[Folate consumption in the preconception period of Sicilian pregnant women and their knowledge about the prevention of neural tube defect by folate supplementation]. / Assunzione di folati in epoca periconcezionale in gravide siciliane e loro conoscenza della prevenzione dei DTN tramite somministrazione di folati.

BACKGROUND AND AIMS: To define the frequency of Sicilian pregnant women taking folic acid during the periconceptional period (three months before and two months after conception) and how many are familiar with the preventive effects of folic acid on NTD. METHODS: 987 pregnant women from eastern Sicily, mainly with low incomes and low levels of education, most with secondary school certificates, underwent biochemical screening for Down's syndrome and NTD in the second trimester of pregnancy. RESULTS: An anencephalous fetus was diagnosed (frequency 0.1%) in a non-risk couple who had not taken folic acid during the periconceptional period: 4.1% (41 cases) of pregnant women reported having taken folic acid before pregnancy and 12.3% (122) during the first two months of pregnancy: five (0.5%) took folic acid during the periconceptional period (three months before conception and two months after). None of the 5 patients with a positive family history of NTD had taken folic acid. In all 122 cases the intake of folic acid supplements during pregnancy started after the positive results of the pregnancy test or echographic evidence of pregnancy, namely between the fifth and eighth week of pregnancy. Only the 5 pregnant women (0.5%) who took folic acid during the periconceptional period were aware of the possibility of preventing NTD through supplements of this vitamin. CONCLUSIONS: Greater efforts must be made to increase periconceptional use of folic acid for the prevention of NTD in pregnant women in Sicily.

Comparison of hemodialysis versus hemoperfusion in the clearance of high-dose methotrexate in pigs.

To evaluate the different capabilities of hemo-perfusion (HP) and hemodialysis (HD) treatment in resolving the side effects during high-dose methotrexate (MTX) therapy, an experimental comparative study was done. Under general anesthesia, 12 female Large-White pigs, 35 +/- 5 kg body weight, underwent a bilateral renal vessel ligature to create an acute renal failure and avoid the physiologic elimination of MTX. An MTX i.v. infusion was performed using a dose of 12.5 g/m2 and for a specific time according to its pharmacokinetics. The animals were divided into 2 groups of 6 animals each and connected to the extracorporeal circuit; the first group was submitted to a 1-h HP with an anion exchange resin (Dow 1X-2, Dow Chemical) and the second group to 1-h HD with capillary polysulfone fibers (F6, Fresenius). Blood samples were taken at established intervals for hematological and biochemical evaluations. The results demonstrate a higher capability of HP treatment (P < 0.001) related to HD in MTX removal.

In vitro evaluation of heparin adsorption during haemoperfusion with Dowex 1 x 2 anion exchange resin.

Haemoperfusion treatments have found clinical applications in various pathologies, even though problems due to the insufficient biocompatibility of sorbents have often limited its employment. Among these problems, there is that of heparin adsorption which can determine coagulation disorders or the necessity of a dosage correction during the extra corporeal circulation. The aim of the study was to test the influence of different methods of coating on heparin adsorption from an anion exchange resin coated with poly-hydroxyethyl-methacrylate. Eight haemoperfusion cartridges were prepared using 8 g of resin for each (4 cartridges contained resin coated by spray-coating technique and 4 coated by phase-separation one). Haemoperfusion was performed by using 600 IU of heparin (25,000 IU) corresponding to 0.12 ml in 500 ml of swine blood and a closed circuit. Blood flow rate was maintained at 15 ml/min and the circuit pressure was 70 torr during haemoperfusion. Blood samples were withdrawn at timed intervals before and after the column in order to evaluate blood heparin levels. The results demonstrated the superiority of the phase-separation technique that does not permit any interactions between adsorbent substance and drug. As a result of this, the adjustment of the dosage may not be necessary during further in vivo experiments.

Monitoring during haemoperfusion (HP).

The relationship between HP and haemodynamic changes is an area which until now has been largely uninvestigated as can be seen from the small amount of material published on this theme. The reasons for this indifference are mainly due to the low extracorporeal flow using during HP. The experiment with a new sorbent on animals must also be analyzed in cardiovascular aspects. This system is the most economical and simple for detecting the elution of vasoactive toxins. In this report the effect on the cardiovascular system of HDMTX and HP with a new trimethylammonium exchange resin versus control groups are evaluated. The results obtained clearly demonstrate the absence of haemodynamic side effects in both groups.

In vitro and ex vivo evaluation of methotrexate removal by different sorbents haemoperfusion.

The administration of high doses of Methotrexate (HDMTX) seems to be very effective in neoplastic treatment. Furthermore high doses of the drug could overcome the Methotrexate (MTX) resistance that it is possible to observe in some kind of cancers. To avoid several serious problems in the therapeutical application of HDMTX such as nephrotoxicity, hepatotoxicity and the difficulty to assess the right therapeutic range of the specific antagonist Leucovorin, a Haemoperfusion (HP) treatment could be very usefulL. In this study 3 anion exchange resins with different active group (trimethylammonium, dimethylethanolammonium and dimethylammina) and a spherical petroleum based charcoal were tested both in vitro and ex vivo to evaluate their capability to remove MTX. These results show a good strength and biocompatibility of the 4 sorbents and demonstrate the active group trimethylammonium resin as the most effective one.