In this issueOriginal articles
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# Original articles {#article-title-2}

**Systemic immune-inflammatory index and platelet-to-lymphocyte ratio in intrahepatic cholestasis of pregnancy**

Çallıoğlu et al investigate the role of systemic immune-inflammation index (SII) in the diagnosis and severity of intrahepatic cholestasis of pregnancy (ICP). This case-control research involves 173 pregnant women with ICP and 266 gestational age-related healthy pregnant women as the control group. Criteria for diagnosing ICP are acceptance of increased serum total bile acid (TBA) levels (≥10 μmol/L). Sociodemographic data, laboratory results, and SII values are compared between groups. Cut-off values are calculated to predict ICP. The SII is calculated as the platelet count × neutrophil count/lymphocyte count. The leukocyte and neutrophil counts are lower (*p*<0.01), and the monocyte count is higher (*p*=0.026) in the severe ICP group compared to the controls. The platelet-to-lymphocyte ratio (PLR) is higher in mild ICP groups than in controls (*p*<0.01). The optimum PRL cut-off value is 126.2238, with a sensitivity of 57.2% and specificity of 57.1%. They concluded that elevated SII values support the evidence for the inflammatory properties of ICP but do not aid in diagnosing and determining its severity. Platelet-to-lymphocyte ratio may be a useful marker in determining ICP.

***see page 1217***

![Figure1](http://smj.org.sa/https://smj.org.sa/content/smj/45/11/1205/F1.medium.gif)

[Figure1](http://smj.org.sa/content/45/11/1205/F1)

Receiver operating characteristic analysis.

**Dense breast tissue in screened postmenopausal women.** ***Prevalence and determinants***

Kanbayti explores the prevalence of dense breast tissue among screened postmenopausal women and identifies the factors influencing breast density in this population. A retrospective analysis of data from postmenopausal women screened for breast cancer in Jeddah, Saudi Arabia, is carried out. Breast density is subjectively assessed, and influencing factors are retrieved from the hospital information system. Proportions are used for descriptive analysis, and binary logistic regression is used to identify the determinants of dense breast tissue. Only 12.7% of the postmenopausal women have dense breast tissue. Non-Saudi women and those who do not breastfeed have a greater likelihood of having dense breast tissue. Women who have never been pregnant (nulliparous) are 4 times more likely to have dense breast tissue than those who have been pregnant. Additionally, women with fewer children have a higher chance of dense breast tissue. He concluded that the prevalence of dense breast tissue among screened postmenopausal women was low. However, certain factors increase the risk of having dense tissue in this population, including not being Saudi Arabian, never having breastfed, being nulliparous, and having fewer children.

***see page 1238***

![Figure2](http://smj.org.sa/https://smj.org.sa/content/smj/45/11/1205/F2.medium.gif)

[Figure2](http://smj.org.sa/content/45/11/1205/F2)

Breast density distribution.

**Central nervous system manifestations of tuberous sclerosis complex.** ***A single centre experience in Qatar***

Aden et al review the clinical and radiological correlation of the central nervous system manifestations of tuberous sclerosis complex (TSC). Severity of epilepsy is determined using the early childhood epilepsy severity score (E-CHESS) tool. The study sample include 38 (50% male) patients, 8 (21%) of whom are native to Qatar. The median age at diagnosis is 4 (range: 0-72) months. A family history of TSC is present in 10 (26%) cases, while 33 (86%) patients have a TSC2 gene mutation. Common presentations include seizures (79%), rhabdomyoma (26%), and developmental delay (13%). On MRI scans, cortical tubers are seen in all patients, subependymal nodules in 37 (97%), and subependymal giant cell astrocytoma is diagnosed in 8 (21%) cases. A total of 30 children develop epilepsy, 9 of whom have favorable and 21 have unfavorable E-CHESS scores, and 6 require pharmaceutical management. A total of 13 children are diagnosed with autistic spectrum disorder and 12 with attention deficit hyperactivity disorder. They concluded that multidisciplinary management and further research is needed to optimize the care and quality of life of TSC affected individuals and their families.

***see page 1245***

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