Does the BMI of Expectant Mothers Influence the Concentration of C-Reactive Protein in Newborns in the Early Neonatal Period?

Aim: The aim of the study is to determine the effect of body mass index in pregnancy on the CRP concentration in pregnant women and their newborn. The results of the study will serve as a guide for a more valid assessment of slightly elevated concentrations of CRP and a potential new guide for the treatment of newborns with antibiotics. Method: The research is a cohort prospective study of 2 groups of pregnant women and their newborn with respect to the body mass index of the pregnant women prior to delivery. The study included 128 pregnant women and their newborn whose serum was analysed to ascertain CRP concentration. Results: The CRP concentration in pregnant women with an elevated BMI was higher than in the pregnant women with normal BMI during pregnancy. The difference is statistically significant (p<0.001). The CRP concentration taken from the umbilical cord and during the second day of life of the newborn of the pregnant women with an elevated BMI was statistically significantly higher than in the newborn of the pregnant women with normal BMI during pregnancy (p<0.001). A repeated blood test conducted between the third and fifth day of life showed that the concentration of CRP in the newborn of both study groups was within referential values. Conclusion: The study indicates a significant correlation between BMI in pregnancy and CRP concentration in pregnant women and their newborn. The results of this study are a potential milepost in addressing the dilemma of whether to administer antibiotics to newborns with elevated CRP values (<20 mg/L) without aggravating their clinical condition. It may be necessary to simply repeat the laboratory tests of CRP in the blood of the newborn in the first days of life and thus follow its dynamics.

Decreased expression of MMP-9 in CD8+ cells in placenta with severe preeclampsia.

We compared the number of CD4-positive (CD4+) and CD8-positive (CD8+) cells in severe and non-severe preeclampsia (PE), and in normal pregnancy. We also evaluated the expression of matrix metalloproteinase 9 (MMP-9) in CD4+ and CD8+ cells. Immunohistochemistry for CD4+ and CD8+ was performed on the decidua basalis of 15 severe and 13 non-severe PE women and compared to decidual tissue of 19 normal pregnancies (control group). Co-expression of MMP-9 with CD8+ and CD4+ cells was determined by double immunofluorescence staining. The median number of CD8+ cells/mm2 was significantly lower for the severe PE group than for the normal pregnancy group, as was the number of CD4+ cells and MMP-9+CD8+ cells. No statistical difference was found between the non-severe PE group and the normal pregnancy group. The significant decrease of CD4+, CD8+ and MMP-9+CD8+ cells at the fetal-maternal interface only in the severe PE group suggests that immunological disorders play a role in the pathophysiology of severe PE.

Transcriptomic and proteomic patterns of systemic inflammation in on-pump and off-pump coronary artery bypass grafting.

BACKGROUND: Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) provides controlled operative conditions but induces a whole-body inflammatory response capable of initiating devastating morbidity and mortality. Although technically more demanding, deliberate avoidance of CPB in off-pump surgery attenuates the physiological insult associated with CABG. METHODS AND RESULTS: To systematically assess the molecular mechanisms underlying the better-preserved remote organ function, we studied gene expression patterns in leukocytes and plasma proteomic response to on-pump and off-pump CABG. Proteomic analysis confirmed (tumor necrosis factor-alpha, interleukin [IL]-6, IL-10) and expanded (eg, interferon [IFN]-gamma, granulocyte colony-stimulating factor [G-CSF], monocyte chemotactic protein-1, macrophage inflammatory protein-1beta) the mediators released on CPB, whereas blood leukocyte transcriptomics suggested that circulating leukocytes are not primarily responsible for this response. Interestingly, release of some cytokines (eg, IL-6, IFN-gamma, G-CSF) was observed on off-pump surgery to a similar extent but with delayed kinetics. A total of 45 of 4868 transcripts were identified to be significantly altered as a result of initiation of CPB. Systematic analysis of transcriptional activation by CPB revealed primarily genes involved in inflammation-related cell-cell communication (such as L-selectin or intercellular adhesion molecule-2) and signaling (such as IL-1, IL-8, or IL-18 receptors and toll-like receptors 4, 5, and 6), thus confirming a "primed" phenotype of circulating peripheral blood mononuclear cells. CONCLUSIONS: Gene array and multiplex protein analysis, only in concert, can illuminate the molecular mechanisms responsible for systemic sequelae of CPB and indicate that circulating leukocytes overexpress adhesion and signaling factors after contact with CPB, which potentially facilitates their trapping, eg, in the lungs and may promote a subsequent tissue-associated inflammatory response.

Morphological characteristics of the gyrus dentatus in some animal species and in man.

Comparative anatomical investigations have been carried out on the gyrus dentatus of rat, fox, cattle, domestic pig, monkey (Cercopithecus sabeus) and man. After removal of the brain stem and scaling off the brain substance from the medial aspect towards the lateral aspect, the gyrus dentatus was preserved and its relation with regard to the hippocampus, the fimbria hippocampi and the gyrus parahippocampalis was studied. A rat's gyrus dentatus occupies a rather wide zone on the medial aspect of the brain. Its surface is almost flat with very poor denticulations, and below the splenium corporis callosi it forms the tuberculum gyri dentati which is wider than the splenium. In the cat somewhat better pronounced denticulations were observed, and the gyrus dentatus was directed from the rostral aspect towards the dorsal and the lateral, and before reaching the splenium corporis callosi it changed its course towards the medial aspect and passed into the tuberculum gyri dentati. The cattle's gyrus dentatus is rather wide and macroscopically without a sharp definition from the hippocampus. Domestic pig's denticulations are better pronounced particularly towards the gyrus parahippocampalis. The gyrus dentatus of the monkey is well retracted into the fissura hippocampi and below the splenium corporis callosi the tuberculum gyri dentati is barely visible. The authors found the most developed gyrus dentatus in man, but here, the tuberculum gyri dentati was missing.

[The beginnings of otorhinolaryngology in Bosnia and Herzegovina and its development in Sarajevo]. / Zaceci otorinolaringologije u Bosni i Hercegovini i njen razvoj u Sarajevu.

The first ENT Department in Bosnia and Herzegovina was established in Sarajevo by Dr. Zarko Prastalo in 1923, as a part of the Surgery Clinic, with 10 beds. The next year (1924) ENT got its own operation theatre, 30 beds more and a new localization. In that period there was only one ENT specialist, Dr. Zarko Prastalo. Three years after some new doctors started the specialization in ENT. By the year 1946 the ENT Department became a University clinic with 7 doctors on duty, the Clinic became an educational centre. To the year 1992, 112 ENT specialists were educated in the ENT Clinic in Sarajevo. Later in time, after Dr. Zarko Prastalo, Dr. Ivo Herlinger, Dr. Josip Gerc and Dr. Emilija Bac became known ENT specialists. The new scientific and operation techniques came to the ENT Clinic, the first chelognapalato schisis was in 1936, done by Dr. Josip Gerc. The first ear operation using operation microscope and microinstruments was performed in 1962, while the first laryngo-micro-operation in 1971. Since 1965 th worked with the Maxilofacial Surgery, together, but in 1972 they moved to the stomatologic Clinic, With the development of the clinic, 10 our patient departments (ambulances) were established in Sarajevo. As for now, during the war, there are 101 beds, 13 ENT specialists. Dr. Sejo Sebic was killed in 1992 by the aggressor.

[Epithelial cells in bronchial asthma]. / Epitelne celije u bronhijalnoj astimi.

The paper deals with the current data on the morphologic and functional damages to the epithelium in asthma. Structure of the normal airway epithelium is briefly described. Damage to the epithelium disrupts the barrier to the external environment, and may result in changes in mucous secretion, and mucociliary clearance; induce bronchoconstriction; promote chemotaxis of inflammatory cells. Epithelial cells can present antigens to T-lymphocytes. Epithelium is both target and effector in asthma. Hypothesis that eosinophils contribute to the damage of the epithelium gained increasing recognition.

Anaerobes isolated from clinical material over three years.

Data on anaerobic bacteria isolated from clinical specimens at the bacteriology department within the 3-year period (1992-1994) were analysed. Anaerobic cultivation was carried out in all aspirates and swabs were transferred in transport media in syringes or blood cultures. Established growth occurred in all samples cultivated in thioglycollate broth after 4 days of incubation. Cultivation methods included enrichment media, GasPak jar, and API (BioMerieux) for final identification. A sulfite-reduction test using the Wilson-Blair medium and the Ellner-Smith sporulation medium was also used for the isolation of Clostridium perfringens. Anaerobes were diagnosed in 899 samples. Wound swabs (266 samples) and aspirates (106 samples) were the most common clinical material used. In total, 964 anaerobes were isolated: Peptostreptococcus species (299 strains), Eubacterium species (188 strains), Propionibacterium species (153 strains), Bacteroides fragilis(149 strains), Bacteroides species (95 strains) and Clostridium perfringens(80 strains).

[Injuries of the thigh bone with a destruction of the neuro-vascular bundle]. / Povrede butne kosti pracene razaranjem zilno-nervnog snopa

From 1969 to 1971 the authors treated 1360 injured patients, eight of which suffered serious injuries of the thigh; fractured femur complicated by a severed Femoral Popliteal Artery, and lesions of the Sciatic Nerve. Six patients were injured at work, one in an automobile accident, and one was a gunshot victim. In approximately 1000 fractures one is complicated by an injured neurovascular bundle. The clinical picture of such a case is characteristic. The arteriograph is used only to locate the lesion. Reconstruction of the artery must be accomplished some eight to twelve hours following the injury. In all of the authors' cases, this was done one to eight hours following the trauma. After twelve hours, ischemic necrosis of the soft tissue (musculature) sets in requiring amputation. The remaining segment of the damaged artery is usually resected. In one case, a segment 8 cm. long was removed. Following the termino-terminal anastomosis, the injured extremity was placed in a flexed position whlich alleviated the tension on the sutures. The result of vein autographs are worse than those of the termino-terminal anastomoses. Thrombosis later begins to restrict blood flow through the reconstructed artery, but by this time, adequate collateral circulation has been established. The limb has thus been saved. Heparin is administrated immediately before and during the operation in a dosage of 5000 units per 500 ml. of physiological solution. Postoperatively, it is not used as it acts on the fibrin thrombi, and not on the thrombocyte thrombi which are formed postoperatively in the areas where the tunica intima has been damaged. Heparin is indicated in the prophylaxis of venous thrombosis. In these cases in which the femur was fractured, the question asked is whether to perform the osteosynthesis and anastomosis simultaneously, or to perform the former at a later time. The authors chose both methods for various reasons. Only a few cases permitted the authors to decide which approach would be better. Usually they performed a temporary fixation of the bone with Rusch's Pin, and sutured the artery. Four months later, a compressive osteosynthesis using an L-plate, was performed. In four cases, the Sciatic Nerve was injured, which, according to the circumstances was sutured either immediately, or 3 to 4 weeks later. In 3 patients, good functional results were obtained. Three cases resulted in a contracture of the knee, two of which also had residual Sciatic Paresis. One case resulted in permanent venous stasis (edema of the legs, and two cases results in amputation.

[Plasmapheresis in clinical practice]. / Plazmafereza u klinickoj praksi.

Plasmapheresis is an immunomodulatory procedure with immunosuppressive effect. Plasmapheresis involves taking blood, separating off the plasma and returning the red cell-enriched fraction to the patient. In plasmapheresis improvement is due to the removal of mediators of tissue damage. Therapeutic plasmapheresis has been used in many diseases in which immunological mechanisms are proved. It has been noted that there may be a "rebound" in the level of antibodies and immune complexes after plasmapheresis, perhaps due to elimination of feedback suppressor mechanisms. For that reason, plasmapheresis is only effective when used as part of an immunosuppressive regimen which also includes steroids and/or cytotoxic agents.