Performance of single serum progesterone in the evaluation of symptomatic first-trimester pregnant patients: a systematic review and meta-analysis.

OBJECTIVES: Pain and bleeding complicate 30% of pregnancies, raising concerns for viability. The objective is to evaluate the diagnostic characteristics of a single serum progesterone level in assessing pregnancy viability among symptomatic patients. METHODS: We conducted a predefined literature search in MEDLINE, Embase (OVID), CINAHL and Cochrane databases for studies that enrolled patients in first trimester with miscarriage symptoms, measured progesterone and reported pregnancy viability, from inception to July 2020. We extracted data for 2 × 2 tables, progesterone threshold levels and viability. We obtained summary estimates of sensitivity, specificity, Diagnostic Odds Ratio (DOR), and predictive values at given prevalence rates. RESULTS: We identified 54 publications. There was a total of 15,878 patients enrolled, of whom 7864 patients (49.5%) were confirmed to have a viable pregnancy and 8014 patients (50.5%) were confirmed to have a non-viable pregnancy. The cut-off value of progesterone ranged from 3.2 to 25 ng/mL (20.034-79.5 nmol/L). We evaluated the performance of the following progesterone cut-off categories: < 6.3, 6.3-12.6, 12.7-19.9, and 20-25 ng/mL. To detect non-viable pregnancy, progesterone with cut-off < 6.3 ng/mL had sensitivity 73.1%, specificity 99.2% and DOR 322.0 (PPV 0.91, 0.97 and 0.99 at prevalences 0.1, 0.25, 0.5, respectively, indicating higher likelihood of non-viable pregnancy), and cut-off category 20-25 ng/mL had sensitivity 91.3%, specificity 75% and DOR 31.4 (NPV 0.99, 0.96 and 0.89 at the prevalences above indicating higher likelihood of viable pregnancy). CONCLUSION: A single progesterone level provides a clinically useful prognostic information on pregnancy viability. More than nine out of ten patients with a level < 6.3 ng/mL (< 20.034 nmol/L) will be diagnosed with a non-viable pregnancy, and more than 90% of patients with a level ≥ 20-25 ng/mL (63.6-79.5 nmol/L) will have a viable pregnancy confirmed.

RéSUMé: OBJECTIVES: La douleur et les saignements compliquent 30% des grossesses, ce qui soulève des inquiétudes quant à la viabilité. L'objectif est d'évaluer les caractéristiques diagnostiques d'un seul taux sérique de progestérone dans l'évaluation de la viabilité de la grossesse chez les patientes symptomatiques. MéTHODES: Nous avons effectué une recherche littérature prédéfinie dans les bases de données MEDLINE, Embase (OVID), CINAHL et Cochrane pour des études qui ont recruté des patientes au cours du premier trimestre présentant des symptômes de fausse couche, mesuré la progestérone et signalé la viabilité de la grossesse, du début à juillet 2020. Nous avons extrait les données pour les tableaux 2 × 2, les niveaux de seuil de progestérone et la viabilité. Nous avons obtenu des estimations sommaires de la sensibilité, de la spécificité, du rapport de cotes diagnostiques (DOR) et des valeurs prédictives à des taux de prévalence donnés. RéSULTATS: On a identifié 54 publications. Il y avait un total de 15 878 patientes recrutées, dont 7864 patientes (49.5%) ont été confirmées comme ayant une grossesse viable et 8014 patientes (50,5%) ont été confirmées comme ayant une grossesse non viable. La valeur seuil de la progestérone variait de 3.2 ­ 25 ng/mL (20.034 ­ 79.5 nmol/L). Nous avons évalué les performances des catégories de seuil de progestérone suivantes: < 6.3, 6.3­12.6, 12.7­19.9 et 20­25 ng/mL. Pour détecter une grossesse non viable, la progestérone avec seuil < 6.3 ng/mL avait une sensibilité de 73.1%, une spécificité de 99.2% et une DOR 322.0 (PPV 0.91, 0.97 et 0.99 à des prévalences de 0.1, 0.25, 0.5 respectivement indiquant une probabilité plus élevée de grossesse non viable), et la catégorie de coupure 20­25 ng/mL avait une sensibilité de 91,3%, une spécificité de 75% et une DOR 31,4 (NPV 0.99, 0.96 et 0.89 aux prévalences ci-dessus indiquant une probabilité plus élevée de grossesse viable). CONCLUSION: Un seul niveau de progestérone fournit une information pronostique cliniquement utile sur la viabilité de la grossesse. Plus de neuf patientes sur dix avec un niveau < 6.3 ng/mL (< 20.034 nmol/L) sera diagnostiqué de grossesse non viable, et plus de 90% des patientes ayant un niveau ≥ 20­25 ng/mL (63.6­79.5 nmol/L) auront une grossesse viable confirmée.

Unusual Presentation of Interventricular Hydatid Cyst: A Case Report.

Echinococcus infection typically affects liver and lungs while rarely occur through heart. Cardiac hydatidosis can be fatal or lead to major complications if it is not treated. The majority of patients with cardiac hydatid cysts complain from cardiac problems as their first presentation. However, this article reports an unusual case suffers from an interventricular hydatid cyst presented by abdominal pain on 2013. After the patient transferred to Tehran Heart Center, surgical cyst excision with removing germinal layer and concurrent albendazole therapy was prescribed for the management of this Iranian 15 year old female.

Evaluation of quality of life after cardiac surgery in high-risk patients.

BACKGROUND: Conventionally, there is controversy over subjecting high-risk patients to cardiac operations, due to major postoperative complications. Higher survival rates and less morbidity as well as better quality of life can be good predictors of the outcome of surgery. This study evaluates the quality of life before and 12 months after cardiac operations on high-risk patients. METHODS: In this study, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was used to separate high-risk patients from others. The quality of life was assessed using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) before surgery and one year afterward. Based on SF-36, the score for each of the eight different dimensions of the quality of life was quantified; and, their differences between pre-surgery and post-follow up period were analyzed. RESULTS: 126 high-risk patients were included in this study. The mean age of the patients was 64.29 ± 12.35 years. The median of EuroSCORE II score in these cases was 6.83 (6.04-25.98). The results reveal that the majority of the quality of life dimensions, except mental health, improved significantly after the follow-up period. CONCLUSION: Cardiac surgery on high-risk patients can noticeably promote the different aspects of their quality of life; although, such improvements should be considered against surgical complications.