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The Significance of (Platelet/White Blood Cell) Counts Ratio in Screening for High Risk for Preeclampsia and Its Related Complications

Authors: Wisam Akram --- Duha Muaeed
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2019 Volume: 18 Issue: 1 Pages: 36-42
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: We have taken a standpoint that the scope of the platelet count or its variance is significantly higher in pregnancy; 50,000-6,00, 000 compared to the white blood cells(WBC) 9,000-11,000. Hence, their ratio may be a useful marker in predicting preeclampsia.Aim of the Study: The aim of this study was to verify that placental weight (PW ratio) or platelet/WBC count might be a useful screeningratio for preeclampsia and its related complications. Patients and Methods: We have taken a total of 104 primigravida patients, each one iscorresponding to the gestational ages (GA) 20–34 weeks, and seven patients per each week for initial PW ratio assessment. In addition, allwomen were told to come again at 34 weeks of gestation for reassessment of PW ratio (platelet/WBC) count, and a meticulous ultrasoundexamination for intrauterine growth restriction (IUGR) as well as biophysical profile. Results: At the end of the study, we subdivided the 104initial sample into three subgroups; normal women (n = 76); women with preeclampsia but no IUGR (n = 16); and women with preeclampsiaand IUGR (n = 12). There was a statistically significant difference between the three groups with regard to systolic, diastolic, and PW ratio.In addition, the PW ratio was significantly different among the three subgroups using the analysis of variance test. Nonlinear polynomial ofthe third degree between PW ratio and GA has shown a significant correlation between PW ratio and GA. The correlation between them wasstatistically significant, yet the distribution of PW was normal in distribution P = 0.16. In addition, since all screening test should be subject toWeibull distribution, we challenged the PW ratio against this distribution and was found to be positive P = 0.3 by using the Kolmogorov–Smirnovtest. At last, logistic regression was constructed to evaluate the correlation between PW ratio and the number of infants with IUGR, and ahighly positive correlation was found P = 0.0001. Moreover, PW was significant with all the items of the biophysical profile which includesbody posture, gross body movement, respiratory fetal movement, oligohydramnios, and NST. At last, we have constructed easily used chartand reference tables for PW ratio between 20 and 34 weeks; hence, they can be used in clinical practice to verify this ratio among womenwith preeclampsia. Conclusion: A simple easily to calculate ratio has been constructed which has been shown in this paper to be significantlycorrelated to preeclampsia and IUGR, and from this ratio, easy reference table and figure have been constructed. Yet, by no mean, we call thatthis ratio or table is used as a substitute for clinical methods to screen or to diagnose preeclampsia until its significance is evaluated by furthertrials. However, it may be of value as an adjuvant test to other standard tests used for preeclampsia screening or monitoring.


Article
Reliability of Clinical Aspect and Transaminases Level as a Guidance for Screening for Sero-positive Hepatitis C in Multi-transfused β-Thalassaemia Patients
إمكانية استخدام الجانب ألسريري و فحص إنزيمات الكبد كدليل للكشف عن التهاب الكبد الوبائي نوع C في مرضى β - الثلاسيميا بعد عمليات نقل الدم إليهم

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Abstract

Background: Although regular blood transfusion enhances the overall survival of thalassaemia patients, it have a significant threat of infection with transfusion-related infections, including hepatitis C; therefore, screening is mandatory. Routine screening with anti-hepatitis C Ab was recommended many years ago; sometimes they depend on level of liver enzymes. Objective: To evaluate the clinical and biochemical features of seropositive hepatitis C virus infection in multi-transfused β-thalassaemia patients to verify if they can be used as a guidance for screening.Patients and Methods: A retrospective- study done from June to September of 2014 at Thalassaemia Center in Baqubah city - Diyala province - Iraq. All registered β- thalassaemia major and intermedia patients were included, involving adults. Enzyme linked immunosorbant assay was used to screen for hepatitis C virus. Symptoms, signs, and biochemical features, including liver transaminases level, of sero-positive patients were gathered and analyzed. Descriptive statistical analysis and Pearson chi- square test was appliedto analyze data by using Statistical Package for Social Sciences software, version 16.Results: The total enrolled subjects were 215, male gender comprises 54.9% (n=118); most of the included patients were under 12 years old. The results indicate that 11.2%(n= 24) of multi-transfused β- thalassaemia patients showed serological evidence of hepatitis C. The highest anti-HCV prevalence was observed at ≥ 18 years old patients (p value=.000). More than two third of cases were male gender (p value=.041), but the gender was not associated with positive serology for hepatitis C in the whole sample of the study (p value=.096). All anti-HCV positive patients were clinically asymptomatic; biochemically, 75% (n=18) of them had normal liver transaminases levels (p value=. 014). Conclusion: Asymptomatic clinical status and unreliable transaminases level elevation cannot be helpful as directory for screening, we encourage the continuation of the usual routine screening test by enzyme linked immunosorbant assay for hepatitis C in β-thalassemia patients; it is more crucial for an older patient.

خلفية الدراسة: بالرغم من فائدة نقل الدم لمرضى الثلاسيميا والتي تبين من خلال زيادة عمر المرضى, إلا انه سبب رئيسي لنقل الأمراض المعدية ومنها التهاب الكبد الفيروسي نوع ج . لهذا فان عملية الكشف الروتيني عن الإصابة بهذا الفيروس عن طريق استخدام تقنية اختبار ارتباط الخميرة للامتزاز المناعي (اليزا) ضرورية ومتبعة منذ عدة سنوات من خلال قياس مستولى الاجسام المضادة في دم المرضى.اهداف الدراسة: لغرض تقييم العلاقة ما بين أعراض مرض التهاب الكبد الفيروسي نوع ج , علاماته ونسبة إنزيمات الكبد مع الاجسام المضادة الخاصة بالمرض و ذلك كمحاولة لغرض إيجاد دليل لحاجة المريض لفحص تلك الاجسام المضادة.المرضى والطرائق : أجريت الدراسة في مركز الثلاسيميا في بعقوبة- ديالى- العراق, حيث ادخل جميع المرضى في المركز إلى الدراسة من حزيران إلى أيلول 2014 , كانت الدراسة استرجاعية حيث تم الرجوع إلى سجلات المرضى و تسجيل أعراض و علامات المرض و نتائج فحوصات وظائف الكبد مع نتيجة فحص الاجسام المضادة باستخدام تقنية اختبار ارتباط الخميرة للامتزاز المناعي (اليزا).النتائج: ادخل جميع مرضى المركز في الدراسة و كان عددهم 215 أكثرهم من الفئات العمرية اقل من 12 سنة, منهم 24 (11.5%) مريض كان مصاب بالتهاب الكبد الفيروسي نوع ج وكان اغلبهم ممن تجاوزت اعمارهم 18 سنة و بذلك يصبح العمر من العوامل المؤثرة في حدوث التهاب الكبد الفيروسي نوع ج (p value=.000 بالنسبة للجنس فكانت النسبة الأكبر هم من الذكور لكن ذلك كان غير مؤثر عند مقارنته مع الحالات غير المصابة بالفايروس. في هذه الدراسة كانت جميع الحالات المصابة بالتهاب الكبد الفايروسي النمط ج بدون أعراض وعلامات, بالإضافة إلى إن إنزيمات الكبد كانت نسبتها طبيعية بنسبة (75%). الاستنتاجات: لا يمكن الاعتماد على الأعراض و العلامات و إنزيمات الكبد للكشف عن الالتهاب المعني, لذا لابد الاعتماد على الطريقة التقليدية و هي تقنية اختبار ارتباط الخميرة للامتزاز المناعي.

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