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Algahtani FH, AlQahtany FS, ElGohary G, Alsharidi A, Sayeeda A, AlArfaj H, Gamal AY. The clinical and laboratory manifestations profile of antiphospholipid syndrome among Saudi Arabia population: Examining the applicability of Sapporo criteria. Saudi J Biol Sci 2020; 27:2425-2430. [PMID: 32884425 PMCID: PMC7451729 DOI: 10.1016/j.sjbs.2020.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022] Open
Abstract
Antiphospholipid syndrome is a organized autoimmune disease presented with vascular thrombosis and pregnancy morbidity. The Sapporo classification criteria of APS were revised in 2006 and are used as the main diagnosis guideline, which validity as standard measurements is still in debate. This study observe the clinical and laboratory indices of APS among Saudi patients. This is a retrospective study hospital-based population. The clinical and Laboratory manifestations of diagnosed APS patients from electronical medical records identifies by ICD-9 code 795.79 in the King Saud University Medical City, Riyadh, Saudi Arabia, between 1990 and 2012. We selected patients with ICD-9 code 795.79 as. Sapporo criteria applied to all patients, then divided into cases fulfilled criteria and cases failed the criteria. To notice the difference in clinical and laboratory indices and comorbidities between the two groups, the T-test was performed and Logistic regression for the fulfilled criteria and clinical indices of vascular thrombosis, DVT/PE, recurrent, and pregnancy morbidity. A total of 72 (90%) females and 8 (10%) males, with the female-to-male ratio 9:1. The mean (±SD) age at diagnosis was 28.1 (±8.7) years (range 11-63 years). There were 22 patients (27.5%) attained the revised criteria (APS confirmed) and no significant difference between the two groups was observed (p > 0.2). However, we found Sapporo confirmed APS cases had significantly higher percentage of serological manifestation presence than clinically diagnosed APS cases. Though there is no statistically significance, Sapporo confirmed APS cases had advanced odds of undergoing vascular thrombosis (OR = 1.61, 95%CI) and DVT/PE (OR = 1.53, 95%CI) and lesser odds of undergoing recurrent DVT/PE (OR = 0.67, 95%CI) and pregnancy morbidity (OR = 0.63, 95%CI) than the clinically diagnosed APS cases. Over 70% of the study population with diagnosed APS did not accomplish the revised Sapporo criteria due to negative laboratory manifestations, which reflects heterogeneous but not degreed disease severity profiles.
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Affiliation(s)
- Farjah H Algahtani
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fatmah S AlQahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ghada ElGohary
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia.,Departement of Adult Hematology/Internal Medicine, Ain Shams University, College of Medicine, Cairo, Egypt
| | - Aynaa Alsharidi
- Infectious Unit, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Afsar Sayeeda
- Rheumatology Unit, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein AlArfaj
- Rheumatology Unit, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Y Gamal
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
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Kunjachen Maducolil M, Abid H, Lobo RM, Chughtai AQ, Afzal AM, Saleh HAH, Lindow SW. Risk factors and classification of stillbirth in a Middle Eastern population: a retrospective study. J Perinat Med 2018; 46:1022-1027. [PMID: 29267175 DOI: 10.1515/jpm-2017-0274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/10/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To estimate the incidence of stillbirth, explore the associated maternal and fetal factors and to evaluate the most appropriate classification of stillbirth for a multiethnic population. METHODS This is a retrospective population-based study of stillbirth in a large tertiary unit. Data of each stillbirth with a gestational age >/=24 weeks in the year 2015 were collected from electronic medical records and analyzed. RESULTS The stillbirth rate for our multiethnic population is 7.81 per 1000 births. Maternal medical factors comprised 52.4% in which the rates of hypertensive disorders, diabetes and other medical disorders were 22.5%, 20.8% and 8.3%, respectively. The most common fetal factor was intrauterine growth restriction (IUGR) (22.5%) followed by congenital anomalies (21.6%). All cases were categorized using the Wigglesworth, Aberdeen, Tulip, ReCoDe and International Classification of Diseases-perinatal mortality (ICD-PM) classifications and the rates of unclassified stillbirths were 59.2%, 46.6%, 16.6%, 11.6% and 7.5%, respectively. An autopsy was performed in 9.1% of cases reflecting local religious and cultural sensitivities. CONCLUSION This study highlighted the modifiable risk factors among the Middle Eastern population. The most appropriate classification was the ICD-PM. The low rates of autopsy prevented a detailed evaluation of stillbirths, therefore it is suggested that a minimally invasive autopsy [postmortem magnetic resonance imaging (MRI)] may improve the quality of care.
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Affiliation(s)
- Mariam Kunjachen Maducolil
- Department of Obstetrics and Gynecology, Women's Hospital, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar, Tel.: +97433938513
| | - Hafsa Abid
- Department of Obstetrics and Gynecology, Womens Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rachael Marian Lobo
- Department of Obstetrics and Gynecology, Womens Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ambreen Qayyum Chughtai
- Department of Obstetrics and Gynecology, Womens Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Arjumand Muhammad Afzal
- Department of Obstetrics and Gynecology, Womens Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Stephen W Lindow
- Division Chief Obstetrics, Sidra Medical and Research Center, Weill Cornell Medical College - Qatar, Doha, Qatar
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King ML, Aden A, Tapa S, Jumah R, Khan S. Evidence-based stillbirth prevention strategies: combining empirical and theoretical paradigms to inform health planning and decision-making. Worldviews Evid Based Nurs 2014; 11:258-65. [PMID: 25040460 DOI: 10.1111/wvn.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A global health project undertaken in Qatar on the Arabian Peninsula immersed undergraduate nursing students in hands-on learning to address the question: What strategies are effective in preventing stillbirth? Worldwide stillbirth estimates of 2.6 million per year and the high rate in the Eastern Mediterranean Region of 27 per 1,000 total live births provided the stimulus for this inquiry. METHODS We used a dual empirical and theoretical approach that combined the principles of evidence-based practice and population health planning. Students were assisted to translate pre-appraised literature based on the 6S hierarchical pyramid of evidence. The PRECEDE-PROCEED (P-P) model served as an organizing template to assemble data extracted from the appraisal of 21 systematic literature reviews ± meta-analyses, 2 synopses of synthesized reports, and 9 individual studies summarizing stillbirth prevention strategies in low, middle, and high income countries. Consistent with elements of the P-P model, stillbirth prevention strategies were classified as social, epidemiological, educational, ecological, administrative, or policy. RESULTS Ten recommendations with clear evidence of effectiveness in preventing stillbirth in low, middle, or high income countries were identified. Several other promising interventions were identified with weak, uncertain, or inconclusive evidence. These require further rigorous testing. LINKING EVIDENCE TO ACTION Two complementary paradigms--evidence-based practice and an ecological population health program planning model--helped baccalaureate nursing students transfer research evidence into useable knowledge for practice. They learned the importance of comprehensive assessments and evidence-informed interventions. The multidimensional elements of the P-P model sensitized students to the complex interrelated factors influencing stillbirth and its prevention.
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Affiliation(s)
- Mary Lou King
- Assistant Professor, University of Calgary-Qatar, Doha, Qatar
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Abstract
A szerzők a hydrops foetus előfordulási gyakoriságát, létrejöttének okait vizsgálták. Öt év alatt 555 foetalis és neonatális autopsziás vizsgálatot végeztek. Hydropsot igazoltak 28 magzatnál. Három esetben Rh-izoimmunizáció állt a háttérben, 25 foetusnál nem immun hydrops került megállapításra. Huszonöt esetben sikerült a hydrops kiváltó okát tisztázni, az ok 3 esetben felderítetlen maradt. Tizenkét esetben középidős spontán vetélés, illetve in utero elhalás történt, míg 12 foetusnál orvosi indok alapján történt a terhesség terminálása. Emellett 4 újszülöttkorban meghalt beteget is vizsgáltak. Az orvosi indok alapján történő terhességmegszakításnál a foetusok átlagos kora a 16. és a 20. gesztációs hét között volt, míg a középidős spontán vetélés és in utero elhalás esetén ez a 24. terhességi hetet jelentette. A patológiai vizsgálat valamennyi esetben a terhességi korhoz képest várható testsúlynövekedését, periferiás oedemát, ascitest, illetve hydrothoraxot igazolt. Az esetek felében hydropericardium is látható volt. Hepatosplenomegália, cardiomegália, pulmonális hypoplasia, fokozott extramedulláris hemopoezis, placenta oedema valamennyi esetben megfigyelhető volt. A nem immun hydrops hátterében a következő rendellenességeket találták: 4 esetben cardiális malformatiót, 1 esetben szkeletális rendellenességet, 3 foetusnál kromoszómarendellenességet, 2 foetusnál cysticus hygromát, 3 esetben iker-iker transzfúzióval járó monochorialis diamnialis ikerterhességet, 7 esetben infekciót, 1 foetusnál sacrococcygeális teratomát. Két esetben a kiváltó ok anyai betegséget jelentett. A klinikai és patológiai diagnózisokat összehasonlítva megállapították, hogy a nem immun hydrops kórokával kapcsolatban csupán 3 esetben volt teljes egyezés a klinikai véleménnyel. A patológiai vizsgálat által feltárt kórokot az öröklődés, terápiás lehetőségek mérlegelése szempontjából 10 esetben szignifikánsnak véleményezték. A szerzők kiemelik nem immun hydrops esetén a részletes patológiai vizsgálat szükségességét, a klinikai vizsgálatokkal való korreláció meghatározásának fontosságát, a szerológiai vizsgálatok jelentőségét és a társszakmákkal való együttműködés szükségességet a hydropsos magzatokkal kapcsolatos további teendők meghatározása érdekében.
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Affiliation(s)
- László Kaiser
- Szegedi Tudományegyetem, Altalános Orvostudományi Kar Patológiai Intézet Szeged Allomás u. 2. 6724, Hungary.
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Say L, Donner A, Gülmezoglu AM, Taljaard M, Piaggio G. The prevalence of stillbirths: a systematic review. Reprod Health 2006; 3:1. [PMID: 16401351 PMCID: PMC1360064 DOI: 10.1186/1742-4755-3-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 01/10/2006] [Indexed: 11/23/2022] Open
Abstract
Background Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. Obtaining overall estimates across various regions of the world is not straightforward due to variation in definitions, data collection methods and reporting. Methods We conducted a systematic review of a range of pregnancy-related conditions including stillbirths and performed meta-analysis of the subset of studies reporting stillbirth rates. We examined variation across rates and used meta-regression techniques to explain observed variation. Results We identified 389 articles on stillbirth prevalence among the 2580 included in the systematic review. We included 70 providing 80 data sets from 50 countries in the meta-analysis. Pooled prevalence rates show variation across various subgroup categories. Rates per 100 births are higher in studies conducted in less developed country settings as compared to more developed (1.17 versus 0.50), of inadequate quality as compared to adequate (1.12 versus 0.66), using sub-national sample as compared to national (1.38 versus 0.68), reporting all stillbirths as compared to late stillbirths (0.95 versus 0.63), published in non-English as compared to English (0.91 versus 0.59) and as journal articles as compared to non-journal (1.37 versus 0.67). The results of the meta-regression show the significance of two predictor variables – development status of the setting and study quality – on stillbirth prevalence. Conclusion Stillbirth prevalence at the community level is typically less than 1% in more developed parts of the world and could exceed 3% in less developed regions. Regular reviews of stillbirth rates in appropriately designed and reported studies are useful in monitoring the adequacy of care. Systematic reviews of prevalence studies are helpful in explaining sources of variation across rates. Exploring these methodological issues will lead to improved standards for assessing the burden of reproductive ill-health.
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Affiliation(s)
- Lale Say
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allan Donner
- Department of Epidemiology and Biostatistics, Faculty of Medicine and Dentistry, University of Western Ontario, London, Canada
- Robarts Clinical Trials, Robarts Research Institute, London, Canada
| | - A Metin Gülmezoglu
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Monica Taljaard
- Department of Epidemiology and Biostatistics, Faculty of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Gilda Piaggio
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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