Relationship Between Recurrent Pregnancy Loss With Unknown Etiology and Endoplasmic Reticulum Stress.

INTRODUCTION: Recurrent pregnancy loss (RPL) is characterized by consecutive pregnancy losses before 20 weeks of gestation, with evolving definitions necessitating adjustments to prevent delays in couples' evaluation. Limited etiological data on RPL prompts comprehensive evaluations, often yielding no pathological findings. Emerging research implicates endoplasmic reticulum (ER) stress in various reproductive processes, yet its association with RPL remains understudied. AIM: To evaluate ER stress in patients with RPL with unknown etiology by determining the plasma concentration of X-box binding protein-1 (XBP-1). MATERIALS AND METHODS: A total of 45 patients aged 18 to 35 years with at least two pregnancy losses with unknown etiology before the completion of 20 weeks of gestation between March 2020 and September 2020 were included in the study group. The control group consisted of 45 healthy women with at least two previous live births, no pregnancy-associated complications, and no history of pregnancy loss or infertility. The XBP-1 levels were determined from serum samples. Statistical analyses assessed differences between groups, and receiver operating characteristic (ROC) curve analysis determined XBP-1's predictive value for RPL. RESULTS: The mean XBP-1 concentration in the RPL group was significantly higher than in the control group (p < 0.001). The mean values were 2243.65 ± 9425.27 pg/mL and 1196.32 ± 4378.81 pg/mL, respectively. The use of XBP-1 levels for the prediction of RPL was evaluated. In an ROC curve analysis, the area under the curve was found to be 87% (95% CI: 80% to 94.8%). The specificity was 78%, the sensitivity was 88%, the positive likelihood ratio (LR) was 4, the negative LR was 0.15, the positive predictive value was 80%, and the negative predictive value was 87% for the cut-off XBP-1 level at 1364.68 pg/mL. CONCLUSION: This study highlights the potential role of ER stress in RPL and proposes XBP-1 as a predictive biomarker for pregnancy loss. Understanding ER stress mechanisms in RPL could inform diagnostic and therapeutic strategies. Further research is essential to validate these findings and explore their clinical implications.

Comparison of transvaginal natural orifice transluminal endoscopic surgery versus conventional surgery for uterosacral ligament suspension in patients who had concomitant vaginal hysterectomy for subtotal uterine prolapse.

INTRODUCTION: The study aimed to compare the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. METHODS: There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow-up visits were scheduled at the first week and 1 month after surgery. RESULTS: The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p = .09). Operation time was significantly shorter in the shull group (p < .001), and the hospitalization period (p = .029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p < .001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. CONCLUSION: vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP-Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short- and long-term results of vNOTES versus conventional USLS are needed.

Progression from Prediabetes to Diabetes in a Diverse U.S. Population: A Machine Learning Model.

Objective: To date, there are no widely implemented machine learning (ML) models that predict progression from prediabetes to diabetes. Addressing this knowledge gap would aid in identifying at-risk patients within this heterogeneous population who may benefit from targeted treatment and management in order to preserve glucose metabolism and prevent adverse outcomes. The objective of this study was to utilize readily available laboratory data to train and test the performance of ML-based predictive risk models for progression from prediabetes to diabetes. Methods: The study population was composed of laboratory information services data procured from a large U.S. outpatient laboratory network. The retrospective dataset was composed of 15,029 adults over a 5-year period with initial hemoglobin A1C (A1C) values between 5.0% and 6.4%. ML models were developed using random forest survival methods. The ground truth outcome was progression to A1C values indicative of diabetes (i.e., ≥6.5%) within 5 years. Results: The prediabetes risk classifier model accurately predicted A1C ≥6.5% within 5 years and achieved an area under the receiver-operator characteristic curve of 0.87. The most important predictors of progression from prediabetes to diabetes were initial A1C, initial serum glucose, A1C slope, serum glucose slope, initial HDL, HDL slope, age, and sex. Conclusions: Leveraging readily obtainable laboratory data, our ML risk classifier accurately predicts elevation in A1C associated with progression from prediabetes to diabetes. Although prospective studies are warranted, the results support the clinical utility of the model to improve timely recognition, risk stratification, and optimal management for patients with prediabetes.

Neutrophil gelatinase-associated lipocalin serum level: A potential noninvasive biomarker of endometriosis?

Neutrophil gelatinase-associated lipocalin (NGAL, also known as lipocalin-2) is an acute-phase protein expressed in many tissues and plays a role in cell proliferation, regulation, and epithelial-mesenchymal transformation. Therefore, this study aimed to investigate serum NGAL levels and endometrioma tissue expression in women with endometriosis. This cross-sectional study was conducted at a university hospital. The endometrioma group included 36 women who underwent ovarian cystectomy for endometrioma, which was compared with a control group (n = 36) of women who underwent ovarian cystectomy due to benign persistent cysts (follicle cyst, theca lutein cyst, and serous cystadenoma). NGAL levels were analyzed using both serum enzyme-linked immunosorbent assay analysis and immunohistochemical tissue staining. Serum C-reactive protein and CA-125 levels were also evaluated. NGAL serum levels were significantly higher in the endometrioma group than in the control group (P < .05). C-reactive protein and CA-125 levels were also significantly higher in the endometrioma group (P < .05) and were correlated with NGAL levels. Immunohistochemical staining for NGAL was also higher in the endometrioma group (P < .001). NGAL may be considered a potential noninvasive biomarker of endometriosis.

CKD Progression Prediction in a Diverse US Population: A Machine-Learning Model.

Rationale & Objective: Chronic kidney disease (CKD) is a major cause of morbidity and mortality. To date, there are no widely used machine-learning models that can predict progressive CKD across the entire disease spectrum, including the earliest stages. The objective of this study was to use readily available demographic and laboratory data from Sonic Healthcare USA laboratories to train and test the performance of machine learning-based predictive risk models for CKD progression. Study Design: Retrospective observational study. Setting & Participants: The study population was composed of deidentified laboratory information services data procured from a large US outpatient laboratory network. The retrospective data set included 110,264 adult patients over a 5-year period with initial estimated glomerular filtration rate (eGFR) values between 15-89 mL/min/1.73 m2. Predictors: Patient demographic and laboratory characteristics. Outcomes: Accelerated (ie, >30%) eGFR decline associated with CKD progression within 5 years. Analytical Approach: Machine-learning models were developed using random forest survival methods, with laboratory-based risk factors analyzed as potential predictors of significant eGFR decline. Results: The 7-variable risk classifier model accurately predicted an eGFR decline of >30% within 5 years and achieved an area under the curve receiver-operator characteristic of 0.85. The most important predictor of progressive decline in kidney function was the eGFR slope. Other key contributors to the model included initial eGFR, urine albumin-creatinine ratio, serum albumin (initial and slope), age, and sex. Limitations: The cohort study did not evaluate the role of clinical variables (eg, blood pressure) on the performance of the model. Conclusions: Our progressive CKD classifier accurately predicts significant eGFR decline in patients with early, mid, and advanced disease using readily obtainable laboratory data. Although prospective studies are warranted, our results support the clinical utility of the model to improve timely recognition and optimal management for patients at risk for CKD progression. Plain-Language Summary: Defined by a significant decrease in estimated glomerular filtration rate (eGFR), chronic kidney disease (CKD) progression is strongly associated with kidney failure. However, to date, there are no broadly used resources that can predict this clinically significant event. Using machine-learning techniques on a diverse US population, this cohort study aimed to address this deficiency and found that a 5-year risk prediction model for CKD progression was accurate. The most important predictor of progressive decline in kidney function was the eGFR slope, followed by the urine albumin-creatinine ratio and serum albumin slope. Although further study is warranted, the results showed that a machine-learning model using readily obtainable laboratory information accurately predicts CKD progression, which may inform clinical diagnosis and management for this at-risk population.

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester.

OBJECTIVE: This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. METHODS: This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. RESULTS: There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). CONCLUSION: These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-Ketenci Gencer technique.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. METHODS: This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-Ketenci Gencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. RESULTS: Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). CONCLUSIONS: With the Salman-Ketenci Gencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-Ketenci Gencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.

Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis.

PURPOSE: The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative findings of deep infiltrating endometriosis using the #ENZIAN score. METHODS: This retrospective study included 64 patients who underwent surgery for deep infiltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the #ENZIAN classification. Operative scores were considered the gold standard, and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. RESULTS: MRI has higher sensitivity and specificity in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100%, 100-100%, and 97-100%, respectively, p < 0.001) compared to the other compartments. The lowest sensitivity, specificity, accuracy, and PPV of the MRI was found in compartment P (14%, 76%, 70%, and 7%, respectively). CONCLUSION: We demonstrated that the #ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.

Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) "first" strategy in benign gynecological surgeries.

PURPOSE: The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases. METHODS: All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively. RESULTS: A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases. CONCLUSION: Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester

SUMMARY OBJECTIVE: This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. METHODS: This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. RESULTS: There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). CONCLUSION: These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

Inactivated COVID-19 vaccine hesitancy among midwifery students: a prospective online survey.

Limited information on vaccines' reliability and lack of sufficient scientific data may cause suspicion among individuals concerning the Coronavirus Disease-2019 (COVID-19) vaccines. This study aimed to investigate the attitudes of midwifery students to an inactivated COVID-19 vaccine. This prospective online survey was conducted between 01 March and 01 May 2021 with 172 midwifery students. An anonymous online survey was developed by the researchers, taking into account the studies in the literature examining the attitudes of individuals towards the vaccine. The online survey included a total of 19 questions, covering five main topics. The study revealed that 118 (68%) of 172 midwifery students were hesitant to get vaccinated. There was a significant difference between the vaccine-hesitant and -accepting groups regarding the general attitude towards the vaccine (respectively; <0.001, 0.001). It was determined that 48.1% of the vaccine-accepting participants strongly agreed that this vaccination should be mandatory for all midwifery students working in a clinical practice internship. Higher vaccination willingness levels are expected in students who attend health curricula due to the high literacy level in health-related issues. In conclusion, healthcare professionals who are in contact with patients should be informed more accurately about newly developed vaccines.IMPACT STATEMENTWhat is already known on this subject? Limited information on vaccines' reliability and lack of sufficient scientific data caused suspicion about the COVID-19 vaccines among many people .What do the results of this study add? Almost half of the participants in both groups agreed that the vaccine could be ineffective if the virus is mutated. Nearly half of the hesitant group thought that the COVID-19 vaccine might not be effective and were concerned about serious side effects.What are the implications of these findings for clinical practice and/or further research? This study reveals that healthcare professionals who are in contact with patients should be informed more accurately about newly developed vaccines.

Serum sestrin 2 levels in patients with uterine leiomyomas.

Our aim was to evaluate SESN2 levels in patients with uterine leiomyomas by comparing serum SESN2 levels in myoma patients with the levels in healthy women to deepen our understanding of the pathophysiology of uterine leiomyomas. Patients 18-50 years of age who applied to the University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital between January and March 2021 and who were diagnosed with uterine leiomyoma were defined as the 'myoma group'. The control group included patients without any sign of leiomyomas in routine ultrasonography. The patients' demographic features, gynecological symptoms, myoma volume and classification were recorded. Serum SESN2 concentrations in venous blood samples were measured using a sandwich enzyme-linked immunosorbent assay (ELISA) kit.The study included 31 patients in the myoma group and 30 in the control group. The mean age/gravid/parity or BMI values did not differ significantly between the groups. The only gynecological symptom that showed a significant difference was menorrhagia. Serum SESN2 levels were significantly higher in the myoma group then the control groups (11.7 ± 2.5) (p < 0.001). In conclusion, although uterine leiomyoma is the most common benign tumour in women of reproductive age, there are no known markers for predicting the development of leiomyomas. Based on the results of the current study, SESN2 could be such a marker.IMPACT STATEMENTWhat is already known on this subject? Uterine leiomyoma is the most common type of benign tumour in women of reproductive age as well as the most common indication for a hysterectomy. Symptoms associated with uterine leiomyoma include abnormal bleeding, chronic pelvic pain, menorrhagia, dysmenorrhoea, dyspareunia and anaemia, which adversely affect the patient's quality of life. Sestrins are a family of metabolic regulator proteins that play a potential role in carcinogenesis.What the results of this study add? This is the first study evaluating the role of sestrin in the development of uterine leiomyomas. Significantly higher levels of sestrin 2 (SESN2) were detected in patients with leiomyomas.What are the implications of these findings for clinical practice and/or further research? Although uterine leiomyoma is the most common type of benign tumour in women of reproductive age, there are still many unknowns regarding its pathophysiology. Further, there are still no known markers for predicting the development of leiomyomas. Hence, primary prevention is not possible. Based on the results of the current study SESN2, could be such a marker. Further studies are needed to confirm the results of this study.

The effect of medical ozone therapy in addition to ovarian detorsion in ischemia reperfusion model.

This study aimed to investigate the protective effect of ozone therapy on ovarian reserve, number of ovarian follicles, ovarian morphology in a rat ischaemia reperfusion (IR) injury model. Twenty-four, Wistar Hannover rats were included. The rats were divided into three groups as control, detorsion-only, and ozone therapy + detorsion groups. There was a statistically significant difference in the follicular damage and inflammation scores between the study groups (p = .019, p = .002, respectively). The highest AMH decrease was observed in the detorsion-only group (p = .012). The total damage score was higher in the detorsion-only group than the ozone therapy + detorsion group. Preantral, small and large antral follicle numbers were less in the detorsion-only group than the ozone therapy + detorsion group. The highest postoperative day 7 TAS level was in the ozone therapy + detorsion group. TOS levels did not differ significantly between the study groups. The combination of the ozone therapy with ovarian detorsion is more effective in protecting the ovarian reserve than ovarian detorsion-only.Impact StatementWhat is already known on this subject? Adnexal torsion is a common gynecological emergency in reproductive-age women. The recommended management is the detorsion of the adnexal pedicle in patients with fertility desire.What do the results of this study add? The combination of the medical ozone therapy with conventional surgical ovarian detorsion is more effective in the protection of the ovarian reserve compared to surgical ovarian detorsion.What are the implications of these findings for clinical practice and/or further research? This study speculates that medical ozone therapy in addition to conventional surgical ovarian detorsion could preserve ovarian reserve and function if confirmed in further clinical studies.

Hysteroscopy-Guided Natural Orifice Repair of Isthmocele.

Isthmocele can be defined as a hypoechoic field within the lower uterine segment, indicating a discontinuation of the myometrium at the uterine scar of a previous cesarean section. Postmenstrual spotting, pelvic pain, dysmenorrhea, dyspareunia, uterine rupture, cesarean scar pregnancy, and secondary infertility could be seen as the complications of existing isthmocele. Such defects are prevalent with the increasing number of cesarean deliveries. A 39-year-old woman who had three prior cesarean sections complaining irregular uterine bleeding for 2 years was examined. A uterine scar defect was observed. A hysteroscopy-guided natural orifice approach was planned to repair the defect. The patient was discharged without any complication in her postoperative 6th h. She had no pain or irregular bleeding in her 2-week postoperative visit.

Comparison of laparoscopic hysterectomy videos on YouTube and WebSurg platforms in terms of educational reliability and quality.

INTRODUCTION: This study aimed to compare the educational reliability of laparoscopic hysterectomy videos on YouTube and WebSurg platforms. MATERIALS AND METHODS: We performed an online search with the keyword "laparoscopic hysterectomy" on YouTube and WebSurg. On WebSurg, the surgical interventions in gynecology section were selected. On YouTube, the most relevant surgical videos according to algorithm of YouTube were included. 22 YouTube and 22 WebSurg videos were included in the study. Technical analysis were performed via calculation of ratios such as view/day, like/view, like/subscriber, view/subscriber, and Video Power Index. The videos were evaluated with usefulness and laparoscopic surgery video educational guidelines (LAP-VEGaS) scoring systems. RESULTS: View/day ratio was higher on YouTube than WebSurg [8.8 (42.1) and 2.5 (5.1), respectively; p = 0.02]. Like/view ratio was lower on YouTube than WebSurg [0.006 (0.01) and 0.01 (0.02), respectively; p = 0.001]. A significant difference was obtained only in the treatment section of usefulness scoring system [0 (0-2), and 0 (0-1) for YouTube and WebSurg, respectively; p = 0.04]. According to LAP-VEGaS, the scores of patient positioning, step-by-step approach, demonstration of intraoperative findings and anatomy, commentary in English parameters were significantly lower on YouTube compared to WebSurg [1(0-2) and 2(2-2), p < 0.001; 2 (0-2) and 2 (2-2), p = 0.004; 2(0-2) and 2(2-2), p < 0.001; 2(0-2) and 2(2-2), p = 0.009, respectively]. The total LAP-VEGaS score of YouTube was lower than WebSurg videos [10(4-16) and 13(10-15), respectively; p = 0.001). DISCUSSION: WebSurg was found to be more reliable platform in terms of educational value and quality of laparoscopic hysterectomy videos compared to YouTube.

Comparison of Depression and Anxiety Scores in Multi/Nulliparous Women who have Undergone Dilatation and Curettage.

AIM: To demonstrate the duration of negative psychological effects of elective curettage on both nulliparous and multiparous women and to determine the association between parity and post-abortion depression and anxiety. MATERIALS AND METHODS: A total of 168 women who applied to our reproductive health clinic for elective abortion were included in this prospective study. 84 nulliparous and 84 multiparous women were asked to fill out Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI-II) forms by a psychiatrist at their pre-abortion consultation and at 3 months follow-up. A thorough anamnesis with demographic data of each patient was recorded at initial consultation. RESULTS: Depression and anxiety measurements in both groups significantly decreased at the end of the 3 months follow-up. The mean depression value in nullipara group decreased from 24.2 ± 5.8 to 9.4 ± 3.3 and anxiety from 23.5 ± 3.7 to 8.8 ± 2.5. In the multipara group, the mean depression score decreased from 15.7 ± 4.0 to 7.3 ± 2.3, and anxiety from 15.9 ± 4.0 to 7.9 ± 2.3. A significant decrease in both depression and anxiety scores could be observed in both groups. CONCLUSION: Although the severity of depression and anxiety varies between multiparous and nulliparous individuals, this study showed that both depression and anxiety scores return to normal values by the end a 3 months follow-up period.