Umran Karabulut Dogan

Polycystic Ovary Syndrome Detection Using Gradient Boosting Algorithms and Explainable Artificial Intelligence: A Comparative Study - Cyprus Journal of Medical Sciences

High altitude is associated with reduced barometric pressure and lower oxygen availability, which may impair fetoplacental oxygen transfer and adversely affect fetal growth and neonatal adaptation. This study compared birth weight, maternal oxygenation parameters, and early neonatal outcomes between two centers located at 1800 m and 2500 m above sea level in Eastern Türkiye.In this comparative cross-sectional study, 540 mother–infant pairs were evaluated, including 270 deliveries from Ardahan (1800 m) and 270 from Göle (2500 m). Data were obtained from retrospectively reviewed hospitals from 2018 year. Maternal partial pressure of oxygen (PaO₂), oxygen saturation (SaO₂), hemoglobin, lactate, gestational age, mode of delivery, birth weight, small-for-gestational-age (SGA) status, and neonatal intensive care unit (NICU) admission were compared between centers. Continuous variables were analyzed using independent-sample t tests and analysis of variance, whereas categorical variables were compared using chi-square tests. Additional analyses included analysis of covariance, multivariable linear regression, logistic regression for SGA and NICU admission, interaction analysis, receiver operating characteristic analysis, and effect size estimation. Compared with the 1800 m group, pregnancies at 2500 m were associated with lower mean birth weight (2315 g vs 3396 g), lower maternal PaO₂ and SaO₂, and higher hemoglobin and lactate levels (all p

The triglyceride–glucose (TyG) index has recently gained attention as a cost-effective and easily calculable surrogate marker reflecting insulin resistance–related metabolic risk. Given the close interplay between thyroid hormones, lipid metabolism, glucose regulation, and inflammation, evaluating the association between thyroid dysfunction and the TyG index remains clinically relevant. This study aimed to investigate variation in the TyG index across different thyroid function states—overt hypothyroidism (OH), subclinical hypothyroidism (SCH), euthyroidism (EH), and healthy controls—and to assess its associations with lipid parameters and inflammatory markers, including the CRP/albumin ratio. In this cross-sectional observational study, 222 adults were categorized according to thyroid status based on TSH and free T4 levels. The TyG index was calculated using fasting glucose and triglyceride values. Associations with lipid and inflammatory markers were evaluated, and receiver operating characteristic (ROC) analysis was performed to assess the ability of the TyG index to discriminate individuals with elevated TyG-defined metabolic risk. No statistically significant differences in TyG index levels were observed across thyroid function groups (p = 0.152). However, the TyG index showed significant positive correlations with triglyceride levels (r = 0.419, p < 0.001), CRP/albumin ratio (r = 0.342, p < 0.001), and LDL-C (r = 0.204, p = 0.009). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.731; 95% CI: 0.652–0.809), identifying individuals with higher TyG levels associated with increased metabolic risk. Although TyG index levels did not differ significantly across thyroid function states, their associations with lipid and inflammatory markers suggest that the TyG index reflects metabolic and inflammatory risk profiles independent of thyroid status, rather than serving as a direct diagnostic measure of insulin resistance.

To evaluate the short- and long-term clinical outcomes of fractional CO₂ laser therapy in postmenopausal women with genitourinary syndrome of menopause (GSM), including durability of symptom control and the need for booster sessions. This retrospective single-center study included 126 postmenopausal women with GSM who underwent a standardized three-session fractional CO₂ laser protocol. Booster sessions were applied in cases of symptom recurrence. Outcomes were assessed at baseline, 4-6 weeks, 1 year, and 2 years using validated instruments: Patient Satisfaction Score, Michigan Incontinence Severity Index (MISI), Female Sexual Function Index (FSFI) and its subdomains, Vulvovaginal Symptoms Questionnaire (VSQ), and Female Genital Self-Image Scale (FGSIS). Significant improvement was observed in all outcome measures at 4-6 weeks, including GSM-related symptoms, sexual function, and genital self-image (all p < 0.0001). These benefits were largely sustained at 1 year. Although a slight decline was noted at 2 years, scores remained significantly improved compared to baseline. For example, FSFI lubrication scores improved from 2.97 ± 0.55 at baseline to 4.54 ± 0.49 at 1 year, and both VSQ and FGSIS demonstrated persistent gains at 2 years. Satisfaction scores continued to increase over time. Post hoc analyses confirmed significant differences across all evaluation time points. Fractional CO₂ laser therapy provides clinically meaningful and durable improvement in GSM-related symptoms in postmenopausal women. While some decline may occur over time, benefits remain superior to baseline, and booster sessions may support long-term maintenance. Fractional CO₂ laser may represent a nonhormonal, symptom-oriented option for carefully selected patients with GSM; however, it should not be considered first-line therapy, and prospective controlled studies are needed to further define long-term efficacy and patient selection.

Objective: To assess women’s awareness, use, and preferences regarding family planning (FP) methods in a remote rural province of northeastern Turkey and to examine how education, parity, and contraceptive knowledge shape contraceptive behavior.Methods: In this descriptive cross-sectional study, 822 sexually active women aged 15–65 years attending Ardahan State Hospital between January 2019 and December 2020 completed a structured questionnaire on sociodemographic characteristics, reproductive history, awareness and use of contraceptive methods, reasons for non-use, and sources of information. Knowledge of ten modern methods was operationalized as recognition of each method and scored from 0 to 10. Descriptive statistics, chi-square tests, one-way ANOVA, and multivariable regression (binary logistic for current contraceptive use; linear for knowledge score) were applied.Results: The mean age was 30.9 ± 8.4 years. Awareness of modern methods was high (77.1% for intrauterine devices and 63.6% for both oral pills and condoms), yet only 41.1% reported current use of any contraceptive method, including withdrawal. Among users, the intrauterine device (52.7%) and withdrawal (21.3%) were the most common methods. In multivariable analysis, higher education (adjusted OR = 1.28, p = 0.003), greater parity (adjusted OR = 1.87, p < 0.001), and higher contraceptive-knowledge score (adjusted OR = 1.35, p = 0.001) were independently associated with current contraceptive use, whereas age and income were not significant predictors.Conclusion: In this rural setting, modern contraceptive methods were widely known; however, uptake of modern methods remained limited and withdrawal remained common. Although pregnancy intention accounted for a substantial share of non-use, strengthening female education and embedding midwife- and physician-led FP counselling into routine primary care may help close the gap between awareness and effective contraceptive practice in rural Turkey and comparable middle-income country contexts.

Background/Objectives: Round spermatid injection (ROSI) is considered an experimental “last resort” option for couples with severe male factor infertility when mature spermatozoa cannot be obtained. We aimed to identify which stage of the clinical chain most strongly constrains overall success in routine practice and to describe the observed safety signal. Methods: We conducted a retrospective single-center cohort study of 221 consecutive ROSI-evaluated cycles (2021–2024). Outcomes were analyzed using a chain-of-outcome framework with explicit denominators: cycle-level feasibility (≥1 injected oocyte), two pronuclei (2PN) formation per injected oocyte, blastocyst development per 2PN, transfer per blastocyst cycle, and clinical pregnancy per transfer and per initiated cycle. Exact (Clopper–Pearson) 95% confidence intervals (CIs) were reported. Results: ROSI feasibility was observed in 5 of 221 initiated cycles (2.3%; exact 95% CI 0.7–5.2). Among the five transfer procedures performed after successful progression through upstream stages, clinical pregnancy occurred in four (80.0%; exact 95% CI 28.4–99.5). At the initiated-cycle level, overall clinical pregnancy was 4 of 221 cycles (1.8%; exact 95% CI 0.5–4.6). Conclusions: The overall effectiveness of ROSI remained low at the initiated-cycle level because very few cycles reached procedural feasibility and early attrition remained substantial. Conditional downstream outcomes may appear favorable only among the rare cycles reaching fertilization and transfer, while safety inference remains highly imprecise due to small denominators. Because only five cycles reached feasibility, all downstream conditional estimates remained highly unstable and sensitive to single-case variation.

Objective The purpose of this study was to evaluate the long-term efficacy of fractional CO₂ laser in the treatment of vaginal laxity (VL) and to determine additional treatment requirements during two-year follow-up. Methods A total of 176 women who underwent fractional CO₂ laser therapy for vaginal laxity between January 2020 and January 2023 were retrospectively evaluated. Three sessions of laser therapy were applied at 4–6 week intervals in all cases. Primary outcome measures were additional laser therapy requirements, patient satisfaction with primary and secondary treatments, and the general clinical effect of laser therapy on VL. Secondary outcomes included the evaluation of genital self-image, sexual function, urinary symptoms, and vulvovaginal complaints assessed using the following five validated measurement tools: the Patient Global Impression of Improvement (PGI-I), Michigan Incontinence Symptom Index (MISI), Female Sexual Function Index (FSFI), Vulvovaginal Symptoms Questionnaire (VSQ), and Female Genital Self-Image Scale (FGSIS). Results Additional laser therapy requirements occurred in 33.5% of patients at the end of two-year follow-up. Significant levels of improvement were determined in all FSFI, FGSIS, PGI-I, MISI, and VSQ scores following completion of the first treatment series (p < 0.001). A marked increase was observed in FSFI total scores and the arousal subdomain, while orgasm decreased significantly at the end of the second application compared to the first (p < 0.05). The increase in FGSIS scores showed that genital self-image improved consistently following both the first and second applications. PGI-I data revealed high post-treatment patient satisfaction (p < 0.001). In addition, the MISI and VSQ scores showed that urinary symptoms and vulvovaginal discomfort decreased significantly following both the initial treatment and second application. However, the marked initial clinical benefit tended to decrease over time, and additional intervention requirements increased one year after the first treatment. Conclusion Fractional CO₂ laser therapy provides significant and clinically important improvement in the management of VL. The positive effects recorded in post-treatment sexual function, genital self-image, and vaginal symptoms are significantly preserved during the first year. However, due to the gradual decrease in the effects, we recommend the application of a second laser session approximately one year following the first treatment series in order to enhance the continuity of the therapeutic benefit.

Introduction and Hypothesis To evaluate the long-term effectiveness of fractional CO₂ laser in the treatment of stress urinary incontinence (SUI), the permanence of symptom control, and additional session requirements over a 2-year follow-up period. Methods This retrospective cohort study included 215 women with clinically diagnosed SUI who underwent a standardized course of fractional CO₂ laser therapy. Assessments were conducted at baseline, 4–6 weeks, 1 year, and 2 years. Primary outcome measures included patient-reported satisfaction and Michigan Incontinence Symptom Index (MISI) scores. Secondary outcomes were changes in sexual function determined using the Female Sexual Function Index (FSFI), vaginal symptom severity using the Vaginal Symptom Questionnaire (VSQ), and genital self-image using the Female Genital Self-Image Scale (FGSIS). Data distribution was evaluated using the Shapiro–Wilk test. Repeated measures were analyzed using Friedman or repeated-measures ANOVA, followed by the Dunn or Newman–Keuls post hoc tests. Statistical significance was set at p < 0.05. Results Significant improvement was observed throughout follow-up in all primary and secondary outcomes (p = 0.0001). Satisfaction scores increased significantly at 4–6 weeks compared to baseline and still exhibited a high level at 1 year. Although a partial decrease occurred in the second year, values still remained significantly above baseline (from median 2 to 4; p = 0.0001). MISI decreased from 19.51 ± 4.41 at baseline to 1.96 ± 1.38 at 4–6 weeks. Although values rose to 6.31 ± 4.01 in the second year, significant improvement compared to baseline was maintained (p = 0.0001). Significant improvement was observed in all FSFI subdomains (including desire, arousal, lubrication, orgasm, satisfaction, pain, and total score) in the early period (p = 0.0001), and despite a slight decrease in the second year, the gains were largely maintained. Similar marked improvements were also observed in VSQ and FGSIS scores, with no return to baseline values despite a partial decline in the second year (p = 0.0001). Supportive additional session requirements were determined in association with subjective worsening in symptoms in the second year in approximately 20% of the participants. Conclusions Fractional CO₂ laser therapy produces significant and clinically important improvement in SUI symptoms, sexual function, vaginal symptoms, sexual function, vaginal comfort, and genital self-image. All effects peak at 4–6 weeks, are largely preserved at 1 year, and despite a partial decline in the second year, remain markedly superior to baseline. These findings show that fractional CO₂ laser is an effective, minimally invasive, nonsurgical option in the management of SUI.

Objectives: Menorrhagia, characterized by excessive menstrual bleeding, impacts 30 % of women of childbearing period and is frequently linked to anemia and discomfort in the pelvic region. Understanding the vascular and hormonal mechanisms underlying this condition could aid in developing non-surgical treatment options. This research focused on exploring the role of apelin and norepinephrine (NE), along with nitric oxide (NO) and prostacyclin (PGI ₂ ), in the pathophysiology of menorrhagia. Methods: The study included 44 women diagnosed with menorrhagia and 44 healthy controls. Blood specimens were taken on the 2nd or 3rd day of menstruation, and serum specimens were prepared. The levels of apelin, NE, NO, and PGI ₂ were determined using commercially available ELISA kits. Furthermore, standard biochemical analyses were conducted on all specimens. Results: Apelin and NE levels were significantly reduced in the menorrhagia group compared to control group (p0.05). In the menorrhagia group, total cholesterol, iron-binding capacity, platelet count, and FSH concentrations were markedly higher than those in control individuals, conversely, albumin, iron, hemoglobin, MCV, hematocrit, and progesterone levels were notably reduced (p<0.05). Conclusions: The study identified apelin and NE as moderately discriminative markers in menorrhagia and suggested that these markers could potentially contribute to impaired vasoconstriction and excessive menstrual bleeding. Future research should focus on evaluating biomarkers across different menstrual phases and exploring new therapeutic strategies for uterine protection.

Background: Same-day discharge and early telehealth follow-up are increasingly combined after minimally invasive benign gynecologic and urogynecologic surgery, but pathway-level evidence is limited. We evaluated the observed combination of same-day discharge and a completed telehealth contact within 48–72 hours in relation to 30-day healthcare utilization, direct institutional cost, recovery, and adverse events. Methods: This retrospective single-center cohort included 289 consecutive patients treated between January 2023 and April 2026. The comparative cohort comprised 212 patients eligible for same-day discharge; 211 had complete covariate data. Four observed pathways were defined by discharge status and telehealth completion. The primary analysis used generalized propensity-score overlap weighting. Pairwise doubly robust estimators, conventional adjustment, a binary pathway-completion analysis, and a full-cohort model served as supportive or sensitivity analyses. Results: The combined pathway was completed by 142 of 212 eligible patients (67.0%). In the primary weighted comparison with no same-day discharge/no telehealth, it was not associated with lower 30-day healthcare utilization (risk ratio 0.72, 95% confidence interval 0.47–1.09; p = 0.122). A binary comparison with all other pathways was also null (risk ratio 1.00, 95% confidence interval 0.68–1.48; p = 0.987). Pairwise augmented inverse probability weighting and targeted maximum likelihood estimation both yielded a risk ratio of 0.61 (95% confidence interval 0.41–0.81; p < 0.001), but residual imbalance remained, estimates varied by method, and these pairwise estimates are susceptible to exposure-timing bias and are not interpreted as causal. Mean nominal direct cost was 56,601 versus 69,882 Turkish lira (cost ratio 0.87, 95% confidence interval 0.83–0.91; p < 0.001). Because the ratio compares contemporaneous groups, it was robust to inflation across the study period. Median time to return to normal activity was 13.25 versus 16.4 days and was descriptive only. Any 30-day safety event occurred in 15.5% versus 28.9% (penalized odds ratio 0.45, 95% confidence interval 0.19–1.02; p = 0.057). Conclusions: The observed same-day-discharge-plus-telehealth pathway was consistently associated with lower direct institutional cost across analytic approaches, whereas evidence for a reduction in 30-day healthcare utilization was not robust across methods. Given the observational design, potential exposure-timing bias, limited effective sample size, and residual confounding, these associations should not be interpreted as causal effects of the pathway on healthcare utilization or clinical outcomes. No clear excess of short-term adverse events was identified, although safety equivalence was not established. Prospective multicenter studies should account explicitly for the timing of telehealth completion.