OBJECTIVETo investigate the optimal method of screening for Down's syndrome (DS) with maternal serum mankers.

METHODSScreening by maternal serum markers for Down's syndrome was offered to all 2886 pregnant women in Peking Union Medical Hospital during 1996.11-2001.3. Alpha-fetoprotein (AFP), human chorionic gonadotrophin (free beta-HCG) were used as markers during the first year of pregnancy. Alpha-fetoprotein, free human chorionic gonadotrophin (HCG) and pregnancy-associated plasma protein A (PAPP-A) were used as mid pregnancy and first-trimester markers in next three years. Amniocentesis and (CVS) were done in those defined as risk cases.

RESULTSThe detection rate of Down's syndrome by maternal serum markers was 3.8% (11/2886). The proportion of false positive results in group of triple markers (alpha FP, free beta-HCG, PAPP-A) was 5%.

CONCLUSIONSThe PAPP-A was a good marker to detect Down's syndrome in early pregnancy and may be used to predict the outcome during mid trimester of pregnancy. The AFP and free beta-HCG can be useful markers to detect Down's syndrome and fetal abnormality. While prenatal diagnostics can be shifted to an early pregnant period.

Adult ; Amniocentesis ; Biomarkers ; blood ; Chorionic Gonadotropin, beta Subunit, Human ; blood ; Down Syndrome ; diagnosis ; prevention & control ; Female ; Fetal Diseases ; diagnosis ; prevention & control ; Humans ; Mass Screening ; Pregnancy ; blood ; Pregnancy-Associated Plasma Protein-A ; analysis ; Prenatal Diagnosis ; methods ; alpha-Fetoproteins ; analysis

Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Angina Pectoris ; blood ; Angina, Unstable ; blood ; C-Reactive Protein ; analysis ; Coronary Disease ; blood ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; Pregnancy-Associated Plasma Protein-A ; analysis

BACKGROUND: Early diagnosis is the cornerstone of management of acute myocardial infarction (AMI). We aimed to compare the diagnostic accuracy of high-sensitivity troponin T (hs-cTnT) with myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) for early diagnosis of AMI in patients at the time of presentation to the emergency department (ED). METHODS: We enrolled 289 patients who presented at the ED of the National Institute of Heart Disease (NIHD) Rawalpindi, Pakistan, within 4 hr of onset of chest pain. Clinical assessment, electrocardiography (ECG), and angiography were carried out. Blood samples were collected at 0, 3, 6, and 12 hr. Analyses of plasma hs-cTnT, MPO, and PAPP-A were carried out using commercial kits. RESULTS: Out of 289 subjects who presented to the ED, we diagnosed 180 patients with coronary heart disease as having AMI (N=61) and 119 as without AMI (stable coronary artery disease, N=61; unstable angina, N=58). Compared to non-AMI patients, the patients with AMI had significantly higher levels (represented here as median [inter quartile range]) of plasma hs-cTnT (136 [39-370] vs. 12 [7-21] ng/L), MPO (906 [564-1,631] vs. 786 [351-1,299] pmol/L) and PAPP-A (5.78 [2.67-13.4] vs. 2.8 [1.8-4.9] mIU/L). Receiver operator characteristic curves (95% CI) for hs-cTnT (0.952 [0.909-0.978]) were significantly higher (P<0.001) than those for MPO (0.886 [0.830-0.929]) and PAPP-A (0.797 [0.730-0.854]), with AMI sensitivity and specificity percentages of 87% and 98% (hs-cTnT), 82% and 84% (MPO), and 65% and 87% (PAPP-A), respectively. CONCLUSIONS: The diagnostic performance of hs-cTnT was superior to that of MPO and PAPP-A for early triage and diagnosis of AMI among patients of coronary heart disease presenting with chest pain to the ED.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Coronary Angiography ; Early Diagnosis ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood/*diagnosis/radiography ; Peroxidase/*blood ; Pregnancy-Associated Plasma Protein-A/*analysis ; ROC Curve ; Time Factors ; Triage ; Troponin T/*blood

BACKGROUND: Early diagnosis is the cornerstone of management of acute myocardial infarction (AMI). We aimed to compare the diagnostic accuracy of high-sensitivity troponin T (hs-cTnT) with myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) for early diagnosis of AMI in patients at the time of presentation to the emergency department (ED). METHODS: We enrolled 289 patients who presented at the ED of the National Institute of Heart Disease (NIHD) Rawalpindi, Pakistan, within 4 hr of onset of chest pain. Clinical assessment, electrocardiography (ECG), and angiography were carried out. Blood samples were collected at 0, 3, 6, and 12 hr. Analyses of plasma hs-cTnT, MPO, and PAPP-A were carried out using commercial kits. RESULTS: Out of 289 subjects who presented to the ED, we diagnosed 180 patients with coronary heart disease as having AMI (N=61) and 119 as without AMI (stable coronary artery disease, N=61; unstable angina, N=58). Compared to non-AMI patients, the patients with AMI had significantly higher levels (represented here as median [inter quartile range]) of plasma hs-cTnT (136 [39-370] vs. 12 [7-21] ng/L), MPO (906 [564-1,631] vs. 786 [351-1,299] pmol/L) and PAPP-A (5.78 [2.67-13.4] vs. 2.8 [1.8-4.9] mIU/L). Receiver operator characteristic curves (95% CI) for hs-cTnT (0.952 [0.909-0.978]) were significantly higher (P<0.001) than those for MPO (0.886 [0.830-0.929]) and PAPP-A (0.797 [0.730-0.854]), with AMI sensitivity and specificity percentages of 87% and 98% (hs-cTnT), 82% and 84% (MPO), and 65% and 87% (PAPP-A), respectively. CONCLUSIONS: The diagnostic performance of hs-cTnT was superior to that of MPO and PAPP-A for early triage and diagnosis of AMI among patients of coronary heart disease presenting with chest pain to the ED.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Coronary Angiography ; Early Diagnosis ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood/*diagnosis/radiography ; Peroxidase/*blood ; Pregnancy-Associated Plasma Protein-A/*analysis ; ROC Curve ; Time Factors ; Triage ; Troponin T/*blood

Chorionic Gonadotropin, beta Subunit, Human ; blood ; Cost-Benefit Analysis ; Down Syndrome ; blood ; diagnosis ; False Positive Reactions ; Female ; Health Care Costs ; Humans ; Maternal Serum Screening Tests ; economics ; methods ; standards ; Pregnancy ; Pregnancy Trimester, First ; blood ; Pregnancy-Associated Plasma Protein-A ; metabolism ; Prenatal Care ; methods ; Prenatal Diagnosis ; economics ; methods ; standards