[Pregnancy during chronic hemodialysis. A series of cases]. / Embarazo en hemodiálisis crónica: experiencia de un hospital universitario.

BACKGROUND: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. AIM: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. MATERIALS AND METHODS: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. RESULTS: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 [625-1,575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29-36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14-25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29-34] weeks. Neonatal median hospitalization length was 4 [4-32] days, with 18% of neonatal deaths. CONCLUSIONS: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential.

Embarazo en hemodiálisis crónica: experiencia de un hospital universitario / Pregnancy during chronic hemodialysis. A series of cases

Background: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. Aim: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. Materials and Methods: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. Results: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 [625-1,575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29-36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14-25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29-34] weeks. Neonatal median hospitalization length was 4 [4-32] days, with 18% of neonatal deaths. Conclusions: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential.

[Prenatal diagnosis of de novo complex balanced rearrangements in chromosomes 3,4, and 13] ]. / Prenatální zjistení de novo vzniklé komplexní vyvázené prestavby mezi chromozómy 3, 4 a 13.

A case of apparently balanced de novo complex chromosome rearrangement with three breaks found in foetus by amniotic fluid examination is described. Amniocentesis was indicated because of low AFP in maternal serum during the first pregnancy of 25-year-old healthy woman. Her family anamnesis as well as her husbands on was insignificant, chromosomes were normal. Fetal karyotype was 46,XY,t(3;13;4)(q26.2;q21.3;q12). To eliminate further cryptic aberrations the multicolor FISH technique was employed. The risk of serious inborn malformation in complex rearrangement with three breaks was estimated on the basis of literary data to be 10.5% (3.5% per each break). The couple decided to terminate the pregnancy. No distinct anomaly was found in the fetus. Only 12 prenatal diagnoses of the complex balanced chromosome rearrangements formed de novo can be found in the literature. Total risk of the serious malformation relating to that small group of described cases is rather high. Only substantial enlargement of the clinic may enable to use prenatal evaluation of each individual case according to the number of chromosomal breaks or according to other criteria with more accurate results.

[Ethics of working with DNA in health care]. / Etika práce s DNA ve zdravotnictví.

The reasoning on DNA as a biological sample of the particular status is based on the author's experience with DNA isolation, analysis and interpretation of genotyping results. The author discusses the nature of the information contained in DNA molecule, he specifies who uses this information and in what way the information is or should be used. The different standpoints concerning the ethical codex of patient's rights versus DNA handling are stressed.

Vibrational circular dichroism of tetraphenylporphyrin in peptide complexes? A computational study.

The Raman and absorption spectra of tetraphenylporphyrin (TPP) were calculated and compared to experiment. The computation was based on the harmonic molecular force field and electric tensors obtained ab initio at the BPW91/6-31G* level. Good agreement was found between experimental and calculated frequencies and intensities. In order to estimate whether induced optical activity in chiral complexes interferes with the signal of peptide vibrations, the vibrational circular dichroism (VCD) spectra of TPP were simulated. The magnetic field perturbation theory (MFP) and the gauge-invariant atomic orbitals (GIAO) were used for the simulation. Such spectra were compared to theoretical VCD intensities of a model tripeptide as well to experimental spectra of a complex of the peptide and tetrakis(p-sulfonatophenyl)porphyrin (TSPP). No significant contribution to VCD signal from the TPP residue was found in experimental spectra. Thus, possible peptide conformational changes occurring during the complexation can be monitored directly in the amide I frequency region.