Methyldopa versus labetalol or no medication for treatment of mild and moderate chronic hypertension during pregnancy: a randomized clinical trial.

OBJECTIVE: to assess the maternal and fetal outcome in women with mild to moderate chronic hypertension on antihypertensive drug (methyldopa or labetalol) therapy compared to no medication. METHODS: This multicenter randomized clinical study was conducted at Menoufia University hospital, Shibin El-kom Teaching hospital at Menoufia governorate, Egypt.486 pregnant women with mild to moderate chronic hypertension were randomized into three groups; methyldopa group (n = 164), labetalol group (n = 160), and control or no medication group (n = 162) who were followed from the beginning of pregnancy till the end of puerperium to record maternal and fetal outcome. RESULTS: There was a highly significant difference between treatment groups (methyldopa and labetalol) and control group regarding the development of maternal severe hypertension, development of preeclampsia, renal impairment, presence of ECG changes, placental abruption, and repeated admission to hospital for blood pressure control (p < 0.001) with higher occurrence in the control (no treatment) group. Neonates in the labetalol group were more prone for the development of small for gestational age (SGA), neonatal hypotension, neonatal hyperbilirubinemia, and admission to NICU than their counterparts in the methyldopa and control groups (p < 0.001). The rate of prematurity was significantly higher in the control group than the treatment groups (p < 0.05). CONCLUSION: Treatment of mild to moderate chronic hypertension during pregnancy is beneficial in decreasing both maternal and fetal morbidity. The use of labetalol was associated with higher rates of SGA, neonatal hypotension, and neonatal hyperbilirubinemia compared to methyldopa or no medication.

Effect of Jet Impingement Velocity and Angle on CO2 Erosion-Corrosion with and without Sand for API 5L-X65 Carbon Steel.

Most oil and gas production wells have plenty of corrosive species present along with solid particles. In such production environments, CO2 gas can dissolve in free phase water and form carbonic acid (H2CO3). This carbonic acid, along with fluid flow and with/without solid particles (sand or other entrained particles), can result in unpredictable severe localized CO2 corrosion and/or erosion-corrosion (EC). So, in this work, the CO2 EC performance of API 5L X-65 carbon steel, a commonly used material in many oil and gas piping infrastructure, was investigated. A recirculating flow loop was used to perform these studies at three different CO2 concentrations (pH values of 4.5, 5.0, and 5.5), two impingement velocities (8 and 16 m/s), three impingement angles (15°, 45°, and 90°), and with/without 2000 ppm sand particles for a duration of 3 h in 0.2 M NaCl solution at room temperature. Corrosion products were characterized using FE-SEM, EDS, and XRD. The CO2 EC rates were found to decrease with an increase in the pH value due to the increased availability of H+ ions. The highest CO2 erosion-corrosion rates were observed at a 45° impingement angle in the presence of solid particles under all conditions. It was also observed that a change in pH value influenced the morphology and corrosion resistance of the corrosion scales.

First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk.

OBJECTIVE: To determine if second trimester mean platelet volume (MPV) and serum uric acid are reasonable predictors of preeclampsia (PE) or not, in patients at moderate and low risk. METHODS: This prospective study was conducted on 9522 women at low or moderate risk for developing PE who underwent dual measurements of MPV and serum uric acid at late first trimester (10-12 weeks) and at second trimester (18-20 weeks) and subsequently divided into two groups; PE group (n = 286) who later developed PE and non-PE group (n = 9236). Test validity of MPV and serum uric acid was the primary outcome measure. Data were collected and analyzed. RESULTS: Second trimester MPV is a good predictor for development of PE at a cutoff value of 9.55 fL with area under the curve (AUC) of 0.86, sensitivity of 95.2%, specificity of 66.7%, positive predictive value (PPV) of 87%, negative predictive value (NPV) of 85.7%, and accuracy of 86.7%. Second trimester serum uric acid is a good predictor for development of PE at a cutoff value of 7.35 mg/dL, with AUC of 0.85, sensitivity of 95.2%, specificity of 55.6%, PPV of 83.3%, NPV of 83.3%, and accuracy of 83.3%. Combination of both tests has a sensitivity of 100%, specificity of 22.2%, PPV of 75%, NPV of 100%, and accuracy of 76.7%. CONCLUSION: Second trimester MPV and serum uric acid alone or in combination could be used as a useful biochemical markers for prediction of PE based on their validity, simplicity, and availability.

IL-10 polymorphisms and T-cell subsets could affect the clinical presentation and outcome of childhood immune thrombocytopenia in Egyptian population.

The aim is to study IL-10 polymorphisms and IL-10 level and assess their relation to T-cell subsets in childhood immune thrombocytopenia (ITP). In all, 40 (25 acute, 15 chronic) ITP child patients were investigated at time of presentation, compared to 15 healthy, age- and gender-matched controls and followed up for 1 year to determine chronic cases. Studying the effect of IL-10 promoter polymorphism was done by PCR-RFLP, IL-10 level was determined by ELISA, natural killer cells and T-cell subsets were evaluated by flow cytometry. Subjects with IL-10 promoter (1082 AA and 592 AA) genotypes had lower IL-10 levels and had lower CD4%, higher CD8%, lower CD4/CD8 ratio and lower T-reg%. IL-10 polymorphisms had no effect on NK%. IL-10 serum levels and IL-10 promoter polymorphic genotype frequencies are not different between ITP cases and controls; however, in ITP patients, IL-10 promoter (1082 AA and 592 AA) genotypes and associated lower CD4, higher CD8, lower CD4/CD8 ratio is associated with more severe thrombocytopenia at presentation and had a poorer response to first-line treatment. Patients with lower T-reg cells had a higher tendency to develop chronic ITP. IL-10 level and polymorphisms as well as disturbed T-cell subsets percentages are demonstrable effectors of immune dysfunction in ITP and can affect the presentation and outcome of childhood ITP.

Serum stromal-derived-factor-1 (CXCL12) and its alpha chemokine receptor (CXCR4) as biomarkers in neonatal sepsis.

BACKGROUND: Neonatal sepsis remains one of the leading causes of morbidity and mortality both among term and preterm infants. Advances in neonatal care improved survival and reduced complications in preterm infants. Chemokines are chemotactic cytokines that give directional guidance for leukocyte migration during inflammatory process. The chemokine CXCL12 and its receptor CXCR4 are now known to play an important role in inflammatory states. However, its value as a biomarker in neonatal sepsis is unclear. OBJECTIVES: To assess the value of measuring the serum levels of alpha-chemokine receptor type 4 (CXCR-4) and stromal-derived-factor-1 (CXCL12) in diagnosis of late onset neonatal sepsis. SUBJECT AND METHODS: Serum levels of CXCL12 and CXCR4 were determined in 38 full term neonates, 23 cases of late onset sepsis (13 males and 10 female), and 15 healthy neonates as control (six males and nine females) by ELISA technique and flow-cytometry. RESULTS: Serum levels of CXCR4 and CXCL12 were significantly higher in neonates with late onset sepsis compared with the non-septic ones. The sensitivity, the specificity, and the overall accuracy of CXCL12 were 100%. The sensitivity of CXCR4 was 87%; the specificity was 80% and the overall accuracy was 84%. CONCLUSIONS: Serum CXCR4 and CXCL12 levels increase significantly in septic neonates and they are valuable marker in diagnosis of neonatal sepsis. Serum concentrations of both chemokines represent promising novel biomarkers for neonatal sepsis.

Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study.

OBJECTIVE: To assess prospectively the maternal cardiovascular hemodynamic changes and obstetric outcome in women with rheumatic heart disease (RHD) and to detect predictors of poor outcome. METHODS: This prospective observational study included 204 pregnant patients with RHD who were divided into two groups; successful pregnancy group with living fetus (n = 126) and poor obstetric outcome group with fetal or neonatal loss (n = 78). Hemodynamic changes, maternal and fetal outcome were assessed and recorded. RESULTS: There was a highly significant difference between the two groups regarding disease criteria with more women suffering from stenotic lesions (mitral and aortic), pulmonary hypertension, previous heart failure, receiving cardiac medications and higher NYHA class (III and IV) in the poor obstetric outcome group (p < .001). These patients were more prone to maternal and fetal morbidity. Maternal age above 28 years, body mass index higher than 28, mean pulmonary artery pressure higher than 50 mmHg, NYHA class III-IV and development of heart failure or cyanosis are predictors of poor outcome (p < .001). CONCLUSIONS: Increased maternal age and body mass index together with NYHA class III-IV, significant pulmonary hypertension, reduced ejection fraction and development of heart failure during pregnancy are strong predictors of poor maternal and fetal outcome.

Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital.

OBJECTIVE: To compare the maternal and fetal outcome in patients with systemic lupus erythematosus (SLE) by a retrospective analysis from 2005 to 2010, and a prospective follow-up of pregnant SLE patients from 2010 to 2015 to find out predictors of poor obstetric outcome. METHODS: The study included 236 SLE pregnant females (retrospective group) whose data were viewed retrospectively from their medical records, and 214 SLE pregnant females (prospective group) who were followed prospectively to record their maternal and fetal outcome. RESULTS: There was a highly significant difference between the two groups regarding abortion, venous thromboembolism, prematurity, and intrauterine fetal death (p < 0.001) with more occurrence in retrospective group. Also, the frequency of lupus flares, worsening of renal functions, blood transfusion, maternal mortality, admission to NICU, and neonatal death was higher in the retrospective group (p < 0.05). Predictors of poor obstetric outcome included Last flare before pregnancy <6 months, number of antenatal hospital admissions ≥ 6, use of immunosuppressive therapy, the presence of anti-SSA/Ro and anti-SSB/La, and SLE with nephritis (p < 0.05). CONCLUSION: Improved maternal and fetal outcome in women with SLE has occurred following integrated multidisciplinary approach. This emphasizes the importance of postponing pregnancy when predictors of poor outcome are encountered.

P-Glycoprotein Activity in Steroid-Responsive vs. Steroid-Resistant Nephrotic Syndrome.

OBJECTIVES: To explore the expression of P-glycoprotein (P-gp) in the peripheral blood nucleated cells (PBNCs) of children with nephrotic syndrome in relation to their clinical response to glucocorticoid treatment. METHODS: Thirty-six children with nephrotic syndrome (20 cases of steroid-responsive and 16 cases of steroid-resistant) were examined. All the participants were subjected to complete history taking, thorough clinical examination, laboratory investigations (24-h urinary protein, serum albumin, complete blood count with differential white blood cell count, serum cholesterol, serum urea, serum creatinine) and functional assay of P-gp using FACS Calibur flowcytometry. P-gp assay was done in both groups during remission. RESULTS: P-gp activity was significantly higher in steroid-resistant than steroid-sensitive cases. CONCLUSIONS: P-gp can be used as a predictor of outcome, as a part of laboratory evaluation of the cases before starting steroid therapy, so as to determine whether to use alternative line of therapy or use one of the P-gp inhibitors with steroid therapy.

Maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria: A 3-year observational study.

OBJECTIVE: To assess the maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria. METHODS: This was a prospective 3-year observational study carried out at Menoufia University Hospital and included 106 patients with gestational hypertension and 124 patients with gestational proteinuria after 20 weeks' gestation. Enrolled patients were followed to assess the maternal and fetal outcome. Data were collected and tabulated. RESULTS: There was a highly significant difference between the two groups regarding the development of preeclampsia (PE) and persistence of the condition after the end of the puerperium (p < 0.001) with more women progressed to PE and lower number suffered persistence of the disorder in the gestational hypertension group. There was no significant difference between the two groups regarding other maternal complications (p > 0.05). There was a significant difference between the two groups regarding preterm delivery, admission to NICU, and neonatal mortality (p < 0.05) which were higher in the gestational proteinuria group. There was no significant difference between the two groups regarding other fetal and neonatal complications (p > 0.05). CONCLUSIONS: Although gestational hypertension progressed more frequently to PE than gestational proteinuria, poorer fetal outcome was more encountered in women with gestational proteinuria. Larger studies are warranted to confirm these findings.

Maternal and fetal outcome in women with antiphospholipid syndrome: a three-year observational study.

OBJECTIVES: To assess prospectively the maternal and fetal outcome in women with primary antiphospholipid syndrome (APS) and to find out predictors of poor obstetric outcome. METHODS: A prospective observational study included 162 patients with primary APS who were divided into two groups, group 1 with previous thrombosis (n = 74) and group 2 without previous thrombosis (n = 88). Patients were followed from the start of pregnancy till delivery under standard treatment to detect maternal and fetal outcome. RESULTS: There was a significant difference between the two groups with higher rate of miscarriage (p < 0.05), maternal venous thromboembolism (p < 0.001), intrauterine fetal demise and neonatal death (p < 0.05) in group 1. No significant difference between the two groups regarding the rate of preeclampsia, eclampsia, postpartum hemorrhage, prematurity and admission to neonatal intensive care unit (p > 0.05). By univariate and multivariate analyzes in the whole study participants, previous thrombosis, triple positivity of APS antibodies, previous delivery before 34 weeks, the presence of antiß2GP1 antibodies and maternal age above 30 years were independent predictors of pregnancy loss. CONCLUSION: Poor obstetric outcome is higher in patients with previous thrombosis. The search for optimal prognostic markers and new therapeutic measures to prevent complications in APS patients is warranted.

Impact of maternal fasting on fetal well-being parameters and fetal-neonatal outcome: a case-control study.

OBJECTIVE: To assess the impact of maternal fasting on fetal well-being parameters and neonatal outcome. METHODS: Two-hundred ten healthy women with singleton uncomplicated pregnancies at 36-40 weeks' gestation who had fasted for 12-16 h were defined as the study group with 240 healthy non-fasted pregnant women matched for age, parity and gestational age were defined as the control group. Both groups were subjected to tests of fetal well-being in the form of non-stress test (NST), modified biophysical profile and Doppler indices of the umbilical and middle cerebral arteries (MCA). Women were followed-up till delivery to record the obstetric outcome. RESULTS: There was no significant difference between the two groups regarding the reactivity of NST, modified biophysical scores, Doppler indices of the umbilical and MCA (resistive index, pulsatility index and systolic/diastolic ratio) and the cerebroplacental ratio (p > 0.05). There was no significant difference between the two groups regarding the gestational age at delivery, mode of delivery, neonatal weight, 5-min Apgar scores and admission to neonatal intensive care unit (p > 0.05). CONCLUSIONS: Short-term maternal fasting has no deleterious effect on fetal well-being parameters or neonatal outcome. Pregnant women who desire fasting, should be reassured regarding the health of their babies.