Prenatal Biochemical and Ultrasound Markers in Chromosomal Anomalies

The unbalanced chromosomal anomalies generate an abnormal pattern of development and usually determine miscarriage. The most frequent prenatal chromosomal anomalies are X monosomy, trisomies of chromosomes 21, 18, 13, 16, 8, triploidy and tetraploidy. Identification of chromosomal anomalies can be done by prenatal screening and diagnosis. Prenatal screening is biochemical, sonographic or molecular (detection of fetal DNA in maternal blood). Biochemical screening can be done in the first or second trimester. First-trimester screening is based on the detection in maternal serum of beta-hCG (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A). Biochemical screening in the second trimester requires the detection of alpha-fetoprotein (aFP) hGC, unconjugated estriol (μE) and inhibin A. The sonographic examination can be used in the first or second trimesters. In the first trimester, an ultrasound can identify soft markers like nuchal translucency, nasal bone and ductus venous flow. In the second trimester the sonographic examination can identify congenital anomalies or different soft markers. Prenatal chromosomal diagnosis requires an invasive procedure to obtain embryonic or fetal material. Such procedures are represented by chorionic villus sampling amniocentesis or cordocentesis. The fetal cells are used for cell cultures (in cytogenetic methods) or for molecular analyses (FISH, QF-PCR, MLPA, array-CGH)

The Hunger Games: Katniss Everdeen\u27s Effort To Gain American Pragmatism Goals In Terms Of American Values

As one of a popular American novel which was published recently, The Hunger Games composed by Suzanne Collins, provides a significant description about the manifestation of American values portrayed by the main character, KatnissEverdeen.Katniss\u27 efforts in the novel are in line with the principle of American Pragmatism, which later on can be analyzed by its relation with the idea of American values, the grounding idea of the framing of this great American philosophy. By applying a sociological approach, this study discover the existence of the two roots of American culture known as American values and American Pragmatism, are still preserved. Katniss successfully manifests the goals of American Pragmatism that certainly taken from American values\u27 idea through her struggle told in the novel. This result leads to the comprehension of how American values influence American\u27s mind in fulfilling their goals or achievements

Is Homocysteine a Marker or a Risk Factor: A Question Still Waits for an Answer

Homocysteine, a non-proteinogenic sulfur-containing amino acid, was discovered in 1932, and 30 years passed until, in 1969, for the first time, its involvement in pathology was reported. It was only in the last two decades that homocysteine has become a subject of scientific interest and has begun to be intensively studied. A large number of scientists consider homocysteine as an independent risk factor particularly for cardiovascular disease, while others indicate homocysteine as a marker of this disease. Both sides bring scientific arguments for their opinions, yet the dilemma of homocysteine characterization still persists. Although the reported studies do not lead to a unique answer, it is generally accepted that homocysteine is associated with vascular dysfunction. Numerous scientific data show that the link between homocysteine and inflammation is achieved via the reactive oxygen species (ROS) pathway. The latest data indicate hydrogen peroxide as a possible messenger in cellular signaling in physiological or pathological processes and present the consequences of disturbing the oxidation-reducing balance. In this chapter, we present the latest scientific evidences gathered from the literature for both hypotheses regarding homocysteine involvement in pathology, and we propose a possible mechanism of action for homocysteine, based on our preliminary (yet unpublished) work

Interplay of Epigenetics with Gynecological Cancer

Recent data on the cell deregulation that occurs during the progression to cancer underlines the cooperation between genetic and epigenetic alterations leading to a malignant phenotype. Unlike genetic alterations, the epigenetic changes do not affect the DNA sequence of the genes, but determine the regulation of gene expression acting upon the genome. Moreover, unlike genetic changes, epigenetic ones are reversible, making them therapeutic targets in various conditions in general and in cancer disease in particular. The term epigenetics includes a series of covalent modifications that regulate the methylation pattern of DNA and posttranslational modifications of histones. Gene expression can also be regulated at the posttranscriptional level by microRNAs (miRNAs), a family of small noncoding RNAs that inhibit the translation of mRNA to protein. miRNAs can act as ‘oncomiRs’, as tumor suppressors, or both. In this chapter, we will (1) summarize the current literature on the key processes responsible for epigenetic regulation: DNA methylation, histone modifications and posttranscriptional gene regulation by miRNAs; (2) evaluate aberrant epigenetic modifications as essential players in cancer progression; (3) establish the roles of microenvironment-mediated epigenetic perturbations in the development of gynecological neoplasia; (4) evaluate epigenetic factors involved in drug resistance

Maternal and fetal outcome in HELLP syndrome in a tertiary care hospital in north east Romania

UMF “Gr.T.Popa”, Iaşi, Spitalul “Cuza Vodă”, IaşiObjective: Hepatic vascular injury in preeclampsia is responsible for HELLP syndrome (Haemolisis, Elevated Liver enzymes, Low Platelet count), sometimes without hypertension or proteinuria. The aim of the study was to evaluate maternal and fetal outcome in pregnant women with HELLP syndrome hospitalized in a third level maternal-fetal unit. Methods: Data concerning the clinical evolution of patients and laboratory analyzes were recuperated from the electronic archive of “Cuza Voda” Hospital. Statistical processing was performed with Microsoft Office Excel 2007 TM. Results: Between 01.01.2009-31.12.2013, in “Cuza Voda” Hospital, Iasi, a number of 29 352 births were recorded, 55 (0.187 %) being diagnosed with HELLP syndrome. Among them, only for 25 cases we could recover complete data for statistical processing. The 25 patients had a mean age of 29.2 years (range 19-39). The mean gestational age when HELLP syndrome was diagnosed, was 31.8 weeks of amenorrhea (range 27-38 ) and the mean biometric age at the preoperative ultrasound was 30.3 weeks of amenorrhea (range 24-37). Caesarean section was completed in 22/25 cases (88 %), the remaining 3 cases delivered vaginally, at a mean of 56.2 hours after admission (range 0.5 – 384 h). Maternal prognosis was burdened with the following complications: severe preeclampsia (10/25 cases), eclampsia (3/25 cases), uteroplacental apoplexy (4/25 cases), pulmonary edema (3/25 cases), acute renal failure (9/25 cases), disseminated intravascular coagulation syndrome (2/25 cases), maternal death (1/25 cases). Fetal evolution presented the following complications: antepartum fetal death (4/25 cases), RCIU (11/25 cases), prematurity (22/25 cases) with a premature birth between 27-34 weeks (17/25 cases) and between 34 -37 weeks (5 cases). One minute Apgar score was 0 in 4 cases, the remaining cases showing an average of 6.3 (range 1-9) at 1 minute and of 7.1 (range 1-9) at 5 minutes. Conclusions: Management and delivery of patients with HELLP syndrome should take place in a tertiary level unit with a trained multidisciplinary team (obstetrician, anesthetist, neonatologist, medical laboratory doctor, operating theater nurses, intensive care nurses, midwives) and technical facilities available. A rapid and accurate diagnosis and a prompt intervention can reduce the risk of maternal and fetal mortality and morbidity.Obiectiv: Atingerea hepatică vasculară în preeclampsie este responsabilă de sindromul HELLP (haemolisis, elevated liver enzymes, low platelet count), uneori fără HTA şi nici proteinurie. Scopul studiului a fost de a evalua prognosticul matern şi fetal la gravidele internate cu HELLP sindrom într-o unitate materno-fetală de nivel trei. Material şi metodă: Datele despre evoluţia clinică a pacientelor şi analizele de laborator au fost preluate din arhiva electronică a Spitalului “Cuza Vodă” cât şi din foile de observaţie. Prelucrarea statistică s-a efectuat utilizând programul Microsoft Office Excel 2007 TM. Rezultate: În perioada 01.01.2009-31.12.2013, în Spitalul Clinic de Obstetrică-Ginecologie Cuza Vodă, Iaşi au fost asistate un număr de 29352 naşteri, dintre care 55 (0.187%) au fost diagnosticate cu HELLP sindrom. Dintre acestea, doar pentru 25 cazuri s-au putut recupera datelele complete pentru prelucrarea statistică. Cele 25 paciente au avut o vârstă medie de 29.2 ani (interval 19-39). Vârsta gestaţională medie la care s-a instalat HELLP sindromul a fost de 31.8 săptămâni amenoree (interval 27-38) iar vârsta medie biometrică conform ecografiei preoperatorii a fost de 30.3 săptămâni amenoree (interval 24-37). Naşterea s-a finalizat prin cezariană în 22/25 cazuri (88%), restul de 3 cazuri care au născut natural internându-se cu naştere declanşată, la o distanţă medie de 56.2 ore de la internare (interval 0,5-384h). Prognosticul matern a fost grevat de următoarele complicaţii: preeclampsie severă (10/25 cazuri), eclampsie (3/25 cazuri), apoplexie utero-placentară (4/25 cazuri), edem pulmonar acut (3/25 cazuri), insuficienţa renală acută (9/25 cazuri), sindrom de coagulare intravasculară diseminată (2/25 cazuri), deces matern (1/25 cazuri). Evoluţia fetală a prezentat următoarele complicaţii: moarte fetală antepartum (4/25 cazuri), RCIU (11/25 cazuri), prematuritate (22/25 cazuri) din care naştere prematură între 27-34 săptămâni (17/25 cazuri), iar între 34-37 săptămâni (5 cazuri). Scorul APGAR la 1 minut a fost 0 în 4 cazuri, restul cazurilor prezentând o medie de 6.3 (interval 1-9) la 1 minut şi de 7.1 (interval 1-9) la 5 minute. Concluzii: Managementul şi naşterea pacientelor cu sindrom HELLP trebuie să aibă loc într-o unitate de nivel trei, cu o echipă multidisciplinară antrenată (obstetrician, anestezist, neonatolog, medic de laborator, asistente de bloc operator, reanimare, moaşe) şi facilităţi tehnice disponibile. Un diagnostic rapid şi corect şi o intervenţie promptă, pot reduce riscul de mortalitate şi morbiditate maternă şi fetală

The Influence of Climate on Critically Ill Pregnant COVID-19 Patients, as Revealed by the Inflammation Indexes, in Spring versus Autumn 2021 Infection

(1) Background: Seasonality is an important environmental factor that influences immune re-sponses (2) Methods: In a retrospective study, we included all pregnant patients admitted to the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection between 1 January and 1 December 2021. The blood counts collected on the specific A, H and E Brixia score- collection days, or the ones collected closest to those days, were considered in our study. We also studied the differences between the two groups regarding the inflammation in-dexes exhibited on those specific days: A (admittance), H (highest Brixia score), and E (end of hospitalization). (3) Results: The values of NLR, dNLR, SII, and AISI are significantly higher and IIC is significantly lower for the spring group versus the autumn group, especially on the H and E Brixia score-collection days. (4) Conclusions: These results suggest that severe-COVID-19 in-flammation was significantly higher in the spring of 2021 in Romania than in autumn 2021, in regard to pregnant patients