Study of Characteristics of Pregnant Women Who Are Refugees and Aged Under 18 Years.

Introduction In recent years, the refugee crisis has become one of the most serious problems. It is well-known that women, individuals aged under 18 years, and pregnant refugees are particularly vulnerable to adverse conditions. In this study, we aimed to determine the characteristics of pregnant refugee women aged under 18 years. Methodology Data for pregnant women were recorded prospectively from 2019 to 2021, and pregnant refugee women aged ≤18 years were enrolled in the study. Sociodemographic characteristics of women, gravidity and parity status, the status of regular antenatal care visits and antenatal care visit any time until birth, type of birth, causes for cesarean section, presence of maternal comorbidities, obstetric complications, and baby-related characteristics were recorded. Results A total of 134 pregnant refugees were enrolled in the study. A total of 31 (23.1%) women had completed primary school, and two (1.5%) women had completed middle school or high school. Additionally, only 3.7% of women had a regular job, and 64.2% of the refugees had a total family income below the minimum wage. Also, 10.4% of women lived with more than three people outside the nuclear family. Gravidity numbers were one for 65 (48.5%) women, two for 50 (37.3%) women, and more than two for 19 (14.2%) women, respectively. The proportion of women with regular antenatal care visits was 19.4% (26), and 45.5% (61) had irregular antenatal care visits. Anemia and urinary tract infections were detected in 52 (28.8%) patients and seven (5.2%) patients, respectively. The proportion of preterm delivery was 8.9%, and 10.5% of infants had low birth weight. A total of 16 (11.9%) babies required neonatal intensive care unit support. Conclusions The present study demonstrated that pregnant women who are refugees and aged under 18 years have low education levels, insufficient family income, and often live in crowded families and even as the second wife of a husband. Moreover, although the birth rate was high in pregnant refugees, the rate of regular antenatal follow-up was low. Finally, this study showed that maternal anemia, preterm birth, and low birth weight were common in pregnant refugees.

Epidemiology of Endometriosis Awareness in Turkey.

INTRODUCTION: Endometriosis is a chronic painful disease that affects the daily quality of life of individuals. Estimated rates show one in 10 women has endometriosis, although the actual prevalence is unknown. In this study, the impact of endometriosis prevalence and symptoms on women's lives in Turkey was questioned through a web-based questionnaire. METHODS: We utilized a version of the World Endometriosis Research Foundation (WERF) EndoCost tool, which was sent to applicants via social media. Data from women aged 18-50 years were analyzed. RESULTS: The results of 15,673 participants have been analyzed, and 2880 (18.3%) participants had endometriosis. Respondents with endometriosis reported urinary, neurological, and gastrointestinal disorders at statistically higher rates when compared to individuals without endometriosis diagnosis (54.2%, 84.5%, and 89.9% vs. 37.2%, 75.5%, and 81.1%, respectively; p = 0.001). Most respondents with endometriosis (80.1%) reported persistent fatigue and 21.2% of endometriosis participants reported feeling socially isolated related to their condition (p = 0.001). Of the participants with endometriosis, 63.2% mentioned that people did not believe their pain or symptoms and 77.9% experienced financial difficulties due to the cost of therapy. Of the participants with endometriosis, 46.0% reported that they had problems in their personal relationships, 28.3% had difficulties at work/school, and 7.4% were unable to attend class/work due to endometriosis-related symptoms. CONCLUSION: Endometriosis is a chronic, underestimated disease that affects 18% of Turkish women of reproductive age. There is a need for guidelines to inform healthcare providers, population professionals, and patients. Societies and governmental health authorities must work together to resolve this public health issue.

The effect of dydrogesterone on sexual function in endometriosis.

Endometriosis is an oestrogen-dependent chronic disease, which is commonly regarded as a disease of reproductive-aged women. We aimed to evaluate the sexual function with Female Sexual Function Index (FSFI) in women with endometriosis who received dydrogesterone for 6 months. A total of 79 women with endometriomas were recruited in the study group and received 10 mg dydrogesterone tablets orally for 6 months. FSFI and visual analog scale (VAS) scores for each patient before and after treatment were recorded. When before treatment VAS scores and after treatment VAS scores (5.7 ± 1.27, 3.97 ± 1.01, respectively) were compared, a significant decrease was observed (p = .001). A significant increase in mean orgasm scores (3.23 ± 0.6 vs. 3.57 ± 0.65, p = .01) and means satisfaction scores (3.85 ± 0.48 vs. 4.10 ± 0.38, p < .001) were observed. In addition, means desire scores were also significantly higher following treatment (p = .01). In conclusion, this study showed that FSFI scores were increased after 6 months of dydrogesterone treatment in patients with endometriosis. Desire, satisfaction, orgasm and pain scores improved significantly, and sexual dysfunction decreased after treatment.Impact statementWhat is already known on this subject? Endometriosis is a chronic inflammatory disease associated with severe dysmenorrhoea, pelvic pain, dyspareunia, painful gastrointestinal symptoms and sub-fertility are among the symptoms. These symptoms can be responsible for a significant decrease in the quality of life scores of the patients. Dydrogesterone is a synthetic progesterone derivative, which suppresses oestrogen levels and ovulation. Dydrogesterone's effect on pain relief in endometriosis patients has already been shown, but it's role on the sexual dysfunction observed in women with endometriosis has not yet been questioned.What do the results of this study add? To the best of our knowledge this is the first study showing the effects of dydrogesterone on sexual function in patients with endometriosis.What are the implications of these findings for clinical practice and/or further research? Dydrogesterone can safely be used in medical treatment of endometriosis not only for pain relief but also patients with additional complaints such as sexual dysfunction can benefit from this treatment. Future studies with larger cohorts and long-term follow-ups are needed to validate our results.

Protocol for the Cultural Translation and Adaptation of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project Endometriosis Participant Questionnaire (EPHect).

Endometriosis affects 10% of women worldwide and is one of the most common causes of chronic pelvic pain and infertility. However, causal mechanisms of this disease remain unknown due to its heterogeneous presentation. In order to successfully study its phenotypic variation, large sample sizes are needed. Pooling of data across sites is not always feasible given the large variation in the complexity and quality of the data collected. The World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonization Project (EPHect) have developed an endometriosis participant questionnaire (EPQ) to harmonize non-surgical clinical participant characteristic data relevant to endometriosis research, allowing for large-scale collaborations in English-speaking populations. Although the WERF EPHect EPQs have been translated into different languages, no study has examined the cross-cultural translation and adaptation for content and face validity. In order to investigate this, we followed the standard guidelines for cross-cultural adaptation and translation of the minimum version of the EPQ (EPQ-M) using 40 patients who underwent laparoscopic surgery in Turkey and 40 women in Northern Cyprus, aged between 18 and 55. We assessed the consistency by using cognitive testing and found the EPHect EPQ-M to be comprehensive, informative, and feasible in these two Turkish-speaking populations. The translated and adapted questionnaire was found to be epidemiologically robust, taking around 30-60 min to complete; furthermore, participants reported a similar understanding of the questions, showing that common perspectives were explored. Results from the cognitive testing process led to minor additions to some items such as further descriptive and/or visuals in order to clarify medical terminology. This paper illustrates the first successful cross-cultural translation and adaptation of the EPHect EPQ-M and should act as a tool to allow for further studies that wish to use this questionnaire in different languages. Standardized tools like this should be adopted by researchers worldwide to facilitate collaboration and aid in the design and conduction of global studies to ultimately help those affected by endometriosis and its associated symptoms.

The Effect of Neural Therapy on Long-Term Postoperative Discomforts after Bilateral Tubal Ligation.

BACKGROUND: In this study, we aimed to assess the effect of neural therapy in the prevention of post-tubal syndrome, which is the combination of dysmenorrhea, bloating, dyspareunia, heavy menstrual bleeding, chronic vaginitis, and cystitis, after elective bilateral tubal ligation with modified Pomeroy technique. MATERIAL AND METHODS: In total, 113 patients who have undergone bilateral tubal ligation with modified Pomeroy technique between January 2016 and December 2018 in our clinic have been included. Postoperatively, patients were divided into two groups. One group received neural therapy (n = 52), and the other group did not receive neural therapy (control group, n = 61). Both groups were evaluated in terms of preoperative and postoperative symptoms. One year after surgery, patients' pain levels were evaluated using visual analog scale (VAS). RESULTS: When both groups were compared in terms of symptoms, dysmenorrhea, dyspareunia, bloating, frequency of vaginitis, and cystitis per year and pain perception using VAS, the symptoms were significantly less in the neural therapy group. However, there was no difference between the groups in terms of the amount of menstrual bleeding. CONCLUSIONS: Patients who received neural therapy showed less pain symptoms (dysmenorrhea and dyspareunia), and their VAS scores were lower when compared to the control group. Thus, we concluded that neural therapy is effective in the treatment of post-tubal syndrome.

Effects of Irisin Compared with Exercise on Specific Metabolic and Obesity Parameters in Female Mice with Obesity.

Objective: We aimed to analyze the changes in metabolic parameters after administration of irisin to obese female mice. Materials and Methods: Sixty mice aged 5-6 weeks were randomized into three groups as irisin, exercise, and control. The control and irisin group remained sedentary, whereas the exercise group started free wheel exercising 6 weeks after the start of the study. The irisin group received irisin after 20 weeks. All mice were sacrificed at the 22nd week of the study, and obesity-related metabolic parameters were analyzed. Results: There was no significant difference between the irisin and exercise groups in weight gain (P > 0.05). By contrast, weight gain in the control group was significantly higher compared with the irisin and exercise groups (P < 0.05). Serum bone morphogenetic protein (BMP), ghrelin, insulin, kisspeptin, leptin, and visfatin levels were statistically lower in the irisin and exercise groups compared with the control group, but no significance was detected between the irisin and exercise groups (P < 0.05 for all parameters). Conclusion: Similar to the effect of exercise, irisin injections resulted in the amelioration of certain obesity-related parameters such as the concentration of adipokines, BMP4, insulin, and ghrelin. Its role as a potential alternative to exercise needs to be further studied.

Is Vaginal Hysterectomy Safe for an Enlarged Uterus?

Objective The purpose of this study was to compare the surgical outcomes between two sets of women undergoing vaginal hysterectomy (VH) for benign gynecological conditions: those with moderately enlarged ( ≥12 weeks') uteruses and those with normal-sized uteruses. Materials and Methods The medical records of 84 women who underwent vaginal hysterectomies for benign gynecological conditions at Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey between 2013 and 2015 were reviewed. Age, uterine sizes, indications, duration of hospitalization, operation time, hematocrit (HCT) levels, and complications were analyzed. Results The most common indications for VH were uterine descensus. However, most women had presented with more than one indication. The mean age of the patients who underwent VH was 56.12. The maximum volume of the uterus was found to be 1244.74 ml, and the smallest volume was found to be 18.83 ml. The mean volume of the uterus was found as 122.6629 ml. The mean duration of operation was 159.70 minutes, whereas the mean duration of hospital stay was 3.79 days. The mean preoperative HCT and hemoglobin (Hgb) values were 37.098 (±3.64) gr/dl and 12.365 (±1.35) gr/dl respectively. Postoperative HCT and Hgb values were 31.363 (±3.94) gr/dl and 10.52 (±1.38) respectively. Conclusion VH is usually a simple procedure with low morbidity. It is important to choose the appropriate patient when deciding on the operation. In addition, having experienced surgeons in the field of VH increases the success of surgery.

Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions.

AIMS: To enable the use of ICIQ-FLUTS, ICIQ-FLUTS-long-form (ICIQ-FLUTS-LF), ICIQ-LUTS-quality-of-life (ICIQ-LUTSqol), and ICIQ-FLUTS sexual functions (ICIQ-FLUTSsex) in Turkish speaking women, questionnaires were translated into Turkish and validity, reliability, and sensitivity to change were evaluated in women suffering from urinary incontinence (UI). MATERIALS AND METHODS: Permissions were obtained from ICIQ Advisory Board, English versions of the questionnaires were initially translated into Turkish, then back-translated into English and translations were modified according to recommendations of ICIQ Advisory Board. Pilot testing was performed in 10 women. Validity (content/face validity and discriminant validity), reliability (test-retest reliability and internal consistency), and sensitivity to change were evaluated. RESULTS: A total of 58 women with UI completed ICIQ-FLUTS, ICIQ-LUTSqol, and the ICIQ-FLUTS-LF, and 37 who were sexually active completed ICIQ-FLUTSsex. All women completed same questionnaires 15 days later. More than 90% of women thought that the questions were clear, unequivocal, and comprehensive. Missing data were less than 1% indicating adequate content/face validity. Cronbach's α coefficients were .933 (ICIQ-FLUTS), .979 (ICIQ-LUTSqol), .865 (ICIQ-FLUTS-LF), and .863 (ICIQ-FLUTSsex), representing adequate internal consistency. Kappa values and intraclass correlation coefficient for individual items were over 0.70, indicating adequate test-retest reliability. A total of 52 healthy volunteers completed ICIQ-FLUTS and ICIQ-FLUTS-LF, 30 completed ICIQ-LUTSqol, and 30 sexually active healthy volunteers completed ICIQ-FLUTSsex. All four questionnaires had good discriminant validity. Twenty-eight women with UI were analyzed 3 months after treatment. There was significant improvement in four questionnaires in correlation with pre- and posttreatment bladder diary results showing good sensitivity to change. CONCLUSION: Turkish versions of four ICIQ modules were shown valid and reliable and can be used in Turkish speaking women in the evaluation of UI.

Comparison of hepatitis B, hepatitis C, and HIV seropositivity of Syrian and Turkish pregnant women.

OBJECTIVE: In this study, we aimed to compare the seroprevalence of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficieney viruse (HIV) in Syrian pregnant women and Turkish pregnant women in our hospital. MATERIALS AND METHODS: In our study, a total of 68,169 Turkish pregnant women who received HB surface antigen (HBsAg), HB surface antibody (anti-HBs), HCV antibody (anti-HCV), anti-HIV test, and a total of 11,015 Syrian pregnant patients who received HBsAg, anti-HBs, anti-HCV and anti-HIV tests were examined retrospectively between January 2012 and January-2018 in Universty of Health Sciences Kanuni Sultan Süleyman Training and Research Hospital, Obstetrics and Gynecology Clinic. RESULTS: In our study, the rates of HBsAg, anti-HCV, and anti-HIV seropositivity were 1.1%, 0.1%, and 0.03% in Syrian pregnant women between 2012 and 2018, respectively. In the other study group, in Turkish pregnant women, HBsAg, anti-HCV, and anti-HIV seropositivity rates for 2012 and 2018 were found as 1.8%, 0.2%, and 0.08%, respectively. CONCLUSION: Although there were no significant differences between the HBsAg, anti-HCV, and anti-HIV results of both groups, the anti-HBs positivity was higher at a significant level in Turkish pregnant women. The reason of the significantly higher anti-HBs positivity levels in pregnant women might stem from the fact that women are vaccinated and controlled regularly due to the policies in this regard in our country.

Effects of Irisin and Exercise on Metabolic Parameters and Reproductive Hormone Levels in High-Fat Diet-Induced Obese Female Mice.

It has been documented that exogenously administered irisin (1010 fibronectin-type III domain-containing 5 [FNDC5]), which is a new polypeptide hormone, induces the browning of subcutaneous fat and thermogenesis. In this study, effects of physical activity and exogenous administration of irisin were investigated on parameters related with reproduction and metabolism in the high-fat diet-induced obesity model of the female C57BL/6J mice. Sixty mice were gathered at age approximately 5 to 6weeks and were divided into 3 groups. Control group remained sedentary. Irisin group remained also sedentary but intravenously received 1010 FNDC5-expressing adenovirus after 20 weeks. Exercise group performed treadmill after 6 weeks. All mice were sacrificed 22 to 23 weeks after the start of the study. There was a significantly greater Δ weight in the controls compared with the irisin and exercise groups ( P < .05). Glucose and insulin levels were significantly higher in the controls ( P < .05). The serum irisin level was significantly higher in the exercise group ( P < .05). Serum luteinizing hormone levels were significantly increased in the irisin group ( P < .05). Serum anti-Müllerian hormone levels were significantly higher in irisin and exercise groups ( P < .05). There were significant negative correlations between serum irisin levels and Δ weight and homeostatic model assessment of insulin resistance ( r = -0.327, r = -0.297, respectively; P < .05 for both). The numbers of primordial follicles per ovary were similar ( P > .05), whereas primary and secondary follicles per ovary were higher in the irisin and exercise groups compared with controls ( P < .05). Pharmacologic introduction of irisin may improve metabolic factors such as insulin sensitivity and obesity by promoting weight loss and consequently improving the reproductive potential.

Evaluation of platelet-rich plasma injection activity in the treatment of abnormal uterine bleeding.

OBJECTIVE: To evaluate the effectiveness of intracavitary platelet-rich plasma (PRP) therapy in patients diagnosed as having abnormal uterine bleeding (AUB). MATERIALS AND METHODS: A total of 149 patients with AUB were included in the study. Seventy-four of these patients were included in the study group and 75 were included in the control group. All patients were evaluated using transvaginal ultrasonography. Endometrial curettage was performed to exclude underlying organic pathologies. The study group underwent intracavitary PRP therapy. Both patient groups were called for follow-up at the end of the third month. Their endometrial thickness and amount of bleeding (pictogram and pads/day) were evaluated using transvaginal ultrasonography. RESULTS: There was no statistically significant difference between the study and control groups in terms of the decrease in the amount of bleeding. In addition, there was no statistically significant difference between the two groups in terms of the increase in endometrial thickness. CONCLUSION: In this study, it was observed that intracavitary PRP therapy did not make a significant difference in the decrease in the amount of bleeding and in the increase in endometrial thickness between the study and control groups.

Effect of infertility on quality of life of women: a validation study of the Turkish FertiQoL.

The fertility quality of life (FertiQoL) measure specifically evaluates the impact of fertility problems in various life areas. The aim of this study was to examine the relationship between FertiQoL and the hospital anxiety and depression scale (HADS) in the Turkish population. All female patients who underwent various fertility treatments in our infertility clinic from May 2011 to May 2014 were approached to participate in the study and 389 completed the questionnaires. Our results showed that the four core scales of the FertiQoL measure had a Cronbach's α value that was between 0.70 and 0.89. Two scales (anxiety and depression) of HADS both had a Cronbach's α value of 0.80. These values present a reliable usage of FertiQoL and HADS measures (α > 0.60). Significant negative correlations were found between the FertiQoL scales and HADS scales, ranging from -0.27 (between relational scale of FertiQoL and anxiety scale of HADS) to -0.65 (between mind-body scale of FertiQoL and depression scale of HADS). The results of this study provide supportive data to confirm that the Turkish version of FertiQol can accurately evaluate QoL in women who seek fertility treatment in Turkey.