Tehran University Medical Journal

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Background: Routine Para clinic evaluation of preoperative patients tends to cause unnecessary costs, extra risk to the patients, inefficient operating room schedules and extra medico legal risk. Furthermore, it seldom affects clinician's preoperative evaluation and decision making process for healthy patients. Numerous studies have shown that about 60% of these will not be performed if they are ordered according to recognizable indications based on history and physical examinations unfortunately the ‘indication based’ method can not replace to “routine” method due to difficulty and complexity to performing.

Materials and Methods: We reviewed records of 1700 patients on a retrospective descriptive study in Sina Hospital from September 2000 to the end of September 2001. These patients had undergone general surgical procedures and were categorized as American society of anesthesiologists classification I or II. Results of complete blood count, fasting blood sugar, blood urea nitrogen, serum creatinin, sodium, potassium, chest X-ray, electrocardiogram and urinalysis were compared between patients under 40 years of age (n= 894) and patients aged 40 and over (n= 806).

Results: Among 4935 tests performed in patients under 40 years of age, only 1004 (20.3%) were indicated, and treatment plan was not altered due to the results of routine tests in any case. In the other group, patients aged 40 and over, 6300 tests were performed, from which 3361 (53.3%) were indicated and treatment plans of 5 patients were influenced by the results of routine tests.

Conclusion: Routine preoperative Para clinical tests is not cost effective method, otherwise the “indication based” also is difficult and complex method. We offer routine preoperative Para clinical tests only in patients over 40 years to combine ease of “routine” with a great reduction in medical costs and no adverse affect to patient care.

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Background: Pre-eclampsia is characterized by hypertension development and proteinuria during pregnancy. Hypertension disorder is a leading cause of maternal and fetal morbidity and death in worldwide. Although the pathophysiology of hypertension during pregnancy is unclear, but there is consensus that early diagnosis and aggressive treatment is warranted to prevent complicated to both fetus and mother. The changes of serum trace elements during pregnancy are paramount important to predict and good understanding the situation of patients. The aim of this study was about this issue.

Materials and Methods: In a case-control study we investigated the possible differences in the level of serum calcium, phosphorus and total protein in 55 healthy pregnant and 52 pregnant with hypertensive disease at 32-40 weeks of gestational age during the recent two years in Loghman hospital of Tehran. Some information such as age, blood group, parity number and blood pressure was taken from patients by a questionnaire.

Results: The case population consisted of 22 sever preeclampsia, 15 mild preeclampsia, 8 eclampsia, and 7 chronic hypertensive. The mean serum calcium concentration (mg/dl) was 9.180.74 in control group, 8.810.9 in mild preeclampsia, 7.850.38 in sever preeclampsia, 7.83 0.47 in eclampsia, 8.91 0.3 in chronic blood pressure. The mean serum phosphorus (mg/dl) level observed, 4.27 in sever preeclampsia, 3.74 in eclampsia, 3.59 in mild eclampsia, 4.09 in chronic blood pressure, and 3.43 in control pregnant women. The mean serum total protein concentration level in sever preeclampsia and eclampsia was 5.46 and 5.04 mg/dl respectively.

Conclusion: In conclusion, sever preeclampsia and eclampsia are associated with decreased level of calcium, total protein, and increased concentration of phosphorus.

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Background: Whatever its etiology, the inflammatory reactions of preeclampsia lead to the activation of endothelium and result in vascular damage. CRP is considered a sensitive index of systemic inflammation, so it is used as predictive factor for disease. This study was carried out to test the screening and predictive abilities of the CRP test in order to detect and diagnose pregnant women prone to preeclampsia prior to the onset of symptoms.

Methods: In this prospective cohort study, conducted in Arash Hospital between 2005 and 2006, we determined the CRP levels of 201 pregnant women at 10-16 weeks of pregnancy. Based on exclusion criteria and illness, 31 patients were excluded and 170 patients were followed until the end of their pregnancies.

Results: In this study, the mean serum CRP values of those who had preeclamptic and those who had normal pregnancies were compared and the statistical differences were significant: 6.18 mg/L for preeclamptic patients compared with 4.12 mg/L for normal patients (p=0.003). Using a chi-square test, we found that patients whose CRP level was ≥4 were six times more likely to have preeclampsia than those with CRP levels <4 (k=9.4 p=0.002 OR=6.15 95% CI=0.69-22.28).

Conclusion: This study confirms the results of previous reports indicating a significant relationship between rising serum CRP in the first trimester of pregnancy and preeclampsia at third trimester. More studies consisting of other inflammation factors are necessary to find an acceptable and reasonable screening test to diagnose pregnant women who are prone to preeclampsia.

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Background: Preeclampsia is a disorder of pregnancy with increased maternal and perinatal morbidity and mortality. An imbalance between free radical induced lipid peroxidation and antioxidant system has been suggested as possible pathogenesis of preeclapsia. It has been shown correlation of some serum antioxidant agents (for example ceruloplasmin) with preeclampsia and its severity. The purpose of this study was to evaluate of this correlation.

Methods: In a analytic case-control study, in clinic and delivery unit of Mirza Koochak Khan university hospital, Tehran, we evaluated 90 pregnant women of 19-38 years old with gestational age higher than 20 weeks in two groups, case (preeclampsia) and control (healty mother). Case group was devided into two groups mild preeclampsia (n=30) and severe preeclampsia (n=30). Patients with preeclampsia (n=60) had either early (n=41) or late preeclampsia (n=19). Control group included 30 normotensive pregnant women. Serum Ceruroplasmin level was measured. Then relationship between this factor and preeclampsia was studied.

Results: The mean level of serum ceruloplasmin in women with severe preeclampsia (390.83mg/dl) and mild preeclampsia (319.43mg/dl) was higher than control group (212.7mg/dl). Likewise it was significantly higher in severe preeclampsia than mild (P<0.001) and higher in early (373.28mg/dl) than late preeclampsi (298.34mg/dl) (P<0.01).

Conclusions: Our data suggest that serum ceruroplasmin level may predict preeclampsia occurrance and its severity. Likewise antioxidant theryapy before the onset of preeclampsia in an attempt to decrease its frequency should be considered.

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Background: Preeclampsia, a specific syndrome in pregnancy, may summits mortality or morbidity in mother and fetus. Diagnostic methods are based on 24 hours urine protein measures which may be tedious, thus it is desirable to apply a faster and more applicable method for this goal. In this study we evaluate measurement of 8-hours urine protein in order to estimate 24-hours urine protein measure.

Methods: Fifty pregnant women were entered in a cross sectional study in Vali-e-asr hospital located in Tehran- Iran, during 2008-2009. A urine sample was given after 8-hours and urine volume as well as protein levels were calculated and compared with the same values of 24-hours urine measures. Other necessary data was obtained by history taking and physical examination as well as using patient's medical records.
Results: Mean of age was 27.5±5.4 years and mean of gestational age was 30.5±4 weeks. Mean of urine protein in 8 and 24 hours urine protein were 79±119 and 532±1218 mg respectively. Sensitivity, specificity, positive predictive value and negative predictive value of 8 hours urine protein were 61%, 98%, 88% and 90% respectively, in order to diagnosis of 24 hours urine protein to consider cut off point 105 mg for 8 hours urine protein. Mean protein levels were significantly higher in group with proteinuria ≥300 mg/24h in these two types of urine samples (p< 0.001).

Conclusion: Sensitivity of 8-hours urine protein is low but its specificity is suitable for normal mothers. We offer measuring of 8-hours urine protein as a valuable method for diagnosis of preeclampsia.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Diabetes insipidus is a rare disease which can be considered as a part of broad spectrum of preeclampsia manifestations.
Case presentation : A 39-year old primigravid woman, with an unremarkable past medical history, was admitted in the 33rd week of gestation for elevated blood pressure. On admission, her blood pressure was 140/90 mmHg and the only abnormal laboratory findings were trace proteinuria and elevated liver enzymes. During the following days her blood pressure rose to 150/100 mmHg with deterioration of clinical and paraclinical status of the patient characterized by excessive thirst, polydipsia and excretion of large amounts of diluted urine. Having considered the patient's aggravating status, termination of pregnancy was planned. Fortunately, all the clinical and paraclinical presentations, including those related to the probable diabetes insipidus disappeared on the second day of postpartum period.
Conclusion: Sign and symptoms of diabetes insipidus should be considered in all cases admitted for preeclampsia.

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Background: Twin pregnancy with a fetus and a diploid complete mole is not rare, but, the cases of twin pregnancy with a partial mole are rare. Nowadays, the prevalence of these cases has been increased due to the high rate of assisted reproductive techniques in reproductive medicine. The importance of twin pregnancy with a fetus and a diploid complete mole is mainly due to systemic complications such as hypertension and maternal hemorrhage and the possibility of trophoblastic tumor following delivery. Different studies have reported some results about similar cases, but limited case reports are presented in our country. The aim of this study is to report a case with incomplete molar pregnancy concomitant with a live fetus. Case presentation: A 21 yr old woman (G2 ab1) referred to emergency department of Ghaem University Hospital in Mashhad. She complained of scant vaginal bleeding and spotting and a sonography report of a combined molar and normal pregnancy with 15 weeks gestational aged. During hospitalization, the pregnancy complicated with hypertension and proteinuria. Termination of pregnancy was planned at 17th weeks of gestation due to severe preeclampsia. After evacuation of uterus, during follow up visits, -hCG titer raised. Metastasis evaluation was negative. Pathology reports showed patial mole. Then, three doses of methotrexate (50 mg/m2 intra muscular) was administered and finally, according to the monthly follow up, -hCG level was undetectable. Conclusion: The rate of pregnancy complications such as hypertension, hyperthyroidism, and obstetrics hemorrhage and also the risk of Gestational Trophoblastic Neoplasm (GTN) are increasing in incomplete molar pregnancy. Therefore, early diagnosis and timely treatment of molar pregnancy is very important to reduce maternal morbidity and mortality.

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Background: Herpes encephalitis is the most common cause of fatal encephalitis in the world which often presents with sudden fever, headache, seizure, focal neurologic symptoms, and consciousness loss. The aim of this study was to report a case of maternal death caused by herpes encephalitis which appropriate antibiotic therapy delayed because of early diagnosis of eclampsia.

Case Presentation: A 16-year-old pregnant woman at 36th weeks of gestation was referred to gynecology emergency department of Ghaem Hospital, Mashhad University of Medical Sciences in 2016. She was admitted due to 4 times of generalized tonic-clonic seizures and blood pressure of 140/90 mmHg with diagnosis of eclampsia. Cesarean section was performed for fetal distress and eclampsia remote from delivery. 6 hours after cesarean section because of higher than 39 °C and reduction in consciousness status, she was transferred to intensive care unit (ICU). The first brain magnetic resonance imaging (MRI) was normal. Lumbar puncture (LP) was performed and brain MRI was repeated that increased signal was observed in two sides of basal ganglia. Intravenous acyclovir was administered by possible diagnosis of viral meningoencephalitis. Cerebrospinal fluid (CSF) was positive in terms of herpes simplex virus type 1 (HSV-1). Unfortunately, the patient died 35 days after hospitalization by diagnosis of HSV-1 encephalitis and bilateral infarction with frequent seizures and clinical manifestation of septic shock refractory to treatment.

Conclusion: Although the first diagnosis for generalized convulsion during pregnancy is eclampsia, but in case of recurrent and specially atypical seizures and low consciousness level, other diagnosis like meningoencephalitis, brain lesions and cavernous sinus thrombosis (CVT) must be considered and ruled out.

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Background: Nephrotic syndrome is a kidney disorder that is identified by signs of nephrosis, severe proteinuria, hypoalbuminemia, and edema. It is a component of glomerulonephrosis, in which different degrees of proteinuria may occur. The complications of this syndrome may include blood clots, infections, and high blood pressure. Essentially, decreased protein through the kidneys (proteinuria) leads to low protein levels in the blood (hypoproteinemia including hypoalbuminemia), which causes water to be drawn into soft tissues (edema). Severe hypoalbuminemia may also lead to different secondary problems, including water in the abdominal cavity (ascites), around the heart or lung (pericardial effusion, pleural effusion), high cholesterol (hyperlipidemia) and, loss of molecules regulating coagulation (increased risk of thrombosis). Other symptoms may be weight gain, feeling tiredness, and also foamy urine. This study aimed to introduce a case of successful treatment of nephrotic syndrome in twin pregnancy.

Conclusion: Early diagnosis of nephrotic syndrome and accurate prenatal care in these patients could have optimal pregnancy outcomes, especially if it was not complicated by hypertension and renal dysfunction.

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Results: In the position of the -513T/C (rs1028181) polymorphism, a significant difference in frequency of all genotypes (CC, CT and TT) (P=0.001) and both alleles (C and T) (P=0.002) between preeclampsia pregnant women and healthy pregnant women was observed. There was no significant relationship between the other parameters of the study with the mentioned polymorphism in the patient and control groups. Conclusion: Due to the significant relationship between (rs1028181) -513T/C polymorphism and the occurrence of preeclampsia, which emphasizes the role of genetic predisposition in the development of preeclampsia disease, the presence of this polymorphism can be considered as a predictor of preeclampsia and concluded that polymorphic genetic markers are good predictive strategies for early detection of preeclampsia before the twentieth week of pregnancy.

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