The Impact of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Epithelial Ovarian Cancer

OBJECTIVE: This study aims to investigate the prognostic value of the preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with epithelial ovarian cancer. STUDY DESIGN: Between January 2012 and December 2018, the data and preoperative levels of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of 116 epithelial ovarian cancer patients were retrospectively collected. The association of these relevant markers with outcomes was analyzed. RESULTS: The difference was observed concerning optimal and suboptimal debulking in platelet-to-lymphocyte ratio ratios (p=0.04). Lymphovascular space involvement was significantly associated with higher platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio ratios (p<0.0001). Patients with ascites and lymph node involvement had a higher platelet-to-lymphocyte ratio ratio (p=0.007 and p=0.004). In recurrences, higher ratios of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were observed (p=0.03 and p=0.02). The analysis revealed that platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were not independent prognostic factors for recurrence (p=0.783 and p=0.391). Regarding mortality, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were not independently prognostic (p=0.621 and p=0.830). It was determined that neutrophil-to-lymphocyte ratio >2.45 (HR 0.714, CI 0.622-0.794, p<0.0001) and platelet-to-lymphocyte ratio >179.4 (HR 0.736, CI 0.646-0.814, p<0.0001) could predict the presence of recurrence with a certain sensitivity and specificity, and for predicting the death, a neutrophil-to-lymphocyte ratio of >2.45 had a sensitivity of 78.26% (95% CI: 56.3 to 92.5%) and a specificity of 54.84% (95%CI: 44.2 - 65.2) (p=0.03). CONCLUSION: The evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio is important in obtaining prognostic information before surgery. However, no significant association between the neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio with survival was identified.

The Relationship Between First-Trimester Aneuploidy Markers and Birth Weight

OBJECTIVE: We aimed to determine the relationship between the first-trimester aneuploidy screeningma and the predicted weight at birth: Small for gestational age and large for gestational age. STUDY DESIGN: 594 low-risk pregnant women with a singleton pregnancy, who underwent first-trimester aneuploidy screening by measuring nuchal translucency, maternal serum free beta-human chorionic gonadotropin, and pregnancy-associated plasma protein-A were included in the study. Those weighing above the 3rd percentile and below the 10th percentile were defined as small for gestational age, and those over the 90th percentile were defined as large for gestational age. RESULTS: A total of 594 pregnant women were enrolled. The mean maternal age of the studied group was 28.8±5.5 years. Low maternal serum pregnancy-associated plasma protein-A levels and decreased nuchal translucency measurements were associated with the small for gestational age newborn (p<0.001 and p=0.001, respectively). There is a significant correlation with large for gestational age for newborns only with an increase in maternal serum pregnancy-associated plasma protein-A levels (p=0.001). beta-human chorionic gonadotropin levels were not associated with the birth weight (p=0.735). CONCLUSION: Maternal serum pregnancy-associated plasma protein-A levels, one of the markers in first-trimester aneuploidy screening, can be used in the prediction of small for gestational age and large for gestational age However, due to its low correlation, it is not a suitable screening test for clinical practice.

Factor V H1299r (Hr2) Heterozygosity: A Risk Factor For Recurrent Implantation Failure Particularly In Non-Carriers For Factor V Leiden Mutation-A Case-Control Study

Objective: The association between recurrent implantation failure and thrombophilia is still controversial depending on the published reports with conflicting results. In this study, we aimed to assess the clinical relevance of screening women with recurrent implantation failure for some thrombophilic variants including factor V H1299R (FV HR2) haplotype. Study Design: A total of 279 women were recruited in this case-control study. 229 women with a history of recurrent implantation failure and 50 fertile control with no history of pregnancy losses were screened for eight specific gene mutations, regarding factor V G1691A gene (FV Leiden), FV HR2, factor II prothrombin G20210A, factor XIII V34L, PAI-1 4G/5G, MTHFR C677T, MTHFR A1298C and A3 haplotype of the endothelial cell protein C receptor gene. Results: Recurrent implantation failure group displayed a significantly higher prevalence of FV HR2 heterozygosity than fertile controls while the frequency of FV Leiden mutation was comparable between groups (p=0.011; p=0.619). Additionally, the difference in the prevalence of other specific or total gene mutations among women with recurrent implantation failure was also insignificant. Discussion: The primer outcome of this study was the co-existence of the higher prevalence of FV HR2 haplotype and the insignificant percentage of FV Leiden mutation in women with recurrent implantation failure. Thus, we emphasize that the HR2 haplotype may be associated with recurrent implantation failure particularly in non-carriers for FV Leiden mutation. In the necessity of screening for thrombophilia in recurrent implantation failure, HR2 haplotype should be involved in the searched gene panel particularly in the absence of FV Leiden mutation. Further large-scale prospective studies are needed to investigate whether screening or treatment for HR2 haplotype has any detrimental impact on implantation success in cases of recurrent implantation failure.

Challenges and Solutions for Keeping Maternity and Gynecology Services Functioning Comprehensively in Secondary Level Health Care Facility in COVID-19 Pandemic Situation Using a Clinical Spproach

OBJECTIVE: With the nationwide lockdown in India, and with a near-exclusive focus on the novel coronavirus disease (COVID-19) there has been a great deal of neglect in the management of other illnesses leading to significant mortality and morbidity. We aimed to assess the feasibility of keeping obstetrics & gynecology services in a secondary care hospital functioning (in terms of regional experiences and comprehensive patient care measures) in the COVID-19 pandemic situation using a clinical approach. STUDY DESIGN: All policies of the World Health Organization and other international obstetrics- gynecological recommendations or guidelines were followed in keeping the services functional. Hospital data of obstetrics and gynecology services were maintained and compared with the previous year’s data of the corresponding period (January to December) through a retrospective observational study. RESULTS: Compared to figures for 2019, in-patient admissions, surgeries, and daycare procedures performed, and deliveries conducted were reduced in total but almost approached previous levels. The number of out-patient attendance and gynecologic laparoscopic surgeries were significantly reduced mostly in the initial month of lockdown (April 2020) and thereafter. Only limited COVID-19 testing was done and there was no mortality in patients or health care workers (HCW) in the obstetrics and gynecological department. CONCLUSION: COVID-19 pandemic had caused an unprecedented global healthcare crisis. The experience and data collected from our hospital in the study period validate the ‘clinical’ working protocol that enables comprehensive maternity and gynecology care at secondary level care centers even in a pandemic situation without adverse outcomes on patients or the hospital staff.

Perioperative SARS-CoV-2 Infection in Patients Undergoing Elective Surgery in Gynecology Clinic: Tertiary Center Experience

OBJECTIVE: The objective of this study was to determine the incidence of perioperative “severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)” infection among women, operated during Coronavirus disease-2019 (COVID-19) era. STUDY DESIGN: All patients who were operated on between March 11, 2020, and December 31, 2020, in our gynecology clinic were included in this cross-sectional study. The clinical and demographic characteristics of the patients, preoperative and postoperative SARS-CoV-2 positivity, the progress of the infection, and the survival rates in positive cases were analyzed. COVID-19 cases were diagnosed by reverse transcription-polymerase chain reaction testing for SARS-CoV-2. RESULTS: Operations of 133 (33%) of 406 patients were canceled for various reasons. 275 patients were operated on. Preoperatively three patients were diagnosed with COVID-19. One of these patients died and two were operated on after treatment and self-isolation. Only one (0.4%) patient was diagnosed with COVID-19 30 days postoperatively and completely recovered. We calculated the perioperative SARS-CoV-2 positivity rate as 1.4% (276 surgeries were planned and 4 patients were diagnosed with COVID-19). During the study, 107 physicians worked in our clinic alternately. Two (1.8%) of these physicians were diagnosed with COVID-19 and completely recovered without the need for intensive care. In addition, nine patients who were previously diagnosed with COVID-19 were operated on. Postoperative respiratory and other system complications did not occur in nine patients, previously diagnosed with COVID-19. CONCLUSION: The results of our study show that gynecological surgical procedures do not increase the transmission and mortality rates of SARS-CoV-2 among patients and healthcare professionals as long as infection control measures are followed.

Comparison of Pregnancy Outcomes of Women with and Without Hypertension at the Latent Phase of Labor Who Were Under Medical Care for Preeclampsia

OBJECTIVE: We explored the association between hypertension (>140/90) at the latent phase of labor (resistant hypertension) and the subsequent development of major maternal complications or adverse infant outcomes in women with preeclampsia under medical care. STUDY DESIGN: We drew data from 824 women who were under follow-up at the Department of Perinatology of Health Sciences University Zeynep Kamil Women and Children’s Health Training and Research Hospital with a diagnosis of preeclampsia. Women with and without resistant hypertension were compared in terms of major maternal complications and adverse infant outcomes. RESULTS: Mean age and body mass index were similar between the two groups (p>0.05). The rate of preeclamptic complaints was significantly higher in groups with resistant hypertension (90.1% vs. 67.2%, p<0.05). Proteinuria was more frequent in the resistant hypertension group (78.7% vs. 66.8%, p<0.001). The newborn intensive care unit admission rate was significantly higher in the group with resistant hypertension (65.6% vs. 45.9%, p<0.001). Gestational age at delivery was significantly lower in the group with resistant hypertension compared to the normotensive group (34.6 vs. 32.9 weeks, p<0.001). There was a significant difference between the two groups in terms of the rate of preterm delivery (78.5% vs. 66.7%, p=0.04). CONCLUSION: Resistant hypertension is associated with a higher rate of preeclamptic symptoms during labor and newborn intensive care unit admission.

Ethnographic Study of Perspective and Attitude of Breastfeeding Mothers Towards the use of Elaeis Guineensis Sap As Galactagogue Among Igbo Women Oof Southeastern Nigeria

OBJECTIVE: As an age-old traditional practice, nursing mothers from southeastern Nigeria use the Elaeis guineensis sap (from the oil palm tree also referred to as palm wine) to induce and sustain lactation a few hours after delivery. This practice is still ongoing to date, despite the scarcity of clinical data supporting its efficacy and safety. This study aimed to generate preliminary data on the prevalence, perceptions, and behaviors related to the use of Elaeis guineensis sap as a galactagogue. STUDY DESIGN: Mothers who had breastfed or breastfeeding at the time of the survey, were invited to complete a questionnaire that asked about their, perceptions, efficacy, and possible side effects of Elaeis guineensis sap on both mother and child during breastfeeding. Chi-square analysis was used to conduct data analysis. RESULT: A total of 5002 mothers completed the survey with 61% reporting use of Elaeis guineensis sap (palm wine) following parturition. Most of the respondents (73%) attained tertiary education. The practice was mostly recommended by direct relatives (38%) while the commonest reason for this practice was perceived insufficient milk production (32.2%). The majority of the respondents (52%) were satisfied with the outcome while 44% reported no negative side effects. CONCLUSION: The use of Elaeis guineensis sap by mothers following parturition is common in south-eastern Nigeria. However, randomized control studies are needed to provide evidence for the efficacy and safety of this plant product. This will be relevant to the formation of intercultural health policies which will value and respect the positive cultural practices of a people.

Effect of “Time To Surgery” On The Endometrial Cancer Prognosis

OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries. Our study aims to determine the effect of the time between diagnosis and surgery of endometrial cancer on the prognosis of the disease. STUDY DESIGN: Patients who were diagnosed with epithelial type endometrial cancer and did not receive preoperative chemotherapy, radiotherapy, or hormonal therapy were included in the study. RESULTS: Two hundred eighty-five patients were included in the study. We divided the patients into two groups regarding before and after 8 weeks from diagnosis to surgery. Clinical characteristics of the patients were comparable between the groups, except for comorbid conditions and body mass index. Using cox-regression analysis, time to operation did not have a significant effect on both recurrence and cancer-associated death risk. The log-rank test analysis also showed that there was no significant difference in progression-free survival and disease-specific survival between the patients. There was no significant difference between the groups in terms of progression-free survival and disease-specific survival for cases with endometrioid type grade 1-2 tumors. There was also no significant difference between the groups regarding progression-free survival and disease-specific survival in the patients with tumors of endometrioid type grade 3 and non-endometrioid histology. CONCLUSION: Time delay between diagnosis to surgery of the patients with endometrial cancer has no prognostic importance for recurrence and survival outcomes.

The Predictive Value of the Pentraxin 3 Concentration in Cumulus Cell Culture Media for the Embryo Implantation

OBJECTIVE: Many studies on the interrelation of cumulus cells and oocytes, and research on cumulus protein factors continue. This study aims to investigate the relationship of Pentraxin 3 level with embryo implantation in the cumulus culture fluid. STUDY DESIGN: A total of 31 women with idiopathic infertility who underwent intracytoplasmic sperm injection treatment were prospectively evaluated. Cell suspensions containing 5 million/mL cumulus cells were obtained post-hyase and incubated for 24 hours in a culture medium. A possible association between the culture media Pentraxin 3 concentrations and embryo implantation was analyzed. RESULTS: The cumulus cell culture media Pentraxin 3 concentrations were significantly higher in the pregnant group compared to the non-pregnant group (98.9 ng/mL vs 53.2 ng/mL, respectively, p=0.005). There was a significant positive correlation between the culture media Pentraxin 3 concentrations and embryo implantation (r=0.500, p=0.005). The culture media Pentraxin 3 concentration was a significant predictor for successful embryo implantation (AUC=0.845, p=0.006). A cut-off value of 64.25 ng/mL had an 86% sensitivity and 80% specificity to predict embryo implantation. There was no pregnancy under the cut-off value of 60 ng/mL, whereby seven women had good quality grade 1 oocytes according to the traditional morphological criteria. CONCLUSION: The cumulus cell culture medium Pentraxin 3 concentration was predictive for successful embryo implantation. Low Pentraxin 3 levels (<60 ng/mL were associated with failure of conception.

Ocular Surface Disease Severity in Polycystic Ovary Syndrome: is This Really Significant in Daily Life?

OBJECTIVE: The purpose of this study was to ascertain the extent to which the ocular surface of women with polycystic ovary syndrome is impacted. STUDY DESIGN: Included in this case-control study were 23 eyes of 23 patients (Group I) with polycystic ovary syndrome and 10 eyes of 10 healthy subjects (Group II). Polycystic ovary syndrome was diagnosed when two of the following conditions were met: oligo- or anovulation, clinical and/or biochemical signs of hyperandrogenism, and ultrasonographic documentation of polycystic ovaries. Ocular surface disease grading was performed using the Ocular Surface Disease Index questionnaire, slit lamp examination, meibomian gland secretion scoring, tear film breakup time, staining scores of ocular surfaces, the Schirmer's test, and tear osmolarity assessment. RESULTS: The study observed no significant difference in age (p=0.896). Group I was found to have a significantly higher median luteinizing hormone level (p=0.027). The Ocular Surface Disease Index scores in group I were significantly higher than those in group II (p=0.031). The prevalence of anterior blepharitis was significantly greater in group I (p=0.05). Tear film breakup time was higher in group I than in group II (p=0.026). The ocular surface disease severity was found to be significantly higher in group I (p=0.03). In group I, Ocular Surface Disease Index scores were significantly positively correlated with free testosterone, while tear osmolarity was significantly positively correlated with estradiol levels but significantly negatively correlated with dehydroepiandrosterone sulfate levels (p<0.05). CONCLUSIONS: Daily activities appear to be slightly impaired in patients with polycystic ovary syndrome due to ocular surface problems. However, environmental factors (humidity, temperature, etc.) contribute to the aggravation of ocular symptoms. Patients with polycystic ovary syndrome may be referred to an ophthalmologist to preserve ocular surface health.