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The objective of the study was to select solid-state plasticizers for hot-melt extrusion (HME) process. The physical and mechanical properties of plasticizers, in selected binary (polymer:plasticizer) and ternary (active pharmaceutical ingredient:polymer:plasticizer) systems, were evaluated to assess their effectiveness as processing aids for HME process. Indomethacin and Eudragit ® E PO were selected as model active pharmaceutical ingredient and polymer, respectively. Solubility parameters, thermal analysis, and rheological evaluation were used as assessment tools. Based on comparable solubility parameters, stearic acid, glyceryl behenate, and polyethylene glycol 8000 were selected as solid-state plasticizers. Binary and ternary physical mixtures were evaluated as a function of plasticizer concentration for thermal and rheological behavior. The thermal and rheological assessments also confirmed the miscibility predictions from solubility parameters. The understanding of thermal and rheological properties of the various mixtures helped in predicating plasticization efficiency of stearic acid, glyceryl behenate, and polyethylene glycol 8000. The evaluation also provided insight into the properties of the final product. An empirical model was also developed correlating rheological property of physical mixtures to actual HME process. Based on plasticizer efficiency, solid-state plasticizers and processing conditions can be selected for a HME process., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

A novel method was developed to manufacture amorphous formulations of poorly soluble compounds that cannot be processed with existing methods such as spray drying and melt extrusion. The manufacturing process and the characterization of the resulting amorphous dispersion are presented via examples of two research compounds. The novel process is utilized N,N-dimethylacetamide (DMA) to dissolve the drug and the selected ionic polymer. This solution is then co-precipitated into aqueous medium. The solvent is extracted out by washing and the co-precipitated material is isolated by filtration followed by drying. The dried material is referred to as microprecipitated bulk powder (MBP). The amorphous form prepared using this method not only provides excellent in vitro and in vivo performance but also showed excellent stability. The stabilization of amorphous dispersion is attributed to the high T(g), ionic nature of the polymer that help to stabilize the amorphous form by possible ionic interactions, and/or due to the insolubility of polymer in water. In addition to being an alternate technology for amorphous formulation of difficult compounds, MBP technology provides advantages with respect to stability, density and downstream processing., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The aim of this study was to select a novel oral formulation for ibandronate (IBN, CAS number: 13892619). In four cohorts of 28, 21, 19 and 29 healthy volunteers, the impact of the carrier molecule sodium N-[8-(2-hydroxybenzoyl) amino] caprylate (SNAC, CAS number: 203787-91-1) on the bioavailability of IBN was investigated. Within each cohort different oral formulations with one dose of ibandronate (30 mg) and three different ratios of IBN:SNAC (1:5, 1:10 and 1:20) were compared to the approved oral IBN tablet formulations (150 and 50 mg IBN) in a 4-way cross-over design and a one week washout between the administrations. The highest mean IBN exposure was achieved with a capsule formulation containing drug-coated beadlets and an IBN:SNAC ratio of 1:5. AUC(last) and C(max) of IBN were approximately 1.3- and 2.2-fold higher compared to the reference treatment (150 mg IBN without SNAC). Increasing the post-dose fasting duration from 15 to 30 min resulted in a more than 2-fold increase in AUC(last), while superimposable IBN serum concentration-time profiles were achieved after a 30 and 60 min fast. The tolerability of the IBN/SNAC treatments in all cohorts was similar to that in the IBN reference groups and most adverse events (AEs) were of mild to moderate intensity.

A non-ionic amorphous active API ((RR)-3((1R)-3-oxocyclopentyl)-2-[3-chloro-4-methyl sulfonyl]phenyl-N-pyrozin-2ylpropanamide) with a glass transition temperature of 60 degrees C and aqueous solubility of 0.8 mg/mL was layered on the cellulose beads by the help of an anionic (Eudragit L100) and a non-ionic (polyvinylpyrrolidone) PVP K30 polymer respectively. An "immediate" and complete release of API from the anionic (Eudragit L100), and "sustained" but incomplete release from the hygroscopic non-ionic polymer coatings were observed. The effect of the PVP K30, and delivery patterns were investigated. Water uptake of the polymers and flow properties of API upon exposure to humidity as well as moisture sorption of beadlets were determined. Drug-polymer interactions and coating morphologies that were examined via near infrared imaging (NIR), microscopy and FTIR, enlightened any possible drug-polymer interaction. From the anionic polymer coating 93.5% API was dissolved in 50 min whereas the non-ionic polymer coating released 60% drug within 5 h. There were no API-polymer interactions as demonstrated by FTIR, implying that, this factor did not play any role in the differences observed in the release profiles. However, gelling, clumping and agglomeration was observed on the surface of the particles coated with PVP which resulted in slow and incomplete release of the drug. The anionic polymer protected API, by preventing its gelling and clumping in situ while the non-ionic polymer promoted gelling. Because API gels at a critical moisture level and at an associated critical time interval, any delivery system that can protect the drug from reaching to the critical moisture level can control API release. The drug was released via surface erosion from the Eudragit L100 coating, whereas PVP K30, the non-ionic polymer, released API via diffusion process. The results indicate that polymer properties can play a critical role in the release mechanism and kinetics of gelleable drugs. The anionic polymers may protect drugs of similar nature from gelling when exposed to the dissolution media. An understanding of mechanisms involved in drug-polymer interactions will be useful to screen the polymers that are useful in engineering suitable delivery systems for such drugs.

Objective: The purpose of this study was to evaluate the effect of elective cesarean delivery plus a lamivudine-zidovudine prophylaxis regimen on non-breastfeeding mothers with human immunodeficiency virus type 1 and their infants., Study Design: Forty-six antiretroviral-naïve, pregnant women with human immunodeficiency virus type 1 were included. The prophylactic regimen was a lamivudine-zidovudine tablet (150 mg/300 mg) twice daily from week 34 of pregnancy until cesarean delivery at week 38 of gestation, preoperative intravenous zidovudine, and neonatal zidovudine syrup for 4 weeks., Results: At weeks 34 and 38 of gestation, the median maternal viral loads were, respectively, 3.65 log(10) copies/mL (range, 2.34-4.70 log(10) copies/mL) and 2.51 log(10) copies/mL (range, 2.04-3.66 log(10) copies/mL; P<.001), respectively; the viral reduction was 1.12 log(10) copies/mL (range, -0.16-2.60 log(10) copies/mL), and the CD4(+) cell counts increased from 335 cells/mm(3) (range, 57-974 cells/mm(3)) to 420 cells/mm(3) (range, 84-1,083 cells/mm(3); P=.002). No mother or infant had a serious adverse event. Two infants were infected (4.3%; 95% CI, 0.5%-15.7%); 1 infant had intrapartum infection., Conclusion: Elective cesarean delivery plus short-course lamivudine-zidovudine is safe but does not eliminate mother-to-child transmission of human immunodeficiency virus type 1.

Nifedipine (N) and nifedipine. Pluronic F-68 solid dispersion (SD) pellets were developed and characterizedfor drug release mechanisms from a multi-unit erosion matrix system for controlled release. Nifedipine was micronized using a jet mill. Solid dispersion with Pluronic F-68 was prepared by the fusion method. Nifedipine and SD were characterized by particle size analysis, solubility, differential scanning calorimetry (DSC), and x-ray diffraction (XRD) studies. Samples were subsequently processed into matrix pellets by extrusion/spheronization using Eudragit L 100-55 and Eudragit S 100 as release rate-controlling polymers. Drug release mechanisms from pellets were characterized by microscopy and mercury intrusion porosimetry; DSC and XRD studies indicated no polymorphic changes in N after micronization and also confirmed the formation of SD of N with Pluronic F-68. Pellets of N showed a 24-hr drug release profile following zero-order kinetics. Pellets of SD showed a 12-hr release profile followingfirst-order kinetics. Aqueous solubility of N after SD formation was found to be increased 10-fold. Due to increased solubility of N in SD, the drug release mechanism from the multi-unit erosion matrix changed from pure surface erosion to an erosion/diffusion mechanism, thereby altering the release rate and kinetics.

Objective: To compare the antioxidant nutrients and lipid peroxide levels in preeclampsia and normal pregnant women., Methods: Antioxidant nutrients (vitamin A and E) were measured by high-pressure liquid chromatography, vitamin C was measured by the dinitrophenyl hydrazine method, lipid peroxides were measured by the malondialdehyde method in 20 severe preeclampsia, 30 mild preeclampsia and 60 normal pregnant women as controls., Results: Vitamin C levels in severe and mild preeclampsia were significantly less than those in control group. The corrected vitamin E and vitamin A levels were significantly decreased only in severe preeclampsia. While the lipid peroxide levels in both mild and severe preeclampsia were significantly increased when compared with the nomal pregnancy., Conclusions: Preeclampsia is associated with the imbalance between lipid peroxides and antioxidant nutrients (vitamin C and E). The imbalances favour lipid peroxides with the increasing severity of preeclampsia.

This cross-sectional study was to assess the nutrients in terms of protein, fat, minerals, and hormones in heat-dried human placenta. Thirty heat-dried human placentas, 15 from male and 15 from female, were analyzed for protein (amino acids), fiber, fat, moisture, minerals (sodium, potassium, phosphorus, calcium, iron, magnesium, zinc, copper, manganese), hormones (estradiol, progesterone, testosterone, growth hormone). Heat-dried female human placentas had slightly higher fiber content than male, but protein and fat components were not different. Mineral levels in placentas were high especially sodium, potassium and phosphorus. There were no significant differences in the amount of minerals and hormonal profile between female and male placentas. However, hormone levels in heat-dried placenta were low compared to physiologic level in human beings. The results of this study suggest that the amount of nutrients particularly protein and minerals in heat-dried human placentas were enriched.

A cross sectional study was carried out at Ramathibodi Hospital between June and August 1997. The objective of this study was to determine maternal serum lipid levels at delivery and the effect of parity on maternal lipid profile. Study population was normal term pregnant women aged 20-35 years who delivered normal infants with a birthweight > or = 2,500 grams. Maternal serum lipid levels at delivery were determined from 177 normal term pregnant women. Their mean age was 27.6 +/- 4.5 years. The first parity (P1) was about 52 per cent, whereas, the second and third parity (P2 and P3) were 37 and 11 per cent, respectively. Mean maternal serum total cholesterol (TC) levels in P1, P2 and P3 were 258.3 +/- 46.9, 266.7 +/- 47.1 and 295.7 +/- 61.2 mg/dl, respectively. Serum triglyceride (TG) levels in P1, P2 and P3 were 265.2 +/- 81.1, 280.3 +/- 72.1 and 260.7 +/- 82.8 mg/dl, respectively; serum low density lipoprotein-cholesterol (LDL-C) in P1, P2 and P3 were 136.9 +/- 45.2, 144.9 +/- 43.3 and 173.4 +/- 62.1 mg/dl, respectively; and serum high density lipoprotein-cholesterol (HDL-C) levels were 64.6 +/- 16.6, 65.7 +/- 17.8, 67.2 +/- 16.0 mg/dl, respectively. Serum TC and LDL-C levels increased with parity. There was a significant difference between maternal TC and parity (F = 4.702, p = 0.01) as well as LDL-C and parity (F = 4.883, p < 0.01), especially P1 and P3. There was no significant difference between maternal TG and parity as to HDL-C and parity (p > 0.05).

The aim of this study was to assess the correlation between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio in HIV-1 infected pregnant women not receiving antiretroviral therapy There were no significant correlations between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio. However, the presence of underlying vitamin A deficiency in these pregnant women was common.

Objectives: To detect newborns with congenital hypothyroidism (CH) and to treat the affected infants as early as possible., Study Design: Cord blood thyrotropin (TSH) screening for CH in Ramathibodi Hospital began in 1993. From October 1993 to December 1998, 35,390 neonates were screened. The infants with elevated TSH level of greater than 30 mU/L were recalled for verification of CH. Confirmation tests included total thyroxine, free thyroxine and TSH level. Thyroid scan and uptake were performed in some affected infants., Results: Twelve infants with CH were detected resulting in an incidence of one in 2,949 live-births. All affected infants were asymptomatic at birth. Of 12 infants with CH, one premature neonate had a delayed TSH elevation and was diagnosed as having primary hypothyroidism at 2 months of age. The recall rate for validation of CH based on a cut-off value at serum TSH level of greater than 30 mU/L is 1.1 per cent. If the cut-off value of serum TSH level was raised to greater than 40 mU/L, the recall rate would decrease to 0.43 per cent. None of the affected infants had cord blood TSH level of less than 50 mU/L except one premature patient. Therefore, beginning in January 1997, the cut-off value of TSH was raised to 40 mU/L or greater. Pitfalls in this program include incomplete blood-specimen collection and incomplete follow-up. To strengthen the program, improvements were made in the follow-up system from 1996 onward. Therefore, the coverage for blood-specimen collection progressively increased from 84 per cent in 1994 to 96 per cent in 1998. Simultaneously, the patients' return after recalls also increased from 38 per cent to 100 per cent., Conclusions: The incidence of CH in Ramathibodi Hospital is approximately 1:3,000 live-births. The optimal cord blood TSH level for recall is 40 mU/L or greater. The intensification of follow-up strategy resulted in better response to recall and earlier treatment in the affected infants.

Background: It is now accepted that the majority of HIV-1 vertical transmissions occur in late gestation and at the time of delivery. However, there is wide variation in the prevalence rate of mid-trimester vertical transmission. We assessed the maternal HIV-1 RNA viral load and in utero transmission during mid-trimester gestation., Methods: Patients were enrolled when they decided to have their pregnancies terminated between 17 and 24 weeks of gestation. Prostaglandin-induced abortion with PGE1 analogue vaginal administration was carried out in all patients. Maternal plasma HIV-1 RNA viral load and plasma HIV-1 RNA (qualitative) from abortus heart blood were assessed., Results: Amongst 41 HIV-1 seropositive pregnant women not receiving antiretroviral therapy plasma HIV-1 RNA was detected in the abortus heart blood from two women (4.9%; 95% confidence interval (CI), 0.6-16.5). Transmission occurred in one out of nine (11.1%; 95% CI, 0.3-48.2) with maternal viral load > or =100000 copies/ml versus one out of 32 (3.1%; 95% CI, 0.1-16.2) of those with <100000 copies/ml (P = 0.39)., Conclusions: The frequency of HIV-1 vertical transmission during mid-trimester was approximately 5% as detected by plasma HIV-1 RNA (qualitative) method in the fetuses aborted from the prostaglandin termination of pregnancy. During mid-trimester gestation there was no correlation between high maternal viral load and vertical transmission.

This study was undertaken to assess the maternal and umbilical cord serum vitamin A, E levels at delivery and mother-to-child transmission in nonsupplemented vitamin A, E HIV-1 infected parturients who received short-course zidovudine therapy. Maternal and umbilical cord serum vitamin A, E levels were quantitated by high-performance liquid chromatography in 67 HIV-1 infected parturients who received short-course zidovudine therapy. Mother-to-child transmission occurred in 13.4 per cent of HIV-1 infected parturients. There were no significant differences in the mean concentrations of vitamin A, E and vitamin E/cholesterol ratio between parturients with HIV-1 infected and non-infected infants. While maternal serum vitamin E level was adequate, nearly one-third of the parturients in the study had vitamin A deficiency. In conclusion our study has shown that there was no correlation between maternal serum vitamin A, E levels and mother-to-child HIV transmission in HIV-1 infected parturients who received short-course zidovudine therapy. However, the presence of underlying vitamin A deficiency in these parturients was common, adequate and intensive maternal-infant nutritional support should be emphasized especially in developing countries as an adjunctive measure in the reduction of mother-to-child transmission of HIV as well as the reduction in maternal and perinatal morbidity.

Objective: To evaluate the relationship between the status of serum vitamin A, E and hemoglobinopathies among Thai pregnant women., Methods: This was a cross-sectional study in which serum vitamin A and E were assessed in 323 pregnant women with normal hemoglobin and 73 with hemoglobinopathies (47 with hemoglobin E and 26 with thalassemia) during the first trimester., Results: There were no significant differences in the mean serum vitamin A, E concentrations and vitamin E/cholesterol ratio between pregnant women with normal hemoglobin and hemoglobinopathies, while confounding variables that might affect serum vitamin levels i.e. maternal age, gravida, BMI, gestational age, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration and blood group were not different., Conclusion: The results of this study suggest that antenatal care in terms of micronutrients-vitamin A, E in Thai pregnant women with hemoglobinopathies should not be different from normal pregnant women.

Objective: To evaluate the role of umbilical Doppler velocimetry as a comprehensive test for the prediction of discordant twins., Methods: The sets of twins were studied with duplex Doppler velocimetry for umbilical artery in third trimester. A systolic/diastolic ratio was measured for each twin. The average difference in the ratios between each twin > or = 0.4 was used to indicate abnormal test. Discordancy was identified when the birth weight difference of > 25%., Results: Among the 52 sets of twin pregnancies studied, 40 sets of twins fulfilled the study criteria. Eight sets of twins were discordant (20%). The mean gestational age at delivery was 37.15 +/- 2.24 weeks (range 28 to 41 weeks). The test correctly identified 6 of the 8 growth discordant twins which had a sensitivity of 75%, specificity of 68.75%, and accuracy of 70%., Conclusion: Umbilical Doppler velocimetry is useful in prediction of discordant twins.

Abstract. The following recommendations are made for prenatal screening for HIV infection 1) Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2) Every seropositive result should be repeated for confirmation before coming to a definititve conclusion to avoid a misdiagnosis. 3) Fetal blood sampling in the mid-trimester for PCR and p24 antigen assay seems inappropriate as a diagnostic tool for in utero HIV infection of the HIV seropositive pregnant women as the infection mostly occurs after this time. 4) Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for antiretroviral administration to the seroconverted pregnant women for reduction of perinatal transmission. 5) There should be available the appropriate back up services for seropositive pregnant women. There is sufficient evidence indicating a higher vertical HIV-1 transmission rate in the last trimester and during labour compared with the first and second trimesters. Antiretroviral therapy either single or in combination given to the mother during the last trimester and delivery can reduce the viral load in the maternal circulation. Vertical HIV-1 transmission during delivery can be minimized by appropriate timing and route of delivery. Elective Cesarean section before the onset of labour with an intact bag of forewaters provides the least mother-to-fetus microtransfusion compared to other modes of delivery. Since an effective combination of HIV-1 immunoglobulin and HIV-1 vaccine given to the HIV-1 exposed newborns to prevent HIV-1 transmission similar to the viral hepatitis B model is not firmly established at present, postexposure antiretroviral prophylaxis and nonbreast-feeding are advocated for infants born from the HIV-1 infected mothers. In cases of advanced stage of maternal HIV-1 infection, and in developing areas where malnutrition prevails, an adequate supply of essential micronutrients is proposed as an adjunctive measure to reduce HIV-1 perinatal transmission.

There is sufficient evidence indicating a higher vertical HIV-1 transmission rate in the last trimester and during labour compared with the first trimester. Antiretroviral therapy either single or in combination given to the mother during the last trimester and delivery can reduce the viral load in the maternal circulation. Vertical HIV-1 transmission during delivery can be minimized by appropriate timing and route of delivery. Elective Caesarean section before the onset of labour with an intact bag of forewaters provides the least mother-to-fetus microtransfusion compared to other modes of delivery. Since an effective combination of HIV-1 immunoglobulin and HIV-1 vaccine given to the HIV-1 exposed newborns to prevent HIV-1 transmission similar to the viral hepatitis B model is not firmly established at present, postexposure antiretroviral prophylaxis and nonbreast-feeding are advocated for infants born from the HIV-1 infected mothers. In cases of advanced stage of maternal HIV-1 infection, and in developing areas where malnutrition prevails, an adequate supply of essential micronutrients is proposed as an adjunctive measure to reduce HIV-1 perinatal transmission.

The aim of this study was to determine the maternal and umbilical cord serum ZDV levels at delivery in HIV-1 infected parturients treated with a short-course ZDV regimens in late pregnancy and labour. Serum ZDV and its metabolite were measured by high-performance liquid chromatography. Concentrations of ZDV and its metabolite in umbilical cord blood appeared similar to maternal concentrations. There was a significant positive correlation between serum ZDV and its metabolite in maternal and umbilical cord concentrations. At delivery, maintenance of optimal virustatic ZDV concentration with oral antenatal and oral intermittent intrapartum ZDV dosage regimen can be achieved in only 53% of cases. The regimens used in this study were useful but not as effective as the ACTG 076 regimen with an intravenous dose intrapartum plus the oral administration to the infants for 6 weeks.

In Thailand, the prevalence of paediatric HIV-1 infection has increased rapidly through vertical transmission. According to the ACTG 076 trial regimen, zidovudine treatment in HIV-infected pregnancy can reduce vertical transmission. However, this treatment is complex and costly. It is not applicable for developing countries. We conducted a study to evaluate the effect of zidovudine treatment in late pregnancy on HIV-1 in utero transmission. Fifty cases of asymptomatic HIV-1 infected-women were voluntarily enrolled to the study. Zidovudine 250 mg orally twice a day was given to these patients from gestational age 36 weeks until labour. The newborns were evaluated at birth by a neonatologist and peripheral blood was tested for HIV genome by PCR technique within 48 hours of birth. The study revealed that no HIV genome was detected from the peripheral blood of newborns. It is suggested that zidovudine treatment in late pregnancy could reduce HIV-1 in utero transmission.

Pheochromocytoma during pregnancy is rare. Only a few hundred cases have been published in the literature. We report patients with pheochromocytoma diagnosed at antepartum period. Manifestation include hypertension with various clinical presentation, possibly resembling those of pregnancy-induced hypertension. Confirmation necessitates special biochemical examination and the use of different radiological imaging tool. Treatment combines medical procedures with surgical exploration, mandating a team approach of diverse medical expertise. In the first and second trimesters, tumor resection has a good fetal outcome; in later pregnancy, delivery by elective cesarean section followed by tumor resection is recommended. The overall prognosis is mainly affected early diagnosis and multidisciplinarian management.

We conducted a case-control study to evaluate the association between contraceptive methods and HIV infection among Thai female commercial sex workers in Khon Kaen and Lumpang provinces, Thailand; 118 cases of HIV-1 infected sex workers were eligible for inclusion and 258 HIV-1 negative women were recruited as controls during the period of October 1, 1993 to December 31, 1994. Cases and controls were matched by age, education, parity, age at first exposure to commercial sex, number of clients per night, duration of work and sexual practice during menstruation. The ratio of case per control was 1:2. Both cases and controls were interviewed and underwent blood testing by a team of investigators. The study revealed no significant association between oral pill, injection, other contraceptives and HIV-1 infection. However, condom usage showed a significant protective effect. It is suggested that these contraceptives in this high-risk group of women do not increase the risk of HIV infection. In contrast, the use of condoms could reduce the risk of HIV infection.

Objective: To determine if low levels of serum vitamin A and beta-carotene are present in pregnant women with human immunodeficiency virus-1 (HIV-1) infection., Methods: Serum concentrations of vitamin A and beta-carotene were measured in 74 pregnant women seropositive for HIV-1 infection (17 with CD4 count below 200 cells/microliter) and in 148 pregnant seronegative controls in the first trimester. Comparisons were made between groups stratified by CD4 count., Results: Compared with controls, women with HIV-1 infection and CD4 count below 200 cells/microliter exhibited 37% lower mean serum vitamin A levels (0.820 versus 1.308 micromol/L, P < .001) and 37% lower mean serum beta-carotene levels (1.486 versus 2.362 micromol/L, P < .001). Mean maternal age, parity, gestational age, hemoglobin levels, and body mass index at entry into the study did not differ significantly between the control and HIV-1 infection groups. In addition, serum vitamin A levels correlated significantly with the percentage of CD4 lymphocytes (r = 0.589, P < .001), CD4 count (r = 0.772, P < .001), and CD4 to CD8 ratio (r = 0.593, P < .001). Serum beta-carotene levels correlated with the percentage of CD4 lymphocytes (r = 0.407, P < .001), CD4 count (r = 0.614, P < .001), and CD4 to CD8 ratio (r = 0.434, P < .001)., Conclusion: Compared with levels in uninfected women, serum vitamin A and beta-carotene are decreased in HIV-1-infected pregnant women in the first trimester with CD4 counts lower than 200 cells/microliter. These micronutrient concentrations also correlate with CD4 count.

Between May, 1994 and May, 1995 serum ferritin concentrations were measured in 74 pregnant women who were HIV-1 positive (17 with CD4 cell counts below 200 cells/uL) and in 148 HIV-1 negative pregnant controls in first trimester of gestation to determine if a high level of serum ferritin is present in pregnant women with HIV-1 infection. Comparisons were made between groups stratified by CD4 cell counts. Pregnant women with HIV-1 infection had 92% higher mean serum ferritin levels (112.8 versus 58.8 ug/L, p < 0.005) compared to controls, whereas the mean maternal age, parity, gestational age, haemoglobin levels and body mass index at entry into the study did not differ significantly between the control and HIV-1 infection groups. The serum ferritin levels inversely correlated with the percentage of CD4 lymphocytes, CD4 cell counts and the CD4/CD8 ratio. This study suggests that serum ferritin levels can also be used as an immunological marker in HIV-1 infected pregnant women.

In summary, the level of HIV infection among teenagers will increase in our community because of their risky behaviour. Education and counselling should be the effective strategies to overcome this problem.

Between July, 1994 and March, 1995, 23 heart blood samples from fresh abortuses of HIV-1 seropositive pregnant women after elective termination of pregnancy between 18 and 25 weeks of gestation by prostaglandin E1 analogue vaginal administration were examined for polymerase chain reaction (PCR) of HIV-1 genome and p24 antigen to investigate the transplacental transfer of HIV-1 infection. All samples of fetal heart blood were positive for HIV-1 antibody (ELISA), but negative for PCR and HIV-1 p24 antigen assay. These negative results could be due to the lack of the virus in the peripheral blood or to a viral load low enough to be undetectable by PCR method at mid-trimester gestation and suggest that HIV-1 vertical transmission occurs mostly during the last trimester of pregnancy and/or at delivery.

The following recommendations are made as a result of this study. 1. Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2. Every seropositive result should be repeated for confirmation before coming to a definitive conclusion to avoid a misdiagnosis. 3. Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for AZT administration to the seroconverted pregnant women for reduction of perinatal transmission. 4. There should be available the appropriate back up services for seropositive pregnant women such as: (i) C--Choice. Having been appropriately counselled the pregnant women should be able to terminate or continue with the pregnancy. (ii) H--High-risk pregnancy concept. The pregnant women should be treated as high-risk cases. Throughout their pregnancy and delivery only experienced personnel should manage them. (iii) I--Integrated services. From our experience it would be reasonable to integrate the care of seropositive pregnant women with any other high-risk cases. Special or anonymous clinics may create an atmosphere of uneasy feelings among the women who could be made to feel alienated and discriminated against. (iv) P--Provision of care. Comprehensive services must be available. These include an experienced counselling team, adequate laboratory services, services for safe first and second trimester therapeutic abortions, appropriate facility in the delivery suite (including Caesarean section) for infected cases, and dedicated paediatricians.

A prospective cross-sectional study of maternal and umbilical cord blood lead levels was conducted in a total of 500 deliveries at Ramathibodi Hospital. The mean concentrations of lead in maternal and cord blood were 6.2 +/- 2.0, 1.6 +/- 0.5 microgram/dl respectively. There was direct relationship between maternal and umbilical cord blood lead level. Maternal occupation and length of stay in Bangkok were related to maternal blood lead levels. There was no association between adverse pregnancy outcomes and maternal blood lead levels. A large scale study and periodic surveillance of blood lead levels in pregnancy is advocated.

Serum magnesium levels were determined in severe preeclampsia patients who were treated with magnesium sulfate infusion. Forty-four patients with diagnosis of severe preeclampsia between 30-41 weeks gestation, given a conventional 5 g magnesium sulfate intravenous bolus infusion and 1 g/hr continuous infusion and continued 24 hours postpartum, were prospectively studied. The mean pre-treatment magnesium level was 2.3 +/- 0.3 mg/dl which was similar to those reports. The levels measured at 1/2, 1, 2, 4, 12 and 24 hours after initiation of magnesium infusion were 4.8 +/- 0.4, 4.7 +/- 0.4, 4.5 +/- 0.3, 4.7 +/- 0.3, 5.4 +/- 0.3 and 5.9 +/- 0.3 mg/dl respectively. After delivery the levels were measured immediately, 12, and 24 hours and found to be 4.7 +/- 0.4, 4.9 +/- 0.4, and 5.2 +/- 0.3 mg/dl respectively. The serum magnesium levels were also varied with maternal weight, the dose regimen used in our study is appropriate for Asian pregnant women whose body weight usually less than 70 kg.

The prediction of preeclampsia by the urinary calcium/creatinine ratio during the early third trimester was assessed in 190 primigravidas, aged less than 35 years and between 28 and 32 weeks' gestation without pregnancy complications. Preeclampsia developed in 6.8% of the patients. The mean maternal age, gestational age at entry into the study and at delivery, and the average mean arterial blood pressure at entry into the study did not differ significantly between the 13 patients with subsequent preeclampsia and the 177 normotensive patients. The patients with preeclampsia did not have significantly less excretion of calcium than the normotensives.

The purpose of this Historical Prospective Study was to analyze factors associated with neonatal hyperbilirubinemia. Data were collected from summary labour records and individual patients' records at Ramathibodi Hospital between January 1, 1988 and December 31, 1988. Of the 7,644 livebirths, neonatal hyperbilirubinemia (> or = 15 mg/100 ml) occurred in 638 cases. There was a statistically significant positive relationship between hyperbilirubinemia and vacuum extraction (RR 2.7), preterm delivery (relative risk, RR 2.1), low birthweight (RR 2.0), antepartum complication (RR 1.7), intrapartum complications (RR 1.5), forceps delivery (RR 1.4), and oxytocin infusion (RR 1.3). No significant relationship emerged between hyperbilirubinemia and fetal sex, cesarean section, breech delivery and the 5 min Apgar score. From 1984 to 1988 there was a pronounced increase in the incidence of neonatal hyperbilirubinemia in Ramathibodi Hospital. This increase was consistent with the increase in use of oxytocin infusion which reflects changes in obstetric practice. Provision of information, education and communication about this adverse effect to obstetricians and auditing their use are suggested solutions.

During the 12-yr period from 1981 to 1992, over 85,000 deliveries at Ramathibodi Hospital from 114 pregnancies (prevalence 0.1%) in 110 patients were complicated by Graves' disease. The diagnosis was made following conception in 52 per cent. Medical treatment with propylthiouracil was the main regimen. Maternal and perinatal outcome were related with thyroid status at delivery including thyrotoxic crisis, preeclampsia and preterm deliveries. There was no case of fetal goitre, hyperthyroidism, but fetal hypothyroidism occurred in 12.2 per cent which calls for close monitoring of antithyroid drug dosage and close neonatal-infant follow-up.