Asociación de nivel bajo de PAPP-A en primer trimestre con resultados obstétricos adversos / Association of low PAPP-A level in the first trimester with adverse obstetric outcomes

ANTECEDENTES: La PAPP-A es una proteína utilizada en obstetricia de forma rutinaria para el cribado de aneuploidías de primer trimestre. En los últimos años se está conociendo más acerca de su papel en la función placentaria. Diversos estudios están mostrando una asociación entre un nivel bajo de PAPP-A y distintos eventos obstétricos. OBJETIVO: Establecer una asociación entre PAPP-A baja y eventos obstétricos adversos. MÉTODO: Estudio retrospectivo de casos y controles anidado en una cohorte. Se han recogido las gestaciones únicas con PAPP-A inferior a percentil 5 en primer trimestre durante 2 años. Se ha recogido de la misma cohorte un grupo control, en proporción 2:1. Se compara mediante análisis estadístico la incidencia de eventos obstétricos adversos de cada grupo. RESULTADOS: Se incluyó un total de 285 pacientes en el grupo de casos y 570 pacientes en el grupo control. Se observó un aumento significativo en el grupo de casos de la incidencia de prematuridad, restricción del crecimiento, hipertensión gestacional y diabetes gestacional. Se ha correlacionado la PAPP-A baja con varios eventos obstétricos adversos, incluyendo prematuridad (OR 4,27), diabetes gestacional (OR 2,40), restricción del crecimiento (OR 2,36) e hipertensión gestacional (OR 2,22). No se observó relación con el resto de eventos obstétricos adversos. CONCLUSIÓN: Un nivel de PAPP-A bajo se asocia con aumentos significativos de prematuridad, diabetes gestacional, restricción del crecimiento e hipertensión gestacional.

BACKGROUND: PAPP-A is a placental protein used in obstetrics as a first trimester marker in aneuploidy screening. In the last few years we are knowing more about its placental function. Some studies are showing a association between low PAPP-A and obstetrical adverse events. AIM: Establish an association between low PAPP-A an obstetrical adverse events. METHOD: This is a retrospective nested case-control study. We identified each singleton pregnancy with a normal phenotype and a low PAPP-A (under percentile 5) in the last 2 years, and match it with a control group of the same population in a 2:1 proportion. It was compared the incidence of each obstetrical adverse outcomes with statistical analysis. RESULTS: We found 285 patients in the case group and match it with 570 patients from control group. It was observed a significative increase in the incidence of prematurity, intrauterine growth restriction, gestational hypertension and gestational diabetes. A low PAPP-A level was correlated with some obstetrical adverse events, like prematurity (OR 4.27), gestational diabetes (OR 2.40), intrauterine growth restriction (OR 2.36) and gestational hypertension (OR 2.22). We observe no correlation with the rest of outcomes. CONCLUSIONS: A low PAPP-A level is related with significative increases of prematurity, gestational diabetes, intrauterine growth restriction and gestational hypertension.

El "chaco": arcilla medicinal comestible del altiplano peruano y sus propiedades en la patología digestiva / The "Chaco": eatable medicinal clay in the Peruvian highlands and his properties in digestive diseases

Los pobladores del altiplano peruano-boliviano consumen una sustancia natural conocida como "chaco", muy difundida desde la época precolombina y apreciada por sus propiedades digestivas. El Chaco es una arcilla medicinal comestible que es usada en forma de suspensión con agua para cohibir molestias dispépticas o manifestaciones ácido-pépticas. En esta contribución damos a conocer aspectos físico-químicos de la composición del Chaco, estudios experimentales en animales que evalúan su efecto antiulceroso y una prueba in vitro que estudia su propiedad antiácida. El mecanismo de acción terapéutico propuesto se debe a una acción citoprotectora sobre la mucosa gástrica por mecanismos independientes de la inhibición de la secreción ácida, ya que no posee propiedad antiácida in vitro. Además tiene una capacidad de adsorción a distintas moléculas orgánicas debido a su gran superficie externa y carga tetraédrica que hace que interaccione con sustancias polares como el agua y toxinas. El otro propósito de esta contribución especial, es reconocer la coexistencia de la "Medicina Tradicional" y la "Medicina Occidental", situación que conlleva a la necesidad de la investigación preclínica de diversos recursos naturales.

The inhabitants of the peruvian-bolivian plateau consume a natural substance known as "Chaco", widespread since pre-Columbian era and appreciated for its digestive properties. The Chaco is an edible medicinal clay that is used as slurry with water to restrain dyspeptic discomfort or acid-peptic manifestations. In this contribution we present physicochemical aspects of the composition of the Chaco, experimental animal studies that evaluate its antiulcer effect and in vitro test that studies the antacid property. The proposed mechanism of therapeutic action is due to a cytoprotective effect on the gastric mucosa by independent mechanisms of acid secretion inhibition, as it has no antacid property in vitro. Also it has an adsorptivity to different organic molecules due to their large surface area and tetrahedral charge that makes it to interact with polar substances such as water and toxins. The other purpose of this special contribution is to recognize the coexistence of "Traditional Medicine" and "Western Medicine", a situation which leads to the need for preclinical research of various natural resources.

Predictive value of phosphorylated insulin-like growth factor binding protein-1 [PIGFBP-1] [bedside test] in preterm labor

This study evaluated the predictive value of phosphorylated insulin like growth factor binding protein-1 in cervical secretion as bedside test for prediction of preterm labor in symptomatic women.A total of 57 patients with singleton pregnancy at 24-34 weeks gestation, with symptoms suggestive of preterm labor were included in this study. A rapid cervical sample for PIGFBP-1 determination [Actim partus test, Medix Biochemical, and Kaunianen, Finland] was taken by means of a polyester-tipped swab during a speculum examination of the cervix, and extracted with specimen- extraction solution. We analyzed the prevalence of preterm labor in these patients within seven days upon admission. And calculate sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] for PIGFBP-1. This study was done at Kuwait Oil Company hospital [KOC] and Taiba hospital [Kuwait] during the period between April 2011 and June 2012.The test was positive in 50.9% of patients and negative in 49.1%, among those tests was positive 64% delivered less than a week, and among those tests was negative 35.7 delivered less than one week, with 74.3% sensitivity, 61% spesivity, 76.3% PPV and 73.6% NPV

Revisão da leucina aminopeptidase no trabalho de parto pré-termo e na pré-eclampsia / Revision of the leucine aminopeptidase in preterm labor and in preeclampsia

Realizou-se um levantamento bibliográfico, com artigos de revisão, analisando e discutindo os trabalhos publicados sobre os efeitos da leucina aminopeptidase e aminopeptidase A no trabalho de parto pré-termo e na pré-eclampsia. A proposta deste trabalho sobre o tema é que grande parte das questões de saúde materna parece pueril, principalmente quanto ao atendimento voltado para os cuidados maternos, no qual, a cada 20minutos, morre uma mulher em decorrência de parto, no mundo todo. Por isso, tais doenças poderão receber mais atenção do que outras. Esse fato fez com que houvesse certa preocupação com o índice de natalidade e morbidade materna, bem como morbidade e mortalidade perinatal. Portanto, abordou-se sobre sua biologia geral, fisiologia de reprodução, síntese de evolução genética, habitação, alimentação, manejo, dor e eutanásia, técnicas de riscos desenvolvidos na experimentação animal, estudos de experimentos farmacológicos e toxicológicos observados dentro dos artigos de revisão. Embora tendências atuais preconizem a utilização de métodos alternativos (estudo in vitro), os modelos animais, como as ratas, apresentam como principal vantagem o fornecimento de informações sobre o organismo como um todo, fato que não é obtido com outros métodos, o que ainda possibilita o seu emprego em pesquisas científicas.

We have carried out a literature review, with review articles, analyzing and discussing the works that have already been published on the effects of leucine aminopeptidade and aminopeptidase A in pre-term labor and preeclampsia. The proposal of this work on the subject is that most of the issues of maternal health seems childish, especially for service oriented maternity care, where, every 20 minutes, a woman dies due to childbirth, worldwide. Therefore, such diseases may receive more attention than others. This led to worry about the birth rate and maternal morbidity and perinatal morbidity and mortality. Therefore, it was addressed their general biology, physiology of reproduction, synthesis of evolution, genetics, housing, feeding, pain and euthanasia techniques developed for animal experimentation risks, studies of pharmacological and toxicological experiments observed within the review articles. Although current trends have preconized the use of alternative methods (in vitro study), animal models, such as rats, have as main advantage the provision of information on the organism as a whole, a fact that is not achieved with other methods, which also allows its use in scientific research.

A study on plasma selenium level among pregnant women at Rohtak, Haryana.

Selenium is an important trace element for human health. Selenium levels in mothers may have significant effects on fetal and neonatal nutrition. In a cross-sectional study undertaken in Rohtak, Haryana, plasma selenium level in mothers was investigated at the time of delivery. The mean plasma selenium level in full term mothers (n=82) was 70.63 +/- 1.62 ppb and in preterm mothers (n = 58), it was 63.28 +/- 2.31 ppb. The difference was statistically significant (p < 0.05). These levels were, however, below the reported normal level of 75-120 ppb in adults. Rura/urban stay, parity, maternal age, socio-economic and literacy status etc. did not influence the selenium level of mothers in either of the groups.

Serum magnesium level in preterm labour.

Preterm labour, (PTL) defined as labour after 28 weeks but before 37 completed week of gestation, is an ill omen for our country as the incidence is 5-10% leading to 70-80% of perinatal deaths. Besides varied etiology, it may be due to alteration in basic biochemical functions of the body at cellular level stating emphasis to trace elements, of which magnesium, being one of them, is subject of interest now a days. Serum magnesium was estimated in fifty cases of Preterm labour of idiopathic etiology (28-37 wks), 35 normal pregnancy cases of the same gestational age and 15 normal non-pregnant ladies. Varied hypomagnesemia was observed in Preterm labour cases (1.47 mg/dl +/- 0.22 S.D.), normal value of serum magnesium was found in normal non-pregnant ladies and slightly low value were observed in pregnant ladies of same gestational age. Age and parity had no significant effect on serum magnesium level in our study. As far as socio-economic study is concerned, it was found to be higher in high socio-economic group and low in lower group. Thus from this study it can be concluded that estimation of serum magnesium in pregnancy may prove to be a valuable tool in predicting preterm onset of labour.

Contenido de ácidos grasos esenciales en los fosfolípidos de eritrocitos maternos: estudio en nacimientos de pretérmino y término en humanos / Essential fatty acid content of maternal erythrocyte phospholipids: a study in pre term and full term human newborns

Background: A high concentration of arachidonic acid in maternal erythrocytes and trophoblast could have a role in pre term deliveries. Aim: To study the fatty acid composition of long chain fatty acids from erythrocytes of mothers who gave birth to pre term and full term infants. Patients and methods: Thirty three healthy women that gave birth to healthy newborns in a public hospital were studied. Twenty two had pre term (34 weeks) and 11 full term (40 weeks) deliveries. The fatty acid profile of phospholipids isolated from erythrocytes of these women was analyzed by gas-liquid chromatography. Results: Compared to women giving birth to full term infants, phospholipids of women giving birth to pre term infants had a higher content of arachidonic acid (20:4w6) and all the species of w6 fatty acids. They also had a lower concentration of palmitic and eicosapentanoic (20:5w3) acids and thus a higher arachidonic acid/eicosapentanoic acid ratio. Conclusions: A high arachidonic acid content in phospholipids of erythrocytes could be a risk factor or predictive marker for pre term deliveries

Proteína C reactiva sérica: asociación con parto pretérmino / Seric C reactive protein: association with preterm labor

El objetivo fué analizar los niveles de proteína C reactiva elevados y su asociación a la amenaza de parto pretérmino, rotura prematura de membranas y coriooamnionitis. Se seleccionaron 56 pacientes del Hospital General del Oeste, divididas en dos grupos: grupo estudio y grupo control. El grupo estudio estaba conformado por 28 pacientes que consultaron por presentar amenaza de parto pretermino o RPM. Se determinaron niveles de proteína C reactiva en ambos grupos. Sólo recibieron tratamiento tocolítico las pacientes con membranas intactas. Las pacientes con niveles de proteína C reactiva elevados (mayor de 6 mg) parieron antes de los siete días de hospitalización en comparación con las gestantes que presentaban niveles de PCR, normales (100 vs 14,2) (p<0.05) hubo dos casos coriomnionitis. El 88 de los recién nacidos provenientes de madres con niveles elevados de PCR, tuvieron un peso de 2500 g (p<0.05). Los niveles elevados de PCR, estan asociados con parto pretérmino y fracaso del tratamiento tocolítico. La PCR, puede ser útil como predictor del exito o fracaso de la terapia tocolítica en la amenaza de parto pretérmino

Significant asymptomatic bacteriuria in high risk pregnancy: preeclamptic toxemia, diabetes mellitus and threatened preterm labor

The study included 162 patients with normal pregnancy as a control group, 50 patients with preeclamptic toxemia [PET], 38 patients with diabetes mellitus complicating pregnancy [DM], and 29 patients with threatened preterm labor [PL] after exclusion of all other causes of PL. They were recruited from Antenatal Care Clinic or from Obstetrics and Gynecology Department, Assiut University Hospital. A clean voided self-collected midstream urine specimen from each patient was tested for bacterial colony count and organisms present. A blood sample was taken from each patient for determination of the serum total protein and serum albumen. The incidence of significant ASB was 9.3% in normal pregnancy, 22% in cases of PET, 27% in cases of threatened PL and 29% in cases of diabetes mellitus complicating pregnancy. In the group of normal pregnancy with significant ASB the highest incidence of organisms was for E. coli and pathogenic staphylococci [40% for each]. In the high risk group the highest incidence was for E. coli [46.6%] and Klebsiella [30%]. There was no significant correlation between significant ASB, on the one hand, and total serum protein and serum albumen, on the other hand, in normal pregnancy. However, serum total protein and serum albumen in PET group with significant ASB showed a significant lowering than in those without and than in normal pregnancy group without significant ASB. This study showed that the incidence of significant ASB in high risk is higher than in normal pregnancy. The incidence in both groups is higher than that recorded in other studies.This may be due to low socioeconomic standard in the studied patients

Copper and zinc levels in premature rupture of membranes and premature Labour

Sixty women in labour were included in this study, 30 patients with premature rupture of membranes [PROM], 15 full term and 15 premature delivery, and 30 patients without PROM, 15 full term and 15 premature delivery. Serum copper and zinc were measured in maternal and cord blood samples in all studied groups. Maternal and fetal copper showed a significant decrease in cases with PROM both in term and preterm when compared to that of patients without PROM while there was no significant change in serum copper levels between the groups with pre term and term labour. Maternal Zinc levels were significantly decreased in the group of premature labour when compared to those in term labour irrespective of presence or absence of PROM. So, it is concluded that copper deficiency may have a role in PROM, while zinc deficiency may be related to the initiation of preterm delivery