Osteitis pubis and osteomyelitis pubisv in pregnancy – two case reports

Pubična bol najčešće je prisutna u urednim trudnoćama i čest je simptom u trudnoći. Ipak, katkad, a osobito ako uzrokuje tegobe pri kretanju, jaka je i/ili perzistentna te ako je povezana s upalom dokazanom laboratorijskim parametrima, trebala bi uputiti na pojačan oprez. Diferencijalna dijagnoza trebala bi uključiti osteitis pubis – nebakterijsku, samoograničavajuću upalu pubične simfize koja ne ostavlja trajne posljedice, ali i puno važnije, osteomijelitis pubis – bakterijsku infekciju pubične simfize koja se rijetko vidi u trudnoći, a zakasnjelo dijagnosticiranje te kasno i neodgovarajuće liječenje mogu ostaviti dugoročne komplikacije kao što su fistule koje nalažu dugotrajno, katkad i kirurško liječenje. Multidisciplinarni pristup obvezatan je radi isključivanja svih potencijalnih uzroka pubične boli i ranog postavljanja dijagnoze osteomijelitisa pubične simfize. Prikazujemo dvije trudnice s pubičnom boli u trudnoći, no s različitom dijagnozom i liječenjem te povoljnim ishodom koji je rezultat multidisciplinarnog pristupa.Pubic pain frequently accompanies uneventful pregnancies and is a common symptom in pregnancy. Still, in some cases, especially when it is associated with walking difficulties, persistent and/or severe pubic pain, and inflammation that can be confirmed by laboratory parameters, it should be taken with additional caution. Differential diagnosis should include osteitis pubis, a non-bacterial, self-limited inflammation that leaves no permanent consequences, but also, more importantly, osteomyelitis of the pubic symphysis. This is a rare bacterial infection in pregnancy, important to be diagnosed in time and treated early and properly since it can leave serious long-term complications such as fistulas that require prolonged treatment and sometimes even surgery. A multidisciplinary approach is mandatory to exclude all the other potential causes of pubic pain and make a timely diagnosis of osteomyelitis. We present two patients with pubic pain during pregnancy, with two different diagnoses and treatment options, and a favorable outcome that was the result of a multidisciplinary approach

Endometrial Glucose Transporters in Health and Disease

Pregnancy loss is a frequent occurrence during the peri-implantation period, when there is high glucose demand for embryonic development and endometrial decidualization. Glucose is among the most essential uterine fluid components required for those processes. Numerous studies associate abnormal glucose metabolism in the endometrium with a higher risk of adverse pregnancy outcomes. The endometrium is incapable of synthesizing glucose, which thus must be delivered into the uterine lumen by glucose transporters (GLUTs) and/or the sodium-dependent glucose transporter 1 (SGLT1). Among the 26 glucose transporters (14 GLUTs and 12 SGLTs) described, 10 (9 GLUTs and SGLT1) are expressed in rodents and 8 (7 GLUTs and SGLT1) in the human uterus. This review summarizes present knowledge on the most studied glucose transporters in the uterine endometrium (GLUT1, GLUT3, GLUT4, and GLUT8), whose data regarding function and regulation are still lacking. We present the recently discovered SGLT1 in the mouse and human endometrium, responsible for controlling glycogen accumulation essential for embryo implantation. Moreover, we describe the epigenetic regulation of endometrial GLUTs, as well as signaling pathways included in uterine GLUT's expression. Further investigation of the GLUTs function in different endometrial cells is of high importance, as numerous glucose transporters are associated with infertility, polycystic ovary syndrome, and gestational diabetes

Dishevelled family proteins (DVL1-3) expression in IUGR placentas

Dishevelled family proteins (DVL1, DVL2, and DVL3) are cytoplasmic mediators involved in canonical and non-canonical Wnt signaling that are important in embryonic development. The role of DVL proteins in the placental tissue remains mostly unknown. In the current study, we explored the role of Dishevelled proteins in naturally invasive tissue, trophoblast. Formalin-fixed paraffin-embedded samples of 15 term placentas from physiologic term pregnancies and 15 term placentas from pregnancies complicated with intrauterine growth restrictions (IUGR) were used for the study. Expression levels of mRNA for DVL1, DVL2, and DVL3 in placentas were analyzed by quantitative real-time PCR (qRT-PCR). DVL1, DVL2, and DVL3 protein expression were semi-quantitatively analyzed using immunohistochemistry. The expression of DVL2 and DVL3 proteins was significantly higher in trophoblasts in placental villi from IUGR pregnancies compared with the control group of term placentas. In contrast, DVL3 protein expression was significantly higher in endothelial cells in placental villi from IUGR pregnancies compared with normal term placentas. The observed differences at protein levels between normal and IUGR placentas were not confirmed at the mRNA levels of DVL genes. Our data indicate the active involvement of DVL proteins in IUGR-related placentas. No significant changes were observed in DVL mRNA levels between the two groups of placentas. Further studies are required to explore the clinical relevance of these observations