Effect of L-arginine on the expression of Bcl-2 and Bax in the placenta of fetal growth restriction

Objective.?To investigate the effect of l-arginine on fetal growth restriction (FGR) in terms of the expression of Bcl-2 and Bax in placenta.

Methods.?Sixty pregnant women with FGR were randomized to receive conventional treatment alone (control group, n?=?30) or in combination with l-arginine (l-arginine group, n?=?30). The parameters of fetal growth and development were monitored by B-ultrasound at regular intervals. The newborn birth weight and perinatal outcomes were also documented. Placental tissue was sampled within 10?min after delivery for analysis. The expression of Bcl-2 and Bax in placental tissue was determined by immunohistochemical technique.

Results.?The fetal growth parameters of biparietal diameter, femur length, and abdominal circumference increased more significantly in l-arginine group than those in control group (p?<?0.0l). The cure rate and birth weight in l-arginine group were higher than those in control group (73.3% vs. 43.3%, 2455.20?g vs. 2402.63?g, respectively). The incidence of small for gestational age newborns in l-arginine group was significantly lower than that in control group. Compared with l-arginine group, the Bax expression increased, but bcl-2 expression decreased in control group.

Conclusions.?l-arginine could reduce the expression of Bax, and enhance the expression of bcl-2, which may be associated with reduced placental apoptosis and improved placental function and fetal development.     

Ultrasound evaluation of intrauterine growth restriction therapy by a nitric oxide donor (L-arginine).

OBJECTIVE: There are numerous methods available of treating intrauterine growth restriction but their results are still not satisfactory. Currently, we are conducting a research project whose main aim is based on the use of the nitric oxide (NO) donor L-arginine in growth restriction therapy. The main aim of this study was the ultrasound evaluation of the efficacy of this therapy based on biometric measurements (the estimated fetal weight) compared with the estimated weight of newborn children. STUDY DESIGN: The investigated group comprised two randomly chosen groups of pregnant women with ultrasound-diagnosed intrauterine growth restriction (biometry < 10th centile for gestation age): 78 patients were treated by L-arginine 3 g daily orally for 20 days; and 30 patients, not treated, acted as the control group. RESULTS: The ultrasound estimation of fetal weight at the start and at the end of the treatment showed a mean increase of 642 g (SE 90 g) using the Shepard method, and 648 g (SE 94 g) using the Hadlock method, respectively. By comparison, within the control group a mean value increase of 395 g (SE 77 g) was found, using the Shepard method, and 404 g (SE 82 g) using the Hadlock method, respectively. There was a significant statistical difference when comparing the estimated fetal weight increase in both methods: p=0.008 for the Shepard calculation and p=0.012 for the Hadlock calculation. The weight of the newborn infants was also evaluated: in the treated group the mean value was 2823 g (SE 85 g) and in the untreated group the mean value was 2495 g (SE 147 g). There was a significant (p=0.027) difference, showing a positive effect of the treatment on the weight of newborns. In the treated group the percentage of growth-retarded newborns was 29% while in the untreated group it was 73%. A significant difference has been found (p < 0.01) between both of the groups of newborns. CONCLUSIONS: The ultrasound evaluation of the estimated fetal weight and the birth weight of the newborns showed an improvement: there was an acceleration of fetal development in the L-arginine-treated group of pregnant women as compared with the untreated group. The ultrasound evaluation of the estimated fetal weight is a good diagnostic tool, properly monitoring the efficacy of the L-arginine treatment of the growth-retarded fetuses.     

Ultrasound evaluation of NO-donor (L-arginine) therapy for intrauterine growth retardation

There are many methods of the growth restriction therapy, but the results are still not satisfactory. Actually, we are conducting a project which main conception is based on the use of the NO donor (L-arginine) in growth retardation therapy. This amino acid is an effective NO donor and has a vasodilating effect on the vessels and anti-aggregation effect on platelets, which plays a great role in improving feto-maternal blood flow. The main aim of this paper is the ultrasound evaluation of the effectiveness of NO-donor (L-arginine) therapy for intrauterine growth retardation based on biometrical measurements (estimated fetal weight) compared with newborns weight estimation. METHODS: The investigated group comprised two groups of pregnant women with ultrasonographically diagnosed intrauterine growth retardation (biometry <10th percentile for the gestation age): --78 patients were treated by L-arginine 3 g daily p.o. in 20 days period. --30 patients not treated (no agreement for therapy) as controls. RESULTS: Ultrasound estimation of fetal weight at the start and at the end of the treatment showed a mean value increase of 642 g (SE 90g) using Shepard method and 648g (SE 94g) using Hadlock method respectively. Comparing not treated group there was assessed a mean value increase of 395 g (SE 77 g) using Shepard method and 404g (SE 82g) using Hadlock method respectively. There is statistical significant difference comparing an estimated fetal weight in both methods: p = 0.008 for Shepard calculation and p = 0.012 for Hadlock calculation. There was analyzed newborn weight also--in a treated group mean value was at 2823 g and in not treated group mean value was at 2495 g. There was no significant difference found but a positive tendency for treated group newborns weight is visible. In the treated group number of the growth retarded newborns was at 29% and in the not treated group was at 73%. There was found a significant difference comparing both newborns groups at p < 0.05. CONCLUSIONS: The ultrasound evaluation of the estimated fetal weight and after-birth weight estimation of the newborns showed an increased dynamic of the fetal development in the L-arginine treated group of pregnant women comparing to the not treated group. The ultrasound evaluation of the estimated fetal weight is a good diagnostic tool for properly monitoring the effectiveness of treatment with L-arginine for growth retarded fetuses.     

PLATELET RESPONSIVENESS TO L-ARGININE IN HYPERTENSIVE DISORDERS OF PREGNANCY

Objective: In chronically hypertensive (CH), preeclamptic (PE), and normotensive pregnant women (N), we investigated ex vivo platelet aggregation in response to L-arginine (L-Arg) and sodium nitroprusside (SN), which are respectively the substrate and donor of nitric oxide (NO).

Methods: Platelet aggregation was determined with a dual-channel aggregometer by measuring transmittance of light through the sample in comparison to platelet poor plasma, as a reference. Aggregation induced by adenosine diphosphate was continuously recorded for 3 min and measured before and after preincubation with L-Arg and SN.

Results: Preincubation with L-Arg significantly reduced platelet aggregation in N and CH patients (p < 0.05) but not in PE women. Preincubation with SN affected aggregation in PE women also (p < 0.001). No correlation was found between platelet response to L-Arg or SN stimuli and the severity of hypertensive disorders expressed as week of gestation at delivery or birth weight.

Conclusions: The present study demonstrates that a decreased platelet sensitivity to L-Arg characterizes PE women, whereas SN maintains its antithrombotic power. This impairment seems to be specific for PE, because platelets of CH patients utilize L-Arg normally. This finding supports the involvement of the L-Arg-NO pathway in the pathogenesis of the procoagulative features of PE and probably in the onset of the disease. The maintained response to SN in PE patients suggests a possible therapeutical use of NO donors in the disease.     

Effect of l-arginine on blood pressure in pregnancy-induced hypertension: A randomized placebo-controlled trial

Objective.?To evaluate the antihypertensive efficacy of l-arginine (l-Arg) repeated infusions in women affected by gestational hypertension.

Methods.?The women were referred to obstetric units in order to assess their clinical conditions and to exclude the presence of severe fetal and/or maternal complications. Inclusion criteria were: maternal age range 16–45 years, diagnosis of gestational hypertension without proteinuria (patients normotensive until the 20th week), and gestational age ranging between 24 and 36 weeks. Each woman was allocated to receive either l-arginine (20 g/500 mL) or placebo treatment through an i.v. line. The infusion was carried out in the morning from 8 a.m. to 10 a.m. and it was repeated for the next four consecutive days. Systolic and diastolic blood pressure values as well as heart rate were recorded with the patient in an upright, seated position at 08:00, 12:00, 16:00 and 20:00 h.

Results.?Maternal clinical features such as age, height, weight, and gestational age at inclusion were similar between groups. Both systolic and diastolic blood pressures were reduced by treatment, the effect of l-arginine being significantly higher than that of the placebo (systolic values F = 8.59, p < 0.005; diastolic values F = 3.36; p < 0.001). Twenty women assigned to the l-Arg group (32.2%) and 23 to the placebo group (37.7%) were concomitantly treated with antihypertensives before starting the study. Analyzing the subgroup of patients not receiving antihypertensive drugs we found that l-arginine was superior to placebo in lowering systolic (F = 5.42, p < 0.005) and diastolic (F = 2.20, p < 0.005) blood pressure values.

Conclusions.?In conclusion, these data support the use of l-Arg as an antihypertensive agent for gestational hypertension especially in view of the other beneficial effects nitric oxide donors display in pregnancy. Further, l-Arg seems well tolerated since in this sample none of the patients reported adverse effects requiring study interruption.     

Asymmetric dimethylarginine and l-arginine levels in neonatal sepsis and septic shock

Objective: Nitric oxide (NO) formed by the enzyme NO synthase (NOS) from l-arginine, is an important mediator for pathogen elimination. Being a potent vasodilator NO is implicated in hypotension and decreased organ perfusion in sepsis. Asymmetric dimethylarginine (ADMA) is an endogenous NOS inhibitor. We investigated ADMA and l-arginine levels in neonatal sepsis and their relation to disease severity.

Methods: A prospective controlled study was conducted including 31 neonates with sepsis and 20 controls. Serum ADMA and l-arginine levels were measured within 24?h of sepsis diagnosis. Clinical and laboratory data including clinical risk index for babies (CRIB) score, presence of septic shock, organ dysfunction and death were recorded.

Results: l-Arginine and ADMA levels were higher in neonates with sepsis compared to controls (p?=?0.029 and p?=?0.001, respectively). Neonates with septic shock had higher ADMA levels compared to septic neonates without shock (p?=?0.026) and controls (p?l-Arginine levels were higher in neonates with septic shock compared to septic neonates without shock (p?=?0.012) and controls (p?l-arginine and ADMA levels. ADMA levels were correlated with CRIB score (rho?=?0.320, p?=?0.025).

Conclusion: l-arginine and ADMA levels are elevated in neonatal sepsis and even higher levels are observed in septic shock.     

l-Arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications

Objective.?To evaluate l-arginine (l-Arg) supplementation in pregnant women with chronic hypertension and its effects on blood pressure (BP) and maternal and neonatal complications.

Methods.?We enrolled 80 women affected by mild chronic hypertension referred to the High Risk Clinic of the Mother–Infant Department of the University of Modena and Reggio Emilia. Each woman after obtaining oral consent was randomized to receive oral l-Arg versus placebo and thereafter submitted to 24-h ambulatory BP monitoring. The primary outcome was BP change after 10–12 weeks of treatment. Secondary outcomes were as follows: percentage of women on antihypertensive treatment at delivery, maternal, and fetal outcome.

Results.?The BP changes after 10–12 weeks of treatment did not differ between groups. A lower percentage of women received antihypertensive drugs in the l-Arg group than the placebo group. The incidence of superimposed preeclampsia indicated delivery before the 34th weeks and certain neonatal complications tended to be higher in the placebo group.

Conclusions.?l-Arg supplementation in pregnant women with mild chronic hypertension does not significantly affect overall BP but is associated with less need for antihypertensive medications and a trend toward fewer maternal and neonatal complications. The results of the study were limited by the small sample size and by the exclusion of women with severe chronic hypertension. In our policy, these patients needed many hypertensive drugs and were normally managed by the cardiologist. Nevertheless, considering the promising results on maternal and fetal outcome, we believe that further studies should be performed to confirm such data and to clarify the role of l-Arg as a protective supplement in high-risk pregnancy.     

Lowered serum total L-carnitine levels are associated with obesity at term pregnancy

Abstract

Objective: This study aims to compare the serum total l-carnitine concentrations of obese and non-obese pregnant women and to identify the role of l-carnitine in both maternal and fetal weight gain during pregnancy.

Method: This study reviews 118 healthy women with singleton term pregnancy (≥37 weeks). The characteristics of the recruited subjects were analyzed according to their pre-pregnancy body mass index (BMI).

Results: The women with pre-pregnancy BMI?<?18.5?kg/m² had significantly higher serum l-carnitine levels whereas the women with BMI?>?29.9?kg/m² at term pregnancy had significantly lower serum l-carnitine levels (p?=?0.001 for both). The neonates born to women with BMI?>?29.9?kg/m² at term pregnancy had significantly longer height and wider head circumference (p?=?0.001 for both). Serum total l-carnitine levels correlated significantly and negatively with pre-pregnancy body weight, pre-pregnancy BMI, pregnancy body weight, pregnancy BMI and serum triglyceride levels (r?=??0.397, p?=?0.001; r?=??0.357, p?=?0.001; r?=??0.460, p?=?0.001; r?=??0.463, p?=?0.001 and r?=??0.216, p?=?0.019, respectively). There was a significant and positive correlation between l-carnitine and HDL values (r?=?0.243, p?=?0.008).

Conclusions: The crucial role of l-carnitine in pregnancy metabolism suggests that nutritional supplementation of this amino acid can be offered to women who are either overweight or obese at the beginning of the pregnancy.     

l-arginine plus drospirenone-ethinyl estradiol in the treatment of patients with PCOS: a prospective,placebo controlled,randomised, pilot study

Objective.?To verify the effects of a pill containing drospirenone on the surrogate markers of arterial function and to evaluate the possible improvements induced by the addition of l-arginine.

Design.?A prospective, placebo controlled, randomised, pilot study.

Setting.?University of Bologna.

Population.?Twenty-eight young women with PCOS.

Methods.?Random submission to: drospirenone?+?ethinylestradiol+?a placebo (Group I; n?=?15) or drospirenone?+ ethinylestradiol?+?oral l-arginine (4?g?×?2/daily) (Group II, n?=?13).

Main outcome measures.?Medical examination; blood measurement of nitrites/nitrates, biochemical and hormonal parameters; ultrasonographic analysis and colour Doppler evaluation of uterine, stromal ovarian and ophthalmic arteries; analysis of brachial artery flow-mediated vasodilatation; and 24-h ambulatory blood pressure monitoring. The above parameters were evaluated before and after 6 months.

Results.?The low dose oral contraceptive containing drospirenone favoured a pre-hypertensive state The l-arginine supplementation increased the circulating levels of nitrites/nitrates and improved the endothelium-dependent vasodilatation counteracting the negative effect of the contraceptive pill.

Conclusions.?Although, the present pilot study was conducted in a limited number of patients, it seems that the l-arginine co-treatment may improve the long-term side effects of the pill reducing the risk of cardiovascular diseases.     

Specific formulas improve the estimation of fetal weight by ultrasound scan

Abstract

Objective: To develop and evaluate local, sex specific, small for gestational age (SGA) specific, large for gestational age (LGA) specific and combined (biometry, sex and Doppler indices) formulas for ultrasound estimated fetal weight (EFW).

Method: Low-risk singleton pregnancies that delivered within 7 days from ultrasound examination were assessed. A formula-generating group (1407 pregnancies) and a validation group (469 pregnancies) were created. Fractional regression analysis was used to develop the formulas. Systematic error, random error, fraction within the 10% of actual birth weight and Bland–Altman analysis were used.

Results: The local formula and the Hadlock formula with local co-efficients performed better than the Hadlock formula. The SGA-specific formula, the LGA-specific formula and the combined formula had the lower systematic error (MSE: +0.0022291, ?0.4226888, +0.8386222, respectively) and the narrower 95% LOA (?292.8 to +292.23, ?485.6 to +461.5, ?425.7 to +450.46, respectively). The SGA- and the LGA-specific formulas had higher fraction within the 10% of actual birth weight (81.5% and 84%, respectively).

Conclusions: Local formulas improve the EFW calculation. The combined formula can further optimize the accuracy and precision. Application of specific formulas for the small and the large fetus had the most pronounced effect in improving fetal weight estimation.     

Ultrasonographic fetal weight estimation: accuracy of formulas and accuracy of examiners by birth weight from 500 to 5000 g

OBJECTIVE: To determine the accuracy of birth weight in different birth weight (BW) groups using widely accepted formulas for fetal weight estimation (EFW). The secondary purpose was to estimate the role of examiners on the accuracy of EFW. METHODS: The cross-sectional data were obtained from 5612 pregnant women. Fetal weight was estimated for each fetus using the formulas of Campbell and Wilkin, Shepard, 2 formulas of Hadlock and Merz. Inclusion criteria were: singleton pregnancy, complete ultrasound parameters, EFW obtained within the last week prior to delivery, the live born infant without congenital malformations or hydrops. RESULTS: The highest intraclass correlation coefficient and the most stable results in all BW groups were generated with both Hadlock formulas. Both Hadlock and Campbell formulas had the lowest percent errors (PE) in BW groups between <1500 g and 3500 g. Shepard and Merz formulas had lower PEs in BW groups between 3501 g and >4000 g. However in BW groups under 3500 g they were imprecise. The PE of EFW varied from -4.0 +/- 8.5% to 1.3 +/- 8.5% between examiners. CONCLUSIONS: Both Hadlock formulas showed the most stable results in all of the weight groups. There is also a need for routine evaluation of the accuracy of EFW for every examiner, to make suggestions, what fetal measurements must be improved to improve EFW.     

Effect of parenterally l-arginine supplementation on the respiratory distress syndrome in preterm newborns

l-Arginine (l-Arg) is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Earlier studies suggested that l-Arg levels in preterm newborns with respiratory distress syndrome (RDS) were low due to its consumption and l-Arg supplementation may reduce the severity of RDS. Our aim was detect the effect of the parenterally l-Arg supplementation on RDS severity. The subjects were chosen between preterm newborns (gestational age <34 weeks) (n?=?30). Twenty of the subjects were diagnosed with permaturity and RDS, and 10 of the subjects were healthy preterm newborns. Ten of the subjects was taken l-Arg (1.5?mmol/kg/d) in addition to routine RDS treatment and assumed as “Group 1”. In this group, daily l-Arg supplementation was started end of the first day, and continued at end of fifth day. The others of the subjects diagnosed with RDS was take routine RDS treatment and assumed as “Group 2”. Healthy preterm newbors assumed as “Group 3”. Blood collections for l-Arg levels via tandem mass spectrometry were made in first day and repeated on the seventh days. Oxygenation index was used to determine severity of RDS. l-Arg consentrations in Group 1 were 8.7?±?4.1?μM/L and 11.9?±?5.0?μM/L in first and seventh day, respectively. l-Arg consentrations were 12.6±4.5?μM/Land 10.9?±?5.4?μM/L in Group 2 and 8.6?±?5.1?μM/L and 9.4?±?4.1?μM/L in Group 3. There is no correlation between l-Arg concentrations and OI also duration of the mechanical ventilation of the subjects in patient groups (Group 1 and 2).     

Comparison of the accuracy of INTERGROWTH-21 formula with other ultrasound formulae in fetal weight estimation

Objective

A new ultrasound formula for fetal weight estimation was proposed from the INTERGROWTH-21 project in 2017. There is no comparison of its accuracy with other ultrasound formulae. This study aims to compare the accuracy of INTERGROWTH-21 formula in fetal weight estimation with the traditional Hadlock1 and Shepard formula.

Adrenomedullin Requires an Intact Nitric Oxide System to Function as an Endogenous Vasodilator in Rat Gestation

Objective: We hypothesize that administration of adrenomedullin (AM), an endogenous vasodilator, will ameliorate the hypertension and growth restriction associated with chronic nitric oxide inhibition induced by l‐ω nitro‐l‐arginine methyl ester (l‐NAME) infusion in pregnant rats. Methods. Osmotic minipumps were inserted on day 14 of gestation to deliver continuously either AM, l‐NAME, AM+l‐NAME, or vehicle control. Systolic blood pressure was recorded daily in pregnant rats. Pregnant rats were either sacrificed on gestational days 15, 16, 17, 18, or 22, or they were allowed to deliver at term. The placentas from all of the treated groups were fixed for 24 hr in Bouin solution, sectioned, processed, embedded in paraffin, and stained with hematoxylin and eosin. The placentas were graded for the quality of fetal vessel development in the labyrinth. Results. Systolic blood pressure was increased in AM+l‐NAME‐treated rats. The animals that delivered in the AM+l‐NAME group exhibited decreased pup weight (l‐NAME and AM+l‐NAME, 5.2±0.1 compared with 6.4±0.1 g for both AM and controls, p<0.001) and increased pup mortality (AM+l‐NAME, 44.4% compared with 16.7% in l‐NAME, 0% in AM and 3.1% in controls, p<0.001 AM+l‐NAME compared with controls). Increased decidual necrosis, necrosis in the labyrinth, and deficient fetal vessel development in the labyrinth was identified in the placentas treated with AM+l‐NAME. Conclusions. Addition of the endogenous vasodilator AM to an l‐NAME‐induced state of chronic NO inhibition did not ameliorate hypertension and growth restriction.     

3D and 2D ultrasound-based fetal weight estimation: a single center experience

Objective: Evaluate two new 3D and two new 2D ultrasound formulae for fetal weight estimation against the modified Hadlock formula and compare their estimation to the actual fetal weight.

Methods: Fifty pregnant females were included. Inclusion criteria: singleton pregnancy, within five days of delivery and normal or IUGR pregnancy. 3D evaluation of the fetal thigh and arm was done to calculate mid-thigh and mid-arm volumes. The actual fetal weight was recorded at delivery and compared to the estimated weights.

Results: Modified Hadlock formula had higher accuracy, whereas fractional limb volume method had higher precision. Systematic errors for the modified Hadlock formula, Model 6 of fractional limb volume and the original mid-thigh soft tissue thickness methods were 2.3%, ?4.8% and 11%, respectively, whereas the random errors were 7.7%, 6.2% and 13.8%, respectively. The percentage of cases estimated within 5%, 10% and 15% of actual fetal weight were 48%, 86% and 92%, respectively, for the modified Hadlock method, whereas for the fractional limb volume method, these were 40%, 78% and 98%, respectively.

Conclusion: Fractional limb volume method is a very promising method for fetal weight estimation. Its performance is not significantly different from the modified Hadlock method.     

Five-dimensional long bones biometry for estimation of femur length and fetal weight at term compared to two-dimensional ultrasound: a pilot study

Background/objective: This study aimed to evaluate accuracy of five-dimensional long bones (5D LB) compared to two-dimensional ultrasound (2DUS) biometry to predict fetal weight among normal term women.

Methods: Fifty six normal term women were recruited at Ain Shams Maternity Hospital, Egypt from 14 May to 30 November 2015. Fetal weight was estimated by Hadlock’s IV formula using 2DUS and 5D LB. Estimated fetal weights (EFW) by 2DUS and 5D LB were compared with actual birth weights (ABW).

Results: Mean femur length (FL) was 7.07?±?0.73?cm and 6.74?±?0.67?cm by 2DUS and 5D LB (p?=?.02). EFW was 3309.86?±?463.06?g by 2DUS and 3205.46?±?447.85?g by 5D LB (p?=?.25). No statistical difference was observed between ABW and EFW by 2DUS (p?=?.7) or 5D LB (p?=?.45). Positive correlation was found between EFW by 2DUS, 5D LB, and ABW (r?=?0.67 and 0.7; p?p?=?.15).

Conclusions: 2DUS and 5D LB had same accuracy for fetal weight estimation at normal term pregnancy.     

Third trimester ultrasound for fetal macrosomia: optimal timing and institutional specific accuracy

Purpose: To determine the performance of third trimester ultrasound in women with suspected fetal macrosomia.

Materials and methods: We performed a retrospective cohort study of fetal ultrasounds from January 2004 to December 2014 with estimated fetal weight (EFW) between 4000 and 5000?g. We determined accuracy of birth weight prediction for ultrasound performed at less than and greater than 38 weeks, accounting for diabetic status and time between ultrasound and delivery.

Results: There were 405 ultrasounds evaluated. One hundred and twelve (27.7%) were performed at less than 38 weeks, 293 (72.3%) at greater than 38 weeks, and 91 (22.5%) were performed in diabetics. Sonographic identification of EFW over 4000?g at less than 38 weeks was associated with higher correlation between EFW and birth weight than ultrasound performed after 38 weeks (71.5 versus 259.4?g, p?Conclusions: Identification of EFW with ultrasound performed less than 38 weeks has greater reliability of predicting fetal macrosomia at birth than measurements performed later in gestation. EFW to birth weight correlation was more accurate than previous reports.     

Changes of red blood cell rheology in newborns with congenital hypothyroidism during treatment

Abstract

Aim: We aimed to evaluate the deformability characteristics of RBC and the affecting factors in newborns diagnosed with congenital hypothyroidism (CH) and to compare the outcomes after the l-thyroxin treatment.

Patients and methods: Enrolled subjects were divided into two subgroups as “patients” and age-matched healthy “controls”. First blood samples were taken from all subjects for measuring elongation index (rEI) and osmotic fragility of RBC (OF), hematic and biochemical analytes affecting the RBC deformability in the neonatal age. All parameters were repeated a month after provided euthyroid state following the treatment in patients and age-matched healthy controls.

Results: There was no difference between both groups in terms of complete blood count parameters and serum analytes (albumin, bilirubin and fibrinogen) except expected age-related changes in the first and second readings. Serum lipid/lipoprotein levels of both groups remained unchanged except triglyceride levels during the study period. The rEI of the patients were lower than that of controls in the first and second readings. The rEIs of the patients became increased, reaching (not equal) the levels of their controls during l-thyroxin treatment. Osmotic fragility of the patients was detected as lower than controls in the first and second readings, and became better during l-thyroxin treatment.

Conclusion: Our results indicate that some changes may occur on the hematic and biochemical analytes affecting the RBC deformability features. Neonates with CH have the worst rEI initially, but they reached the indices of the healthy infants thanks to l-thyroxin treatment. Also, their OF features have been improved by l-thyroxin.     

Effect of l-Arginine Supplementation on Blood Pressure in Pregnant Women: A Meta-Analysis of Placebo-Controlled Trials

Objective. A meta-analysis of placebo-controlled trials was conducted to evaluate the effect of l-arginine supplementation on blood pressure (BP) in pregnancy. Methods. Trials were searched in PubMed, Embase, and Cochrane Library. A total of five trials were included in the meta-analysis. Results. l-Arginine supplementation exhibited a mean decrease of 3.07 mmHg (p = 0.004) for diastolic blood pressure and a mean increase of 1.23 weeks (p = 0.002) for gestation age at delivery in pregnancy, but did not reduce systolic BP (p = 0.19) as compared to placebo. Conclusion. l-Arginine supplementation had a significant effect of lowering diastolic blood pressure and prolonging gestation age in pregnancy.     

Accuracy and modifying factors of the sonographic estimation of fetal weight in a high-risk population

There have been a number of reviews assessing the accuracy of different methods of sonographic estimation of fetal weight, without identifying any clearly superior equation. In order to optimise accuracy in a high-risk population, we decided to compare some of the most popular early equations with the newer volume-based equations, and to try and identify factors that affect the ability of these equations to estimate fetal weight accurately We collected the scan and delivery details of 192 fetuses born within one week of a sonographic estimation of fetal weight. We then applied three of the most popular equations and two newer volume-based equations to the recorded fetal biometric parameters to assess the performance of each equation overall, and under varying maternal, fetal, and scan conditions. The equations of Shepard, Hadlock A, Hadlock B and Combs produced similar results with systematic (mean) errors in the range 1.2-1.9% and random error characterised by one standard deviation in the range of 8.6-9.5%. Dudley's volume-based equation produced a significant systematic error in the form of a mean error of 7.4%, which corresponds to a mean birthweight (BW) which is 7.4% above the mean estimated fetal weight (EFW). When we stratified the study group by birthweight, Combs' equation produced significant differences in the mean error, (p < 0.00001), that ranged from a mean overestimation in fetal weight of 8.5% for babies with BW < 1000 g to a mean underestimation in fetal weight of 6.2% for babies with BW > 3000 g. Oligohydramnios resulted in a trend towards an increased mean error for all equations which was only statistically significant for Hadlock B. The equations Shepard and Hadlock A performed best in our high-risk population. They produced the smallest systematic errors across the entire study group and were not adversely affected by variations in birthweight, liquor volume, or fetal presentation. The newer, volume-based equations were disappointing, producing large systematic errors. Large random errors in all equations continue to be the Achilles' heel that limit the value of sonographic EFW.