Here are the top 5 posts this week.

Ovarian Transposition: A novel laparoscopic surgical method video by Cleveland Clinics.

A recent article published in forthcoming issue of Fertility and Sterility describes and demonstrate novel surgical method of laparoscopic ovarian transposition. This is a minimal invasive approach in which the ovary is tunneled through a peritoneum.

https://obgynupdated.blogspot.com/2017/03/ovarian-transposition-novel_17.html

Treating Hypothyroidism and hypothyroxinemia in pregnancy? Clinical dilemma continues.

Treating antenatal patients with levothyroxine who have hypothyroidism or hypothyroxinemia between 8 to 20 weeks of pregnancy did not result in better cognitive outcome and IQ in children through 5 years of age as compared to women who received placebo.

The study was published online on March 2, 2017 in the New England Journal of Medicine.

https://obgynupdated.blogspot.com/2017/03/treating-hypothyroidism-and.html

Vitamin B, a personal weapon to mitigate the effects of Air Pollution.

Vitamin B could attenuate the effects of most dangerous type of air pollution and could be used at personal level to protect against the ill effects. The study was recently published in Proceedings of the National Academy of Sciences of the United States of America.

https://obgynupdated.blogspot.com/2017/03/vitamin-b-personal-weapon-to-mitigate.html

Wow, new paper based test can tell your blood group in 30 seconds!

Researchers working at the Third Military Medical University in Chongqing, China have developed a quick and reliable test to know the blood type in seconds and rapidly determine the compatibility of donor and recipient blood samples before transfusion.

https://obgynupdated.blogspot.com/2017/03/wow-new-paper-based-test-can-tell-your.html

CRISPR co-inventor Jennifer Doudna keynote address about responsible use of gene editing in future.

“What if a cell’s DNA could be edited just like the text of a document so that you could actually erase letters, you could erase whole sentences, [you could] replace sentences, and you could do things that would enable scientists to change the mutations that might cause genetic disease, make changes that allow us to understand the function of DNA and different kinds of organisms and perhaps, enable us to really direct the way that organisms are evolving on the planet?”

With this promising words about future of CRISPR Cas9 technology Jennifer Doudna, co-inventor of CRISPR Cas9 technology started her keynote address at 2017 South by Southwest (SXSW) conference.

https://obgynupdated.blogspot.com/2017/03/crispr-co-inventor-jennifer-doudna.html

Vitamin B, a personal weapon to mitigate the effects of Air Pollution.

Vitamin B could attenuate the effects of most dangerous type of air pollution and could be used at personal level to protect against the ill effects. The study was recently published in Proceedings of the National Academy of Sciences of the United States of America.[1]

The investigators looked at the effects caused by PM2.5, one of the most dangerous type of pollution on volunteers in a cross over trial.  PM2.5 refers to atmospheric particulate matter (PM) that have a diameter less than 2.5 micrometers, which is about 3% the diameter of a human hair.

The fine PM finds its way into blood stream through lungs and causes pulmonary and placental inflammation, coagulopathies, endothelial dysfunction and hematological responses and eventually lead to heart attack and stroke.

Studies have also shown adverse effects on mother and neonates due to Pollution. Outdoor air pollution has been identified as a possible risk factor for preterm births across the globe according to a study published in Journal of Environment International online February 10, 2017. Air pollution identified as a possible risk factor for nearly 3 million preterm births every year.

Scientist also suspect that exposure to PM2.5 can cause "epigenetic" changes to our cells leading to mutations that can damage our health.

WHO recently estimated that 92% of the world's population lives is exposed to dangerous levels of pollution exceeding the recommended threshold.[2]

WHO map depicting global air pollution 

In this cross over study, 10 volunteers were exposed to clean air and given placebo as supplements to know the baseline levels. Than the same 10 persons were exposed to polluted air and given placebo for 4 weeks. Lastly the individuals received polluted air but this time with Vitamin B supplementation (2.5 mg/d folic acid, 50 mg/d vitamin B6, and 1 mg/d vitamin B12), respectively.

The researchers looked at epigenome-wide methylation before and after each exposure. PM2.5 induced methylation changes in genes involved in mitochondrial oxidative energy metabolism.

PM2.5 depleted 11.1% of the mitochondrial DNA content and B-vitamin supplementation attenuated the PM2.5 effect by 102% (P= 0.01).

Andrea A. Baccarellia, Mailman School of Public Health, Columbia University, New York "Future studies, especially in heavily polluted areas, are urgently needed to validate our findings and ultimately develop preventive interventions using B vitamins to contain the health effects of air pollution," said Baccarelli.

"While emission control and regulation is the backbone of prevention, high exposures are, unfortunately, the rule still in many megacities throughout the world," she further added.

Although this study has small sample size, it helps fill the critical knowledge gap regarding ways of personal protection at individual level. People around the globe use all kind of masks, scarf but nothing was known about taking supplementation to mitigate the effects at cellular level.

 We as individuals do not have the choice to determine the type of air we breathe in; government regulation implementation will go a long way in protecting the society members and society against the effects of Global Warming.

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[1] http://www.pnas.org/content/early/2017/03/07/1618545114.abstract

[2] http://www.who.int/phe/publications/air-pollution-global-assessment/en/

Air pollution identified as a possible risk factor for nearly 3 million preterm births every year.

Air pollution 

Outdoor air pollution has been identified as a possible risk factor for preterm births across the globe according to a study published in Journal of Environment International online February 10, 2017.[1] 

The 2010 study estimated that 2.7–3.4 million preterm births may be prevented if PM_2.5 exposure is brought down.

It is estimated that 14·9 million babies were born preterm worldwide in 2010.

There exists a wide disparity between Preterm Births(PTBs) rates across the globe, European countries have the lowest rate at 4-5% vs. countries in Africa and South Asia with rates as high as 15–18%.

In South Asia, about 1 million   PM_2.5 associated PTBs happened in India, followed by China which contributed another 500,000.

                                       

A pregnant woman in India or China will likely be exposed to 10 times more pollution as compared to a woman in Canada or UK.

It is estimated that in 2010, out of 135 million livebirths globally 14.9 million babies (11.1%) were preterm, including both spontaneous and iatrogenic births. [2]

Exposure of mother to fine particulate matter(PM) has been identified as one of the many risk factors for PTBs as well low birth weight babies. The fine PM finds its way into blood stream through lungs and causes pulmonary and placental inflammation, coagulopathies, endothelial dysfunction and hematological responses.

Fine particles are produced from all types of combustion, including motor vehicles, power plants, solid cooking fuels, residential wood burning, forest fires, agricultural burning, and some industrial processes.

Desert dust also contributes to Particulate Matter ( PM) and in Sub Saharan Africa, Middle East and North Africa it is the major exposure. 

"Air pollution may not just harm people who are breathing the air directly - it may also seriously affect a baby in its mother's womb," said Chris Malley, lead author of the study which is based on data for 2010.

The study further demonstrated that majority of the PM_2.5 associated preterm birth could be prevented by implementing strict emission control strategies in these regions except in in Sub Saharan Africa, Middle East and North Africa where nothing much can be done to change the geography of the area.

Johan Kuylenstierna, co-author of the study, and SEI's policy director said "In a city, maybe only half the pollution comes from sources within the city itself - the rest will be transported there by the wind from other regions or even other countries."

Nevertheless, the study demonstrated that reduction of maternal PM_2.5 exposure through emission reduction strategies could bring down the global preterm rate, limit in utero exposure to PM_2.5 bringing down postnatal and long term neonatal morbidity.

Exposure to PM_2.5 is also responsible for 9–14% of total preterm births globally out of the total risk percentage. It should also be targeted along with other risk factors to reduce the incidence of preterm birth.

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[1] http://www.sciencedirect.com/science/article/pii/S0160412016305992

[2] http://www.sciencedirect.com/science/article/pii/S0140673612608204