For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.
Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.
Recurrent hydatidiform mole (RHM) is a rare disorder which is characterized by the presence of at least two molar pregnancies. The mutations in the NLRP7 and KHDC3L genes are responsible for the majority of recurrent molar pregnancies. This study aimed to demonstrate the diversity and frequency of NLRP7 and KHDC3L gene mutations in our Turkish cohort with recurrent molar pregnancies, and to establish genotype-phenotype correlation. It was aimed to represent the detected NLRP7 and KHDC3L gene variants and reproductive history of 32 recurrent mole hydatidiform patients. We analysed the retrospective clinical and sequence data of 32 patients, who were referred to the laboratory for NLRP7 and KHDC3L sequencing. Among the detected 32 patients with recurrent molar pregnancy, 18 of 32 patients had no mutation in these two genes; we found 7 cases of homozygous NLRP7 variant, 1 case of heterozygous NLRP77 variant, 3 cases of homozygous KHDC3L gene variant, and 1 case of heterozygous KHDC3L gene variant. Among the detected NLRP7 variants, 3 of 11 variants were classified as pathogenic, 7 of 11 variants were classified as likely pathogenic, and 1 of 11 variants was classified as variant of unknown significance (VUS). Among the detected KHDC3L variants, 1 of 4 was classified as pathogenic, 2 of 4 were classified as likely pathogenic, and 1 of 4 was classified as VUS. Seven unpublished NLRP7 gene variants and two unpublished KHDC3L gene variants were first reported in this study. Here we report new RHM patients with NLRP7 and KHDC3L mutations. The current study highlights the importance of defining new cases and novel mutations in the pathogenesis and clinical management of RHM. Understanding genotype-phenotype correlations in RHM patients will also contribute to the selection of treatment methods and patient management. Tekrarlayan mol gebeliklerin (RHM) büyük bir kısmından NLRP7 ve KHDC3L genlerinin mutasyonları sorumludur. Bu çalışmada tekrarlayan mol gebelikli Türk kohortumuzdaki NLRP7 ve KHDC3L gen mutasyonlarının çeşitliği ve sıklığının gösterilmesi ve genotip-fenotip korelasyonunun kurulması amaçlandı. Otuz iki tekrarlayan mol hidatidiform hastanın NLRP7 ve KHDC3L gen varyantları ve üreme geçmişleri sunulmuştur. NLRP7 ve KHDC3L dizilmesi için laboratuvara sevk edilen 32 hastanın retrospektif klinik ve dizi verilerini analiz ettik. Tespit edilen 32 tekrarlayan molar gebelik hastası arasında 32 hastanın 18’inde bu iki gende mutasyon saptanmamış olup, 7 olguda homozigot NLRP7 varyantı, 1 olguda heterozigot NLRP7 varyantı, 3 olguda homozigot KHDC3L gen varyantı ve 1 olguda heterozigot KHDC3L gen varyantı saptandı. Tespit edilen NLRP7 varyantlarından 11 varyanttan 3’ü patojenik, 11 varyanttan 7’si muhtemel patojenik ve 11 varyanttan 1’i önemi bilinmeyen varyant (VUS) olarak sınıflandırıldı. Tespit edilen KHDC3L varyantlarından 4 varyanttan 1’i patojenik, 4 varyanttan 2’si olası patojenik ve 4 varyanttan 1’i VUS olarak sınıflandırıldı. Bu çalışmada ilk kez 7 adet yayınlanmamış NLRP7 gen varyantı ve 2 adet yayınlanmamış KHDC3L gen varyantı bildirildi. Bu çalışmada NLRP7 ve KHDC3L mutasyonları olan yeni RHM hastalarını bildirilmektedir. Mevcut çalışma, RHM’nin patogenezinde ve klinik yönetiminde yeni olguların ve yeni mutasyonların tanımlanmasının önemini göstermektedir. RHM hastalarında genotip-fenotip korelasyonlarının anlaşılması tedavi yöntemlerinin seçimi ve hasta yönetimine de katkı sağlayacaktır.
This study was conducted to test the validity and reliability of the Turkish version of the Comprehensive Breastfeeding Knowledge Scale. This methodological study was carried out between July 1, 2023, and May 1, 2024, in the Department of Obstetrics and Gynecology at a university hospital. Approvals were obtained from the original scale author, the ethics committee, the institution where data were collected, and the participants. The study sample comprised 350 participants, including 200 primiparous pregnant women and 150 postpartum women. For validity, the Content Validity Ratio (CVR) and Content Validity Index (CVI) were used to assess language and content validity, and Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to evaluate construct validity. For reliability, item analyses were conducted, and the Intraclass Correlation Coefficient (ICC) and Paired t-Test were used to determine test-retest reliability, while Cronbach's alpha coefficient was employed to assess internal consistency. Of the women who participated in the study, 57.1 % were pregnant and 42.9 % were in the postpartum period. Among the participants, 39.7 % were between the ages of 18 and 25, 38.9 % were high school graduates, and 51.4 % had received breastfeeding education. EFA results revealed that the scale maintained a three-factor structure consistent with the original scale, the items were distributed across the factors in a similar manner, factor loadings ranged from 0.50 to 0.65, and the explained variance was 37.3 %. The CFA results indicated excellent model fit with a chi-square/df ratio of 1.912, and good fit indices, including GFI (0.904), RMSEA (0.051), and CFI (0.894). The findings of this study demonstrate that the Turkish version of the Comprehensive Breastfeeding Knowledge Scale is a valid and reliable measurement tool for assessing breastfeeding knowledge among primiparous pregnant and postpartum women. The scale can be utilized in descriptive studies evaluating breastfeeding knowledge and in experimental studies aimed at improving breastfeeding knowledge, as a pre-test and post-test assessment tool.
The main purpose of the research is to demonstrate the scientific validity and reliability of the Turkish translation of the Menopausal Spousal Support Questionnaire (MSSQ). A total of 176 women participated in this methodological study. Research data were gathered through the MSSQ and a personal information form. Following the confirmation of language and content validity, analyses such as exploratory and confirmatory factor analysis, item-total correlation, calculation of Cronbach alpha reliability coefficient, test-retest (time invariance), split-half reliability, and comparison of the top and bottom 27% groups were conducted on the data. Factor analyses confirmed the original four-factor structure of the MSSQ. The total explained variance was 70.824%, and factor loadings ranged between 0.65 and 0.84. Confirmatory factor analysis yielded excellent fit indices (χ²/df = 1.60; Goodness of Fit Index = 0.99; Adjusted Goodness of Fit Index = 0.99; Comparative Fit Index = 1.00; Root Mean Square Error of Approximation = 0.059; Standardized Root Mean Square Residual = 0.050), indicating a good model fit without any modifications. The overall Cronbach alpha coefficient was 0.933, and all item-total correlations were above 0.40. The average total MSSQ score was 109.24 ± 33.56. The Turkish version of the MSSQ is a valid and highly reliable instrument for measuring spousal support in postmenopausal women and is appropriate for use within the cultural context of Turkish society.
This study aimed to adapt the Assessment of Survivor Concern Scale to Turkish and test its validity and reliability in gynecological cancer survivors. This methodological study was conducted with 76 gynecological cancer survivors. During the adaptation phase of the Assessment of Survivor Concern Scale, the scale was first translated into Turkish and then culturally adapted. Next, the construct validity of the scale was evaluated by confirmatory factor analysis. The reliability of the scale was tested using Cronbach's alpha internal consistency coefficient, item-total score correlation coefficients, and intraclass correlation coefficients. It was determined that the Assessment of Survivor Concern Scale consisted of five items and two subscales. In the confirmatory factor analysis, the fit index values of the scale showed a good fit in general. The Cronbach's alpha internal consistency coefficient of the scale was found to be 0.83, its intraclass correlation coefficients of the scale were above 0.70, and its item-total score correlation coefficients varied between 0.53 and 0.72. The Turkish version of the Assessment of Survivor Concern Scale is a valid and reliable instrument for assessing the worry levels of gynecological cancer survivors. Assessment of Survivor Concern Scale can help assess worry levels in survivors of gynecological cancers. This makes it possible to identify survivors with high worry levels and provide them with personalized counseling and psychosocial support.
The aim of this study was to investigate prognostic determinants of survival in early-stage endometrial cancer (EC), focusing on clinicopathological parameters including histologic grade, tumor stage, myometrial invasion, lymphovascular space invasion (LVSI), and preoperative CA-125, as well as the role of adjuvant therapies in disease-free survival (DFS) and overall survival (OS). We retrospectively analyzed women treated surgically for International Federation of Gynecology and Obstetrics 2009 stage I-II EC at a tertiary center between January 2011 and January 2023. Demographic and pathological data were collected, including age, body mass index, reproductive history, menopausal status, comorbidities, tumor size, histologic subtype and grade, depth of myometrial invasion, LVSI, serum CA-125 levels, and surgical procedures. Adjuvant therapies-external beam radiotherapy, vaginal brachytherapy, and chemotherapy-were also documented. Associations between these variables and survival outcomes were assessed using Kaplan-Meier and Cox regression analyses. A total of 241 women with early-stage EC were included. Median age was 57 years (range: 34-86 years). Of these, 181 (75.1%) were stage IA, 47 (19.5%) were stage IB, and 13 (5.4%) were stage II. Histologic grades were grade 1 in 44.8%, grade 2 in 39.0%, and grade 3 in 16.2%. During a median follow-up of 75 months, recurrence occurred in 4.6% of patients and mortality in 7.9% of patients. Univariate analysis showed that elevated CA-125, higher stage, and higher grade were associated with worse OS. Multivariate analysis identified histologic grade as an independent predictor of both OS and DFS. Neither adjuvant radiotherapy nor chemotherapy improved survival outcomes. Histologic grade was the strongest independent prognostic factor for OS and DFS in early-stage EC, surpassing tumor stage, myometrial invasion, and LVSI. These findings highlight the importance of comprehensive surgical staging, especially when high-grade tumors are detected intraoperatively, to ensure accurate risk stratification and appropriate use of adjuvant therapies. Bu çalışmanın amacı, erken evre endometriyal kanserde (EK) sağkalımın prognostik belirleyicilerini araştırmak olup, histolojik grade, tümör evresi, myometriyal invazyon, lenfovasküler alan invazyonu (LVSI) ve preoperatif CA-125 düzeyine ek olarak adjuvan tedavilerin hastalıksız sağkalım (DFS) ve genel sağkalım (OS) üzerindeki rolünü incelemektir. Ocak 2011-Ocak 2023 tarihleri arasında üçüncü basamak bir merkezde Uluslararası Jinekoloji ve Obstetrik Federasyonu 2009 evre I-II EK nedeniyle cerrahi tedavi uygulanan kadınlar retrospektif olarak analiz edildi. Yaş, vücut kitle indeksi, üreme öyküsü, menopoz durumu, ek hastalıklar, tümör boyutu, histolojik alt tip ve grade, miyometriyal invazyon derinliği, LVSI varlığı, serum CA-125 düzeyi ve uygulanan cerrahi prosedür gibi demografik ve patolojik veriler kaydedildi. Ayrıca eksternal radyoterapi, vajinal brakiterapi ve kemoterapi gibi adjuvan tedaviler de dokümante edildi. Sağkalım sonuçları ile değişkenler arasındaki ilişkiler Kaplan-Meier ve Cox regresyon analizleri ile değerlendirildi. Analize toplam 241 erken evre EK’li kadın dahil edildi. Medyan yaş 57 idi (34-86). Olguların 181’i (%75,1) evre IA, 47’si (%19,5) evre IB, 13’ü (%5,4) evre II idi. Histolojik grade dağılımı %44,8 grade 1, %39,0 grade 2 ve %16,2 grade 3 olarak bulundu. Medyan 75 aylık takip süresinde nüks %4,6, mortalite %7,9 oranında gerçekleşti. Univariate analizde yüksek CA-125, ileri evre ve yüksek grade’in OS üzerine olumsuz etkisi saptandı. Multivariate analizde histolojik grade hem OS hem de DFS için bağımsız prediktör olarak belirlendi. Adjuvan radyoterapi veya kemoterapinin sağkalım üzerine anlamlı katkısı gösterilmedi. Erken evre EK’de histolojik grade, OS ve DFS için en güçlü bağımsız prognostik faktör olarak ortaya çıkmıştır. Bu bulgu, özellikle yüksek grade tümörlerin intraoperatif saptandığı olgularda doğru risk sınıflaması ve adjuvan tedavilerin dikkatli uygulanabilmesi için kapsamlı cerrahi evrelemenin önemini vurgulamaktadır.
To evaluate the psychometric properties and cross-cultural validity of the Turkish version of the adolescent Menstrual Bleeding Questionnaire (aMBQ) through comprehensive reliability and validity analyses. We conducted a two-phase methodological study involving translation/cross-cultural adaptation and psychometric validation using standardized guidelines. The validation phase included 181 adolescents aged 12-18 years. Tools included the Turkish aMBQ and Menstrual Practice Needs Scale (MPNS). Reliability was assessed through internal consistency (Cronbach's alpha), test-retest reliability (n = 30, two-week interval), and item analysis. For validity assessment, the sample was randomly split into two subsets for exploratory (n = 91) and confirmatory (n = 90) factor analyses, with convergent validity testing and known-groups comparison. Factor analysis revealed a three-dimensional structure explaining 68.4% of total variance: Bleeding Severity, Daily Activities Impact, and Social/School Impact (factor loadings: 0.685-0.845). The instrument demonstrated excellent internal consistency (Cronbach's α = 0.892) and test-retest reliability (ICC = 0.876, 95% CI: 0.841-0.912). Confirmatory factor analysis showed good model fit (CFI = 0.942, RMSEA = 0.048). The aMBQ correlated significantly with MPNS scores (r = 0.684, p < 0.001) and effectively discriminated between severity groups across all components (Cohen's d = 1.85-2.12). Content validity indices met acceptance criteria (I-CVI ≥ 0.78, S-CVI ≥ 0.90). The Turkish aMBQ demonstrates robust psychometric properties and structural validity, supporting its use in clinical and research settings. The three-factor structure provides comprehensive assessment of menstrual bleeding impact among Turkish adolescents, enabling standardized evaluation of menstrual health in Turkish healthcare settings.
The 2023 update of the International Federation of Gynecology and Obstetrics (FIGO) staging system introduced significant changes in the classification of endometrial cancer by incorporating key pathological and molecular features. This study aimed to evaluate the impact of the revised FIGO 2023 staging system on stage distribution and adjuvant treatment decisions in patients undergoing surgical management of this malignancy. This retrospective study included 220 patients who underwent surgical staging for endometrial cancer between January 2018 and December 2025. All patients were initially staged using the FIGO 2009 classification. Cases were subsequently reclassified according to the FIGO 2023 staging criteria, using the algorithm proposed for settings in which routine molecular classification is unavailable. The McNemar test was used to compare stage categories between the two staging systems, and the Wilcoxon signed-rank test was applied to evaluate the impact of stage migration on adjuvant treatment recommendations. Stage migration occurred in 12.7% of patients (28/220) following the application of the FIGO 2023 criteria, predominantly due to upstaging. The most common factor associated with stage reclassification was substantial lymphovascular space invasion (LVSI). The proportion of patients managed with observation alone significantly decreased from 44.5% to 32.7% (p<0.001), while the use of pelvic radiotherapy increased from 19.1% to 28.2% (p=0.004). Similarly, the proportion of patients receiving combined chemoradiotherapy significantly increased from 11.8% to 17.3% (p=0.012). The implementation of the FIGO 2023 staging system has resulted in clinically meaningful stage migration and significantly impacted adjuvant treatment strategies. In particular, the recognition of substantial LVSI as a defining feature of stage IIC disease has led to more intensive adjuvant therapy in a subset of patients previously categorized as low risk. Uluslararası Jinekoloji ve Obstetrik Federasyonu (FIGO) evreleme sisteminin 2023 güncellemesi, endometriyum kanserinin sınıflandırılmasında temel patolojik ve moleküler özellikleri içerecek şekilde önemli değişiklikler getirmiştir. Bu çalışmanın amacı, revize edilen FIGO 2023 evreleme sisteminin cerrahi tedavi uygulanan endometriyum kanseri hastalarında evre dağılımı ve adjuvan tedavi kararları üzerindeki etkisini değerlendirmektir. Bu retrospektif çalışmaya Ocak 2018 ile Aralık 2025 tarihleri arasında endometriyum kanseri nedeniyle cerrahi evreleme uygulanan hastalar dahil edilmiştir (n=220). Tüm hastalar başlangıçta FIGO 2009 sınıflamasına göre evrelendirilmiştir. Bu çalışmanın amacı doğrultusunda olgular daha sonra, rutin moleküler sınıflandırmanın yapılamadığı durumlar için önerilen algoritma kullanılarak FIGO 2023 evreleme kriterlerine göre yeniden sınıflandırılmıştır. İki evreleme sistemi arasındaki evre kategorilerini karşılaştırmak için McNemar testi, evre değişiminin adjuvan tedavi önerileri üzerindeki etkisini değerlendirmek için ise Wilcoxon işaretli sıralar testi kullanılmıştır. FIGO 2023 kriterlerinin uygulanması sonrasında hastaların %12,7’sinde (28/220) evre değişimi saptanmış olup bu değişim çoğunlukla evre yükselmesi şeklinde gerçekleşmiştir. Evre yeniden sınıflandırmasına yol açan en sık faktör substantif lenfovasküler alan invazyonu (LVSI) olmuştur. Yalnızca gözlem ile takip edilen hasta oranı %44,5’ten %32,7’ye düşerken (p<0.001), pelvik radyoterapi uygulanan hasta oranı %19,1’den %28,2’ye yükselmiştir (p=0.004). Benzer şekilde kombine kemoradyoterapi uygulanan hasta oranı da %11,8’den %17,3’e artmıştır (p=0.012). FIGO 2023 evreleme sisteminin uygulanması klinik olarak anlamlı evre değişimine yol açmış ve adjuvan tedavi stratejileri üzerinde önemli bir etki oluşturmuştur. Özellikle substantif LVSI evre IIC hastalığın tanımlayıcı bir özelliği olarak kabul edilmesi, daha önce düşük riskli olarak değerlendirilen bazı hastalarda daha yoğun adjuvan tedavi uygulanmasına neden olmuştur.
Sexual health literacy is critical for young people to make informed decisions and access sexual and reproductive health services. In Türkiye, factors such as social stigma, lack of information, and cultural taboos and structural barriers may negatively affect young people's sexual and reproductive health service-seeking behaviors. The aim of this study is to determine the levels of sexual health literacy and sexual and reproductive health service seeking among Turkish youth, identify the factors affecting these levels, and to examine the relationship between sexual health literacy and service-seeking behavior. The cross-sectional descriptive study was completed with 512 young people aged 18-30 years in Türkiye using an online survey distributed via social media platforms. Data were collected using the Sexual Health Literacy Scale and the Sexual and Reproductive Health Service Seeking Scale. Descriptive statistics, t-test, one-way ANOVA, Pearson correlation, and linear regression analyses were used in the analysis of the data. Participants' sexual health literacy was found to be at a moderate level (50.09 ± 9.23), while service seeking was above moderate (37.62 ± 9.87). A positive relationship was found between sexual health literacy and service seeking (p < 0.05). According to regression analysis, sexual health literacy level and history of unwanted pregnancy were factors predicting service seeking (R²=0.125, F = 7.983, p < 0.001). The level of sexual health literacy was found to be associated with gender, income level, family type, parents' education level, receipt of sexual health education, active sexual life, contraceptive use, unwanted pregnancy, and sexually transmitted disease history. The level of service seeking was influenced by marital status, family type, parental education, sexual activity, sexually transmitted disease diagnosis, unwanted pregnancy, and the need for emergency contraception. Main barriers to service seeking were embarrassment (35%), not prioritizing sexual health (22.1%), minimizing the problem (21.5%), and lack of information (18%). This study shows that limited sexual health literacy may restrict Turkish youth's access to sexual and reproductive health services. Strengthening sexual health education, improving access to reliable online information, and fostering youth-friendly health services including guidance by nurses are essential. These measures can ensure equitable, inclusive, and effective sexual and reproductive health care.
C-kit, E-cadherin and beta-catenin adhesion molecules and proto-oncogenes are thought to be associated with molecular mechanisms related to the invasion, implantation and persistence of ectopic endometrial cells. Comparing the expression levels of these molecules in endometriomas, other types of endometriosis, and normal endometrial tissue may provide further insight into the mechanisms driving endometriosis development. The present study sought to examine the molecular pathophysiological roles of these molecules by determining their expression profiles in different types of endometriosis and in the healthy endometrium. Retrospective data from 180 cases were analyzed, comprising 60 endometriomas, 60 cases of other types of endometriosis (superficial and deep), and 60 normal proliferative endometrial tissue samples. Immunohistochemical staining for c-kit, E-cadherin, and beta-catenin was performed. The expression levels of E-cadherin and beta-catenin were quantified using the H-score method. C-kit positivity was found in 9% of endometriomas and 10% of other endometriosis tissues, but was absent in normal endometrium. Beta-catenin H-scores were significantly lower in endometriosis tissues compared with normal endometrial tissues (p<0.001). E-cadherin levels showed no significant difference between the groups. A post-hoc power analysis confirmed that the study was adequately powered to detect group differences in E-cadherin, indicating that the non-significant finding likely reflects a true absence of a difference. Increased c-kit expression, along with reduced beta-catenin expression in endometriosis samples, suggests that these molecules contribute to endometriosis pathogenesis. However, because no significant difference was found in E-cadherin expression, a definitive conclusion cannot be made regarding the involvement of E-cadherin in endometriosis development. C-kit, E-kaderin ve beta-katenin gibi adezyon molekülleri ve proto-onkogenlerin, ektopik endometriyal hücrelerin invazyonu, implantasyonu ve persistansı ile ilişkili moleküler mekanizmalarla bağlantılı olduğu düşünülmektedir. Bu çalışma, farklı endometriozis tiplerinde ve sağlıklı endometriyumda bu moleküllerin ekspresyon profillerini belirleyerek moleküler patofizyolojik rollerini incelemeyi amaçlamıştır. Yüz seksen olgunun retrospektif verileri analiz edildi; bunlar arasında 60 endometrioma, 60 diğer endometriozis türü (yüzeyel ve derin) ve 60 normal proliferatif endometriyal doku örneği bulunmaktaydı. C-kit, E-kadherin ve beta-katenin için immünohistokimyasal boyama yapıldı. E-kadherin ve beta-katenin ekspresyon düzeyleri H-skor yöntemi kullanılarak ölçüldü. C-kit pozitifliği endometriomaların %9’unda ve diğer endometriozis dokularının %10’unda saptandı, ancak normal endometriyumda gözlenmedi. Beta-katenin H-skorları, normal endometrial dokulara kıyasla endometriozis dokularında anlamlı olarak daha düşüktü (p<0,001). E-kaderin düzeyleri gruplar arasında anlamlı farklılık göstermedi. Post-hoc güç analizi, çalışmanın E-kadherin’deki grup farklılıklarını tespit etmek için yeterli güce sahip olduğunu doğruladı ve bu da anlamlı olmayan bulgunun muhtemelen gerçek bir farkın olmadığını yansıttığını gösterdi. Endometriozis dokularında artmış c-kit ekspresyonu ile azalmış beta-katenin ekspresyonu, bu moleküllerin endometriozis patogenezine katkıda bulunabileceğini düşündürmektedir. Ancak, E-kaderin ekspresyonunda önemli bir fark bulunmadığından, endometriozis gelişiminde E-kaderinin rolünü kesin olarak belirlemek mümkün değildir.
To compare follicular fluid (FF) cytokine and homocysteine profiles in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF), with and without sonographic endometrioma, and to explore potential inflammatory alterations associated with endometrioma in this population. This prospective comparative study was conducted among 60 women diagnosed with POR who were undergoing IVF treatment. Participants were divided into two groups according to the presence of sonographic endometrioma: Group I included women without sonographic endometrioma (n=30) and Group II included women with sonographic endometrioma (n=30). FF samples were collected during oocyte retrieval and analyzed for inflammatory biomarkers. Concentrations of interleukin-1β (IL-1β), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon-α2 (IFN-α2), IFN-γ, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and homocysteine were measured using LEGENDplex multiplex assays and flow cytometry. Cytokine and homocysteine levels were compared between groups. Most inflammatory cytokines, including IL-1β, IL-6, IL-8, IFN-γ, and MCP-1, showed lower levels in women with sonographic endometrioma compared with women without sonographic endometrioma. In contrast, TNF-α and IL-33 levels tended to be higher in the endometrioma group. Homocysteine levels were also lower in women with sonographic endometriomas. However, none of the observed differences reached statistical significance. Overall, the findings suggested distinct, albeit non-significant, inflammatory trends in the FF microenvironment of women with POR and sonographic endometrioma. Women with POR and sonographic endometrioma showed altered trends in FF inflammatory-marker profiles compared with women without sonographic endometrioma; however, these differences were not statistically significant. Since the absence of sonographic endometrioma does not exclude endometriosis, the findings should be interpreted cautiously. Larger prospective studies that include IVF and assess embryological and reproductive outcomes are required to clarify the clinical significance of FF biomarkers in women with POR and endometrioma. Bu çalışmanın amacı, in vitro fertilizasyon (IVF) tedavisi gören düşük over rezerv (DOR) tanılı kadınlarda, sonografik endometrioma varlığına göre follikül sıvısı (FS) sitokin ve homosistein profillerini karşılaştırmak ve endometrioma ile ilişkili olası enflamatuvar değişiklikleri araştırmaktır. Bu prospektif karşılaştırmalı çalışmaya IVF tedavisi gören ve DOR tanısı bulunan toplam 60 kadın dahil edildi. Katılımcılar sonografik endometrioma varlığına göre iki gruba ayrıldı: Grup I, sonografik endometrioması olmayan kadınlardan (n=30); Grup II ise sonografik endometrioması bulunan kadınlardan (n=30) oluştu. FS örnekleri oosit toplama işlemi sırasında elde edildi ve inflamatuvar biyobelirteçler açısından analiz edildi. İnterlökin-1β (IL-1β), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon-α2 (IFN-α2), IFN-γ, tümör nekroz faktörü-α (TNF-α), monosit kemoatraktan protein-1 (MCP-1) ve homosistein düzeyleri LEGENDplex multipleks analiz yöntemi ve akım sitometrisi kullanılarak ölçüldü. Sitokin ve homosistein düzeyleri gruplar arasında karşılaştırıldı. IL-1β, IL-6, IL-8, IFN-γ ve MCP-1 dahil olmak üzere çoğu enflamatuvar sitokin düzeyi, sonografik endometrioması bulunan kadınlarda, sonografik endometrioması olmayan kadınlara kıyasla daha düşük bulundu. Buna karşılık TNF-α ve IL-33 düzeyleri endometrioma grubunda daha yüksek eğilim gösterdi. Homosistein düzeyleri de sonografik endometrioması bulunan kadınlarda daha düşük saptandı. Ancak gözlenen farklılıkların hiçbiri istatistiksel anlamlılığa ulaşmadı. Genel olarak bulgular, DOR ve sonografik endometrioması bulunan kadınların FS mikroçevresinde belirgin ancak istatistiksel olarak anlamlı olmayan inflamatuvar eğilimler olduğunu düşündürdü. DOR ve sonografik endometrioması bulunan kadınlarda, sonografik endometrioması olmayan kadınlara kıyasla FS enflamatuvar belirteç profillerinde değişmiş eğilimler gözlenmiş, ancak istatistiksel olarak anlamlı farklılık saptanmamıştır. Sonografik endometrioma yokluğunun endometriozisi dışlamadığı göz önünde bulundurularak bulgular dikkatli yorumlanmalıdır. IVF, embriyolojik ve üreme sonuçlarını içeren daha geniş prospektif çalışmalara, DOR ve endometriomalı kadınlarda FS biyobelirteçlerinin klinik önemini daha iyi açıklığa kavuşturmak için ihtiyaç vardır.
This study aimed to evaluate the prevalence of asymptomatic bacteriuria (ASB) in the second half of pregnancy, identify causative microorganisms, and assess their antimicrobial resistance and multidrug resistance (MDR) patterns in Kırşehir, Türkiye. Between April-December 2024, 182 pregnant women without urinary tract infection symptoms were screened at Kırşehir Training and Research Hospital. Midstream urine samples were cultured, and bacterial isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix™ automated system. Data were interpreted according to EUCAST 2024 criteria. ASB prevalence was 37.36%. Escherichia coli (51.47%) was the most common pathogen, followed by Candida spp. (17.65%), Klebsiella pneumoniae (8.82%), and Streptococcus agalactiae (7.36%). In Gram-negative isolates, the highest resistance was to ampicillin (72.7%), cefazolin (43.2%), and amoxicillin-clavulanate (40.9%), with universal susceptibility to amikacin, carbapenems, and nitrofurantoin. Gram-positive isolates showed the highest resistance to moxifloxacin and tetracycline (41.7% each). MDR was detected in 20% of Escherichia coli, 16.7% of Klebsiella pneumoniae, 60% of Streptococcus agalactiae, and 66.6% of Staphylococcus epidermidis isolates. ASB prevalence during second half of pregnancy was high, and a significant proportion of pathogens demonstrated MDR. The findings highlight the necessity of culture-based diagnosis and region-specific empirical therapy. High resistance to ampicillin and trimethoprim-sulfamethoxazole suggests that empirical protocols should be updated according to local antibiograms. Strengthening antibiotic stewardship and expanding routine ASB screening are critical to reducing maternal-fetal complications. Bu çalışma, gebeliğin ikinci yarısında asemptomatik bakteriüri (ASB) prevalansını değerlendirmek, etken mikroorganizmaları belirlemek ve bunların antimikrobiyal direnç ile çoklu ilaç direnci (MDR) paternlerini incelemek amacıyla Kırşehir, Türkiye’de gerçekleştirilmiştir. Gereç ve Yöntemler: Nisan-Aralık 2024 tarihleri arasında, Kırşehir Eğitim ve Araştırma Hastanesi’nde üriner sistem enfeksiyonu semptomu olmayan 182 gebe kadın taranmıştır. Orta akım idrar örnekleri kültüre alınmış, bakteri izolatları tanımlanmış ve antimikrobiyal duyarlılık testleri BD Phoenix™ otomatize sistemi ile yapılmıştır. Veriler, EUCAST 2024 kriterlerine göre yorumlanmıştır. ASB prevalansı %37,36 olarak bulunmuştur. En sık patojen Escherichia coli (%51,47) olup, bunu Candida spp. (%17,65), Klebsiella pneumoniae (%8,82) ve Streptococcus agalactiae (%7,36) izlemiştir. Gram-negatif izolatlarda en yüksek direnç ampisilin (%72,7), sefazolin (%43,2) ve amoksisilin-klavulanata (%40,9) karşı belirlenmiş; tüm izolatların amikasin, karbapenemler ve nitrofurantoine duyarlı oldukları saptanmıştır. Gram-pozitif izolatlarda en yüksek direnç moksifloksasin ve tetrasikline (%41,7) karşı görülmüştür. MDR oranları Escherichia coli izolatlarında %20, Klebsiella pneumoniae’de %16,7, Streptococcus agalactiae’de %60 ve Staphylococcus epidermidis’de %66,6 olarak belirlenmiştir. Gebeliğin ikinci yarısında ASB prevalansı yüksek olup, patojenlerin önemli bir kısmı MDR göstermiştir. Bulgular, kültür bazlı tanının ve bölgeye özgü ampirik tedavi yaklaşımlarının önemini ortaya koymaktadır. Ampisilin ve trimethoprim-sülfametoksazole karşı yüksek direnç, ampirik tedavi protokollerinin yerel antibiyogramlara göre güncellenmesi gerektiğini göstermektedir. Antibiyotik yönetiminin güçlendirilmesi ve rutin ASB taramalarının yaygınlaştırılması, maternal-fetal komplikasyonların azaltılması açısından kritik öneme sahiptir.
This study aims to evaluate the diagnostic accuracy of the Pipelle biopsy based on sensitivity and specificity in women with abnormal uterine bleeding. This retrospective observational study included women who reported abnormal uterine bleeding and underwent endometrial sampling via a Pipelle, followed by hysterectomy at a Turkish tertiary hospital. Women with abnormal uterine bleeding were excluded from the study if they underwent hysteroscopy for biopsy, dilation and curettage, or if their data could not be accessed. All women with abnormal uterine bleeding underwent an endometrial Pipelle biopsy using an index test. Women who underwent hysterectomy were used as references. The study confirmed the sensitivity, specificity, predictive values, and accuracy of the Pipelle biopsy for various endometrial diseases. A total of 501 patients were definitively assessed for eligibility. Of them, 45 were excluded from the study. Finally, 456 patients were retained. The Pipelle endometrial biopsy is a reliable method for detecting endometrial cancer, with a sensitivity of 88.63% and a specificity of 100%. It has a perfect positive predictive value of 100% and a high negative predictive value of 98.80%, ensuring reliability. Its overall diagnostic accuracy of 98.90% confirms its superiority in diagnosis. Eighty-one endometrial polyps were detected in the hysterectomy specimens, but only 27 (33.33%) could be diagnosed using a Pipelle biopsy. The assessment of endometrial polyps shows a sensitivity of 33.33%, specificity of 88.00%, a positive predictive value of 37.50%, and a negative predictive value of 85.93%. The diagnostic accuracy of endometrial polyps was 78.25%. Pipelle biopsy is a highly effective and straightforward method for diagnosing endometrial cancer. Early diagnosis is crucial and significantly enhances treatment options. However, the polyps could not be identified. A positive biopsy result definitively confirms the diagnosis; however, a negative biopsy result does not eliminate the possibility of endometrial disease.
Occupational balance plays a crucial role in maintaining overall well-being and quality of life, particularly during pregnancy, a period marked by significant physiological, psychological, and social changes. This study aims to evaluate the relationship between occupational balance and quality of life in pregnant and non-pregnant women. This analytical cross-sectional study was conducted in a foundation university hospital with 220 participants, 110 pregnant women in different trimesters of pregnancy (case group) and 110 non-pregnant women (control group). Participants were selected through a purposive sampling method from among volunteers who applied to the pregnancy clinic and hospital for various reasons. Data collection instruments included the Personal Information Form, the Occupational-Role Balance Questionnaire-11 Turkish Version (OBQ11-T), and the SF-12 Quality of Life Scale. Statistical analyses were performed using SPSS 20.0, employing t-tests, chi-square tests, Pearson correlation, and regression analysis to determine relationships between variables. Statistical significance was considered at p < 0.05. No statistically significant differences were found between the groups regarding age, education, employment, and income status. The mean OBQ11-T score was higher in the case group (28.77 ± 6.54) than in the control group (26.30 ± 6.43) (p = 0. 005). SF-12 Physical Component Summary (PCS) scores were significantly higher in the case group (53.95 ± 9.34) compared to the control group (45.44 ± 10.89) (p = 0.000), while the Mental Component Summary (MCS) scores showed no significant difference. A weak but positive correlation was identified between OBQ11-T and the PCS subdimension of SF-12 in both groups (case: r = 0.229, p = 0.016; control: r = 0.209, p = 0.028). Regression analysis revealed that OBQ11-T scores were a significant predictor of SF-12 PCS scores (β = 0.229, R = 0.229; R² = 0.052; p = 0.016). Regression analysis indicated that occupational balance accounted for 5% of the variance in PCS scores. This finding reveals that as the level of occupational balance increases, participants' perceptions of quality of life related to physical health also increase slightly. Women in both groups demonstrated above-average occupational balance scores, and a weak but positive relationship was observed between occupational balance and the physical component of quality of life. Therefore, it may be useful to develop strategies to protect and maintain occupational balance, especially in order to support quality of life related to physical health.
To evaluate the bleeding degree with objective indices and treatment interventions in the delivery of inherited factor deficiency pregnancies. The presented case-control study was conducted with pregnancies with factor deficiencies. Maternal obstetrical history, disease characteristics (factor levels, duration of disease, and bleeding history), and treatment features during pregnancy were evaluated. Obstetric (delivery mode, antepartum/postpartum bleedings) and neonatal outcomes (birth weights, birth weeks, APGAR scores) of the study group were compared to those of the control group. The Delta hemoglobin/hematocrit (prepartum - postpartum hemoglobin/hematocrit), and hemoglobin and hematocrit % change [(prepartum - postpartum hemoglobin/hematocrit)/prepartum hemoglobin/hematocrit] indices were used to assess the extent of bleeding during delivery. None of the patients had an early postpartum hemorrhage. The delta hemoglobin and hematocrit values were increased in the factor deficiency group, with p-values of 0.019 and <0.001. The hemoglobin and hematocrit percentage changes were also found to increase, associated with p-values of <0.001 and 0.010. Three of the patients (16.7%) had postpartum complications. Gestational age at birth, APGAR scores at 1 and 5 minutes were lower in the factor deficiency group with p-values of 0.016, <0.001, and <0.001, respectively. There was one stillbirth. Most patients received peripartum tranexamic acid treatment, with factor derivatives and desmopressin in required cases. Hemoglobin/hematocrit delta and change rate indices were increased, although none of the patients were recorded as having early peripartum hemorrhage or needing transfusion. New delta bleeding indices are promising for objectively identifying bleeding and regulating treatment in clinical practice. The experience of this clinical study might guide future studies. Bu çalışmanın amacı kalıtsal faktör eksikliği olan gebeliklerin doğumunda kanama derecesini objektif indeksler ve tedavi müdahaleleriyle değerlendirmektir. Sunulan olgu kontrol çalışması faktör eksikliği olan gebeliklerle yürütülmüştür. Annenin obstetrik öyküsü, hastalık özellikleri (faktör düzeyleri, hastalık süresi ve kanama öyküsü) ve gebelik sırasındaki tedavi özellikleri değerlendirilmiştir. Obstetrik (doğum şekli, doğum öncesi/doğum sonrası kanamalar) ve neonatal sonuçlar (doğum ağırlıkları, doğum haftaları, APGAR skorları) kontrol grubuyla karşılaştırılmıştır. Delta hemoglobin/hematokrit (doğum öncesi - doğum sonrası hemoglobin/hematokrit), hemoglobin ve hematokrit % değişimi [(doğum öncesi - doğum sonrası hemoglobin/hematokrit)/doğum öncesi hemoglobin/hematokrit] indeksleri doğumdaki kanama derecesini değerlendirmek için kullanılmıştır. Hastaların hiçbiri erken postpartum kanama yaşamadı. Delta hemoglobin ve hematokrit değerleri faktör eksikliği grubunda artmıştı, p-değerleri 0,019 ve <0,001 idi. Hemoglobin ve hematokrit % değişimlerinin de p-değerleri <0,001 ve 0,010 değerleri ile arttığı bulundu. Hastaların üçünde (%16,7) doğum sonrası komplikasyonlar görüldü. Doğum haftası, APGAR 1 ve 5 faktör eksikliği grubunda daha düşüktü, p-değerleri sırasıyla 0,016, <0,001 ve <0,001 idi. Bir hasta intrauterin eksitus oldu. Çoğu hasta peripartum traneksamik asit tedavisi aldı, gerekli durumlarda faktör türevleri ve desmopressin aldı. Hemoglobin/hematokrit delta ve değişim oranı indeksleri artmıştı, ancak hastaların hiçbirinde erken postpartum kanama gelişmedi veya transfüzyon ihtiyacı olmadı. Yeni delta kanama indeksleri klinik uygulamada kanamayı objektif olarak belirlemek ve tedaviyi düzenlemek için umut vericidir. Bu klinik çalışmanın gelecekteki ileri çalışmalara rehberlik edebileceğine inanıyoruz.
Cervical cancer screening through cytology and human papillomavirus (HPV) testing is essential for early detection of precancerous lesions, yet long-term institutional data integrating cytological trends, HPV genotype epidemiology, and diagnostic performance from Turkey remain limited. This study aimed to analyze the distribution and temporal trends of cervical cytological abnormalities, HPV prevalence and genotype distribution, and cytology-histopathology concordance over a 12-year period at a tertiary care center in Istanbul. A retrospective analysis of all cervical smear samples collected between January 2014 and December 2025 was conducted. Cytology results were classified according to the Bethesda 2014 system. HPV testing, which was performed on a subset of the study population based on clinical indications and kit availability, included mRNA-based assay (Aptima, 2020-2021, n = 4,648) and DNA genotyping (2024-2025, n = 4,308). Cytology-histopathology correlation was assessed for cases with biopsy within 180 days. Among 83,148 cervical smear records, 76,232 evaluable results from women aged ≥21 years were included. The overall epithelial cell abnormality rate was 7.93%, with atypical squamous cells of undetermined significance (5.83%) and low-grade squamous intraepithelial lesions (1.77%) being the most common findings. Epithelial cell abnormality rates varied significantly across age groups, with the highest rate in the 18-20 age group (12.78%) and a significant inverse correlation with increasing age (r = -0.955, p < 0.001). Among tested patients, HPV positivity was 9.1% by mRNA testing and 9.9% by DNA genotyping, with HPV-16 predominating in both methods (20.5 and 32.8% of positive cases, respectively). Notably, HPV-56 (16.6%) and HPV-51 (14.3%) were more prevalent than HPV-18 (8.9%). High-grade squamous intraepithelial lesion cytology demonstrated a positive predictive value of 89.2% for detecting cervical intraepithelial neoplasia grade 2 or higher. A significant decrease in epithelial cell abnormality rates was observed over the study period (r = -0.591, p = 0.043), with a more pronounced decline in high-grade abnormalities (r = -0.911, p < 0.001). The 12-year analysis shows a decrease in cervical cytological abnormalities and provides valuable epidemiological data on HPV genotype distribution in a Turkish population. The high prevalence of non-vaccine-targeted genotypes, such as HPV-56 and HPV-51, should be considered in future vaccination strategies.
To compare the ability of three-dimensional (3D) and conventional two-dimensional (2D) ultrasound to predict oocyte maturity during in vitro fertilization cycles, and to evaluate their contribution to trigger timing and to the determination of optimal cut-off values for maximizing metaphase II (MII) oocyte yield using automated volume-calculation software. Forty-three infertile women who had ≤5 follicles, were younger than 40 years, had a body mass index <30, and had no previous oocyte maturation problems were included in this retrospective study. Follicle diameter was measured using 2D ultrasound, while follicle volume was measured using 3D ultrasound with SonoAVC software. The obtained values were compared with those from MII oocytes, and receiver operating characteristic (ROC) analysis and logistic regression were performed. A total of 203 oocytes were analyzed; 70% of them were in the MII stage. In the ROC analysis, the optimal cut-off for 2D measurement was determined to be 17.05 mm [area under curve (AUC)=0.737], and for 3D measurement, it was 1.83 cm³ (AUC=0.709). 2D measurements showed specificity, while 3D measurements showed sensitivity. In logistic regression analysis, both 2D diameter and 3D volume were found to be independent predictors of MII oocyte development. Our findings suggest that 3D ultrasound measurements may provide greater sensitivity for predicting oocyte maturity. However, falsepositive results may occur in the presence of multiple or nested follicles, and observer dependence cannot be completely eliminated. Therefore, optimization and large-scale validation studies are needed to improve the accuracy of the method. Bu çalışmada, in vitro fertilizasyon sikluslarında oosit olgunluğunu öngörmede üç boyutlu (3D) ultrason ile ölçülen folikül hacmi ile geleneksel iki boyutlu (2D) ultrason ölçümlerinin karşılaştırılması ve triger zamanlamasında klinik katkılarının araştırılması amaçlanmıştır. Ayrıca, yapay zeka tabanlı otomatik hacim hesaplama yazılım desteğiyle ovaryen hiperstimülasyon döngülerinde maksimum metafaz II (MII) oosit elde edilebilmesi için en uygun cut-off değerinin belirlenmesi hedeflenmiştir. Retrospektif olarak planlanan çalışmaya, ≤5 folikülü bulunan, 40 yaş altı, vücut kitle indeksi <30 olan ve daha önce oosit maturasyon problemi bulunmayan 43 infertil kadın dahil edilmiştir. Folikül çapı 2D ultrason ile, folikül hacmi ise SonoAVC yazılımı kullanılarak 3D ultrason ile ölçülmüştür. Elde edilen değerler MII oositler ile karşılaştırılmış, alıcı işletim karakteristiği (ROC) analizi ve lojistik regresyon testleri uygulanmıştır. Toplam 203 oosit analiz edilmiştir; bunların %70’i MII evresinde bulunmuştur. ROC analizinde 2D ölçüm için en uygun cut-off 17,05 mm [eğrinin altındaki alan (AUC)=0,737], 3D ölçüm için ise 1,83 cm³ (AUC=0,709) olarak belirlenmiştir. 2D ölçümler özgüllük açısından, 3D ölçümler ise duyarlılık açısından daha yüksek performans göstermiştir. Lojistik regresyon analizinde hem 2D çap hem de 3D hacim MII oosit gelişimi için bağımsız prediktör bulunmuştur. Bulgularımız, literatür ile uyumlu olarak 3D ultrason ölçümlerinin oosit olgunluğunu öngörmede duyarlılık avantajı sağlayabileceğini göstermektedir. Ancak çok sayıda veya iç içe folikül varlığında yanlış pozitif sonuçlar oluşabilmekte, ayrıca gözlemci bağımlılığı tamamen ortadan kalkmamaktadır. Bu nedenle yöntemin doğruluğunun artırılmasına yönelik optimizasyon ve geniş ölçekli doğrulama çalışmalarına ihtiyaç vardır.
To compare the efficacy and safety of single-incision laparoscopic surgery (SILS) versus conventional laparoscopic surgery (CLS) for the surgical management of ectopic pregnancy through a systematic review and meta-analysis. We searched Medline, PubMed, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane databases from inception to May, 2023 for studies comparing SILS with CLS in ectopic pregnancy treatment. Included studies were controlled and observational, excluding single-arm studies, meta-analyses, and reviews. Quality was assessed using ROBINS-I for observational studies and the Cochrane tool for randomized trials. Data were analyzed with OpenMetaAnalyst and Review Manager 5.4.1, using odds ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes. Twelve studies involving 880 women (372 SILS, 508 CLS) were included. SILS showed significantly less blood loss (MD=-51.01 mL, p=0.004), shorter postoperative hospital stay (MD=-0.24 days, p=0.003), and faster return of bowel function (MD=-1.03 hours, p<0.01), compared to CLS. No significant differences were found in total operative time, hemoglobin change, blood transfusion requirements, or number of patients needing transfusions. Patient satisfaction data were limited but suggested better cosmetic outcomes with SILS. SILS is a feasible and effective alternative to CLS for ectopic pregnancy, offering reduced blood loss, shorter hospital stays, and quicker bowel function recovery. These benefits, alongside potential cosmetic advantages, make SILS a promising option, particularly for young women. Further research is needed to confirm long-term outcomes and optimize patient selection. Ektopik gebeliğin cerrahi tedavisinde tek kesi laparoskopik cerrahinin (SILS) etkinliğini ve güvenliğini sistematik bir inceleme ve meta-analiz yoluyla konvansiyonel laparoskopik cerrahinin (CLS) etkinliği ve güvenliği ile karşılaştırmak amaçlanmıştır. Medline, PubMed, Scopus, Web of Science, ClinicalTrials. gov ve Cochrane veri tabanlarında, ektopik gebelik tedavisinde SILS’yi CLS ile karşılaştıran çalışmalar Mayıs 2023 tarihine kadar taranmıştır. Dahil edilen çalışmalar kontrollü ve gözlemsel olup, tek kollu çalışmalar, meta-analizler ve derlemeler hariç tutulmuştur. Kalite, gözlemsel çalışmalar için ROBINS-I ve randomize çalışmalar için Cochrane aracı kullanılarak değerlendirilmiştir. Veriler, ikili sonuçlar için olasılık oranları ve sürekli sonuçlar için ortalama farklar (OF) kullanılarak OpenMetaAnalyst ve Review Manager 5.4.1 ile analiz edildi. Sekiz yüz seksen kadını (372 SILS, 508 CLS) içeren on iki çalışma dahil edildi. SILS, CLS ile karşılaştırıldığında önemli ölçüde daha az kan kaybı (OF=-51,01 mL, p=0,004), daha kısa postoperatif hastanede kalış süresi (OF=-0,24 gün, p=0,003) ve bağırsak fonksiyonunun daha hızlı geri dönüşü (OF=-1,03 saat, p<0,01) ile ilişkili idi. Toplam ameliyat süresi, hemoglobin düzeyinde değişim, kan transfüzyonu gereksinimi veya transfüzyona ihtiyaç duyan hasta sayısı açısından önemli bir fark bulunamadı. Hasta memnuniyeti verileri sınırlıydı ancak SILS ile daha iyi kozmetik sonuçlar olduğunu düşündürmekteydi. SILS, ektopik gebelik tedavisinde CLS’nin uygulanabilir ve etkili bir alternatifidir; daha az kan kaybı, daha kısa hastanede kalış süresi ve daha hızlı bağırsak fonksiyonu iyileşmesi ile ilişkilidir. Bu faydalar, potansiyel kozmetik avantajlarının yanı sıra, SILS’yi özellikle genç kadınlar için umut verici bir seçenek haline getirir. Uzun vadeli sonuçları doğrulamak ve hasta seçimini optimize etmek için daha fazla araştırmaya ihtiyaç vardır.
This study aimed to investigate the association between the day-to-day impact of vaginal aging and female sexual function among postmenopausal Turkish women. The McCoy Female Sexuality Questionnaire (MFSQ) and the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire were distributed to 195 postmenopausal women. The most bothersome vulvovaginal symptoms were recorded. The scores for each of the MFSQ and DIVA domains were compared between women with moderate to severe symptoms and those with no or mild symptoms. The mean scores for the MFSQ sexual interest and MFSQ partner satisfaction domains, the total MFSQ, and the total DIVA decreased as women got older. Women with moderate to severe pain with penetration had a lower score for the MFSQ sexual interest domain, and a higher score for the DIVA self-concept and body image domain. Women with moderate to severe dryness had a higher score for the MFSQ sexual interest domain, and a lower score for the DIVA self-concept and body image domain. The mean scores of each of the MFSQ and DIVA domains were not influenced by vulvovaginal symptoms such as itching, pain, and irritation. The mean scores of the MFSQ sexual interest and DIVA self-concept and body image domains differed with the severity of dryness and pain with penetration.