Patient Physical Examination Research Articles

POSSIBILITIES OF USING MINIINVASIVE CATHETER TECHNOLOGIES IN THE TREATMENT OF LUNG BLEEDING

Aim – improve the results of the treatment of patients with pulmonary bleeding through widespread use of endovascular surgery methods for hemostasis. Materials and methods. Method of endovascular embolization of bronchial arteries is widely used in our clinic SI «Zaycev V. T. Institute of General and Emergency surgery of NAMS of Ukraine» not only as independent surgery in patients with LB, but also as way of preparation of patients with lung bleeding for planned thorax surgery. The most of the often spread nosological forms complicated by bleeding in our research were polycystic lung disease, chronic obstructive pulmonary disease, bronchiectasis disease, community-acquired pneumonia. Indications to the сatheter embolization procedure of bronchial arteries are the following: conservative treatment failure, hemoptysis in patients with bilateral inflammatory processes who was not prescribed surgical treatment for a range of reasons, absence of gross structural changes, lung resection, mainly in patients with oncologic lung injury, at massive and life-threatening profuse bleedings as a mean of temporary or constant hemostasis. Discussed treatment method is applied only in bleeding or within a 6 – 12 hour after its treatment. Successful result in embolization can be obtained in 79–99 %. Results. As a result of complete physical examination of patients with LB, it has been established that lung hemorrhage was the result of obstructive bronchitis in 14 patients (42 %), there was chronic obstructive pulmonary disease in 7 (21 %) patients and bronchiectasis was diagnosed in 6 (18 %) patients. In 2 (6 %) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12 %) patients. Conclusion. Therefore bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases, for determination of localization and source of bleeding. Endovascular occlusion of bronchial arteries in pulmonary hemorrhage permits: – to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumour; – to perform effective endovascular hemostasis; – to gain time for stabilization the patient with the aim of planned surgical treatment.

Gait, balance, mobility and muscle strength in people with anxiety compared to healthy individuals

BackgroundAnxiety disorders are the most common mental disorders. Changes in psychomotor behavior can be observed in gross motor skills, with gait disturbances thought to reflect defective brain functions in psychiatric conditions. While balance deficits are well documented in anxiety, only little is known about gait characteristics of people with anxiety. ObjectiveThis study wishes to examine the existence of differences in gait, balance, mobility and muscle strength between people with anxiety and healthy individuals, and to investigate the relationship between level of anxiety and motor characteristics. MethodsAn observational study was conducted in a psychiatric out-patient unit at a large Israeli general hospital. The sample consisted of 93 participants, ages 18–65: 48 of them (27 female, 21 male) categorized as having anxiety, and 45 (25 female, 20 male) without anxiety. Participants were divided into two groups of various ages and both genders, and completed two questionnaires and four physical tests: objective anxiety assessment (Hamilton Anxiety Rating Scale); spatiotemporal gait parameters (10-meter walking test); balance function (Unipedal Stance Test); muscle strength evaluation, and mobility (Time Up and Go Test). No attempt was made to correlate between the anxiety and control groups based on age and/or gender. ResultsParticipants with anxiety (both genders) were characterized by slower walking speed, shorter step length, and fewer steps per minute (p < 0.001), as well as balance deficiency and mobility dysfunction (p < 0.001), compared to the control group. Muscle strength in women with anxiety was found to be significantly lower than in healthy women. ConclusionsTo the best of our knowledge, this study is the first of its kind to examine spatiotemporal gait components in patients with anxiety. Based on the findings, there is room to consider implementing gait analysis into the physical examination of patients with anxiety, as well as muscle strength, balance, and mobility function. Correct assessment and proper treatment of these aspects might contribute to the well-being of patients with anxiety.

Correction to: 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Correction to: 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Perioperative vestibular assessment and testing

Vestibular disorders can be difficult to accurately diagnose and manage. A careful history and focused physical examination are typically adequate to establish a diagnosis and initiate medical treatment. Vestibular testing is an important component of the work-up, but it is particularly essential for patients being considered for surgical intervention for a vestibular disorder, where the testing can be used to more definitively confirm a suspected diagnosis and to determine baseline vestibular organ function. In this article, we will first briefly review key components of the history and physical examination of patients with vestibular complaints. We will then discuss the most commonly used vestibular tests and their role in the preoperative assessment of patients undergoing vestibular surgery, including nystagmography, caloric testing, rotary chair testing, video head impulse testing, and vestibular evoked myogenic potential testing.

Squawks in interstitial lung disease prevalence and causes in a cohort of one thousand patients.

Squawks are lung adventitious sounds with a mix of both musical and nonmusical components heard during the inspiratory phase. Small series have described squawks in interstitial lung diseases. Hypersensitivity pneumonitis and other diseases involving small airways can result in squawks, but new interstitial lung diseases (ILDs) involving peripheral airways are being described. A retrospective analysis was performed on 1000 consecutive patients from a database of ILD of a tertiary referral center. Squawks were recorded in 49 cases (4.9%), hypersensitivity pneumonitis (23 cases), connective tissue disease (7), microaspiration (4), pleuroparenchymal fibroelastosis (4), fibrosing cryptogenic organizing pneumonia (, 3), familial ILD (2), sarcoidosis (2), idiopathic pulmonary fibrosis (IPF; 1), bronchiolitis (2), and nonspecific interstitial pneumonia (1). One patient had a final diagnosis of IPF. There was a significant association between mosaic pattern and squawks: 20 cases with squawks (40.8%) had mosaic pattern compared with 140 (14.7%) cases without squawks (x2 = 23.6, P < .001).Findings indicative of fibrosis were described on high-resolution chest tomography (HRCT) in 715 cases (71.5%). Squawks were more common in patients with findings indicative of fibrosis on HRCT: 45 of 715 (6.3%) compared with 4 of 285 (1.4%) of those without findings indicative of fibrosis (x2 = 10.46, P = .001).In conclusion, squawks are an uncommon finding on physical examination in patients with ILD, but when present suggest fibrosing ILD associated with bronchiolar involvement. However, squawks are rare in IPF.

Evaluation of the Diagnostic Performance of Physical Examination Combined with Transvaginal Ultrasonography in Patients with Endometriosis

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study Design:&lt;/strong&gt; In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.&lt;/p&gt;

Diagnostics and fracture risk prediction

Diagnostics in osteoporosis and fracture risk prediction should never rely on bone mineral density (BMD) measurements alone. Data from the National Osteoporosis Risk Assessment (NORA) in the USA revealed some 15 years ago that only 6.4% of postmenopausal women with new fragility fractures had T-scores of −2.5 or less (WHO definition of osteoporosis) in BMD tests performed one year before the event. The majority of fractures occurs in patients with osteopenia or normal BMD. Many of them are middle-aged women, 40 to 65 years old, an age group not much attended to in most studies on osteoporosis. A study on 100.000 women treated in a specialized Viennese menopause and osteoporosis clinic showed that 66.8% of patients with non-vertebral fractures were less than 65 years of age. Such results point to the urgent need of moving away from the preoccupation with BMD alone to a multi-causal risk-of-fracture approach for improving identification of women at risk. Fracture risk assessment tools as FRAX® may be of great help to ease the handling of anamnestic information, weight clinical risk factors and spot secondary causes of osteoporosis. Beside the medical history and physical examination of patients more attention should be paid to x-ray imaging of the spine for detection of vertebral fractures, which otherwise are overlooked to a great extent, to measuring muscle mass and -strength for diagnosing sarcopenia, and to laboratory tests for evaluating the impact of a wide array of diseases and functional disorders on the bone and mineral metabolism. Both, primary fracture prevention by identification of women at risk as early as age 40, and secondary prevention in patients with preexisting fractures, preferably by fracture liaison services, will be of crucial importance to avoid detrimental sequelae for the affected patients and associated costs to the health-care system.

Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms?

Our primary objective was to determine the association between rectocele size on defecography and physical examination in symptomatic patients. Our secondary objective was to describe the associations between both defecography and physical examination findings with defecatory symptoms and progression to surgical repair of rectocele. We performed a retrospective review of all patients referred to a female pelvic medicine and reconstructive surgery clinic with a diagnosis of rectocele based on defecography and/or physical examination at a single institution from 2003 to 2017. Patients who did not have defecatory symptoms, did not undergo defecography imaging, or did not have a physical examination in a female pelvic medicine and reconstructive surgery clinic within 12 months of defecography imaging were excluded. Of 200 patients, 181 (90.5%) had a rectocele diagnosed on defecography and 170 (85%) had a rectocele diagnosed on physical examination. Pearson and Spearman tests of correlation both showed a positive relationship between the rectocele size on defecography and rectocele stage on physical examination; however, one was not reliable to predict the results of the other (Pearson correlation = 0.25; Spearman ρ = 0.29). The strongest predictor of surgery was rectocele stage on physical examination (P < 0.001). Size of rectocele on defecography was not a strong independent predictor for surgery (P = 0.01), although its significance improved with the addition of splinting (P = 0.004). Our results suggest that rectocele on defecography does not necessarily equate to rectocele on physical examination in patients with defecatory symptoms. Rectocele on physical examination was more predictive for surgery than rectocele on defecography.

The Role of Physical Examination in Patients with Obstructive Sleep Apne Syndrome

The Role of Physical Examination in Patients with Obstructive Sleep Apne Syndrome

Blood transfusion therapy for β-thalassemia major and hemoglobin E β-thalassemia: Adequacy, trends, and determinants in Sri Lanka.

Regular blood transfusion therapy still remains the cornerstone in the management of β-thalassemia. Although recommendations are clear for patients with β-thalassemia major, uniform transfusion guidelines are lacking for patients with hemoglobin E β-thalassemia. In this study, we aim to describe the adequacy, trends, and determinants of blood transfusion therapy in a large cohort of pediatric patients with β-thalassemia major and hemoglobin E β-thalassemia. This cross-sectional study was performed among all regularly transfused patents with β-thalassemia aged 2 to 18 years attending three large thalassemia centers in Sri Lanka. Data were collected using an interviewer-administered questionnaire, perusal of clinical records, and physical examination of patients by trained doctors. A total of 328 patients (male 47%) were recruited; 83% had β-thalassemia major, whereas 16% had hemoglobin E β-thalassemia. Sixty-one percent of patients had low pretransfusion hemoglobin levels (<9.0g/dL) despite receiving high transfusion volumes (>200mL/kg/year) by a majority (56%). Median pretransfusion hemoglobin was significantly lower in patients with hemoglobin E β-thalassemia compared with β-thalassemia major (P<0.001); however, there was no difference in requirement for high transfusion volumes over 200mL/kg/year in both groups (P=0.14). Hepatomegaly and splenomegaly were more common in hemoglobin E β-thalassemia and were associated with lower pretransfusion hemoglobin. Transfusion requirements were higher among patients with hepatitis C and in those who are underweight. Over 60% of regularly transfused patients with β-thalassemia have low pretransfusion hemoglobin levels despite receiving large transfusion volumes. Patients with hemoglobin E β-thalassemia are undertransfused and specific recommendations should be developed to guide transfusions in these patients.

Association Between Self-reported Measures, Physical Examination, and Early Magnetic Resonance Imaging Signs of Osteoarthritis in Patients With Patellofemoral Pain.

Structural abnormalities associated with osteoarthritis (OA) are found in some patients with patellofemoral pain (PFP). To investigate the association between early signs of OA on magnetic resonance imaging (MRI) and characteristics from self-reported measures and physical examination in patients with PFP. This exploratory study included data from patients with PFP from a previously published cross-sectional case-control study (n = 64; 55% female; mean ± SD age, 23.4 ± 7.0 years). Structural OA features (osteophytes, bone marrow lesions, cartilage defects, Hoffa synovitis, patellar tendon abnormalities) and quantitative T2 measurements of cartilage composition were extracted from MRI. Associations between characteristics from self-reported measures (pain at rest, pain during stair walking, knee function, duration of complaints, hours of sports participation each week), physical examination (crepitus, quadriceps strength), and early MRI signs of OA were assessed. Symptom duration was associated with bone marrow lesions in the patella (odds ratio [OR] = 1.1; 95% confidence interval [CI]: 1.0, 1.2). Sports participation (hours per week) was inversely associated with patellar tendon abnormalities on MRI (OR = 0.8; 95% CI: 0.6, 1.0). Crepitus and bilateral nature of the complaints were associated with minor patellar cartilage defects (OR = 12.0; 95% CI: 2.3, 63.6 and OR = 7.6; 95% CI: 1.1, 53.8, respectively). There were no significant associations between clinical characteristics and cartilage T2 relaxation time. Presence of crepitus, bilateral complaints, a long PFP symptom duration, and reduced weekly sport participation were associated with early signs of OA in a young PFP population. Etiology, level 2c. J Orthop Sports Phys Ther 2019;49(9):634-639. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8889.

Carcinoma with unknown primary site: Morphological diagnosis

Carcinoma with unknown primary site (CUPs) is a group of malignant tumors, the first manifestation of which is metastatic dissemination. A primary tumor cannot be usually identified by a physical examination of patients with CUPs; a postmortem study plays a significant role in the diagnosis of the origin of metastasis. The paper gives the data available in the literature data on the postmortem diagnosis of CUPs and considers the morphological characteristics of metastases and the possibilities of immunohistochemical diagnosis and a molecular genetic method in the search for a primary focus.

Intelligent Analysis of Medical Big Data Based on Deep Learning

With the wide application of computer technology, medical health data has also increased dramatically, and data-driven medical big data analysis methods have emerged as the times require, providing assistance for intelligent identification of medical health. However, due to the mixed medical big data format, many incomplete records, and a lot of noise, it is still difficult to analyze medical big data. Traditional machine learning methods can't effectively mine the rich information contained in medical big data, while deep learning builds a hierarchical model by simulating the human brain. It has powerful automatic feature extraction, complex model construction and efficient feature expression, and more important. It is a deep learning method that extracts features from the bottom to the top level from the original medical image data. Therefore, this paper constructs a data analysis model based on deep learning for medical images and transcripts, and is used for intelligent identification and diagnosis of diseases. The model uses massive medical big data to select and optimize model parameters, and automatically learns the pathological analysis process of doctors or medical researchers through the model, and finally intelligently conducts disease judgment and effective decision based on the analysis results of medical big data. The experimental results show that the method can analyze the medical big data, and can realize the early diagnosis of the disease. At the same time, it can analyze the physical health status according to the patient's physical examination records and predict the risk of a certain disease in the future. Greatly reduce the work pressure of doctors or medical researchers and improve their work efficiency.

The predictive value of Neutrophil-Lymphocyte ratio in patient with heart failure in Morocco: A retrospective cross-sectional study

The purpose of this study was to test the hypothesis that the Neutrophils to Lymphocytes count ratio (NLR) provides better correlate of the Heart failure (HF) the severity in addition to the physical examination in patients with suspected HF. Thus, its use in the resource limited health facilities lacking with ultrasound and or CT scan, may reduce treatment delay and also improve the follow-up and referral system for HF patients. Patients admitted for HF underwent physical examination, ECG and echocardiogram. Venous blood collected from each patient was assessed for the haematological and biochemistry parameters. Of 105 patients were included in this study, of them, 81 cases were classified into moderate including NYHA class I and II and 24 cases as severe including NYHA class III and IV. The median-age was 64.8 years (IQR: 55.5-72.6) and 58.4 (IQR: 52.3-67.84) for moderate and severe HF respectively. The NLR (p = 0.029) and HDL levels (p = 0.018) were found to be an independent risk factor for a severe HF. After adjusting other factors, area under the ROC curve of NLR and HDL in predicting severe HF were 0.68 (95% CI = 0.541–0.816) and 0.168 (95% CI = 0.076–0.259) respectively. NLR showed the better predicting ability of the severe HF. Our findings revealed that NLR derived as a simple marker using a routine complete blood count data, was significantly and independently related to the severity of HF. Therefore, NLR is a potential indicator for HF severity in the resource limited health facilities.

Tolerability of antidementive therapy: results of observational research

Tere are 44 patients (5 males and 39 females), aged 56 to 90 years were included in the study. To assess the tolerability and safety of the drug, undesirable events were recorded, associated and not associated with taking the drugwith taking the drug, a physical examination of patients was performed, an ECG was recorded and a biochemical blood test was performed at each visit of the patient to the center. During the observation period, two undesirable events chronologically associated with taking the drug were recorded During the study, none of the patients was excluded from the program due to the development of side effects and none of the patients refused to take the drug. We did not fnd any statistically signifcant increase in the incidence of cardiac pathology in patients taking the study drug, nor worsening of the already existing symptoms on the background of taking the drug for six months. Te observed growth trends in the level of blood creatinine a give grounds to recommend monitoring of kidney function in the patients taking the drug. In general, noogerone showed good tolerability, despite the elderly age of its patients and the high prevalence of concomitant somatic diseases in the sample.

Improved utilization of waist-to-height ratio in cardiometabolic risk counselling in children: Application of DMAIC strategy.

Waist circumference (WC) and waist-to-height ratio (WHtR) are superior surrogate markers of central obesity than body mass index. However, WC is not measured routinely in paediatric clinics. The objective of this study was to implement measurement of WC during routine assessment of children in an ambulatory outpatient clinic setting and subsequent dissemination of cardiometabolic risk counselling in children with central obesity (defined as WHtR ≥0.5). Prospective cohort of patients aged 6 to 20years. Study period was divided into three phases: baseline (3months), process improvement (2months), and implementation (6months). Define-Measure-Analyse-Improve-Control (DMAIC) strategy was applied. Measurement of WC was implemented as a component of the physical examination in patients. Outcome measures were (1) improvement in frequency of WC measurement and (2) utilization of WHtR in cardiometabolic risk counselling. Waist circumference was not measured in any patient during baseline phase (n=551). During process improvement phase, of the total 347 patients, WC was measured in 35% vs target of 30%. In the implementation phase, WC was measured in 37% patients (365 out of 964). Of these 365 patients, 175 (48%) had elevated WHtR, and 73% of them (n=128) were counselled about their increased cardiometabolic risk. Application of an evidence-based DMAIC protocol led to significant improvement in assessment for central obesity in an ambulatory clinic practice and appropriate counselling regarding cardiometabolic risk reduction in children and adolescents with central obesity over an 8-month period. Meticulous planning and execution, frequent reinforcement, and integrating feedback from the involved multi-disciplinary team were important factors in successful implementation of this quality improvement project.

Clinical grading and color Doppler ultrasonography-based grading of varicocele: how compatible are the two grading systems?

Inhere, we compared two of the most common grading systems based on color Doppler ultrasonography (CDU) and physical examination in patients suspected of varicocele. This is a cross-sectional study. Overall, 66 patients clinically suspected of varicocele were visited by an attending urologist and a radiologist for physical examination and CDU. Varicocele was then graded according to the WHO criteria and Sarteschi criteria. For comparing the results of the two grading systems, each grading systems was then categorized into four scoring groups. Clinical- and CDU-based scoring, and mean maximum variceal vein diameter (MMVD) were evaluated and compared. The two scoring systems were statistically similar (p < 0.001). CDU scoring of right and left testicles had significant agreement with clinical scoring of varicocele (κ = 0.723 and κ = 0.809, respectively; p < 0.001). MMDV was associated with clinical (right sided: r = 0.681; left sided: r = 0.797; p < 0.001) and ultrasonography scoring (right sided: r = 0.648; left sided: r = 0.821; p < 0.001). Grades zero, one and two in ultrasonographic grading are most compatible with grade zero (sub-clinical) in clinical evaluation; so these grades most probably remain undetected in routine physical examination. Furthermore, grade three in ultrasonography and grade one in clinical grading, grade four in ultrasonography and grade two in clinical grading, and finally grade five in ultrasonography and grade three in clinical grading are most compatible. So, by deducting two grades from the ultrasonography grading of varicocele measured by the Sarteschi method, one can obtain a compatible estimate of the clinical grading.

Validity of Ankle Brachial Index using Palpation Method in Screening for Peripheral Arterial Disease in Type 2 Diabetes Mellitus Patients at a Tertiary Hospital in the Philippines.

IntroductionPeripheral Artery Disease (PAD) is a significant marker of cardiovascular disease and is prevalent but underdiagnosed. Ankle-Brachial Index (ABI) is the recommended screening test for PAD. However, not all clinics have a Doppler ultrasound. ABI by palpation offers a more feasible alternative.ObjectiveThis study aims to determine the validity of ABI measurement by palpation method in the screening of PAD.MethodologyThis prospective validation study utilized a cross-sectional analytic design. Three physicians performed the ABI by palpation method and their result was compared to the Doppler ABI. The accuracy indices for validation was computed per physician conducting the ABI by palpation and also as an average of all 3 palpation method readings. During the course of sampling, there were no patients with severe PAD found during the prospective period.ResultsThe accuracy of Ankle Brachial Index using Palpation method yielded the following ranges, sensitivity between 63.16 % - 73.68%, specificity of 94.06% - 98.02%, PPV within 85.37% - 95.45%, and NPV within 80.73% - 86.84% in predicting PAD. The accuracy indices were clinically acceptable. Meanwhile, the raters’ usage of Ankle Brachial Index using Palpation method demonstrated a substantial agreement with ABI by Doppler Method performed by the angiologist (Cohen Kappa >0.60).ConclusionThe ABI by palpation is a good screening tool for PAD, but the person performing it must be adequately trained to do the procedure. The procedure is affordable and convenient, and should be done routinely during clinic visits in the physical examination of patients with known risk factors for PAD.

GW29-e0845 Differences in Physical Examination of Patients with Symptomatic and Asymptomatic Fluid Overload and Low Ejection fraction

In patients with heart failure (HF), the main physical finding is the sign of fluid accumulation. However, many patients with fluid overload are asymptomatic. If the patient has no symptom of HF, at the very early stage of fluid overload, where is the fluid accumulated? Patients with low ejection

15. Preeclampsia and hellp syndrome – Obstetric prognosis

We are selected 185 pregnant women with HELLP syndrome and severe preeclampsia. The physical examination of patients the blood, function of liver, ultrasound. Patient with HELLP syndrome is a microangiopathic hemolytic anemia. Red blood cells become fragmented as they pass through small blood vessels with endothelial damage and fibrin deposits. The peripheral smear may reveal spherocytes, schistocytes, triangular cells and burr cells. increase in Bilirubin and lactic dehydrogenase levels. The elevated liver enzyme levels in the syndrome are thought to be secondary to obstruction of hepatic blood flow by fibrin deposits in the sinusoids. This obstruction leads to periportal necrosis and, in severe cases, intrahepatic hemorrhage, subcapsular hematoma formation or hepatic rupture. The thrombocytopenia has been attributed to increased consumption and/or destruction of platelets. Our results of clinical presentation: 90% of patients present with generalized malaise, 65% with epigastric pain, 30% with nausea and vomiting, 31% with headache. Because of the variable nature of the clinical presentation, the diagnosis of HELLP syndrome is generally delayed for an average of eight days. Only two of 14 patients entered the hospital with the correct diagnosis. Because early diagnosis of this syndrome is critical, any pregnant woman who presents with malaise or a viral-type illness in the third trimester should be evaluated with a complete blood cell count and liver function tests. However, there is obviously still a lack of consensus on the laboratory parameters and their cutoff values used to diagnose. We are examination laboratory diagnostic criteria for HELLP syndrome. Clinical utility of strict diagnostic criteria for the HELLP the use of strict diagnostic criteria in the definition of the HELLP syndrome allows for greater prediction of complication rates. and define the cases that are Eligible to conservative management.