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Dolgova, Yu S., D. R. Eremeeva i M. S. Zainulina. "Risks of reproductive loss and placenta-mediated pregnancy complications in women with antiphospholipid antibodies". Obstetrics, Gynecology and Reproduction 14, nr 6 (11.01.2021): 592–601. http://dx.doi.org/10.17749/2313-7347/ob.gyn.rep.2020.181.
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Introduction. Antiphospholipid syndrome (AРS) is a multisystem disease characterized by elevated levels of antiphospholipid antibodies (AРA), arterial and/or venous thrombosis, thrombocytopenia, and habitual miscarriage. Various AРA types have multifactorial and indirect effects on pregnancy course from the earliest stages, leading to termination of pregnancy and putting the prerequisites for further obstetric complications. Aim: determine rate and relative risk of pregnancy complications in AРA carriers. Materials and Methods. The retrospective study, conducted between 2017 and 2019, included 268 pregnant women. All women underwent a comprehensive study consisting of clinical examination and laboratory methods. AРA of IgM and IgG classes were measured by using ELISA, lupus anticoagulant (LA) was estimated by using a coagulometer. Results. APA were detected in 213 (79.48 %) women examined; 55 (20.52 %) patients (n = 55) lacked APA. Failed in vitro fertilization attempts were 2 times more common in women with AРA (10.33 vs. 5.45 %, respectively; p < 0.001). Also, significant differences were found in this group in antenatal fetal death (4.23 vs. 1.82 %, respectively; p < 0.001) and chronic placental insufficiency without fetal malnutrition (23.47 vs. 18.18 %, respectively; p < 0.05). Of 165 women with early pregnancy loss syndrome, AРA were found in 130 (78.79 %), late pregnancy loss – in 29 (76.32 %) and antenatal fetal death – in 9 (90.0 %) women carrying serum AРA. The relative risks of unfavorable pregnancy outcomes have been identified for various AРA subtypes. Conclusion. Identifying clear-cut relative risks of adverse pregnancy outcomes for various subtypes of antiphospholipid antibodies will allow to determine risk groups and develop a special treatment algorithm for preventing pregnancy complications and perinatal losses.
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Pires, Isadora Garcia, Iluskhanney Gomes de Medeiros Nóbrega Miranda, Ingrid Rafaella Mauricio Silva Reis i Juscelino Kubitschek Bevenuto Da Silva. "Doença falciforme, estado nutricional e sua relação com intercorrências obstétricas". STUDIES IN HEALTH SCIENCES 2, nr 2 (17.09.2021): 25–37. http://dx.doi.org/10.54018/shsv2n2-001.
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A anemia falciforme (AF) é uma doença autossômica recessiva, que leva à produção de hemoglobina anormal, denominada hemoglobina S (HbS). Seus portadores sofrem com o crescimento deficiente, desde a infância, além de disfunções endócrinas, baixo consumo alimentar, alto requerimento energético, deficiência de minerais, que podem resultar em desnutrição. Durante a gestação, está associada ao aumento de complicações relacionadas à própria doença, morbimortalidade materna e perinatal mais elevada, nascimento de crianças com baixo peso e maiores taxas de complicações infecciosas puerperais. O objetivo do estudo foi buscar, através de uma revisão integrativa, esclarecer sobre o estado nutricional e as complicações clínicas de gestantes com anemia falciforme. Para tanto, realizou-se um estudo exploratório, por meio de pesquisa bibliográfica. Sendo a seleção e a localização das referências retiradas das bases de dados PubMed/LILACS, Plos One e da biblioteca eletrônica SciELO, utilizando também a Biblioteca Virtual em Saúde (BVS), a fim de identificar artigos científicos publicados no período entre 2008 e 2020, utilizando os seguintes descritores: anemia falciforme e intercorrências obstétricas; anemia falciforme e gestante; hemoglobina S e gestante e versões em inglês. Verificou-se que gestantes portadoras de anemia falciforme possuem maior propensão a complicações, como aborto espontâneo, crescimento intra-uterino restrito, aumento da mortalidade fetal intra-útero, recém-nascido de baixo peso, trabalho de parto pré-termo, somados à deficiência de macro e micronutrientes durante o período gestacional, podendo chegar à desnutrição materna e à morbimortalidade materna e neonatal. Em suma, a suscetibilidade à desnutrição materna, infecções, complicações hemolíticas e vaso-oclusivas de gestantes com anemia falciforme mostrou-se um prognóstico desfavorável, trazendo consigo complicações para a mãe e o neonato. Reforçando a importância do acompanhamento nutricional como estratégia de prevenção e orientação relativas às alterações nutricionais das gestantes portadoras da doença, como alternativa para a minimização dos resultados adversos e garantir melhoria da saúde materna e fetal.
Sickle cell anemia (SCA) is an autosomal recessive disease that leads to the production of abnormal hemoglobin called hemoglobin S (HbS). Their carriers suffer from deficient growth, since childhood, in addition to endocrine dysfunction, low food consumption, high energy requirement, mineral deficiency, which can result in malnutrition. During pregnancy, it is associated with an increase in complications related to the disease itself, higher maternal and perinatal morbidity and mortality, birth of low birth weight children and higher rates of puerperal infectious complications. The aim of the study was to seek, through an integrative review, to clarify the nutritional status and clinical complications of pregnant women with sickle cell anemia. For that, an exploratory study was carried out, through bibliographical research. With the selection and location of references taken from the PubMed/LILACS, Plos One and SciELO electronic library databases, also using the Virtual Health Library (VHL), in order to identify scientific articles published in the period between 2008 and 2020, using the following descriptors: sickle cell anemia and obstetric complications; sickle cell anemia and pregnant women; hemoglobin S and pregnant women and English versions. It was found that pregnant women with sickle cell anemia are more prone to complications, such as miscarriage, restricted intrauterine growth, increased intrauterine fetal mortality, low birth weight newborn, preterm labor, in addition to disability of macro and micronutrients during the gestational period, which can lead to maternal malnutrition and maternal and neonatal morbidity and mortality. In short, the susceptibility to maternal malnutrition, infections, hemolytic and vaso-occlusive complications of pregnant women with sickle cell anemia proved to be an unfavorable prognosis, bringing with it complications for the mother and the newborn. Reinforcing the importance of nutritional monitoring as a prevention and guidance strategy regarding nutritional changes in pregnant women with the disease, as an alternative to minimizing adverse outcomes and ensuring improved maternal and fetal health.
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Mikhaylin, Yevgeniy Sergeyevich, Lada Anatolyevna Ivanova i Aleksey Gennadyevich Savitskiy. "Comparative characteristic of pregnancy and delivery in adolescents and women of average reproductive age". Journal of obstetrics and women's diseases 63, nr 4 (15.09.2014): 47–53. http://dx.doi.org/10.17816/jowd63447-53.
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The article provides a comparative characteristic the main clinical parameters of pregnancy and delivery in adolescents and women of average reproductive age. The results of this study generally confirm the literature data on the greater frequency of complications of pregnancy and childbirth in juvenile women than in women of average reproductive age. Thus, significantly more frequently in pregnant adolescents dated anemia, preeclampsia, fetal malnutrition, during delivery more frequently dated premature rupture of membranes, perineotomy and newborn injury. At the same time, significant differences in the incidence of weakness of labor activity, hemorrhage, neonatal asphyxia and maternal injury was not observed according to our data, which is not consistent with the known literature data.
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Briana, Despina D., i Ariadne Malamitsi-Puchner. "Intrauterine growth restriction and adult disease: the role of adipocytokines". European Journal of Endocrinology 160, nr 3 (marzec 2009): 337–47. http://dx.doi.org/10.1530/eje-08-0621.
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Intrauterine growth restriction (IUGR) is the failure of the fetus to achieve his/her intrinsic growth potential, due to anatomical and/or functional disorders and diseases in the feto–placental–maternal unit. IUGR results in significant perinatal and long-term complications, including the development of insulin resistance/metabolic syndrome in adulthood.The thrifty phenotype hypothesis holds that intrauterine malnutrition leads to an adaptive response that alters the fetal metabolic and hormonal milieu designed for intrauterine survival. This fetal programming predisposes to an increased susceptibility for chronic diseases. Although the mechanisms controlling intrauterine growth are poorly understood, adipose tissue may play an important role in linking poor fetal growth to the subsequent development of adult diseases. Adipose tissue secretes a number of hormones, called adipocytokines, important in modulating metabolism and recently involved in intrauterine growth.This review aims to summarize reported findings concerning the role of adipocytokines (leptin, adiponectin, ghrelin, tumor necrosis factor (TNF), interleukin-6 (IL6), visfatin, resistin, apelin) in early life, while attempting to speculate mechanisms through which differential regulation of adipocytokines in IUGR may influence the risk for development of chronic diseases in later life.
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Brohi, Sumera, Shazia Ahmed Jatoi, Saeed U. Nisa Sangi, Shaista Tabasum Abro, Rukhsana Shaikh i Ayesha Jalbani. "Prevalence of Teenage Pregnancy & Its Outcome at Shaikh Zaid Women Hospital Larkana". Pakistan Journal of Medical and Health Sciences 16, nr 5 (30.05.2022): 1461–63. http://dx.doi.org/10.53350/pjmhs221651461.
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Background: Teenage adolescent pregnancy is an important community health issue globally. Research shows that mothers in teenage period are at a higher risk of maternal death and complications related with pregnancy in comparison to the mothers who are adult. Therefore, this research was directed to examine the sociodemographic profile and fetal and maternal outcomes related with teenage pregnancy and their comparison with mothers of 20-30 years of age. Study Design: A comparative cross-sectional study. Place and Duration: In the obstetrics and Gynecology department of Sheikh Zaid Women Hospital Larkana for one-year duration from March 2021 to February 2022. Methods: A total of 60 teenage mothers ≤19 and 60 mothers who were 20-30 years of age respectively, were nominated as controls and cases. Data on the obstetric complications, fetal outcomes and sociodemographic profile were collected through face-to-face interviews using a pre-tested, pre-designed, partially structured questionnaire. The statistics were analyzed by entering data in the excel sheet of Microsoft. Results: In this study, 18.1 years was the mean age in teenage pregnant females and 24.3 years in the control group. 17.8 years was the mean age at which teenage mothers were married and for adults it was 20.1 years. 66.7% of teenage mothers and 61.7% of the control group are of high-low socioeconomic status. 80% of teenage pregnant females and 75% of control group were from rural areas. The mainstream of teenage mothers (70%) and control mothers (58.3%) are housewives by profession. The consanguineous marriages were observed in 33.3% of adolescent pregnant females and 41.7% in the control group. In this study, 38.3% and 46.7% of the mothers in adolescent and control group respectively had ante-natal checks during their pregnancy. Stillbirth / miscarriage were reported in 13.3% of adolescent mothers and 25% in the control group. 63.3% of teenage mothers had mild anemia and 53.3% in controls. The incidence of malnutrition (40% vs 15%, p <0.05), PPH (25% vs 6.7%, p <0.05), PROM (20% vs 3.3%, p <0.05) was significant in teenage mothers in comparison to mothers who were adults. The incidence of PIH was lower significantly in mothers during adolescence in comparison to adult mothers (13.3% vs. 31.7%, p <0.05). Conclusions: Complications such as PROM, maternal malnutrition, premature delivery, PPH and low birth weight occurred more frequently in adolescent mothers than in mothers who were adults. The adult mother’s higher proportion of PIH than in teenage mothers. Keywords: Adult pregnancy, teenage pregnancy, sociodemographic factors, adverse fetal and maternal outcomes.
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Brohi, Sumera, Shazia Ahmed Jatoi, Saeed U. Nisa Sangi, Shaista Tabasum Abro, Rukhsana Shaikh i Ayesha Jalbani. "Prevalence of Teenage Pregnancy & Its Outcome at Shaikh Zaid Women Hospital Larkana". Pakistan Journal of Medical and Health Sciences 16, nr 5 (30.05.2022): 1461–63. http://dx.doi.org/10.53350/pjmhs221651461.
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Background: Teenage adolescent pregnancy is an important community health issue globally. Research shows that mothers in teenage period are at a higher risk of maternal death and complications related with pregnancy in comparison to the mothers who are adult. Therefore, this research was directed to examine the sociodemographic profile and fetal and maternal outcomes related with teenage pregnancy and their comparison with mothers of 20-30 years of age. Study Design: A comparative cross-sectional study. Place and Duration: In the obstetrics and Gynecology department of Sheikh Zaid Women Hospital Larkana for one-year duration from March 2021 to February 2022. Methods: A total of 60 teenage mothers ≤19 and 60 mothers who were 20-30 years of age respectively, were nominated as controls and cases. Data on the obstetric complications, fetal outcomes and sociodemographic profile were collected through face-to-face interviews using a pre-tested, pre-designed, partially structured questionnaire. The statistics were analyzed by entering data in the excel sheet of Microsoft. Results: In this study, 18.1 years was the mean age in teenage pregnant females and 24.3 years in the control group. 17.8 years was the mean age at which teenage mothers were married and for adults it was 20.1 years. 66.7% of teenage mothers and 61.7% of the control group are of high-low socioeconomic status. 80% of teenage pregnant females and 75% of control group were from rural areas. The mainstream of teenage mothers (70%) and control mothers (58.3%) are housewives by profession. The consanguineous marriages were observed in 33.3% of adolescent pregnant females and 41.7% in the control group. In this study, 38.3% and 46.7% of the mothers in adolescent and control group respectively had ante-natal checks during their pregnancy. Stillbirth / miscarriage were reported in 13.3% of adolescent mothers and 25% in the control group. 63.3% of teenage mothers had mild anemia and 53.3% in controls. The incidence of malnutrition (40% vs 15%, p <0.05), PPH (25% vs 6.7%, p <0.05), PROM (20% vs 3.3%, p <0.05) was significant in teenage mothers in comparison to mothers who were adults. The incidence of PIH was lower significantly in mothers during adolescence in comparison to adult mothers (13.3% vs. 31.7%, p <0.05). Conclusions: Complications such as PROM, maternal malnutrition, premature delivery, PPH and low birth weight occurred more frequently in adolescent mothers than in mothers who were adults. The adult mother’s higher proportion of PIH than in teenage mothers. Keywords: Adult pregnancy, teenage pregnancy, sociodemographic factors, adverse fetal and maternal outcomes.
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Zhuk, S. I., i O. D. Shchurevska. "Fetal macrosomia: obstetrical, psychological and social aspects". HEALTH OF WOMAN, nr 7(153) (29.09.2020): 36–39. http://dx.doi.org/10.15574/hw.2020.153.36.
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One of the main markers of socially unfavorable pregnancy is anthropometric indicators of newborns. They reflect not only the narrow medical problems of complicated gestation but also social problems in general, the quality and access to the medical care. The objective: to determine the risk factors for fetal macrosomia in pregnancy with high levels of psychosocial stress. Materials and methods. The course of pregnancy and childbirth, demographic and medical risk factors for a fetal macrosomia were analyzed in 140 pregnant women with different levels of psychosocial stress. They were divided into 2 groups: 1 group (main) – 56 women-forced migrants from Luhansk and Donetsk regions, 2 group – 84 women with low and moderate level stress according to the questionnaires and psychological tests (L. Reeder, Spielberg–Khanin scale). Results. Gestational diabetes was the main reason for the birth of heavy children in both groups. Women–forced migrants had late manifestation of impaired tolerance to carbohydrates and a higher frequency of pathological weight gain. Male neonates are at risk for macrosomia. Childbirth in women with macrosomia is accompanied by a high frequency of complications and abnormal births. Conclusions. The frequency of births of macrosomic children in women - forced migrants is higher than in women at low risk of psychosocial stress. Risk factors in this group of pregnants include: the level of stress and behavioral responses to stress, impaired carbohydrate tolerance due to gestational diabetes, abnormal weight gain due to malnutrition and male sex of the fetus. Keywords: macrosomia, pregnancy, childbirth, women–forced migrants psychosocial stress, gestational diabetes, weight gain.
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Kachkovskii, M. A., O. V. Kosheleva i G. M. Mingulova. "Liver diseases at new coronavirus infection in pregnant women of Samara region". Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 11, nr 5 (27.10.2021): 34–41. http://dx.doi.org/10.20340/vmi-rvz.2021.5.covid.1.
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The new coronavirus infection (COVID-19) is a life-threatening condition. The features of the treatment of COVID-19 in pregnant women are not sufficiently studied and contradictory, therefore, research in this area is relevant.Objective. Assess the presence of liver disease in pregnant women with COVID-19 infection during pregnancy and after childbirth, taking into account the treatment.Methods. A retrospective analysis of medical records of 43 pregnant women aged 19 to 39 years (mean age 29.1 ± 5.4 years) who were hospitalized with laboratory-confirmed COVID-19 infection was performed. The selection was carried out by the method of continuous sampling.Results. 17 women (39.5%) had an acute respiratory viral disease, 26 people (60.5%) were diagnosed with bilateral polysegmental pneumonia with pulmonary tissue damage from 5 to 25%. In the structure of extragenital pathology, 46.5% of women had anemia and 23.3% of diseases of the hepatobiliary system, including chronic non-calculous cholecystitis (4.7%), biliary dysfunction (7%), chronic viral hepatitis B (2.3%) and chronic viral hepatitis C (9.3%). 6.9% were diagnosed with cholestatic hepatosis of pregnant women before admission to the hospital. An increase in the level of transaminases above the upper normal values was noted in 69.8% of cases, alkaline phosphatase – in 76.7%. In the structure of pregnancy complications in women with COVID-19 infection, fetal hypoxia prevailed in 15 women (34.9%). In second place is premature rupture of amniotic fluid (16.3%) and fetal malnutrition (16.3%).Conclusions. Pregnant women with diseases of the hepatobiliary system and anemia are most susceptible to new coronavirus infection. They have an increase in the level of transaminases and alkaline phosphatase, which can be caused by liver damage due to the increased tropism of the virus to cholangiocytes and hepatocytes, as well as hepatotoxic drugs. The most common complications of pregnancy in women with a new infection are premature birth, fetal hypoxia, and antenatal death.
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Mishra, Seema Kumari, Roshan Pradhan, Roshan Pradhan, Hanoon P. Pokharel i Surya B. Parajuli. "Maternal and Perinatal outcome in eclampsia at a teaching hospital of Eastern Nepal". Birat Journal of Health Sciences 5, nr 3 (30.12.2020): 1186–90. http://dx.doi.org/10.3126/bjhs.v5i3.33692.
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Introduction: Eclampsia is a multisystem disorder with potential life-threatening complications that can result in significant maternal and fetal morbidity and mortality. The case fatality rate of eclampsia is 1.8% in developed countries, 17.7% in India and 13% in Nepal. The incidence of pre-eclampsia and eclampsia is high in developing countries due to hypoproteinemia, malnutrition and poor obstetric facilities.
Objective: To assess the maternal and perinatal outcome in patients of eclampsia
Methodology: This was a hospital based cross-sectional study where all the patients presenting with eclampsia from June 2019 to November 2020 in the department of Obstetrics & Gynecology, Birat Medical College and Teaching Hospital were enrolled for the study. Data analyzed included various maternal parameters and fetal parameters along with the mode of delivery, outcome of baby, postpartum maternal condition and maternal mortality were noted.
Results: Among 6631 deliveries, 50 patients had eclampsia with the incidence of 7.54/1000 deliveries. Thirty four (68%) patients were of 20-30 years of age, 37 (74%) were primigravidas, 36 (72%) from rural areas, 34 (68%) were illiterate, 49 (98%) were low to middle socioeconomic status, 41 (82%) were unbooked and 33 (66%) patients had antepartum eclampsia. Eleven (22%) women developed eclampsia related complications. There were 02 (4%) maternal deaths and the common causes were HELLP Syndrome and pulmonary oedema. Neonatal outcome consisted of live births in 39 (78%) newborns, 03 (6%) were still births, 08 (16%) were birth asphyxia and 15 (30%) were low birth weight.
Conclusion: Majority of the patients were young, illiterate, unbooked primi gravidas with poor to average socioeconomic status from rural areas. Majority of the eclamptic women nearly 39 (78%) cases delivered via caesarean section for better neonatal outcome. Two (4%) eclamptic women died as a result of eclamptic complications and three (6%) newborns had neonatal deaths because of low birth weight and prematurity. Adequate antenatal screening, early detection of hypertension, timely referral, and early initiation of treatment and termination of eclamptic patients can help to improve the maternal and perinatal outcomes.
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Kaminskyi, V. V., O. I. Zhdanovich, T. V. Kolomiychenko i A. D. Derkach. "Pregnancy after influenza in the first trimester". HEALTH OF WOMAN, nr 7(153) (29.09.2020): 14–18. http://dx.doi.org/10.15574/hw.2020.153.14.
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The endpoint of the negative impact of adverse processes in the mother’s body with influenza is the formation of placental insufficiency, the basis of which is a violation of the uteroplacental blood flow. The objective: to study the features of the course of pregnancy, the state of the fetus and the newborn after the influenza in the first trimester of pregnancy. Materials and methods. 120 women who had the influenza in the first trimester of pregnancy were examined. In 68 (56.7%) pregnant women signs of feto-placental dysfunction were observed, 2 groups were distinguished: the main group - 68 patients with feto-placental dysfunction, the comparison group – 52 pregnant women without signs of feto-placental insufficiency. Results. 3 times more often than women without manifestations of placental insufficiency (42.6% versus 15.4%; p<0.05) a severe course of influenza was observed, it accompanied by a high frequency of clinical manifestations, including in almost all patients (95.6% versus 67.3%; p<0.05), body temperature rose to 38 °C and higher, and in 61.7% of women it stayed for 4–6 days (versus 11.5%; p<0.05). Among the complications of influenza: bronchitis (25.0% versus 9.3%; p<0.05), pneumonia (17.6% versus 5.7%; p<0.05), sinusitis (17.6% versus 7.7%; p<0.05). The threat of abortion was noted in 57.4% of cases, the threat of preterm birth was observed in 39.7% of women. Most often, placental dysfunction was associated with fetal distress (76.5% versus 13.5%; p<0.05) and growth retardation (54.4% versus 3.8%; p<0.05). 32.4% versus 13.5% of women had preeclampsia (p<0.05). The frequency of both polyhydramnios (17.6%) and low water (10.3%) is significantly higher. By cesarean section, 35.3% women were delivered (versus 15.4%, (p<0.05). Delivery was preterm in 17.6% of women versus 7.7% (p<0.05). Premature discharge of amniotic fluid (17.6%) and pathological blood loss during childbirth (16.2%), fetal distress during childbirth (48.5% versus 9.6%; p<0.05) were noted. Maternal placental dysfunction, fetal distress, prematurity (17.6%) and malnutrition (22.1%) led to a high incidence of birth asphyxia (46.5% versus 19.2%, p <0.05). Half (51.5%) of children had disadaptation syndromes, most often neurological disorders (32.4% versus 11.5%; p<0.05) and respiratory disorders (27.9% versus 7.7%; p<0.05). Conclusion. Influenza in early pregnancy with a severe course and a high frequency of complications is associated with a high frequency of feto-placental dysfunction and other obstetric and perinatal complications, which requires a more detailed study to determine risk factors and develop tactics for managing this category of pregnant women. Keywords: pregnancy, influenza, feto-placental dysfunction, obstetric and perinatal complications, newborn.
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Weckman, Andrea M., Chloe R. McDonald, Jo-Anna B. Baxter, Wafaie W. Fawzi, Andrea L. Conroy i Kevin C. Kain. "Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes in Low-Resource Settings". Advances in Nutrition 10, nr 5 (10.05.2019): 765–77. http://dx.doi.org/10.1093/advances/nmz015.
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ABSTRACT The available data support the hypothesis that L-arginine or L-citrulline supplementation would be suitable for implementation in resource-constrained settings and will enhance placental vascular development and improve birth outcomes. In resource-constrained settings, the rates of adverse birth outcomes, including fetal growth restriction, preterm birth, and low birth weight, are disproportionately high. Complications resulting from preterm birth are now the leading cause of mortality in children <5 y of age worldwide. Despite the global health burden of adverse birth outcomes, few effective interventions are currently available and new strategies are urgently needed, especially for low-resource settings. L-arginine is a nutritionally essential amino acid in pregnancy and an immediate precursor of nitric oxide. During pregnancy, placental and embryonic growth increases the demand for L-arginine, which can exceed endogenous synthesis of L-arginine from L-citrulline, necessitating increased dietary intake. In many low-resource settings, dietary intake of L-arginine in pregnancy is inadequate owing to widespread protein malnutrition and depletion of endogenous L-arginine due to maternal infections, in particular malaria. Here we examine the role of the L-arginine–nitric oxide biosynthetic pathway in pregnancy including placental vascular development and fetal growth. We review the evidence for the relations between altered L-arginine bioavailability and pregnancy outcomes, and strategies for arginine supplementation in pregnancy. Existing studies of L-arginine supplementation in pregnancy in high-resource settings have shown improved maternal and fetal hemodynamics, prevention of pre-eclampsia, and improved birth outcomes including higher birth weight and longer gestation. Arginine supplementation studies now need to be extended to pregnant women in low-resource settings, especially those at risk of malaria.
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Muratova, Nigora J., i Nargiza G. Shokirova. "TREATMENT OF PLACENTAL INSUFFICIENCY IN PREGNANT WOMEN WITH ANTIPHOSPHOLIPID SYNDROME AND VARICOSE VEINS". Oriental Journal of Medicine and Pharmacology 02, nr 02 (1.04.2022): 46–54. http://dx.doi.org/10.37547/supsci-ojmp-02-02-06.
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In recent years, there has been an increase in the frequency of placental insufficiency (PI) in pregnant women with obstetric and somatic pathology, including in patients with varicose veins, especially in the presence of autoimmune antibodies of various etiologies. The antiphospholipid syndrome (APS) attracts more and more attention of scientists, which significantly increases both maternal and perinatal mortality [8, 9]. Most of the adverse outcomes in APS are associated with PI. One of the reasons for the development of PI are disorders of the hemostasis system in pregnant women with the presence of circulating antiphospholipid antibodies (APA). AFAs circulating in the blood plasma contribute to the activation of the platelet link of hemostasis, disruption of the hemostatic potential, and potentiation of endothelial damage. Such changes lead to local ischemia of the villous chorion, impaired placental blood flow. The consequences of pathological changes in PI in the fetoplacental system lead to hypoxia, fetal malnutrition, increase perinatal mortality, and also have adverse consequences for the development of the child [2,8,9]. Risk factors for the development of fetal malnutrition are numerous. These include various somatic diseases, disorders in the reproductive system, pregnancy complications, social factors and much more. According to the literature, in women with an autoimmune cause of miscarriage without treatment, up to 90% of pregnancies are interrupted, and the effectiveness of treatment with the most modern approaches reaches 80% or more [5, 10]. Pregnancy is a favorable condition for the implementation of the pathogenic action of AFA. The manifestation of pathological processes can occur at different times, starting from the moment of conception: the process of implantation and early embryogenesis are disrupted. According to the literature, AFAs are capable of disrupting several aspects in the process of trophoblast differentiation, which is expressed in a change in the adhesiveness of the embryo, impaired fusion of syncytium, and a decrease in the depth of trophoblast invasion; a decrease in the production of hCG, an increase in thrombotic tendencies. As a result, these changes lead to a decrease in the protein-synthesizing and hormonal functions of the placenta. In the absence of adequate therapy, thrombosis occurs in the microcirculatory bed, which causes PI, chronic hypoxia, and often fetal death due to acute circulatory disorders in the vessels of the placenta [5, 6, 10]. Among patients with PN, 16-25% of women have manifestations of varicose veins, chronic venous insufficiency and varicose veins of the pelvis. Some authors attach significant importance in the occurrence of varicose veins in pregnant women to immunological mechanisms that lead not only to functional, but also to structural changes in the vessels. As a result, a cascade of pathological changes occurs, initiated by venous stasis and hemocoagulation abnormalities, which lead to PI. Treatment of this category of patients presents significant difficulties, as it can lead to the most severe complications in obstetrics, thrombosis and pulmonary embolism [1, 3].
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Budhewar, Amita, Sunita Ubale, Mamta Anand, Priti Naykodi i Jaynarayan Senapati. "Study of fetomaternal outcome in eclampsia". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 11, nr 5 (27.04.2022): 1555. http://dx.doi.org/10.18203/2320-1770.ijrcog20221293.
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Background: Eclampsia is preventable and treatable cause of maternal mortality and morbidity with poor fetomaternal outcomes in developing countries. Poor knowledge, lack of education, malnutrition and lack of antenatal care major causative factors for increase in eclampsia in developing countries.Methods: This was a retrospective single center observational study including 106 pregnant women with eclampsia in antenatal, intranatal and postnatal period over period of one year in our institute.Results: 106 women included in this study. In present study mean age of the study population was 25.41 years. 1 maternal death reported during study period. Antepartum eclampsia was commonest type 78%. Most of the patients were referred. In this study LSCS most common mode of deliveries. Perinatal mortality rate was 152/1000 live birth.Conclusions: Eclampsia is important cause of maternal and Fetal mortality and morbidity. Prevention of eclampsia is not possible, whereas early diagnosis can be done through clinical signs and symptoms, so as to prevent complications leading to mortality and morbidity related to eclampsia. Improvement in antenatal care services quality, increasing patient awareness about warning symptoms, investigations timely delivery, intensive monitoring in intrapartum and postpartum period have potential to improve fetomaternal outcomes.
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Moreno-Fernandez, Jorge, Julio J. Ochoa, Magdalena Lopez-Frias i Javier Diaz-Castro. "Impact of Early Nutrition, Physical Activity and Sleep on the Fetal Programming of Disease in the Pregnancy: A Narrative Review". Nutrients 12, nr 12 (20.12.2020): 3900. http://dx.doi.org/10.3390/nu12123900.
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Early programming is the adaptation process by which nutrition and environmental factors alter development pathways during prenatal growth, inducing changes in postnatal metabolism and diseases. The aim of this narrative review, is evaluating the current knowledge in the scientific literature on the effects of nutrition, environmental factors, physical activity and sleep on development pathways. If in utero adaptations were incorrect, this would cause a mismatch between prenatal programming and adulthood. Adequate caloric intake, protein, mineral, vitamin, and long-chain fatty acids, have been noted for their relevance in the offspring brain functions and behavior. Fetus undernutrition/malnutrition causes a delay in growth and have detrimental effects on the development and subsequent functioning of the organs. Pregnancy is a particularly vulnerable period for the development of food preferences and for modifications in the emotional response. Maternal obesity increases the risk of developing perinatal complications and delivery by cesarean section and has long-term implications in the development of metabolic diseases. Physical exercise during pregnancy contributes to overall improved health post-partum. It is also interesting to highlight the relevance of sleep problems during pregnancy, which influence adequate growth and fetal development. Taking into account these considerations, we conclude that nutrition and metabolic factors during early life play a key role of health promotion and public health nutrition programs worldwide to improve the health of the offspring and the health costs of hospitalization.
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Chhetry, Manisha, Shanti Subedi i Basudeb Banerjee. "Risk factors for post caesarean surgical site infection at a tertiary care center in Eastern Nepal". Journal of College of Medical Sciences-Nepal 13, nr 3 (19.10.2017): 314–17. http://dx.doi.org/10.3126/jcmsn.v13i3.18402.
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Background & Objectives:Post cesarean surgical site infection (SSI) is one of the commonly encountered complications which considerably increase the burden to health care. It is caused due to the interplay of various patient related, procedure related and iatrogenic factors. This study aims at identifying common risk factors for post cesarean SSI at our centre.Materials & Methods:This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included and their risk factors were studied.Results:Emergency procedures (82.97%) were more likely to develop SSI as compared to elective cesarean (17%). Among the patient related risk factors most of them were nulliparous (48.9%), term gestation (42.6%), malnourished (53.1%) and had history of prolonged leaking (44.68%) The mean age was 24.04±4.6years.Most of the patients who developed SSI were operated for repeat cesarean and fetal indications. Most patients who had SSI had at three to five per vaginal examinations (2.72±2). 66% of patient who had SSI had duration of surgery more than one hour. 68% of the surgeries which developed SSI were done by residents as compared to 32% of those done by consultantsConclusion:The commonly associated risk factors linked with post cesarean SSI are maternal age, emergency procedures, prolonged membrane rupture, multiple vaginal examinations, malnutrition and the experience of surgeon.
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Suismaya, Ni Luh Gede Wahyuni, I. Made Kardana i Kadek Deddy Ariyanta. "Annular pancreas in two cases after diamond-shaped anastomosis duodenoduodenostomy: case reports". Intisari Sains Medis 11, nr 2 (1.08.2020): 445–51. http://dx.doi.org/10.15562/ism.v11i2.581.
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Background: Annular pancreas is an infrequent congenital disorder characterized as a partial or complete pancreatic tissue around the descending part of the duodenum. Prenatal control is essential in the early detection of the annular pancreas. Initial management might increase better prognosis. We report two cases of the annular pancreas in Sanglah General Hospital, Denpasar, Bali in 2016-2019 to describe the clinical characteristics and outcome of different ages in annular pancreas managed by diamond-shaped duodenoduodenostomy.Case Description: The first case was a six days old baby boy with bile stained vomiting every time he breastfed when she was three days old and got worsen. USG fetal showed polyhydramnios with duodenal or jejunal stenosis. Besides, the abdominal X-ray showed double bubble sign and the laboratory findings were in a standard limit. The second case was a nine months old girl with bile-stained vomiting when she was eight months old and got worsen along with the time. She found with severe malnutrition and mild-moderate dehydration. The laboratory examination revealed electrolyte imbalanced, and abdominal X-ray showed double bubble sign. Postoperative to first feed was 1 day in both cases and full feed duration was 5 and 10 days. Length of stay was 16 and 25 days—both of the cases without complication after surgery.Conclusion: Annular pancreas is a rare congenital malformation that manifests primarily by signs related to duodenal obstruction. Earlier identifications will help to ensure that appropriate treatment can be instigated as soon as possible. Treatment by surgical with duodenoduodenostomy procedure is a surgical technique in the treatment of annular pancreas, with the advances in neonatal intensive care, may reduce the postoperative complications and will make a better outcome.
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Lassi, Zohra S., Zahra A. Padhani, Amna Rabbani, Fahad Rind, Rehana A. Salam, Jai K. Das i Zulfiqar A. Bhutta. "Impact of Dietary Interventions during Pregnancy on Maternal, Neonatal, and Child Outcomes in Low- and Middle-Income Countries". Nutrients 12, nr 2 (19.02.2020): 531. http://dx.doi.org/10.3390/nu12020531.
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Optimal nutrition plays a crucial role in pregnancy. Maternal malnutrition is a risk factor for maternal, fetal, and neonatal complications and is more prevalent in low and middle-income countries (LMICs). This review aims to study the effectiveness of antenatal macronutrient nutritional interventions on maternal, neonatal, and child outcomes. We searched the CENTRAL, PubMed, Embase, and other databases for randomized controlled trials and quasi-experimental designs on healthy pregnant women in LMICs. We also searched grey literature and reports from Google Scholar, Web of Science, and websites of different organizations. Title/abstract screening, full-text screening, and data extraction filtered 15 studies for inclusion. Balanced energy protein (BEP) supplementation (n = 8) studies showed a reduced incidence of perinatal mortality, stillbirths, low birth weight (LBW) infants, small for gestational age (SGA) babies and increased birth weight. Food distribution programs (FDPs) (n =5) witnessed reduced rates of SGA, stunting, wasting, and increased birth weight and birth length. Studies on intervention for obesity prevention (n = 2) showed reductions in birth weight. Other findings were statistically insignificant. Subgroup analyses were conducted to study the effectiveness of supplementation between regions, location, the timing of supplementation and nutritional status; however, there were a limited number of studies in each subgroup. Data from our review supports the antenatal supplementation of BEP and FDP for the prevention of adverse maternal, neonatal, and child outcomes that can be utilized for future policymaking. However, more research is required before recommending obesity prevention programs.
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Mariko, Seydou, Mamadou Haidara, Pierre Coulibaly, Mahamoud Coulibaly, Kalilou Samaké, Soumana Oumar Traoré i Alou Samaké. "Severe Anemia during Pregnancy in the Maternity Ward of the Kalabancoro Reference Health Center". Scholars International Journal of Obstetrics and Gynecology 5, nr 4 (23.04.2022): 192–97. http://dx.doi.org/10.36348/sijog.2022.v05i04.010.
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Introduction: The main objective was to determine the maternal and fetal consequences of severe anemia in pregnancy at the maternity ward of the Kalabancoro Reference Health Center. Methods: Our descriptive cross-sectional study with prospective data collection was conducted from January 1, 2019 to September 30, 2019 at the maternity ward of the Kalabancoro Health Center. Eligible patients were all consenting pregnant women presenting for prenatal consultation or in the delivery room in which the diagnosis of severe anemia was retained. The anemia was considered severe when the hemoglobin level was less than 7 g/dl and/or with clinical manifestations of decompensation of the anemia. Data were processed and analyzed by SPSS 12 software. Results: A total of 161 cases out of 2010 pregnant women were recruited and treated at the Kalabancoro Health Center, which represents a prevalence of 8% of severe anemia in pregnancy. The 14-19 year age group was the most representative, i.e. 52.2% of pregnant women, with extremes of 14 to 35 years and over. Malaria was the most predominant etiology with 31.05% followed by blood spoliation 25.47% and malaria plus malnutrition 14.29%. Prematurity represented 5% of cases. Maternal death was 1.9%. Low birth weight was 16.7% and stillbirths represented 3.7%. Conclusion: Severe anemia in pregnancy remains, through its complications, one of the most dreaded pathologies. Thus, a prospective analytical study is necessary to better study the causes of severe anemia in pregnancy.
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Lebovitz, Harold E. "Type 2 Diabetes: An Overview". Clinical Chemistry 45, nr 8 (1.08.1999): 1339–45. http://dx.doi.org/10.1093/clinchem/45.8.1339.
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Abstract Type 2 diabetes is a heterogeneous disorder. Clinical expression of the disorder requires both genetic and environmental factors. One theory concerning its etiology is that it is the result of the evolution of a thrifty genotype that had survival benefits in the past but is detrimental in the current environment. An opposing theory is that it represents an adult metabolic response to fetal malnutrition. Hyperglycemia in type 2 diabetes results from absolute or relative insulin deficiency. Most often relative insulin deficiency is attributable to an inability to adequately compensate for insulin resistance. Insulin resistance may be caused by a variety of genetic or metabolic factors. The most common etiological factor in insulin resistance is central obesity. Insulin resistance is associated with a cluster of metabolic abnormalities that include glucose intolerance, hypertension, a unique dyslipidemia, a procoagulant state, and an increase in macrovascular disease. Clinical intervention studies have demonstrated that reduction in the chronic microvascular and macrovascular complications of type 2 diabetes requires treatment of hyperglycemia to achieve hemoglobin A1c <7.0%, blood pressure ≤130/80 mmHg, and plasma LDL-cholesterol ≤2.6 mmol/L (≤100 mg/dL). Oral antihyperglycemic agents increase endogenous insulin secretion, decrease insulin resistance, or lower postprandial plasma glucose rise by delaying absorption of complex carbohydrates. Long-term glycemic control in type 2 diabetes requires progressive, stepwise, combination treatment with oral agents and eventually combination treatment with oral agents and insulin.
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Denkl, Barbara, Nada Cordasic, Hanna Huebner, Carlos Menendez-Castro, Marius Schmidt, Alexander Mocker, Joachim Woelfle, Andrea Hartner i Fabian B. Fahlbusch. "No evidence of the unfolded protein response in the placenta of two rodent models of preeclampsia and intrauterine growth restriction". Biology of Reproduction 105, nr 2 (6.05.2021): 449–63. http://dx.doi.org/10.1093/biolre/ioab087.
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Abstract In humans, intrauterine growth restriction (IUGR) and preeclampsia (PE) are associated with induction of the unfolded protein response (UPR) and increased placental endoplasmic reticulum (ER) stress. Especially in PE, oxidative stress occurs relative to the severity of maternal vascular underperfusion (MVU) of the placental bed. On the premise that understanding the mechanisms of placental dysfunction could lead to targeted therapeutic options for human IUGR and PE, we investigated the roles of the placental UPR and oxidative stress in two rodent models of these human gestational pathologies. We employed a rat IUGR model of gestational maternal protein restriction, as well as an endothelial nitric oxide synthase knockout mouse model (eNOS−/−) of PE/IUGR. Placental expression of UPR members was analyzed via qRT-PCR (Grp78, Calnexin, Perk, Chop, Atf6, and Ern1), immunohistochemistry, and Western blotting (Calnexin, ATF6, GRP78, CHOP, phospho-eIF2α, and phospho-IRE1). Oxidative stress was determined via Western blotting (3-nitrotyrosine and 4-hydroxy-2-nonenal). Both animal models showed a significant reduction of fetal and placental weight. These effects did not induce placental UPR. In contrast to human data, results from our rodent models suggest retention of placental plasticity in the setting of ER stress under an adverse gestational environment. Oxidative stress was significantly increased only in female IUGR rat placentas, suggesting a sexually dimorphic response to maternal malnutrition. Our study advances understanding of the involvement of the placental UPR in IUGR and PE. Moreover, it emphasizes the appropriate choice of animal models researching various aspects of these pregnancy complications.
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Alka i Kavita Dudhrejia. "An observational study of feto-maternal outcome in cases of abruptio placentae". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, nr 8 (26.07.2017): 3264. http://dx.doi.org/10.18203/2320-1770.ijrcog20173173.
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Background: Abruptio placentae defined as the preterm partial or complete separation of normally situated placenta from the uterine wall, complicating 1 in every 200 pregnancies (0.5-1%) in western nations, with rates as high as 4% in developing nations.Methods: This was a descriptive observational hospital-based study design with a follow-up component conducted over a period of 16 months, from January 2015 to April 2016 in the department of Obstetrics and Gynecology at RZH, PDU Medical College and hospital, Rajkot comprising of 83 cases.Results: A total of 83 cases of abruption placentae were present out of 9102 deliveries at RZH, PDU Medical College, Rajkot between January 2015 to April 2016. The incidence of abruption placentae in our study is 0.9%. Overall global incidence of abruptio placentae ranges between 0.5 to 2 % with more in developing countries as compared to the developed nations. (1a,6a,17a). Fetal adverse outcomes of abruptio placentae observed during study period were perinatal mortality 75.9%, prematurity 71%, low birth weight 69.8% and asphyxia 3.6%. Out of 83 cases, 59 deaths occurred in utero while 4 died in the first week of life.Conclusions: Abruptio placentae is one of the gravest hemorrhagic complications of pregnancy. Incidence in alarmingly high in resource poor set ups of developing countries like ours.The predictors of maternal adverse outcomes were found to be malnutrition, anemia, , PPH, DIC and maternal shock. Predictors for perinatal death were low birth weight, birth asphyxia, low APGAR score, retroplacental clot volume more than 500 ML.
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Kuntal, Neha, Madhu Patni Bhat, Amit Nimawat, Munmun Yadav i Mahendra Kumar Verma. "Feto-maternal outcomes following caesarean section: a prospective comparative study at tertiary care centre in North-Western Rajasthan". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, nr 6 (26.05.2018): 2311. http://dx.doi.org/10.18203/2320-1770.ijrcog20182341.
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Background: Caesarean section (CS) is employed when vaginal delivery is not feasible or hazardous to the mother and/or her baby. The procedure, however, is not without risk. We determined the fetomaternal outcomes of CS conducted at P.B.M Tertiary hospital situated in the North-Western region of Rajasthan.Methods: This is a Hospital based prospective comparative study of all CSs performed for various indications at the Dept. of Gynaecology and Obst., S.P. Medical College and P.B.M Hospital, Bikaner, India, from August 01, 2016, to July 31, 2017. All patients who had CS at any time within the 24 h period were noted and followed up until discharge. The sociodemographic data, types of CS, indications, and feto-maternal outcomes were documented in a proforma. Statistical analysis was carried out using the SPSS version 24.Results: There were 16386 deliveries out of which 4456 (27.1%) were by LSCS. The age range of the group A was 21-25 years while in group B it was 26-30 years. The mean age group A was 22.4, and group B it was 27.9 years. Total 6572 primigravida patients delivered and 32.1% had LSCS. Total 9814 multigravida patients delivered and 12.6% had primary LSCS. In group A, 119(79.3%) LSCS were elective as compared to group B where only 19(12.7%) were elective and this difference was found statistically highly significant (p<0.001). Indication of LSCS is different in both the groups. Fetal distress was most common indication in group A (53.3%) while in group B most common indication was APH (35.9%). Perinatal mortality/morbidity was significantly higher in group B (7.3%) as compared to group A (2.7%).Conclusions: The CS rate in this study was 27.1%. Although primary caesarean section in multipara constitutes only a small percentage of total deliveries and caesarean, they are associated with high maternal and perinatal morbidity. The reason for these complications is many. Beside obstetrical causes, factors like lack of antenatal care, low socioeconomic status, anaemia, malnutrition and illiteracy also play a major role obstructed labor and previous CS among Maternal and perinatal complications were more frequent with emergency CS and in the referred cases.
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Ayensu, Jessica, Reginald Adjetey Annan, Anthony Edusei i Eric Badu. "Impact of maternal weight on pregnancy outcomes: a systematic review". Nutrition & Food Science 46, nr 4 (11.07.2016): 542–56. http://dx.doi.org/10.1108/nfs-11-2015-0146.
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Purpose The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. The increasing prevalence of maternal overweight and obesity worldwide has become a problem of concern among public health professionals. The purpose of this paper is to review the evidence regarding the impact of maternal weight on pregnancy outcomes to facilitate the provision of evidence-based information to pregnant women during antenatal clinics in Ghana. Design/methodology/approach A search was conducted in PubMed, PLOS ONE, Cochrane, Embase and bibliographies for all studies on maternal weight and pregnancy outcomes published from January 2000 to May 2013. The key words used for the search were: “pre-pregnancy BMI”, “gestational weight gain”, “maternal weight”, “pregnancy outcomes” and “birth outcomes”. Findings The search yielded 113 papers; out of these, 35 studies were included in the review after exclusion of duplicates and irrelevant papers. Excluded papers included animal studies and human studies that did not meet inclusion criteria. Research limitations/implications The review only considered papers published from 2000 to 2013 and might have left out other important papers published before 2000 and after 2013. Practical implications The origins of the studies included in the review suggest paucity of studies on maternal weight and pregnancy outcomes in developing countries where there is a double burden of malnutrition. There is the need for more studies to be initiated in this area. Social implications Results of this review have revealed that the extremes of maternal weight prior to and during pregnancy increase the risk of maternal and fetal complications. Originality/value This paper provides evidential information on the impact of maternal weight on pregnancy outcomes for counseling during antenatal clinics.
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Vyalkova, A. A., B. A. Frolov, E. V. Savelyeva i S. A. Chesnokova. "Prenatal stress and its role in children's pathology: historical aspects and the current status of the question (review of literature)". Nephrology (Saint-Petersburg) 24, nr 3 (23.04.2020): 28–41. http://dx.doi.org/10.36485/1561-6274-2020-24-3-28-41.
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The article presents an analysis of fundamental data on the problem of stress and its role in the development of stressful diseases. Scientific evidence on the role of stress in childhood pathology indicates the extreme pathogenetic significance of stress. It is proved that stress has three interconnected faces: stress as a link in the adaptation mechanism, stress as a link in the pathogenesis of diseases and adaptation to stressful situations as a natural prevention of stressful diseases. The scientific substantiation of the main evolutionarily determined role of stress as an adaptation link indicates the possibility of acquiring some degree of resistance to stressful situations. Prevention of reducing the excess of stress reactions and reducing the possibility of its transformation into a link in the pathogenesis of diseases limits the complex of mechanisms designated as a stress-limiting system. Important information is the development and coordination of the stress response, which is provided by a complex set of mechanisms of neuroendocrine regulation, united by the concept of “stress-implementing system”. The most common forms of stress are fetal hypoxia, metabolic disturbances, and toxic effects leading to uncontrolled oxidative stress at the cellular and tissue levels with the development of pregnancy complications, intrauterine growth retardation syndrome (IUGR), persistent changes and pathological conditions. As the fetus grows, the flow of oxygen and nutrients from the mother through the placenta increases, which is accompanied by an increased risk of the formation of pathologies of the brain, heart, liver and kidneys with the development of a multi-organ pathology in the subsequent life. It has been proven that oxidative stress combined with stress of malnutrition in the prenatal period increases the risk of endocrinopathies, kidney diseases, and a number of other chronic diseases in the adult state. In practical terms, the negative effects of stress are of particular interest. Early detection of psychosocial and sympathomimetic factors causing stress is the basis for the prevention of childhood pathology.
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Zhelezov, D. N., i O. M. Platonova. "Perinatal pregnancy outcomes with uterine scar". Ukrainian journal of Perinatology and Pediatrics, nr 1(85) (29.03.2021): 11–16. http://dx.doi.org/10.15574/pp.2021.85.11.
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The increase in the frequency of surgical interventions on the uterus in women of fertile age caused increasing occurrence of pregnancies with one or more scars on the uterus. Purpose — to evaluate perinatal outcomes in women with a uterine scar. Materials and methods. The study involved 120 pregnant women who had a history of reconstructive surgery. The total sample was divided into the following clinical groups: I (n=70) — women who underwent conservative myomectomy, including 6 12 months before conception (group IA, n=30) and more than 1 year before conception (IB group, n=40); Group II (n=50) — women who underwent a cesarean section. All patients were examined in accordance with the order of the Ministry of Health of Ukraine No. 676 dated December 31, 2004 «On the approval of clinical protocols for obstetric and gynecological care» (as amended by the order of the Ministry of Health No. 782 (v0782282-05) dated December 29, 2005, No. 624 (v0624282-08) from 03.11.2008, No. 205 (v0205282-14) from 24.03.2014). Statistical processing was performed using the ANOVA method using post-hoc correction with Bonferoni. The null hypothesis was accepted at p<0.05 Results. When analyzing the results of measuring the main fetometric indicators, it was found that in most cases there were no deviations from the population standard values. Only 7 (5.8%) pregnant women were expecting the birth of children with low birth weight, they had a fetal weight that did not correspond to gestational age (so-called SGA — small for gestational age). There were no cases of perinatal mortality. There were 8 (6.5%) cases of children born with malnutrition. There were 2 children born with asphyxiation (1.6%). There were 5 (4.0%) with respiratory disorders syndrome, 6 (4.8%) with manifestations of conjugational jaundice. 4 (3.2%) cases of morphofunctional immaturity were registered. Perinatal lesion of the central nervous system of hypoxic-ischemic origin was detected in 3 (2.4%) newborns. Conclusions. With the correct choice of tactics for the management of pregnancy and childbirth in women who have undergone surgery on the uterus, the number of perinatal complications does not exceed the general population levels. The incidence of unfavorable perinatal outcomes does not exceed 19.4%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: uterine scar, pregnancy, childbirth, complications, perinatal outcomes.
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Kaminsky, Viacheslav, Tetiana Anoshina i Tetiana Kolomiychenko. "Social and Medical Aspects of the Association HIV and Herpes Virus Infection in Pregnant Women". Family Medicine, nr 6 (30.12.2016): 25–29. http://dx.doi.org/10.30841/2307-5112.6.2016.249003.
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The objective: to evaluate the social and health aspects of the association of HIV and herpes infections (GVI) in pregnant women.
Patients and methods. Clinical and statistical analysis of 1177 individual cards of pregnant women with HIV for 5 years. The control group consisted of 200 pregnant women with physiological pregnancy.
Results. Analysis of individual cards of pregnant women with HIV found insufficient to TORCH-infection survey (74,7%). The frequency of herpes infections in HIV-infected patients was 42,3%. The most common laboratory revealed HSV1/2 – 41,9%, CMV – 22,4% and mixed infection (both HSV1/2 and CMV) – 28,1%, other types of AIT is quite rare. At 8,5% of pregnant women stated primary infection herpes viruses, 27,2% – the reactivation of infection. HIV infection is often associated with other infections: hepatitis, fungal infections, toxoplasmosis, papillomavirus infections, respiratory infections, infections of the genitourinary system. Fixed low social status of HIV-infected women with AIT, the presence of harmful habits, a high frequency of co-infections and low compliance to treatment, are additional factors of perinatal risk. History data indicate a high rate of abortions and missed abortion in women with HIV infection and GVI. Going the way of HIV infection with parenteral on sex strengthens the role of herpes virus infection as a cofactor transition from HIV to AIDS, and the development of perinatal complications. The current pregnancy burdened with 84,3% of women: high incidence of placental insufficiency (41,3%), the threat of miscarriage and preterm labor, fetal distress. Maternal mortality in 5 years was noted in 2 cases (0,1‰), both women were GVI, perinatal – in 12 cases, 8 (21,5‰) of them women with AIT. 12,1% of children were born in a state of severe asphyxia, malnutrition with 31,3%, from 3,8% of the children at the end of 1st day intrauterine diagnosed pneumonia.
Conclusions. The high frequency of co-infection of HIV and herpes viruses, joining other infections and comorbidity in these women, their low social adaptation, and susceptibility to treatment, the negative impact of herpes infection in the course of HIV infection, the condition of women during pregnancy, the fetus and the newborn, which requires individual approach to the management of women based on established medical and social aspects of the problem.
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Lumbala, Paul Kabuyi, Gloire Mbayabo, Mamy Nzita Ngole, Aimé Lumaka, Valerie Race, Gert Matthijs, Chris Van Geet, Prosper Tshilobo Lukusa, Koenraad Devriendt i Tite Minga Mikobi. "Clinical and laboratory characterization of adult sickle cell anemia patients in Kinshasa". PLOS ONE 17, nr 12 (16.12.2022): e0278478. http://dx.doi.org/10.1371/journal.pone.0278478.
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Background Sickle cell anemia (SCA) is a monogenic hemoglobinopathy associated with severe acute and chronic complications, with the highest incidence worldwide in Sub-Saharan Africa. The wide variability in clinical manifestations suggest that a uniform response to hydroxurea may not be attained. In view of a potential treatment with hydroxyurea (HU), we assessed the variability of clinical and hematological manifestations in a cohort of adults with SCA in Kinshasa, capital of the DR Congo in Central Africa. Methods A cross-sectional study was conducted in a hospital dedicated to SCA management in Kinshasa. Clinical history of patients was recorded, a complete physical examination performed. The diagnosis was confirmed by means of DNA analysis. A full blood count and hemolysis markers were measured. The severity of the disease was evaluated by means of a previously reported score. Results The study group consisted of 166 genetically confirmed SCA patients. The SCA severity was mild in 28.9%, moderate in 64.5% and severe in 6.6%. The disease severity score increased with patient’s age (p ≤ 0.001). The severity was higher in males compared to females (p = 0.012). In males, the severity score was correlated with the presence of priapism (p = 0.045), a manifestation not previously incorporated in the severity score. The severity score was inversely correlated with the fetal hemoglobin (HbF) rate (p = 0.005). Malnutrition (BMI <18.5 kg/m2) was present in 47% of patients and was related to the male sex, hip disease (aOR 3.11; p = 0.019) and severe phenotype (aOR 3.53; p = 0.012). Leg ulcers were more frequent in males than in females (p = 0.001; OR 24.3) and were correlated with the number of days of hospitalization (p = 0.029). Hip disease was related to the increasing age (p = 0.008). Conclusion In this selected, hospital-based populations of adults with SCA, severe disease was rare, which may be due to survival bias. However, two thirds had moderate severity of the disease, mostly with a low HbF, and they may benefit from HU treatment. In the Central-African setting the separation between vaso-occlusive and hyperhemolytic sub-phenotypes was not applicable.
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Fiorentini, Elisa, Edda Russo, Amedeo Amedei i Silvia Bellando Randone. "Fecal microbiome in systemic sclerosis, in search for the best candidate for microbiota-targeted therapy for small intestinal bacterial overgrowth control". Journal of Scleroderma and Related Disorders 7, nr 3 (25.09.2022): 163–67. http://dx.doi.org/10.1177/23971983221118871.
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Gastrointestinal involvement is a common complication in systemic sclerosis patients and must be suspected and investigated already in the early stages of the disease. Gastrointestinal symptoms and complications—such as gastroesophageal reflux disease, intestinal pseudo-obstruction, malnutrition, diarrhea, constipation, and small intestinal bacterial overgrowth—severely impair systemic sclerosis patients’ quality of life and affect their prognosis. Although some pathogenetic aspects of the gastrointestinal involvement in systemic sclerosis remain unclear, defining the characteristics of the microbiota and its role could help in risk stratification, selection of candidates for microbiota-targeted therapies, prediction of standard treatment efficacy, and prognosis of systemic sclerosis patients. Finally, understanding how to modify the microbiota composition may represent an important therapeutic approach to target gastrointestinal involvement in systemic sclerosis.
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Nakanishi, Takehisa, Kento Mizutani, Shohei Iida, Yoshiaki Matsushima, Ai Umaoka, Makoto Kondo, Koji Habe i Keiichi Yamanaka. "Janus Kinase Inhibitors Ameliorated Gastrointestinal Amyloidosis and Hypoalbuminemia in Persistent Dermatitis Mouse Model". International Journal of Molecular Sciences 23, nr 1 (21.12.2021): 28. http://dx.doi.org/10.3390/ijms23010028.
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Malnutrition is not only regarded as a complication of rheumatoid arthritis and inflammatory bowel disease but also that of inflammatory skin disease; however, the mechanisms and efficacy of its treatment have not been elucidated. Using a mouse model of dermatitis, we investigated the pathophysiology of malnutrition in inflammatory skin conditions and efficacy of its treatment. We employed spontaneous skin inflammation mice models overexpressing human caspase-1 in the epidermal keratinocytes. Body weight, nutrition level, and α1-antitrypsin fecal concentration were measured. The gastrointestinal tract was histologically and functionally investigated. Fluorescein isothiocyanate (FITC)-dextran was forcibly fed on an empty stomach, and plasma FITC-dextran was measured. The treatment efficacy of antibodies against tumor necrosis factor-α (TNF-α) and interleukin (IL)-α/β as well as Janus kinase (JAK) inhibitors was investigated. Compared with wild-type littermates, the inflammatory skin mice models showed a lowered body weight, reduction of serum albumin level, amyloid deposition in the stomach, small intestine, and large intestine, and increased α1-antitrypsin fecal concentration. However, the plasma FITC-dextran was unchanged between the dermatitis models and wild-type littermates. The over-produced serum amyloid A1 in the liver was detected in the plasma in the dermatitis model. Antibodies against TNF-α and IL-α/β showed partial effects on amyloid deposition; however, JAK inhibitors improved gastrointestinal amyloidosis with the improvement of skin symptoms. Chronic dermatitis is closely related to secondary amyloidosis in the gastrointestinal tract, resulting in hypoalbuminemia. Therefore, active control of skin inflammation is essential for preventing gastrointestinal complications.
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Xie, Yan-Chun, Xu-Bin Jing, Xiang Chen, Ling-Zi Chen, Shao-Hui Zhang i Xian-Bin Cai. "Fecal microbiota transplantation treatment for type 1 diabetes mellitus with malnutrition: a case report". Therapeutic Advances in Chronic Disease 13 (styczeń 2022): 204062232211174. http://dx.doi.org/10.1177/20406223221117449.
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Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease. Not only genetics, but the intestinal environment affected by gut microbiota is also the key to pathogenesis. Besides the occurrence of diabetes, gut microbiota dysbiosis may also contribute to the development of diabetes-related complications. Fecal microbiota transplantation (FMT) is an emerging technique that had shown its potential as a treatment for metabolic disease. Here, we report the first case of T1DM with malnutrition and gastrointestinal symptoms treated with FMT. A 24-year-old T1DM patient suffered from poor blood glucose control, recurrent nausea and vomiting, severe malnutrition, and intractable constipation after insulin treatment. The clinical response of the patients after FMT was well, especially nausea and vomiting were significantly relieved. In addition, constipation, nutritional status, and blood glucose control (fasting blood glucose, HbA1c) gradually improved. A degree of similarity was found in gut microbiota composition between the patient and healthy donor after FMT while it was totally different before the treatment. Furthermore, pathway function analysis of MetaCYC database implies that the potential mechanism of the response of FMT may be driven by specific bacteria involved in several metabolic pathways that need further exploration. To sum up, we believe that the reconstruction of intestinal flora by FMT may be a new choice for the treatment of T1DM patients with malnutrition.
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Sibarani, Abraham Talent Bawadi, Hesti Triwahyu Hutami, Nani Maharani i Yora Nindita. "Antidiarrheal Effect of Lime Peel Extract on Bisacodyl-Induced Mice". DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) 10, nr 6 (30.11.2021): 438–44. http://dx.doi.org/10.14710/dmj.v10i6.32144.
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Background: Diarrhea is a condition of increased fecal water content of more than 200 grams or 200 ml/24 hours with a liquid or semi-liquid consistency. Complications of diarrhea, dehydration and malnutrition are still world health problems. Lime peel extract contains tannins which have astringent properties. Tannins are indicated as an alternative anti-diarrheal agent by tightening and forming a protective layer on the intestinal mucosa thereby reducing osmolarity.Aim: To examine the consistency, fecal water content, and frequency of defecation of bisacodyl-induced diarrhea in mice that are given lime peel extract.Methods: This research was an experimental with post test only group design. Thirty-six male mice were included and then divided into 5 groups with bisacodyl induction and 1 normal control group (KM) without bisacodyl induction. The negative control group (KN) was given 0.5 ml Tween 80 1%, the positive control group (KP) was given attalpugite 0.4 mg/40gW, treatment group 1 (X1), treatment group 2 (X2), treatment group 3 (X3 ) were given lime peel extract at graded doses of 125, 250, and 500 mg/KgW. Consistency, fecal water content, and frequency of defecation were observed every 30 minutes for 4 hours by observing the consistency of feces, weighing wet and dry feces to measure the water content, and measuring the frequency of defecation in each group. Data were analyzed statitiscally using Kruskal Wallis test with Post Hoc Mann Whitney test.Results: There were significant differences between the comparison of defecation frequency in the X3 group and the KM group, for the fecal water content comparison between the X3 group and the KN group, and no significant differences in the following group comparisons.Conclusion: Lime peel extract cannot reduce the frequency of defecation, fecal water content, and increase the consistency of feces significantly.Keywords: Diarrhea, lime peel extract, tannins, astringent, consistency, fecal water content, frequency of defecation.
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Lesage, J., D. Hahn, M. Leonhardt, B. Blondeau, B. Breant i JP Dupouy. "Maternal undernutrition during late gestation-induced intrauterine growth restriction in the rat is associated with impaired placental GLUT3 expression, but does not correlate with endogenous corticosterone levels". Journal of Endocrinology 174, nr 1 (1.07.2002): 37–43. http://dx.doi.org/10.1677/joe.0.1740037.
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Fetal intrauterine growth restriction (IUGR) is a frequently occurring and serious complication of pregnancy. Infants exposed to IUGR are at risk for numerous perinatal morbidities, including hypoglycemia in the neonatal period, as well as increased risk of later physical and/or mental impairments, cardiovascular disease and non-insulin-dependent diabetes mellitus. Fetal growth restriction most often results from uteroplacental dysfunction during the later stage of pregnancy. As glucose, which is the most abundant nutrient crossing the placenta, fulfills a large portion of the fetal energy requirements during gestational development, and since impaired placental glucose transport is thought to result in growth restriction, we investigated the effects of maternal 50% food restriction (FR50) during the last week of gestation on rat placental expression of glucose transporters, GLUT1, GLUT3 and GLUT4, and on plasma glucose content in both maternal and fetal compartments. Moreover, as maternal FR50 induces fetal overexposure to glucocorticoids and since these hormones are potent regulators of placental glucose transporter expression, we investigated whether putative alterations in placental GLUT expression correlate with changes in maternal and/or fetal corticosterone levels. At term (day 21 of pregnancy), plasma glucose content was significantly reduced (P<0.05) in mothers subjected to FR50, but was not affected in fetuses. Food restriction reduced maternal body weight (P<0.001) but did not affect placental weight. Plasma corticosterone concentration, at term, was increased (P<0.05) in FR50 mothers. Fetuses from FR50 mothers showed reduced body weight (P<0.001) but higher plasma corticosterone levels (P<0.05). Adrenalectomy (ADX) followed by corticosterone supplementation of the mother prevented the FR50-induced rise in maternal plasma corticosterone at term. Food restriction performed on either sham-ADX or ADX mothers induced a similar reduction in the body weight of the pups at term (P<0.01). Moreover, plasma corticosterone levels were increased in pups from sham-ADX FR50 mothers (P<0.01) and in pups from ADX control mothers (P<0.01). Western blot analysis of placental GLUT proteins showed that maternal FR50 decreased placental GLUT3 protein levels in all experimental groups at term (P<0.05 and P<0.01), but did not affect either GLUT1 or GLUT4 protein levels. Northern blot analysis of placental GLUT expression showed that both GLUT1 and GLUT3 mRNA were not affected by the maternal feeding regimen or surgery. We concluded that prolonged maternal malnutrition during late gestation decreases maternal plasma glucose content and placental GLUT3 glucose transporter expression, but does not obviously affect fetal plasma glucose concentration. Moreover, the present results are not compatible with a role of maternal corticosterone in the development of growth-restricted rat fetuses.
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Bhattacharya, Saptarshi, Lakshmi Nagendra, Aishwarya Krishnamurthy, Om J. Lakhani, Nitin Kapoor, Bharti Kalra i Sanjay Kalra. "Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications". Medical Sciences 9, nr 4 (23.09.2021): 59. http://dx.doi.org/10.3390/medsci9040059.
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Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.
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Minwuyelet, Awoke, Yibeltal Aschale i Solomon Ayenew. "Extraintestinal Amoebiasis in Women after 6th Day of Delivery". Case Reports in Gastrointestinal Medicine 2021 (20.09.2021): 1–4. http://dx.doi.org/10.1155/2021/1395404.
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Background. Extraintestinal amoebiasis is more common in countries with lower socioeconomic status. Complication related to amoebiasis is common in pregnant patients with malnutrition and others. Severe cases can be associated with high fatality rates. We would like to report a patient with a presumptive diagnosis of extraintestinal amoebiasis who was on the 6th postpartum day after intrauterine fetal death (IUFD). Case Presentation. The patient was a 31 year-old female who was on 6th postpartum day after IUFD after the 9th month of amenorrhea. She presented with severe epigastric pain, hiccups, and bloody vomiting of ingested matter for 5 days. She also had right upper quadrat pain and fatigue. In addition, she had generalized body weakness and yellowish discoloration of the eyes for one week. Moreover, she had pruritus, fever, and a history of watery diarrhea 6 days ago which got subsided during the presentation. Laboratory investigation indicated leukocytosis and increased level of alkaline phosphatase and direct and total bilirubin. Trophozoite of E. histolytica was seen on stool microscope, negative for viral marker and Helicobacter pylori. Abdominal ultrasonography showed normal liver parenchyma and biliary system. She was treated onsite with 500 mg metronidazole and 500 mg ceftriaxone for five days and discharged with metronidazole 500 mg PO three times a day and cloxacillin 500 mg PO four times a day for 7 days. Conclusions. Extraintesinal amoebiasis can be resolved if it is diagnosed early and treated with metronidazole. Clinicians should not neglect amoebiasis in patients presenting with jaundice and right upper quadrant pain.
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Ritivoiu, Mirela-Elena, Cristina Manuela Drăgoi, Dumitru Matei, Iustina Violeta Stan, Alina Crenguţa Nicolae, Mihai Craiu, Ion-Bogdan Dumitrescu i Alina Angelica Ciolpan. "Current and Future Therapeutic Approaches of Exocrine Pancreatic Insufficiency in Children with Cystic Fibrosis in the Era of Personalized Medicine". Pharmaceutics 15, nr 1 (3.01.2023): 162. http://dx.doi.org/10.3390/pharmaceutics15010162.
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This review presents current updates of pancreatic enzyme replacement therapy in children with cystic fibrosis based on literature published in the last decade and some special considerations regarding pancreatic enzyme replacement therapy in the era of new therapies, such as cystic fibrosis transmembrane conductance regulator modulator therapies. Few articles evaluate the efficacy of pancreatic enzyme replacement therapy in the pediatric population, and most studies also included children and adults with cystic fibrosis. Approximately 85% of cystic fibrosis patients have exocrine pancreatic insufficiency and need pancreatic enzyme replacement therapy. Fecal elastase is the most commonly used diagnostic test for exocrine pancreatic insufficiency, although this value can fluctuate over time. While it is used as a diagnostic test, it cannot be used for monitoring the effectiveness of pancreatic enzyme replacement therapy and for adjusting doses. Pancreatic enzyme replacement therapy, the actual treatment for exocrine pancreatic insufficiency, is essential in children with cystic fibrosis to prevent malabsorption and malnutrition and needs to be urgently initiated. This therapy presents many considerations for physicians, patients, and their families, including types and timing of administration, dose monitoring, and therapy failures. Based on clinical trials, pancreatic enzyme replacement therapy is considered effective and well-tolerated in children with cystic fibrosis. An important key point in cystic fibrosis treatment is the recent hypothesis that cystic fibrosis transmembrane conductance regulator modulators could improve pancreatic function, further studies being essential. Pancreatic enzyme replacement therapy is addressed a complication of the disease (exocrine pancreatic insufficiency), while modulators target the defective cystic fibrosis transmembrane conductance regulator protein. Exocrine pancreatic insufficiency in cystic fibrosis remains an active area of research in this era of cystic fibrosis transmembrane conductance regulator modulator therapies. This new therapy could represent an example of personalized medicine in cystic fibrosis patients, with each class of modulators being addressed to patients with specific genetic mutations.
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Gramaglia, S. M. C., U. Cucinotta, V. Dipasquale, S. Arrigo, P. Gandullia i C. Romano. "P263 Very early onset Inflammatory Bowel Diseases: Review of the Genoa-Messina joint clinical experience. Clinical history: Part I". Journal of Crohn's and Colitis 16, Supplement_1 (1.01.2022): i304. http://dx.doi.org/10.1093/ecco-jcc/jjab232.390.
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Abstract Background Pediatric inflammatory bowel diseases (pIBD) have specific phenotypes compared to Inflammatory Bowel Diseases (IBD) in adults. The Very Early Onset-IBD (VEO-IBD) is considered a diagnosis of IBD in children before age 6 years old with 15% of prevalence. Methods The objective of this study was to compare the clinical and endoscopic features of VEO-IBD compared to pediatric IBD (diagnosis > 6 years old) also in terms of natural history and response to treatment. The VEO patients followed at the IBD-Centers of Messina and Gaslini were enrolled retrospectively. We compared the results of this population with what is reported in the literature in terms of clinical characteristics at onset (symptoms, age at onset, age at diagnosis), comorbidities, complications, associated immunodeficiencies, endoscopic models. Percentage comparison and chi-square test of data was performed. Results 74 VEO-IBD patients were enrolled. The onset is around 3 years, a predominantly colonic localization, inflammatory pattern. Positive family history for IBD in 8.1%. Histology is very nonspecific and is characterized above all by basal plasmacytosis (CD 68,4%; CU 72,7%) and hypereosinophilia (CD 36,8%; CU 40%). At diagnosis, IBD-U (= Unclassified) is prevalent (47,2%), the frequency of which will decrease over the years (3 years after onset, 32.4%), differentiating into CU and CD (table 1). The main clinical manifestations at onset are chronic diarrhea (CD 89,5%; CU 91%), blood in the stool and / or hematochezia (CD 78,9%; CU 96,4%; table 2). Sensitive onset tests for IBD are ESR, fecal calprotectin and iron deficiency anemia (positive respectively in CD 75-60-71,4%%; CU 58,8-84,6-66,7%). The most frequent extraintestinal manifestations are arthritis (CD 22,2%) and sclerosing cholangitis (CU 7,3%). To highlight the significant statistical association (p <0.05) between VEO-IBD and neuro / nephrological diseases (major renal malformations and nephropathies, autism and neuropsychiatric disorders; table 3). Among the most common complications are severe anemia (CD 31,6%; CU 42,6%), acute attack of severe colitis, malnutrition and fistulization. A monogenic form of VEO-IBD was found in 5.4% frequently linked to immunedeficiency, 2 cases required allogenic HSC transplantation (XIAP, WAS). Conclusion VEO-IBDs represent a challenge for the pediatric gastroenterologist. The clinical course is no more severe than pediatric inflammatory bowel diseases, with the exception of monogenic forms. A genetic association between nephro / neurological comorbidities and VEO-IBDs is likely, the genetics is still to be discovered. Further studies will be needed to define the best therapeutic and diagnostic approach for these diseases.
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O’Higgins, Amy C., Anne Doolan, Laura Mullaney, Niamh Daly, Daniel McCartney i Michael J. Turner. "The relationship between gestational weight gain and fetal growth: time to take stock?" Journal of Perinatal Medicine 42, nr 4 (1.01.2014). http://dx.doi.org/10.1515/jpm-2013-0209.
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AbstractThe aim of this article is to review the current evidence on gestational weight gain (GWG). Maternal obesity has emerged as one of the great challenges in modern obstetrics as it is becoming increasingly common and is associated with increased maternal and fetal complications. There has been an upsurge of interest in GWG with an emphasis on the relationship between excessive GWG and increased fetal growth. Recent recommendations from the Institute of Medicine in the USA have revised downwards the weight gain recommendations in pregnancy for obese mothers. We believe that it is time to take stock again about the advice that pregnant women are given about GWG and their lifestyle before, during, and after pregnancy. The epidemiological links between excessive GWG and aberrant fetal growth are weak, particularly in obese women. There is little evidence that intervention studies decrease excessive GWG or improve intrauterine fetal growth. Indeed, there is a potential risk that inappropriate interventions during the course of pregnancy may lead to fetal malnutrition that may have adverse clinical consequences, both in the short- and long-term. It may be more appropriate to shift the focus of attention from monitoring maternal weight to increasing physical activity levels and improving nutritional intakes.
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Snoek, Katinka M., Régine P. M. Steegers-Theunissen, Eric J. Hazebroek, Sten P. Willemsen, Sander Galjaard, Joop S. E. Laven i Sam Schoenmakers. "The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis". Human Reproduction Update, 13.08.2021. http://dx.doi.org/10.1093/humupd/dmab022.
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Abstract BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.
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Leung, Alexander K. C., Amy A. M. Leung, Alex H. C. Wong i Kam L. Hon. "Human Ascariasis: An Updated Review". Recent Patents on Inflammation & Allergy Drug Discovery 14 (5.07.2020). http://dx.doi.org/10.2174/1872213x14666200705235757.
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Background: Ascaris lumbricoides is the most common helminthic infection. More than 1.2 billion people have ascariasis worldwide. Objective: This article aimed to provide an update on the evaluation, diagnosis, and treatment of ascariasis. Methods: A PubMed search was conducted in February 2020 in Clinical Queries using the key terms “ascariasis” OR "Ascaris lumbricoides". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 10 years. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. Patents were searched using the key term “ascariasis” OR "Ascaris lumbricoides" in www.freepatentsonline.com. Results: Ascaris lumbricoides is transmitted through ingestion of embryonated eggs from fecal-contaminated material. Ascariasis has high endemicity in tropical and subtropical areas. Predisposing factors include poverty, poor sanitation, inadequate sewage disposal, and poor personal hygiene. The prevalence is greatest in children younger than 5 years of age. The majority of patients with intestinal ascariasis are asymptomatic. For those with symptoms, anorexia, nausea, bloating, abdominal discomfort, recurrent abdominal pain, abdominal distension, and intermittent diarrhea are not uncommon. Other clinical manifestations vary widely, depending on the underlying complications. Complications include Löeffler syndrome, intestinal obstruction, biliary colic, recurrent pyogenic cholangitis, cholecystitis, acalculous cholecystitis, obstructive jaundice, cholelithiasis, pancreatitis, and malnutrition. The diagnosis is best established by microscopic examination of fecal smears or following concentration techniques for the characteristic ova. Patients with A. lumbricoides infection warrant anthelminthic treatment, even if they are asymptomatic, to prevent complications from migration of the parasite. Albendazole and mebendazole are the drugs of choice for children and nonpregnant individuals with ascariasis. Pregnant women with ascariasis should be treated with pyrantel pamoate. Recent patents related to the management of ascariasis are also discussed. Conclusion: The average cure rate with anthelminthic treatment is over 95%. Unfortunately, most treated patients in endemic areas become re-infected within months. Health education, personal hygiene, improved sanitary conditions, proper disposal of human excreta, and discontinuing the use of human fecal matter as a fertilizer are effective long-term preventive measures. Targeting deworming treatment and mass anthelminthic treatment should be considered in regions where A. lumbricoides is prevalent.