Christopher Houlihan

Elucidation of the chemical structure of a novel antioxidant, rosmaridiphenol, isolated from rosemary

A novel antioxidant compound has been isolated and identified from the leaves of theRosmarinus officinalis L. The compound, named rosmaridiphenol, is a diphenolic diterpene. When tested in lard, the antioxidant activity of this compound was superior to BHA. Structural elucidation of rosmaridiphenol was accomplished by infrared spectroscopy (IR), mass spectroscopy (MS),1H-NMR (nuclear magnetic resonance) and13C-NMR spectroscopy.

The structure of rosmariquinone — A new antioxidant isolated fromRosmarinus officinalis L.

A new diterpene, named rosmariquinone, was isolated from the leaves ofRosmarinus officinalis L. The leaves were first extracted using methanol and, upon further purification, this extract yielded rosmariquinone. Structure elucidation of the antioxidant was done using IR, MS,1H-NMR and13C-NMR.

The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage

OBJECTIVE Our purpose was to determine whether perioperative transvaginal ultrasonographic evaluation of the incompetent cervix treated with emergency cerclage is predictive of pregnancy outcome. STUDY DESIGN Twenty-nine women who underwent emergency cerclage at 16 to 26 weeks of gestation had transvaginal ultrasonographic evaluation of the cervix within 48 hours before and after surgery and at least three times thereafter until 28 weeks of gestation. The following measurements were obtained: (1) funnel width, (2) funnel length, (3) endocervical canal length, (4) the distance between the internal and external os, (5) upper cervix (length of closed endocervical canal above the cervical cerclage), (6) lower cervix (endocervical canal length below suture), and (7) cervical index (1+ Funnel length/Endocervical canal length). Values are reported as the median in millimeters, and statistical analysis was performed by use of the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman rank correlation, 2 x 2 contingency tables, and multiple regression analysis with significance set at p < 0.05. RESULTS Cerclage procedures resulted in significant improvement in postoperative median measurements of funnel width (15 vs 4.0 mm, p < 0.0001), funnel length (29 vs 3 mm, p < 0.0001), and endocervical canal length (2 vs 27 mm, p < 0.0001). There was a significant relationship between gestational age at delivery and the following measurements: preoperative funnel width (r = -0.51, p = 0.007), postoperative endocervical canal length (r = 0.39, p = 0.04), length of the lower cervix (r = 0.39, p = 0.038), and the cervical index (r = -0.39, p = 0.038). An upper cervical length < 10 mm was a good predictor of delivery before 36 weeks of gestation, sensitivity 85.7% (12/14), specificity 66.7% (10/15), positive predictive value 70.6% (12/17), negative predictive value 83% (10/12), and Fishers exact p = 0.008. Postoperatively all patients had upper cervical lengths < 10 mm by 28 weeks of gestation. Preoperative digital assessments of cervical dilatation before surgery did not correlate with gestational age at birth (r = -0.031, p = 0.36). CONCLUSIONS In cases of cervical incompetence treated with emergency cerclage, perioperative transvaginal ultrasonographic assessment of the cervix reveals that the procedure results in improved ultrasonographic status of the cervix and that the ultrasonographic cervical findings before and after surgery correlate with pregnancy outcome.

Sonography and Transfundal Pressure in the Evaluation of the Cervix During Pregnancy

Ultrasonographic evaluation of the cervix in pregnancy has provided some insight into premature delivery and pregnancy wastage. Its use has led to the development of cervical length nomograms in uncomplicated singleton pregnancies and to the realization that varying degrees of cervical incompetence exist. In some instances the internal os has been observed to dilate and funnel in the early second trimester while in others these changes occur gradually into the third trimester. Transient cervical changes have been linked to premature delivery and extended ultrasonographic inspection is required for their detection. Although sonography may allow the identification of women who deliver prematurely, it has not demonstrated enough discriminatory power to recommend its routine use for this purpose. Pre- and postoperative inspection of the cervix in elective and emergency cerclage procedures may become influential in outpatient management. A method of functional evaluation of the cervix using transfundal pressure (TFP) has been introduced which may lead to earlier diagnosis of cervical incompetence. The significance of descent of the membranes in response to TFP and sonographic findings consistent with premature cervical changes have not been validated because of surgical intervention performed in response to these findings. Our review concludes that, although sonography of the cervix may be useful in selective cases, more information on the natural history of abnormal cervical sonographic findings and controlled randomized trials are needed before recommendations on surgical intervention can be made.

Effects of Narcotic and Non-Narcotic Continuous Epidural Anesthesia on Intrapartum Fetal Heart Rate Tracings as Measured by Computer Analysis

OBJECTIVE To evaluate the effect of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate (FHR) tracings as measured by computer analysis. METHODS We studied 37 women with uncomplicated pregnancies at term with reactive FHR tracings. The women were randomized to receive epidural anesthesia with either bupivicaine with fentanyl or bupivicaine alone. One-hour FHR tracings were obtained before epidural anesthesia. Thirty minutes after the initial bolus of the epidural a repeat computer analysis of 60-minute FHR tracing was obtained. Median values are reported for FHR parameters with statistical analysis performed by the Mann-Whitney U and Wilcoxon signed rank tests where appropriate. A power calculation was performed using a power of 90% to determine a required sample size of 28 patients. Statistical significance was set at P < .05. RESULTS In early first stage of labor, there was no significant difference in pre- and postepidural anesthesia FHR baseline, accelerations of 10 and 15 beats per minute, episodes of high and low variation, and short- and long-term variation when using either narcotic or non-narcotic anesthetic agents. CONCLUSIONS Thus, the clinician can consider the use of narcotic as well as non-narcotic continuous epidural anesthesia in the dosages used in our study with its attendant advantages without fear of obscuring the fetal heart rate tracing.

Effects of therapeutic amniocentesis on uterine and umbilical artery velocimetry in cases of severe symptomatic polyhydramnios

The objective of this study was to determine the effects of removal of amniotic fluid in cases of symptomatic severe polyhydramnios on Doppler waveform indices of the uterine and umbilical arteries and flow velocities of the uterine arteries. Nine women underwent therapeutic amniocentesis during ten pregnancies for symptomatic polyhydramnios due to Beckwith-Wiedemann Syndrome (n = 1), esophageal atresia (n = 2), chorioangioma (n = 1), twin-twin transfusion syndrome (n = 3), a presumed autosomal recessive syndrome (n = 2), and an unbalanced double translocation (n = 1; partial dup 3q and partial del 9p syndrome). An average of 2.78 +/- 0.9 (range 1-4) 1 of fluid were removed at each procedure between the gestational ages of 18 and 34 weeks (mean of 28 weeks). The systolic/diastolic (S/D) ratio, pulsitility index (PI), and resistance index (RI) of the uterine and umbilical arteries were obtained before and after the procedure using color and pulsed Doppler. After angle correction, the peak systolic velocity (PSV) and mean velocity (MV) in centimeters/second (cm/s) of the uterine arteries were also determined. The presence or absence of a uterine artery waveform notch was determined. Dominant uterine arteries were defined as those with lower impedance indices or higher flow velocities. Statistical analysis was performed with the Wilcoxon signed-rank test. Significance was set at P < 0.05. There was a significant increase in the median value of the uterine artery MV (43.8 vs. 81.1 cm/s, P = 0.005) and PSV (74.2 vs. 125.5 cm/s, P = 0.007) after amniocentesis. The uterine S/D (3.0 vs. 1.84, P = 0.007), PI (1.12 vs. 0.68, P = 0.008), and RI (0.60 vs. 0.45, P = 0.005) impedance indices significantly decreased following amniocentesis. When uterine arteries were categorized as dominant vs. nondominant, there were greater improvements in impedance indices and flow velocities in the nondominant uterine arteries. There were three cases of unilateral and one case of bilateral early diastolic notches of the uterine artery waveforms which either resolved (n = 4) or improved (n = 1). There was no effect on the umbilical artery impedance indices. Therapeutic amniocentesis significantly improved uterine artery impedance indices and resulted in improved flow velocities, while there was no effect on umbilical artery waveform indices. The procedure resulted in the disappearance or improvement of the uterine waveform notch. Our findings suggest that in cases of severe polyhydramnios abnormal uterine artery velocimetry may not be due to lack of trophoblastic invasion of the spiral arteries but to increased intrauterine pressure secondary to polyhydramnios.

Does First-Trimester Hemoglobin A1C Predict Gestational Diabetes and Fetal Outcome?

INTRODUCTION: Whereas hemoglobin A1C is an established tool for the management of diabetes, the benefit of hemoglobin A1C as a first-trimester screen and the relevance of established normal values in pregnancy has not been determined. We evaluated whether glucose-intolerant patients (hemoglobin A1C 5.7–6.4) had a higher likelihood of developing gestational diabetes (GDM) and an increased risk for having large-for-gestational-age neonates than those in a control group (hemoglobin A1C less than 5.7). METHODS: Patients presenting before 14 weeks of gestation between 2011 and 2013 were included in this case–control study. First-trimester hemoglobin A1C was evaluated in addition to routine GDM screening and treatment. One woman delivering a large-for-gestational-age neonate control was randomly selected for each glucose-intolerant patient. RESULTS: Five hundred sixty-four patients were screened; three had overt diabetes, 94 glucose-intolerant, and 467 had a large-for-gestational age neonate. Of the 94 glucose-intolerant patients, 19 were lost to follow-up, terminated, or delivered before 34 weeks of gestation, leaving 75 glucose-intolerant patients. There were no differences between groups for age and body mass index. Fifty-six percent of those delivering large-for-gestational-age neonates and 54.3% of who were glucose-intolerant were obese by body mass index. Glucose-intolerant patients were more frequently African American or Asian compared with those delivering large-for-gestational-age neonates (P=.034). Glucose-intolerant patients were three times more likely to develop GDM than those delivering large-for-gestational-age neonates (P=.001). At hemoglobin A1C less than 5.2, no patient developed GDM; at hemoglobin A1C of 6.1, all developed GDM. There were no birth weight differences between groups. CONCLUSIONS: First-trimester hemoglobin A1C is useful in identifying undiagnosed overt diabetes. Patients with first-trimester glucose intolerance are more likely to develop GDM and may benefit from early testing. Further diabetic screening may not be necessary with hemoglobin A1C less than 5.2 or greater than 6.0. First-trimester hemoglobin A1C did not predict having large-for-gestational-age neonates.

Human immunodeficiency virus, pregnancy, and Stevens-Johnson syndrome.

BACKGROUND: Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening dermatologic disorders that are more common in the setting of a compromised immune system. We present the case of a pregnant patient with known human immunodeficiency virus (HIV) infection who presented with Stevens-Johnson syndrome after treatment with antibiotics for a urinary tract infection. Case: A young woman at 33 4/7 weeks of gestation with known HIV infection presented to the emergency room with a chief complaint of rash, fever, blisters, and lower abdominal pain. Her symptoms were present for 2 days after ingestion of nitrofurantoin, prescribed for a urinary tract infection. She was diagnosed with preterm labor and possibly Stevens-Johnson syndrome. Due to active labor, HIV, and vaginal stenosis, a primary cesarean was performed. A skin biopsy performed at the time of admission confirmed the diagnosis of a drug-induced dermatosis (erythema multiforme), evidenced by subepidermal bullae, hemorrhage, and acantolated, dyskeratotic eosinophilic cells. CONCLUSION: Stevens-Johnson syndrome and toxic epidermal necrolysis represent a spectrum of disease that has been long associated with multiple drugs, recently including many antiretroviral medications. It also seems that the incidence of these conditions is increased in immunocompromised patients. We speculate that the combination of HIV and pregnancy in addition to antibiotic treatment, such as with nitrofurantoin, may induce Stevens-Johnson syndrome in patients with severely altered immune systems.

Cervical Cerclage for Preterm Birth Prevention in Twin Gestations with Short Cervix: A Case-Control Study.

To determine if cervical cerclage reduces the rate of spontaneous early preterm birth in cases of dichorionic–diamniotic (DCDA) twin gestation with an ultrasound‐detected short cervix.