The importance of blood-count-derived inflammatory markers in predicting methotrexate success in patients with tubal ectopic pregnancy.

OBJECTIVE: To investigate the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in predicting a successful methotrexate response in tubal ectopic pregnancy (TEP). METHODS: Women treated for TEP at a tertiary hospital between 2017 and 2021 were retrospectively reviewed. A total of 502 (100%) eligible patients who received methotrexate were included and divided into two groups based on whether or not they were successfully treated with methotrexate alone. Inflammatory parameters derived from the patients' hemograms at hospital admission were compared. RESULTS: In total, 434 (86.4%) patients were successfully treated with methotrexate alone (Group 1), while 68 (13.6%) patients underwent surgery after methotrexate failure (Group 2). Median neutrophil count, NLR, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, largest ectopic mass diameter, and ß-human chorionic gonadotropin (ß-hCG) were significantly lower, whereas median lymphocyte and platelet counts were significantly higher in Group 1. According to the receiver operating characteristic analysis performed for the discriminatory power of NLR, ß-hCG, and SII for methotrexate response, the area under the curve values were 0.742, 0.730, and 0.699, respectively. CONCLUSION: Low NLR and SII are associated with methotrexate success and could be used to refine decision making regarding ß-hCG for predicting successful response to methotrexate in patients with TEP.

Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage-indicating scores (albumin-bilirubin [ALBI], Model for End-Stage Liver Disease [MELD], aspartate aminotransferase-to-platelet ratio [APRI]) and inflammatory markers (platelet-to-lymphocyte ratio [PLR] and neutrophil-to-lymphocyte ratio [NLR]). METHODS: Eighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis. RESULTS: Patients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false-positive rate of 10%. CONCLUSION: This study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.

Investigation of human papilloma virus frequency in pregnant women.

OBJECTIVE: The aim of this study was to determine the frequency of human papillomavirus (HPV), HPV types, and the association with age, pregnancy, and childbirth in pregnant women. METHOD: Four hundred and forty-eight pregnant women who visited our clinic were enrolled in the study. Polymerase chain reaction was used to determine HPV DNA and typing by cervical smear in the initial applications of patients with detailed history. Statistical Package for the Social Sciences (SPSS) 13.0 was used to analyze the data. RESULTS: HPV DNA was positive in 26 (5.8%) of 448 patients who participated in the study. High-risk HPV types were detected in 77% of HPV-positive cases and low-risk HPV types in 23% of cases. Only one HPV type was detected in 13 patients (50%), while multiple HPV types were detected in 13 patients (50%) of the HPV-positive cases. A significant negative association was found between gravidity and positivity of HPV DNA. HPV is more common in women with lower parity and gravidity. CONCLUSION: Studies conducted in different populations in different regions of Turkey have shown that the incidence of HPV in women ranges from 2.2% to 26%. In our study, the incidence of HPV DNA in pregnant women was 5.8%. It was found that there was an inverse relationship between parity and HPV DNA positivity. The HPV DNA positivity decreased with the number of births.