Platelet Counts during Pregnancy.

BACKGROUND: Platelet counts of less than 150,000 per cubic millimeter during uncomplicated pregnancies are described as gestational thrombocytopenia if no alternative cause is identified. Platelet counts may be even lower in women with pregnancy-related complications. However, the occurrence and severity of thrombocytopenia throughout pregnancy are not defined. METHODS: We evaluated platelet counts throughout pregnancy in women who delivered at Oklahoma University Medical Center between 2011 and 2014. These platelet counts were compared with those of nonpregnant women who were included in the National Health and Nutrition Examination Survey from 1999 through 2012. RESULTS: Among the 15,723 deliveries that occurred during the study period, 7351 women had sufficient data for our analyses. Of these women, 4568 had uncomplicated pregnancies, 2586 had pregnancy-related complications, and 197 had preexisting disorders associated with thrombocytopenia. Among the women who had uncomplicated pregnancies, the mean platelet count in the first trimester (mean gestation, 8.7 weeks) was 251,000 per cubic millimeter, which was lower than the mean platelet count in the 8885 nonpregnant women (273,000 per cubic millimeter) (P<0.001). At the time of delivery, 9.9% of the women with uncomplicated pregnancies had a platelet count below 150,000 per cubic millimeter. During the course of the uncomplicated pregnancies and deliveries, only 45 women (1.0%) had a platelet count below 100,000 per cubic millimeter. Among the 12 women with uncomplicated pregnancies who had a platelet count below 80,000 per cubic millimeter, only 5 (0.1%, among whom the range of platelet counts was 62,000 to 78,000 per cubic millimeter; median, 65,000) were identified by medical record review as having no alternative cause for the thrombocytopenia. Platelet counts of less than 150,000 per cubic millimeter at the time of delivery were more common among women who had pregnancy-related complications than among women who had uncomplicated pregnancies (11.9% vs. 9.9%, P=0.01). Throughout their pregnancies and deliveries, 59 women (2.3%) with pregnancy-related complications had a platelet count below 100,000 per cubic millimeter, and 31 (1.2%) had a platelet count below 80,000 per cubic millimeter. CONCLUSIONS: Mean platelet counts decreased during pregnancy in all the women, beginning in the first trimester. In women who have a platelet count of less than 100,000 per cubic millimeter, a cause other than pregnancy or its complications should be considered. (Funded by the National Heart, Lung, and Blood Institute.).

Interaction Between Progesterone and Interleukin-1ß in Modulating Progesterone Receptor Expression and the Inflammatory Phenotype in Human Cervical Fibroblasts.

Progesterone helps maintain cervical structure during pregnancy via the progesterone receptor (PR). Two PR isoforms exist, PR-A and PR-B, which have overlapping as well as isoform-specific target genes. During late gestation, leukocytes infiltrate the cervical stroma accompanied by increased cervical cytokine levels, resembling an inflammatory process. We examined interleukin (IL)-1ß regulation of the expression of PR-A, PR-B, and genes governing prostaglandin synthesis in human cervical fibroblasts (HCFs). Since progesterone has been shown to exert anti-inflammatory actions, we also examined the capacity of progesterone (R5020) to ameliorate the actions of IL-1ß in HCFs. Interleukin-1ß induced both PR-A and PR-B mRNA in HCFs. Interleukin-1ß induced a rapid and transient loss of both PR-A and PR-B protein, followed by a latent (24 hours) increase in both PR isoforms. R5020 negated the IL-1ß-induced increase in PR-A and PR-B mRNA and protein as well as the rapid IL-1ß-induced downregulation of nuclear PR. Interleukin-1ß induced prostaglandin G/H synthase-2 (PGHS-2), but not prostaglandin G/H synthase-1 (PGHS-1), as well as prostaglandin E synthase-1 (PGES-1), but not prostaglandin F synthase (PGFS). R5020 did not ameliorate IL-1ß induction of PGHS-2 or PGES-1. Blockade of prostaglandin synthesis (indomethacin) prevented both the IL-1ß-induced increase in PR mRNA and the acute decrease in PR-A and PR-B protein, implicating a role for prostaglandins in regulating PR expression in HCFs. Although progesterone may function to maintain PR expression in a milieu of increasing cytokines in the late gestation human cervix, it does not exert an anti-inflammatory role with regard to prostaglandin E2 (PGE2) production.

Fetal epicardial fat thickness in diabetic and non-diabetic pregnancies: A retrospective cross-sectional study.

OBJECTIVE: To evaluate fetal epicardial fat thickness (EFT) in diabetic and control pregnancies. METHODS: A retrospective cross-sectional study was performed in which fetal EFT was measured in the second trimester in 28 diabetics and 28 non-diabetic patients. Maternal BMI, estimated fetal weight, birth weight, fetal abdominal circumference, and subcutaneous fat thickness were also collected. Statistical analysis was carried out by means of chi-square, Wilcoxon rank-sum test, Student's T test, and linear regression as appropriate. RESULTS: EFT was significantly higher in diabetic (1.43 mm) vs. control fetuses (1.16 mm), P = 0.02. This relationship remained significant when controlling for covariates. CONCLUSIONS: EFT was higher in fetuses of diabetic mothers vs. fetuses from controls. If confirmed in prospective studies, this may represent a novel marker for altered fetal metabolism due to maternal diabetes.

Outcomes in cephalic vs noncephalic presentation in the setting of preterm premature rupture of membranes.

OBJECTIVE: This study was conducted to determine whether fetal position at the time of preterm premature rupture of membranes (PPROM) diagnosis affects outcomes. STUDY DESIGN: A retrospective study was designed to assess differences in outcomes between cephalic and noncephalic presentation at PPROM diagnosis between 24 and 34 weeks' gestation. RESULTS: Five hundred sixty-six cases of PPROM were identified; 108 cases (19.1%) were noncephalic at time of PPROM diagnosis. The 2 groups were similar with regard to demographics. Although membrane rupture and delivery occurred earlier in the noncephalic group, there was no difference in latency between groups (cephalic group, 6.22 days vs noncephalic group, 7.85 days; P = .07). Noncephalic pregnancies were substantially more likely to be complicated by oligohydramnios, abruption, intrauterine fetal death, and infectious morbidity. CONCLUSION: Noncephalic presentation at the time of diagnosis of PPROM independently and significantly increases the risk of maternal complications in such affected pregnancies.

Implications of head and neck cancer treatment failure in the neck.

OBJECTIVE: Study the survival of patients with cervical lymphatic squamous cell carcinoma recurrence. STUDY DESIGN: Review of tumor registry database. SETTING: Academic health science center. SUBJECTS AND METHODS: Forty-seven isolated neck recurrence patients identified from 224 recurrences from a total of 1291 patients treated between 1998 and 2007. The main outcome measurements were neck lymph nodal recurrence, treatment-specific survival, and overall survival. RESULTS: A total of 47 patients had neck recurrence; 10 of the neck recurrence patients (21.3%) had regional disease (N+) at initial presentation. Median survival for patients with neck recurrence was 14.7 months (95% confidence interval [CI] 8.6-18.1 mo), and five-year survival for this group was five percent (95% CI 0%-30%). Neck dissection salvage therapy for neck recurrence resulted in the best survival. CONCLUSION: Neck dissection as a salvage therapy for neck recurrence resulted in the best survival, and there was no survival benefit in terms of whether a patient had a neck dissection or not as his or her initial therapy.

Conocimiento sobre la epilepsia del profesorado de enseñanza primaria en la Isla de Gran Canaria / Knowledge of epilepsy of primary school teachers in Gran Canary Island, Spain

La motivación para la realización de este estudio surge de la preocupación por conocer cuál es el grado de información que los profesores de centros de enseñanza primaria de nuestra provincia tienen sobre la epilepsia, a la vez que detectar su interés por la misma con el fin de plantear acciones formativas futuras. Los datos recogidos mediante un cuestionario permitieron hacernos una idea de este colectivo, el cual evidencia un cierto grado de preocupación por estos alumnos al no tener una información clara y en algunos casos hasta estigmatizada, pero que a la vez demuestran su sensibilidad y predisposición positiva hacia la plena integración de los alumnos en las actividades de la vida escolar, así como su deseo de ampliar conocimientos en este y otros campos, que les proporcionen seguridadante los mismos (AU)