Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study.

OBJECTIVE: To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes. METHODS: This was a prospective observational cohort study of consecutive women with confirmed intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014 to March 2016. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding during the first trimester. Pregnancies were followed up until the final outcome was known. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis was used to assess the association between first-trimester symptoms and pregnancy complications by calculating adjusted odds ratios (aOR) with correction for maternal age. RESULTS: Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first-trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow-up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17-2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81-1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. CONCLUSIONS: Our study suggests that there is an increased incidence of antenatal complications in women experiencing pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending early-pregnancy units. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Monte Carlo QSAR models for predicting organophosphate inhibition of acetycholinesterase.

A series of 278 organophosphate compounds acting as acetylcholinesterase inhibitors has been studied. The Monte Carlo method was used as a tool for building up one-variable quantitative structure-activity relationship (QSAR) models for acetylcholinesterase inhibition activity based on the principle that the target endpoint is treated as a random event. As an activity, bimolecular rate constants were used. The QSAR models were based on optimal descriptors obtained from Simplified Molecular Input-Line Entry System (SMILES) used for the representation of molecular structure. Two modelling approaches were examined: (1) 'classic' training-test system where the QSAR model was built with one random split into a training, test and validation set; and (2) the correlation balance based QSAR models were built with two random splits into a sub-training, calibration, test and validation set. The DModX method was used for defining the applicability domain. The obtained results suggest that studied activity can be determined with the application of QSAR models calculated with the Monte Carlo method since the statistical quality of all build models was very good. Finally, structural indicators for the increase and the decrease of the bimolecular rate constant are defined. The possibility of using these results for the computer-aided design of new organophosphate compounds is presented.

Interactions of metronidazole with other medicines: a brief review.

Metronidazole, a medicine discovered in the late 1950 s is mainly an antibiotic active against anaerobes and protozoa. There are numerous side effects of metronidazole. Some interactions with other medicines enhance its activity, and some cause the decrease in activity and plasma concentration. A short review of its side effects, mechanisms of action and interactions with other medicines is provided. As resistance towards metronidazole occurred, these mechanisms are described as well. The data presented in the review were selected on the basis of relevancy, citation and age of the used references.

Effect of commercial or depurinized milk on rat liver growth-regulatory kinases, nuclear factor-kappa B, and endonuclease in experimental hyperuricemia: comparison with allopurinol therapy.

Hyperuricemia is a biochemical hallmark of gout, renal urate lithiasis, and inherited purine disorders, and may be a result of enormous ATP breakdown or purine release as a result of cardiovascular disease, hypertension, kidney disease, eclampsia, obesity, metabolic syndrome, psoriasis, tumor lysis syndrome, or intense physical training. The beneficial role of dairy products on hyperuricemia management and prevention is well documented in the literature. The primary aim of our experimental study was to examine the effect of milk dietary regimen (commercial 1.5% fat UHT milk or patented depurinized milk) compared with allopurinol therapy on experimental hyperuricemia induced by oxonic acid in rats. Principal component analysis was applied on a data set consisting of 11 variables for 8 different experimental groups. Among the 11 parameters measured (plasma uric acid and the liver parameters NFκB-p65, Akt kinase/phospho-Akt kinase, ERK kinase/phospho-ERK kinase, IRAK kinase/phospho IRAK kinase, p38/phospho-p38, and DNase), Akt/phospho Akt and ERK/phospho-ERK signaling were extracted as the most discriminating. We also compared the content of various potentially toxic compounds (sulfur compounds, ketones, aldehydes, alcohols, esters, carboxylic acids, and phthalates) in untreated commercial milk and depurinized milk. Of all the compounds investigated in this study that were observed in commercial milk (24 volatile organic compounds and 4 phthalates), 6 volatile organic compounds were not detected in depurinized milk. For almost all of the other compounds, significant decreases in concentration were observed in depurinized milk compared with commercial milk. In conclusion, a depurinized milk diet may be recommended in nutritional treatment of primary and secondary hyperuricemia to avoid uric acid and other volatile, potentially toxic compounds that may slow down liver regeneration and may induce chronic liver diseases.

Constructed wetlands as an alternative restoration measure for shallow lakes.

This paper deals with the consequences of cultural eutrophication and unconventional solutions for shallow lake restoration. Cultural eutrophication is the primary problem that affects especially shallow lakes, due to their physical characteristics (e.g. shallow depth, lack of stratification). Palic Lake, a very shallow Pannonian lake, received treated municipal wastewaters coming from the lagoons of a wastewater treatment plant. The sewage discharge mainly increased the nutrient load to the lake in the last decades. The lake sustainability is affected by inappropriate quality of water that flows into the lake, and abundance of deposited sediment. The technology that can provide both improvement of water quality and resolution of the sediment problem is a constructed wetland, which is designed to utilise the natural processes involving wetland vegetation, soil and their associated microbial assemblages to assist in additional water treatment. The technical solution is based on three key aspects: quality and quantity of deposited sediment, enriched by nutrients; effluent quality; desired lake water quality. A designed constructed wetland can accomplish the desired water quality and gradually remediate deposited sediment.

The effect of depurinized milk draught diet on rat serum uric acid, lipid status and haematological parameters.

Hyperuricaemia and gout are closely related, but hyperuricaemia is an independent risk factor for endothelial damage, autoinflammation and haemodynamic abnormalities. Milk, generally known as a 'purine-free diet', is an essential protein source for patients suffering from hyperuricaemia and gout. As milk still contains different purine ribonucleotides, the new product, depurinized milk, almost free of purine nucleotides and uric acid, was produced. The potential effect of depurinized milk diet on serum uric acid (SUA) level, lipid parameters and blood haematological parameters was explored in rats after 72 h and 15 days, in relation to standard laboratory chow or the untreated milk diet. The beneficial effect on SUA was achieved when depurinized milk draught was given instead of standard chow for 72 h [28.39 ± 4.76 µm; p < 0.001 vs. standard diet (STD) 47.6 ± 6.12, vs. untreated milk diet 31.55 ± 8.50; p < 0.05] or as a supplement for STD for 15 days experiment (35.38 ± 6.40 µm; p < 0.05 vs. STD only 48.05 ± 4.32; vs. untreated milk + STD 46.02 ± 9.48). Depurinized milk diet significantly decreased the low density lipoproteins/high density lipoproteins (LDL/HDL) ratio (p < 0.001), triglycerides (p < 0.05) and leucocyte count (p < 0.001), while both milk draughts enhanced haemoglobin concentration (p < 0.01). In conclusion, considering the detrimental effect of persisting hyperuricaemia, the depurinized milk draught may meet the demand of healthy dairy product for population under hyperuricaemic risk.

Circulating nucleic acids in type 1 diabetes may modulate the thymocyte turnover rate.

The autoimmunity of type 1 diabetes is associated with T-cell hyperactivity. Current study was designed to examine the effect of circulating ribonucleic acids (RNAs), isolated from type 1 diabetic patients on proliferative, apoptotic and inflammatory potential of rat thymocytes. Rat thymocytes were assayed for proliferating nuclear cell antigen (PCNA), Bcl-2, Bax and NF-κB level, using the flow cytometric and fluorometric assays. Cells were allocated into groups, treated with RNAs purified from plasma of juvenile diabetics, adult type 1 diabetic patients, control healthy children, healthy adult persons, nucleic acids and polynucleotide standards (RNA, polyC, PolyA, PolyIC, and CpG). The upregulation of PCNA and Bcl-2 protein and downregulation of Bax protein and NF-κB was shown when the thymocytes where incubated with RNA purified from plasma of juvenile type 1 diabetic patients. The dysregulation of inflammatory cascade and central tolerance may be a defect in autoimmune diseases related to innate immunity leading to corresponding alteration in adaptive immune response.

Hyperglycemia, oxidative and nitrosative stress affect antiviral, inflammatory and apoptotic signaling of cultured thymocytes.

A high prevalence of various infectious diseases is reported in diabetic patients, which may suggest impaired innate immunity against different pathogen-associated molecular patterns. This study investigated the effects of hyperglycemia, oxidative stress (H(2)O(2)), nitric oxide (NO) and peroxynitrite (ONOO(-)) on the modulation of antiviral (MDA-5, IRF-3 and phospho-IRF-3), inflammatory (NF-kappaB) and pro/anti-apoptotic molecules (Bax and Bcl-2) in BALB/c mice thymocytes. Each of the experimental conditions, except the weakest NO concentration, resulted in down-regulation of MDA-5, IRF-3 and phospho-IRF-3. In contrast, each of the experimental conditions elicited up-regulation of NF-kappaB, Bcl-2 and Bax. These results suggest that hyperglycemia, oxidative and nitrosative stress may contribute to the reduced immunity of the host by altering the MDA-5/IRF-3/phosphoIRF-3 axis, as well as contributing to the mechanisms of inflammatory reaction via increased NF-kappaB, and to augmented turnover rate of thymocyte cells via Bcl2/Bax up-regulation.

Characteristics of depression in obese people living in an insecure environment.

BACKGROUND: Obesity and depression are significant characteristics of people living in a state of chronic stress. PURPOSE: Our aim was to determine the characteristics of depression in obese people living in an insecure unstable environment. MATERIALS AND METHODS: The case-control study was organized in two rural environments in Kosovo and Metochia, Serbia. The main criterion for selection of participants was that respondents were more than 18 years old and had a body mass index of 25 kg/m 2 or more. Other anthropometric parameters determined were body weight, height, body fat mass, hip and waist circumference and the waist/hip ratio. The sex, demographic characteristics, profession, marital status, social status, existence of comorbidity, and cigarette smoking habits were recorded, and the arterial blood pressure measured for all participants. In the form of an interview, all respondents answered 17 questions, based on the Hamilton scale for depression. RESULTS: The group of depressed patients was dominated by women (P = 0.009). A significant difference (P = 0.007) was found in relation to profession. Depression was significantly more frequent in those without a regular income (P < 0.001). Depressed patients were significantly older (P = 0.017), more obese (P = 0.04), shorter (P = 0.0001), had a larger hip circumference (P = 0.039) and WHR index (P = 0.049) compared to patients in whom depression was not established. CONCLUSIONS: Depression is a significant characteristic in people living in an insecure environment, more common in women, without a permanent financial income.

Possible impact of impaired double-stranded RNA degradation and nitrosative stress on immuno-inflammatory cascade in type 2 diabetes.

The immune response can be triggered by molecules derived from microorganisms (PAMP) or from molecules derived from damaged or dead host cells, known as the damage-associated molecular-pattern molecules (DAMP). Their immune effects are accompanied by altered redox environment. The level of stable end products of nitric oxide (NO)- plasma nitrate and nitrite (NOx), carbonyl groups (PCO) and nitrotyrosine (NTY), in relation to the metabolism of dsRNAs (poly I:C and poly A:U) and xanthine oxidase (XO activity), in plasma of type2 diabetic patients was determined. Thirty-six patients with type 2 diabetes (age group 34-66 years, 19 male and 17 female) were allocated to the study. Diabetic patients had a significantly higher level of plasma NOx products, NTY and PCO, fructosamine (FA) and XO activity indicating about altered redox environment. The concentration of circulating ribonucleic acids (CNAs) was significantly higher in type 2 diabetic patients, which was accompanied by a significantly decreased activity of RNase against double stranded RNA forms (poly I:C and poly A:U), compared to control samples. To determine whether CNAs, as possible DAMP molecules, are capable of exerting effect on inflammatory and host antiviral response, the effect of isolated CNAs on NF-kappaB, Bcl-2, Bax, MDA-5 and IRF-3 regulation was evaluated in culture of fresh isolated thymocytes. Circulating nucleic acids isolated from type 2 diabetic patients were able to upregulate NF-kappaB more than control RNA samples. In the same experimental conditions the mild Bcl-2 upregulation, followed by the marked Bax upregulation, was demonstrated. Since the Bcl-2/Bax ratio was lower in type 2 diabetic samples, obtained results may implicate that CNAs may exert proapoptotic response in type 2 diabetes. The CNAs isolated from diabetic patients were able to downregulate MDA-5 and IRF-3, very important subjects of the surveillance and cellular anti-viral response. The major findings of the present study are that impaired dsRNA metabolism may lead to increased level of different sized RNAs in type 2 diabetic patients. Acting as possible DAMP molecules, they may contribute to higher susceptibility of immune cells to inflammatory cascade via NF-kappaB activation, and possible MDA-5/IRF-3 axis downregulation, what may have an influence on further ineffective response against different pathogens.

Gastrojejunocolic fistula as a complication of Billroth II gastrectomy: a case report.

Gastrojejunocolic fistula is a late, severe complication of a stomal ulcer, which develops as a result of inadequate resection of the stomach or incomplete vagotomy. It is uncommon and in our century is reported only sporadically in medical literature The authors report a case of benign gastrojejunocolic fistula, diagnosed by barium based contrast radiography, which demonstrated reflux of contrast from the transverse colon to the stomach and jejunum via a fistulous tract. Therapy of the gastrojejunal fistula is always radical and comprises en bloc resection of the fistula and revision of gastrectomy, partial resection of the jejunum and the colon, which is involved in the fistula, and restoration of continuity of the digestive tract by gastrojejunostomy, jejunojejunostomy and colocolostomy. If trunkal vagotomy has not previously been completed, it is advisable to perform it nonetheless.

Altered degradation of circulating nucleic acids and oligonucleotides in diabetic patients.

Foreign, infection-associated or endogenously generated circulating nucleotide motifs may represent the critical determinants for the activation of the Toll-like receptors (TLRs), leading to immune stimulation and cytokine secretion. The importance of circulating nucleases is to destroy nucleic acids and oligonucleotides in the blood stream and during cell entry. Patients with juvenile insulin-dependent diabetes, adult patients with insulin-dependent diabetes and adult patients with type 2 diabetes were allocated to the study, together with the age-matched control subjects. Plasma RNase and nuclease activity were examined, in relation to different substrates-TLRs response modifiers, and circulating RNA and oligonucleotides were isolated. The fall in enzyme activity in plasma was obtained for rRNA, poly(C), poly(U), poly(I:C), poly(A:U) and CpG, especially in juvenile diabetics. In order to test the non-enzymatic glycation, commercial RNase (E.C.3.1.27.5) and control plasma samples were incubated with increasing glucose concentrations (5, 10, 20 and 50 mmol/l). The fall of enzyme activity was expressed more significantly in control plasma samples than for the commercial enzyme. Total amount of purified plasma RNA and oligonucleotides was significantly higher in diabetic patients, especially in juvenile diabetics. The increase in the concentration of nucleotides corresponded to the peak absorbance at 270 nm, similar to polyC. The electrophoretic bands shared similar characteristics between controls and each type of diabetic patients, except that the bands were more expressed in diabetic patients. Decreased RNase activity and related increase of circulating oligonucleotides may favor the increase of nucleic acid "danger motifs", leading to TLRs activation.

[Postoperative rehabilitation in patients with peripheral nerve lesions]. / Postoperativna rehabilitacija bolesnika sa lezijom perifernih nerava.

UNLABELLED: Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. MATERIAL AND METHODS: Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3-6 months after injury. In early postoperative Postoperative rehabilitation in patients with peripherial treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual psychiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and psychiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.

Synthesis of some new antianemics I. Iron pullulan complexes of pharmaceutical interest.

First experiments were performed in order to obtain a polynuclear iron(III) complex with pullulan, which could be applied in therapy of sideropenic anemia. Complete synthesis of the complex can be realized with oligomers of depolymerized pullulan at an average molar mass 8000-10,000 g.mol-1. Maximum iron contents of 51.4 mg.cm-3 is effected by pullulan depolymerizates (Mw approximately 9000 g.mol-1, [eta] = 0.085 dl.g-1) at 130 degrees C for 240 min, at pH = 10.5 and at an initial mass ratio Fe/ligand of 1:3. The effected concentrations and complex stability respond to requirements of pharmacological application of parenteral antianemic preparations.