Partner Satisfaction in Labiaplasty Patients.

BACKGROUND: Labiaplasty operation, which has become increasingly popular in recent years, is frequently preferred by women for cosmetic and functional reasons. It creates significant changes on female sexuality with high satsfaction rates. But there is limited data on its effects on male sexual response. OBJECTIVES: To investigate the effects of labiaplasty on partners. METHODS: Partners of 49 patients who underwent labiaplasty between January 2020 and May 2023 were included in the study. Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Golombok Rust Sexual Satisfaction Scale and New Sexual Satisfaction Scale (NSSS) questionnaires were administered to the partners preoperatively and 6 months postoperatively. RESULTS: There was no significant difference between preoperative and postoperative results in the MSHQ-EjD questionnaire applied to the partners included in the study. The postoperative increase in the new sexual satisfaction scale compared to the preoperative sexual satisfaction score was statistically significant. In the Golombok Rust sexual satisfaction scale, statistically significant, positive changes were observed in the categories of frequency of intercourse, communication, satisfaction, and nature of sexual intercourse in postoperative results. CONCLUSIONS: Labiaplasty operation had positive effects onmale sexual response, but had no effect on ejaculation function and difficulty.

The effect of compliance with PAP therapy on biochemical parameters in patients with obstructive sleep apnea syndrome: A 6-month follow-up study.

Introduction: The gold standard treatment for obstructive sleep apnea syndrome (OSAS) is positive airway pressure therapy (PAP) treatments. PAP treatments reduce complications by reducing apnea and hypopnea attacks by creating airflow at a determined pressure. In our study, we aimed to examine the effect of treatment compliance on kidney and liver functions, apneahypopnea (AHI) index, and lipid profile of patients diagnosed with OSAS and started PAP treatment. Materials and Methods: Patients who were admitted to the sleep laboratory of our hospital between September 2022 and September 2023 and started PAP treatment after PSG were included in our study. Patients who were called for follow-up six months after the initiation of PAP treatment were divided into two groups according to their compliance with PAP treatment. Patients who used the device for at least four hours per night and more than 70% at night were grouped as PAP-compliant patients, while the other patients were grouped as non-PAP-compliant patients. Result: It was observed that uric acid, BUN, triglyceride, total cholesterol, ALT, GGT, ALP, and AHI levels of the patients who started PAP treatment decreased after six months (p= 0.001, 0.006, <0.001, 0.006, 0.01, <0.001, <0.001, <0.001 with). It was observed that HDL cholesterol levels increased (p≤ 0.001). It was observed that the change in uric acid, AHI, total cholesterol, and GGT levels in group 1 (n= 36) patients who were compliant with PAP treatment was statistically higher than in group 2 (n= 30) patients (p< 0.001, <0.03, <0.001, 0.008, respectively). Conclusions: Uric acid, total cholesterol and GGT are biomarkers that may increase in OSAS due to intermittent hypoxia with the involvement of other systems. Since a decrease in these biomarkers can be observed in the early period depending on treatment compliance, these biomarkers can be used practically in the follow-up of treatment compliance and treatment efficacy.

Evaluation of Pulmonary Function Tests, Dyspnea Scores, and Antibody Levels at the Six-Month Follow-Up of Patients Hospitalized for COVID-19 Pneumonia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes various signs and symptoms, especially lung involvement, during acute infection and in the long term. In this study, we evaluated the follow-up results of patients with chronic COVID-19 over a 24-week period. METHODS: The study included a total of 100 post-COVID-19 patients (confirmed by real-time polymerase chain reaction (PCR) of a nasopharyngeal swab) who presented to the post-COVID-19 outpatient clinic with chronic COVID-19 symptoms 12 weeks after diagnosis, between April and June 2021. All of the patients in the study had a history of hospitalization and were grouped based on the severity of the acute COVID-19 infection (moderate: group 1, severe: group 2). RESULTS: A comparison of pulmonary function test parameters at week 12 showed that forced expiratory volume (FEV1)%, forced vital capacity (FVC)%, diffusing capacity of the lungs for carbon monoxide (DLCO)%, and DLCO divided by the alveolar volume (DLCO/VA)% values were significantly lower in group 2 than in group 1 (p<0.001 for all). At week 24, only DLCO and DLCO/VA values were lower (<0.001 for both). The mean modified Medical Research Council (mMRC) dyspnea scores of groups 1 and 2 were 1.4 ± 0.9 and 2.8 ± 1.1 at 12 weeks and improved to 0.9 ± 0.6 and 1.6 ± 0.6 at 24 weeks, respectively. The groups' mMRC scores at 12 and 24 weeks differed significantly (p=0.001, p=0.02). There was no difference in levels of IgM and IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein between the groups at 12 or 24 weeks (p>0.05 for all). CONCLUSION: Improvement in pulmonary function parameters and mMRC scores may take longer than 24 weeks, especially in patients with severe COVID-19. Our results indicated that the levels of IgM and IgG neutralizing antibodies did not differ between patients with moderate and severe illness at 12 or 24 weeks.

Does the Surgical Margin Affect Sexual Function Following Linear Labiaplasty Technique?

BACKGROUND: How much labial tissue should be left after labiaplasty is a controversial issue. OBJECTIVES: The objective was to investigate the effect of residual labial tissue following labiaplasty operations on sexual function. METHODS: A total of 150 females who underwent labiaplasty between 2019 and 2021 and their partners were included in the study. In this retrospective study, linear labiaplasty technique was applied according to the patient's request. Patients were either below 1 cm or above 1 cm according to the remaining labial width at follow-up. The remaining labial tissues were classified according to the Motakef classification. Patients with a labial width above 1 cm were included in Group 1, and patients with a labial width below 1 cm were included in Group 2. Sexual function, sexual experience, body image, and erectile function of their partners were compared preoperatively and 2 years postoperatively with appropriate questionnaires. RESULTS: Sexual function, sexual experience, and body image of females improved in all patients. However, the improvement was more apparent with with remaining labial tissue of greater than 1 cm. The increase in the survey results of the partners was found to be similar. CONCLUSIONS: The sexual function of the patients was better when the width of the labium was longer than 1 cm. This may be due to better protection of the neurovascular structures. This favorable effect was also seen in the subjective evaluation of the partners.

Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

OBJECTIVE: The older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey. METHODS: The data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire. RESULTS: Of the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma. CONCLUSIONS: Herein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.

Analysis of one-year follow-up results and treatment costs of patients with PTE in a tertiary care center.

Introduction: Pulmonary thromboembolism (PTE) is a life-threatening disease, with substantial treatment-related complications, difficult follow-up, treatment compliance, and high costs. This study aimed to assess treatment costs with various maintenance therapy regimens, complications, and patient adherence to treatment over a one-year follow-up period. Materials and Methods: This observational, prospective study included 142 patients with PTE who received maintenance anticoagulation therapy between November 2020 and March 2023. The patients were observed at three-month intervals for a year. Possible treatment-related complications, recurrence, mortality, and treatment costs were recorded. Result: Our results showed that there was no significant difference in bleeding risk based on the drugs used for initial or maintenance treatment. In maintenance therapy, low-molecular-weight heparin (LMWH), warfarin, and direct oral anticoagulant (DOAC) treatment regimens had similar treatment adherence and comparable efficacy and safety in terms of recurrence and bleeding (p> 0.05). Four patients (2.8%) were diagnosed with chronic thromboembolic disease. The one-year mortality rate was 24.6% (n= 35), of which 82.9% (n= 29) occurred within the first three months. Hospital mortality rates with the different maintenance therapies were 8.8% in the LMWH group, 5.7% in the warfarin group, and 3.2% in the DOAC group. The annual cost of using LMWH was higher than that of rivaroxaban, apixaban, and warfarin (p< 0.001) while there was no significant cost difference between DOACs and warfarin (p> 0.05). Conclusions: In our study, the LMWH, warfarin, and DOAC treatment regimens had similar efficacy, safety, and patient compliance. In terms of cost, LMWH was the costliest while DOAC and warfarin were similar.

Evaluation of the Relationship between FeNO and Clinical Risk Stratification for Early Mortality in Pulmonary Embolism.

BACKGROUND: Pulmonary embolism (PE) is a common complication of deep vein thrombosis that causes high mortality and morbidity. This study aimed to determine the relationship between clinical risk scoring for early mortality and fractional exhaled nitric oxide (FeNO) in PE patients. METHODS: The study included a total of 98 subjects, 68 patients diagnosed with PE in the emergency department, and 30 healthy controls. Patients with PE were grouped according to clinical scoring of early mortality risk as low (n = 20), moderate-low (n = 24), and moderate-high (n = 24) risk. FeNO levels were measured after diagnosis. RESULTS: FeNO levels were significantly higher in patients with moderate-high risk PE compared to the other three groups and in those with moderate-low risk PE compared to the control group (p < 0.001 for all). Moderate to strong positive correlations were observed between FeNO level and mean pulmonary artery pressure (r = 0.818, p = 0.01), troponin-I (r = 0.67, p = 0.01), pro-BNP (r = 0.762, p = 0.01), and D-dimer levels (r = 0.652, p = 0.01). A FeNO cutoff value of 7.5 ppb had 84% sensitivity and 78% specificity in differentiating moderate-high risk PE from moderate-low risk PE. CONCLUSIONS: FeNO may be as reliable, noninvasive, and easily accessible as cardiac biomarkers in clinical risk scoring for early mortality in PE patients.

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.

Effect of atmospheric pressure changes on the development of pulmonary embolism: a retrospective analysis of 8 years of data.

BACKGROUND: Pulmonary embolism (PE) is a condition with high mortality, and determining its etiology is as important as its treatment. There are limited studies in the literature examining the effect of atmospheric pressure (AP) change on PE. OBJECTIVES: Analyze the effect of AP level and the change in AP level on the development of PE according to year, season and months. DESIGN: Retrospective SETTING: Department of tertiary care center PATIENTS AND METHODS: Patients with diagnosed or presumed PE who were followed up in the Erzurum Atatürk University Medicine Chest Diseases Clinic between 2012 and 2020 (8 years) were retrospectively screened for inclusion in the study by examining hospital records. Daily AP values were obtained electronically through official correspondence with the Erzurum Regional Meteorological Directorate. Patients diagnosed with PE were recorded using the hospital database and anamnesis forms. The dates of admission to hospital were recorded. Risk factors leading to the development of PE were identified using the records. MAIN OUTCOME MEASURES: Relationship between AP values and the incidence of PE. SAMPLE SIZE: 592 RESULTS: APmin, APmax, and APmean were significantly lower on days with PE cases compared to days without PE cases (P<.001 for all). ΔAPmin, ΔAPmax, and ΔAPmean values were all negative on days with PE, but only the difference in ΔAPmin was significant (P=.04). CONCLUSIONS: This study showed that lower AP values were significantly associated with the incidence of PE. In particular, a drop in APmin compared to the previous day seemed to be most associated with PE development. LIMITATIONS: Retrospective design and only applicable to region. CONFLICT OF INTEREST: None.

Picturing asthma in Turkey: results from the Turkish adult asthma registry.

INTRODUCTION: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Evaluation of serum YKL-40 level among clinical risk scores for early mortality in acute pulmonary thromboembolism.

INTRODUCTION: Pulmonary embolism (PE) often occurs secondary to deep vein thrombosis and is an important cause of mortality and morbidity. This study aimed to evaluate the relationship between YKL-40 level and clinical risk score in patients with PE. METHODS: The study included a total of 100 patients, 80 patients diagnosed with PE in the emergency department and 20 healthy controls. Patients with PE were divided into four groups: high-risk patients (n = 20), high-intermediate-risk patients (n = 20), low-intermediate-risk patients (n = 20), and low-risk patients (n = 20). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. Pulmonary artery obstruction index (PAOI) was calculated from computed tomography angiography images. RESULTS: PAOI increased in correlation with PE risk and differed significantly between all patient groups (p < 0.001). Troponin-I levels were significantly higher in the high-risk and high-intermediate-risk groups compared to the other groups (p < 0.001), but did not differ significantly between high-risk and high-intermediate-risk patients (p = 0.09). YKL-40 level was significantly higher in the high-risk PE group than the high-intermediate-risk group (p < 0.001). In receiving operator characteristic curve analysis assessing the discriminatory value of YKL-40 for high-risk PE patients, a cut-off value of 227.2 ng/mL had sensitivity of 85 % and specificity of 70 %. DISCUSSION: YKL-40 may be an important biomarker in decisions regarding early thrombolytic treatment in patients with high-intermediate-risk PE. In addition, medical treatments targeting YKL-40 may also reduce thrombotic tendency in high-risk patient groups.

Investigation of the need for computed tomography pulmonary angiography in the decision to discontinue treatment for pulmonary thromboembolism.

BACKGROUND: Acute pulmonary thromboembolism (PTE) is an important cause of morbidity and mortality that can reduce quality of life due to long-term complications during and after treatment discontinuation. OBJECTIVES: The aim of this study was to evaluate patients for these complications before discontinuing treatment and determine the necessity of computed tomography pulmonary angiography (CTPA) imaging. METHODS: This retrospective study included 116 patients over the age of 18 who received anticoagulant treatment for at least 3 months and presented for treatment discontinuation to the Atatürk University Research Hospital Chest Diseases Outpatient Clinic between January 2015 and September 2019. RESULTS: CTPA performed at treatment discontinuation showed complete thrombus resolution with treatment in 73 patients (62.9%). High pulmonary artery obstruction index (PAOI) at diagnosis was statistically associated with findings of residual or chronic thrombus on CTPA at treatment discontinuation (p = 0.001). In the differentiation of patients with residual/chronic thrombus and those with thrombus resolution, D-dimer at a cut-off value of 474 µg/L had 60% sensitivity and 70% specificity. At a cut-off value of 35.5 mmHg, mean pulmonary artery pressure on echocardiography had sensitivity and specificity of 72% and 77%, respectively. At a cut-off of 23.75, PAOI had sensitivity and specificity of 93% and 69%, respectively. CONCLUSION: In addition to physical examination findings, D-dimer and echocardiography were guiding parameters in the evaluation of treatment discontinuation and thrombus resolution in patients presenting to the outpatient clinic for discontinuation of treatment for acute PTE. PAOI at diagnosis may be another important guiding parameter in addition to these examinations.

Frequency of Direct Oral Anticoagulants Usage in Acute Pulmonary Thromboembolism Treatment in Turkey (TUPEDO).

Background: Direct oral anticoagulants (DOACs) have been used in acute pulmonary thromboembolism as an alternative to warfarin due to drug interactions, narrow therapeutic range, and necessary close International Normalized Ratio (INR) monitoring. Phase 3 study results have reported that these drugs are at least as effective as warfarin and beneficial in terms of bleeding; however, studies that present up-to-date life data are necessary. Aims: To evaluate the frequency of using DOACs, which are prescribed with a limited number of indications in our country, and real-life data results. Study Design: Cross-sectional study. Methods: This cross-sectional survey collected the clinical data (history, current treatment, treatment duration, etc.) of patients with pulmonary thromboembolism and who applied to the physician for follow-up between October 15, 2019, and March 15, 2020. The researchers kept the patient records sequentially. Results: Data from 836 patients with acute pulmonary thromboembolism from 25 centers were collected, and DOAC was used in 320 (38.5%) of them. The most preferred DOAC was rivaroxaban (n = 294, 91.9%). DOAC was mostly preferred because it could not provide an effective INR level with warfarin (n=133, 41.6%). Bleeding was observed in 13 (4%) patients. Conclusion: The use of direct oral anticoagulants is becoming almost as widespread as conventional therapy. Real-life data results are important for their contribution to clinical practice.

Evaluation of 3-month follow-up of patients with postacute COVID-19 syndrome.

In addition to the highly variable clinical presentation of acute COVID-19 infection, it can also cause various postacute signs and symptoms. This study aimed to evaluate patients with postacute COVID-19 over 12 weeks of follow-up. The study included 151 patients who were diagnosed with COVID-19 by real-time polymerase chain reaction of a nasopharyngeal swab 1 month earlier, had radiologic findings consistent with COVID-19 pneumonia, and presented to the post-COVID-19 outpatient clinic between May and August 2021. The patients were divided into three groups based on COVID-19 severity: nonsevere pneumonia (Group 1), severe pneumonia (Group 2), and severe pneumonia requiring intensive care (Group 3). Evaluation of laboratory parameters at 4 and 12 weeks showed that Group 3 had a higher lactose dehydrogenase (LDH) level and a lower mean platelet volume than the other groups at both time points (p = 0.001 for all). Group 3 also had lower percent predicted forced vital capacity (FVC%), percent predicted forced expiration volume in 1 s (FEV1%), and percent predicted diffusion capacity of the lungs for carbon monoxide divided by alveolar volume (DLCO/VA%) compared to Groups 1 and 2 at Week 4 (p = 0.001, 0.004, 0.001, respectively) and compared to Group 1 at 12 weeks (p = 0.002, 0.03, 0.001, respectively). Patients with persistent dyspnea at 12 weeks had significantly lower FEV1%, FVC%, DLCO/VA%, and saturation levels in room air and significantly higher LDH, pro-BNP, D-dimer, and heart rate compared to those without dyspnea (p = 0.001 for all). Although the lungs are most commonly affected after COVID-19 infection, vascular and endothelial damage also causes multisystem involvement. Our study indicates that laboratory values, radiological signs, and pulmonary functional capacity improved in most patients after 12 weeks of follow-up.

Comparison of the effectiveness of high-flow and conventional nasal cannula oxygen therapy in pulmonary embolism patients with acute hypoxemic respiratory failure.

INTRODUCTION: The leading cause of mortality in pulmonary embolism (PE) is hypoxemic respiratory failure. The aim of this study was to compare the efficacy of high-flow nasal cannula (HFNC) and conventional nasal cannula (CNC) oxygen therapy in PE patients with hypoxemia. MATERIALS AND METHODS: Fifty-eight patients with a PaO2/FIO2 ratio below 300 who were admitted to the emergency department with acute respiratory distress and followed up in our intensive care unit due to PE between March and October 2019 were included in the study. One group (n= 29) received HFNC oxygen therapy and the other group (n= 29) received CNC oxygen therapy. RESULT: Arterial blood gas analysis showed no significant differences in baseline SpO2 and PaO2 between the HFNC and CNC groups, whereas both values were significantly higher in the HFNC group starting at 1 hour (PaO2: p= .01, p= .001, p= .001; SpO2: p= .009, p= .005, p= .002). Among massive PE patients with contraindications for thrombolytic therapy, there was no significant difference between the HFNC and CNC groups in baseline SpO2, PaO2, or respiratory rate, but those who received HFNC therapy had significant higher SpO2 starting at 15 minutes (p= .004 for all), significantly higher PaO2 starting at 1 hour (p= .01, p= .001, p= .001), and significantly lower respiratory rate starting at 30 minutes (p= .003, p= .001, p= .001, p= .002, p= .002). CONCLUSIONS: In patients presenting with PE and hypoxemic respiratory failure, HFNC oxygen therapy was more effective on both vital signs and arterial blood gas parameters compared to conventional oxygen therapy and can be used safely as primary treatment.