasis was evaluated using a validated automated spectrophotometric method, which measured native thiol (NT), total thiol (TT), and disulfide levels. Detailed quality control measures ensured the reliability of the results. Results: In the study, no significant difference was found between the infertile and fertile groups’ demographic (age) and clinical variables in terms of height, weight, BMI, FSH, LH, E2, TSH, prolactin, antral follicle count, TT, NT, and disulfide values (P > .05). The rates were found to be greater in the infertile group in disulfide/NT ratio and disulfide/TT ratio compared to the fertile group, even though there was no statistically significant difference between the groups’ disulfide/NT ratio, disulfide/TT ratio, and NT/TT ratio values. The fertile group, however, had a higher NT/TT ratio rate. Conclusion: Although the unexplained infertility and fertile groups in the study did not differ in serum thiol and disulfide levels, the infertile group was found to have a relatively high disulfide/thiol ratio. More prospective studies on thiol/disulfide balance related to unexplained infertility may help to understand the relationship.

Delphi yöntemi, sağlık bilimlerinde uzmanlar arasında fikir birliğine ulaşmak için kullanılan yapılandırılmış bir iletişim ve karar alma sürecidir. Bu yöntem, uzmanların anonim olarak geri bildirimde bulunmasını sağlayarak önyargı ve sosyal etkileri en aza indirir. Genellikle birden fazla tur üzerinden yürütülen Delphi yöntemi, her turda elde edilen geri bildirimlerin iyileştirilmesine olanak tanır ve böylece sağlam bir ortak görüş oluşturur. Delphi, özellikle klinik rehberlerin geliştirilmesinde etkili bir araç olarak kabul edilir ve uzmanlar arasında mevcut araştırmaların eksik olduğu veya çelişkili olduğu durumlarda kullanılır.Adenomyozis, teşhisi zor olan jinekolojik bir durumdur çünkü hastalığın semptomları genellikle diğer jinekolojik rahatsızlıklarla örtüşür. Ayrıca, görüntüleme yöntemleri her zaman kesin sonuç vermemekte ve tanı koymada histopatolojik inceleme gibi invaziv prosedürlere ihtiyaç duyulabilmektedir. Adenomyozisin tanısında doğru kriterlerin belirlenmesi ve standart hale getirilmesi önemli bir zorluktur, bu da klinisyenler arasında değişken uygulamalara ve tutarsız sonuçlara neden olabilir.Delphi yöntemi, adenomyozis gibi teşhisi zor hastalıklarda uzman görüşlerinin sistematik olarak bir araya getirilmesini sağlayarak, tanı kriterlerinin standardize edilmesine katkı sunar. Bu yöntem, ultrason ve MRI gibi görüntüleme tekniklerinde kullanılacak tanı kriterlerinin belirlenmesinde önemli bir rol oynayabilir. Ayrıca, klinik rehberlerin geliştirilmesinde uzmanların ortak görüşüne dayalı daha doğru ve güvenilir tanı araçları sağlanarak, adenomyozisli hastaların yönetiminde klinik uygulamaların iyileştirilmesine olanak tanır. Delphi yöntemi, adenomyozis teşhisinin standardizasyonunu sağlayarak klinik uygulamalarda büyük fayda sağlar. The Delphi method is a structured communication and decision-making process used to reach consensus among experts in health sciences. This method minimizes bias and social influences by allowing experts to provide anonymous feedback. The Delphi method, which is usually conducted over multiple rounds, allows for the improvement of feedback obtained in each round, thus creating a solid consensus. Delphi is considered an effective tool, especially in the development of clinical guidelines, and is used in cases where existing research among experts is incomplete or contradictory. Adenomyosis is a gynecological condition that is difficult to diagnose because the symptoms of the disease often overlap with other gynecological disorders. In addition, imaging methods are not always conclusive, and invasive procedures such as histopathological examination may be needed for diagnosis. Determining and standardizing accurate criteria for the diagnosis of adenomyosis is a significant challenge, which can lead to variable practices and inconsistent results among clinicians. The Delphi method contributes to the standardization of diagnostic criteria by systematically gathering expert opinions in difficult-to-diagnose diseases such as adenomyosis. This method can play an important role in determining diagnostic criteria to be used in imaging techniques such as ultrasound and MRI. In addition, it allows for the improvement of clinical practices in the management of patients with adenomyosis by providing more accurate and reliable diagnostic tools based on the consensus of experts in the development of clinical guidelines. The Delphi method provides great benefits in clinical practices by standardizing the diagnosis of adenomyosis.

Pelvic organ prolapse (POP) is a common issue affecting women. The development of minimally invasive surgical techniques has introduced a new era in POP treatment, with laparoscopic methods gaining popularity. This abstract highlights the simplified technique as an efficient alternative. BalsAksin technique aims to treat POP with a minimally invasive approach, eliminating the need for laparoscopic suturing. It provides a faster and more effective surgical option. In this technique, vaginally, the vesicouterine gap was opened. The mesh was fixed to the serviko-isthmik area vaginally, and the mesh arms were sent into the abdomen, and then the mesh arms were removed laparoscopically by pulling the bilateral trocar ports. The uterine position is adjusted vaginally In summary, the BalsAksin technique offers a simplified alternative to laparoscopic suturing in pelvic organ prolapse surgery. Its ability to eliminate the need for laparoscopic suturing while reducing operation times makes it an appealing option for surgeons, ultimately improving patient care and surgical outcomes.

Background: The aim of this study was to determine whether orexigenic neuropeptides, orexin and galanin, and anorexigenic neuropeptides, alpha-melanocyte-stimulating hormone (α-MSH) and cocaine- and amphetamine-regulated transcript (CART), are implicated in hyperemesis gravidarum (HG). Methods: Fifty pregnant women who had been diagnosed with HG between April 2022 and February 2023 at the Siirt University Faculty of Medicine Training and Research Hospital (tertiary center) were recruited for this study. An equal number of pregnant women without an HG diagnosis were included in the study as the control group. Participants’ age, pregnancy history, medical history, thyroid function test results, complete blood count results, and electrolyte levels were recorded, and their orexin, galanin, α-MSH, and CART serum levels were analyzed using an enzyme-linked immunosorbent assay. Results: No statistically significant differences in orexigenic neuropeptides (orexin and galanin) were observed between the HG and control groups. A statistical difference was found between an anorexigenic neuropeptide (α-MSH) and the control group (P = .012). Based on a receiver operating characteristic analysis, the α-MSH parameter was statistically significant for distinguishing between participants with an HG diagnosis and those without, with a sensitivity of 63.6%, specificity of 65.9%, and cutoff value of 11769.3 pg/mL (P = .012, area under curve: 0.655). Based on the severity classification of ketonuria (ketonuria levels of +1 or +2 were classified as mild, whereas levels of +3 or +4 were classified as moderate to severe), the anorexigenic CART neuropeptide was found to be a statistically significant diagnostic indicator of severe ketonuria (P = .020). Conclusion: α-MSH and CART levels were found to be related in HG patients and in HG patients with severe ketonuria.

OBJECTIVE: This study investigated vimentin expression in placentas of patients with preeclampsia and gestational diabetes mellitus (GDM). STUDY DESIGN: Placentas of preeclamptic women (n=25), women with GDM (n=25), and control cases (n=25) were enrolled in this study. Placental samples were fixed in zinc-formalin and further processed for paraffin wax tissue embedding. Demographic and laboratory parameters of patients were recorded. Vimentin immune activity was analyzed in the placental sections with immunohistochemistry. Sections were imaged and analyzed under a light microscope. A semiquantitative measurement was done between groups by comparing the Vimentin signal and significance was calculated. Network construction and pathway enrichment analysis were conducted using Cytoscape (v3.10.1) and ShinyGO, respectively. RESULTS: Vimentin expression was high in the placental sections of the control group. The preeclampsia group showed positive Vimentin expression in cytotrophoblast and syncytiotrophoblast cells and connective tissue of placental villi in the preeclampsia group. Vimentin expression was generally recorded as negative in placental villi, fibrinoid substances, and connective tissue cells in the GDM group. Bioinformatic analysis showed that the AGE-RAGE signaling pathway and cancer-related pathways were mainly observed in Vimentin-associated pathways, which finally activate inflammatory pathways in both preeclampsia and GDM. CONCLUSION: Vimentin expression patterns in placental tissue sections reveal nuanced regulatory mechanisms, emphasizing the need for further exploration into the functional roles of vimentin in placental physiology and pathology.

Objective: Our study aimed to investigate the levels of anti-Müllerian hormone (AMH) to determine ovarian reserve in women in intensive care units experiencing metabolic and physiological stress. Materials and Methods: For this purpose, 37 women were hospitalized in the intensive care unit (ICU) of Siirt Training and Research Hospital between November 2022 and February 2023. The same number of healthy control groups were included in the study. Patient selection was based on acute physiology and chronic health assessment (APACHI II) score and injury severity score (ISS).Anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4), adrenocorticotropic hormone (ACTH), cortisol. , prolactin, C-reactive hormone (CRP) serum levels were examined Results: There was no significant difference in mean age between intensive care patients (29.3±8.3 , n=37) and control group (28.0±0.0, n=37) (p=0.349). A statistically significant difference was found between the AMH values between the patients hospitalized in the intensive care unit and the control group (p=0.012).AMH values were significantly lower in ICU patients. However, the T3 value was observed to be significantly lower in ICU patients compared to the control group (p < 0.0001). Additionally, prolactin, CRP, and cortisol values were found to be statistically significantly higher. Conclusion: This study revealed a significant decrease in anti-Müllerian hormone (AMH) levels among women experiencing metabolic and physiological stress in intensive care units. The lowered AMH levels suggest a potential impact on ovarian reserve in such conditions. Additionally, the observation of reduced T3 levels in ICU patients could indicate thyroid function alterations during times of stress. The elevated prolactin, CRP, and cortisol levels further underscore the physiological disruptions experienced by ICU patients. These findings emphasize the importance of considering hormonal and metabolic changes in critically ill women, particularly in relation to their ovarian health. Further research is warranted to elucidate the intricate mechanisms underlying these hormonal alterations and their potential long-term implications.

Antecedentes: la pandemia de COVID-19 ha afectado a todo el mundo. La consecuencia de la infección por COVID-19 provoca muchos trastornos en muchos órganos, uno de ellos es la placenta. La enfermedad COVID-19 tiene efectos a largo plazo en varios tejidos después de la recuperación. El objetivo de este estudio fue investigar las placentas de mujeres embarazadas sanas, COVID-19 positivas durante el segundo trimestre y el trabajo de parto. Material y métodos: Se incluyeron en el estudio un total de veinticuatro gestantes (8 pacientes por cada grupo). Sus placentas se procesaron para el protocolo de inclusión de cera de parafina de rutina. Se registraron los parámetros sanguíneos de los pacientes. Los tejidos placentarios se tiñeron con colorante de hematoxilina-eosina y se tiñeron inmunes con TNF-α y ADAMTS-8. El análisis estadístico se realizó sobre la sangre y los parámetros histológicos. Resultados: Los valores de AST y PCR de los parámetros bioquímicos fueron mayores en las mujeres con segundo trimestre y grupos de trabajo de parto que en el grupo sano. Además, se observó un aumento significativo en los valores de ALT en el grupo de trabajo. Se observó histología normal en las placentas de pacientes sanas. Se registró más histopatología en las placentas de mujeres infectadas con COVID-19 en comparación con las placentas sanas. La expresión de TNF-α y ADAMTS-8 se encontró significativamente más alta en las placentas con COVID-19 en comparación con el grupo sin COVID-19. Conclusiones: La infección por COVID-19 puede causar cambios patológicos durante el embarazo y el parto. Este estudio muestra que la COVID-19 no solo tiene efectos adversos agudos sobre las patologías placentarias, sino que también tiene efectos a largo plazo. Los anticuerpos primarios TNF-α y ADAMTS-8 pueden ser una guía para demostrar estos efectos.