Teenagers' Awareness of Peers' Substance and Drug Use in Kuwait.

BACKGROUND: Teenage substance use is a global challenge, and youths residing in Kuwait are not immune from it. Tobacco products are licit; however, alcohol and other mood-altering illicit substance are prohibited with severe penalties including imprisonment. Youths residing in Kuwait are being initiated into the use of mood-altering substances like tobacco at an early age, and it is postulated that, as they grow older, they may progress into using alcohol and other prohibited illicit drugs. AIMS: The aim of this study was to determine licit and illicit substance use by teenagers residing in Kuwait. The study will also explore their awareness of substance use among their peers. DESIGN: A cross-sectional survey using a snowball sampling technique was used to recruit 190 teenagers aged 15-18 years residing in Kuwait. Data were collected using the 130-item questionnaire adapted from 1998 New Jersey Triennial Public High School Survey of Drug and Alcohol Use. Data collection was from September 2012 to June 2013. DATA ANALYSIS: The Statistical Package for Social Sciences Version 22 for Windows was used. Pearson's chi-square, Kruskal-Wallis, and Mann-Whitney U tests were used to test the hypotheses. RESULTS: Tobacco was the most commonly used substance by these teenagers; 8.4% were current smokers, and 50% had experimented. Age of initiation for 21% was before 14 years old. Hashish (marijuana) was the most commonly used illicit drug, with 3.7% current users and 5.3% claiming to have used it. More male than female teenagers in Grade 9 were using tobacco products (χ = 27.428, df = 5, p < .001). CONCLUSION: The use and abuse of mood/mind-altering licit and illicit substances appear to be increasing among older teenagers. Intensifying campaigns about the hazards of substance use and drug testing should start from the primary school level.

Molecular basis for the effects of zinc deficiency on spermatogenesis: An experimental study in the Sprague-dawley rat model.

INTRODUCTION: The objective of this study is to investigate the molecular mechanisms underlying the effects of zinc deficiency on spermatogenesis in the Sprague-Dawley (SD) rat. MATERIALS AND METHODS: Three groups of eight adult male SD rats were maintained for 4 weeks on a normal diet as control, zinc deficient diet and zinc deficient diet with zinc supplementation of 28 mg zinc/kg body weight respectively. Using standard techniques, the following parameters were compared between the three groups of experimental animals at the end of 4 weeks: (a) Serum zinc, magnesium (Mg), copper (Cu), selenium (Se) and cadmium (Cd), (b) serum sex hormones, malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPX), (c) interleukin-4 (IL-4), tumor necrosis factor-alpha (TNF-α), Bcl-2, Bax and caspase-3 expression in the testes, (d) assessment of apoptosis of testicular cells using electron microscopy and (e) testicular volume and histology using the orchidometer and Johnsen score, respectively. RESULTS: The zinc deficient group showed a reduction of testicular volume, serum concentrations of Zn, Cu, Se, Mg, SOD, GPX, IL-4, Bcl-2 and testosterone (P < 0.05), as well as increased levels of serum Cd, MDA and tissue TNF-α, Bax, caspase-3 and apoptosis of the germ cells (P < 0.05) compared with control and zinc supplementation groups. CONCLUSION: Zinc deficiency is associated with impaired spermatogenesis because of reduced testosterone production, increased oxidative stress and apoptosis. These findings suggest that zinc has a role in male reproduction.

Sperm parameters: paradigmatic index of good health and longevity.

Since the discovery of spermatozoon by Anton van Leeuwenhoek in 1677, there has been an ever increasing understanding of its role in reproduction. Many factors adversely affect sperm quality, including varicocele, accessory gland infection, immunological factors, congenital abnormalities, and iatrogenic systemic and endocrine causes, such as diabetes mellitus, obesity, metabolic syndrome, and smoking. The mechanisms responsible for the association between poor sperm parameters and ill health may include oxidative stress, low-grade inflammation, low testosterone, and low sex-hormone-binding globulin. Oxidative stress in the testicular microenvironment may result in decreased spermatogenesis and sperm DNA damage, loss of sperm motility, and abnormal sperm morphology. Low testosterone caused by advanced age, visceral obesity, and inflammation is associated with the development of cardiovascular disease. Hence, semen analysis has an important role in the routine evaluation of idiopathic male infertility, usually manifested as low sperm counts, impaired sperm motility, or absence of sperm, and remains the most common single diagnostic tool. Several studies have shown an inverse relationship between semen quality and medical disorders. This review elucidates the effect of medical disorders and social habits on sperm quality, the mechanisms that are involved in the impairment of sperm quality, and whether or not sperm quality can be used as an index of good health and longevity in a man.

Trace elements and cell-mediated immunity in gestational and pre-gestational diabetes mellitus at third trimester of pregnancy.

THE AIM OF THE STUDY: To evaluate the correlations between Zn2+, Cu2+, Mg2+, Se2+ and Cr3+ and alteration in T cell subsets during diabetic and normal pregnancy. METHODS: The study involved 63 women with gestational diabetes mellitus (GD) and 16 pregnant women with Type 2 diabetes and 48 healthy, non-pregnant women were included as controls. Ten ml of whole venous blood from each participant was analyzed for electrolytes by atomic absorption; total antioxidant activity, individual enzymatic antioxidants by spectrophotometry; and lymphocyte sub-populations by flow cytometry. RESULTS: There were significant changes in lymphocyte sub-populations: Naïve T cells were decreased and memory T-cells and activated T cells (CD4+HLA-DR+, CD4+CD29+) were increased in diabetes in pregnancy. Zn2+ and Cr3+ deficiency were observed in Type 2 diabetics with an increase in Cu2+ in all pregnant cohorts. In healthy pregnant subjects, CD4+-HLA-DR+ was increased in direct proportion to serum Mg2+ (p<0.05) and Se2+ (p<0.01). In insulin-treated GD patients, CD4+CD29+ cells were increased proportionally to serum Zn2+ (p<0.05) while in diet controlled GD cohort CD45RO+/ CD45RA+ T cells correlated directly with serum Mg (p<0.05) and Zn2+ (p<0.01) while it correlated inversely with serum Cu2+ (p<0.01). CONCLUSIONS: The results of the present study show a correlation between trace element deficiency and increased lipid peroxidation in diabetes in pregnancy and lymphocyte activation. Dietary manipulation may, therefore, point to improvement in existing approaches to management of diabetes mellitus in pregnancy.

Prevalence of Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum infections and seminal quality in infertile and fertile men in Kuwait.

This study was undertaken to determine the prevalence of Chlamydia trachomatis, mycoplasmas, and ureaplasmas in semen samples of infertile compared with fertile men and to evaluate the seminological variables of semen from infected and noninfected men. A total of 127 infertile and 188 fertile men seen in a maternity hospital clinic were recruited into the study over a period of 14 months. Specimens were obtained by masturbation and examined for the presence of Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and C trachomatis by polymerase chain reaction. Semen analysis was performed according to World Health Organization guidelines. U urealyticum, M hominis, M genitalium, and C trachomatis were demonstrated in the semen samples of 31 (24.4%) vs 49 (26.1%), 22 (17.1%) vs 61 (32.4%), 6 (4.7%) vs 6 (3.2%), and 5 (3.9%) vs 7 (3.7%), respectively, of infertile and control men. Mixed infections were detected in 14 (11%) of infertile and 29 (15.4%) of fertile men. The infertile men positive for M hominis had semen samples that showed statistically significant differences in the mean of sperm pH and leukocyte count between infected and uninfected men (P < .03 and P < .001, respectively). Similarly, there was statistically significant difference in the leukocyte counts of M genitalium and C trachomatis in infected compared with uninfected men. A similar trend was noted in infected fertile compared with uninfected men. The difference in prevalence of these urogenital pathogens among infertile compared with fertile men was not statistically significant. However, genital mycoplasmas and chlamydial infections appeared to influence semen quality negatively.

Premenstrual dysphoric disorder: prevalence and effects on nursing students' academic performance and clinical training in Kuwait.

AIMS: This study investigated the prevalence of Premenstrual Dysphoric Disorder among non-treatment seeking female students at the College of Nursing Kuwait. It also explored the effects of the disorder on their academic performance as shown by their grade point average and rate of absenteeism at clinical training. BACKGROUND: Many women worldwide are unaware of this distressing menstrual disorder which affects about 3-8% of women of childbearing age. The cyclical mood symptoms often appear during the last week prior to the onset of menstruation. These symptoms interfere with sufferers activities of daily living including occupational, biopsychosocial and sexual activities. DESIGN: A prospective observational study. METHODS: The study used an adapted Arabic version of Daily Record of Severity of Problem for two menstrual cycles to collect data from 110 nursing students. RESULT: Data analysis showed Cronbach's alpha coefficient for the adapted tool was 0·95. The rate of premenstrual dysphoric disorder was 5·6%. Hypotheses tested showed no significant effect on students' academic performance but a significant association with absenteeism at clinical training. CONCLUSION: The rate obtained in this study was similar to those from recent studies. Participants with high luteal scores believe that the condition have lowered their quality of life by making them choose to be in isolation during the period. RELEVANCE TO CLINICAL PRACTICE: Nursing students' absenteeism rate at clinical training is a predictor of their work absence pattern after qualification. Absenteeism due to premenstrual dysphoric disorder, a cyclic monthly disorder will be of monthly occurrences if sufferers do not sought medical treatment. Registered nurses absenteeism will not only result in shortage of trained nursing personnel, but also lowered standard of client care. It also has cost implications as temporary substitute staff may have to be employed during their period of absence or sick leave. This has implications for nursing management.

Lithium protects against toxic effects of cadmium in the rat testes.

PURPOSE: To investigate the protective effect of Lithium against the toxic effect of Cadmium in the rat testes. METHODS: Twenty four adult male Sprague-Dawley rats were treated with four different regimens: Cadmium only, Cadmium and lithium, lithium only and controls. Rats were sacrificed after 6 weeks and testicular levels of pro-inflammatory cytokine (IL-4), anti-inflammatory cytokine (TNF-α), Pro-apoptotic protein (Bax) and anti-apoptotic protein (Bcl-2) were measured by ELISA while serum levels of FSH, LH, Prolactin and Testosterone were measured using the Vidas parametric system. Antioxidant status (MDA, SOD) was also assessed in serum. Histopathological changes of testes were examined using light and electron microscopy. Immunohistochemical staining for Bax, Bcl-2 and Caspase 3 were performed. RESULTS: Treatment with lithium was associated with significant reduction in the toxic effects of Cadmium as shown by reduced testicular levels of TNF-α, serum levels of Malondialdehyde and testicular level of Bax, and increased levels of IL-4, Zn-Cu SOD, Bcl-2 and Testosterone. Testicular histopathology showed that Cadmium produced an extensive germ cells apoptosis and the addition of lithium in Cadmium-treated rats significantly reduced cadmium-induced testicular damage. CONCLUSION(S): Lithium has a protective effect against cadmium-induced testicular apoptosis in the rat.

Emotional reaction to diagnosis of infertility in Kuwait and successful clients' perception of nurses' role during treatment.

BACKGROUND: The unfulfilled desire of millions of infertile couples worldwide to have their own biological children results in emotional distress. This study evaluated the emotional reactions of couples attending a combined infertility clinic in Kuwait and successful clients' perception of nurses. METHODS: Quantitative and qualitative methods were used. The first phase was by structured interview using two standardized psychological scales: the 25-item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale. Data were collected from 268 couples attending the combined infertility clinic, between October 2002 and September 2007. The second phase was a semi-structured interview of 10 clients who got pregnant following treatment. The interview explored their feelings and perception of the nurses' role. Interviews were transcribed verbatim and analyzed. RESULTS: The average duration of infertility was 4 years; 65.7% of the women and 76.1% of men suffered from primary infertility. Emotional reactions experienced were: anxiety in women (12.7%) and men (6%), depression in women (5.2%) and men (14.9%) and reduced libido in women (6.7%) and men (29.9%). Also in men, 14.9% experienced premature ejaculation, 5.2% weak ejaculation and 7.9% had impotence although 4.9% were transient. In the semi-structured interviews, the emotions expressed were similar and in addition to anger, feelings of devastation, powerlessness, sense of failure and frustration. In the survey, 12.7% of the men were found to show more anxiety than women (6%). Although all the 10 women interviewed confirmed they were anxious; only 4 of their partners were reported to be sad or anxious. Successful clients' perception of nurses' roles included nurses carrying out basic nursing procedures, communicating, educating about investigative and treatment procedures, providing emotional support by listening, encouraging, reassuring and being empathetic. CONCLUSIONS: This study illuminates the emotional reactions of infertile clients. Fertility nurses in Kuwait can provide emotional support through communication. The need for additional and continuous training for nurses employed in fertility settings in Kuwait is paramount.

Butyrylcholinesterase activity in gestational diabetes: correlation with lymphocyte subpopulations in peripheral blood.

PROBLEM: Inefficient clearance of pregnancy-threatening toxins may contribute to gestational diabetes (GD) and Type II diabetes mellitus (DM) through mechanisms involving immune dysregulation. METHOD OF STUDY: Peripheral venous blood from pregnant Kuwaiti women in third trimester, including 15 GD and 17 DM patients, 14 healthy pregnant (HP) and eight non-pregnant subjects, was analyzed by two-color flow cytometery for number and percentage representation of T lymphocytes. Buterylcholinesterase (BuChE) activity was measured using buterylthiocholine iodide and spectrophotometry. RESULTS: Relative to HP, GD patients exhibited higher ratios of activated and memory phenotypes, including CD4+ CD25+ (P < 0.01), CD4+ HLA-DR (P < 0.05) and CD4+ CD45RO+ (P < 0.05) cells. Serum BuChE activity exhibited positive correlation within the HP cohort with CD4+ CD25+ (P < 0.05), but not in GD and DM cohorts. CONCLUSIONS: Positive correlation between BuChE and a (presumptive) 'regulatory' T-cell phenotype in HP, but not GD or DM may indicate existence of protective detoxification mechanisms against oxidative stress in normal pregnancies.

Allopurinol provides long-term protection for experimentally induced testicular torsion in a rabbit model.

OBJECTIVE: To assess the effect of five antioxidants on exocrine function of rabbit testes retained in situ for 24 h and 3 months after experimental torsion. MATERIALS AND METHODS: The left testes of peripubertal rabbits were clamped for 60 min, after which the clamps were removed and the testes allowed to reperfuse. The right testes served as internal controls. There were eight rabbits in each of the following experimental groups: (a) sham; (b) 60-min ischaemia followed by reperfusion; (c) 60-min ischaemia followed by left orchidectomy. In five further groups, rabbits were exposed to 60-min ischaemia followed by reperfusion, but received one of the following antioxidants before reperfusion: acetyl salicylic acid, ascorbic acid, allopurinol, quercetin or superoxide dismutase. Both testes were excised at 24 h or 3 months. The degree of lipid peroxidation, a measure of free radical damage, was assessed in testicular tissue homogenates by measuring the tissue levels of malondialdehyde (MDA). The Johnsen score was used to assess the morphological damage at 24 h and 3 months for each group. RESULTS: At 3 months twisted viable testes allowed to reperfuse had higher MDA levels than controls; the left testes of rabbits treated with allopurinol had significantly lower MDA levels than untreated rabbits and rabbits given other antioxidants. Rabbits given quercetin, ascorbic acid or superoxide dismutase had lower (but not significantly) left testicular MDA levels than untreated rabbits, while rabbits given acetyl salicylic acid had even higher levels. Allopurinol-treated rabbits had a Johnsen score of > 7.6 and those given other antioxidants had scores of < 7.6 at 3 months. CONCLUSION: The twisted viable testis treated by orchidopexy contains high free radical levels at 3 months. Of the antioxidants studied, only allopurinol had a beneficial long-term effect, by significantly reducing testicular MDA levels at 3 months.

Evidence for the presence of beta-3-adrenoceptors mediating relaxation in the human oviduct.

Beta1- and beta2-adrenoceptors mediate relaxation in the oviductal smooth muscle. This study examines the existence and function of beta3-adrenoceptors in the human oviduct. Ring segments of the oviduct were set up for isometric tension recording. The effect of isoprenaline and BRL 37344 on smooth muscle tone was examined. The expression of beta3-adrenoceptors in the oviduct was also examined. Isoprenaline and BRL 37344 concentration-dependently relaxed circular muscles of the oviduct. BRL 37344 was less potent than isoprenaline and was a partial agonist. Propranolol shifted isoprenaline but not BRL 37344 concentration-response curve to the right without reducing the maximum response. Cyanopindolol (1 micromol/l), a beta3-adrenoceptor antagonist, shifted the isoprenaline concentration response curve to the right. The -log K(B) value of 7.8 indicates activation of beta3-adrenoceptors by isoprenaline. mRNA for beta3-adrenoceptors was expressed in the oviduct. These results suggest that beta3-adrenoceptors, mediating relaxation, are expressed in the human oviduct.

Lymphocyte sub-populations in gestational diabetes.

PROBLEM: We hypothesize that the normal immunologic responses by the maternal immune system during pregnancy are not as well-regulated in gestational diabetes (GD) patients as in healthy pregnant women. METHOD OF STUDY: Using two-color flow cytometry we evaluated frequencies of peripheral blood lymphocytes in 20 GD patients being treated with insulin; 43 GD patients treated with dietary therapy but no insulin; 44 women experiencing normal pregnancies; and 48 non-pregnant women. RESULTS: When compared with healthy pregnant women, both GD cohorts showed higher percentages CD4(+)CD25(+) (P < 0.05), CD4(+)CD45RO(+) (P < 0.05) and CD4(+)CD29(+) (P < 0.01) but lower percentages of CD4(+)CD45RA(+) (P < 0.05). Higher percentages of the activated phenotypes CD8(+)CD25(+) and CD8(+)HLA-DR(+) cells in the diet-treated cohort and CD4(+)HLA-DR(+) cells in insulin-treated GB cohort, were observed compared with healthy pregnant subjects (P < 0.05). CONCLUSIONS: Expanded populations of activated peripheral blood T cells are associated with GD, suggesting that normal maternal immunosuppression is less effective in GD-afflicted women.

Significance of determining the point of reperfusion failure in experimental torsion of testis.

BACKGROUND: Experimental studies of the use of free radical scavengers in ischemic/reperfusion (I/R) injury following detorsion of the torted testis have yielded conflicting results due to differences in the period of ischemia used. The authors studied I/R injury in the rabbit model, to define the point beyond which there is reperfusion failure. METHODS: Ischemia/reperfusion injury of the testis was created in 3-6-month-old male New Zealand white rabbits by cross-clamping the left spermatic cord for periods of ischemia lasting 0, 15, 30, 60, 90, 120 and 180 min. There were eight animals per experimental group. The right testis served as internal control. Both testes were harvested after 24 h of reperfusion in four animals and after 3 months in the remaining four animals for each group. Testicular malondialdehyde (MDA), a measure of free radical damage, was determined by using the thiobarbituric acid reaction on testicular homogenates. Johnsen score was used to assess morphological damage caused by the ischemia. RESULTS: After 24 h of reperfusion, the mean testicular MDA in the control right testes at 0, 15, 30, 60, 90, 120 and 180 min was 2.1, 2.5, 2.9, 2.4, 2.1 and 1.9 nmol/mg protein, respectively. The mean left testicular MDA at corresponding ischemic periods was 1.6, 2.0, 3.9, 10.0, 4.4, 6.1 and 1.0 nmol/mg protein, respectively. The maximum left testicular MDA was at 60 min (10.0 nmol/mg protein), following which the level dropped significantly to 1.0 nmol/mg protein at 180 min. At 3 months, the mean Johnsen scores for left testes subjected to 0, 60, 120 and 180 min ischemia were 9.4, 8.8, 2.3, 3.5, respectively. CONCLUSION: The results suggest that following ischemia of up to 60 min in the rabbit testis, adequate reperfusion is possible, but ischemia lasting beyond 60 min results in inadequate reperfusion leading to irreversible damage. Thus, in experiments for assessing the effect of antioxidants on I/R injury of the testis in rabbits, periods up to 60 min of ischemia should be regarded as optimum to observe an effect.

Connection between human leucocyte antigens D region and T helper cytokines in preeclampsia.

Preeclampsia is a common and major cause of maternal and perinatal morbidity and mortality. Human leucocyte antigen (HLA) susceptibility and impaired adaptation of the T lymphocyte sub-population and a bi-directional effect of T helper cytokines on the outcome of pregnancy have been reported in patients with preeclampsia. The association between maternal HLA class II and T helper cytokines in women with preeclampsia was investigated in seventy-six preeclamptic women and normotensive controls using Terasaki microlymphocytotoxicity test. T helper cytokines interleukin (IL)-8, IL-6, IL-4, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma were estimated in the maternal blood and placenta by enzyme-linked immunosorbent assay (ELISA). Histopathological evaluation of the placenta was also carried out. HLA class II DR2, DR4, DR5, DRw8, DRw10, DRw11, DRw18, and DQw2 had significant relative risk ratios for preeclampsia, while DQw3 was more common in the controls. DR4-DRw11-DQw2 haplotype was more common in preeclamptic women with intrauterine growth restriction, low birth weight and placental weight, increased expression of T helper cytokines IL-8, TNF-alpha and IFN-gamma and abnormal uteroplacental vasculature. These findings suggest that HLA class II DR4-DRw11 -DQw2 haplotypes may be associated with preeclampsia with intrauterine growth restriction through low placental weight from impaired placental development, as a result of increased expression of T helper 1 cytokines IL-8, TNF-alpha and IFN-gamma.

The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome.

INTRODUCTION: Obesity has become a worldwide epidemic with ever increasing incidence and public health problems in both developing and developed countries. OBJECTIVE: The objective of the study is to investigate the incidence of obesity among patients with polycystic ovarian syndrome attending infertility clinic and the effect on treatment outcome. METHODOLOGY: Two hundred and seventy women with polycystic ovarian syndrome attending the infertility clinic were evaluated clinically, biochemically, and laparoscopically. They were stratified according to their body mass index (BMI) as follows: normal weight: 18-24; overweight: 25-29, obese:30-34, and grossly obese: > or = 35. Therapy included induction of ovulation with clomiphene citrate and gonadotrophins. The patients were followed up through during induction of ovulation and pregnancy. RESULTS: There were ethnic differences in mean BMI. Significantly more obese women had oligomenorrhoea (p<0.01) and anovulation (p<0.01) than women with normal weight. Obesity adversely affected the outcome of ovulation induction with clomiphene citrate and gonadotrophins; 79% of women with BMI 18-24 ovulated at 6 months compared to 15.3% in those with BMI 30-34 (p<0.001) and 11.8% in women with BMI > or = 35 (p<0.001). The pregnancy rate and outcome were also adversely affected by obesity. CONCLUSION: Obesity has a negative impact on the outcome of treatment of infertility. Weight reduction programme should be an essential component of infertility management.

Measurement of inhibin A and inhibin pro-alphaC in early human pregnancy and their role in the prediction of pregnancy outcome in patients with recurrent pregnancy loss.

OBJECTIVE: To examine the temporal relationship among inhibin A, beta-hCG, and pro-alphaC in early pregnancy and to determine whether the measurement of these hormones has any role in prediction of pregnancy outcome in patients with recurrent spontaneous miscarriage. DESIGN: Prospective descriptive study. SETTING: A tertiary referral center for recurrent miscarriage. PATIENT(S): Thirty-six pregnant women with previous history of recurrent spontaneous pregnancy loss. INTERVENTION(S): Serial blood samples were collected prospectively at 6, 8, 10, and 12 weeks of gestation and were analyzed for inhibin A and inhibin pro-alphac using a two-site enzyme-linked immunosorbent assay as well as for beta-hCG using the microparticle enzyme immunoassay. MAIN OUTCOME MEASURE(S): Serum levels of inhibin A, inhibin pro-alphac, and beta-hCG. RESULT(S): The patients were allocated to two groups according to the pregnancy outcome: group 1 consisted of patients whose pregnancy continued beyond 20 weeks (control group); and group 2 consisted of patients who spontaneously aborted (aborted group). There was a significant difference in inhibin A concentrations between the control and aborted groups at 8, 10, and 12 weeks' gestation. Significant differences in beta-hCG concentrations between the two groups is evident only at 10 weeks' gestation. There were no significant differences in inhibin pro-alphac concentrations between the two groups at any gestational age. Assessment of the trend in the control group over the study period showed a significant increase in inhibin A and beta-hCG but not inhibin pro-alphac levels. CONCLUSION(S): Low serum levels of inhibin A at early gestational age in pregnancies destined to miscarry suggest a role for this glycoprotein as a marker for early pregnancy viability. Its measurement at the time of the first pregnancy test might be able to predict pregnancy outcome.

Nitric oxide metabolites in preterm and induced labor.

BACKGROUND: Nitric oxide has potent relaxant effects on the pregnant uterus and has been associated with a quiescent uterus in animal and human studies. Nitric oxide donors have been used to arrest preterm labor and a reduction in nitric oxide production has been reported before the onset of labor. OBJECTIVE: The aim of the study was to estimate the serum levels of nitrate and nitrite in women undergoing spontaneous preterm labor and induced labor. MATERIALS AND METHOD: Venous blood was drawn from 39 patients before the onset of labor (control) and also from 17 patients undergoing induction of labor who were in active labor (study group A), and 24 patients in spontaneous preterm labor (study group B). Serum concentrations of nitrate and nitrite were estimated in the samples using the HPLC method. RESULTS: The maternal age of the patients was similar in all the groups. There was no significant difference in the mean gestational age at delivery between the control and group-A patients (38.86 vs. 38.29 weeks); however, there was a significant difference between the control and group-B patients (38.86 vs. 30.92; p < 0.0001), and between study groups A and B (38.29 vs. 30.92 weeks; p < 0.0001). The mean serum levels of nitrite in groups A and B (0.563 +/- 0.15 and 0.512 +/- 0.13, respectively) were significantly lower than the level in the control group (0.915 +/- 0.13; p < 0.0001). Although the serum nitrate levels in study groups A and B were lower than in the control group, this difference was not significant. The maternal outcome was satisfactory but, as expected, the mean birth weight of the babies in group B (1,665.73 +/- 863.84 g) was significantly lower than the birth weights in the control and group-A patients (p < 0.0001). CONCLUSION: There is a drop in nitric oxide production in active preterm labor and induced labor. These findings need to be confirmed in larger studies to establish the role of nitric oxide in the initiation of labor.

Butyrylcholinesterase activity and pregnancy-associated differences in immunologically relevant peripheral blood leukocyte populations.

PROBLEM: Toxic anticholinesterases (AC) are known contributors to negative pregnancy outcome. Impairment of detoxification mechanisms may correlate with occurrence of pregnancy disorders in Kuwait. METHOD OF STUDY: Butyrylcholinesterase (BuChE), an enzyme which detoxifies AC was evaluated in 18 Kuwaiti women with pregnancy-induced hypertension (PIH), compared with 15 healthy pregnant and eight healthy non-pregnant women. T-lymphocyte subpopulations were measured by flow cytometry, and BuChE activity was measured by spectrophotometry. RESULTS: Unlike the PIH group, the normal pregnancy group exhibited a significant increase in BuChE activity compared with non-pregnant control subjects (P = 0.04). Within the PIH cohort, inverse correlations were observed between BuChE activity and percentage of CD4+ CD25+ cells (P = 0.001), and CD8+ CD25+ cells (P = 0.007). CONCLUSIONS: Elevated BuChE activity in normal pregnancy may correlate with better ability to clear pregnancy-threatening toxins, while lesser ability to do this in PIH women may be a contributor to disease. The fact that PIH subjects with large subpopulations of activated T cells also exhibited low BuChE activity further suggests a correlation between susceptibility to pregnancy loss and decreased activity of the enzyme.