Ratio In Pregnant Women Research Articles

Blood pressure, Alkaline Phosphstase, serum Globulin, A: G ratio in pregnant women and matched controls in a population with tapioca as staple food

Background: Tapioca has been the staple food for the people of Kerala, India. Recent studies show that it has become more toxic due to changes in environment. There have been few studies in recent years to observe the effects of consuming more toxic tapioca. Objective: The combination of pregnancy and tapioca diet on blood pressure (BP), serum alkaline phosphatase, serum globulin and A:G ratio are studied to assess the general health and liver function. Materials and Methods: A descriptive cross-sectional study design was conducted in the Obstetrics out-patient department of a tertiary care hospital of central Kerala. The systolic and diastolic blood pressures were determined. The serum alkaline phosphatase, total proteins, and serum albumin levels were tested in a sample of blood collected under aseptic conditions. The serum globulin values were calculated from total protein and serum albumin values by subtraction. The A:G values were calculated by dividing the values of serum albumin and serum globulin. This study was conducted after obtaining ethical clearance from the institute. Result: There were significant differences (p = 0.002) in the mean values of systolic and diastolic blood pressure in the third-trimester pregnancy. There was significant difference in the mean value of serum alkaline phosphatase levels in the first trimester (p = 0.007), the second trimester (p = 0.001) and the third trimester (p = 0.000001). There was significant difference in the mean value of serum globulin in the first trimester (p = 0.03), the second trimester (p = 0.0003), and the third trimester (0.000008). The A:G ratio showed significant difference in the first trimester (p = 0.0003), the second trimester (p = 0.0001), and the third trimester (p = 0.001). Conclusion: The above study shows that there is significant decrease in systolic and diastolic blood pressure towards the third trimester compared to normal controls. This is comparable to other similar studies. The alkaline phosphatase levels are also comparable with the values obtained in other studies. The serum globulin values were also comparable to other similar studies. The decreasing A:G ratio values were unique to this population.

Urinary protein-to-creatinine ratio in pregnant women after dipstick testing: prospective observational study.

BackgroundThe dipstick test is widely used as a primary screening test for detection of significant proteinuria in pregnancy (SPIP). However, it often shows a false positive test result. This study was performed to determine which pregnant women should be recommended to undergo determination of urinary protein-to-creatinine ratio (mg/mg, P/Cr test) after dipstick test for confirmation of SPIP.MethodsThis was a multicenter, prospective, and observational study of 2212 urine specimens from 1033 pregnant women who underwent simultaneous dipstick and P/Cr tests in the same spot urine samples at least once. SPIP was defined as P/Cr > 0.27. Preeclampsia was diagnosed in women with both hypertension and SPIP.ResultsPreeclampsia, hypertension alone, and SPIP alone developed in 202 (20 %), 73 (7.1 %), and 120 (12 %) women, respectively. Creatinine concentration [Cr] varied greatly, ranging from 8.1 to 831 mg/dL in the 2212 urine samples. Rate of positive dipstick test results increased with increasing [Cr], while SPIP prevalence rate was lower in urine samples with higher [Cr], yielding higher false positive rates in samples with higher [Cr]. Postpartum urine samples had significantly lower [Cr] compared to those obtained antepartum (60 [8.7–297] vs. 100 [10–401] mg/dL, respectively). At the first P/Cr test among women with similar dipstick test results, the risk of having SPIP was consistently and significantly higher for hypertensive women than for normotensive women at any dipstick test result: 18 % (14/77) vs. 3.2 % (8/251), 47 % (26/55) vs. 8.7 % (37/425), 91 % (82/90) vs. 59 % (44/75) for negative/equivocal, 1+, and ≥ 2+ test results, respectively. The risk of SPIP was 16 % (9/55) for normotensive women when two successive antenatal urine samples showed a dipstick test result of 1 + .ConclusionsFor prediction of SPIP, the dipstick test was more likely to show a false positive result in concentrated urine samples with higher [Cr]. Hypertensive women with ≥ 1+ as well as normotensive women with ≥ 2+ on dipstick test should be advised to undergo the P/Cr test.

The role of recent thymic emigrant-regulatory T-cell (RTE-Treg) differentiation during pregnancy.

During pregnancy, regulatory T cells (Tregs) have a key role in maternal immune tolerance to the semi-allogeneic fetus. Our previous results showed that the naive CD45RA(+)-Treg pool is functionally improved in pregnant women compared with non-pregnant women. Therefore, we examined the thymic output and differentiation of CD45RA(+)CD31(+) recent thymic emigrant (RTE)-Tregs during normal pregnancy and in the presence of preeclampsia. With the onset of pregnancy, the composition of the total CD4(+)CD127(low+/-)FoxP3(+)-Treg pool changed in the way that its percentage of RTE- and CD45RA(-)CD31(+)-memory Tregs decreased strongly, whereas that of the CD45RA(+)CD31(-)-mature naive (MN)-Tregs did not change and that of the CD45RA(-)CD31(-)-memory Tregs increased complementary. Thereby, the ratio of RTE-/MN-Tregs decreased from 1.0 to 0.7 leading to a significant increase in the suppressive activity of the naive CD45RA(+)-Treg pool. This effect was confirmed by re-assembling separated RTE- and MN-Tregs from non-pregnant women in the ratio of pregnant women. The suppressive activity of both separated naive Treg subsets was equally high in non-pregnant and pregnant women, but considerably reduced in preeclampsia patients, who showed significantly increased percentages of CD45RA(-)CD31(+)-memory Tregs, but decreased percentages of RTE- and MN-Tregs. Our results suggest a reduced thymic output of RTE-Tregs during pregnancy, which causes a decrease in the ratio of RTE-/MN-Tregs and thus an increase in the differentiation of RTE-Tregs towards CD45RA(-)CD31(-)-memory Tregs. Presumably, this differentiation of RTE-Tregs, which was impaired in preeclampsia patients, ensures the improved suppressive activity of the CD45RA(+)-naive Treg pool and thus retains the maintenance of pregnancy.

Effects of Selenium Supplementation on Soluble FMS-Like Tyrosine Kinase-1 and Glutathione Peroxidase Levels and the Plasminogen Activator Inhibitor-1: Plasminogen Activator Inhibitor-2 Ratio in Pregnant Women

Background: Preeclampsia is a hypertensive disorder of pregnancy, which is associated with increased maternal and prenatal morbidity and mortality. Oxidative stress associated with preeclampsia may be a consequence of reduced antioxidant defense pathways that might involve inadequate glutathione peroxidase (GPx) levels, perhaps linked to reduced selenium availability. The soluble FMS-like tyrosine kinase-1 (sFlt-1) that contributes to endothelial dysfunction may be partially responsible for the clinical manifestation of preeclampsia. Furthermore, elevated plasminogen activator inhibitor-1 (PAI-1) and decreased plasminogen activator inhibitor-2 (PAI-2) are found in preeclamptic women. Hence, the PAI1: PAI2 ratio maybe a predictor of preeclampsia. Objectives: The objective of this study was to evaluate the effects of selenium supplementation on sFlt-1, GPx activity and PAI1: PAI2 ratio in pregnant women. Materials and Methods: A total of 125 high-risk pregnant women (with a familial history of hypertension, hyperlipidemia and other risk factors for preeclampsia) in the first trimesters of pregnancy were assigned to either selenium (n = 61) or placebo (n = 64) groups. The selenium group received 100 μg/day of selenium as a selenium-yeast tablet for six months. The placebo group received a placebo yeast tablet for the same period. At the beginning of the trial and at the end, blood samples were collected and the levels of sFlt-1, PAI-1, PAI2 and GPx were measured in blood serum and plasma. Results: Serum selenium concentrations were raised in the selenium group (P < 0.001) from the first to the third trimester, but was unchanged in the placebo group (P = 0.85). The results showed that sFlt-1 had significantly increased in both groups by the end of the gestation period, and selenium supplementation had no significant effect on the selenium group (P = 0.51). However, GPx activity was significantly increased in the selenium treatment group after supplementation compared to the control group (P < 0.001). The PAI1: PAI2 ratio was not significantly different between the two groups (P = 0.44). Conclusions: Selenium intake during the second and third trimester of pregnancy increased GPx activity but did not have a significant effect on serum sFlt-1 levels or the ratio of PAI1: PAI2 in the serum.

Study of Plasma Metanephrine Level As Biochemical Parameter in Pregnant Women with Preeclampsia

Pregnancy- including hypertension(PIH), also known as preeclampsia, is one of the major causes of maternal and fetal death. This study was carried out on 30 pregnant women with preeclampsia and 30 healthy pregnant women as control ranging in age mean ±SD (28.84±3.55) years , BMI (76.80±9.78) Kg/m2 and gestation age(30.82±0.75)week. The aim of this research was studied the plasma Metanephrine level and other biochemical parameters such as Hemoglobin(Hb), serum Protein, S. Albumin, Globulin, Albumin/Globulin ratio (Alb/Glu. ratio), S.Glutamate Pyruvate aminotransferase (GPT), S.Glutamate Oxaloacetate aminotransferase(GOT). The obtained results have been compared with 30 healthy pregnant women as control group. The result showed that there was significant increase in mean value of Hb in group A(pregnant women with preeclampsia) when compared to group B(healthy pregnant women). The present study showed no significant changes was observed in the level of S. Protein, globulin, Alb./Glu. ratio, GPT and GOT as compared to control group. While Albumin showed a significant decrease in group A(pregnant women with preeclampsia) when compared with group B(healthy pregnant women) and significant increase in the levels of metanephrine, metanephrine/protein ratio, metanephrine/Alb ratio in group A (pregnant women with preeclampsia) to group B(healthy pregnant women).The present study conclude that the increase in the levels of metanephrine, metanephrine/protein ratio, metanephrine/Alb ratio in pregnant women with preeclampsia may be used as a marker to evaluate the development of disease. The current study recommend to take more case and measurement metanephrine in plasma and urine.

Study of Plasma Metanephrine Level As Biochemical Parameter in Pregnant Women with Preeclampsia

Pregnancy- including hypertension(PIH), also known as preeclampsia, is one of the major causes of maternal and fetal death. This study was carried out on 30 pregnant women with preeclampsia and 30 healthy pregnant women as control ranging in age mean ±SD (28.84±3.55) years , BMI (76.80±9.78) Kg/m2 and gestation age(30.82±0.75)week. The aim of this research was studied the plasma Metanephrine level and other biochemical parameters such as Hemoglobin(Hb), serum Protein, S. Albumin, Globulin, Albumin/Globulin ratio (Alb/Glu. ratio), S.Glutamate Pyruvate aminotransferase (GPT), S.Glutamate Oxaloacetate aminotransferase(GOT). The obtained results have been compared with 30 healthy pregnant women as control group. The result showed that there was significant increase in mean value of Hb in group A(pregnant women with preeclampsia) when compared to group B(healthy pregnant women). The present study showed no significant changes was observed in the level of S. Protein, globulin, Alb./Glu. ratio, GPT and GOT as compared to control group. While Albumin showed a significant decrease in group A(pregnant women with preeclampsia) when compared with group B(healthy pregnant women) and significant increase in the levels of metanephrine, metanephrine/protein ratio, metanephrine/Alb ratio in group A (pregnant women with preeclampsia) to group B(healthy pregnant women).The present study conclude that the increase in the levels of metanephrine, metanephrine/protein ratio, metanephrine/Alb ratio in pregnant women with preeclampsia may be used as a marker to evaluate the development of disease. The current study recommend to take more case and measurement metanephrine in plasma and urine.

Identification of predictive marker of prerenal damage in pregnant women with Preeclampsia and women at high risk- A Prospective study conducted in Riyadh,Saudi Arabia

Background: Preeclampsia is characterized by development of high blood pressure and proteinuria. It affects 5–8% of all pregnancies and is a major contributor to maternal and fetal morbidity and mortality. There is no single test that fulfils all the criteria for a good predictor of preeclampsia and associated renal damage. Aims & Objectives: To evaluate the role of serum and urine biochemical parameters as early predictors of preeclampsia. To investigate the role of BUN: Creatinine ratio in diagnosing preeclampsia and evaluating prognosis of the disease. Material and Methods: In the present prospective study, one hundred and twenty pregnant women divided into three groups: normotensive (control), women at high risk and with preeclampsia were included. Analyses of different biochemical parameters including BUN: Creatinine were carried out. Results: There was significant difference in the mean value of serum uric acid, blood urea nitrogen, creatinine, urinary protein and BUN: Creatinine ratio in preeclampsia group compared to control group (p < 0.001). There was significant difference (p < 0.05) in serum uric acid between control and preeclampsia group. However, there was no significant change in haematocrit, serum creatinine and urine protein between control and high risk group. Conclusion: BUN: Creatinine ratio in pregnant women with preeclampsia and also in high risk group was significantly increased (t = 15.55, p < 0.001 and t = 8.66, p < 0.001 respectively) in comparison to the control group. This index could be useful in evaluating the severity of preeclampsia and could be used as a predictor in prognosis of preeclampsia and subsequent early renal disease.

Blood urea nitrogen/creatinine index is a predictor of prerenal damage in preeclampsia

Introduction: Preeclampsia is a disease whose etiology is not very clearly explained. The aim of this study was to investigate the importance of blood urea nitrogen (BUN)/creatinine ratio in diagnosing preeclampsiaand evaluating prognosis.Methods: The patients in this research were examined and diagnosed in the Department of Obstetrics and Gynecology, University Clinical Centre of Kosovo. Control group included 25 pregnant women with a normalblood pressure and with a gestational age of more than 20 weeks, whereas the investigation group included 25 women diagnosed with preeclampsia. The patients were not administered therapy four days before the examination. For the determination of biochemical parameters we used end point bichromatic enzymatic rate and enzymatic conductivity rate.Results: BUN/Creatinine index in the preeclamptic group was 19±7.7, uric acid 280±70 μmol/L, lactate dehydrogenase198±63 U/L, while the number of platelets was 195±5061 x 109/L. In control group BUN/Creatinine index was 12±3, lactate dehydrogenase was 165±57 U/L, uric acid 197±79 μmol/La and the platelet numberwas 243±61 x109/L. Albumin/Globulin index in the preeclamptic group was 0.8±0.12, whereas in the control group it was 0.9±0.16.Conclusions: BUN/Creatinine ratio in pregnant women with preeclampsia was significantly increased (t=-4.14; p=0.00013) in comparison to the control group. It indicates the prerenal source of azotemia. This indexcan be important for the evaluation of preeclampsia severity.

Hair Nicotine: Cotinine Metabolic Ratio in Pregnant Women: A New Method to Study Metabolism in Late Pregnancy

A large number of smoking women cannot quit their habit when they become pregnant. Preliminary evidence suggests an enhanced nicotine clearance rate in late pregnancy. To evaluate the change in nicotine metabolism in late pregnancy, we undertook a prospective cohort study of a large, diverse group of pregnant women recruited from four Montreal maternal hospitals. Smoking histories were obtained by structured questionnaires administered at 24 to 26 weeks of gestation and postpartum. Hair concentrations of nicotine and cotinine were measured by immunoassays for each trimester based on sectioning the hair and assuming average hair growth of 1 cm per month. A strong correlation was observed between average number of cigarettes smoked per day and hair nicotine and cotinine in all three trimesters. A significant decrease in hair nicotine was observed among steady smokers from the first to third trimester paralleled by a significant increase in hair cotinine. The ratio of hair nicotine:cotinine decreased significantly from the first to the third trimester. Increased nicotine metabolism in late pregnancy results in lower systemic exposure to nicotine. This phenomenon may explain why many pregnant women feel the urge to continue smoking and why standard-dose nicotine replacement therapy has not been effective in reducing smoking during pregnancy in several clinical trials.

Urine albumin/creatinine ratio for the assessment of albuminuria in pregnancy hypertension

An accurate method to assess albuminuria in pregnancy is mandatory to diagnose pre-eclampsia. Twenty-four-hour urine collection is still the only universally accepted method. This is, however, a cumbersome and inconvenient method. Therefore, the present study aimed at assessing the accuracy of a spot urine albumin/creatinine ratio in pregnant women with hypertension. In 54 pregnant women with blood pressure >or=140/90 mmHg, 24-h albumin excretion and subsequent albumin/creatinine ratio on morning spot urine were analyzed in the individual patients. Altogether 75 paired samples were included. Receiver operating characteristic curves, relating different albumin/creatinine ratio cut-off values to 24-h albumin excretion >300 mg were constructed. Correlations were assessed by Spearman rank correlation tests. The area under the receiver operating characteristic curve was 0.985. At the optimal cut-off albumin/creatinine ratio value of 27 mg/mmol the sensitivity, specificity, positive and negative predictive value for detecting albuminuria >300 mg/24 h were: 95, 100, 100 and 86% respectively. There was a close correlation between albumin/creatinine ratio and 24-h albumin excretion values (r=0.95; p<0.001). It is suggested that in most cases the more cumbersome 24-h urine collection can be replaced by the more convenient albumin/creatinine ratio on spot urine.

High Mortality Associated with an Outbreak of Hepatitis E among Displaced Persons in Darfur, Sudan

Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan. We reviewed hospital records. A sample of 20 clinical cases underwent laboratory confirmation. These patients were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody to HEV (serum) and for amplification of the HEV genome (serum and stool). We performed a cross-sectional survey in the community to determine the attack rate and case-fatality ratio in pregnant women. Over 6 months, 253 HEV cases were recorded at the hospital, of which 61 (24.1%) were in pregnant women. A total of 72 cases (39.1% of those for whom clinical records were available) had a diagnosis of hepatic encephalopathy. Of the 45 who died (case-fatality ratio, 17.8%), 19 were pregnant women (specific case-fatality ratio, 31.1%). Acute hepatitis E was confirmed in 95% (19/20) of cases sampled; 18 case-patients were positive for IgG (optical density ratio > or =3), for IgM (optical density ratio >2 ), or for both, whereas 1 was negative for IgG and IgM but positive for HEV RNA in serum. The survey identified 220 jaundiced women among the 1133 pregnant women recorded over 3 months (attack rate, 19.4%). A total of 18 deaths were recorded among these jaundiced pregnant women (specific case-fatality ratio, 8.2%). This large epidemic of HEV infection illustrates the dramatic impact of this disease on pregnant women. Timely interventions and a vaccine are urgently needed to prevent mortality in this special group.

The Relationship of Maternal Iodine Status and Neonatal Thyrotropin Concentration: A Study in Southern Thailand

Iodine deficiency disorder (IDD) is a global health problem. Previous studies in Southern Thailand have shown that the prevalence of goiter in schoolchildren is 3-5%, indicating that Southern Thailand is an iodine sufficient area. We conducted a study in pregnant women to determine their iodine status and whether there was an association between maternal urinary iodine excretion (UIE) and the neonatal thyrotropin (TSH) concentration. We recruited 244 pregnant women attending the antenatal clinic at Songklanagarind Hospital. Their mean age was 28.5 +/- 5.3 years (range 15-42) with a mean gestation age of 9.4 +/- 2.7 weeks (range 6-15). Ten ml urine was collected for UIE measurement. All women were delivered at Songklanagarind Hospital. The mean gestational age at delivery was 38.2 +/- 2.1 weeks (range 28-41). The median maternal UIE was 139.5 microg/l with 78 (32%) women having UIE below 100 microg/l. The median TSH of the infants was 4.14 mIU/l (range 0.30-17.89) with 88 (36.1%) of infants having TSH concentration above 5 mIU/l. Logistic regression analysis revealed that the odds ratio of pregnant women with UIE below 100 microg/l giving birth to infants with neonatal TSH above 5 mIU/l was 2.04 (95% confidence interval 1.17-3.66, p = 0.012). In conclusion, our findings demonstrate that 32% of pregnant women have UIE below 100 microg/l, and that UIE below 100 microg/l in pregnant women is associated with neonatal TSH concentration above 5 mIU/l. These findings suggest that iodine deficiency is prevalent in pregnant women in Southern Thailand.

Interaction between Polymorphisms MTHFR C677T and MTRR A66G and Vitamin Levels in Pregnant Women.

In the homocysteine metabolic pathway, several key enzymes, including methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR), have been implicated in abnormal homocysteine accumulation in the presence of rare alleles. In previous study, we showed that lower maternal Cbl levels were associated with higher tHcy and lower S-adenosylmethionine/S-adenosylhomocysteine ratio in pregnant women and their neonates.The aim of this study is to investigate whether MTHFR and MTRR polymorphisms are involved in the risk for elevated total homocysteine (tHcy) and its interaction with low cobalamin (Cbl) or serum folate (SF) levels. Genotypes for polymorphisms MTHFR C677T and MTRR A66G were determined by PCR-FLRP. The serum levels of Cbl, SF and tHcy were determined in 377 pregnant women (37–42 weeks of gestational age), and cutoff values for Cbl and SF were considered the first quartile (low values). Four models of univariate logistic regression analyses were used (Table 1). Pregnant women with MTHFR 677T allele have high risk for elevated tHcy that is increased when 677T allele is associated with low Cbl. Increased risk for elevated tHcy is also met when MTRR 66G allele and low Cbl levels were associated. Women with low SF and common MTHFR and MTRR alleles have high risk for elevated tHcy, that is increased when in association with 677T allele or with 66G allele.Interaction between MTHFR C677T and MTRR A66G polymorphisms and vitamins levels in pregnant womenDependent variablesComparation levels (N)P valueOdd Ratios95% CItHcy>8.3μmol/LMTHFR 677CC genotype and Cbl> 115.8 pmol/L (ref) (136) a1.00MTHFR 677CC genotype and≤Cbl 115.8 pmol/L (45)0.2981.570.67 – 3.63MTHFR 677CT and 677TT genotypes and Cbl>115.8 pmol/L (145)0.0152.091.16 – 3.77MTHFR 677CT and 677TT genotypes and≤Cbl 115.8 pmol/L (48)0.0014.632.22 – 9.65tHcy>8.3μmol/LMTHFR 677CC genotype and SF > 10.9 nmol/L (ref) (148) b1.00MTHFR 677CC genotype and≤SF 10.9 nmol/L (33)0.0083.201.35 – 7.59MTHFR 677CT and 677TT genotypes and SF > 10.9 nmol/L (133)0.0351.951.05 – 3.61MTHFR 677CT and 677TT genotypes and≤SF 10.9 nmol/L (59)0.0016.623.31 – 13.26tHcy>8.3μmol/LMTRR 66AA genotype and Cbl> 115.8 pmol/L (ref) (96) c1.00MTRR 66AA genotype and ≤Cbl 115.8 pmol/L (23)0.2221.900.68 – 5.29MTRR 66AG and 66GG genotypes and Cbl>115.8 pmol/L (183)0.4181.290.70 – 2.39MTRR 66AG and 66GG genotypes and ≤Cbl 115.8 pmol/L (69)0.0132.461.21 – 5.01tHcy>8.3μmol/LMTRR 66AA genotype and SF > 10.9 nmol/L (ref) (92) d1.00MTRR 66AA genotype and ≤SF 10.9 nmol/L (27)0.0063.831.47 – 9.96MTRR 66AG and 66GG genotypes and SF > 10.9 nmol/L (186)0.3991.340.68 – 2.63MTRR 66AG and 66GG genotypes and≤SF 10.9 nmol/L (65)0.0014.782.26 – 10.10P for trend: (a) P<0.001; (b) P<0.001; (c) P=0.067; (d) P<0.001In conclusion, the interaction between MTHFR and MTRR polymorphisms and low folate and cobalamin serum levels may explain the increased risk for elevated tHcy found in pregnant women.

Acute Hepatitis E. virus infection in Egypt

Hepatitis E virus (HEV) is largely responsible for water borne epidemics in many developing countries. The principle mode of HEV transmission is the fecal oral route in epidemic and sporadic forms with a high case fatality ratio in pregnant women. Serum samples from 50 healthy subjects and from 435 acute viral hepatitis patients, 4-75 years old, were screened for markers of acute viral hepatitis. These included (HBsAg, anti-HBc (IgM), anti- HDV (IgM), HAV (IgM), anti-HCV (IgG), and anti-HEV (IgG), and (IgM) tests by enzyme- linked immunoassays (EIA). Furthermore isolation of HEV from peripheral blood lymphocytes and from stools belonging to anti-HEV IgG-positive patients was attempted by inoculation of HepG2 and Vero cell line cultures. The inoculated cell cultures were examined after immunoperoxidase staining for the detection of HEV antigen. Plasma, lymphocytes and stool samples from anti-HEV IgM positive patients were examined for HEV RNA by PCR. Anti-HEV IgG was found in 144/435 (33%) of these acute hepatitis patients. Anti-HEV (IgM) was detected in 8/52 (15.4%) out of 52 chosen from the 144 sera that were anti-HEV IgG positive cases. HEV was isolated in HepG2 from 32.6% of lymphocyte and from 34.9% of stools from patients positive for anti-HEV (IgG). While it was isolated from 71.4% of lymphocytes and from 100% of stools from patients positive for anti-HEV (IgM). In Vero cell cultures there was no HEV isolation from stools but HEV was isolated from 50% of lymphocytes. HEV RNA was detected by PCR in 85.7% of stools, 62.5% of plasma, and in 37.5% of lymphocyte samples belonging to anti-HEV IgM positive cases. Analysis of these diagnostic tests indicated that virus isolation from peripheral blood lymphocytes and stools by inoculation of HepG2 cell cultures is more sensitive than virus-RNA detection by PCR

Acute Hepatitis E. virus infection in Egypt

Hepatitis E virus (HEV) is largely responsible for water borne epidemics in many developing countries. The principle mode of HEV transmission is the fecal oral route in epidemic and sporadic forms with a high case fatality ratio in pregnant women. Serum samples from 50 healthy subjects and from 435 acute viral hepatitis patients, 4-75 years old, were screened for markers of acute viral hepatitis. These included (HBsAg, anti-HBc (IgM), anti- HDV (IgM), HAV (IgM), anti-HCV (IgG), and anti-HEV (IgG), and (IgM) tests by enzyme- linked immunoassays (EIA). Furthermore isolation of HEV from peripheral blood lymphocytes and from stools belonging to anti-HEV IgG-positive patients was attempted by inoculation of HepG2 and Vero cell line cultures. The inoculated cell cultures were examined after immunoperoxidase staining for the detection of HEV antigen. Plasma, lymphocytes and stool samples from anti-HEV IgM positive patients were examined for HEV RNA by PCR. Anti-HEV IgG was found in 144/435 (33%) of these acute hepatitis patients. Anti-HEV (IgM) was detected in 8/52 (15.4%) out of 52 chosen from the 144 sera that were anti-HEV IgG positive cases. HEV was isolated in HepG2 from 32.6% of lymphocyte and from 34.9% of stools from patients positive for anti-HEV (IgG). While it was isolated from 71.4% of lymphocytes and from 100% of stools from patients positive for anti-HEV (IgM). In Vero cell cultures there was no HEV isolation from stools but HEV was isolated from 50% of lymphocytes. HEV RNA was detected by PCR in 85.7% of stools, 62.5% of plasma, and in 37.5% of lymphocyte samples belonging to anti-HEV IgM positive cases. Analysis of these diagnostic tests indicated that virus isolation from peripheral blood lymphocytes and stools by inoculation of HepG2 cell cultures is more sensitive than virus-RNA detection by PCR

Assessment of copper status in pregnancy by means of determining the specific oxidase activity of ceruloplasmin

Background: Conditions not directly related to copper nutriture, such as pregnancy, infections and inflammation, which increase serum copper concentration even during copper deprivation, may be expected to conceal changes in copper status. It has been suggested that the specific enzymatic activity of ceruloplasmin (activity per unit mass of enzyme protein) may be a sensitive indicator of copper status and is not affected by factors such as hormones or sex. In this study, we investigated the behaviour of specific oxidase activity of ceruloplasmin and the copper/ceruloplasmin ratio in pregnant women. Methods: Copper, immunoreactive ceruloplasmin and its oxidase activity were determined in serum from 52 women in the last trimester of normal pregnancy, and in 50 control women of similar age living in the same area and who were not taking oral contraceptives. The results are expressed as mean±S.E.M. Results: In the group of pregnant women, significantly higher serum levels of copper, ceruloplasmin and its oxidase activity were found than in the control group ( p<0.001). In both groups, a high correlation was found between these biochemical variables ( r≥0.905, p<0.001). However, in the group of pregnant women the specific oxidase activity for ceruloplasmin (364.4±3.3 vs. 407.5±3.8 U/g) and the copper/ceruloplasmin ratio (2.82±0.03 vs. 3.19±0.04 μg/mg) were significantly lower than in the control group ( p<0.001). Conclusions: Although pregnancy accelerates the rate of ceruloplasmin protein synthesis and release with an increase of serum copper, the decrease in specific oxidase activity of circulating ceruloplasmin would be an indicator of the degree of depletion of the mother's copper deposits in order to deal with the foetus' needs.

SERUM ANTIBODIES TO OXIDIZED LOW-DENSITY LIPOPROTEIN IN PREGNANT WOMEN WITH PREECLAMPSIA AND CHRONIC HYPERTENSION: LACK OF CORRELATION WITH LIPID PEROXIDES

Objectives: To evaluate the circulating levels of antibodies to oxidized low-density lipoprotein (LDL) and their correlation with the lipid peroxide/vitamin E ratio in pregnant women with preeclampsia and chronic hypertension.Methods: Antibodies to oxidized LDL were measured by enzyme-linked immunoassay, lipid peroxides (malondialdehyde), and vitamin E were measured by high-pressure liquid chromatography. Patients were 25 healthy pregnant women, 20 previously nonhypertensive women diagnosed with preeclampsia, and 20 women with uncomplicated chronic hypertension.Results: Serum levels of antibodies to LDL in preeclamptic patients were similar to controls, whereas women with chronic hypertension showed a trend for increased mean levels. Lipid peroxides in serum were significantly increased and vitamin E levels were significantly decreased in preeclampsia with respect to nonhypertensive pregnancy, but no differences were observed for chronic hypertensive women.Conclusions: Our results suggest that preeclampsia is not accompanied by increased levels of antibodies to oxidized LDL. By contrast, and according to previous studies in nonpregnant patients, chronic hypertensive patients showed a trend for elevated levels.

Perinatal bile acid metabolism: analysis of urinary bile acids in pregnant women and newborns

The metabolism of bile acids in 30 pregnant women was evaluated by analyzing the urinary composition of bile acids during late gestation (weeks 30-41) and again in these women and their newborn infants during the first week after delivery. The levels of individual bile acids were determined by gas chromatography-mass spectrometry after solvolysis and hydrolysis of bile acid conjugates. The mean total bile acid/creatinine ratio in pregnant women decreased from 1.22 micromol/mmol creatinine at 30-32 weeks of gestation to 0.15 micromol/mmol creatinine at 6-7 days after delivery. The mean percentage of 1beta-hydroxylated bile acids peaked at 27% at 3-4 days after delivery. In newborn infants, the mean total bile acid/creatinine ratio rapidly increased from 3.39 micromol/mmol creatinine at birth to 54.33 micromol/mmol creatinine at 7 days. During this period, large amounts (40-50%) of unsaturated ketonic bile acids, especially 7alpha,12alpha-dihydroxy-3-oxo-5beta-chol-1-en-24-oic acid and 7alpha,12alpha-dihydroxy-3-oxo-4-cholen-24-oic acid, were observed in the infants' urine. These data suggest that, during the perinatal period, the formation of polyhydroxylated and unsaturated ketonic bile acids probably represents a mechanism for the excretion of bile salts, and that the metabolism of bile acids in both the mother and the infant changes significantly after birth.

Exhaled carbon monoxide and urinary cotinine as measures of smoking in pregnancy

We examined the relationships among self-reported cigarette consumption, exhaled carbon monoxide, and urinary cotinine/creatinine ratio in pregnant women. Information on these measures of smoking was collected at first and 36th week prenatal visits. Correlations between cigarette consumption and exhaled carbon monoxide were .65 at the first visit and .70 at the 36th-week visit. For urinary cotinine/creatinine ratio, the correlations were .61 and .65, respectively, at these visits. Correlations with change in cigarette consumption between the two visits were .37 for change in carbon monoxide and .33 for change in urinary cotinine/creatinine ratio. Urinary cotinine/creatinine ratio had slightly higher overall agreement with self-reported smoking status and was less likely to misclassify smokers than carbon monoxide. We conclude that urinary cotinine/creatinine ratio is the more accurate measure for validating smoking status among pregnant women, but exhaled carbon monoxide is the better measure of cigarette consumption and of changes in consumption.

Activated protein C sensitivity ratio in pregnant women at delivery

We studied activated protein C sensitivity ratio (APC‐SR), factors V and VIII activity and von Willebrand antigen in control women, women using oral contraceptives, and pregnant women at delivery. The mean APC‐SR of 2.4 in pregnant women was significantly lower than the mean APC‐SR value of 3.5 for both the other groups and 45% of pregnant women had a ratio below the 5th percentile of the control group. None of them carried the R506→Q mutation. This decreased ratio at delivery appeared to be connected, at least in part, with increased VIII activity. Thus, APC‐SR at delivery should not be used to detect APC resistance.