The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients.

BACKGROUND: Acute appendicitis (AA) is the most common extra-obstetric condition requiring surgery during pregnancy. AA diagnosis is made by laboratory tests along with anamnesis and physical examination findings. Due to the physiological and anatomical changes during the pregnancy, AA diagnosis is more challenging in pregnant women compared to non-pregnant patients. The present study evaluated the significance of white blood cell counts (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) to diagnose acute appendicitis during pregnancy. METHODS: Pregnant patients admitted to General Surgery Inpatient Clinic with AA pre-diagnosis in September 2015-December 2019 period were screened using International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) diagnosis code (K35= acute appendicitis, Z33= pregnancy), and AA patients were identified retrospectively. The patients were divided into two groups. The Group I included the patients who had appendectomy due to AA and had a suppurative appendicitis diagnosis based on the pathological evaluation. On the other hand, Group II had the patients admitted as an inpatient with AA pre-diagnosis, but discharged from the hospital with full recovery without operation. Group III, i.e., the control group, on the other hand, was constituted by 32 randomly and prospectively recruited healthy pregnant women who were willing to participate in the study and who had matching study criteria among the patients followed in Obstetrics and Gynecology outpatient clinic of our hospital. RESULTS: This study included 96 pregnant women with an average age of 29.20±4.47 years (32 healthy pregnant women, 32 pregnant women followed for acute abdominal observation and 32 pregnant women who underwent appendectomy). Of these patients, three cases who turned out not to have suppurative appendicitis (negative appendectomy) and two cases found to have perforated appendicitis based on intraoperative and histopathological evaluations were excluded from this study. The results showed that Group I patients had significantly higher WBC (p=0.001), CAR (p=0.001) and NLR (p=0.001), but significantly lower LCR values (p=0.001) compared to the Groups II and III. Besides, based on logistic regression analysis, it was revealed that higher WBC, CAR and NLR values and lower LCR values were independent variables that could be used for the diagnosis of AA in pregnant women. CONCLUSION: Considering WBC, NLR, CAR and LCR parameters in addition to medical history, physical examination and imaging techniques could help clinicians diagnose acute appendicitis in pregnant women.

Skin venous thromboembolism by combined oral contraceptive in a woman with acquired angioedema and Factor V Leiden mutation.

OBJECTIVE: The purpose of this study is to report a case of acquired angioedema and Factor V Leiden mutation in a woman who had started taking an oral contraceptive (OC), and to review the literature. RESULTS: A 44-year-old nonobese and nonsmoking woman was admitted to our hospital because of pain and progressive erythematous lesion on her left groin. The patient had had a 6-week history of combined OC use. There was no family history of angioedema. With a diagnosis of necrotizing fasciitis, surgical debridement of all necrotic tissue was considered with fasciocutaneous flap. Histopathological analysis showed diffusely fresh bleeding areas with diffused subcutaneous necrosis. The culture of the necrotic tissue was negative. Postoperatively, she restarted combined OC, and then the painful petechial and rapidly disseminated ecchymotic lesions were seen. Oral contraceptive was stopped immediately. A venous Doppler ultrasonography of the lower extremities showed subacute thrombosis in the left popliteal vein. Complement C3 level was normal, but amounts of C4, C1 esterase inhibitor level and activity were low. Factor V Leiden was positive for the heterozygous presence of Factor V gene. CONCLUSIONS: Women with angioedema and Factor V Leiden should be counseled against using hormonal contraceptives containing estrogen, and because they may interact in a synergistic manner in the pathogenesis of cutaneous lesions and/or venous thrombosis, appropriate individualized therapy should be defined. Further studies are needed.

Effect of different preparations of hormone therapy on lipid and glucose metabolism, coagulation factors, and bone mineral density in overweight and obese postmenopausal women.

OBJECTIVE: To determine the effects of different preparations of hormone therapy (HT) on lipid and glucose metabolism, coagulation factors, and bone mineral density (BMD) in overweight and obese postmenopausal women. DESIGN: A randomized, nonblinded, controlled study. SETTING: Karadeniz Technical University, Department of Obstetrics and Gynecology. PATIENT(S): A total of 352 overweight and obese (body mass index >25 kg/m2) postmenopausal women. INTERVENTION(S): Ninety women received 2.5 mg of tibolone; 84 received 2 mg of E2 plus 1 mg of norethisterone acetate (E2/NETA); 90 received 0.625 mg of conjugated equine estrogen plus 2.5 mg of medroxyprogesterone acetate (CEE/MPA); and 88 did not receive any menopausal therapy (control). MAIN OUTCOME MEASURE(S): At baseline and after 6 months of treatment, we measured total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), insulin, glucose, factor VII, factor VIII, von Willebrand factor, antithrombin III, protein S, protein C, fibrinogen, and BMD at the lumbar spine L1-L4. RESULT(S): There were no statistically significant differences among the groups for any variables at baseline. After 6 months of treatment, the three regimens decreased total cholesterol, triglyceride, LDL, and fibrinogen; E2/NETA and CEE/MPA increased HDL, and tibolone decreased HDL; higher insulin concentrations were found in the control and tibolone groups. Body mass index, HDL, fibrinogen levels, and L1-L4 BMD were independent factors in the prediction of HT use. CONCLUSION(S): Body mass index, HDL, fibrinogen levels and L1-L4 BMD were independent factors in the prediction of HT use. Treatment with tibolone, E2/NETA, and CEE/MPA resulted in minimal improvement in lumbar spine BMD but had a beneficial effect on the procoagulation system, with minimal changes in glucose metabolism after 6 months of therapy.

The relationship between serum dehydroepiandrosterone sulfate concentration and bone mineral density, lipids, and hormone replacement therapy in premenopausal and postmenopausal women.

OBJECTIVE: To investigate the relationship between serum dehydroepiandrosterone sulfate (DHEAS) concentration and bone mineral density (BMD), lipids, and hormone replacement therapy (HRT) in postmenopausal women. METHODS: Two hundred twenty-seven women aged >40 years were admitted to the study and divided into three groups: 61 premenopausal normally menstruating women, 108 postmenopausal women who were not receiving HRT, and 58 postmenopausal women receiving HRT. DHEAS levels and lipid patterns were measured. BMD measurements of the lumbar spine (L1-L4) were performed by dual-energy x-ray absorptiometry (DXA). RESULTS: A positive correlation between DHEAS levels and BMD was found in all three groups. A linear regression model was used to assess the effect of age, body mass index (BMI), parity, and BMD of lumbar vertebrae (L1-L4) on changes in the serum level of DHEAS and found that aging and BMD at the spine had a significant association with serum level of DHEAS and only aging after adjustment for age, BMI, parity, and lipid patterns among the three groups. Age (RR 0.80), DHEAS (RR 0.98), and osteoporosis/osteopenia rate (RR 24.94) were also found to be independent influencing factors for HRT use. CONCLUSIONS: A positive correlation between DHEAS levels and BMD was found in all three groups. Our study confirms earlier reports that DHEAS levels decrease with age in premenopausal and, especially, postmenopausal women regardless of estrogen treatment. DHEAS levels in postmenopausal women were not associated with atherogenic lipid patterns in the present study.