Estimation of Serum Levels of VEGF & SVEGFR-1 (sFLT-1) in Preeclampsia

Previously in normotensive non–proteinuric pregnant women, preeclampsia which is characterized by hypertension and proteinuria has been the main reason for foetal and maternal mortality and morbidity. Previous studies have shown that preeclampsia occurs mostly when the placenta is present and remits after its delivery and since angiogenic factors are involved in placentation, it is of immense importance to study the levels of circulating angiogenic factors during preeclampsia.METHODSBlood samples of 20 preeclamptic and 20 normotensive, non-proteinuric pregnant women were collected and stored at -20 º C. Enzyme linked immunosorbent assay was used to measure the serum level of VEGF. Various concentrations of the standard VEGF (15.6 – 1000 pg/ml) and sFlt-1 (31.2 – 20000 pg/ml) were used.RESULTSIn the preeclamptic pregnant women the levels of free VEGF were found to be significantly lower than the VEGF level of control women. The levels of VEGF in the maternal serum of preeclamptic patients were 38.06 ± 7.18 pg/ml (mean ± SD).CONCLUSIONSThe present study concludes that in preeclamptic patients, low levels of VEGF shows a potential connection between the circulating angiogenic factors and development of the clinical manifestations of preeclampsia.

Feasibility study of a novel intraosseous device in adult human cadavers.

Background & objectives: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers. Methods: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications. Results: A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances. Interpretation & conclusions: The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.

Circulating angiogenic factors in pregnancies complicated by pre-eclampsia.

Background. Pre-eclampsia is an inflammatory disorder characterized by diffuse endothelial dysfunction possibly secondary to impaired trophoblast invasion of the spiral arteries during implantation. It is associated with alterations in maternal serum concentrations of vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). We did a case–control study to ascertain whether pre-eclampsia is associated with changes in serum concentrations of VEGF, PlGF and sFlt-1 in Indian patients. Methods. Serum samples were obtained from 40 women with pre-eclampsia and 40 normotensive, non-proteinuric pregnant women. The levels of VEGF, PlGF and sFlt-1 were analysed using ELISA. Results. In the sera of pregnant women with pre-eclampsia, the levels of sFlt-1 were significantly higher than those in the sera of normotensive, non-proteinuric pregnant women (median 11 295.25 v. 2936.2 pg/ml, p<0.0001), whereas there was a significant reduction in the levels of free VEGF (mean [SD] 170.53 [36.56] pg/ml v. 254.61 [47.39] pg/ml, p<0.0001) and PlGF (mean [SD] 236.77 [93.70] pg/ml v. 744.98 [168.55] pg/ml, p<0.0001). Conclusion. An increase in sFlt-1 levels and a simultaneous decrease in free VEGF and PlGF levels in the sera of women with pre-eclampsia as compared with normotensive, nonproteinuric pregnant women suggest that an imbalance between the levels of these pro- and anti-angiogenic factors may have a role to play in the pathogenesis of pre-eclampsia.