Cyclic GMP in urine to monitor the response to ovarian cancer to therapy

Guanosine 3':5'-phosphate (cycle GMP) in urine has been used to monitor the response of patients with ovarian cancer to treatment. Changes in the cyclic GMP level appear to correlate well with clinical status in that the disappearance of clinically detectable tumour is associated with a drop in the level whereas a tumour recurrence is associated with an elevation. Serially measured cyclic GMP is valuable for detecting a recurrence of tumour growth in patients in clinical remission and can predate any clinical signs by as much as 10 months. In patients who show no response to treatment, cyclic GMP levels in urine are elevated in the majority of specimens collected.     

Applying a social disparities lens to obesity in pregnancy to inform efforts to intervene

Objective

to examine the social correlates of pre-pregnancy overweight and obesity in an Australian population-based sample and consider implications for intervention effectiveness during pregnancy.

Design

population-based survey distributed by hospitals to women 6 months after birth.

Setting

two states of Australia.

Participants

women who gave birth in Victoria and South Australia in September/October 2007.

Measurements and findings

surveys were completed by 4,366 women. Pre-pregnancy body mass index (BMI) was calculated from women's self-reported weight in kilograms/(height in metres)². Results showed high rates of overweight (22%) and obesity (14%) among Australian women entering pregnancy. After adjusting for other factors in the model, pre-pregnancy obesity was significantly associated with lower household income levels, less education, the experience of financial stress in pregnancy and increasing parity.

Key conclusions

to date, there is little evidence to support the efficacy of interventions to manage problematic weight in pregnancy. Applying a social disparities lens to obesity in pregnancy challenges us to consider social factors that may seem distal to obesity but are highly relevant to efficacious intervention.

Implications for practice

pregnancy care offers an opportunity to address social issues on the pathway to obesity. Current clinical care guidelines on maternal overweight and obesity in pregnancy rarely consider social contexts that place some women at risk and are a likely impediment to efficacious intervention.     

FSH levels in relation to hysterectomy and to unilateral oophorectomy

OBJECTIVE: To examine the association between hysterectomy, unilateral oophorectomy, and ovarian status, measured by FSH concentrations, in women aged 35-49 years. METHODS: From the National Health and Examination Survey III, 1716 women aged 35-49 years were studied. Information on menopausal status, surgical history (hysterectomy, single or bilateral oophorectomy), smoking, and other characteristics was collected in a structured interview, height and weight were measured, and one blood sample was collected. We used logistic regression to analyze FSH concentration in relation to hysterectomy and oophorectomy, controlling for age, ethnicity, body mass index, smoking, education, nulligravidity, and exercise. RESULTS: Hysterectomy with unilateral oophorectomy was associated with an increased prevalence of elevated FSH (above 20 IU/L) (adjusted odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3, 4.6) compared with women who had not had hysterectomies or oophorectomies. Among women with two ovaries, hysterectomy was associated with increased prevalence of elevated FSH (adjusted OR 1.5, 95% CI 1.0, 2.5). As a comparison of the effect size, the observed association between hysterectomy and elevated FSH was smaller than the association between FSH and current smoking (OR 2.0), a factor associated with a 1-2 year decrease in mean age at natural menopause. CONCLUSION: Although the differences in FSH levels were small, there was evidence of elevated FSH in women who have had hysterectomies, even if at least one ovary remained.     

Drugs to avoid in pregnancy

Drugs given in pregnancy can adversely affect the fetus in many ways. Anxiety about birth defects is a major parental concern during pregnancy. Doctors and their patients often seek information about the potential teratogenicity of drugs that are taken by or prescribed for the pregnant woman. Because no drug is entirely without side effects, great caution should be taken when prescribing in pregnancy. The development of knowledge in understanding the use of drugs during pregnancy has been in stalemate in comparison to other areas of therapeutics, mainly due to difficulties in testing new products in pregnant women and paucity of good quality research. In this article, we aim to review current knowledge of the epidemiology of drug use among pregnant women, drug metabolism in pregnancy, adverse fetal and neonatal effects of drugs and specific effects of drugs that are relatively or absolutely contraindicated in pregnancy.     

Evaluation of seven- to nine-year-old children exposed to ritodrine in utero

Twenty children who had been exposed to ritodrine in the management of preterm labor between 24 and 34 weeks' gestational age were examined at seven to nine years of life and compared with matched control subjects. No significant differences were detected in factors of growth, neurologic findings, and psychometric testing.     

Differences in chromosome susceptibility to aneuploidy and survival to first trimester

The purpose of this study was to find specific rates of aneuploidy in cleavage-stage embryos compared with first trimester data and to evaluate post-zygotic selection against aneuploidy. A total of 2058 embryos were analysed by flurorescence in-situ hybridization (FISH), and specific aneuploidy rates were obtained for 14 chromosomes. Data from morphologically abnormal embryos could be pooled with data from preimplantation genetic diagnosis (PGD) cycles because it was observed that they had similar rates of aneuploidy; thus, for the purpose of studying aneuploidy they could be, and were, pooled. Specific chromosome aneuploidy rates were not related to morphology or development of the embryos. The average maternal age of patients with aneuploid embryos was significantly higher than the overall analysed population. Monosomy appeared more commonly than trisomy. The chromosomes most frequently involved in aneuploidy were (in order) 22, 16, 21 and 15. When compared with first trimester pregnancy data, aneuploidies detected at cleavage stage seem to die in excess of 90% before reaching first trimester, with the exception of chromosome 16 and gonosomes (76% and 14% respectively). Differences in chromosome-specific aneuploidy rates at first trimester conceptions are probably produced by different chromosome-specific aneuploidy rates at cleavage stage and different survival rates to first trimester.     

The medically certified inability to work in relation to prenatal care

The specificity of medical care is analyzed by investigations of causes for disablement during pregnancy in 4,742 cases of working pregnant women. The diagnoses of disablement with a frequency of 9.31% are distributed by equal parts of causes dependent on pregnancy or not. The percentage of sick pregnant women not treated by the gynecologist is very high with 36.4% of causes dependent on pregnancy. For an improvement of the health protection of mother and child the pregnant women with these types of diseases should be referred to the gynecologist for further diagnostic and treatment.     

Three-dimensional ultrasound to assess the response to treatment in gynecological malignancies

OBJECTIVE: To report the potential role of 3D ultrasound to assess the response to treatment in gynecological malignancies. METHODS: The volumes and three 3D power Doppler indices are measured in one case of cervix carcinoma and in one case of ovarian carcinoma with primary radio- and/or chemotherapy before and after treatment. RESULTS: After treatment, tumor volume, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were reduced in both two cases. CONCLUSION: 3D ultrasound may provide a new method to assess the response to treatment in gynecological malignancies.     

Statistical methods to examine contributors to racial disparities in perinatal outcomes

Longstanding racial disparities in preterm birth in the US remain incompletely understood. Often investigators use interaction terms or stratify epidemiologic analyses by race and ethnicity to examine disparities. However, these approaches presume differential susceptibility to similar exposures. However, American life remains largely racially segregated. As such, vastly different doses of harmful and beneficial exposures exist across racial and ethnic groups. Differences in exposure patterns and their sources likely explain a larger proportion of racial health disparities (mediation) than differential responses to exposures by race (effect modification). Thus, recently developed, user-friendly mediation analysis may be a more relevant and powerful tool to quantify the contribution of specific exposures to racial disparities. Such statistical methods coupled with evaluation of real-world reduction of exposures to toxicants may be used to focus policymakers’ efforts to improve perinatal health equity through targeted interventions.     

Using the right to life to confront unsafe abortion in Africa

Unsafe abortion is one of the leading causes of maternal mortality in Africa. In international human rights law, there are two possible approaches to tackling the problem of unsafe abortion. One is to advocate the right of privacy, which means states must refrain from interfering in women's abortion decisions; the other is to advocate the right to life of women, which stresses the duty of states to take affirmative measures to minimise the consequences of unsafe abortion. African societies are communal and duty is the central element in them. The African Charter on Human and Peoples' Rights reflects communal values by stressing the duty of individuals to help their communities. Unlike other human rights documents, it does not have a right of privacy provision. This paper focuses mainly on the right to life and discusses the interpretation of this right for women, as applied to unsafe abortion, under the International Covenant on Civil and Political Rights. Advocating states' duties in ensuring women's right to life, to minimise the consequences of unsafe abortion, is more consistent with duty-based African communal values than the right of privacy.     

Heme Oxygenase Expression in Human Placental Villous Tissue in Response to Exposure to in vitro Ischemia-Reperfusion Injury

Heme oxygenases (HO-1 and HO-2) are responsible for the production of carbon monoxide, a vasodilator. The products of heme oxygenase are also anti-oxidants. HO is expressed within the placenta and is important in controlling placental blood flow. HO can be sensitive to oxygen, with responses differing depending on the cell type. Recent studies have suggested that in preeclampsia, the placenta would be subjected to fluctuations in oxygen tension analogous to an ischemia-reperfusion injury. Thus the present study tested the hypothesis that HO-1 and or HO-2 expression in placental villous explants would be altered by an ischemic-reperfusion insult. Human term placental explants were exposed to hypoxia then re-oxygenation in 5% or 20% O₂ or repeated cycles of hypoxia-re-oxygenation. HO protein concentrations were assessed by Western blotting. No changes in HO-1 or HO-2 were found with any treatment protocol. Chemical induction of HO-1 was possible in explants showing that HO-1 induction in explants is possible. The results suggest that cells in term placental villous tissue do not respond to hypoxia-re-oxygenation by altering the amount of HO-1 or HO-2 protein.     

Conversion of estrone to estradiol and estradiol to estrone in postmenopausal women

The conversion of estrone to estradiol and metabolism of estradiol to estrone have been measured in postmenopausal women to examine factors that influence these conversions. Transfer constants for the conversion of estrone to estradiol and estradiol to estrone were not significantly correlated with age (r = -.01 and r = .1, respectively) or subjects' percentage of ideal body weight (r = -.25 and r = -.22, respectively). There was a significant negative correlation between the transfer constants for the conversion of estradiol to estrone and plasma levels of dehydroepiandrosterone sulphate (r = -.45, P less than .05) but not plasma levels of progesterone. Transfer constants for the conversion of estrone to estradiol and metabolism of estradiol to estrone in women with breast or endometrial disease were similar to values in normal women, but metabolism of estradiol to estrone was elevated in two women with primary biliary cirrhosis.     

Chlamydia in colposcopy clinics: to screen or not to screen?

The objective of the study was to assess the prevalence of Chlamydia trachomatis in our colposcopy clinic. A total of 337 consecutive patients newly referred to the colposcopy clinic between May and November 2003 were screened for chlamydia trachomatis. All our patients were referred by their GPs and none of the patients had had a recent chlamydia test performed. Four patients screened positive, overall giving a prevalence of 1.2% [95% CI 0.04-2.36%]. Three of those with positive results were in the 21 - 30 year age group (139 in the group, which equals 2.2% prevalence [95% CI 0 - 4.6%]). The fourth positive result was in the group over the age of 60. None of those screened in the other age groups was positive (< or =20, 31 - 40, 41 - 50, 51 - 60 years). Numbers screened in each of those groups were: 14, 115, 53 and 12, consecutively. Our study, though small in sample size, supports the view that the prevalence of chlamydia is not high in all colposcopy clinic attenders. Women younger than 30 years old are more likely to be infected than older women; hence opportunistic screening should target this age group. The prevalence rate may be low due to the enzyme linked immunosorbent assay giving a poor detection rate for chlamydia screening.