Pregnancy associated plasma protein A: An indicator of adverse obstetric outcomes in a South India population.

OBJECTIVE: First trimester aneuploidy screening (FTAS) has become an integral part of antenatal care in most of centers in India. The serum markers used for FTAS are pregnancy-associated plasma protein A (PAPP-A) and beta human chorionic gonadotropin. In the present study, we aimed to assess the role of PAPP-A in specific adverse fetal maternal events. To analyze pregnancy outcomes with low maternal PAPP-A (≤5th percentile) at the FTAS screening test in southern India, and them compared with a control group of >5th percentile value. MATERIALS AND METHODS: A total of 1800 consecutive pregnancies in the first trimester were followed up with PAPP-A levels. The study group consisted 108 subjects, which was compared with a matched control group of 288 subjects. The outcomes considered were spontaneous abortions, fetal anomalies, preterm delivery (PTD), hypertension in pregnancy, intrauterine growth restriction, gestational diabetes, mode of delivery, and birthweight. RESULTS: For our grouped data, the 5th percentile value for PAPP-A was 0.49 multiple of medians, (incidence-6%). The incidence of fetal major anomalies was higher in the study group [odds ratio (OR): 1.87]. The incidence of minor anomalies, gestational diabetes, and hypertensive disorders was higher in the study group but not statistically significant. The total rate of PTDs (OR:2.1), small-for-gestation-age fetuses (OR:2.3), and low birthweight babies (OR- 2.12) was significantly higher in the study group. We found positive likelihood ratio of 1.4 for PTD, 2 for <5th percentile birthweight, and 1.7 for <10th centile birthweight. CONCLUSION: Low PAPP-A pregnancies are at risk of various obstetric complications. Hence, such a pregnancy should have closer surveillance. Further research work on intervention strategy is needed.

Juvenile idiopathic arthritis.

Juvenile Idiopathic Arthritis (JIA) is the most chronic musculoskeletal disease of pediatric population. The chronic course of disease has a great impact on oral health. Temporomandibular joint is involved in JIA causing limited mouth opening with progressive open bite, retrognathia, microgenia and bird like appearance. Joints of upper and lower extremities are also involved. Effect on upper limb function leads to difficulty with fine motor movements required for brushing and flossing. This increases incidence of caries and periodontal disease in children. The cause of JIA is still poorly understood and none of the available drugs for JIA can cure the disease. However, prognosis has improved as a result of progress in disease classification and management. The dental practitioner should be familiar with the symptoms and oral manifestations of JIA to help manage as multidisciplinary management is essential.

A novel mutation (g.106737G>T) in zone of polarizing activity regulatory sequence (ZRS) causes variable limb phenotypes in Werner mesomelia.

Werner mesomelia is characterized by a sequence variation in the specific region (position 404) of the enhancer ZRS of SHH. The phenotype comprises variable mesomelia, abnormalities of the thumb and great toe and supernumerary digits. We describe extensive variation in limb phenotype in a large family and report on a novel sequence variation NG_009240.1: g.106737G>T (traditional nomenclature: ZRS404G>T) in the ZRS within the LMBR1 gene. The newly recognized clinical features in this family include small thenar eminence, sandal gap, broad first metatarsals, mesoaxial polydactyly, and postaxial polydactyly. We provide information on 12 affected family members. We review the literature on how a sequence variation in ZRS may cause such diverse phenotypes.

Development of modified release gliclazide biological macromolecules using natural biodegradable polymers.

Modified release biological macromolecules (beads) of gliclazide using sodium alginate combined with either gellan gum or pectin in different ratios were prepared by Ionotropic gelation method. Biological macromolecules were evaluated for different physico-chemical parameters. Increase in polymers proportion showed difficulty in production of biological macromolecules due to high viscosity of dispersion. As the polymer concentration increases, the swelling and entrapment efficiency of drug increased. Compared to all other batches and commercial modified release gliclazide tablet, formulated biological macromolecules of sodium alginate with pectin (2:1 ratio) and with gellan gum (6:0.75 ratio) exhibited spherical shape, biphasic in vitro release profile and initial high drug release followed by moderate release up to 12 h as matrix diffusion kinetics and Higuchi model as well as Korsmeyer model.

Studies on the mechanism of allylic coupling reactions: a hammett analysis of the coupling of aryl silicate derivatives.

Hammett analysis of the palladium-catalyzed allyl-aryl coupling reaction has demonstrated that the rate of the coupling reaction is enhanced by electron-withdrawing groups on the aryl siloxane. The positive slope of the Hammett plot indicated involvement of a charged transition state in which negative charge on the aryl ring is stabilized inductively. This result is consistent with either transmetalation or reductive elimination being the rate-determining step in the coupling process. Furthermore, the influence of ligand on the metal site has been assessed from competition studies as a function of ligand type, cone angle, and electronic effects. From the relative ratios of coupling products produced in the Hammett study, it is possible to gather insight into the role of the electronic as well as the steric effects of ligands on the mechanism of the coupling reaction.

Application of palladium-catalyzed allylic arylation to the synthesis of a (+/-)-7-deoxypancratistatin analogue.

Palladium-catalyzed coupling of an aryl siloxane and an allylic carbonate proceeded in good yield to give an adduct that was converted to an analogue of (+/-)-7-deoxypancratistatin.

[Tachycardia-induced cardiomyopathy]. / Arytmogenna kardiomiopatia rozstrzeniowa.

Dilated cardiomyopathy induces circulatory insufficiency with poor prognosis. Persistent tachyarrhythmias may be the cause of this disease. At particular high risk for heart damage and insufficiency are young people and children. The group of most dangerous arrhythmias consist of: incessant tachycardia in patients with preexcitation syndrome and supraventricular tachyarrhythmias (atrial flutter and fibrillation, ectopic atrial tachycardia) with high rate of ventricles. The result of arrhythmias is dilatation of the heart and thinness of ventricular walls with hemodynamic disorders. The effective therapy of arrhythmias--ablation of the accessory pathway in patients with pre-excitation syndrome or reversion to sinus rhythm (pharmacological or electric cardioversion) in patients with atrial fibrillation and flutter, often leads to normalisation of heart ejection function and diameter. Therefore it exist important question: is dilated cardiomyopathy the cause or consequence of tachyarrhythmias? Causative antiarrhythmic therapy in these second cases gives a possibility to improve the prognosis in patients with such a disease.

[Use of intravascular ultrasonography (IVUS) for diagnosis and treatment of coronary artery disease--case report]. / Zastosowanie ultrasonografii wewnatrznaczyniowej (IVUS) w diagnostyce i leczeniu choroby niedokrwiennej serca--opis przypadku.

One of the additional methods of coronary artery assessment is intravascular ultrasound (IVUS). Contrary to coronary angiography this relatively new technic provides new information including precise calculations of stenosis degree, morphology of atheromatous plaque and differentiation of its structure. Coronary angiography was performed in 54 years old male patient with unstable angina, revealing 99% stenosis in distal RCA. Discrepancy between clinical presentation and angiographic findings and exercise test resulted in performing IVUS of LAD. Angiographically clear LM and LAD were found to be narrowed 52% and 58% on IVUS. Subsequent CABG resulted in symptoms withdrawal and increase of physical tolerance. Exercise test after CABG did not reveal ischaemia in area of LCA at 10 METs. IVUS is found to be an important technic in assessment of silent or ambiguous lesions and in many cases allows to choose the optimal method of treatment of coronary artery disease.

[Arrhythmogenic dysplasia of the right heart ventricle]. / Arytmogenna dysplazja prawej komory serca.

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disease in which muscle tissue has been partially replaced by adipose or fibro-adipose tissue. Morphologic changes in the right ventricle and ventricular arrhythmias are characteristic. Pathomorphological changes should be confirmed by NMR or endomyocardial biopsy. Morphological changes ought to be found by ultrasound methods or angiographic examination. ECG exercise test, Holter monitoring, late potentials, total ventricular activation time and programmed stimulation of right ventricle are used to evaluate the risk of sudden death due to ventricular arrhythmias which is the most important problem. Those methods indicate pharmacologic or invasive therapy (RF ablation, implanted cardioverter-defibrillators), and are used to establish the effectiveness of treatment.

[Cardiomyopathy in diabetes. Ultrastructural examinations]. / Uszkodzenie serca w cukrzycy. Badania ultrastrukturalne.

The functional and morphological changes in myocardium of diabetic patients is caused by diabetic macroangiopathy, diabetic microangiopathy, autonomic neuropathy and metabolic disorders. Mechanism of these changes in the course of diabetes is not fully known. To determine whether there are myocardial ultrastructure differences between patients with diabetic cardiomyopathy (normal coronary angiograms) and diabetic patients with coronary artery disease, electron microscopy examination were performed of 70 sections received from seven biopsied patients (1F, 6M), average age 53 years (range: 42-60) with diabetes type II WHO (group A) without clinical evidence of prior coronary artery disease and hypertension, and 100 sections from 10 patients (2F, 8M), average age 54 years (range: 42-65) with diabetes and coronary atherosclerosis. These patients had clinical evidence of heart failure and were submitted to bypass-graft operations (group B). Endomyocardial biopsy tissues were obtained from the right ventricle without complications either during or after the procedure. Obtained biopsy specimens were fixed in 3% glutaraldehyde stabilized with 1M cacodylate buffer at pH 7.4, postfixed in 1% OsO4 on cacodylate buffer. The materials were then dehydrated and embedded in epon. The Irvin-Fischer test for statistical analysis was used. A p value < 0.05 was considered significant. The presence of focal mild loss of myofibrils (+) was statistically more frequent in the patients in A group (p < 0.05). It was found in 86% (6/7) of cases in A group, while in the B group was observed in 20% of (2/10) cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiogenic shock. Coronary angioplasty after failed intravenous thrombolysis]. / Wstrzas kardiogenny. Koronaroplastyka przy niepowodzeniu trombolizy dowiencowej.

Rescue coronary angioplasty (PTCA) was employed as reperfusion strategy after unsuccessful intracoronary infusion of streptokinase in 13 patients with AMI complicated by cardiogenic shock (CS). Reperfusion defined as reestablishment of TIMI 3 degree flow in the infarct related artery and reduction in luminal narrowing to less than 50% was achieved in 8 patients (61.5%). The failure of PTCA was caused by: inability to cross occlusion in 2 patients and recurrent thrombosis despite repeated dilatations resulting in hemodynamic instability requiring cardiopulmonary resuscitations during the procedure in 3 patients. There was no significant differences in mean age, sex, time from onset of symptoms, LVEF, artery involved, extent of coronary disease and incidence of cardiopulmonary resuscitations during the procedures. There where 4 in-hospital deaths among patients with failed PTCA (80%) compared to 25% mortality in reperfused group. We conclude that PTCA is an effective method of achieving reperfusion in patients with CS complicating AMI after failed thrombolysis with intracoronary streptokinase and that it improves in-hospital survival.

[Acute myocardial infarction with shock. Intracoronary thrombolysis]. / Ostry zawal serca ze wstrzasem. Tromboliza dowiencowa.

UNLABELLED: Of 932 pts with acute myocardial infarction (AMI) who underwent reperfusion therapy (RT) by intracoronary streptokinase (IC.STK), 32 pts had cardiogenic shock (CS). Shock was defined as systolic blood pressure (BP) < or = 80 mmHg without inotropic support or BP < or = 90 mmHg with inotropic or balloon counterpulsation support and left ventricular end diastolic pressure < 18 mmHg and clinical symptoms of hypoperfusion. Time from onset of symptoms to initiation of therapy was less than 6 hours. Reperfusion was defined as reestablishment of antegrade TIMI-2 or 3 flow in occluded artery. Comparison revealed no significant differences in sex, age, time after onset of symptoms, artery involved, history of previous AMI, left ventricular ejection fraction and in extent of coronary disease between pts with successful and failed thrombolysis. IC.STK was successful in 12 pts with CS (37.5%) and in 67.2% of pts without CS (p < or = 0.001). Mortality rate in pts with CS was 25% in reperfused and 81.8% among nonreperfused (p = 0.0095). CONCLUSIONS: 1. IC.STK gives a considerably lower rate of reperfusion in pts with AMI complicated by CS. 2. No influence on the frequency of effective reperfusion with respect to the analyzed clinical and angiographical data was found. 3. The high mortality in the group with unsuccessful reperfusion as well as the low effectiveness of the IC STK indicates the necessity to apply more effective methods of reperfusion in pts with AMI complicated by CS.

In vitro synthesis of dopamine and noradrenaline in the isolated rat pineal gland: day-night variations and effects of electrical stimulation.

Isolated rat pineal glands were incubated in vitro in a medium containing [14C]dopamine or [14C]tyrosine, and the tissue contents of 14C-labelled and total dopamine and noradrenaline were determined by HPLC followed by electrochemical detection and scintillation spectrometry. During incubation with [14C]dopamine, the labelled amine accumulated in pineal glands and was partially converted into [14C]noradrenaline. Nomifensine, a neuronal amine uptake blocker, largely inhibited the accumulation of [14C]dopamine and the formation of [14C]noradrenaline. These experiments demonstrated dopamine beta-hydroxylase activity in the sympathetic nerves of the pineal gland. During incubation with [14C]tyrosine, formation of [14C]dopamine and [14C]noradrenaline was observed in the pineal tissue, indicating that noradrenaline can also be synthesized from dopamine, endogenously formed in the gland. Electrical stimulation of the stalk region of the pineal gland during incubation with [14C]dopamine enhanced the accumulation of [14C]dopamine and synthesis of [14C]noradrenaline. Electrical stimulation also enhanced the formation of [14C]dopamine during incubation with [14C]tyrosine. Compared to that at midday, the tissue content of endogenous noradrenaline at midnight was enhanced by 50% and that of dopamine by 450%. The in vitro accumulation of [14C]dopamine, as well as the synthesis of [14C]dopamine and [14C]noradrenaline, was also increased at midnight. In conclusion, sympathetic nerves in the rat pineal gland contain tyrosine hydroxylase and dopamine beta-hydroxylase, the two enzymes required for the synthesis of noradrenaline.(ABSTRACT TRUNCATED AT 250 WORDS)