Combined delta neutrophil index and red blood cell distribution width as a new biomarker to predict endometriosis

Objective: The aim of this study was to evaluate the use of delta neutrophil index (DNI) in predicting endometriosis. Material and Methods: A retrospective, case-control study was performed in a tertiary care center. DNI, red cell distribution width (RDW), and other blood parameters obtained from complete blood counts of 267 patients, consisting of 122 (45.7%) endometriosis patients with proven pathology reports of stages 3-4, and a control group of 145 women who underwent laparoscopy for simple ovarian cyst and/or diagnostic purposes and had normal histopathology, were compared. Receiver operating characteristic and logistic regression analyses were performed. Results: DNI and RDW were significantly higher in endometriosis patients than in the control group (p=0.034 and p=0.003, respectively). Other parameters obtained from complete blood counts (leukocyte, neutrophil, lymphocyte, monocytes, and platelet counts and neutrophil-to-lymphocyte ratio), did not differ (p>0.05). For DNI, at a cut-off value of 0.025, area under the curve (AUC) was 0.572 and it was statistically significant [p=0.042; 95% confidence interval (CI): 0.503-0.642, sensitivity: 45.9%, specificity: 67.6%, Youden's index: 0.135]. For RDW, AUC: 0.601 for cut-off value of 13.65 was statistically significant (p=0.004, 95% CI: 0.553-0.669, sensitivity: 50.8%, specificity: 67.6%, Youden's index: 0.184). The logistic regression model established with the combined marker obtained by multiplying the DNI and RDW was statistically significant (p<0.001, Nagelkerke R2=0.72, 95% CI: 2.58-47.26, B: 2.40, negative predictive value: 78.6%, positive predictive value: 37.7%). Conclusion: DNI, a new inflammatory marker, and RDW, known to be associated with inflammation, may be useful minimally invasive biomarkers of endometriosis.

The Effect of Affective Temperament, Pain Catastrophizing, and Anxiety Sensitivity on Pain Severity in Patients With Chronic Pelvic Pain: A Pilot Study.

OBJECTIVE: The goals of this study were to investigate whether there was a dominant temperament type, and to assess the effect of temperament, pain catastrophizing, and anxiety sensitivity on pain severity, in female patients diagnosed with chronic pelvic pain (CPP) compared with healthy controls. METHODS: This cross-sectional study involved 51 patients 18 to 65 years of age who were diagnosed with CPP without a history of psychiatric treatment and 97 healthy volunteer women with sociodemographic characteristics similar to those of the study group. A sociodemographic form prepared by the researchers, the Anxiety Sensitivity Index, the Pain Catastrophizing Scale, a temperament scale (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire), and a visual analog pain scale (VAS) were completed. The results were compared between the patient and control groups. Multiple regression analyses were performed to examine the predictive effects of temperament characteristics, pain catastrophizing, and anxiety sensitivity on pain severity. RESULTS: Scores on the Pain Catastrophizing Scale and the VAS were statistically significantly higher in the CPP group ( P <0.001). The frequency of depressive, cyclothymic, and irritable temperaments was found to be significantly higher in the CPP group (CPP: 7.78±3.32 vs. controls: 6.54±3.19; P =0.027; CPP:10.61±4.41 vs. controls: 8.82±4.21; P =0.017; CPP: 5.22±4.29 vs. controls: 3.75±3.41; P =0.025). According to the model established by temperament traits, anxiety sensitivity, and pain catastrophizing level, pain catastrophizing level explained 11.6% of the variance in pain severity. A 1-unit change in the score for pain catastrophizing level caused a 0.278-point change in the VAS total score ( P <0.01). CONCLUSIONS: Cyclothymic, depressive, and irritable temperament types that increase the risk of affective disease are more common in patients with CPP. The level of pain catastrophizing in patients with CPP affects their perception of the severity of the pain.

Corrigendum to "The status of depression and anxiety in infertile Turkish couples" [Iran J Reprod Med 2011; 9: 99-104].

[This corrects the article on p. 99 in vol. 9 PMCPMC4216443.].

Delta neutrophil index in obese and non-obese polycystic ovary syndrome patients.

OBJECTIVE: We aimed to evaluate the usefulness of delta neutrophil index (DNI), a new inflammatory marker, in polycystic ovary syndrome (PCOS). METHODS: This retrospective case-control study was conducted at a tertiary health center. The DNI and other blood parameters obtained from the complete blood count examination of 227 individuals, consisting of 72 PCOS patients and 155 controls, were compared between the two groups. A receiver operating characteristic analysis was performed to examine the relationship between DNI and PCOS. RESULTS: DNI, white blood cell (WBC) count, and neutrophil count were significantly higher in the PCOS group than in the control group (P=0.028, 0.011, and 0.037; respectively). DNI and WBC counts were significantly higher in nonobese-PCOS patients (P=0.018 and 0.041; respectively). When the obese-PCOS and obese-control groups were compared, only neutrophil count was significantly higher in obese-PCOS patients (P=0.016). Significance was observed at cut-off values of 0.015 (area under the curve [AUC]=0.588) (P=0.034; sensitivity, 78%; specificity, 35%; Youden's index=0.133) for DNI: 9.35 (AUC=0.594) (P=0.022) for WBC; and 5.38 (AUC=0.628) (P=0.002) for neutrophils. CONCLUSION: Higher DNI in PCOS patients and similar results in the non-obese-PCOS group were observed when obese and non-obese-PCOS patients were considered separately. However, the lack of difference in the obese-PCOS group strengthens the hypothesis that there is obesity-independent inflammation in PCOS.

Association of endometrial polyps with STC-1 and STC-2 in infertile patients.

OBJECTIVE: The present study aimed to evaluate the impact of endometrial polyps (EPs) on the endometrium of patients with unexplained infertility using stanniocalcin-1 and -2 proteins (STC), whose effects on endometrial receptivity have been reported recently. MATERIALS AND METHODS: A case-control study was performed, consisting of 26 patients who underwent endometrial sampling for diagnosis and/or treatment and diagnosed with EP on biopsy and/or excision material, and 23 patients with normal endometrial findings in the pathology, for a total of 49 patients with unexplained infertility. An immunohistochemistry examination was performed on paraffin-embedded tissue samples from both groups to understand whether there was a relationship between EP and STC. Staining results of the polyp and control groups for STC-1 and STC-2 were compared, and it was investigated whether STCs were predictive for EP. RESULTS: In the comparison performed between the H-score evaluation results of the control and polyp groups after the immunohistochemical staining method, the staining in the polyp group was significantly higher for both STC-1 (p < 0.001) and STC-2 (p < 0.001). There was more staining with STC-1 than STC-2 in all groups (STC-1: 15.08; STC-2: 8.27; p < 0.05). In the logistic regression analysis established with STC-1, STC-2, and age, the predictive effect of STC-1 for EP was statistically significant (p = 0.040; odds ratio: 1.66; 95% confidence interval: 1.02-2.68). In EP, according to receiver operating characteristic curve analysis, area under the curve was 0.980 (likelihood ratio: 20.35; p < 0.05), and the cut-off value was 18 for STC-1. CONCLUSION: In infertile patients, since STC-1, which affects endometrial receptivity, is found to be significantly higher in polyps and has a predictive effect on polyps, in patients with unexplained infertility, routine uterine cavity evaluation and routine excision of polypoid lesions detected during this period may have a positive effect on endometrial receptivity.

The effect of hCG day progesterone in 1318 cycles on pregnancy outcomes: ongoing discussion.

OBJECTIVES: To investigate the effect of human chorionic gonadotropin day progesterone (hCG-P) level on pregnancy outcomes in in vitro fertilization (IVF) cycles. MATERIAL AND METHODS: This study is an analysis of a cohort of 1318 fresh IVF- embryo transfer cycles, including 579 agonists and 739 antagonists, performed at a single IVF center between 2007 and 2018. For fresh cycles, we performed Receiver Operating Characteristic analysis (ROC) to calculate the threshold value of hCG-P, which affects pregnancy outcomes. We divided patients below and above the determined threshold value into two groups, then, correlation analysis and we performed logistic regression analysis. RESULTS: According to ROC curve analysis of hCG-P,AUC was 0.537 (95% CI: 0.510-0.564, p < 0.05) for LBR, and the threshold value for P was 0.78. The hCG-P threshold value of 0.78 proved to be significant in relation to BMI, type of drug used during induction, the hCG day E2, the total number of oocytes, the number of oocytes and the subsequent pregnancy outcome between the two groups (p < 0.05). However, the model we built, which accounted for hCG-P, total number of oocytes, age, BMI, induction protocol, total dose of gonadotropin used in induction did not prove significant in terms of its effect on LBR. CONCLUSIONS: The threshold value of hCG-P that we found to have an effect on LBR was quite low compared with the P-value generally recommended in the literature. Therefore, further studies are needed to determine an accurate P-value that reduces success in managing fresh cycles.

The effect of metformin treatment on leukocyte telomere length in patients with polycystic ovary syndrome: a prospective case-control study.

PURPOSE: The study aimed to investigate the effect of metformin treatment on leukocyte telomere length (LTL) and the relationship of LTL with C-reactive protein (CRP), homocysteine, albumin, complete blood count, and HOMA-IR values in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHOD: A prospective case-control study consisting of 30 women with PCOS and 30 healthy women without PCOS was performed. The relationship between clinical and laboratory parameters and LTL was analyzed. PCOS patients were treated with metformin (850 mg/day) for three months. Before treatment (BT) and after treatment (AT), each patient's LTL was evaluated and compared with the control group. RESULTS: In the comparison between PCOS and control groups, the difference was significant for LTL, age, body mass index (BMI), and CRP (p = 0.002; p < 0.001; p = 0.001; p = 0.01, respectively). In PCOS patients, the difference between BT and AT, LTL was not statistically significant (BT: 6.06 ± 2.12; AT: 6.30 ± 1.93; p = 0.623; 95% C.I: - 1.22-0.74); however, the difference for weight was significant (BT: 83.78 ± 15.31; AT: 80.62 ± 15.40; p = 0.02; 95% CI: 1.34-4.99). The logistic regression model established by BMI (group 1: 21-24, group 2: 24-29, group 3: 29-34, group 4: > 34), age, and RDW, which predicted the PCOS group by affecting the LTL level, was statistically significant (p < 0.001/PPV = 96.3%; NPV = 88.5%). Each unit reduction in telomere length increased women's probability of PCOS by 0.4 times (p = 0.013; OR = 0.419, 95% CI: 0.211-0.835). CONCLUSION: Although statistically insignificant, LTL increased after metformin use in PCOS patients, and the mean weight loss reduction was statistically significant. Telomere shortening increased the likelihood of PCOS 0.4 times.

Supraphysiological hCG day estradiol levels can predict pregnancy-associated plasma protein A levels in maternal serum in the first trimester.

OBJECTIVE: To investigate the effect of hCG day estradiol (hCG-E2) used in Down Syndrome screening on maternal serum levels of PAPP-A in fresh in vitro fertilization (IVF) cycles. METHODS: This study was a retrospective analysis of a cohort that resulted in a single pregnancy after a total of 92 fresh IVF cycles. The primary outcome of this study was to determine the effect of fresh IVF cycle parameters on the PAPP-A level and the cutoff value for hCG-E2 predicting a low PAPP-A level, while the secondary outcome was to determine whether the effect of IVF parameters on the PAPP-A level was significant. RESULTS: There was a negative correlation between PAPP-A levels and the number of hCG-E2 and grade 1 embryos (respectively, p = .049; .047), while a positive correlation was observed between baby weight at birth and the PAPP-A (p < .05). At a PAPP-A value of 0.82, the difference between the two groups, in terms of hCG-E2, the number of grade 1 embryos, and pregnancy-related complications was significant (p = .050; .029; .033, respectively). The threshold value of hCG-E2 affecting PAPP-A levels was statistically significant (AUC = 0.618; p = .050; hCG-E2 = 4869.5 pg/ml). In the model, an increase in the number of grade 1 embryos resulted in higher PAPP-A levels (OR = 2.26; p = .044). CONCLUSION: The fact that the hCG-E2 cutoff value, which lowers PAPP-A, reflects excessive ovarian stimulation argues for the correction of the dual screening test in a subset of patients with high response to the first-trimester screening test.

The status of depression and anxiety in infertile Turkish couples.

BACKGROUND: Infertility is a major psychosocial crisis as well as being a medical problem. The factors that predict psychosocial consequences of infertility may vary in different gender and different infertile populations. OBJECTIVE: The primary purpose of this study was to investigate whether Turkish infertile couples had higher levels of depression and anxiety when compared to non-infertile couples. Our secondary aim was to evaluate the relationship between sociodemographic characteristics and levels of depression and anxiety in Turkish infertile couples. MATERIALS AND METHODS: We designed a descriptive cross sectional study of 248 infertile women and 96 infertile men with no psychiatric disturbance and 51 women and 40 men who have children to evaluate the depression and anxiety levels between infertile couples and fertile couples. A gynecologist evaluated participants for demographic data and then they were visited by a psychologist to perform questionnaire scales which were The Beck Depression Inventory and the State-Trait Anxiety Inventory for the evaluation of the degree of psychopathology. The data were statistically analyzed, with p<0.05 as the level of statistical significance. RESULTS: We observed significant differences between the infertile couples and fertile couples with respect to state and trait anxiety (p<0.0001) while no difference was regarding with depression, both of women and men. Anxiety and depression were observed as independent from gender when infertile women and men were compared (p=0.213). CONCLUSION: We believed that the psychological management at infertile couples must be individualized with cultural, religious, and class related aspects.