Prediction of Placenta Previa from Serial Reading of Serum Human Chorionic Gonadotropin Late in the First Half of Pregnancy

Background

Abnormally sited placenta is considered a major life-threatening condition for pregnant woman, and many debate about the way of early diagnosis and management to decrease the mortality and morbidity.

Aim of Study

To evaluate the role of beta-human chorionic gonadotrophin (B-HCG) level in the first half of pregnancy as a marker for prediction of placenta previa.

Study Design

This is a prospective study done in Al-Yarmouk Teaching Hospital from first of January 2020 till first of January 2021.

Material and Methods

A total of 57 patients have been recruited. For all participated women in this study were sampled between 14 and 18 weeks of gestational age for serum human chorionic gonadotropins measured in international units. Patients who developed placenta previa were diagnosed on the basis of development of vaginal bleeding either late in the second trimester or early in the second trimester. After developing vaginal bleeding, all patients were sent for routine ultrasound scan to confirm the presence of placenta previa.

Result

After recruiting a total of 57 women among which 14 patients were found to have placenta previa, ANOVA test shows a statistically significant difference between women with normal placenta and women with placenta previa P value < 0.001. Receiver operator characteristics curve was constructed to evaluate the optimum cutoff value for serum HCG between normal women and women with placenta previa sampled at 14-18 weeks of gestation. The optimum cutoff value is mean serum HCG > 105,380 IU in 14 weeks of gestation, and the sensitivity and specificity were calculated as 100% and 72.2%, respectively.

Conclusion

B-HCG level in first half of pregnancy can be used as a predictor marker for placenta previa.

Cadmium (Cd) influences calcium (Ca) levels in the skeleton of a freshwater fish Channa gachua

Abstract Environmental contamination with heavy metals is a threat to the organisms due to their toxicity, persistence and bioaccumulation in food chains. The study was aimed to assess cadmium (Cd) effect on calcium (Ca) level in bones of a freshwater fish Channa gachua. 42 fish individuals were kept into six (6) aquaria; labelled aq.0, 1, 2, 3,4 and 5 in the laboratory for treatment. Aq.0 was control group and aq.1, 2,3,4,5 were experimental with treatment solution of Cd 0, 0.1ppm, 0.5ppm, 1ppm, 2.5ppm and 5ppm respectively for three months. After exposure, bones tissue were examined for Cd accumulation and Ca concentration. Highest accumulation of Cd were recorded in aq.5 mean 46.86 ± 0.46 mgkg-1 .and lowest in the control group with mean 0.61 ± 0.06 mgkg-1. The order of Cd bioaccumulation in bones were aq.5 > aq.4 >aq.3 > aq.2 > aq.1 > aq.0. Highest concentration of Ca were noted in aq.0 (Control group) mean 7888.06 ± 4827.22 mgkg-1 and lowest were 1132.36 ± 203.73 mgkg-1 in aq.5 (at 5.0 ppm). Generally a pattern of decreasing Ca level were observed with each rise of Cd bioaccumulation aq.0 > aq.1 > aq.2 > aq.3 > aq.4 > aq.5. Current study indicated that Cd accumulation have substantial effect on Ca level in bones and hence on skeleton system. Strict rules must be implemented by government to control metals pollution and exploitations of biota.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia: A single-center experience

BACKGROUND

Preeclampsia (PE) is a pregnancy syndrome of undetermined etiology; inflammation was one of the proposed theories for its development.

AIM

To examine the platelet to lymphocyte ratio (PLR), an inflammatory biomarker, as a marker to predict poor maternal-neonatal outcomes in early-onset PE (EoPE).

METHODS

A cross-sectional study enrolled 60 pregnant women with EoPE (at 32-30 wk of gestation) at a university hospital. Demographic criteria and hematological indices were collected, including platelet counts and indices (mean platelet volume and platelet distribution width), PLR, and the Doppler study, which calculated estimated fetal weight (EFW), amniotic fluid index (AFI), resistance index (RI), and pulsatility index (PI). Participants were followed until delivery, where maternal outcomes were recorded, including; delivery mode and reason for cesarean section, and neonatal outcomes, including fetal growth restriction (FGR), meconium-stained liquid, the 5-min Apgar score, and admission to the intensive care unit.

RESULTS

There was a trend of insignificant increases in cesarean sections. Sixty-one-point two percent (37/60) fetuses were admitted to the neonatal care unit; 70.0% of admitted fetuses were meconium-stained liquor, and 56.7% of them had FGR. PLR was positively correlated with AFI and EFW as r = 0.98, 0.97, P < 0.001; PLR showed negative correlations with PI and RI as r = -0.99, -0.98, P < 0.001. The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation (0.69, -0.98), P < 0.0001, respectively. Receiver operating characteristic calculated a PLR cutoff value (7.49) that distinguished FGR at 100% sensitivity and 80% specificity.

CONCLUSION

Strong, meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications. Further studies are suggested to see the impact on maternal-neonatal health.

Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome

BACKGROUND

Insulin resistance (IR) was reported in most polycystic ovarian syndrome (PCOS) cases. Metformin, a biguanide drug, successfully reduced IR. Homeostatic Model Assessment for IR (HOMA-IR) and Doppler parameters assessed metformin's effectiveness.

AIM

To verify whether the area under the curve of the internal carotid artery (AUC-ICA) Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.

METHODS

An observational, cross-sectional study recruited 54 eligible PCOS women; the anthropometrics were as follows: age, body mass index (BMI), menstrual cycle days, biochemical serum cholesterol, low and high-density lipoprotein, sex hormone-binding globulin, fasting blood glucose, and HOMA-IR, hormonal testosterone, luteinizing hormone over follicle-stimulating hormone ratio, and ultrasonic pulsatility index (PI) and resistance index (RI), carotid artery intima-media thickness (CIMT) and (AUC-ICA) parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg; three times/day for 6 mo. In addition, AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.

RESULTS

Metformin caused a progressive reduction in BMI, menstrual cycle days, biochemical hormonal, and Doppler parameters (CIMT, PI, RI, and AUC-ICA). AUC-ICA correlated strongly to all PCOS parameters. AUC-ICA correlated inversely with treatment time (r = -0.98, P < 0.001) and positively with HOMA-IR (r = 0.98, P < 0.0001). Via the best subset regression model, the AUC-ICA had the highest predictive value for HOMA-IR.

CONCLUSION

AUC-ICA preceded PI, RI, and CIMT with a strong, meaningful correlation to all PCOS parameters, making it a reliable marker for the assessment of IR, especially during metformin therapy. Further studies are recommended to promote the application in practice.

Fertility outcomes following bariatric surgery

Obesity impacts human health in more than one way. The influence of obesity on human reproduction and fertility has been extensively examined. Bariatric surgery (BS) has been used as an effective tool to achieve long-term weight loss in both sexes. BS improves hormonal profiling, increasing the odds of spontaneous pregnancy and success rates following assisted reproductive techniques in infertile females. For obese males, BS does improve sexual function and hormonal profile; however, conflicting reports discuss reduced sperm parameters following BS. Although the benefits of BS in the fertility field are acknowledged, many areas call for further research, like choosing the safest surgical techniques, determining the optimal timing to get pregnant, and resolving the uncertainty of sperm parameters.

Effect of gender on the reliability of COVID-19 rapid antigen test among elderly

Defining con-founders that affect the reliability of diagnostic tests for coronavirus disease 2019 is vital to breaking the chain of infection. The elderly population is a higher risk group for the emerging virus. However, gender seems to exert a critical role in modifying the infection risk among women owing to hormonal changes. The menopause transition is an exceptional period for older women where the protective and immunomodulatory effects of the estrogen hormone are lost. Accordingly, attention should be given to postmenopausal women since they will have an increased risk compared to their pre-menopausal peers.

The dilemma of COVID-19 Diagnosis in Pregnancy

Coronavirus Disease 2019 is a new and rapidly developing health crisis. Ongoing researches are looking at the prevalence and consequences of COVID-19 in the obstetric community and postnatal period. In COVID 19 era, pregnant mothers are prone to infection with the severe acute respiratory syndrome coronavirus 2, with a higher risk of poor pregnancy outcomes. Therefore, an accurate and early diagnosis is a necessity for this vulnerable group. Screening for asymptomatic carriers is a cornerstone to limit the COVID-19 pandemic. It is vital to evaluate patients’ clinical symptoms and epidemiological history carefully. Although the serological test; Polymerase chain reaction RT-PCR can confirm infection, it cannot determine the degree or severity of the illness. Moreover, it has false-negative results. Imaging tests allow exact diagnosis of lung damage, the severity of the disease, and the classification of patients. Comprehensive analyses of serological and imaging data will assist in the formation of an appropriate clinical diagnosis. This review will discuss the updates and critical points in establishing COVID-19 infection in pregnant women with their pros and cons.

Alpha-1antitrypsin in pre-eclampsia; from a clinical perspective

OBJECTIVE

To assess serum Alpha-1 antitrypsin (AAT) levels in women with pre-ecclampsia and correlate them with other parameters of pre-eclampsia.

METHODS

A case-control study was conducted at Al-Yarmouk Teaching Hospital, Baghdad from February 2019 to February 2020. Included were 85 pregnant women with 32-34 weeks of gestation. They were divided in 2 groups: pre-eclamptic cases 40/85, and normotensive controls (45/85). PE was defined based on NICE 2018 guidelines. Patients' age and blood pressure (BP) were recorded. We evaluated mean platelet volume (MPV), platelet distribution width (PDW), serum levels of uric acid, and AAT blood samples.

RESULTS

AAT levels were significantly lower among preeclamptic cases (0.26) mg/dl versus controls (0.63) mg/dl. Negative correlations were found between levels of AAT and other variables (systolic BP, diastolic BP, MPV, PDW, and serum uric acid levels) with a coefficient of correlation ( r) -0.43,-0.43,-0.25,-0.25, and- 0.26 respectively. P-value <0.05 was estimated for all.

CONCLUSION

Significant lower levels of AAT in pre-eclamptic patients versus controls suggest that it contributes to pre-eclampsia development. The second finding was negative correlations of reduced AAT with the most common maternal parameters assessing pre-eclampsia severity. Taken together, these results indicate that AAT is intimately linked to the pathophysiology of PE development and progression. Further work is warranted to verify the AAT role in pre-eclampsia.

Pinworm infection in school children of four districts of Malakand region, Khyber Pakhtunkhwa, Pakistan

Illnesses caused by human pinworm remains a pediatric health problem in developing nations including Pakistan. This study aimed to investigate the prevalence of Enterobius vermicularis in school children of four districts in Malakand region, Pakistan. Four hundred faecal specimens were screened from May 2014 to July 2017 using normal saline and Lugol Iodine solution. Twenty three (5.75%) individuals were found infected with E. vermicularis. Five children (1.25%) were infected with only E. vermicularis and eighteen (4.5%) were mixed with other helminths. E. vermicularis 23 (5.75%), hookworm 11 (2.75%), Ascaris lumbricoides 5 (1.25%), Taenia saginata 2 (0.5%) and Trichuris trichuira 4 (1%) were detected. Age wise 5-8 years were more parasitized followed by 13-15 and 9-12 years of age (0.0296, P<0.05). Male children were highly (0.06700, P<0.05) infected than female. Children in Malakand district were found more infected followed by Dir Upper, similar infection rate was noted in children of districts Lower Dir and Swat (0.0192, P<0.05). Children in primary level were highly (0.0013, P<0.05) infected than those of middle and high levels. Enterobiosis is still the most common parasitic diseases in children. Studies on enterobiosis should be conducted time by time to recognize the hazardous of such parasitic infection in remote areas of the country.

First Report of Curvularia lunata Causing Leaf Spots on Sorghum bicolor from Pakistan

In October 2012, reddish brown, oblong lesions with chlorotic centers were observed on the leaves of Sorghum bicolor in Punjab Province, Pakistan. Early symptoms appeared as reddish brown circular spots on the leaves. These spots increased in size and coalesced to form oblong lesions. Entire fields were severely affected by the disease. Pathogen isolations were made on malt extract agar (MEA) media. Symptomatic leaf samples were cut into 4 to 6 mm² pieces, surface sterilized (10% bleach for 1 min, 90% ethanol for 30 sec) and rinsed in sterilized water several times, followed by air drying. These samples were plated onto 2% MEA media, supplemented with 10 mg/liter chloramphenicol, and incubated at 25°C for 6 days in the dark. A mitosporic fungus of dark brown colony, bearing large stroma, appeared on the media. Conidiophores were brown, septate, geniculate, simple or unbranched, with dark brown scar. Conidia were brown, straight to pyriform, with 3 to 4 cells, with large and curved central cells, smooth walled, ranging in size from 7.3 to 21.26 μm, and produced apically in a sympodial manner. Based on morphological characteristics, the pathogen was identified as Curvularia lunata (Wakk.) Boedijn. (1,2). Morphological identification was also confirmed by the First Fungal Culture Bank of Pakistan (FCBP), Institute of Agricultural Sciences, University of the Punjab, Lahore, Pakistan, and samples were submitted to FCBP (Accession No. 1201). The fungus was further identified by amplifying internal transcribed spacer region sequences (ITS1, rDNA, ITS2) by using ITS4 and ITS5 primers (4). The resulting 584-bp sequence was submitted to GenBank with Accession No. HG326308. This sequence showed 99% homology with C. lunata strain pingxiang (GenBank Accession No. JQ701897), causing leaf spots of lotus in China. Pathogenicity assay was conducted on 20-day-old seedlings of S. bicolor variety Indian Gold, grown from surface sterilized seeds. Fifteen replicate plants were sprayed with a spore suspension of 1 × 10⁶ spore/ml in distilled sterilized water, prepared from 1-week-old fungal culture, grown in the dark on 2% MEA media. Five replicate plants were sprayed with distilled sterilized water as control. Plants were covered with transparent polyethylene bags to retain moisture and enhance disease development, and kept in a greenhouse at ~30°C. Bags were removed after 5 days of incubation. Inoculated plants developed lesions similar to those observed on naturally infected plants. No symptoms were observed on control plants. The pathogen was re-isolated from infected leaves, and the morphology features were again studied, matching those of the pathogen isolated from field samples. Curvularia leaf spot diseases, caused by different Curvularia species, have been previously found on many grass species worldwide (3). To our knowledge, this is the first report of C. lunata leaf spots on S. bicolor in Pakistan. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes. Commonwealth Mycological Institute, Kew, Surrey, England, 1971. (2) F. B. Rocha et al. Austral. Plant Pathol. 33:601, 2004. (3) J. D. Smith et al. Fungal diseases of amenity turf grasses. E & F.N. Spon., New York, 1989. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

First Record of Acremonium Wilt in Tomato from Pakistan

During a survey in May 2011, tomato (Lycopersicon esculentum Mill.) plants were observed exhibiting wilt symptoms on the vegetable farm of the University of the Punjab Lahore (31°32'59″ N, 74°20'37″ E), Pakistan. Plants were pale yellow and stunted. Diseased plants were scattered in the field either singly or in groups of two or three. Lower leaves turned yellow following necrosis and shedding from the plants. Roots of diseased plants were dark brown in comparison to the healthy ones. Vascular browning was observed when infected stems were split longitudinally and sectioned transversely. Necrotic vascular strands were also observed in infected stems. With a stereoscope, white hyphae were noticed in the vascular region of infected plants. Stained cross sections of stems of wilted plants showed fungal hypha. A diseased plant sample was taken to the First Fungal Culture Bank of Pakistan (FCBP) for identification of the pathogen. Conidia appeared on potato dextrose agar after incubation in diurnal light, and were unicellular, smooth, thin-walled, and oval in shape (3 to 6 × 1 to 3 μm), forming aggregations on the tip of conidiophores. With the help of diagnostic keys and available literature, the isolated fungus was identified as Acremonium strictum W. Gams. The fungus formed whitish flat colonies with deposition of gum granules on its surface. Hyphae and phialides were hyaline and non-pigmented. Phialides with expanded bottoms were elongated measuring 25 to 40 μm and solitary in position at right angles to the filament. To further confirm identification, amplification of the ITS1 and ITS2 regions was performed with universal primers ITS1 and ITS4 (4). The ITS sequence obtained was submitted to NCBI as accession JQ916901. The culture was deposited in FCBP (1099), Institute of Agricultural Sciences, University of the Punjab, Pakistan. A pathogenicity test of the isolated fungus was performed by inoculating 15 healthy tomato plants cv. Rio Grande in three replicates. The spore suspension (2 × 10⁵ conidia/ml of sterile distilled water) was prepared from 12-day-old cultures of the fungus grown from a single spore on PDA in continuous light. Control plants were treated with sterile distilled water. Tomato plants inoculated with the fungus started showing wilting symptoms within 2 weeks, while the control remained healthy. A. strictum was re-isolated from inoculated wilted plants, thus satisfying Koch's postulates. Previously, A. strictum was a reported cause of wilt in many plants including Chrysanthemum maximum (2), watermelon (1), and Gladiolous grandiflorus (3). To our knowledge, wilt in tomatoes has been reported only from Fusarium oxysporum and Pseudomonas solanacearum from Pakistan. To our knowledge, this is the first record of Acremonium wilt in this economically important crop. References: (1) B. D. Bruton et al. Plant Dis. 79:754, 1995. (2) A. R. Chase. Calif. Agric. 32(10):21, 1978. (3) E. Gonzalez-Perez. J. Plant Pathol. 90:586, 2008. (4) T. J. White et al. Pages 315-322 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

Origin and subsurface history of geothermal water of Murtazabad area, Pakistan--an isotopic evidence

The Murtazabad area represents one of the major geothermal fields in Pakistan, with seven hot springs lying along the Main Karakoram Thrust. Discharge of the springs is 50-1200 l per minute with the surface temperature from 40 to 94 degrees C. Environmental isotopes and chemical concentrations have been used to investigate the origin and subsurface history of thermal water. Four sets of water samples were collected and analyzed for various isotopes including 18O, 2H and 3H of water; 34S and 18O of dissolved sulphates and chemical contents. Isotopic and chemical data show that the origin of thermal water is meteoric water. On the delta-diagram, delta18O and delta2H data plotting below the local meteoric water line with a slope around 12.3 show that the original thermal water receives recharge from precipitation at higher altitude (3000 m) and undergoes delta18O shift of about 1 per thousand due to exchange with rocks. Different correlations between isotopes, temperature and Cl indicate that the observed isotopic compositions have evolved due to mixing of different proportions of shallow water at different spring paths during movement of thermal water towards the surface. It is also inferred from the tritium data along with delta18O and delta2H that the circulation time is long and is estimated to be more than 50 years.