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Prevention of Preeclampsia  [PDF]
Sammya Bezerra Maia e Holanda Moura,Laudelino Marques Lopes,Padma Murthi,Fabricio da Silva Costa
Journal of Pregnancy , 2012, DOI: 10.1155/2012/435090
Abstract: Preeclampsia (PE) affects around 2–5% of pregnant women. It is a major cause of maternal and perinatal morbidity and mortality. In an attempt to prevent preeclampsia, many strategies based on antenatal care, change in lifestyle, nutritional supplementation, and drugs have been studied. The aim of this paper is to review recent evidence about primary and secondary prevention of preeclampsia. 1. Introduction Preeclampsia (PE) is a multisystem disorder characterized by de novo hypertension and proteinuria or superimposed to maternal hypertension or nephropathy in pregnant women who are usually beyond 20 weeks of gestational age. It affects around 2–5% of pregnancies. The prevalence may range as high as 10 to 18% in some developing countries [1]. PE can be classified into early-onset and late-onset PE and these subtypes may represent different forms of the disease. Early-onset PE is commonly associated with fetal growth restriction (FGR), abnormal uterine and umbilical artery Doppler waveforms, and adverse maternal and neonatal outcomes. In contrast, late-onset PE is mostly associated with milder maternal disease and a lower rate of fetal involvement, with usually favorable perinatal outcomes [2–4]. Screening for PE attempts to identify high-risk pregnancies to modify antenatal care and institute preventive treatment regimens in order to reduce complications and deaths [2, 5–9]. The SCOPE group developed a predictive model for PE based on clinical risk factors for nulliparous women and concluded that screening for PE using maternal history alone is an unreliable method. MAP (mean arterial pressure, defined as “twice the diastolic plus the systolic blood pressure divided by three”) when studied alone in the second trimester of 90?mmHg or above presents a positive likelihood ratio of 3.5 (95% CI 2–5) and a negative likelihood ratio of 0.46 (95% CI 0.16–0.75) to predict PE onset [10]. Howewer, a study combined maternal factors to uterine artery Doppler PI. The detection rate of early PE at a 10% false-positive rate increased from 47% in screening by maternal factors alone to 81% in screening by maternal factors and the lowest UtA-PI. The respective detection rates for late PE increased from 41% to 45% [11]. The concentration of many biomarkers including pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PIGF) in the maternal serum are known to be altered during the first trimester of pregnancies destined to develop PE [12, 13]. Furthermore, numerous studies have examined the effectiveness of uterine artery Doppler in the second
Aspectos prácticos en la prevención del cáncer oral Practical aspects in the prevention of oral cancer  [cached]
E. Chimenos Küstner
Avances en Odontoestomatología , 2008,
Abstract: El cáncer es una de las principales causas de morbilidad y mortalidad en el mundo. Por esta razón, la lucha contra el cáncer debe ser interdisciplinaria. Entre un 80 y un 90% de las neoplasias se relacionan con factores externos al organismo. Alrededor del 35% de estos factores tienen relación con la alimentación. La mayoría de los tumores malignos tienen una latencia de 10-20 a os. Todos estos aspectos hacen que sea posible su prevención. La quimioprevención del cáncer persigue retrasar la aparición de la carcinogénesis, mediante agentes que previenen, suprimen o revierten transformaciones malignas. El objetivo de este trabajo radica en destacar aspectos etiopatogénicos del cáncer, así como proponer medidas de prevención frente al mismo. Cancer is one of the main causes of morbidity and mortality in the world. For that reason, it must to be fight in an interdisciplinary way. Between 80 and 90% of neoplasms are related to external factors to the organism. About 35% of these factors are in relationship with the feeding. Most of the malign tumors have a latency of 10-20 years. All those aspects make possible their prevention. The chemiprevention of cancer pursuits delaying of carcinogenesis with the use of chemical agents that prevent, suppress or revert malign transformations. The objective of this work is to emphasize some etiopathogenical aspects of cancer, as well as to propose prevention measures.
Prevention of Preeclampsia: Is it Still a Disappointment?
Abeer Eddib and John Yeh
Clinical Medicine Insights: Women's Health , 2012,
Abstract: Preeclampsia is a major cause of maternal mortality worldwide, with many preventive strategies tested. In this review we intend to provide a synthesis of available studies of these strategies that have been tested, including systematic reviews. We will not be performing systematic review of the studies here. Of these strategies tested only low dose acetyl salicylic acid (ASA) and calcium can be considered helpful for prevention at this time. A recent meta-analysis showed a benefit of low dose ASA for both high (RR 0.75, 95% CI 0.66 to 0.85) and moderate risk groups (RR 0.86, 95% CI 0.79 to 0.95). Therefore, low dose ASA in high risk groups may be useful, with a possible smaller benefit in moderate to low risk women. Another meta-analysis looking at calcium shows benefit for both high and low risk groups with an overall reduction in the risk of preeclampsia (RR 0.48, 95% CI 0.33 to 0.69). As a result, prenatal supplementation of calcium may be beneficial for the prevention of preeclampsia. However, vitamins C and E, zinc, fish oil, and magnesium supplementation have been discounted as potential preventive strategies. Nitric oxide, folic acid, and antithrombotics have not been well studied and there is insufficient data for reliable conclusions to be made. Areas of ongoing research that appear promising in the prevention of preeclampsia include modifiable metabolic factors, angiogenic proteins, angiotensin receptor antibodies, and syncytiotrophoblast microparticles. Strategies targeting these areas may provide opportunities for therapeutic interventions.
Genetic Aspects of Preeclampsia and the HELLP Syndrome  [PDF]
Kjell Haram,Jan Helge Mortensen,Bálint Nagy
Journal of Pregnancy , 2014, DOI: 10.1155/2014/910751
Abstract: Both preeclampsia and the HELLP syndrome have their origin in the placenta. The aim of this study is to review genetic factors involved in development of preeclampsia and the HELLP syndrome using literature search in PubMed. A familial cohort links chromosomes 2q, 5q, and 13q to preeclampsia. The chromosome 12q is coupled with the HELLP syndrome. The STOX1 gene, the ERAP1 and 2 genes, the syncytin envelope gene, and the ?670 Fas receptor polymorphisms are involved in the development of preeclampsia. The ACVR2A gene on chromosome 2q22 is also implicated. The toll-like receptor-4 (TLR-4) and factor V Leiden mutation participate both in development of preeclampsia and the HELLP syndrome. Carriers of the TT and the CC genotype of the MTHFR C677T polymorphism seem to have an increased risk of the HELLP syndrome. The placental levels of VEGF mRNA are reduced both in women with preeclampsia and in women with the HELLP syndrome. The BclI polymorphism is engaged in development of the HELLP syndrome but not in development of severe preeclampsia. The ACE I/D polymorphism affects uteroplacental and umbilical artery blood flows in women with preeclampsia. In women with preeclampsia and the HELLP syndrome several genes in the placenta are deregulated. Preeclampsia and the HELLP syndrome are multiplex genetic diseases. 1. Introduction Preeclampsia is a multisystemic disorder in pregnancy with de novo hypertension and proteinuria occurring after the 20th gestational week and is characterised by hypertension and proteinuria, with or without oedema. The condition is associated with a reduced plasma volume, hemoconcentration, and increased vascular resistance. One of the chief targets is the kidneys and the clinical picture is dominated by hypertension and proteinuria [1–3]. The clinical findings of preeclampsia can manifest as either a maternal syndrome (hypertension and proteinuria with or without other multisystem abnormalities) or fetal syndrome (fetal growth restriction, reduced amniotic fluid, and abnormal oxygenation) [3]. The condition may cause serious maternal and fetal complications [3]. Women with preeclampsia may develop the HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet), which occurs in 0.5% to 0.9% of all pregnancies and in 10% to 20% of women with severe preeclampsia. The syndrome may be complete or incomplete. The majority of women with the HELLP syndrome have hypertension and proteinuria but the condition may also occur without these [4]. Typical clinical symptoms of the HELLP syndrome are right upper abdominal quadrant or
TRIAL OF ASPIRIN AND CALCIUM ON PREVENTION OF PREECLAMPSIA  [cached]
ALI AKBA TAHERIAN,A TAHERIAN,A SHIRVANI
Journal of Research in Medical Sciences , 2002,
Abstract: ntroduction. Preelampsia is a common and serious complication of pregnancy that affects both mother and newborn. This study designed to determine whether low-dose aspirin or calcium supplements taken throughout pregnancy reduce the incidence of preeclampsia. Methods. The present study was a randomized controlled clinical trial. 990 healthy nulliparous women, who were pregnant for 13 to 20 weeks were chosen to receive daily treatment with low dose of aspirin 75 mg (330 patients, aspirin group), calcium D 500 mg (330 Patients, calcium group) and no medication (330 patients, control group) for remainder of theirs pregnancies. Data included demographic, obstetric, prenatal care, hospital records and final diagnosis were collected. Statistical analysis was performed using Chi-Squre, ANOVA and Duncan test at significance level of 0.05. Results. Preeclampsia occurred in 15 of 330 women in the aspirin group (4.6%), 13 of 330 women in the calcium group (4%) and in 33 of 330 women in control group (10.1%). There were significant differences between aspirin and control groups (4.6% vs. 10.1% P < 0.05) also between calcium and control group (4% vs. 10.1% P < 0.05). Discussion. These results suggest that low dose of aspirin or calcium D during pregnancy in healthy nulliparous women is effective to reduce the prevalence of preeclampsia.
PRACTICAL ASPECTS OF MEDIATION
IULIA FLOCA
Challenges of the Knowledge Society , 2011,
Abstract: Today the Romanian state gives some advantages to those who use mediation. If the Romanian state would take further steps, mediation would work as in the countries with old tradition. The article refers to success and failure got in the two years of practice. The mediation can be seen in two aspects: The first aspect regarding the mediation itself can lead to a mediation agreement. The mediation agreement gives both winnings to the conflict parts and professional satisfactions to the mediator. The second part concerns the mediation contract. It is very important for the mediator who wants to practice and to gain money. The mediation will work in Romania when the mediator passes from the pro-bono stage to winnings. The article refers to the conditions of the appearance of mediation in Romania, the purpose for which it was founded, the usefulness of mediations to relieve the number of court cases and increase the efficiency of the courts, as well as the results obtained from the adoption of the mediation laws until now. The practical aspects leading to the mode in which Romanians perceive mediation and wish to participate or not in the sessions of mediation Recommendations for promoting mediation in Romania
Effect of lycopene in prevention of preeclampsia in high risk pregnant women  [cached]
Ramalingappa Antartani,Kiran Ashok
Journal of the Turkish-German Gynecological Association , 2011,
Abstract: Objective: To evaluate the effect of pre-natal supplementation of antioxidant Lycopene in prevention of pre-eclampsia in the high risk pregnant women. We also assessed the effect of lycopene supplementation on intra-uterine growth restriction and the perinatal outcome in women at high risk of developing pre-eclampsia.Materials and Methods: A total of 54 women between 14-28 weeks of pregnancy who were at high risk of developing pre-eclampsia were considered for the study. Inclusion criteria were women with a previous history of preeclampsia, a growth-retarded fetus, perinatal death, multifetal gestation and chronic hypertension. Of the total of 54 women, 30 women were randomized to receive Lycopene in a dose of 2 mg twice daily starting from the date of entry and were instructed to continue the drug regularly until delivery. The other 24 women were randomized to the control group and they did not take lycopene. The controls were matched to cases with respect to the risk factors for the development of preeclampsia. Both groups were followed at monthly intervals. In addition, a Doppler assessment for evidence of intrauterine growth retardation was done at around 28 wks of gestation. Data regarding development of preeclampsia, period of gestation during delivery, mode of delivery, fetal weight and perinatal outcome were recorded and subjected to statistical analysis.Results: Of the 30 women randomized to receive the drug, ten women were lost to follow-up. Thus only 20 women in the treatment group completed the study. All the 24 women in the control group completed the study. Lycopene was not found to decrease the incidence of pre-eclampsia in high risk women. Women in the lycopene supplementation group had significantly lesser incidence of growth restricted babies and had a significantly better perinatal outcome compared to women in the placebo group.Conclusion: Lycopene supplementation does not decrease the incidence of preeclampsia in high risk women. However lycopene supplementation does seem to help in reducing the incidence of intra-uterine growth restriction.
SOME THEORETICAL AND PRACTICAL ASPECTS REGARDING ACTION OF EVICTION
CLAUDIA LUCIANA IVANESCU
Challenges of the Knowledge Society , 2011,
Abstract: The paper is dealing with a few theoretical and practical aspects regarding eviction. This action is not legally established which in turn generated doctrinal debates and practical contradictions.
Prevention of preeclampsia with low-dose aspirin: a systematic review and meta-analysis of the main randomized controlled trials
Ruano, Rodrigo;Fontes, Rosana S.;Zugaib, Marcelo;
Clinics , 2005, DOI: 10.1590/S1807-59322005000500010
Abstract: the purpose of this paper is to evaluate the effectiveness of low-dose aspirin in the prevention of preeclampsia in low-risk and high-risk women. we identified randomized clinical trials of the use of low-dose aspirin to prevent preeclampsia through the pubmed search engine, and through the cochran library database. twenty-two studies met our inclusion criteria, and were divided according to the studied population into 2 groups: trials with women at low risk for preeclampsia and trials with women at high risk. effects were measured through the incidence of preeclampsia in women taking either placebo or aspirin, in studies where the relative risks and the 95% confidence intervals were calculated for both groups. a total of 33,598 women were studied, comprising 5 trials with 16,700 women at low-risk and 17 trials including 16,898 women at high risk. the incidence of preeclampsia was 3.75% (626/17,700), in the low-risk group, 9.01% (1,524/16,898) in the high-risk group, and 6.40% (2,150/33,598) overall. low-dose aspirin had no statistically significantly effect on the incidence of preeclampsia in the low-risk group (rr = 0.95, 95% ci = 0.81-1.11), but had a small beneficial effect in the high-risk group (rr = 0.87, 95% ci = 0.79-0.96). therefore, low-dose aspirin is mildly beneficial in terms of reducing the incidence of preeclampsia in women at high risk of developing preeclampsia.
Involvement of haptoglobin in prevention of oxidative stress cause by hemoglobin in preeclampsia  [PDF]
Hagit Goldenstein, Nina Levy, Andrew Levy
Advances in Bioscience and Biotechnology (ABB) , 2012, DOI: 10.4236/abb.2012.327126
Abstract: Haptoglobin (Hp) is a hemoglobin (Hb) binding protein which plays an important role in neutralizing oxidation reactions stimulated by heme-derived iron. Differences in Hp types due to the polymorphic nature of the gene have led to the discovery that individuals carrying the Hp 2-2 genotype are at increased risk of developing vascular complications in the setting of diabetes. Preeclampsia is a pregnancy related disease that is thought to be caused by increases in oxidative stress. The role of Hp polymorphism is determining preeclampsia has been addressed by several clinical studies but the results have been contradictory. Larger longitudinal studies are needed to answer this important question.
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