Objective We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa. Methods The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements). Results Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814–0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770–0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) Conclusion Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

Objective: To compare the results of operations of commercial uterine manipulators. Considering that the optimal uterine manipulator is still not found, our goal was to give an idea for gynecologists to choose the most suitable uterine manipulator for their purposes and expectations. Methods: Between January 2016 and September 2021, 294 laparoscopic hysterectomy cases met the inclusion criteria and were operated in İzmir Katip Çelebi University Atatürk Training and Research Hospital Gynecology and Obstetrics Clinic. They were divided into four groups according to the type of manipulator used. Group-1 (RUMI-I), Group-2 (Clermont-Ferrand), Group-3 (sharp intrauterine curette-tenaculum), and Group-4 (without uterine manipulator). All four groups were compared with operation time, hospital stay, absolute change in hemoglobin (g/dl), and per-op complications. Results: Considering the operation times in all groups, the mean operation time in the first Group-was 180 minutes (98-349); in Group-2 was 159 minutes (96-564); in the 3rd Group was 178 minutes (141-540); in the 4th Group was 189 minutes (115-453). The group with the shortest operation time was Group-2; the difference was statistically significant (p=0.015). In general terms, the effect of all manipulators on patient parameters wasn’t very different. Clermont-Ferrand seems more advantageous than others in making the surgeon’s work more straightforward regarding operation time only. Conclusions: In our study, the choice of uterine manipulator did not affect the surgical results except for the duration of the operation. The personalization of uterine manipulators according to the needs of the surgery and the easiness of use of the surgeon should be at the forefront. doi: https://doi.org/10.12669/pjms.39.4.6728 How to cite this: Sengul M, Selim HS. Comparison of Uterine manipulators types in total Laparoscopic Hysterectomy: A retrospective study. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.6728 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Background:Helicobacter pylori is a gram-negative, microaerophilic rod-shaped bacterium that lives beneath the gastric mucosal layers, on the surface of epithelial cells. Gastric infection with this organism causes inflammation of the gastric mucosa, which can lead to gastritis, duodenal or gastric ulcers and even in rare cases to gastric carcinoma or MALT lymphoma. Approximately 50% of the population of the entire world is believed to be infected with H. pylori, but the exact route of transmission is still uncertain. It has been speculated that the cervix, with its endocervical columnar epithelium and acidic mucous layer, might provide a suitable environment for H. pylori. H. pylori might be a pathogenic agent for cervical infection. In order to address this issue we studied H. pylori in the endocervical tissue. Methods: To investigate our hypothesis, we examined cervical tissue using PCR, culture, and Gramstain. Thirty-three cervices from women who underwent total hysterectomy for noninvasive noncervical benign uterine diseases were analyzed in this study. Twenty-one patients had cervicitis and 12 patients were included as controls. Results: Of the 29 patients studied, none showed evidence of H. pylori infection. H. pylori was not detected by PCR, histology, or culture. Conclusions: We could not detect H. pylori in the cervix of patients with cervicitis. H. pylori-infected patients’ cervices remain to be investigated, and a larger study is needed to draw firm conclusions.

The aim of this study was to assess unnecessary immunization rates and compare the cost-effectiveness of targeted prophylaxis with fetal Rh genotyping with that of traditional management of Rh-Rh incompatibility in a virtual economic model. Materials and methods:This retrospective data analysis was conducted at two tertiary centers between 2011 and 2015. The data of 1135 pregnant women were analyzed. The main outcome measure was to determine the unnecessary immunization rate among the whole Rh-Rh incompatibility group. The second outcome measure was to compare the cost-effectiveness of universal immunization with that of targeted prophylaxis with fetal Rh genotyping in a virtual economic model. Results:Average cost per patient was found as $259.20 with universal prophylaxis and the total cost was $177,344, whereas if targeted prophylaxis had been applied to these patients the total cost would have been $263,392 and cost per patient would have been $385. Universal prophylaxis was more cost-effective than targeted prophylaxis in terms of both total cost and cost per patient (P < 0.0001). Conclusion:Unless the cost of noninvasive fetal Rh genotyping is reduced, a universal approach of anti-D immune globulin prophylaxis is more cost-effective than noninvasive determination of fetal Rh genotyping with targeted prophylaxis.