Screening Tool For Prediction Research Articles

Liposome electrokinetic chromatography based in vitro model for early screening of the drug-induced phospholipidosis risk

Drug-induced phospholipidosis (PLD) is a storage disorder of lysosomes characterized by the excessive accumulation of phospholipids as a result of improper medical treatments. Although few evidences have supported that PLD can induce significant pathological consequences, this potential toxicity indeed can put off the drug discovery process. In this research, a high-throughput liposome electrokinetic chromatography (LEKC) method was validated to evaluate the PLD risk of drug candidates by screening drug-phospholipid interaction, which correlates to the phospholipidosis inducing risk. A statistical analysis based on the Spearman's correlation test showed that the retention factors (log k) of the tested drugs in the LEKC system and the literature reported in vivo and in vitro PLD data were highly correlated. In order to investigate the predictability of LEKC, the effect of liposome composition such as the molar ratio of phospholipids and the addition of cholesterol were also discussed in this study. The results indicated that the LEKC method could offer a fast, reliable and cost-effective screening tool for early prediction of the PLD inducing potential of drug candidates.

Image-based modeling for better understanding and assessment of atherosclerotic plaque progression and vulnerability: Data, modeling, validation, uncertainty and predictions

Medical imaging and image-based modeling have made considerable progress in recent years in identifying atherosclerotic plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. However, a clear understanding is needed about what we have achieved and what is really needed to translate research to actual clinical practices and bring benefits to public health. Lack of in vivo data and clinical events to serve as gold standard to validate model predictions is a severe limitation. While this perspective paper provides a review of the key steps and findings of our group in image-based models for human carotid and coronary plaques and a limited review of related work by other groups, we also focus on grand challenges and uncertainties facing the researchers in the field to develop more accurate and predictive patient screening tools.

Waist height ratio: A universal screening tool for prediction of metabolic syndrome in urban and rural population of Haryana.

Aims:To compare waist circumference (WC), body mass index (BMI), waist hip ratio (WHR), and waist-to-height ratio (WHtR) and define an appropriate cut-off, which is most closely predictive of the non-adipose components of the IDF metabolic syndrome (MetS) definition.Methods and Results:A total of 3,042 adults (1,693 in rural area and 1,349 in urban area) were screened for the presence of MetS according to the IDF definition. Among 3,042 adults selected as subjects, 1,518 were male and 1,524 were female. The receiver operating curve (ROC) analysis was done to determine the optimal cut-off value and the best discriminatory value of each of these anthropometric parameters to predict two or more non-obese components of metabolic syndrome. The area under ROC (AURC) for WC was superior to that for other anthropometric variables. The optimal cut-off value of WC in urban and rural males was >89 cm, which is higher than that in urban and rural females at 83 cm and 79 cm, respectively; the optimal cut-off for WHtR was >0.51 in rural females, 0.52 in rural males, and 0.53 in both urban males and females. Both parameters were found to be better than BMI and WHR. ROC and AURC values for WC were better than those for WHtR in men and women in both urban and rural areas (P = 0.0054); however, when the entire study cohort was analyzed together, irrespective of gender and place of residence, then at a value of 0.52, WHtR scored over WC as a predictor of metabolic syndrome (P = 0.001).Conclusion:Although the predictive value of different gender-specific WC values is clearly superior to other anthropometric measures for predicting two or more non-adipose components of MetS, a single value of WHtR irrespective of gender and the area of residence can be used as a universal screening tool for the identification of individuals at high risk of development of metabolic complications.

Potential of thermal imaging as a tool for prediction of cardiovascular disease.

Vascular dysfunction is associated with onset of cardiovascular disease (CVD). Its effect is reflected as temperature change on the skin. The aim of this work was to test the potential of thermal imaging as cost effective screening tool for prediction of CVD. Thermal imaging of various parts of the subject (N = 80, male/female =44/36, aged 25-75 years) was done using noncontact infrared (IR) camera. In each subject, total cholesterol (TC; mg/dl) and high-density lipoprotein (HDL, mg/dl) were measured according to standard biochemical analysis. Based on National Cholesterol Education Program ATP III criteria, subject with known CVD (N = 16) and age- and sex- matched normal subjects (N = 21) were included in the study. The average surface temperature of various parts from head to toe was calculated and statistical analysis was performed between the groups. In the total population (N = 37), correlation study shows TC (mg/dl) was correlated with measured surface temperature of the following regions: Temporal left (r = −0.316) and right (r = −0.417), neck left (r = 0.347) and right (r = −0.410), and hand left (r = 0.387). HDL (mg/dl) was found to be correlated with measured surface temperature of the following regions: Temporal left (r = 0.445) and right (r = 0.458), hand left (r = −0.470), and foot anterior left (r = −0.332) and right (r = −0.336). Temperature asymmetry was more significant in upper extremity in CVD group. Using the surface temperature, regression models were calculated for noninvasive estimation of TC and HDL. The predictive ability of measured surface temperature for TC and HDL was 60%. The model for noninvasive estimation gave sensitivity and specificity value of 79 and 83% for TC and 78 and 81% for HDL, respectively. Thus, the surface temperature can be one of the screening tools for prediction of CVD. The limitation of the present study is also discussed under future work.

PS7 - 3. Predicting Glycated Haemoglobin in the Non-Diabetic General Population: a DIRECT Study

The DETECT-2 risk score is a simple screening tool for prediction of incident type 2 diabetes (based on fasting and/or Oral Glucose Tolerance Test glucose levels). Recently, glycated haemoglobin (HbA1c) levels have been added to diabetes diagnostic criteria. Our study evaluates whether predictors from the DETECT-2 score could be used to predict HbA1c levels after 6 years.

The utility of fat mass index vs. body mass index and percentage of body fat in the screening of metabolic syndrome

BackgroundIt has been well documented that obesity is closely associated with metabolic syndrome (MetS). Although body mass index (BMI) is the most frequently used method to assess overweightness and obesity, this method has been criticized because BMI does not always reflect true body fatness, which may be better evaluated by assessment of body fat and fat-free mass. The objective of this study was to investigate the best indicator to predict the presence of MetS among fat mass index, BMI and percentage of body fat (BF %) and determine its optimal cut-off value in the screening of MetS in practice.MethodsA cross-sectional study of 1698 subjects (aged 20–79 years) who participated in the annual health check-ups was employed. Body composition was measured by bioelectrical impedance analysis (BIA). Fat mass index (FMI) was calculated. Sex-specific FMI quartiles were defined as follows: Q1: <4.39, Q2:4.39- < 5.65, Q3:5.65- < 7.03, Q4:≥7.03,in men; and Q1:<5.25, Q2:5.25- < 6.33, Q3:6.33- < 7.93,Q4:≥7.93, in women. MetS was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria. The association between FMI quartiles and MetS was assessed using Binary logistic regression. Receiver operating curve(ROC) analysis was used to determine optimal cutoff points for BMI,BF% and FMI in relation to the area under the curve(AUC),sensitivity and specificity in men and women.ResultsThe adjusted odds ratios (95% CI) for the presence of MetS in the highest FMI quartile versus lowest quartile were 79.143(21.243-294.852) for men( P < 0.01) and 52.039(4.144-653.436) for women( P < 0.01) after adjusting age, BMI, BF%, TC, LDL, CRP, smoking status and exercise status, and the odds ratios were 9.166(2.157-38.952) for men( P < 0.01) and 25.574(1.945-336.228) for women( P < 0.05) when WC was also added into the adjustment. It was determined that BMI values of 27.45 and 23.85 kg/m2, BF% of 23.95% and 31.35% and FMI of 7.00 and 7.90 kg/m2 were the optimal cutoff values to predict the presence of MetS among men and women according to the ROC curve analysis. Among the indicators used to predict MetS, FMI was the index that showed the greatest area under the ROC curve in both sexes.ConclusionsHigher FMI levels appear to be independently and positively associated with the presence of MetS regardless of BMI and BF%. FMI seems to be a better screening tool in prediction of the presence of metabolic syndrome than BMI and percentage of body fat in men and women.

Palmar Dermatoglyphics, a Possible Screening Tool among Some Egyptian Children with Acute Lymphoblastic Leukemia

Study of dermatoglyphics has a great importance in judicial and criminal researches. Nowadays its relation to some genetic diseases has an immense application. The patterns of dermatoglyphics have been studied in various congenital disorders like Down syndrome, Klinefelter’s syndrome and also in chronic diseases like hypertension, diabetes mellitus etc. The present study was carried out to demonstrate the association between acute lymphoblastic leukemia among children and palmar dermatoglyphics to assess the possibility of using this association as a screening tool for early prediction of leukemia. The study was conducted on 50 children suffering from acute lymphoblastic leukemia who attended at the Hematology and Oncology Unit, Pediatric Department, El-Shatby Hospital, Main Alexandria University Hospital. Matched healthy controls were selected within the same age group. The dermatoglyphic features (ab-ridge count, atd, tda and dat angles) were measured. Results: The present study showed a significant relation between palmar dermatoglyphics and childhood acute lymphoblastic leukemia. The patients group had significantly lower atd, tad and ab-ridge with no significant difference as regards adt angle than control group as regards the right hand measurements. On the other hand the patients group had significantly lower atd, adt angles and ab-ridge count and significantly greater tad angle than the control group as regards the left hand measurements. The present study developed an equation for prediction of acute lymphoblastic leukemia in children with an accuracy of 66.7%. Conclusion: palmar dermatoglyphics can represent non-invasive anatomical marker of acute lymphoblastic leukemia risk facilitating its early detection among childre

Fall risk and fracture. Fall risk assessment

For the prevention of fall and its associated injuries including various fractures among the elderly, some simple and clinical screening tools for prediction of falls for the community-dwelling elderly have been developed. In Japan, Toba et al. (2005) explored a portable Fall Risk Index (FRI) consisting of 22items for the elderly living in the community. Among these 22 items, selected seven items which were revealed as independent risk factors for previous falls, are also now considered as good predictor for future falls with the sensitivity and specificity of 0.65 and 0.72, respectively. Thus, FRI is considered as useful screening tools to identify high risk elderly people of falls in the community in Japan.

Anti-inflammatory Lactobacillus rhamnosus CNCM I-3690 strain protects against oxidative stress and increases lifespan in Caenorhabditis elegans.

Numerous studies have shown that resistance to oxidative stress is crucial to stay healthy and to reduce the adverse effects of aging. Accordingly, nutritional interventions using antioxidant food-grade compounds or food products are currently an interesting option to help improve health and quality of life in the elderly. Live lactic acid bacteria (LAB) administered in food, such as probiotics, may be good antioxidant candidates. Nevertheless, information about LAB-induced oxidative stress protection is scarce. To identify and characterize new potential antioxidant probiotic strains, we have developed a new functional screening method using the nematode Caenorhabditis elegans as host. C. elegans were fed on different LAB strains (78 in total) and nematode viability was assessed after oxidative stress (3 mM and 5 mM H2O2). One strain, identified as Lactobacillus rhamnosus CNCM I-3690, protected worms by increasing their viability by 30% and, also, increased average worm lifespan by 20%. Moreover, transcriptomic analysis of C. elegans fed with this strain showed that increased lifespan is correlated with differential expression of the DAF-16/insulin-like pathway, which is highly conserved in humans. This strain also had a clear anti-inflammatory profile when co-cultured with HT-29 cells, stimulated by pro-inflammatory cytokines, and co-culture systems with HT-29 cells and DC in the presence of LPS. Finally, this Lactobacillus strain reduced inflammation in a murine model of colitis. This work suggests that C. elegans is a fast, predictive and convenient screening tool to identify new potential antioxidant probiotic strains for subsequent use in humans.

Improving the screening accuracy for preterm labor: is the combination of fetal fibronectin and cervical length in symptomatic patients a useful predictor of preterm birth? A systematic review

Our objective was to systematically review the current medical literature to assess the accuracy of the combination of fetal fibronectin (fFN) plus ultrasound assessment of cervical length (CL) as screening tools for preterm labor and prediction of preterm birth (PTB), and to compare this to the traditional clinical method of digital cervical examination. We searched PubMed and Cochrane databases without date restriction using the key words "fibronectin" and "cervical length," limited to human studies published in English. In all, 85 studies were identified and supplemented by 1 additional study found through bibliographic search. Nine studies reported the association between fFN positivity plus CL measurement with PTB in women presenting with symptomatic uterine contractions. We conducted an analytic review of the sensitivity, specificity, positive predictive value, and negative predictive value of fFN plus CL for PTB. Further metaanalysis was not performed due to study heterogeneity, especially with respect to the range of gestational ages and variations in cutoff values for the diagnosis of short cervix. Although the clinical diagnostic methodology of preterm labor diagnosis by documenting uterine contractions plus cervical change is currently standard practice, a newer approach combining fFN and CL screening results in a higher sensitivity and positive predictive value for PTB risk while maintaining high negative predictive value. We conclude that this combined screening approach yields useful information regarding short-term risks that can be used to guide acute management, and effectively identifies a population at low risk in whom expensive and potentially dangerous interventions could be avoided.

Which Screening Tools Can Predict Injury to the Lower Extremities in Team Sports?

Injuries to lower extremities are common in team sports such as soccer, basketball, volleyball, football and field hockey. Considering personal grief, disabling consequences and high costs caused by injuries to lower extremities, the importance for the prevention of these injuries is evident. From this point of view it is important to know which screening tools can identify athletes who are at risk of injury to their lower extremities. The aim of this article is to determine the predictive values of anthropometric and/or physical screening tests for injuries to the leg, anterior cruciate ligament (ACL), knee, hamstring, groin and ankle in team sports. A systematic review was conducted in MEDLINE (1966 to September 2011), EMBASE (1989 to September 2011) and CINAHL (1982 to September 2011). Based on inclusion criteria defined a priori, titles, abstracts and full texts were analysed to find relevant studies. The analysis showed that different screening tools can be predictive for injuries to the knee, ACL, hamstring, groin and ankle. For injuries in general there is some support in the literature to suggest that general joint laxity is a predictive measure for leg injuries. The anterior right/left reach distance >4cm and the composite reach distance <4.0% of limb length in girls measured with the star excursion balance test (SEBT) may predict leg injuries. Furthermore, an increasing age, a lower hamstring/quadriceps (H:Q) ratio and a decreased range of motion (ROM) of hip abduction may predict the occurrence of leg injuries. Hyperextension of the knee, side-to-side differences in anterior-posterior knee laxity and differences in knee abduction moment between both legs are suggested to be predictive tests for sustaining an ACL injury and height was a predictive screening tool for knee ligament injuries. There is some evidence that when age increases, the probability of sustaining a hamstring injury increases. Debate exists in the analysed literature regarding measurement of the flexibility of the hamstring as a predictive screening tool, as well as using the H:Q ratio. Hip-adduction-to-abduction strength is a predictive test for hip adductor muscle strain. Studies do not agree on whether ROM of the hamstring is a predictive screening tool for groin injury. Body mass index and the age of an athlete could contribute to an ankle sprain. There is support in the literature to suggest that greater strength of the plantar flexors may be a predictive measure for sustaining an ankle injury. Furthermore, there is some agreement that the measurement of postural sway is a predictive test for an ankle injury. The screening tools mentioned above can be recommended to medical staff and coaches for screening their athletes. Future research should focus on prospective studies in larger groups and should follow athletes over several seasons.

Clinical overview of the seizure risk of dalfampridine

Introduction: Dalfampridine extended release tablets (dalfampridine-ER; known as prolonged-, modified or sustained-release fampridine in some countries) is a potassium channel blocker approved at 10 mg taken every 12 h, for the improvement of walking in patients with multiple sclerosis (MS). This has been demonstrated by an increase in walking speed. Its mechanism of action and narrow therapeutic range suggest the need to evaluate the seizure risk in treated MS patients.Areas covered: This paper discusses the seizure risk in clinical trials, and postmarketing experience of dalfampridine, relative to that in patients with MS. Electroencephalography as a predictive screening tool for seizure risk in dalfampridine-treated patients is also discussed.Expert opinion: The apparent seizure risk at the recommended dose of dalfampridine among patients with no prior seizure history may not be greater than the risk already present in the MS population. For MS patients, dalfampridine represents a promising new therapy for the improvement of walking impairment; its quick onset of action allows rapid determination of therapeutic response. The lack of prognostic value of electroencephalography for determining seizure risk suggests that treatment can be initiated without further screening when patients have no other contraindications. Strict adherence to the prescribed dosing regimen is essential.

Emergency Department Assessment of Self-Harm Risk Using Psychometric Questionnaires

To examine several potential predictive screening tools for emergency department assessment of risk of self-harm. Adult patients presenting with self-harm or suicidal ideation were enrolled at 2 emergency departments at large teaching hospitals in Edmonton, Alberta. Patients completed a brief interview assessing demographics and psychiatric history and several questionnaires (the Beck Hopelessness Scale, the Barrett Impulsiveness Scale [BIS], and the Brief Symptom Inventory [BSI]) and drug and alcohol abuse screens (Drug Abuse Screening Test [DAST-10] and the Cut down, Annoyed, Guilt, Eye-opener [commonly referred to as CAGE] Questionnaire). At 3 months, patients were followed up via telephone and electronic health records to ascertain self-harm outcome. Questionnaires and their subscales were assessed using logistic regression. Receiver operating characteristic (ROC) analysis was performed on the results. Among the 157 patients enrolled, 49% were women and 36% (of the total) were aged 18 to 29 years. Several of the subscales of the BSI and BIS as well as the DAST-10 were significant predictors of self-harm (P < 0.05). ROC analysis showed that none of the scales in isolation were very strong predictors. Hierarchical regression analysis that combined the significant scales with clinical risk factors that were significantly related to self-harm (that is, age, education level, history of self-harm, and whether they presented with self-harm or only suicidal ideation) indicated that the BIS and DAST-10 questionnaires each added significantly to the predictive ability of a model with these risk factors. While many of the questionnaires and their related constructs are related to future self-harm, none of them are particularly strong and their diagnostic usefulness is limited.

A material sparing test to predict punch sticking during formulation development

Context: A qualitative and material sparing test for punch sticking was developed as a predictive development screening tool for comparison of formulation strategies and processing methods to eliminate punch adhesion.Objective: To develop a predictive test for a formulation’s potential to adhere to tablet punches during compression.Materials and methods: Two proprietary compounds, A and B, with histories of punch sticking during manufacturing but not in development, were formulated with microcrystalline cellulose, lactose, croscarmellose sodium, and magnesium stearate. Matching placebos were also prepared by the same methods. Flat faced bevel edge (FFBE) punches of 1/2″ diameter were compared with 1/4″ SRC punches and 1/4″ Flat Faced (FF) punches for adhesion potential using a Kilian rotary tablet press and a Huxley Bertram compaction simulator.Results and discussion: Formulation accumulated on the punches after compression, which indicated potential for punch sticking that resulted in defective tablets with successive compactions. In all cases, only active formulations adhered to the FFBE and FF punches during tableting runs and with fewer compactions than the SRC punches. Those APIs were then reformulated and successfully manufactured using the predictive test results. Reducing the punch size to 1/4″ permitted testing with 50 g of formulation, a ten-fold reduction in consumption compared to the 1/2″ punches.Conclusion: Flat surfaced punches were shown to be more challenging to adhesive formulations than SRC punches. Adhesive formulations were reformulated and successfully manufactured without punch sticking.

Assessment of Obstructive Sleep Apnea and its Severity during Wakefulness

In this article, a novel technique for assessment of obstructive sleep apnea (OSA) during wakefulness is proposed; the technique is based on tracheal breath sound analysis of normal breathing in upright sitting and supine body positions. We recorded tracheal breath sounds of 17 non-apneic individuals and 35 people with various degrees of severity of OSA in supine and upright sitting positions during both nose and mouth breathing at medium flow rate. We calculated the power spectrum, Kurtosis, and Katz fractal dimensions of the recorded signals and used the one-way analysis of variance to select the features, which were statistically significant between the groups. Then, the maximum relevancy minimum redundancy method was used to reduce the number of characteristic features to two. Using the best two selected features, we classified the participant into severe OSA and non-OSA groups as well as non-OSA or mild vs. moderate and severe OSA groups; the results showed more than 91 and 83% accuracy; 85 and 81% specificity; 92 and 95% sensitivity, for the two types of classification, respectively. The results are encouraging for identifying people with OSA and also prediction of OSA severity. Once verified on a larger population, the proposed method offers a simple and non-invasive screening tool for prediction of OSA during wakefulness.

Predicting Phospholipidosis: A Fluorescence Noncell Based in Vitro Assay for the Determination of Drug–Phospholipid Complex Formation in Early Drug Discovery

This paper describes for the first time, a high-throughput fluorescence noncell based assay to screen for the drug-phospholipid interaction, which correlates to phospholipidosis. Anionic amphiphilic phospholipids can form complexes in aqueous solution, and its critical micelle concentration (CMC) can be determined using the fluorescence probe N,N-dimethyl-6-propionyl-2-naphthylamine (Prodan). Upon interaction with drug candidates, this CMC may shift to a lower value due to the association between lipids and drug candidates, the stronger the interaction, the greater the shift. Metabolism of a drug can change the degree of phospholipidosis depending on the rate of metabolism and the nature of the metabolite(s). Our data from 45 drugs and metabolites of 10 drugs using this fluorescence approach demonstrate a good correlation with phospholipidosis as reported with human studies, in vivo testing, and cellular assays. This assay therefore offers a fast, reliable, and cost-effective screening tool for early prediction of the phospholipidosis-inducing potential of drug candidates.

Development and Validation of a Predictive Screening Tool for Uninterpretable Coronary CT Angiography Results

Coronary CT angiography (CCTA) is an excellent tool for noninvasive assessment of coronary arteries in low- to intermediate-risk individuals. However, the accuracy of CCTA heavily depends on image quality. Our objective was to develop and validate a tool to predict pre-CCTA risk of obtaining an uninterpretable result in symptomatic patients. Among 8585 symptomatic patients, we identified variables independently associated with the presence of at least 1 uninterpretable major coronary segment to create the uninterpretable risk score (URS). This risk score was developed using both clinical variables and patient variables acquired at the time the CCTA was performed (heart rate and coronary calcium). The URS was then prospectively validated among an additional 915 symptomatic patients. The URS was predictive of uninterpretable results in both the development and the validation cohorts. For every 4-point increase in the URS (range, 0 to 12), the rate of at least 1 uninterpretable coronary segment per 100 CCTA studies increased ≈1.5 fold. Increased heart rate and coronary artery calcium score were predictive of uninterpretable CCTA study results. Uninterpretable results were associated with 3-month outcomes in the development cohort. The URS can categorize patients who are likely to have at least 1 uninterpretable major coronary segment on CCTA. This may aid in appropriate patient selection for CCTA and avoiding radiation exposure in those likely to have an uninterpretable study. Clinical Trial Registration- URL: http:///www.clinicaltrials.gov. Unique identifier: NCT00640068.

Personalized Prostate Cancer Screening: Improving PSA Tests with Genomic Information

The use of a prostate-specific antigen (PSA) test to screen for prostate cancer is controversial because of its modest predictive value and the potential overdiagnosis and over-treatment of the disease. A research article in this issue of Science Translational Medicine describes single-nucleotide polymorphisms (SNPs) in or near six genes that are independently associated with serum PSA concentrations and that help to explain interindividual PSA variation. Three of these SNPs are also associated with prostate biopsy outcomes. These findings are an important step toward incorporating genetic markers into PSA screening, with the ultimate goal of devising personalized PSA tests for use in the clinic.

Per Aspera Ad Astra : Application of Simplex Qsar Approach in Antiviral Research

This review explores the application of the Simplex representation of molecular structure (SiRMS) QSAR approach in antiviral research. We provide an introduction to and description of SiRMS, its application in antiviral research and future directions of development of the Simplex approach and the whole QSAR field. In the Simplex approach every molecule is represented as a system of different simplexes (tetratomic fragments with fixed composition, structure, chirality and symmetry). The main advantages of SiRMS are consideration of the different physical-chemical properties of atoms, high adequacy and good interpretability of models obtained and clear procedures for molecular design. The reliability of developed QSAR models as predictive virtual screening tools and their ability to serve as the basis of directed drug design was validated by subsequent synthetic and biological experiments. The SiRMS approach is realized as the complex of the computer program 'HiT QSAR', which is available on request.

A multicentre matched case control study of risk factors for preeclampsia in healthy women in Pakistan.

BackgroundPreeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi.MethodsWe conducted a hospital based matched case-control study to assess the factors associated with preeclampsia in Karachi and Rawalpindi, from January 2006 to December 2007. 131 hospital-reported cases of PE and 262 controls without history of preeclampsia were enrolled within 3 days of delivery. Cases and controls were matched on the hospital, day of delivery and parity. Potential risk factors for preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).ResultsIn multivariate analysis, women having a family history of hypertension (adjusted OR 2.06, 95% CI; 1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25), pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46, for each 5 unit increase in Perceived stress scale score) were at increased risk of preeclampsia. However, high body mass index, maternal age, urinary tract infection, use of condoms prior to index pregnancy and sociodemographic factors were not associated with higher risk of having preeclampsia.ConclusionsDevelopment of preeclampsia was associated with gestational diabetes, pregestational diabetes, family history of hypertension and mental stress during pregnancy. These factors can be used as a screening tool for preeclampsia prediction. Identification of the above mentioned predictors would enhance the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions and better maternal and fetal outcomes.