Antenatal screening for pre-eclampsia: evaluation of the NICE and pre-eclampsia community guidelines.

The NICE and PRECOG guidelines are based on systematic reviews of risk factors for pre-eclampsia to identify mothers at risk before 20 weeks' gestation. Cases (64) and controls (112) were classified retrospectively as screen positive or negative as recommended by the two guidelines The NICE guideline had a higher sensitivity rate of 77% (95% CI 65-87%) vs 59% (95% CI 46-71%) but a lower specificity of 54% (95% CI 44-64%) vs 81% (95% CI 73-88%) with the PRECOG guideline. Based on an incidence of pre-eclampsia of 4% the positive predictive values of PRECOG and NICE guidelines were estimated at only 11% and 7%, respectively. The most discriminatory risk factor was history of pre-eclampsia in a previous pregnancy. Neither guideline has a reasonable performance and cannot be recommended for use in clinical practice. Resources should rather be focussed on development of new strategies to identify women at risk of pre-eclampsia.

Platelet activation and endogenous thrombin potential in pre-eclampsia.

INTRODUCTION: Platelets and the coagulation system may be involved in the pathogenesis of pre-eclampsia. We investigated whether platelet and coagulation activation markers, are elevated in pre-eclampsia. MATERIALS/METHODS: Case-control study in which activated platelets, platelet-monocyte/ neutrophil aggregates, platelet microparticles (measured by flow cytometry) and four markers of thrombin generation capacity (endogenous thrombin potential (ETP), peak height, lag time and time to peak) using the Calibrated Automated Thrombogram system were assessed in pregnant women of similar gestational age with (n=46) and without (n=46) pre-eclampsia, and in healthy non-pregnant women (n=42). RESULTS: The percentage of, CD62P+ platelets (p=0.013), CD62P+ platelet microparticles (p=0.029) and platelet-monocyte aggregates (p=0.019) were significantly higher in women with pre-eclampsia than the pregnant controls. Both groups of pregnant women had significantly higher ETP and peak height (p <0.001) than the healthy non pregnant group and the women with pre-eclampsia had significantly higher ETP and peak height (p<0.001) than the normotensive pregnant controls. CONCLUSION: In the most comprehensive laboratory analysis to date, we found evidence of both platelet and coagulation activation in women with pre-eclampsia.

Case reports: scrub typhus during pregnancy in India.

Scrub typhus, caused by Orientia tsutsugamushi, is a rural zoonosis endemic in the Asian Pacific region. Doxycycline and chloramphenicol, the recommended drugs for treating this infection, may not be safe during pregnancy. We report on 5 patients with scrub typhus during pregnancy who were seen in India between October 2001 and February 2002. Four of the 5 women were treated initially with ciprofloxacin. Three women had stillbirths, 1 an abortion and 1 a low birthweight baby, which suggests that ciprofloxacin should not be used for treating pregnant women and that scrub typhus leads to severe adverse effects during pregnancy. Randomized controlled trials are urgently needed to ascertain the optimal drug choice, given that currently recommended drugs are contraindicated in pregnant women.

Sporadic occurrence of nondeletion Prader-Willi syndrome in two cases: a female with maternal uniparental disomy and a male with complex chromosomal rearrangement.

We report here two cases of nondeletion Prader-Willi syndrome (PWS). Case 1 is a 9-yr-old female patient with classical features of the syndrome and cytogenetically normal chromosome 15. DNA analysis using polymorphic probes for Prader-Willi Critical Region (PWCR) showed absence of paternal alleles while maternal uniparental isodisomy (UPisoD) was confirmed. This is the first report of nondeletion PWS with uniparental disomy (UPD) in the population of Kuwait. The second case with Prader-Willi syndrome-like features had normal chromosome 15 but showed familial complex chromosomal rearrangement (CCR) involving chromosomes 13, 19, and 20 inherited from his mother. No paternal deletion or UPD disomy was observed after DNA molecular analysis. This is a case of "atypical" PWS with no cytogenetic or molecular abnormality for PWCR. The two cases represent two different mechanisms associated with nondeletion PWS.

Effect of negative ion atmospheric loading on cognitive performance in human volunteers.

Negative ion atmospheric loading has been reported to affect a range of psychological functions, from alertness to circadian rhythms, and has been suggested to benefit a variety of medical conditions, from allergies to migraine. In a double-blind study planned to assess the effect of negative ions on cognitive performance in human volunteers, 65 female graduate course students were randomized into ionized atmosphere (n = 34) and control (n = 31) groups. The following cognitive tasks were administered: Digit Symbol Substitution Test, Addition Test, Visual Memory (Complex Figure) Test, Verbal Memeory (Complex Passage) Test, Ideational Fluency Test and Clerical Speed and Accuracy test. On all but the last two tests, the negative ion groupperfonned significantly better (to a 15-40% extent) than controls. It is concluded that negative ionization of the atmosphere by artificial means may be of benefit in certain common, practical situation in which depletion of these ions occurs.