Correlation of Serum CA-125 and progesterone levels with ultrasound markers in the prediction of pregnancy outcome in threatened miscarriage

Background: The aim of this study was to evaluate the relationship between ultrasonographic findings and serum progesterone and cancer antigen-125 [CA-125] levels in threatened miscar-riage and to predict pregnancy outcome

Materials and Methods: In a prospective comparative case-control study, serum CA-125 and progesterone levels were measured for 100 pregnant women with threatened miscarriage who attended the outpatient clinic or the causality department of Obstetrics and Gynecology at Kasr El-Aini Hospital, Giza, Egypt, during the period from March 2013 to October 2013. Ultrasound was performed for fetal viability, crown-rump length [CRL], gestational sac diameter [GSD] and fetal heart rate [FHR]. The patients were followed up and divided into two groups based on the outcome: 20 women who miscarried [group 1], and 80 women who continued pregnancy [group 2]. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and overall accuracy were tested for CA-125 and progesterone levels in prediction of the pregnancy outcome. Correlation of these chemical markers with the ultrasound markers was also examined

Results: In the group that miscarried, CA-125 level was significantly higher [P<0.001] and serum progesterone level was significantly lower [P<0.001]. For prediction of the outcome of pregnancy, the cut-off limit of 31.2 IU/ml for CA-125 level yielded sensitivity, specificity and an overall accuracy of 96.2, 100 and 99.4% respectively. The cut-off limit of 11.5 ng/ml for progesterone level yielded sensitivity, specificity and an overall accuracy of 97.5, 100 and 99.8% respectively. CA-125 level had a negative correlation with progesterone level and FHR levels [r=-0.716, P<0.001] and [r=-0.414, P<0.001] respectively. Serum progesterone level correlated with GSD [r=0.521, P<0.001] and with CRL [r=0.407, P<0.001] and FHR [r=0.363, P<0.001]. CA-125 level was significantly higher in the group that showed hematoma as compared with the group without hematoma [P<0.001]. Also, serum progesterone level was significantly lower in the group that showed hematoma as compared with the group without hematoma [P=0.017]

Conclusion: Serum CA-125 and progesterone levels are valid early predictors of the outcome of pregnancy in women with threatened miscarriage. They are correlated with some ultrasonographic markers [GSD, CRL, and FHR]

Prevalence and predictors of depression and anxiety among the elderly population living in geriatric homes in Cairo, Egypt

Anxiety and depression are common in the elderly and affect their quality of life. The rates of depression and anxiety are higher among those living in institutional settings and are usually undiagnosed. The aim of the study was to determine the prevalence and predictors of depression, anxiety and mixed form [i.e. depression and anxiety] in the elderly living at geriatric homes. A cross-sectional study was conducted on 240 elderly participants from four randomly selected geriatric homes in Cairo. A pretested interview questionnaire was used to collect data. A short version of the Geriatric Depression Scale [GDS-15], the Hamilton Anxiety Scale, the Katz scale for Activity of Daily living, the three-item loneliness scale and the Personal Well being Index Scale were used. The prevalence of depression, anxiety and mixed disorder among the studied group were 37.5, 14.2 and 30%, respectively. Old age and the presence of comorbidities were predictors for depression and/or anxiety. Female sex, a lower social class, insufficient income, partial independence and loneliness feeling are significant predictors for depression. Being married and loneliness feeling are significant predictors for anxiety, whereas the functional status is a significant predictor for mixed depression and anxiety. Depression and/or anxiety were found in more than 80% of the studied group. An older age, female sex, insufficient income, a lower social class, a partially independent functional status, the presence of comorbidities, more frequent loneliness feeling and being married or divorced were found to be significant predictors for these problems. This study reflects the need for the screening of the elderly in geriatric homes for depression and/or anxiety, especially among high-risk groups, and developing interventions to prevent and control such problems

Value of TC-99M DMSA scintigraphy in urinary tract infection: comparative study with other imaging modalities

Urinary tract infection [UTI] is a common medical problem. It causes considerable morbidity specially if complicated, can cause severe renal damage. The aim of this study is to evaluate value of Tc-99m DMSA in UTI comparing with ultrasound and CT scan. We analyzed a random sample of 63 patients approved to have urinary tract infection. Abdominal ultrasound, CT, and [99m] Tc-DMSA scintigraphy of the kidneys were performed in all patients. Tc-99m DMSA scan showed scintigraphic changes consistent with pyelonephritis in all patients. The involvement was either unilateral in 53 patients [84%] or bilateral in 10 patients [16%]. The number of diseased kidneys were 73/126 [58%], 16/73 kidneys had abnormal unifocal defects [22%], 27/73 kidneys had multifocal defects [37%], while 30/73 kidneys had diffuse hypoactivity [41%]. The sensitivity of CT scan in detecting pyelonephritis was 82.8% while the sensitivity of ultrasound was poor [23.8%] and there was a statistically significant difference between the sensitivity of ultrasound and that of Tc-99m DMSA. Tc-99m DMSA is reliable diagnostic, cost-effective, simple, safe and noninvasive modality and may be taken as a routine procedure for the patients with clinical suspicion of upper UTI whenever the facilities are available

Fluconazole prophylaxis prevents invasive fungal infection in very low birth weight preterm infants

Neonatal candidiasis is associated with substantial morbidity and mortality rates. Despite the promising preliminary results observed in low birth weight [LBW] populations, the use of fluconazole to prevent fungal colonization and infection in preterm neonates in the NICU is still an open question and not yet recommended as a standard of care. The aim of the present work is to evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight [VLBW] infants and extremely LBW. We conducted a randomised clinical trial to evaluate the efficacy of fluconazole prophylaxis in VLBW preterm infants. There were two study groups: Fluconazole group: All preterm infants with birth weight less than 1500 grams admitted to Kasr El Aini Cairo University neonatal intensive care unit during a period from January 2006 to September 2006 were given prophylactic Fluconazole. This group was compared with a control group; All preterm infants [birth weight less than 1500gm] admitted to Kasr El Aini Cairo University neonatal intensive care unit during a period from April 2005 to December 2005 who did not receive fluconazole. There were no significant differences between the control and fluconazole groups in the base-line demographic characteristics or risk factors for fungal infection. Eight patients from the control group developed systemic fungal infection which was diagnosed by positive blood culture for candida. On the other hand none of the neonates receiving fluconazole developed candida infection. There was no significant difference in mortality between the two groups [38 infants in the fluconazole group died, as compared with 31 in the control group]. Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants. Further studies involving larger numbers are necessary

Factors affecting survival in surgically treated neonates with necrotizing enterocolitis

Necrotizing enterocolitis [NEC] is a life threatening disease of stressed neonates that is more common in low-birth weight [LBW] and preterm infants. It is considered as the most devastating gastrointestinal emergency in newborn infants. As more premature infants with NEC survive, the morbidity, mortality, functional outcome and prognosis in neonates with NEC have become a subject of great interest. The aim of this study is to identify mortality predictive factors in neonates with NEC who required surgical intervention. The study was conducted at Cairo University Children Hospital [CUCH] during the period from May 2001 to June 2003. Forty one patients with NEC requiring exploratory laparotomy were studied. Patients underwent follow-up for 90 days after the procedure. Certain variables have been taken into consideration as predictive factors for mortality. These variables were: Weight at birth, Gestational age, Sex, Presence of sepsis, Type of feeding, Gas in the peritoneal cavity at abdominal x-ray, Extent of disease, operative strategy [Resection and anastomosis or resection and enterostomy], and extent of bowel resection [ileocecal valve retained or removed]. Database configuration and analysis was performed with Microsoft access and statistical analysis was performed with the use of X2-analysis and the student t-test for paired groups using two tailed comparisons with P-value less than 0.05 considered statistically significant. Statistical analysis revealed that mortality was significantly higher with pan intestinal disease, weight less than 1.8 kg and gestational age less than 30 weeks

Evaluation of high sensitivity C-reactive protein and Von Willebrand factor in patients with myocardial infarction

Many patients who present with acute coronary syndromes have no apparent clinical risk factors. This finding points out the need for markers that better predict cardiovascular risk. Evaluation of high sensitivity C-reactive protein [hs-CRP] serum levels as well as some other inflammatory markers such as von Willebrand factor [vWF] and erythrocyte sedimentation rate [ESR] in patients with acute myocardial infarction [AMI]. This study was performed on twenty five patients with AMI [21 males and 4 females], and twenty five apparently healthy persons as a reference group [20 males and 5 females]. Patients were subdivided into two groups: Group I: included ten patients presenting more than 6 hours after the onset of symptoms.Group II: included fifteen patients presenting within the first 6 hours after the onset of symptoms. Clinical examination and the following laboratory investigations were done: [A] Routine investigations: blood picture, serum glucose, kidney function tests, prothrombin time and concentration, liver function tests, lipogram, ESR, creatine phosphokinase [CPK] and lactate dehydrogenase [LDH] [B] Special Investigations: hg-CRP, vWF-Ag, and Troponin I. LDH, CPK as well as both ESR-1st h and 2nd h values showed elevations in both patient groups compared to controls [p<0.001], but there was no significant difference between the two patient groups: CRP values showed significant elevation in both patients groups compared to controls [p<0.001], and the elevation was significantly pronounced in group I compared to group II [p<0. 001]. Both plasma vWF-Ag and serum Troponin I values showed significant increase in both patient groups compared to controls [p<0.001], but there was no significant difference between the two groups. Significant positive correlations between vWF and CPK [r=0.646, P < 0.001] and between vWF and LDH [r = 0.507, P < 0.01] were found in AMI patients. Both hs-CRP and vWF are significantly high in patients with AMI. Thus, they can be considered as valuable markers of AMI that can aid in the diagnosis of AMI. Consistent and significant elevation of hs-CRP within the first 6 hours in patients developing myocardial infarction, which is attributed to chronic inflammatory atherosclerotic process rather than myocardial damage, suggest that hs-CRP has a potential predictive value for MI