Diagnostic value of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio to predict recurrent pregnancy loss and abortion; a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with a history of abortion (missed and threatened) and recurrent pregnancy loss (RPL) in comparison with healthy pregnancies. METHODS: Electronic databases including MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library were searched for NLR and PLR in women who experienced early pregnancy loss up to January 1, 2023 with a combination of proper keywords. Meta-analysis was done for comparison with three or more studies and summary estimates were measured. RESULTS: A total of 390 citations were retrieved initially, and after screening, 16 articles were deemed eligible for the final review. Among these, 14 studies underwent meta-analysis. The meta-analysis revealed that the standard mean of the NLR was significantly higher in abortion cases compared to the control group. However, there was no significant difference in the PLR between the pregnancy loss group and the control group. CONCLUSION: NLR was significantly higher among RPL patients compared to the control group, according to these data, NLR may be capable of being used in the diagnosis of RPL as an easy, cheap, and accessible modality. Further studies, which take these variables into account, will need to be undertaken to determine the diagnostic value of NLR and PLR in early pregnancy loss.

Lethal multiple pterygium syndrome in a newborn, a case report.

Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies, joint contracture, and skin webbing (pterygia). This disorder is fatal before birth or shortly after birth. We reported a case of lethal multiple pterygium syndrome with multiple anomalies including pterygia involving the axilla, bilateral antecubital fossa, and groin. Arthrogryposis involving multiple lower and upper extremities joints. Cleft palate, microstomia and limitation of mouth opening, webbed neck, asymmetric small and narrow chest, ambiguous genitalia, depressed and wide nasal bridge, antemongoloid slant, low-set, malformed, and posteriorly rotated ears, pterygia, syndactyly and camptodactyly of hands and rocket bottom feet. LMPS is a congenital genetic disease with multiple anomalies that is fatal in the second and third trimesters of pregnancy or shortly after birth. With genetic testing and counseling, it can be prevented from recurring in subsequent pregnancies.

Cord blood antibodies following BBIBP-CorV (Sinopharm) vaccination during pregnancy.

OBJECTIVE: This study aimed to evaluate the maternal and umbilical cord blood antibody levels, after COVID vaccination during pregnancy. METHOD: The women who received the COVID-19 vaccine (Sinopharm) during pregnancy were included. Maternal and cord blood samples were tested to detect the severe acute respiratory syndrome coronavirus 2 receptor binding domain (RBD) specific antibodies. In addition, obstetric information and side effects after vaccination were gathered. RESULT: A total of 23 women were included. Eleven pregnant women took two doses and 12 cases received a single dose of the vaccine. No IgM antibody was detected in any maternal blood or cord blood samples. The RBD-specific Immunoglobulin G (IgG) antibody was positive in mothers receiving 2 doses of the vaccine and their infants. But the antibody titers were under the positive cut-off threshold for the other 12 women who were vaccinated with a single dose. Women who received both doses of vaccine had significantly higher IgG levels than a single dose of Sinopharm (p = .025). The same result was demonstrated in infants born to these mothers (p = .019). CONCLUSION: There was a significant correlation between maternal and neonatal IgG concentrations. Although, receiving both doses of the BBIBP-CorV vaccine (not 1 dose) during pregnancy is highly beneficial for increasing humoral immunity for the mother and fetus.

Verbal Fluency Performance in Normal Adult Population in Iran: Norms and Effects of Age, Education, and Gender.

Introduction: Verbal fluency is a cognitive function that can be easily assessed at the bedside and provide valuable data for clinical assessment of various cognitive functions. We decided to provide a standardized test to assess verbal fluency in the Persian language, including both phonemic and semantic fluency subtests. Methods: First, three phonemes (/p/, /d/, and /ʃ/) and three categories (animals, fruits, and kitchen appliances) were selected based on a pilot study and a panel of specialists. Then, we selected 500 Persian-speaking participants (47.8% male) aged 18 to 65 years via a convenient sampling method from the general population. Participants were grouped according to age, gender, and education. They performed the verbal fluency test. Results: The Mean±SD number of generated words in letter fluency and semantic fluency was 8.3±4.1 and 18.0±5.5, respectively. Age, educational level, and mother tongue were associated with letter fluency. Semantic fluency was associated with age, gender, education level, and mother tongue. Conclusion: For a more reliable clinical assessment, we suggest using all three letters (phonemes) and three semantic categories for each subject, calculating the mean of the produced words, and comparing them with the suggested cut-off points provided for each subcategory. Age was negatively correlated with the number of generated words in letter fluency (r=-0.33; P<0.001) and semantic fluency tasks (r=-0.26; P<0.001). In the letter fluency task, there was no statistically significant difference between males and females according to the number of generated words (P=0.057). However, in semantic fluency, female participants generated more words (P=0.005). Mother tongue (Farsi) showed a significant effect both on letter fluency (t=5.55, P<0.001) and semantic fluency (t=9.41, P<0.001). Level of education had a significant association with both letter fluency (F=117.23, P<0.001) and semantic fluency (F=64.48, P<0.001). Highlights: The study subjects generated 8.3±4.1 words in one minute in the letter fluency test.Letter fluency was associated with educational level and mother tongue.The Mean±SD number of generated words in semantic fluency (18±5.5) was higher than letter fluency.Semantic fluency was associated with age, gender, education level, and mother tongue. Plain Language Summary: Practitioners use neuropsychological tests to diagnose mental problems. Verbal fluency is a test in which participants have to generate as many words as possible from a specified category in a given time. This category can be phonemic (letter), which means words beginning with a specified letter or semantic, including objects such as animals or fruits. The number of words produced by participants is essential, and if it is fewer than normal, it shows psychological or neurological conditions such as Alzheimer disease. The norms are variable in different languages, cultures, and educational levels. We found that the Mean±SD numbers of generated words in letter fluency and semantic fluency were 8.3±4.1 and 18.0±5.5, respectively. These values can be used for neuropsychological testing in the Iranian population.

Sequestrectomy Versus Conventional Microdiscectomy for the Treatment of a Lumbar Disc Herniation: A Systematic Review.

STUDY DESIGN: A systematic review. OBJECTIVE: The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA: Open surgery for LDH can be performed by sequestrectomy (removal of disc fragments) or conventional discectomy (removal of disc fragments and disc). Sequestrectomy might be associated with a higher risk of recurrence but less low back pain (LBP) after surgery. METHODS: We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and nonrandomized prospective studies of conventional discectomy versus sequestrectomy for adult patients with LDH that evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analog scale, or neurological deficits of the lower extremity. We also evaluated the following secondary outcomes: complications of surgery, reherniation rate, duration of hospital stay, postoperative analgesic use, and health-related quality-of-life measures. Two authors independently reviewed citations and articles for inclusion. We assessed the risk of bias, synthesized data, and the level evidence using standard methodological procedures as recommended by the Cochrane Back Review Group. RESULTS: We identified 5 studies (746 participants) of sequestrectomy versus microdiscectomy. One study was RCT and the other 4 were nonrandomized prospective comparisons; all studies were assessed as being at a high risk of bias. There were no significant differences for leg pain, LBP, functional outcomes, complications, and hospital stay or recurrence rate for 2 years (level of evidence: Low). Sequestrectomy was associated with less analgesic consumption versus discectomy (level of evidence: Very low). CONCLUSION: Sequestrectomy and standard microdiscectomy were associated with similar effects on pain after surgery, recurrence rate, functional outcome, and complications; more evidence is needed to determine whether sequestrectomy is associated with less postoperative analgesic consumption. LEVEL OF EVIDENCE: 2.