Analysis of HLA-G 5'URR regulatory polymorphisms in Slovak women with pre-eclampsia.

OBJECTIVES: The objective of this study was to identify the impact of the selected HLA-G gene polymorphisms in the 5'URR region on the risk to develop pre-eclampsia. BACKGROUND: Pre-eclampsia (PE) is a serious multisystem disorder that affects women during pregnancy. Despite many research studies, the pathology of PE is not fully understood. Human leukocyte antigen G (HLA-G) belongs to the molecules that induce immune tolerance at the fetal-maternal interface. HLA-G expression was found to be impaired in the women suffering from PE suggesting its involvement in the development of PE. METHODS: 116 women with pre-eclampsia and 130 women with normotensive pregnancy were included in the study. The 16 gene polymorphisms in the HLA-G 5'URR region (promoter) affecting HLA-G expression were typed by direct sequencing. RESULTS: The -201AA genotypes in recessive model were significantly more frequent in women with pre-eclampsia than in the controls (p = 0.047). Furthermore, the analysis of HLA-G 5'URR variants with clinical findings of PE showed a significant association of the -533delA-/+ genotype with a higher mean level of diastolic blood pressure (p = 0.02). CONCLUSION: Our results suggest a genetic association of selected HLA-G 5'URR variants with a risk of developing pre-eclampsia and possible contribution of HLA-G to disease pathology (Tab. 4, Ref. 51).

Analysis of HLA-G gene polymorphisms in Slovak women with pre-eclampsia.

OBJECTIVES: To identify possible association between the selected HLA-G gene polymorphisms and risk of pre-eclampsia. BACKGROUND: Pre-eclampsia is a serious multisystem disorder that affects women during pregnancy. Despite many research studies, the pathology of pre-eclampsia is not fully understood. Human leukocyte antigen G (HLA-G) belongs to the molecules that induce fetal acceptance by the maternal immune system. HLA-G expression was found to be impaired in the women suffering from pre-eclampsia suggesting its involvement in the development of pre-eclampsia. METHODS: 123 women with pre-eclampsia and 102 women with normotensive pregnancy were included in the study. HLA-G gene polymorphisms affecting its expression was determined, namely the HLA-G 14 bp insertion/deletion polymorphism in the 3'UTR and HLA-G 1597ΔC polymorphism tagging the HLA-G*01:05N null allele. Genotyping was performed by PCR and PCR-RFLP. RESULTS: No statistically significant differences in either allele or genotype frequencies between pre-eclampsia cases and control group have been observed (p > 0.05). CONCLUSION: Genetic predisposition of HLA-G to pre-eclampsia in Slovak women was examined for the first time. No association between analysed HLA-G gene polymorphisms and susceptibility to pre-eclampsia was observed. Further investigations are needed to determine the role of immunosuppressive molecule HLA-G in pre-eclampsia development (Tab. 5, Fig. 2, Ref. 37).

Longitudinal evaluation of markers of hemostasis in pregnancy.

OBJECTIVE: The aim of this study was to establish the physiologic changes in hemostasis during pregnancy and to find the association between the factor V Leiden mutation and adverse pregnancy outcome. METHODS: We investigated blood samples of 148 pregnant women during each trimester of pregnancy. We measured their serum concentrations of factors I, II, V, VII, VIII, IX, X, XI, XII, D-dimers, prothrombin time, INR, aPTT, activity of protein C and S, antithrombin III and platelet count. The pregnancy outcome of women with factor V Leiden mutation was compared to those without congenital thrombophilia. RESULTS: Prothrombin time, INR and aPTT were significantly shorter. We found significantly higher plasma concentrations of fibrinogen and d-dimers and higher levels of activity of factor VII and X in the third trimester. No significant difference was found in protein C and antithrombin III activity. The protein S activity was lower in the second trimester and it increased in the third trimester. Although most of the clotting factors were rising during the pregnancy, there was no evidence of fibrinolytic overactivation. In our study, the carriership of factor V Leiden mutation did not affect the incidence of preeclampsia, eclampsia, intrauterine fetal death and venous thromboembolism. Placental abruption was rare. CONCLUSION: Hemostatic changes in pregnancy are significant and essential, and have the potential to cause adverse pregnancy outcome. In addition, hypercoagulable state during pregnancy is considered to be physiological (Tab. 4, Ref. 36).

Ultrasound diagnosis of macrosomia.

Over the last two to three decades, there has been a 15-25 % increase in many countries in the number of women giving birth to large infant. Fetal macrosomia is associated with an increased risk of complications both for the mother and the newborn. In current obstetrics, the macrosomic fetus represents a frequent clinical challenge. The early detection and identification of the risks associated with fetal macrosomia is important to managing the pregnancies and at last the timing and mode of delivery. This article provides possibilities of ultrasound diagnosis throughout the pregnancy and investigates the effectiveness of fetal measurements in identifying the large fetus (Tab. 1, Ref. 24).

Metabolic syndrome and the risk of preeclampsia.

OBJECTIVE: The purpose of this study was to determine if the evaluation of the metabolic score is a suitable approach to assess the risk of preeclampsia. RESULTS: The overall number of deliveries in the study period was 2263, preeclampsia occurs in 182 cases. The evaluated metabolic score in these patients was following: 0 in 34 cases, 1 in 121 cases, 2 in 19 cases and 3 in 8 cases. The presence of metabolic syndrome (3 risk factors) was find only in 4.4% of cases of preeclampsia, but at least one risk factor for the metabolic syndrome occurred in 81.3% cases of preeclampsia. CONCLUSIONS: The assessment of risk of preeclampsia is of interest due to higher perinatal mortality and morbidity in this group of patients. An association between preeclampsia and metabolic syndrome seems to be clear. In this situation, the use of metabolic score in assessing the risk of preeclampsia can help in early diagnosis and treatment of preeclampsia. Modification of metabolic score may be an appropriate method how to distinguish the risk of preeclampsia (Tab. 1, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Sonography in the management of symptomatic pregnancies of unknown location.

OBJECTIVE: To evaluate the management of pregnancy of unknown location in our conditions and to assess possibilities to improve on the performance of it. METHODS: This was a retrospective study of a population of women classified as having PUL. Out- and inpatients were recruited. Their medical history, gynaecological examinations, transvaginal sonography and serum beta-hCG were carried out. Final outcome of each PUL was established. RESULTS: Diagnostic models for variant courses of PUL were established. EPs after PUL were evaluated. The following sonagraphic findings were associated with EP after PUL: blob sign in 4 of 16 cases (25%), bagel sign in 1 case (6.25%), EP established by sonography in 2/16 cases (12.5%) and no valid sonographic structures in 9/16 cases (56.25%). CONCLUSIONS: Conditions for improvement the management of PUL are: implementation of PUL in the clinical practice, creation of EPU, improvent in the evaluation of serum beta-hCG levels and resolution of sonographic examination (Tab. 1, Fig. 1, Ref. 18).

A self-report questionnaire for measuring separation anxiety in adulthood.

Little attention has been given to measuring symptoms of separation anxiety (SA) in adulthood. The development of an Adult Separation Anxiety Questionnaire (ASA-27) is described and compared to a previously derived Adult Separation Anxiety Semistructured Interview (ASA-SI). Principal components analysis revealed a coherent construct of SA with high internal consistency (Cronbach's alpha =.95) and sound test-retest reliability (r =.86; P <.001). A receiver operation characteristic (ROC) analysis against the semistructured interview yielded a high area under the curve index (AUC = 0.9) suggesting that the questionnaire is an adequate alternative measure of SA. Results of this study support previous research suggesting that a construct of SA may be readily measured in adults.

Problems Tamil asylum seekers encounter in accessing health and welfare services in Australia.

Over the last decade, western countries have reduced their intake of refugees, even though a substantial number of persons continue to be displaced by war and persecution. At the same time, there has been a substantial increase in the number of asylum seekers who apply for refugee status after entering western countries without resettlement documents. Evidence is accruing that asylum seekers are at high risk to trauma-related psychiatric and physical disorders. Increasing concerns have been raised, therefore, about the difficulties that asylum seekers face in accessing health and welfare services. The present Australian-based volunteer study compared Tamil asylum seekers (n = 62) from Sri Lanka with compatriots (30 refugees; 62 immigrants) on a number of indices relating to difficulties accessing medical, counselling and welfare services. The majority of asylum seekers (>60%) reported serious difficulties accessing medical and dental services and a sizeable minority reported problems obtaining assistance with welfare (40%), counselling (34%), and charity (23%). Difficulties accessing medical and dental services consistently exceeded those reported by refugees and immigrants. In spite of the inevitable sampling limitations, the data support past research as well as clinical impressions in suggesting that asylum seekers are particularly disadvantaged in accessing health care services.