Maternal alpha-1-antitrypsin as a noval marker for growth restriction in pre-eclampsia.

AIM: To verify the role of maternal serum levels of alpha-1-antitrypsin (AAT), an acute-phase inflammatory protein, as a marker for distinguishing between fetal growth restriction (FGR) and normal birth weight in pre-eclamptic women. We correlate serum AAT levels to the essential feto-maternal parameters for an earlier and cost-benefit diagnostic method, thus distinguishing between FGR and normal birth weight in pre-eclamptic women. METHODS: An observational study conducted at the University hospital recruited 100 pregnant women in 32/34 weeks of a singleton single tone pregnancy; all were pre-eclampsia cases. All were tested by laboratory and ultrasound examination. Two sets of data were collected; one is maternal parameters such as blood pressure (BP), maternal serum AAT mean platelet volume (MPV), platelet distribution width (PDW), and serum uric acid levels, and the other is fetal parameters such as amniotic fluid index (AFI), fetal weight centile and estimated fetal weight. RESULTS: A strong negative correlation proved between serum levels of AAT and all study variables except fetal weight (systolic BP, diastolic BP, MPV, PDW, serum uric acid, fetal weight percentile, and AFI) with a correlation coefficient of; -0.95, -0.95, -0.85, -0.93, -0.91, -0.94, and -0.93 respectively. The cut-off value for AAT 0.013 mg/ml showed the highest sensitivity and specificity as a diagnostic marker for FGR. Area under the curve was 0.99. CONCLUSIONS: Negative correlations between maternal serum AAT and fetal parameters used to assess FGR were confirmed, suggesting that AAT is closely related to the pathophysiology of FGR among pre-eclamptic patients and may serve as a helpful tool in distinguishing between FGR and normal birth weight babies, pending further validation in feto-maternal outcomes.

Vitamin C and IL-6 in women with preterm premature rupture of membranes compared to normal pregnant women - a case-control study.

OBJECTIVE: The study assessed the relationship of plasma ascorbic acid (vitamin C) level and IL-6 with preterm premature rupture of membranes (PPROM) in pregnant women. METHODS: A case-control study was carried out in University Hospital, Baghdad from July 2019 to July 2020. Two groups of pregnant women with a gestational age between 28-36+6 weeks were included. There were 50 PPROM cases, and 50 healthy controls showing uncomplicated pregnancy and intact amniotic membrane. Both groups matched with their body mass index and gestational age. Plasma vitamin C and interleukin-6 (IL-6) were assessed at the time of admission and 48 hours later in the study group while it was measured at the onset of labour in healthy controls. In addition, the culture and sensitivity of the placental membranes after delivery were assessed in both groups. RESULTS: The mean serum vitamin C value was 2.016±0.15 mg/dl in the PPROM group while it was 5.04±0.22 mg/dl for controls at the time of enrollment. Therefore, women with low vitamin C levels were at a higher risk to have PPROM. The plasma IL-6 mean values were higher in the PPROM group versus healthy controls (18.88±0.31pg/ml vs 5.99±0.12 pg/ml ), P <0.0001. CONCLUSIONS: This study highlighted the ability of vitamin C deficiency with the elevated level of IL-6 in pregnant women in the third trimester to predict preterm premature rupture of the membrane.

Hyperemesis gravidarum and risks of placental dysfunction disorders.

OBJECTIVE: To investigate the association between hospitalisation of cases affected during the first and second trimester of pregnancy with the increased intrapartum complication attributed to placental dysfunction disorders. Additionally to highlight the distinct maternal factors and foetal morbidity patterns for improving the obstetrical outcome. METHODS: An observational study was carried out in Al-Yarmouk Hospital, Baghdad, Iraq from the 1st December 2019 to end December, 2020, recruiting 250 singleton pregnancy of gestational age >10 to >21 completed weeks until delivery. Patients were grouped into two; taking gestational age on admission as a divider; group1 < 10 weeks and group 2 > 12 weeks till completed 21weeks. Participants had at least one hospitalisation for this diagnosis. After a detailed history and examination and recording associated maternal morbidities, including hypertension, hyperthyroidism and diabetes; furthermore, we excluded intrapartum complications as Prematurity, abnormality in foetal weight including stillbirth and preeclampsia risk. RESULTS: None of the demographic criteria nor maternal morbidity factors were significant on analyses. Conversely, all intrapartum complications were significantly higher in both recruited groups. CONCLUSIONS: The strong relationship between hyperemesis gravidarum and placental dysfunction related complications highlight admitted HG cases as a higher risk group; being liable for severe foetomaternal morbidities, demanding more surveillance for a better outcome.

Increased serum amyloid A and C- Reactive Protein in preterm labour women: A case control study.

OBJECTIVE: To assess the possible relation between serum Amyloid A and pregnant women presenting with preterm births. METHOD: The retrospective case-control study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, and comprised data from December 1, 2019, to December 1, 2020, of patients who presented with preterm labour with gestational age 28-37 weeks. Data of similar women with complication-free pregnancy was taken to raise the control group. Serum samples were taken from the subjects at admission before any intervention for the measurement of serum amyloid A, total white blood cells, C-reactive protein, and neutrophil-leukocytes ratio. Data was analysed using SPSS 25. RESULTS: Of the 100 subjects, 50(50%) were in each of the two groups that had no significant differences regarding age, gravida, parity, smoking, and neutrophil-leukocytes ratio (p>0.05). There were significant inter-group differences regarding serum amyloid A and C-reactive protein levels (p<0.05). The cut-off value for serum amyloid A level was 84.61ng/ml. There was a positive correlation between micro-C-reactive protein and serum amyloid A (p<0.05). CONCLUSIONS: Maternal serum amyloid A level in the 2nd trimester may be a predictive marker for preterm labour.

Correlation of Serum Visfatin Level in Non-obese Women with Polycystic Ovary Syndrome and Matched Control.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrinopathy affecting reproductive-age women. Visfatin, an adipocytokine, and insulin resistance (IR) marker in diabetes since PCOS and diabetes share insulin resistance as an etiological factor, this study aimed to investigate visfatin as a predictive marker for IR and hyperandrogenemia in non-obese PCOS women and test its correlation to other parameters. A cross-sectional study conducted at the University Hospital recruited 140 women, divided into two groups. Group I (70/140, study group) was PCOS patients' diagnosis based on 2003 Rotterdam criteria and Group II (70/140, healthy controls). Both were aged, and body mass index (BMI) matched. After a detailed history and general examination, the clinical, demographic, biochemical, hormonal, and metabolic parameters were taken for comparison's sake. PCOS patients were subdivided according to the clinical or hormonal evidence of hyperandrogenemia into two groups: those with hyperandrogenemia and those without. Higher serum visfatin was estimated in the PCOS group (4.4 ± 1.7) versus healthy controls (3.1 ± 0.7) ng/mL, P < 0.0001. Significantly higher visfatin was confirmed in hyperandrogenic PCOS versus non-hyperandrogenic PCOS women (5.69 ± 1.1 vs. 2.76 ± 0.51 ng/mL). A strong correlation was found between visfatin versus hemoglobin A1c and free androgen index (FAI); r = 0.784 and 0.624, respectively. BMI and free testosterone scored a modest correlation. BMI centiles' correlation with serum visfatin revealed no significant effect on serum visfatin, P = 0.62. The ROC calculated visfatin cut-off value; 4.34 ng/mL with 51.4% sensitivity and 100% specificity, and a P-value < 0.001 in discriminating PCOS cases. In conclusion, a strong positive correlation of visfatin with insulin resistance, followed by FAI in PCOS cases irrespective of BMI, suggests the intimate relation of visfatin in PCOS pathophysiology among non-obese women. Further research is warranted to explore this association's therapeutic and prognostic value.

Tacrolimus inhibits angiogenesis and induces disaggregation of endothelial cells in spheroids - Toxicity testing in a 3D cell culture approach.

The administration of immunosuppressive drugs is a necessary therapeutic measure in organ transplantation to prevent rejections. However, the use of temporarily high dosed immunosuppressive drugs is associated with cytotoxicity and adverse side effects that could induce endothelial dysfunction. The aim of this work is to evaluate the effect of the administrated drugs tacrolimus and mycophenolic acid (MPA) on human umbilical vein endothelial cells (HUVECs). Whereas MPA showed no significant toxicity in a dose-dependent manner, a dose-response curve of tacrolimus treatment could be obtained in 2D monolayer. Due to limited cell-cell and cell-extracellular matrix (ECM) interactions in 2D monolayers, 3D spheroids have been established. The comparison of IC50 values demonstrated that tacrolimus is more toxic towards endothelial cells in 3D spheroids (IC50 value = 27.19 µg/ml) than in 2D monolayers (IC50 value = 40.23 µg/ml). Moreover, the maximal trough level of tacrolimus achieved in immunosuppressive therapy (18 ng/ml) resulted in low disaggregation of the spheroids and decreased vessel areas with increased number of end points of tubular-like structures in the angiogenesis assay even if no toxic effect could be detected. Thus, our approach unseals very sensitive cytotoxic effects of tacrolimus on the vasculature in organ recipients after immunosuppressive therapy.

Investigation of Drug-Polymer Compatibility Using Chemometric-Assisted UV-Spectrophotometry.

A simple chemometric-assisted UV-spectrophotometric method was used to study the compatibility of clindamycin hydrochloride (HC1) with two commonly used natural controlled-release polymers, alginate (Ag) and chitosan (Ch). Standard mixtures containing 1:1, 1:2, and 1:0.5 w/w drug-polymer ratios were prepared and UV scanned. A calibration model was developed with partial least square (PLS) regression analysis for each polymer separately. Then, test mixtures containing 1:1 w/w drug-polymer ratios with different sets of drug concentrations were prepared. These were UV scanned initially and after three and seven days of storage at 25 °C. Using the calibration model, the drug recovery percent was estimated and a decrease in concentration of 10% or more from initial concentration was considered to indicate instability. PLS models with PC3 (for Ag) and PC2 (for Ch) showed a good correlation between actual and found values with root mean square error of cross validation (RMSECV) of 0.00284 and 0.01228, and calibration coefficient (R²) values of 0.996 and 0.942, respectively. The average drug recovery percent after three and seven days was 98.1 ± 2.9 and 95.4 ± 4.0 (for Ag), and 97.3 ± 2.1 and 91.4 ± 3.8 (for Ch), which suggests more drug compatibility with an Ag than a Ch polymer. Conventional techniques including DSC, XRD, FTIR, and in vitro minimum inhibitory concentration (MIC) for (1:1) drug-polymer mixtures were also performed to confirm clindamycin compatibility with Ag and Ch polymers.