Fibronectin as an Early Predictor of Gestational Hypertension/Preeclampsia.

Hypertensive disorders complicate 2% to 8% of pregnancies globally. They are one of the leading causes of maternal mortality responsible for 16% of maternal deaths. Preeclampsia is a pregnancy specific syndrome whose pathophysiologic features have not been clearly established, but research during past two decades has suggested that maternal endothelial damage and improper placental development are involved in the genesis of preeclampsia. Fibronectin is known to be a marker of endothelial dysfunction, which occurs in early gestation in women who develop preeclampsia in later gestation and hence levels of fibronectin may vary in first trimester itself in such women. We wanted to examine the usefulness of single biomarker ‘plasma fibronectin’ in screening of pregnant women for gestational hypertension/preeclampsia, study the difference in fibronectin levels in early versus late onset gestational hypertension/preeclampsia and evaluate its levels in preeclampsia with severe features.METHODS200 antenatal women with singleton pregnancy, who were normotensive were enrolled in the study and plasma fibronectin levels were measured at 10-12 weeks of gestation. Women were followed throughout pregnancy and 12 weeks postpartum. Plasma fibronectin levels were compared between normotensive women and women who developed gestational hypertension/preeclampsia.RESULTSThe mean values of plasma fibronectin are significantly higher in group who developed gestational hypertension/preeclampsia compared to group who remained normotensive (167+/-81 vs 114+/-58; p<0.05). The mean value in group with early onset disease as well as preeclampsia with severe features is higher than that of group with late onset disease and preeclampsia without severe features respectively. But the difference is not statistically significant.CONCLUSIONSStudy showed that plasma fibronectin could be used as a marker for early prediction of gestational hypertension/ preeclampsia.

Study of Correlation Between Mid Trimester Serum Beta Human Chorionic Gonadotropin Levels and Prediction of Hypertensive Disorders of Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP)are among the commonest medical disorders during pregnancyconstituting one of the greatest causes of maternal and perinatalmorbidity and mortality worldwide. In view of increasedmaternal and foetal morbidity and mortality associated withHDP and lack of definite predictive test for early identificationof the woman at the risk of HDP, this study was undertaken tocorrelate the raised serum beta hCG measured in early secondtrimester with prediction of HDP.Material and Methods: The study group consisted of A totalof 150 pregnant women attending Maharaja Agrasen hospitalOPD/IPD during their second trimester (14-20 weeks) ofpregnancy from Dec 2016 to Nov 2017.Results: Out of 146 cases studied, 129 cases remainednormotensive and 17 cases developed HDP. Out of 17 cases,8 cases had mild HDPs and 9 cases had severe HDPs. Weobserved that serum β hCG levels for those women (GroupA) who developed HDPs were significantly higher thannormotensive group (B). By using β hCG value of 2 MoM asa cut off, its sensitivity as a screening test for HDP was 58.8%,the specificity was 96.9%, and the positive and negativepredictive values were 71.43% and 94.70 respectively.Conclusion: My study showed that raised mid trimesterserum β hCG value can be used for prediction of Hypertensivedisorder of pregnancy before its clinical outset as well asdrawing special attention and care of cases having raised βhCG value from initial phase to prevent both maternal andfetal morbidity and mortality resulting from HDP. Our studyalso revealed correlation between raised mid trimester serumβ HCG value and severity of HDP.

Hypertensive disorders of pregnancy: a clinical study in a rural tertiary care centre of western Uttar Pradesh, India

Background: The aim of study was to find out the frequency and clinical outcome in hypertensive disorder of pregnancy (HDP) in a rural tertiary care centre. Hypertensive disorder of pregnancy is a commonest medical disorder which constitutes about 12-22% of all pregnancies and it is a major cause of maternal morbidity as well as mortality world wide.Methods: It is a retrospective hospital-based study to find out the clinical outcome in different hypertensive disorder of pregnancy in a rural tertiary care centre of western Uttar Pradesh.Results: Present study showed the prevalence of HDP was 4.01% among the study population. Most of the patients were primipara ,unbooked and less than 25 years of age. The most common HDP was mild preeclampsia  and HELLP was its commonest  complication.Conclusions: Hypertensive disorder of pregnancy (HDP) is still a major cause of maternal mortality and morbidity. Authors intend to aware the pregnant women regarding high risk factors of pregnancy and motivate them for regular antenatal care so that  complications of  hypertensive disorders can be  managed timely.

Periodic Assessment of Antenatal and Post Natal Serum Endothelin-1 (ET-1) and Nitric Oxide (NO) Levels in Hypertensive Disorders of Pregnancy (HDP)

@#Introduction: Hypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Materials and Methods: Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk.

Study on the New Clinical Significance of Routine Indexes in Pregnant Women with HDP before 20 Weeks of Pregnancy / 现代检验医学杂志

Objective To explore the new clinical significance of these routine test indexes and find the early biomarkers for predicting hypertension disorder complicating pregnancy(HDP) by the comparative analysis between pregnant women with HDP and normal pregnant women before 20 weeks,including biochemical,blood coagulation and blood routine indexes.Methods A case-control study was conducted to review the clinical data of pregnant women who were undertaken prenatal examination and delivered in Guangzhou Women and Children's Medical Center from 2012 to 2016.The pregnancy were divided into HDP group and control group according to the gestational week and age.Analyzed the related test indexes before 20 weeks of pregnancy.The two groups variables were analyzed by Kolmogorov-Smirnov for normal distribution.Approximate measurement data of normal distribution were mean± standard deviation (x± s) for statistical description,while the data of the skewed distribution was median and percentile[M(P25～P75)]for statistical description.The diagnostic value was analyzed by logistic regression equation and receiver operating characteristic curves (ROC).Results The level of biochemical indexes (AST,γ GT and UA) of HDP group was significantly higher thanthe normal group (t=2.50,3.34,4.56,P＜ 0.05).Meanwhile the level of blood indexes (RBC,PLT and HCT) of HDP group was significantly higher than the normal group (t=2.89,4.51,3.29,all P＜0.01).Other indicators of two groups (ALT,TBIL,Cr,Urea,PT,APTT,TT,FIB and HGB) were not significantly different (t=0.25～ 1.85,all P＞0.05).Then the logistic regression model equation was Y=-5.497+0.010 * PLT+0.043 * γ-GT+0.007 * UA+0.045 * AST.The area under ROC curve (AUC) was 0.746 for the combination of the four indexes.The combination resulted in a higher sensitivity of 0.818 and specificity of 0.523.Conclusion Before 20 weeks of gestation,compared with normal group,liver and kidney function in patients with HDP and high blood coagulation state was damaged.Can by combined detection of AST,UA,γ-GT and PLT index,early prevention and diagnosis of gestational hypertension,effective intervention measures taken as soon as possible to improve the prognosis of pregnancy.

Bone Positron Emission Tomography with or without CT Is More Accurate than Bone Scan for Detection of Bone Metastasis

OBJECTIVE: Na18F bone positron emission tomography (bone PET) is a new imaging modality which is useful for the evaluation of bone diseases. Here, we compared the diagnostic accuracies between bone PET and bone scan for the detection of bone metastasis (BM). MATERIALS AND METHODS: Sixteen cancer patients (M:F = 10:6, mean age = 60 +/- 12 years) who underwent both bone PET and bone scan were analyzed. Bone PET was conducted 30 minutes after the injection of 370 MBq Na18F, and a bone scan was performed 3 hours after the injection of 1295 MBq 99mTc-hydroxymethylene diphosphonate. RESULTS: In the patient-based analysis (8 patients with BM and 8 without BM), the sensitivities of bone PET (100% = 8/8) and bone scan (87.5% = 7/8) were not significantly different (p > 0.05), whereas the specificity of bone PET (87.5% = 7/8) was significantly greater than that of the bone scan (25% = 2/8) (p < 0.05). In the lesion-based analysis (43 lesions in 14 patients; 31 malignant and 12 benign), the sensitivity of bone PET (100% = 31/31) was significantly greater than that of bone scan (38.7% = 12/31) (p < 0.01), and the specificity of bone PET (75.0% = 9/12) was also significantly higher than that of bone scan (8.3% = 1/12) (p < 0.05). The receiver operating characteristic curve analysis showed that bone PET was significantly more accurate than the bone scan in the patient (p = 0.0306) and lesion (p = 0.0001) based analyses. CONCLUSION: Na18F bone PET is more accurate than bone scan for BM evaluation.

(99m)Tc-HDP Bone Scintigraphy Finding of Metastatic Renal Cell Carcinoma Bone Lesion Changed from Hot to Cold Lesion: Comparing with (18)F-FDG PET/CT / 핵의학분자영상

A 26-year-old man with renal cell carcinoma underwent (99m)Tc-HDP bone scintigraphy for detecting bony metastasis after left total nephrectomy for renal cell carcinoma. (99m)Tc-HDP bone scintigraphy showed small hot lesion in the first lumbar spine. About 12 months later, he underwent spinal MRI for lower back pain. A large mass was seen around spinous process of the first lumbar spine (L1) on spinal MRI and confirmed as metastatic renal cell carcinoma by bone biopsy. (99m)Tc-HDP bone scintigraphy and (18)F-FDG PET/CT were underwent for further evaluation. (99m)Tc-HDP bone scintigraphy showed cold lesion in the first lumbar spine which was initially hot and newly developed hot lesion in the twelfth thoracic spine, and which were shown as hypermetabolic lesions in (18)F-FDG PET/CT. We report a case of bony metastasis from renal cell carcinoma which is changed from hot lesion to cold lesion in (99m)Tc-HDP bone scintigraphy and compare with (18)F-FDG PET/CT.

Juvenile Dermatomyositis Diagnosed by (99m)Tc-HDP Three-phase Bone Scintigraphy / 핵의학분자영상

Juvenile dermatomyositis is a common inflammatory muscle disease of childhood, characterized by weakness in proximal muscles and specific skin rash. In case of juvenile dermatomyositis without characteristic clinical features, non-invasive imaging tools such as (99m)Tc-HDP three-phase bone scan are very helpful in diagnostic workup of myopathies. We report a case of 13-year old female with juvenile dermatomyositis, in which (99m)Tc-HDP three-phase bone scan was useful in diagnosis and assessing therapy response.