Serum nitrate and NOx levels in preeclampsia are higher than in normal pregnancy

Objectives: To compare nitric oxide (NO) serum levels in women with and without preeclampsia. Methods: 106 women were classified into preeclampsia group (n = 40) and normotensive group (n = 66). NO content was measured in the serum. Clinical and laboratorial data were recorded for comparison. Results: Preeclampsia presented a significant increase in nitrate and NOx levels compared to the control group. Uric acid, gestational age, systolic and diastolic blood pressure, and creatinine showed correlation with nitrates and NOx. Conclusion: Increase of NO was observed in preeclampsia women. Failure in the mechanism of action, dependent on cyclic GMP, may justify this finding.     

Levels of agreement between clinical examination and transabdominal ultrasound evaluation of fetal head position in the second stage of labor

Aim: To compare transvaginal digital examination performed by residents and attending physicians to transabdominal suprapubic ultrasound in the evaluation of fetal head position in the second stage of labor.

Methods: A prospective study was conducted at a tertiary center and included pregnant women at term, with normal singleton cephalic presentation fetuses. All patients had ruptured membranes and were evaluated during the second stage of labor. Fetal head position was assessed consecutively by two clinicians (one resident and one attending physician). Afterwards, transabdominal suprapubic ultrasound was performed by another observer. Examiners were blinded to each other’s findings. Cohen’s kappa test was used to assess the degree of agreement between the evaluation methods.

Results: One-hundred sixty-one women were included. Transvaginal examination was consistent with the ultrasound in 45.0% of cases (95% CI: 37–53%) when the examination was performed by residents (k?=?0.349) and in 67% (95% CI: 60–74%) if the attending physician carried out the evaluation (k?=?0.604). When considering only the anterior positions, the Cohen’s kappa test was 0.426 and 0.709, respectively.

Conclusion: Transabdominal suprapubic ultrasound improved the accuracy of the evaluation of fetal head position, namely when transvaginal digital examination was performed by residents. This may be important especially when instrumental deliveries are considered.     

Effector memory CD4+ T cells differentially express activation associated molecules depending on the duration of American cutaneous leishmaniasis lesions

A high number of Leishmania‐responder T cells is found in cutaneous leishmaniasis lesions, suggesting that important immunological events occur at the site of infection. Although activated, cytotoxic and regulatory T cells infiltrating into lesions may influence disease pathogenesis, the role of the T cell differentiation pattern of lymphocytes in lesions is unknown. Our aim was to investigate whether the phase of lesion development (early or late) is influenced by the functional status of cells present in inflammatory infiltrate. Activation, cytotoxity and T cell differentiation molecules were evaluated in lesion mononuclear cells by flow cytometry. The frequency of T cells was correlated with the lesion area (r = 0·68; P = 0·020). CD4⁺CD25⁺ T cells predominated over CD4⁺CD69⁺ T cells in early lesions (less than 30 days), whereas late lesions (more than 60 days) exhibited more CD4⁺CD69⁺ T cells than CD4⁺CD25⁺ T cells. The duration of illness was correlated positively with CD4⁺CD69⁺ (r = 0·68; P = 0·005) and negatively with CD4⁺CD25⁺ T cells (r = ?0·45; P = 0·046). Most CD8⁺ T cells expressed cytotoxic‐associated molecules (CD244⁺), and the percentages were correlated with the lesion area (r = 0·52; P = 0·04). Both CD4⁺ and CD8⁺ effector memory T cells (T_EM‐CD45RO⁺CCR7^–) predominated in CL lesions and were significantly higher than central memory (T_CM‐CD45RO⁺CCR7⁺) or naive T cells (CD45RO^–CCR7⁺). An enrichment of T_EM cells and contraction of naive T cells were observed in lesions in comparison to blood (P = 0·006) for both CD4⁺ and CD8⁺ T cells. Lesion chronicity is associated with a shift in activation phenotype. The enrichment of T_EM and activated cytotoxic cells can contribute to immune‐mediated tissue damage.