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.

Arterial-embolic Strokes and Painless Vision Loss Due to Phase II Aortitis and Giant Cell Arteritis: A Case Report.

INTRODUCTION: Aortitis refers to abnormal inflammation of the aorta, most commonly caused by giant cell arteritis (GCA). Herein, we present a 57-year-old female with aortitis and arterial-embolic strokes secondary to GCA. CASE REPORT: Our patient presented to the emergency department following an episode of transient, monocular, painless vision loss. Computed tomography angiogram head and neck demonstrated phase II aortitis, and magnetic resonance imaging revealed evidence of arterial-embolic strokes. CONCLUSION: Cerebrovascular accident is a rare complication of large-vessel vasculitis and can occur due to multiple underlying etiologies including intracranial vasculitis, aortic branch proximal occlusion, or arterial-embolic stroke.

The role of atypical pathogens in community-acquired pneumonia.

The term atypical pneumonia was first used in 1938, and by the 1970s it was widely used to refer to pneumonia due to Mycoplasma pneumoniae, Legionella pneumophila (or other Legionella species), and Chlamydophila pneumoniae. However, in the purest sense all pneumonias other than the classic bacterial pneumonias are atypical. Currently many favor abolition of the term atypical pneumonia.This review categorizes atypical pneumonia pathogens as conventional ones; viral agents and emerging atypical pneumonia pathogens. We emphasize viral pneumonia because with the increasing availability of multiplex polymerase chain reaction we can identify the agent(s) responsible for viral pneumonia. By using a sensitive assay for procalcitonin one can distinguish between viral and bacterial pneumonia. This allows pneumonia to be categorized as bacterial or viral at the time of admission to hospital or at discharge from the emergency department and soon thereafter further classified as to the etiology, which should be stated as definite or probable.

13q13.1-q13.2 deletion in tetralogy of Fallot: clinical report and a literature review.

Recent advances in microarray technology are helping to identify more genetic anomalies associated with tetralogy of Fallot and other congenital heart defects. We report on a 24-year-old woman with a syndromic form of tetralogy of Fallot who was found to have a novel de novo deletion of the proximal long arm of chromosome 13. History of developmental delay and learning difficulties, mild dysmorphic facial features, and anal atresia prompted genetic investigations. A review of the literature on deletions that overlap this region showed that several were associated with major congenital heart defects. The results suggest that the 13q13.1-q13.2 region may harbour a gene or genes important in cardiac development.