Prenatal diagnosis of chorionicity in twins

The aim of this audit was to assess the accuracy of transabdominal ultrasound scan in predicting chorionicity in twin pregnancies in our unit. The presence or absence of lambda sign, T-sign, dividing membrane thickness and number of placentae were used to determine chorionicity. We retrospectively analysed these antenatal markers in 268 sets of twins delivered over a 5 year period and compared it with the postpartum placental histology and neonatal gender. Of 268 twin deliveries, 204 (76%) had both chorionicity and placental histology to compare. 67 of 84 (80%) were correctly diagnosed antenatally as monochorionic and 137 of 151 (91%) as dichorionic. In 31 cases (15%) the ultrasound diagnosis of chorionicity didn't match placental histology. Seventeen were thought to be monochorionic antenatally but were confirmed dichorionic on placental histology. Overall chorionicity was correctly diagnosed in 171/204 (84%) using transabdominal ultrasound scan (USS) in all trimesters. However the sensitivity and specificity of USS was much higher for dichorionic twins when carried out before 14 weeks of gestation.

Thoraco-amniotic shunting for fetal pleural effusion--a case series

Fetal pleural effusion is a rare occurrence, with an incidence of 1 per 10-15,000 pregnancies. The prognosis is related to the underlying cause and is often poor. There is increasing evidence that in utero therapy with thoraco-amniotic shunting improves prognosis by allowing lung expansion thereby preventing hydrops and pulmonary hypoplasia. This is a review of all cases of fetal pleural effusion managed over an eight year period the National Maternity Hospital Dublin. Over the nine year period there were 21 cases of fetal pleural effusion giving an overall incidence of 1 per 9281 deliveries. Of these, 15 underwent thoraco-amniotic shunting. There were associated anomalies diagnosed in 5 (33%) of cases. The overall survival in our cohort was 53%. The presence of hydrops was a poor prognostic factor, with survival in cases with hydrops of 33% (3/9) compared to 83% (5/6) in those cases without associated hydrops.

Successful fetoscopic laser coagulation for twin-to-twin transfusion syndrome under local anaesthesia

A review of the efficacy and outcome of fifteen fetoscopic laser ablations under local anaesthesia for twin to twin transfusion syndrome (TTTS) in the National Maternity Hospital Dublin was undertaken. The mean gestation at laser was 19.7 weeks (range 16-25 weeks) with a mean gestation at delivery of 29.1 weeks (range 20-35 weeks). The overall liveborn birth rate was 79% (22 infants) and one pregnancy was still ongoing. There were four neonatal deaths secondary to complications of prematurity. The surviving eighteen infants (64%) undergo regular paediatric review. The procedure was performed successfully in all cases with local anaesthesia. In no case was there maternal discomfort that warranted the procedure to be abandoned and good visual access of the vascular anastamoses was obtained in all cases. Local anaesthesia therefore offers a safe effective anaesthetic option for fetoscopic laser coagulation in monochorionic pregnancies complicated by TTTS.

Maternal post natal hospital readmission-trends and association with mode of delivery

The aim of this study is to examine the trend in maternal postnatal readmission within six weeks of discharge from childbirth hospitalisation. It is a retrospective review of the maternity computer records system, patient's clinical notes and HIPE data base. All women who delivered babies weighing > 500 g and/ > or = 24 weeks gestational age at Our Lady of Lourdes Hospital, Drogheda, Ireland from 1st January 2005 to 31st December 2008 who were re-hospitalised within six weeks of discharge from hospital following child birth were included in the study. A total of 15782 women were delivered over the four year study period. Of these, 236 were readmitted. A series of chi-square analysis were conducted to assess the difference in readmission rates between the year 2008 86 (2.03%) and the years 2005-51(1.46%), 2006-39 (1.01%) and 2007-60 (1.42%). The readmission rate was found to be significantly higher in 2008 compared with the three preceding years. Complications of Caesarean section and secondary postpartum haemorrhage following spontaneous vaginal delivery constitute the major indications for readmission.

Practices for predicting and preventing preterm birth in Ireland: a national survey

BACKGROUND

Preterm birth can result in adverse outcomes for the neonate and/or his/her family. The accurate prediction and prevention of preterm birth is paramount. This study describes and critically analyses practices for predicting and preventing preterm birth in Ireland.

METHODS

A questionnaire seeking information on practices for predicting and preventing preterm birth was mailed to all consultant obstetricians practising in Ireland in February 2006.

RESULTS

For predicting preterm birth, 97% of respondents did not use foetal fibronectin testing, 71% carried out routine second and third trimester cervical assessments and 75% routinely screened for genital tract infection. For preventing preterm birth, 62% prescribed bed rest, 24% prescribed antibiotics, 14% routinely inserted a cervical cerclage in women with a history of mid-trimester miscarriage and 61% routinely used tocolytics.

CONCLUSION

The findings of this survey, for the most part, reflect the empirical evidence base, international practices and best practice recommendations.

Erythrocyte fatty acid composition and insulin sensitivity in daughters of Type 2 diabetic patients and women with no family history of diabetes

BACKGROUND

There is evidence that the impact of environmental factors on insulin sensitivity is modified by the presence of family history of diabetes.

AIM

To compare the association between the erythrocyte phospholipid fatty acid composition (a biomarker of dietary fatty acids) and insulin sensitivity in daughters of Type 2 diabetic patients with the corresponding association in women without family history of diabetes.

MATERIAL/SUBJECTS AND METHODS

Eighteen offspring of Type 2 diabetic patients [age 30+/-6.5 yr; body mass index (BMI) 22.2+/-2.5 kg/m2; body fat 31.8+/-5.1%] and 18 matched women (age 30.1+/-6.8 yr; BMI 22.2+/-1.8 kg/m2; body fat 32.2+/-6.0%) participated in the study.

RESULTS

Insulin Sensitivity Index (ISI)-Matsuda tended to be lower (p=0.06) in the Offspring than the control group. Weight proportions of erythrocyte phospholipid saturated (SFA), polyunsaturated (PUFA), and monounsaturated fatty acids (MUFA) were similar between the two groups. In the offspring, erythrocyte total SFA were negatively correlated with ISI-Matsuda [r=-0.47, p<0.05), ISI(gly)-Belfiore (r=-0.52, p<0.05) and ISI(ffa)-Belfiore (r=-0.53, p<0.05)], whereas total PUFA were positively correlated with insulin sensitivity [ISI-Matsuda, r=0.46, p<0.05; ISI(gly)-Belfiore, r=0.53, p<0.05; ISI(ffa)-Belfiore, r=0.54, p<0.05]. No significant correlations were observed in the control group.

CONCLUSIONS

The associations between erythrocyte fatty acid composition and insulin sensitivity are distinct between daughters of Type 2 diabetic patients and women without family history of diabetes.

Preparation and evaluation of microspheres prepared from novel polyester-ibuprofen conjugates blended with non-conjugated ibuprofen

A novel polyester, poly(glycerol-adipate-co-omega-pentadecalactone) (PGA-co-PL), was conjugated with a model drug, ibuprofen, through the free hydroxyl groups of the former and the free carboxyl group of the latter at various levels of substitution. The conjugated material was processed into microspheres by both emulsion solvent evaporation and spray-drying methods. Samples of conjugated material were also blended with non-conjugated drug and the microspheres produced were evaluated by various methods. Morphologically, the microspheres produced were satisfactory. However, there was some initial burst drug release from all samples, probably due to the presence of non-conjugated drug. Subsequent drug release was very slow due to the relative stability of the covalent bonding of the drug-polyester conjugate. Stability tests showed that storage at high relative humidity resulted in increased burst release.

Fibroblast growth factor 2 reactivates G1 checkpoint in SK-N-MC cells via regulation of p21, inhibitor of differentiation genes (Id1-3), and epithelium-mesenchyme transition-like events

We have recently demonstrated that fibroblast growth factor (FGF)-2 promotes neuroblastoma cell differentiation and overrides their mitogenic response to IGF-I. However, the mechanisms involved are unknown. SK-N-MC cells were cultured with FGF-2 (50 ng/ml) and/or IGF-I (100 ng/ml) up to 48 h. Fluorescence-activated cell sorting analysis indicated that FGF-2 promotes G1/G0 cell cycle phase arrest. Gene expression by RT2-PCR and cellular localization showed up-regulation of p21. We then investigated whether FGF-2-induced differentiation of SK-N-MC cells (by GAP43 and NeuroD-6 expression) involves epithelium-mesenchyme transition interconversion. Real-time PCR (RT2-PCR) showed modulation of genes involved in maintenance of the epithelial phenotype and cell-matrix interactions (E-cadherin, Snail-1, MMPs). Zymography confirmed FGF-2 up-regulated MMP2 and induced MMP9, known to contribute to neuronal differentiation and neurite extension. Id1-3 expression was determined by RT2-PCR. FGF-2 induced Id2, while down-regulating Id1 and Id3. FGF-2 induced nuclear accumulation of ID2 protein, while ID1 and ID3 remained cytoplasmic. RNA interference demonstrated that Id3 regulates differentiation and cell cycle (increased Neuro-D6 and p21 mRNA), while d Id2 modulates epithelium-mesenchyme transition-like events (increased E-cadherin mRNA). In conclusion, we have shown for the first time that FGF-2 induces differentiation of neuroblastoma cells via activation of a complex gene expression program enabling modulation of cell cycle, transcription factors, and suppression of the cancer phenotype. The use of RNA interference indicated that Id-3 is a key regulator of these events, thus pointing to a novel therapeutic target for this devastating childhood cancer.

Effect of advice to increase carbohydrate and reduce fat intake on dietary profile and plasma lipid concentrations in healthy postmenopausal women

BACKGROUND

The current dietary guidelines advise an increase in carbohydrate intake. However, there is concern regarding the effect this may have on coronary heart disease (CHD) risk, in particular in postmenopausal women, in light of the knowledge that raised triacylglycerol (TAG) may pose a stronger risk for CHD in this group.

AIM

To evaluate the effect of advice to increase carbohydrate intake to 50% of energy intake as part of advice to follow current dietary guidelines on the dietary profile, including dietary glycaemic index (GI) and plasma lipids in healthy postmenopausal women.

METHODS

Twelve healthy postmenopausal women (56 +/- 6.5 years) took part in the study. Habitual diet was assessed by a 7-day weighed intake. On the basis of the results, subjects were advised to increase their carbohydrate intake to comply with the current dietary guidelines. Subjects were asked to follow this diet for 4 weeks, in a free-living situation. Fasting blood samples were obtained at baseline and after 1 and 4 weeks.

RESULTS

There was a significant decrease in body mass index (BMI; p < 0.05) after 4 weeks. There was a significant increase in fasting TAG concentrations after 1 week (p < 0.05), and the high-density lipoprotein (HDL) cholesterol concentration was significantly decreased (p < 0.05) after 1 and 4 weeks. The subjects significantly increased their percentage of energy from carbohydrates and starch (p < 0.05 and p < 0.01, respectively) after 1 week, and their percentage of energy from starch after 4 weeks (p < 0.05). Dietary GI was significantly increased (p < 0.05) after 1 and 4 weeks. Fruit and vegetable intake was significantly increased after 1 week (p < 0.01), as was fruit intake alone (p < 0.05), and there was a significant increase (p < 0.05) in the 'antioxidant power' as measured by the ferric reducing ability of plasma assay.

CONCLUSION

In postmenopausal women, following the UK dietary guidelines resulted in changes in the lipid profile that were more likely to favour an increased risk of CHD, as TAG concentrations were increased and HDL cholesterol concentrations were reduced. However, in addition, we found a significant reduction in BMI and a significant increase in the 'antioxidant power' of plasma, which should benefit health.

Dental injury during seizures associated with juvenile myoclonic epilepsy

BACKGROUND

Patients can sustain injuries during seizures and the pattern and type of injury (eg, tongue biting) can be a useful silent witness in the diagnosis of seizures. In addition, the seizure type potentially influences the type of injury.

METHODS

Patients with dental injury were identified from the Gloucestershire Epilepsy Database (n = 1673). These patients' notes were reviewed and the following data collected: demographic data; seizure types and age of onset; injury; EEG; and MRI.

RESULTS

14 people had dental injuries: 10 incisors (seven had >1 incisor) and five other teeth. Eight had juvenile myoclonic epilepsy (JME), two other primary generalised epilepsy and four focal onset epilepsy. Compared with the rest of the database population (JME; n = 81) there was a highly significant association of dental injury with JME (p<0.0001).

CONCLUSIONS

Incisor injury is rare but appears to be associated with JME in patients with epilepsy, presumably reflecting the pattern of seizure onset. This pattern of injury should prompt consideration of this diagnosis. It is hoped that recognition of this can both facilitate earlier diagnosis and help educate patients to protect their teeth.

Synthesis and evaluation of novel polyester-ibuprofen conjugates for modified drug release

Ibuprofen was conjugated at different levels to a novel polyester, poly(glycerol-adipate-co-omega-pentadecalactone) (PGA-co-PL), via an ester linkage to form a prodrug. The conjugates were characterized by differential scanning calorimetry (DSC), nuclear magnetic resonance (NMR), infrared (IR), gel permeation chromatography (GPC), ultraviolet (UV), and high-performance liquid chromatography (HPLC). The conjugates had a molecular weight between 18 and 24 kDa, and there was a suppression of the free hydroxyl groups within the conjugated polymer. DSC scans showed a lowering of the melting point (T(m)) when compared with the polyester alone and a difference in the number and area of T(m) peaks. Drug release studies showed an initial burst release (13-18%) followed thereafter by very slow release (maximum 35% after 18 days). Continuous work may produce ester-linked conjugates that are sufficiently labile to allow for complete release of ibuprofen over the time period studied.

Intimate partner violence: how does it impact major depressive disorder and post traumatic stress disorder among immigrant Latinas?

Intimate Partner Violence (IPV) is prevalent in the general US population, as well as the Latino community. In a cross-sectional study at an immigrant, primary care clinic, we assessed the correlation between IPV history and symptoms of MDD and PTSD in Latino women. We used a structured interview format. Among the 105 women recruited, the 4-week incidence of MDD was 45.7% and the prevalence of PTSD was 19%. Abused women had three times the odds of meeting PTSD criteria than non-abused women. Women meeting PTSD criteria were 10 times likelier to also report MDD. There was no difference in the incidence of MDD among women who reported IPV and those who did not. This study found a correlation of IPV with PTSD, and PTSD with MDD, but not IPV with MDD. Our results indicate a need for mental health interventions in primary care settings for Latina women regardless of IPV history.