Research Topics: Preventive Medicine

Is there a prophylactic use for aspirin?

Is there a prophylactic use for aspirin?               All people over the age of 20 years would benefit from taking a low dose of aspirin per day. Various researchers can attest to this.             A study found that taking aspirin every day for five years lowers the chances of developing cancers of the mouth, throat and oesophagus by two thirds. Another study shows that a daily dose cuts by a third the risk of colon polyps – small growths considered to be precursors to colorectal cancer (2003). These findings come on top of well-established evidence over the past 20 years showing that aspirin can significantly reduce the probability of a heart attack or stroke. A number of studies have conclusively shown that aspirin can significantly reduce the risk of heart attacks, strokes and other serious disorders of the vascular (blood) system.             Despite the overwhelming evidence of aspirin’s benefits, it can have side effects. One study found that men with high blood pressure are unlikely to benefit from aspirin’s anti-stroke effects, and might even put themselves at higher risk if they take the drug each day. A number of studies have also shown that the drug can produce gastro- intestinal bleeding. Oxford researchers who analysed 24 studies found that bleeding occurred in 2.5 per cent of patients taking aspirin, compared with 1.4 per cent in those who did not (2003).             Aspirin’s role in preventing initial cardiovascular events in women was dramatically focused by the results of the first study to test aspirin prophylaxis in a large number of apparently healthy women, the Women’s Health Study (2005).             The clearest result was that among women at least 65 years old, a regimen of 100 mg of aspirin every other day cut the incidence of ischemic stroke, MI, and all major cardiovascular disease (CVD) events, while causing a small number of adverse events. Among women younger than 65, the benefit was limited to cutting the risk of ischemic strokes, and the reduction was so modest that aspirin prophylaxis will have to be targeted to a select group of women for whom the likely benefits of regular aspirin will outweigh the risks (2005). Prophylactic aspirin is an option for women aged 65 or older if their blood pressure is controlled.             Aspirin, even in low doses, is associated with adverse events, primarily of gastrointestinal tract bleeding. These risks appear to be unrelated to the risks of CVD. So there is considerable variation in the overall risk-benefit ratio for an individual as those with low CVD risk will be at the same risk level of gastrointestinal bleeding as those at high CVD risk (2005).     Credit:ivythesis.typepad.com

Is there a prophylactic use for aspirin?

Is there a prophylactic use for aspirin? All people over the age of 20 years would benefit from taking a low dose of aspi...

Can beta hcg at 16-21 weeks be used as one of the prenatal laboratory to predict preeclampsia?

Can beta hcg at 16-21 weeks be used as one of the prenatal laboratory to predict preeclampsia?   Human chronic gonadotropin (hcg) refers to the glycoprotein hormone that results during pregnancy and made by the developing embryo following conception.[1] Beta hcg or the pregnancy hormone is produced by the implanting egg’s cells and can  also occur without an embryo. It can be detected 8 to 9 days after ovulation in maternal plasma or urine and reaches its peak at about 8 to 10 weeks and then declines in the course of the pregnancy.[2]   Preeclampsia refers to the incidence of hypertension in pregnancy linked with significant amounts of protein in the urine and entails damage to the maternal endothelium, kidneys and liver. It may progress from 20 weeks gestation and differs among patients, with most cases being diagnosed as pre-term. Preeclampsia has no known cure excepting Caesarean section or induction of labor.[3]   According to one study, women prone to hypertension development during pregnancy may be identified by a second-trimester test for elevated levels of beta-human chronic gonadotropin (beta-hcg), which however, may lack the accuracy in identifying women at  risk for preeclampsia. Based on a study of preeclampsia in 6,286 nondiabetic women,  those who had more than one child and had elevated beta-hcg levels had a greater risk  of developing hypertension and preeclampsia.[4]   According to a second study, second-trimester elevated maternal urine beta-core  fragment of hcg predicted small for gestational age (SGA) infants, and was better in  prediction than other serum analytes. The beta-core fragment that accumulates in  maternal urine is the terminal metabolite of hcg. There was previous evidence that  beta-core fragment of hcg may be used as trophoblastic function marker, with second- trimester urine beta-core fragment having been elevated in clinically normal women who  became preeclamptic in due time.[5]   Spot urine specimens from women in the gestational age range of 14-24 weeks were obtained and refrigerated. To determine whether there was significant connection between beta-core fragment levels and later SGA birth, the Mantel-Haenszel test of linear association was used. There was a plotting of receiver operating characteristics (ROC) sensitivity curve against false-positive rate for SGA prediction at various beta- core fragment threshold values.[6]   The etiology of fetal growth restriction (FGR) is heterogeneous, with many factors being considered, and preeclampsia is an accepted FGR risk factor. Women may be predisposed to preeclampsia if there is failure of the second wave of endovascular trophoblastic invasion. Based on the findings, early disturbance of trophoblast dysfunction occurs in a notable percentage of women who deliver SGA offspring. The intial effect of a hypersecretory state development might be the cause of heightened levels of placental function markers found in preeclamptic women, like hcg, inhibin-A and activin-A. As FGR predictor, beta-core fragment may be better than its parent molecule.[7]   According to a third study, there is strong correlation between elevated maternal inhibin A concentration with a later risk of preeclampsia. Further investigation is in order on the potential use of second trimester inhibin A measurement in a preeclampsia screening strategy.[8]   		 		 		 		[1] “Human chronic gonadotropin”, 		Wikipedia, 27 April 2011, <http://en.wikipedia.org/wiki/Human_chorionic_gonadotropin>  		[accessed 30 April 2011] 		 		 		 		[2] “What is beta hcg?”, OBfocus, 		2009, <http://www.obfocus.com/questions/qanda7.htm> 		[accessed 30 April 2011] 		 		 		 		[3] “Pre-eclampsia”, Wikipedia, 		2 April 2011, <http://en.wikipedia.org/wiki/Pre-eclampsia> 		[accessed 30 April 2011] 		 		 		 		[4] Ellice S. Lieberman et al, “The 		value of elevated second-trimester beta-human chronic gonadotropin in 		predicting development of preeclampsia”, Abstracts Health, 1997, 		 <http://www.faqs.org/abstracts/Health/The-value-of-elevated-second-trimester-beta-human-chorionic-gonadotropin-in-predicting-development-o.html>  		[accessed 30 April 2011] 		 		 		 		[5] Ray Bahado-Singh, MD et al, 		“Maternal Urine [beta]-core hcg Fragment Level and Small for Gestational 		Age Neonates”, Obstetrics & Gynecology, May 2000, <http://journals.lww.com/greenjournal/Fulltext/2000/05000/Maternal_Urine__beta__core_hCG_Fragment_Level_> 		[accessed 30 April 2011] 		 		 		 		[6] ibid 		 		 		 		[7] ibid 		 		 		 		[8] J. Aquilina et al, 		“Second-Trimester Maternal Serum Inhibin A Concentration as an Early 		Marker for 		Preeclampsia”, PubMed.gov, July 1999, <http://www.ncbi.nlm.nih.gov/pubmed/10411808> 		[accessed 30 April 2011]   Credit:ivythesis.typepad.com

Can beta hcg at 16-21 weeks be used as one of the prenatal laboratory to predict preeclampsia?

Can beta hcg at 16-21 weeks be used as one of the prenatal laboratory to predict preeclampsia? Human chronic gonadotropin (hcg) ref...