First-trimester placental protein 13 screening for preeclampsia and intrauterine growth restriction.

OBJECTIVE: The purpose of this study was to evaluate first-trimester serum placental protein 13 (PP13) as a screening test for preeclampsia and intrauterine growth restriction (IUGR). STUDY DESIGN: We performed a prospective, nested case-control study in the Massachusetts General Hospital Obstetric Maternal Study. PP13 was measured by solid-phase sandwich enzyme-linked immunosorbent assay in serum samples that were collected at the first prenatal visit (9-12 weeks of gestation) from women who subsequently experienced preeclampsia (n = 47), IUGR (n = 42), or preterm delivery (n = 46). Women with uncomplicated term deliveries served as control subjects (n = 290) and were matched to cases by gestational age when serum was collected and for the duration of specimen storage. RESULTS: The median first-trimester PP13 level was 132.5 pg/mL in the control subjects. Median PP13 levels were significantly lower among women who had preeclampsia (27.2 pg/mL; P < .001), IUGR (86.6 pg/mL; P < .001), and preterm delivery (84.9 pg/mL; P = .007). When PP13 was expressed as multiples of the gestational age-specific medians among the control subjects, the multiples of the medians were 0.2 for preeclampsia, 0.6 for IUGR, and 0.6 for preterm delivery (P < .001 for each disorder compared with control subjects). Receiver operating characteristic analysis yielded areas under the curve of 0.91, 0.65, and 0.60 for preeclampsia, IUGR, and preterm delivery, respectively. At a 90% specificity rate, the corresponding sensitivities were 79%, 33%, and 28%, respectively. CONCLUSION: The screening of maternal PP13 levels in the first trimester is a promising diagnostic tool for the prediction of preeclampsia with high sensitivity and specificity.

Azithromycin versus comparative therapy for the treatment of community acquired pneumonia.

A 3-day course of azithromycin was compared with the 10 days of other antibiotics, which general practitioners routinely use as therapy for community acquired pneumonia (CAP). The study was a prospective open labelled, randomised, multicentre, comparative study from five family clinics. Patients with clinical and radiological evidence of pneumonia were included. The pneumonia resolved in 98.4% (61/62) of patients treated with azithromycin and in 87% (40/46) of patients treated with other antibiotics (P < 0.017). Restitution of normal function at home (2.3 +/- 1.2 and 4.3 +/- 2.6 days) and return to work (3.4 +/- 2.0 and 5.5 +/- 3.1 days) was more rapid among the group treated with azithromycin ( P < 0.001). Three days of azithromycin was more convenient and cost effective than the comparators used to treat pneumonia.