Venous Thromboembolism in the Context of Reproduction: The Royal College of Obstetricians and Gynecologists Recommendations

Venous thromboembolism complicates 1–2 of every 1000 deliveries. It may manifest as deep vein thrombosis or pulmonary embolism. Pregnancy-associated venous thromboembolism is an important major cause of maternal morbidity and mortality. Prophylaxis and therapy in pregnancy are complicated by the need to take both fetal and maternal well-being into consideration. Risk factors for venous thromboembolism during pregnancy or the puerperium are multiple. They include, but are not limited to, thrombophilia, multiparity, orthopedic injuries, medical comorbidities, prior venous thromboembolism, smoking, gross varicose veins, age, if older than 35, obesity, multiple pregnancy, preeclampsia, cesarean section, prolonged labor, instrumental vaginal delivery, stillbirth, preterm birth, postpartum hemorrhage, hyperemesis gravidarum, ovarian hyperstimulation syndrome, immobility, long periods of hospitalization, and long haul travel. This chapter is a clinical guide that covers prophylaxis and therapy of pregnancy-associated venous thromboembolism, based on evidence-based research and consensus opinion

Mapping of five candidate sex-determining loci in rainbow trout (Oncorhynchus mykiss)

<p>Abstract</p> <p>Background</p> <p>Rainbow trout have an XX/XY genetic mechanism of sex determination where males are the heterogametic sex. The homology of the sex-determining gene (SDG) in medaka to <it>Dmrt1 </it>suggested that SDGs evolve from downstream genes by gene duplication. Orthologous sequences of the major genes of the mammalian sex determination pathway have been reported in the rainbow trout but the map position for the majority of these genes has not been assigned.</p> <p>Results</p> <p>Five loci of four candidate genes (<it>Amh</it>, <it>Dax1</it>, <it>Dmrt1 </it>and <it>Sox6</it>) were tested for linkage to the Y chromosome of rainbow trout. We exclude the role of all these loci as candidates for the primary SDG in this species. <it>Sox6i </it>and <it>Sox6ii</it>, duplicated copies of <it>Sox6</it>, mapped to homeologous linkage groups 10 and 18 respectively. Genotyping fishes of the OSU × Arlee mapping family for <it>Sox6i </it>and <it>Sox6ii </it>alleles indicated that <it>Sox6i </it>locus might be deleted in the Arlee lineage.</p> <p>Conclusion</p> <p>Additional candidate genes should be tested for their linkage to the Y chromosome. Mapping data of duplicated <it>Sox6 </it>loci supports previously suggested homeology between linkage groups 10 and 18. Enrichment of the rainbow trout genomic map with known gene markers allows map comparisons with other salmonids. Mapping of candidate sex-determining loci is important for analyses of potential autosomal modifiers of sex-determination in rainbow trout.</p

Perspectives and attitudes of jordanian medical and paramedical students toward surrogate pregnancy

Purpose: This study aims at investigating the perspectives of Jordanian medical and paramedical students on surrogate pregnancy. Methods: A questionnaire-based cross-sectional study design was used. The sample consisted of n=328 students of both genders. The questionnaire responses were numerically coded and analyzed across gender and the level of education. Results: Approximately, 18% of the students reported good awareness about the ethical dilemmas of surrogacy. The results showed a general reluctance to accept surrogate pregnancy as the majority (80.5% of male students and 97.6% of female students) had a negative attitude toward surrogacy. In addition, undergraduate students were less supportive to surrogate pregnancy than graduate students. Religious considerations were the main reason (accounts for about 70%) for driving negative attitude toward surrogacy. Conclusion: The findings of the study indicate a general reluctance toward accepting the concept of surrogate pregnancy, which is mainly due to religious reasons

The current evidence on statin use and prostate cancer prevention: are we there yet?

An increasing amount of data supports an inverse association between statin use and cancer risk. The findings for prostate cancer, particularly advanced disease, are the most promising of all cancers studied. Use of these agents seems to also be associated with improved prostate-cancer-specific survival, particularly in men undergoing radiotherapy, suggesting usefulness of statins in secondary and tertiary prevention. Some study results might be influenced by increased PSA screening and health-conscious behaviour in statin users but these factors are unlikely to completely account for observed beneficial effects. The epidemiological evidence is supported by preclinical studies that show that statins directly inhibit prostate cancer development and progression in cell-based and animal-based models. The antineoplastic effect of statins might arise from a number of cholesterol-mediated and non-cholesterol-mediated mechanisms that affect pathways essential for cancer formation and progression. Understanding these mechanisms is instrumental in drug discovery research for the development of future prostate cancer therapeutics, as well as in designing clinical trials to test a role for statins in prostate cancer prevention. Currently, sufficient data are lacking to support the use of statins for the primary prevention of prostate cancer and further research is clearly warranted. Secondary and tertiary prevention trials in men who have been diagnosed with prostate cancer might soon be performed

Association of Adiponectin and rs1501299 of the ADIPOQ Gene with Prediabetes in Jordan

Type 2 diabetes mellitus (T2DM) is a worldwide health problem caused by resistance to insulin action. This chronic debilitating diseaseis preceded by a stage, known as prediabetes, in which a healthy lifestyle can delay the disease. The discovery of biochemical changes in prediabetes is important to identify individuals at risk of developing T2DM and in explaining disease pathogenesis. Adiponectin is secreted by fat cells and is linked with insulin resistance. Adiponectin levels are dysregulated in prediabetic subjects. This relationship had not been tested in Jordan. We recruited 130 subjects with prediabetes and 130 control subjects. We measured serum levels of adiponectin and genotyped subjects for three single nucleotide polymorphisms (SNPs) in the ADIPOQ gene; rs266729, rs1501299 and rs2241766. In multivariate analysis, we found that serum adiponectin lowers the risk of prediabetes (p = 0.002; odds ratio (OR), 0.764; 95% confidence interval (CI), 0.646&ndash;0.905). The rs1501299 SNP of the ADIPOQ gene was associated with prediabetes in our population (p = 0.041). Specifically, in multivariate analysis, the GT genotype of rs1501299 increased the risk of prediabetes (p = 0.010; OR, 2.350; 95% CI, 1.231&ndash;4.486) as well as the TT genotype (p = 0.006; OR, 4.774; 95% CI, 1.551&ndash;14.693). Our findings indicate that serum adiponectin and SNPs in the ADIPOQ gene are associated with prediabetes in Jordan

Dysregulation of the RANKL/RANK/OPG axis in thalassemia intermedia patients

Abstract Objective Thalassemia intermedia (TI) describes a disease ranging in severity between β thalassemia major (TM) and β thalassemia trait. Osteoporosis is observed in TI and TM. The exact reason of osteoporosis in TI could be hypogonadism and/or an increase in erythropoietin (EPO) levels. The carboxy-terminal collagen cross links (CTX), a marker of bone resorption, and the N-terminal propeptide of type 1 collagen (P1NP), a marker of bone formation are serum markers of osteoporosis. The receptor activator of NF-kappaB ligand (RANKL)/receptor activator of NF-kappaB (RANK)/osteoprotegerin (OPG) axis plays an important role in metabolic bone diseases. Herein, we tested the relationship between the RANKL/RANK/OPG axis and the bone-turnover markers CTX and P1NP in TI. Results We recruited 44 TI patients and 33 non-thalassemic controls and measured the serum levels of hemoglobin, sex steroid hormones, CTX, P1NP, RANKL and OPG. We then used a general linear model to test the association of the above variables with CTX and P1NP as outcome variables. We showed that EPO levels were the strongest predictor of CTX change (P < 0.000), followed by RANKL (P = 0.017). On the other hand, RANKL was the strongest predictor of P1NP change (P < 0.000), followed by OPG (P = 0.009) and EPO (P = 0.024)

Exploring perception and hesitancy toward COVID-19 vaccine: A study from Jordan

Vaccination against COVID-19 may present the most effective strategy to control current viral pandemic. The success of delivering mass vaccination, on the scale of what would be applied to contain COVID-19, largely depends on the compliance of the public to programs mandated by public health officials. This study was aimed to evaluate the perception and possible hesitance of people in Jordan toward a tentative COVID-19 vaccine using self-administrated online survey. During the study period, a total of 1287 agreed to participate in the study. More than half of the participants (n = 734, 57%) were females and the majority (n = 893, 69%) had a University degree. Most of the participants (n = 871, 68%) believed that scientists have adequate tools to develop a safe and efficacious COVID-19 vaccine and two-third of them (n = 861, 67%) believed that developing vaccines would end the pandemic. However, around half of them (n = 665, 52%) reported not having adequate information on the benefits of COVID-19 vaccination. Preference of study participants to achieve immunity against COVID-19 using natural way was the most commonly reported reason to refuse vaccination (n = 826, 64%), followed by their concern about adverse effects associated with the vaccine (n = 781, 61%). In conclusion, the sampled participants showed an overall positive attitude toward receiving a COVID-19 vaccine. Educational campaigns using television and social media are recommended to better inform the public of the benefits of COVID-19 vaccine in reaching a “herd immunity” based strategy to control the current pandemic

EFFECT OF INSULIN ON LPS-INDUCED INFLAMMATORY MARKERS IN MOUSE COLON SMOOTH MUSCLE CELLS IN VITRO

 Objective: The aim of the research is to determine the effect of supraphysiological doses of insulin on mouse colon smooth muscle cells (CSMCs) expression and secretion of pro-inflammatory cytokines interleukin 1 alpha (IL-1α) and tumor necrosis factor alpha (TNF-α) in vitro.Methods: Freshly isolated CSMCs from BALBc mice were cultured in Dulbecco's Modified Eagle Medium and treated with various doses of insulin (0, 1, 5, 10, and 20 nM) for 48 h, with/without lipopolysaccharides (LPS; 1 ug/mL) to induce inflammation. The levels of IL-1α and TNF-α in the cell homogenates and conditioned media were measured using ELISA.Results: Insulin alone (1, 5, 10, and 20 nM) did not elicit a significant change in the expression or secretion of IL-1α or TNF-α form CSMCs; however, insulin (10 and 20 nM) significantly (p&lt;0.05) increased the expression and secretion (~1.3–1.6-fold) of both IL-1α and TNF-α from CSMCs in the presence of inflammatory stimulus LPS when compared to LPS alone.Conclusion: This study highlights the role of hyperinsulinemia on CSMC inflammation and its potential role in the pathogenesis of inflammatory bowel disease (IBD) during obesity. Measures that prevent obesity may protect against the development of IBD since the worldwide incidence of both obesity and IBD is increasing in a parallel fashion

Empirical treatment with parenteral acyclovir in a child with herpes simplex virus hepatitis and acute lymphoblastic leukemia

Introduction: Hepatitis secondary to Herpes Simplex Virus (HSV) infection is a complication that often leads to fatal hepatic failure. Early treatment with the anti-viral drug, acyclovir, is life-saving. In view of the non-specific nature of the signs and symptoms associated with HSV hepatitis, diagnosis is often made late during the course of the disease; a factor that largely contributes to the high mortality rate of this treatable disease complication. There is thus a growing consensus in the field to initiate empirical treatment with acyclovir once suspicion of HSV hepatitis is raised even before reaching a conclusive diagnosis. Presentation of case: We present clinical evidence on the benefit of starting empirical acyclovir treatment on the outcome of patients suffering from HSV hepatitis. We report two cases of HSV hepatitis in children with cancer. One case presented with fulminant hepatitis which was fatal and the diagnosis was only reached post mortem. In the second case, there was enough suspicion of HSV hepatitis to start early empirical acyclovir therapy. The diagnosis was confirmed 48 hours following the initiation of treatment and the early intervention with anti-virals proved to be life-saving. Discussion: In both cases above, the following symptoms were shared; fever, elevated transaminase levels and mucositis without clear cutaneous lesions. HSV hepatitis should thus be considered in the differential diagnosis of immuonocomprimised patients exhibiting the above symptoms. Conclusion: Due to the frequent delay in HSV diagnosis and the safety of acyclovir, we recommend empirically administering acyclovir in patients suspected of HSV hepatitis. Keywords: Herpes simplex virus, Hepatitis, Acyclovir, Empirical treatment, Acute lymphoblastic leukemi