Single measurement of total serum cholesterol, HDL-C, LDL-C and triglycerides in the second trimester as a predictor of pre-eclampsia in high risk pregnant women

To evaluate the utility of measuring different serum lipids in the second trimester of pregnancy for predicting pre-eclampsia in high risk patients. The study comprised 90 pregnant females with high risk of developing pre-eclampsia. Serum measurements of total cholesterol, HDL-C, LDL-C and triglycerides were taken between 18-24 weeks of gestation. Patients were followed up and divided into 2 groups accordingly. Group I [healthy patients], Group II [patients who develop pre-eclampsia]. Serum triglycerides showed a sensitivity of 100%, a specificity of 100%, a PPV of 100% and a NPV of 100% with a total accuracy of 100%. Total serum cholesterol showed a sensitivity of 88.1%, a specificity of 70.83%, a PPV of 72.55% and a NPV of 87.18% with a total accuracy of 78.89%. HLD-C showed a sensitivity of 74.19%, a specificity of 52.54%, a PPV of 45.1% and a NPV of 79.49% with a total accuracy of 60%. Moreover, LDL-C showed a sensitivity of 100%, a specificity of 44.32%, a PPV of 3.92% and a NPV of 100% with a total accuracy of 45.56% and finally TC/HDL ratio showed a sensitivity of 96.43%, a specificity of 61.29%, a PPV of 52.94% and a NPV of 97.44% with a total accuracy of 72.22%. According to the results of the study, the most accurate predictor for the prediction of pre-eclampsia, was the serum triglycerides level, while Total serum cholesterol and TC/HDL ratio came next in accuracy

Predicting preterm delivery in asymptomatic pregnant women with prior preterm delivery by measurement of cervical length, fetal fibronectin and phosphorylated insulin-like growth factor-binding protein-1

To evaluate the accuracy of cervical length measurement in combination with assessment of fetal fibronectin [FFN] and phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions as a predictor of preterm delivery in asymptomatic pregnant women with a history of preterm birth. 91 singleton pregnant mothers [between 22-24 weeks of gestation] with previous history of one or more unexplained preterm birth were included in the study. For all participants transvaginal sonographic measurement of cervical length was carried out together with qualitative assay of fetal fibronectin and quantitative measurement of phosphorylated insulin-like growth factor binding protein-1 in cervico-vaginal secretions. The primary outcome of the study was delivery before completed 37 weeks of gestation. There was a significant association between cervical length and the occurrence of preterm delivery [p=0.002], cervical length was 23.12 +/- 8.5mm in 33 cases who experienced preterm delivery compared to 29.34 +/- 9.4mm in 58 cases who delivered at term. Regarding fetal fibronectin assay in cervico-vaginal secretions, no statistically significant difference was found between those who delivered preterm and those who had term delivery [p=0.972]. Measurement of phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions showed statistically significant difference among patients who delivered preterm compared to those who did not [p=0.007]. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for cervical length, phIGFBP-1, and for their combination, and our results demonstrated high sensitivity, specificity, positive and negative predictive values for the combined method compared with either method alone. Both cervical length and phIGFBP-1 measurement in cervico-vaginal secretions at 22-24 weeks are likely to be useful in predicting preterm delivery in asymptomatic women with a history of preterm birth and their combination increased their sensitivity, specificity, positive and negative predictive values as predictors

Association between serum leptin and bone mineral density in non obese postmenopausal women

Total body fat mass is considered to be one of the major determinants of bone mass. Plasma leptin concentrations correlate with body fat content. Raised peripheral leptin levels may favour bone formation while suggesting adipogensis Estimation of serum leptin may be of value: In screening postmenopausal women with low bone mineral density. The aim of this study is to investigate the relationship between plasma leptin concentrations and bone mineral density in non obese postmenopausal women. Cross-sectional study. Menopausal and Outpatient clinics of Gyenecology and Orthopedics departments at Kasr El-Aini, Faculty of Medicine, Cairo University. The study included 93 non-obese, nonsmoker postmenopausal women with a body mass index [BMI] of less than 30kg/m[2]. Bone mineral density [BMP] measure was done using dual x ray absorptiometry [DEXA] of the lumber spine. According to the results the study sample was divided into: Low BMD group [36 women]; and control group [57 women]. Plasma assay for leptin and biomarkers of bone turnover [plasma bone specific alkaline phosphates, phosphatase osteocalcin and urinary deoxypridioline] were all measured. Analysis of the results showed that leptin appears not to be a marker for bone mineral density and it may be just a refection of weight or obesity. Higher parity is more associated with low BMD

Diagnostic value of serum CA-125, CA 19-9, IL-13 and TNF-alpha in endometriosis and prediction of its severity

Endometriosis is one of the most common benign gynecological disorders affecting more than 10% of women of reproductive age A non-surgical diagnostic approach would be of great benefit to both physicians and women alike. To test the diagnostic potential of serum biochemical markers: CA-125, CA 19-9, IL-13 and TNF-alpha conditions as well as to predict its severity. Cross- sectional study. Obstetric and Gynecology Department, Kasr El-Aini hospital - Cairo University. Ninety one consecutive non-pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic pain. Serum biochemical markers: CA-125, CA 19-9, IL-13 and TNF-alpha were measured using specific kits and techniques for each in the 91 patients. According to the results of laparoscopic and histopathological examination the study population were divided into 4 groups: early endometnosis, advanced endometrosis, non-endometriotic pelvic inflammations/adhesions and patients with normal findings respectively. Accuracy of the study markers in differentiating between the various pathological situations was calculated, to predict the specificity of each marker, to distinguish endometriosis from other clinical conditions and to predict its severity. Serum CA 125 in group of patients with early endometriosis [26 patients] showed significant difference when compared to the control group [16 patients]. Also significant difference of serum CA125, CA 19-9 and TNF- between cases of advanced endometriosis [14 patients] compared to PID and control groups, [51 patients]. This same significant difference was also detected with TNF-alpha between group of early endometriosis and compared to PID and control groups. CA 19-9 showed significant difference in its level in group of early endometriosis compared to other groups. After combining cases with endometriosis, the three serum biochemical markers which slowed significant difference when compared to other groups were CA-125, CA 19-9 and TNF-alpha while JL-B showed no significant difference. The accuracy of the serum biochemical markers CA-125, CA 19-9 and TNF-alpha regarding the sensitivity and specificity were 79.962, 75.82 and 93.4 respectively. TNF-alpha is characterized by perfect sensitivity while both CA-125 ed CA 19-9 have perfect specificity. Combining the results of assaying serum TNF-alpha plus any of the other markers CA 125 or CA 19-9 will have 100 accuracy in distinguishing cases with endometriosis from those with non-endometriotic lesions. Only serum level of CA 19-9 can distinguish between cases with early and advanced endometriosis

Prediction of pre-eclampsia and neonatal outcome by the combined use of early second trimester maternal serum homocysteine and uterine artery doppler velocimetry

To evaluate the value of combining early second trimester maternal serum homocysteine and uterine artery doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome. This prospective observational study was conducted on eighty seven pregnant mothers [in their 16-19 gestational weeks] at risk to develop pre-eclampsia. All enrolled women should have one or more risk factors to develop pre-eclampsia. Mothers with medical disorders during the current pregnancy were excluded. All participants were investigated with maternal serum homocysteine assay and Doppler analysis of both uterine arteries. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for homocysteine levels, uterine artery resistance index, diastolic notch [unilateral, bilateral], and for the combination of both homocysteine levels and uterine artery Doppler studies. Pre-eclampsia had occurred in 28 out of the 87 participants [32.18%] of whom 17 cases were diagnosed as mild pre-eclampsia [19.54%] and 11 were diagnosed as severe disease [12.64%]. The mean +/- SD of uterine RI for all cases who developed severe pre-eclampsia was 0.62 +/- 0.09 while it was 0.58 +/- 0.06 in those who did not develop the disease all over their pregnancies and the difference was statistically significant [p=0.016]. Early diastolic notch was detected in 11 out of the 28 mothers who developed pre-eclampsia [39.29%; 5 unilateral and 6 bilateral] versus 4 out of the 59 women who passed uncomplicated pregnancies [6.78%; 2 unilateral and 2 bilateral]. This revealed a statistically significant different [p=0.001]. Serum levels of homocysteine was also significantly higher in cases who developed pre-eclampsia than controls. The median [range] of serum homocysteine in mothers who developed pre-eclampsia [mild and severe disease] was 6.24 [1.9 - 23.4] micro mol/l while in women passed uncomplicated pregnancy it was 5.1 [1.6-19.9] micro mol/l [p=0.024]. Out of all delivered neonates of preeclampsia mothers [31 neonates from 28 mothers], 9 neonates were classified to have poor prognosis [29.03%] all of them were from severe preeclamptic mothers. No early neonatal deaths were recorded. This prospective study confirms the value of combining early second trimester maternal serum homocysteine and uterine artery Doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome