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Nevbahar Tamçelik,1 Belgin Izgi,2 Ahmet Temel,3 Nilgun Yildirim,4 Mehmet Okka,5 Altan Özcan,6 Nurşen Yüksel,7 Ufuk Elgin,8 Çiğdem Altan,9 Baris Ozer10 1Cerrahpaşa School of Medicine, Istanbul University, 2Çapa School of Medicine, Istanbul University, 3Pendik Research and Training Hospital, Marmara University, Istanbul, 4School of Medicine, Osmangazi University, Eskisehir, 5Meram School of Medicine, Necmettin Erbakan University, Konya, 6Faculty of Medicine, Çukurova University, Adana, 7Kocaeli University Medical Faculty, Kocaeli, 8Ulucanlar Eye Hospital, Ankara, 9Beyoglu Eye Training and Research Hospital, Istanbul, 10Allergan İIaçları Tic AŞ, Istanbul, Turkey Objective: The objective of this study was to assess the intraocular pressure (IOP)-lowering efficacy, tolerability, safety, and usage patterns of prostaglandin analog/prostamide (PGA/P)-containing topical ocular hypotensives in ocular hypertension (OHT) and primary open-angle glaucoma in the Turkish clinical setting.Methods: This non-interventional, multicenter study enrolled previously treated patients who failed to achieve target IOP (or experienced unacceptable adverse events [AEs]) and were prescribed a PGA/P-containing IOP-lowering agent. Treatment was initiated at baseline (V1), and patients returned at weeks 4–6 (V2) and 8–12 (V3). The primary efficacy measure was the change in IOP from baseline at V3 in each eye. The secondary measures were physician’s assessment of IOP-lowering efficacy, patients (%) reaching target IOP determined at V1, hyperemia score, physician and patient assessment of study treatment tolerability at V3, and AE frequency/severity. A subgroup analysis of patients receiving the most common study treatment was conducted. All analyses were performed using the safety population (patients who received one or more doses and had any data available).Results: Of 358 enrolled patients, 60.6% had primary open-angle glaucoma, 29.9% had secondary open-angle glaucoma (protocol amendment), and 13.1% had OHT; 13 patients had multiple diagnoses. At V3, the mean IOP change from baseline was ≥-4.2 mmHg (≥21.1%). IOP met or was lower than the target in 81.7% of patients, 95% exhibited none to mild conjunctival hyperemia (most common AE), and tolerability was rated good/very good by >91.1% of patients and physicians. The results were similar in patients who received the most common study treatment, bimatoprost 0.03%/timolol 0.5% (bim/tim; n=310).Conclusion: PGA/P-containing medications, including bim/tim, significantly reduced IOP in previously treated patients with open-angle glaucoma or OHT; most reached their target IOP or an IOP even lower than their target and reported good/very good tolerability. PGA/P-containing medications such as bim/tim should be considered as a safe, effective therapeutic option for Turkish patients who exhibit poor response, tolerance, or adherence to their previous therapy. Keywords: glaucoma, ocular hypertension, bimatoprost, timolol, prostaglandin analog, prostamide

Cette étude stratigraphique, réalisée dans les bassins tertiaires du sud de la Turquie ouverts sur la Méditerranée, a permis de caractériser les différentes biozones du Tertiaire méditerranéen de l'Éocène inférieur au Pliocène. A l'ouest du bassin d'Anlalya la continuité des dépôts depuis le Crétacé terminal jusqu'au Langhien n'est pas interrompue par des lacunes importantes. Par contre à l'est (Antalya, Mut, Adana) la transgression néogène (Burdigalian à Langhien) est très nette sur les séries tectonisées, la série y est plus complète, comportant les niveaux évaporitiques du Miocène supérieur puis les marnes de Pliocène inférieur. Ces résultats sont complétés par une analyse micropoléontologique de quelques niveaux fossilifères du bassin de Mut où une espèce voisine de Globigerina ciperoensis Bolli (Oligocène) se trouve associée en très grand nombre à une microfaune d'àge burdigalien supérieur à la population observée ici est très similaire à celle de la, Paratéthys mais rend difficile l'utilisation stratigraphique de l'espèce Globigerina ciperoensis dans le domaine méditerranéen. This stratigraphic survey made in the Tertiary basins in southern Turkey (all opening out into the Mediterranean) served to characterize the différent Mediterranean Tertiary biozones from the early Eocene to the Pliocene. To the West of the Antalya Basin, the continuity of the deposits from the terminal Cretaceous to the Langhian is not interrupted by any large gaps. In the East, however (Antalya, Mut, Adana), the Neogene transgression (Burdigalian to Langhian) is very clearcut on the tectonized bosement where the series is more complete and contains evaporitic levels from the laie Miocene and then early Pliocene marls. These findings are completed by a micropaleontological analysis of some fossiliferous horizons in the Mut Basin where a species similarto Globigerina ciperoensis Bolli (Oligocene) is found in association with a great number of lote Burdigalian microfauna. The population here is quite similar to the one found in the Paratethys, but this makes it difficultto moke stratigraphic use of the species Globigerina ciperoensis in the Mediterranean realm.

Abstract Aims This study aims to examine cases identified with endometrial polyp and carcinoma originating from polyps in patients presenting with gynaecological problems, and to highlight the significance of risk factors contributing to malignancy. Materials and methods The study comprised 203 patients who visited our clinic between January 2019 and 2024 with various gynaecological problems and were identified with endometrial polyps after a clinical, radiographic, and laboratory assessment. We retrospectively analysed data from 191 benign endometrial polyps and hyperplasia without atypia and 12 patients with endometrial polyps and underlying endometrial hyperplasia with atypia and/or endometrial carcinoma, diagnosed histopathologically after hysteroscopic resection, retrieved from our hospital's electronic archive system. Two hundred three participants were tested in the study, with 191 classifieds with benign tumours and 12 diagnosed with malignant tumours and atypical endometrial hyperplasia (premalignant). Cases were chosen according on consistent criteria for age, BMI, gravida, parity, abortion, educational level, smoking habits, operation history, and co-morbidities. After determining the sample size for the malignant group, patients from the control group were selected to be included in the study. Initially, patients with similar age and BMI distributions were included into the study. Next, the cases were analysed for similarities in gravida, parity, and abortion parameters, and those that matched were chosen. Following this step, the educational status was compared for resemblance, and examples with matching educational status were chosen. Consequently, the study covered a total of 34 patients, with 12 identified with malignant tumours and atypical endometrial hyperplasia (premalignant) and 22 with benign tumours. Two groups of cases were diagnosed with endometrial polyp, and risk factors that may cause the development of endometrial polyp and underlying carcinoma: age, gravida, parity, abortion, education level, smoking, previous operation history, comorbidity, gynaecological complaints, fasting blood sugar, CRP values, haemoglobin, and haematocrit were evaluated in terms of endometrial polyp sizes, endometrial thickness level, and endometrial polyp localization. By examining the pathological risk factors of these cases, particularly during the premenopausal period, the goal is to predict endometrial cancer, the most prevalent gynaecological cancer in women, along with its antecedents, and implement preventive measures proactively. Results Age, BMI, gravida, parity, number of abortions, educational status, smoking status, operation history, co-morbidity, and complaint variables did not exhibit a statistically significant difference between the groups (p > 0.05). It was revealed that the FBG level, CRP level, Polyp length and Endometrial thickness level of the malignant group were statistically significantly higher than the benign group (p

Key Clinical Message Complications of uterine perforation and herniation of intra‐abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Abstract Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002–1.7. A 30‐year‐old multiparous case with a 7‐week 4‐day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.

Key Clinical Message The diagnosis of chronic uterine inversion occurs after birth or secondary to pathologies of the pelvic region organs. Especially, the diagnosis and treatment of isolated chronic inversion rapidly under appropriate conditions seem to reduce maternal morbidity and mortality. Abstract Chronic uterine inversion is a rare clinical diagnosis and difficult to diagnose and treat. This is a 22‐year‐old patient with no particular history known for a month for uterine fibroid with a polyp, who gave birth through the cervix in the context of subfertility for a year. Non puerperal uterine inversion is a rare clinical condition, and it should be kept in mind that this may be uterine inversion when mass lesions causing clinical complaints are detected, especially in the vulva, vagina, and cervix uteri region. The quality of life of the patients is increased by reducing the morbidity and mortality rates by making a diagnosis with a good clinical and ultrasonographic evaluation.

The aim of this study is to investigate the diagnostic and prognostic characteristics of fetuin A and fetuin B in chronic hepatitis B (CHB) and HBe Ag-negative chronic infection (HCI) and the relationship between the levels of these proteins and fibrosis in CHB.

Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women ages 18 to 43. Routine pregnancy follow-up began at the first antenatal examination for all pregnant women before 14 weeks gestation, with IMA levels measured during the first, second, and third trimesters. The albumin cobalt binding test was used to determine the amount of ischemia-modified albumin (IMA). The patients’ medical, sociodemographic, and nutritional data were analyzed. The primary outcome was to investigate how changes in maternal ischemia affected albumin levels during pregnancy and the relationship between these changes and newborn weight. Results: This study included 43 cases with a mean age of 28.5 ± 5.2 years and a mean gestation period of 39.2 ± 1.3 weeks. The mean IMA levels for cases in the first trimester, second trimester, and third trimester were 0.53 ± 0.06, 0.64 ± 0.11, and 0.64 ± 0.06, respectively. The second and third trimesters showed significantly higher levels of ischemia-modified albumin (IMA) than the first trimester (p < 0.01). There was no statistically significant difference in IMA levels between the second and third trimesters (p = 1.000; p > 0.05). There was no statistically significant correlation between fetal birth and percentage changes in IMA measurements between the first and second trimesters, the first and third trimesters, or the second and third trimesters (p > 0.05). Conclusions: Our study determined that maternal ischemia-modified albumin levels during pregnancy did not correlate with fetal birth weight. Our findings revealed that age, sociodemographic changes, BMI, weight gain, and pregnancy complications had no effect on the change in IMA levels during pregnancy. We believe that this result will serve as a benchmark for future studies on IMA levels during pregnancy.

Background and Objectives: The purpose of the present study was to compare the results of colposcopic biopsies in patients with breast cancer and those who tested positive for HPV in cervix uteri cytological screenings, with a control group of HPV-positive individuals without breast cancer. Additionally, through this study, we aimed to investigate the impact of tamoxifen treatment, an anti-oestrogen drug used following breast cancer treatment, on histopathological changes. Breast cancer is the most common type of cancer and cause of death in women worldwide. Cervical cancer ranks as the second most prevalent form of cancer among women globally, with prevalence rates ranking just behind those of breast cancer. Human papillomavirus (HPV) positivity is a requirement for the development of cervical cancer, although it is not the sole factor responsible. Materials and Methods: A comparison was made between the histopathological results of 52 patients diagnosed with breast cancer, who tested positive for HPV in routine cervical cytological screenings and underwent colposcopic biopsy, and 230 cases without any abnormalities. A study was conducted to compare healthy individuals between the ages of 30 and 65 who were diagnosed with breast cancer and those who did not have breast cancer. The participants underwent HPV screening as part of the national cervical cytology screening programme. Results: The average age of those diagnosed with breast cancer was 46.73 ± 7.54; in comparison, the average age of participants in the control group was 47.49 ± 7.95. There was no statistically significant difference in age between the two groups (p: 0.530). A total of 51 cases (98.1%) of breast cancer were found to have actively used the anti-oestrogen drug tamoxifen for a duration ranging from at least 6 months to 5 years. One patient (1.9%) in the breast cancer group did not use tamoxifen. During routine cervical cytological screenings, it was observed that both breast cancer cases and healthy cases tested positive for HPV. The most commonly detected types of HPV in both groups were HPV 16 and 18, with rates of 73.1% noted in the breast cancer group and 92.6% noted in the healthy group, results consistent with the rates found in the general population. HPV 16 was found in 58.7% of participants in the control group and 42.3% of participants in the breast cancer group. There was a statistically significant difference between the two groups (p: 0.032). There was no statistically significant difference observed between the two groups in terms of normal, high-grade cervical intraepithelial lesions (HGSILs); low-grade cervical intraepithelial lesions (LGSILs); and chronic cervicitis histopathological lesions based on colposcopic and endocervical biopsy results, smear cytology, and HPV results (p-values of 0.913 and 0.877, respectively). Conclusions: Our study results indicate that tamoxifen treatment, an anti-oestrogen drug administered for chemoprevention purposes in the management of breast cancer, does not lead to an increase in abnormal histological changes in the cervix uteri. In all cases of breast cancer, gynaecological examination and cervical cytological screening should be advised.

Background and Aim:We aim to demonstrate the periprocedural and long-term results of alcohol septal ablation (ASA) treatment in patients with hypertrophic cardiomyopathy (HCM) and specify the differences between female and male patients.Materials and Methods:We enrolled 53 consecutive patients with HCM who underwent ASA treatment. Preprocedural demographic data, pre-and postprocedural characteristics and complications, echocardiographic data, and long-term results, including all-cause mortality and major adverse cardiovascular events (MACE), were recorded. MACE was defined as sudden cardiac death due to ventricular arrhythmias or heart failure (HF) and rehospitalizations due to HF or atrial fibrillation after the procedure.Results:The mean age was 56.4 ± 12.1 years and 29 (54.7%) of the patients were female. Age at the time of ablation was higher (P = 0.04), and the presentation New York Heart Association functional class (P = 0.03) was worse in female patients. The median volume of ethanol usage was higher in male patients (P = 0.03) and the median duration of intensive care unit stay was higher in female patients (P = 0.02). The overall survival rates after ASA at 1, 5, 10, and 12 years were 96%, 87%, 76%, and 76%, respectively. There was no difference in the overall survival rates between genders (log-rank P = 0.4) and MACE was significantly higher in women patients (log-rank P = 0.03).Conclusion:Women patients with HCM were older and had a worse functional capacity during the ASA procedure. Despite the similar mortality rates between genders, MACE was higher in women after the procedure. Earlier evaluation and treatment in female patients might decrease MACE during follow-up after ASA treatment.

Figen Sarıgül Yıldırım,1 Aslıhan Candevir,2 Sıla Akhan,3 Selçuk Kaya,4 Mehmet Çabalak,5 Gülden Ersöz,6 Dilara İnan,7 Nurgül Ceren,8 İlkay Karaoğlan,9 Tuba Damar Çakırca,10 Şafak Özer Balin,11 Sevil Alkan,12 Özlem Kandemir,6 Ülkü Üser,13 Oğuz Karabay,14 Mustafa Kemal Çelen15 1Antalya Life Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey; 2Cukurova University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey; 3Kocaeli Üniversity, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey; 4Karadeniz Teknik University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey; 5Mustafa Kemal University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Hatay, Turkey; 6Mersin University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey; 7Akdeniz University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey; 8Health Science University, Haydarpaşa Numune Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey; 9Gaziantep University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey; 10Health Science University, Şanlıurfa Numune Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Şanlıurfa, Turkey; 11Fırat University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Elazığ, Turkey; 12Çanakkale 18 Mart University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Çanakkale, Turkey; 13Health Science University, Antalya Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey; 14Sakarya University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Hatay, Turkey; 15Dicle University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, TurkeyCorrespondence: Figen Sarıgül Yıldırım, Antalya Life Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey, Tel +90 532 473 44 46, Email drfigensarigul@yahoo.com.trBackground: Rapid initiation of antiretroviral therapy (ART) reduces the transmission of HIV infection in the community. This study aimed to determine whether rapid ART initiation is effective compared to standard ART treatment in our country.Methods: Patients were grouped based on time to treatment initiation. HIV RNA levels, CD+4 T cell count, CD4/CD8 ratio, and ART regimens were recorded at baseline and follow-up visits for 12 months.Results: There were 368-ART naive adults (treatment initiated at the time of HIV diagnosis; 143 on the first day, 48 on the second-seventh day, and 177 after the seventh day). Although virological suppression rates at 12th months were higher in all groups, over 90% on average, there were no statistically significant differences in HIV-1 RNA suppression rates, CD+4 T cell count, and CD4/CD8 ratio normalization in the studied months but in multivariate logistic regression analysis; showed a significant correlation between both virological and immunological response and those with CD4+ T < 350 cells/mL at 12th month in total patients.Conclusion: Our findings support the broader application of recommendations for rapid ART initiation in HIV patients.Keywords: HIV, ART, antiretroviral, rapid start

Background and Objectives: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with the neuromuscular structure of the vagina in women without prolapse, to determine the difference, and to demonstrate the role of neuromuscular structure in the physiopathology of prolapse. Materials and Methods: In this prospective study, women aged between 40 and 75 years who had not undergone any vaginal surgery and had not undergone any abdominal prolapse surgery were included. Thirty-one women diagnosed with rectocele on examination were included in the study group. Thirty-one patients who underwent vaginal intervention and hysterectomy for reasons other than rectocele (colposcopy, conization, etc.) without anterior or posterior wall prolapse were included in the control group. Biopsy material was obtained from the epithelium of the posterior wall of the vagina, including the fascia that fits the Ap point. Immunohistochemical staining with Protein Gene Product 9.5 and smooth muscle α-actin was performed in the pathology laboratory. The epithelial thickness measurement and smooth muscle density parameters obtained with these immunohistochemical stainings were compared between the two groups. The collected data were analyzed using the SPSS 23 package program. p values less than 0.05 were considered statistically significant. Results: In the control group, muscle thickness and the number of nerves per mm2 of fascia were statistically significantly higher than in the study group (p < 0.05). Conclusions: We found that smooth muscle tissue and the number of nerves per mm2 of fascia were decreased in posterior vaginal wall prolapse compared to the general population. Based on the correlation coefficients, age was the parameter that most affected the degree of prolapse, followed by parity, number of live births, and number of vaginal deliveries.

Objective:To evaluate the thiol-disulfide homeostasis in patients with a diagnosis of non-muscle invasive bladder tumor (NMIBC), which is a new oxidative stress marker, and to investigate the relationship between the development of NMIBC and native thiol, total thiol, and dynamic disulfide values.Materials and Methods:Fifty-three patients who were operated for bladder tumor in Karabük University Karabük Training and Research Hospital, Clinic of Urology between February and November 2020 and diagnosed with NMIBC in the pathological examination and 60 healthy volunteers were included in the study. Plasma native thiol, total thiol and disulfide levels of these two groups were measured and compared.Results:There was a statistically significant difference between the two groups in terms of native thiol, total thiol and disulfide values. In the subgroup analysis in those diagnosed with NMIBC, native thiol values were found to be 255,870 μmol/L in the low grade patient group and 169,420 μmol/L in the high grade patient group. This difference was statistically significant.Conclusion:The thiol disulfide homeostasis shifted to the disulfide side in the NMIBC group. It was determined that an increase in serum disulfide level and a decrease in native thiol level may have diagnostic value in predicting NMIBC. In addition, in the group diagnosed with NMIBC, there was a significant decrease in native thiol values as the pathological grade increased. This was interpreted as a shift of the equilibrium towards the oxidant side as the tumor showed an aggressive course.

Abstract Objective The aim of the present study is to evaluate the long-term outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery. Methods The present study performed a retrospective analysis of recurrence, pregnancy and survival of a total of 66 patients who were diagnosed with early stage ovarian cancer (stage I) in XXX Faculty of Medicine Hospital between 2004 and 2019. Of these patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical surgery. Results Of 66 eligible patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical complete surgery. When demographic and descriptive data are taken into consideration, the mean age was 32.6 ± 6.76 years in patients undergoing fertility-sparing surgery and 54.05 ± 10.8 years in patients undergoing complete surgery, and the difference between the groups was statistically significant (p = 0.001). Of patients undergoing fertility-sparing surgery, 11 (16.7%) had stage Ia disease (most common), 5 (7.5%) had stage Ic disease, whereas no patient with stage Ib disease was detected. Of patients undergoing complete radical surgery, 32 (48.5%) had stage Ia disease (most common), 1 (1.5%) had stage Ib disease with bilateral ovarian involvement, and stage Ic was the second most common disease stage. Also, stage Ic3 was the most common disease stage (8 patients, 12.1%) among those with stage Ic disease. The rate of recurrence was 4.5% (3 patients) in patients undergoing fertility-sparing surgery, and recurrences occurred at 37 months, 69 months, and 76 months, respectively. A patient with stage Ic3 disease and endometrioid type tumor who developed recurrence at 37 months died at 130 months. Of patients undergoing complete surgery, ten patients (15.2%) developed recurrence, and there was no significant difference between the two groups in terms of recurrence (p = 1.00). At the end of 15-year follow-up period, there was no significant difference between patients undergoing fertility-preserving surgery and those undergoing complete surgery in terms of mortality (p = 0.668). Conclusion The observation of significant findings in terms of the rate of recurrence and disease-free survival following fertility-sparing surgery in patients with low-risk early stage ovarian cancer suggests that survival is positively affected in early stage ovarian cancer.

Nitrogen (N) excreted by poultry is converted to ammonia (NH3), presenting an environmental risk and a health risk to the farmer and animals. A study was performed to investigate the effect of reduced CP and feed form on broiler performance and welfare, meat and litter quality, N utilization, and NH3 concentrations at litter level. A total of 2,232 Ross 308 male broilers was divided into 6 treatments and 6 replicates, which was fed diets in both pellet and mash forms with different CP levels of 205.0 g/kg (H, high), 187.5 g/kg (M, intermediate) and 175.0 g/kg (L, low) in the grower phase and 195.0 g/kg (H), 180.0 g/kg (M) and 165.6 g/kg (L) in the finisher phase. Individual amino acids (AA) were supplemented to maintain digestible AA-to-digestible lysine ratios. Decreasing dietary CP content to 187.5 g/kg in the grower phase and 180.0 g/kg in the finisher phase reduced NH3 concentrations at litter level (P

Abstract Background We aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction. Results The prevalence of FGM/C was 87.2% in Sudan and Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed to show the effect of FGM/C on pelvic organ prolapse (POP), it was observed that FGM/C frequency in POP group 2 was statistically similar when POP group 1 was taken as reference category. In the evaluation for symptomatic POP (POP group 3), risk of developing POP in patients without FGM/C was significantly lower than patients with type 3 FGM/C with a rate of 82.9% (OR(odds ratio): 0.171 (p: 0.002), (Confidence Interval (CI) %95; 0.058–0.511). Risk of developing POP rate in patients with type 1 FGM/C was 75% (OR:0.250 (p: 0.005), CI %95; 0.094–0.666) and in patients with type 2 FGM/C was 78.4% (OR:0.216 (p: 0.0001), CI%95; 0.115–0.406). In the multinominal logistic regression analysis including other variables affecting POP, when group 1 was taken as the reference category, it was found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for the symptomatic POP group showed up a significantly lower risk of developing POP in patients with type 2 FGM/C compared to patients with type 3 FGM/C, with a rate of 58.4%. (OR:0.419 (p: 0.016), CI%95; 0.206–0.851) (Table 3). In addition, older age was found to be significant risk factor for increasing symptomatic POP (p: 0.003). Conclusions Type 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.

Abstract Background Uterine cervical cancer rates also increase with aging. Especially, the primary treatments of patients with cervical cancer include surgery, chemotherapy, and radiotherapy. Aim Our aim is to discuss the effect of clinical and histopathological risk factors on survival in patients over 65 years old with invasive cervical cancer in the light of the literature. Methods and Results The files of 60 patients aged 65 and over who were diagnosed, examined, and treated for invasive cervical uteri cancer between 2004 and 2021 by the gynecological oncology clinic of Akdeniz University were analyzed retrospectively after obtaining approval from the Akdeniz University ethics committee with the number KAEK‐110. Detailed written consent was obtained from all patients and their relatives for data analysis. Patients aged 65 and over who were diagnosed with invasive cervical uteri cancer at all stages who accepted treatment were included in the study. The patients who were not included in the study were those who did not accept treatment, did not continue their follow‐up regularly, were under 65 years of age, had preinvasive cervical lesion, had a second primary cancer, had an unknown stage, and died due to accidents or similar reasons. When the demographic data of 60 cases were examined, the mean age was 70.5, the youngest age was 65, and the oldest age was 84. When we divided them into two groups by age groups, 76.7% were between 65 and 75 years old and 23.3% were over 75 years old. When the data of 60 patients who were referred to our hospital, which was a tertiary center in the 15 years duration, were examined, the mean disease‐progression free survival (PFS) of patients with locally advanced stage was 45 months, however, it was 4 months for metastatic patients, this difference was significant and a statistically significant difference was found between the two groups (p: .001). When the total survival was examined, the mean was 108.7 months in the locally advanced stage group, while it was 2.9 months in metastatic cases, and this difference was also statistically significant between the two groups (p: .001). When we divide the cases into two groups as between 65 and 75 and over 75 years of age, the mean age of disease‐free survival is 76.9 months in the 65–75 years old group, while 16 months in the 76–85 years old group, however, the p value of this difference in PFS between the two groups was not significant (p: 0.154). However, when the total survival was examined, it was seen that the mean was 140.4 in the 65–75 years old group, while it was 56 months in the 76–85 years old group and this difference was significant between the two groups (p: .046). Conclusion In parallel with the increased population worldwide, advanced age cancer rates are increasing. In parallel with the population growth, it should be remembered that the patients over 65 years of age who were diagnosed with invasive uterine cervical cancer had difficulty in accessing screening tests, late diagnosis and inadequate treatment regimens due to concomitant diseases, resulting in recurrence in a short time and poor clinical symptoms due to short total survival.

Background: Ligneous cervicitis is a rarely reported disease in the literature, and it is commonly misdiagnosed as genital cancer. Patients with ligneous cervicitis can have multiple systemic problems. The lesions resemble malignancies. Multiple biopsies are essential for the diagnosis. Herein, we present 2 cases of ligneous cervicitis, both of which had plasminogen deficiency. Our aim in this report was to discuss these cases with guidance of the literature. Conclusion: Ligneous cervicitis commonly mimics female genital cancers. Hence, it is very important to utilize a multidisciplinary approach in making a differential diagnosis.

Abstract Background Hidradenoma papilliferum is a rare benign neoplasm arising from apocrine glands. It occurs commonly on the anogenital region of middle-aged women. It usually presents as a slow growing, solitary asymptomatic, skin colored or red nodule less than 1 cm in diameter. Case presentation The case is a 38-year-old, white woman who presented with a painful nodule occurring within a month in the himenal region of the posterior vaginal introitus. The nodule was excisied and the histology revealed a hidradenoma papilliferum. The diagnosis and treatment of hidradenoma papilliferum is possible with surgical removal and histopathological evaluation of nodules. Conclusion When an adult woman presents with a noduler lesion in the anogenital area, sexually transmitted diseases and other benign and malignant vulvar lesions, as well as malignant transformation is very rare but,should be kept in mind; however because it has been reported and long-term clinical follow-up is suggested

Background: Carcinosarcoma is a rare malignancy of the female reproductive system, consisting of carcinomatous and sarcomatous components. It originates from the paramesonephric and mesonephric duct residues and is also called malignant mixed Mullerian tumor. Case Presentation: A 58-year-old post-menopausal woman, gravida 2, parity 2, who had no known diseases and no previous surgery presented to another clinic with pelvic pain that had been persisting for about a year and vaginal bleeding for the past month. There was continuous bleeding that was not associated with coitus, and cervical biopsy was reported as carcinosarcoma of heterologous type (the epithelial part was serous carcinoma and the mesenchymal part was chondrosarcoma); the patient was referred to our clinic and underwent evaluation. Conclusion: Effective follow-up is very important considering the aggressive clinical picture of carcinosarcoma cases. It should be kept in mind that metastasis may occur, especially in cases with hypercalcemia and deterioration of the general condition.

Abstract Background The human ovary is the target of autoimmune attack in cases of autoimmune disorders, which can cause ovarian dysfunction. Due to the higher prevalence of Hashimoto’s Thyroiditis (HT) in Polycystic Ovary Syndrome (PCOS) patients, we aimed to evaluate ovarian reserve and the effect of autoimmune exposure time on ovarian reserve in PCOS patients with HT by Anti-Müllerian hormone (AMH) levels. Methods Forty-six PCOS patients and 46 PCOS with HT diagnosed patients who are between 18 and 35 years old were recruited for this study. Detailed medical histories were obtained from all participants. Polycystic ovary image was evaluated and antral follicles were counted by transvaginal ultrasound. Modified Ferriman Gallwey score, body mass index, waist/hip ratio of the patients were examined. Hormonal, biochemical profiles and AMH levels of the patients were evaluated during the early follicular phase. The data of both groups were statistically analyzed with SPSS 18.0. Results 20 (43.5%) patients in the PCOS group were fertile, 8 (17.4%) patients in the PCOS + HT group were fertile, fertility rate was significantly lower in PCOS + HT group. The mean AMH value was 8.8 ± 8.8 in the PCOS + HT group and 12.4 ± 8.1 in the PCOS group and it was significantly lower in the PCOS + HT group (p = 0.043). AMH values were significantly negatively correlated with anti-thyroid peroxidase antibody (anti-TPO) level and the duration of HT. There was a significant positive correlation between the anti-TPO level and the duration of HT. Conclusıon We pointed out that the coexistence of PCOS and HT, two prevalent diseases of reproductive age, further diminished ovarian reserve. More exposure of the ovaries to autoantibodies can cause ovarian destruction, similar to the thyroid gland like HT. Because of all these close relations with PCOS and thyroid dysfunctions, we recommend evaluating both thyroid autoantibodies and hormone levels in PCOS patients at the first visit. Patients with PCOS + HT should be monitored more closely to determine the fertility treatment options and control premature ovarian failure (POF) table.

Abstract Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts.

Background and Aim: Despite the advances in oral anticoagulation with NOACs, careful patient and dose selection is required with NOAC therapy. Our study aimed to assess treatment patterns of NOACs in AF along with patients’ continuity to NOAC treatments in first year, and their knowledge level of AF and NOAC treatment. Methods: ASPECT-NOAC was designed as an observational, prospective, and multicenter study. AF patients who were prescribed NOACs within last four months were recruited from 34 outpatient cardiology clinics covering all geographic regions of Turkey. Baseline data were collected initially whereas patient awareness was evaluated at 3 to 4 weeks. Final study visit was performed at 12 months. Results: In total, 991 patients were included to the study. Mean ± standard deviation of age was 69.4 ± 10.2 years and 53.0% of patients were female. Mean duration from AF diagnosis was 24.9 ± 50.9 months. Mean CHA2DS2-VASc and HAS-BLED scores were 3.1 ± 1.5 and 1.6 ± 1.1, respectively. AF disease and NOAC treatment knowledge levels were found to be 48.9 ± 23.1% and 73.0 ± 19.3%, respectively. Among reduced dose users 71.4% of patients were prescribed inappropriate reduced doses. Through the study follow-up, 32 patients (3.2%) deceased and NOAC therapy was discontinued in 74 patients (8.7%). Conclusion: AF patients who recently started NOAC treatment in Turkey were found to have variable knowledge about their disease and anticoagulation treatment. It was observed that most of the patients continued the NOAC treatment throughout the study. Reduced dosing of NOACs was common, which was associated with higher baseline risk for bleeding as well as stroke.

Aim:Our study aims to investigate whether there is a difference between the African pregnant population at 14-42 weeks of gestation and standard ultrasonographic fetal biometric measurements.Methods:This study was carried out at Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Hodan District, Mogadishu, Somalia from July 2018 to September 2018. Four hundred and eighty-six females at 14-42 weeks’ gestation were evaluated. Obstetrical ultrasound was done using a 3.5 MHz convex transducer on Toshiba Aplio XG Ssa-790a. Biparietal diameter (BPD), head circumference (HC), femur length (FL), and abdominal circumference (AC) were identified and measured.Results:The median maternal age in the study sample was 26 years with the mode value of 30 years. The highest number of participants were in 38 weeks (31, 6.4%) and the lowest number of participants were in weeks 15 and 18 with 1 in each (0.2%). BPD gradually increased from a minimum of 26.0 mm at week 14 to a maximum of 95.9 mm. HC gradually increased from a minimum of 101.1 mm at week 14 to a maximum of 95.9 mm at week 42. AC increased gradually from a minimum of 76.6 mm at week 14 to a maximum of 369.2 mm at week 42. FL increased gradually from a minimum of 15.0 mm at week 14 to a maximum of 79.1 mm at week 42.Conclusion:The frequently used parameters of fetal biometry along with ultrasonographic appearance and measurements in our local population are in agreement with international studies except for HC which was lower than the Hadlock’s measurement by an average of 7.8 mm.

BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were

Objective:To show our retrograde intrarenal surgery (RIRS) experience in anomalous kidney stones and compare its safety and efficiency with normal kidney stones.Materials and Methods:Between 2012 and 2018, patient data was reviewed retrospectively and 1700 procedures were taken into consideration. Forty-seven anomalous kidney stones were included in the study (group A). In these patients, 18 had calyx diverticulum, 12 had horseshoe kidney, 8 had ureteral duplication, 2 had ectopic kidneys, 1 had malrotation, and 1 had bifid pelvis. After making a matched pair analysis, 47 normal kidney stones with similar demographic and stone characteristics were included in our study (group N). Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency and safety.Results:Average scope time, hospitalization time, and postoperative double J-stent rate were higher in group A. The difference was statistically insignificant (p>0.05). Ureteral access sheath usage was higher in group N, though the difference was statistically insignificant (p=0.63). Stone-free rates and success rates were higher in group N though the difference was not statistically significant (p>0.05). The rate of complications was statistically significantly higher in group A (p=0.02).Conclusion:RIRS can be used in the management of anomalous kidney stones. It is an efficient and safe method. Prospective and larger patient numbered studies are needed.

Abstract Background Isolated fallopian tube torsion is a very rare cause of acute abdominal pain in women and, as can be expected, its being bilateral is an extremely rare condition. It is more common in women in reproductive age compared to other age groups. Symptoms, physical examination, imaging and laboratory findings being nonspecific makes it difficult to establish the correct diagnosis and often the diagnosis can be made during surgery. Despite being a very rare condition in general, it is important in terms of preservation of tube and thus the fertility especially in women of reproductive age with early diagnosis and treatment. Therefore, keeping in mind the fallopian tube torsion among the differential diagnoses in women presenting with acute abdominal pain will contribute to early diagnosis and treatment. Case presentation A 38-year-old white Arabian woman, gravida 1, parity 0, abort 1, sought medical advice in our outpatient clinic with a complaint of lower abdominal pain that had started 2 days earlier. The pain had first started as mild cramps, which then suddenly intensified nearly 2 hours before her presentation to our clinic, spread to the groin and femur, more prominent on the right side, and became an ongoing pain. As preoperative diagnoses of the patient, ovarian cyst rupture and ectopic pregnancy were suspected, and fallopian tube torsion was also suspected due to the normal appearance of the ovaries and the appearance of the hydrosalpinx on ultrasonography. The patient underwent laparotomy with a Pfannenstiel incision. Both tubes had hydrosalpinx, and the fimbrial ends were blunt and obliterated. Bilateral salpingectomy was performed because the right tube had a prominent necrotic appearance, and there was a significant hydrosalpinx in both tubes. Conclusion Bilateral fallopian tube torsion should be considered among the differential diagnoses in women presenting with acute pelvic pain.

Arm anthropometry is a commonly used method for determining the nutritional status of children and adolescents. The purpose of the study is to evaluate the arm anthropometry of 1484 children and adolescents (760 boys and 724 girls) aged between 6–17 years. The sample groups are selected who are living in Ankara to establish local reference values. In order to determine upper Arm Muscle Area (AMA) and upper Arm Fat Area (AFA), height, weight, upper arm circumference and triceps skinfold thickness measurements were taken in accordance with International Biological Program (IBP) protocols. Smoothed percentiles of AMA and AFA were obtained. Body mass index was calculated with weight and height measurements (kg/m2). Fat mass (FM) and fat free mass (FFM) were measured using bio-impedance analyzer. According to the obtained results, arm muscle area values were higher in boys and arm fat area was higher in girls. In addition, sex difference in these variables increased with age. There was a high positive correlation between body mass index (BMI) and AMA, AFA. It has been found that there is a difference in AMA and AFA values for Ankara children compared to previous studies in Turkey.

Abstract Because of the accessory polar renal artery (APRA) is functional, it is extremely important to be careful with vascular injuries, to prevent ischemic damage and not to cause kidney failure complications.

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