Background Several lines of evidence point to the dysfunction of the endothelial l‐arginine–NO system in preeclampsia. We investigated the influence of dietary supplementation with l‐arginine on blood pressure and biochemical measures of NO production in women with preeclampsia in prospective, randomized, placebo‐controlled study. Design The 61 preeclamptic women on a standardized low nitrate diet received orally 3 g of l‐arginine (n = 30) or placebo (n = 31) daily for 3 weeks as a supplement to standard therapy. The differences between the two groups in systolic (SBP), diastolic (DBP) and mean arterial blood pressures (MAP) as well as in plasma levels of selected aminoacids, plasma concentrations of nitrates/nitrites (NOx) and in 24‐h urine NOx excretion were determined. Results After 3 weeks of treatment, values of SBP, DPB and MAP were significantly lower in the group taking l‐arginine as compared with the placebo group (SBP: 134·2 ± 2·9 vs. 143·1 ± 2·8; DBP: 81·6 ± 1·7 vs. 86·5 ± 0·9; MAP: 101·8 ± 1·5 vs. 108·0 ± 1·2 mmHg, P < 0·01). Importantly, treatment with exogenous l‐arginine significantly elevated 24‐h urinary excretion of NOx and mean plasma levels of l‐citrulline. Exogenous l‐arginine did not influence plasma concentrations of l‐arginine, l‐ornithine and methylated arginines (ADMA, SDMA, L‐NMMA). Conclusions We conclude that in women with preeclampsia, prolonged dietary supplementation with l‐arginine significantly decreased blood pressure through increased endothelial synthesis and/or bioavailability of NO. It is tempting to speculate that the supplementary treatment with l‐arginine may represent a new, safe and efficient strategy to improve the function of the endothelium in preeclampsia.
These changes in the Treg cell subpopulation in the decidua would seem to be related to a brief activation of the maternal immune system as labor begins and lack of analogical changes in the subpopulation of decidual suppressive B7-H4+ macrophages that enable the restriction of this same activation as labor progresses.
Estimation of the influence of oral supplementation with low dose of L-arginine on biophysical profile, foetoplacental circulation and neonatal outcome in preeclampsia. Randomized, placebo-controlled, double-blind, clinical trial. Oral therapy with 3 g of L-arginine daily or placebo as a supplement to standard therapy. Eighty-three preeclamptic women, randomly assigned to the L-arginine (nΩ42) or placebo (nΩ41) groups; [nΩ30 (L-arginine) and nΩ31 (placebo) ended the study, respectively]. Foetal gain chances due to ultrasound biometry, biophysical profile, Doppler velocimetry of pulsatility indices of umbilical and middle cerebral arteries, cerebro-placental ratio, as well as differences in duration of pregnancy and clinical data of newborn. L-arginine treatment transitory accelerated foetal gain and improved biophysical profile. Starting from 3rd week of therapy, the umbilical artery pulsatility indices values were significantly lower in Larginine than in placebo group. Moreover, treatment with L-arginine caused significant increase of middle cerebral artery pulsatility indices and cerbro-placental ratio values. Latency was longer in L-arginine group. Neonates delivered in the Larginine group revealed higher Apgar score. Supplementary treatment with oral L-arginine seems to be promising in improving foetal well-being and neonatal outcome as well as in prolonging pregnancy complicated with preeclampsia. However, these benefits require confirmation in more-powered, larger studies.
The study was arranged to assess the actual rates of colonization of pregnant women and their children with group B streptococcus (GBS) in a Polish university hospital. Resistance of these cocci to macrolides and clindamycin was also tested and routes of transmission of GBS were followed in some cases using molecular typing. Colonization with GBS was checked in 340 pregnant women living in the south-eastern region of Poland (Małopolska) in the years [2004][2005][2006]. Women with a complicated pregnancy were more often colonized than those with a normal pregnancy (20.0 % versus 17.2 %). Moreover, women with a complicated pregnancy were twice as often colonized with GBS strains with the MLS B phenotype indicating resistance to macrolides and clindamycin. Regarding neonatal colonization by GBS, we found that neonates born from the colonized mothers with a complicated pregnancy were more often colonized with GBS than those from the mothers with a normal pregnancy (35 % versus 26.7 %). By molecular typing of the GBS strains isolated from mothers and their newborns we have been able to suggest the possibility of horizontal transmission of the strains from the hospital environment to newborns. Our results clearly indicate that rates of GBS colonization among pregnant women and neonates in a Polish university hospital have reached levels comparable to those reported in other European clinical centres. INTRODUCTIONGroup B streptococcus (GBS; Streptococcus agalactiae) has been implicated as a leading cause of neonatal invasive infections. Many adults are asymptomatically colonized with GBS in the genital and gastrointestinal tracts but colonized pregnant women are at increased risk of premature delivery and perinatal transmission to their neonates (Schuchat, 2000). GBS has been the principal cause of sepsis and meningitis during the early and late onset of neonatal infection. It is generally accepted that a neonate acquires its microflora, including GBS, by aspiration of the infected amniotic fluid, by vertical transmission during labour and later on also from the hospital environment.The systemic introduction of the appropriate antimicrobial drug after the onset of labour or rupture of membranes is highly effective in reducing neonatal colonization with GBS, and therefore in 1996 in the USA two consensus statement guidelines were issued on intrapartum prophylaxis (CDC, 1996;Schrag et al., 2002), which reduced early neonatal GBS infection to less than 50 % of previous levels. The recommended laboratory techniques may be enhanced by applying rapid identification methods and, when susceptibility testing is indicated, by determining inducible clindamycin resistance in conjunction with screening (Welch & Aldridge, 2005).Epidemiological data on GBS-infected newborns indicate that the mean incidence rate of invasive GBS infection is 0.
We concluded that the measurement of plasma ATIII and, especially, PC levels may facilitate the recognition of sepsis and, with respect to PC, may have a prognostic value. Plasma PC functional concentration below 10% might be the indication for supplementation of PC concentrate.
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