Lyell McEwin Hospital

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Lyell McEwin Hospital

Australia

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Buckberry S.,University of Adelaide | Bianco-Miotto T.,University of Adelaide | Bent S.J.,University of Adelaide | Dekker G.A.,University of Adelaide | And 2 more authors.
Molecular Human Reproduction | Year: 2014

As males and females share highly similar genomes, the regulation of many sexually dimorphic traits is constrained to occur through sex-biased gene regulation. There is strong evidence that human males and females differ in terms of growth and development in utero and that these divergent growth strategies appear to place males at increased risk when in sub-optimal conditions. Since the placenta is the interface of maternal-fetal exchange throughout pregnancy, these developmental differences are most likely orchestrated by differential placental function. To date, progress in this field has been hampered by a lack of genome-wide information on sex differences in placental gene expression. Therefore, our motivation in this study was to characterize sex-biased gene expression in the human placenta. We obtained gene expression data for > 300 non-pathological placenta samples from11 microarray datasets and applied mapping-based array probe re-annotation and inverse-variance meta-analysis methods which showed that > 140 genes (false discovery rate (FDR) <0.05) are differentially expressed between male and female placentae. A majority of these genes (>60%) are autosomal, many of which are involved in high-level regulatory processes such as gene transcription, cell growth and proliferation and hormonal function. Of particular interest, we detected higher female expression from all seven genes in the LHB-CGB cluster, which includes genes involved in placental development, the maintenance of pregnancy and maternal immune tolerance of the conceptus. These results demonstrate that sex-biased gene expression in the normal human placenta occurs across the genome and includes genes that are central to growth, development and the maintenance of pregnancy. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Andraweera P.H.,University of Adelaide | Andraweera P.H.,University of Colombo | Dekker G.A.,University of Adelaide | Dekker G.A.,Lyell McEwin Hospital | Roberts C.T.,University of Adelaide
Human Reproduction Update | Year: 2012

Background: Pre-eclampsia, small-for-gestational-age infants, preterm birth and recurrent miscarriage complicate a significant number of pregnancies. The vascular endothelial growth factor (VEGF) family of angiogenic growth factors is implicated in the pathophysiology of these complications. We aimed to elucidate the role of these angiogenic factors in placentation and to evaluate the predictive value of their protein concentrations and genetic variations in pregnancy complications. Methods: We performed a systematic search of PubMed, and retrieved original articles. The search included a combination of terms such as VEGF-A, placental growth factor (PlGF), kinase insert domain receptor, fms-like-tyrosine-kinase receptor 1, soluble fms-like-tyrosine-kinase receptor 1, pre-eclampsia, small-for-gestational-age infants, preterm birth, recurrent miscarriage, placenta, prediction and polymorphisms. Results: This review summarizes the current knowledge of the roles of the VEGF family in early placentation and of the abnormalities in maternal plasma and placental expression of angiogenic proteins in adverse pregnancy outcomes compared with normal pregnancy. PlGF and sFLT-1 in combination with other clinical and biochemical markers in late first or second trimester appear to predict early-onset pre-eclampsia with a high sensitivity and specificity. However, VEGF family proteins do not have sufficient power to accurately predict late-onset pre-eclampsia, small-for-gestational age pregnancies or preterm birth. Functional polymorphisms in these angiogenic genes are implicated in pregnancy complications, but their contribution appears to be minor. Conclusions: Although the VEGF family has important roles in normal and complicated pregnancy, the current predictive value of the VEGF family as biomarkers appears to be limited to early-onset pre-eclampsia. © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Froessler B.,Lyell McEwin Hospital | Froessler B.,University of Adelaide | Collingwood J.,Ballarat Base Hospital | Hodyl N.A.,University of Adelaide | Dekker G.,Lyell McEwin Hospital
BMC Pregnancy and Childbirth | Year: 2014

Background: Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated.The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester.Methods: Prospective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.Results: Intravenous ferric carboxymaltose infusion significantly increased Hb values (p < 0.01) above baseline levels in all women. Increased Hb values were observed at 3 and 6 weeks post infusion and up to 8 weeks post-infusion. Ferritin values increased significantly after the infusion. Only 4 women had repeat ferritin values post-partum which remained above baseline levels. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. Of the 29 (44.6%) women interviewed, 19 (65.5%) women reported an improvement in their well-being and 9 (31%) felt no different after the infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 13 (20%) patients.Conclusions: Our prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anaemia in pregnancy. © 2014 Froessler et al.; licensee BioMed Central Ltd.


Pasupathy S.,University of Adelaide | Pasupathy S.,Queen Elizabeth Hospital | Air T.,University of Adelaide | Dreyer R.P.,University of Adelaide | And 9 more authors.
Circulation | Year: 2015

Background - Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a puzzling clinical entity with no previous evaluation of the literature. This systematic review aims to (1) quantify the prevalence, risk factors, and 12-month prognosis in patients with MINOCA, and (2) evaluate potential pathophysiological mechanisms underlying this disorder. Methods and Results - Quantitative assessment of 28 publications using a meta-analytic approach evaluated the prevalence, clinical features, and prognosis of MINOCA. The prevalence of MINOCA was 6% [95% confidence interval, 5%-7%] with a median patient age of 55 years (95% confidence interval, 51-59 years) and 40% women. However, in comparison with those with myocardial infarction associated with obstructive coronary artery disease, the patients with MINOCA were more likely to be younger and female but less likely to have hyperlipidemia, although other cardiovascular risk factors were similar. All-cause mortality at 12 months was lower in MINOCA (4.7%; 95% confidence interval, 2.6%-6.9%) compared with myocardial infarction associated with obstructive coronary artery disease (6.7%, 95% confidence interval, 4.3%-9.0%). Qualitative assessment of 46 publications evaluating the underlying pathophysiology responsible for MINOCA revealed the presence of a typical myocardial infarct on cardiac magnetic resonance imaging in only 24% of patients, with myocarditis occurring in 33% and no significant abnormality in 26%. Coronary artery spasm was inducible in 27% of MINOCA patients, and thrombophilia disorders were detected in 14%. Conclusions - MINOCA should be considered as a working diagnosis with multiple potential causes that require evaluation so that directed therapies may improve its guarded prognosis. © 2015 American Heart Association, Inc.


News Article | November 16, 2016
Site: www.sciencedaily.com

Research led by the University of Adelaide has found that women whose babies are conceived in winter are more likely to develop gestational diabetes during pregnancy, increasing a range of risk factors for both child and mother. The study -- investigating more than 60,000 births in South Australia over a five-year period -- is the first population-based study of its kind to confirm a seasonal variation in gestational diabetes. Published in the journal BMJ Diabetes Research & Care, the study was led by the Robinson Research Institute at the University of Adelaide, and involved the University of Groningen in the Netherlands and the Pregnancy Outcome Unit of SA Health. Gestational diabetes mellitus is a serious pregnancy complication characterized by inadequate blood sugar control in pregnancy. Complications of gestational diabetes include excessive birth weight, pre-term birth, low blood sugar (which, in extreme cases, can lead to seizures in the baby), and developing type 2 diabetes later in life. "Our study is the first of its kind to find strong evidence of a relationship between gestational diabetes and the season in which a child is conceived," says lead author Dr Petra Verburg from the University of Groningen, who is currently based at the University of Adelaide's Robinson Research Institute and at the Lyell McEwin Hospital. The study found that: • In the five years from 2007-2011, the incidence of pregnancies affected by gestational diabetes increased, with 4.9% of pregnancies affected in 2007, increasing to 7.2% in 2011 • Women who conceived in winter were more likely to develop gestational diabetes during their pregnancy, with 6.6% of pregnancies from winter conceptions affected • Women who conceived in summer were less likely to develop gestational diabetes, with 5.4% of summer conceptions affected. "The mechanisms that cause gestational diabetes are still not fully understood," Dr Verburg says. "Previous studies have suggested that meteorological factors, physical activity, diet and vitamin D are risk factors for gestational diabetes, all of which are impacted by the winter season. "Not only should our results be confirmed in other populations, future research should also investigate other factors that vary with season," she says. Research leader and senior author Professor Claire Roberts, from the University's Robinson Research Institute, says the results continue to show the broader impacts of the increasing body mass index (BMI) in women of reproductive age. "Elevated BMI and low physical activity are risk factors for gestational diabetes, as well as low socio-economic status. These factors are modifiable, and they represent targets for interventions to prevent the rising tide of gestational diabetes," Professor Roberts says.


News Article | November 15, 2016
Site: www.eurekalert.org

Research led by the University of Adelaide has found that women whose babies are conceived in winter are more likely to develop gestational diabetes during pregnancy, increasing a range of risk factors for both child and mother. The study - investigating more than 60,000 births in South Australia over a five-year period - is the first population-based study of its kind to confirm a seasonal variation in gestational diabetes. Published in the journal BMJ Diabetes Research & Care, the study was led by the Robinson Research Institute at the University of Adelaide, and involved the University of Groningen in the Netherlands and the Pregnancy Outcome Unit of SA Health. Gestational diabetes mellitus is a serious pregnancy complication characterized by inadequate blood sugar control in pregnancy. Complications of gestational diabetes include excessive birth weight, pre-term birth, low blood sugar (which, in extreme cases, can lead to seizures in the baby), and developing type 2 diabetes later in life. "Our study is the first of its kind to find strong evidence of a relationship between gestational diabetes and the season in which a child is conceived," says lead author Dr Petra Verburg from the University of Groningen, who is currently based at the University of Adelaide's Robinson Research Institute and at the Lyell McEwin Hospital. "The mechanisms that cause gestational diabetes are still not fully understood," Dr Verburg says. "Previous studies have suggested that meteorological factors, physical activity, diet and vitamin D are risk factors for gestational diabetes, all of which are impacted by the winter season. "Not only should our results be confirmed in other populations, future research should also investigate other factors that vary with season," she says. Research leader and senior author Professor Claire Roberts, from the University's Robinson Research Institute, says the results continue to show the broader impacts of the increasing body mass index (BMI) in women of reproductive age. "Elevated BMI and low physical activity are risk factors for gestational diabetes, as well as low socio-economic status. These factors are modifiable, and they represent targets for interventions to prevent the rising tide of gestational diabetes," Professor Roberts says. This research has been supported by the National Health and Medical Research Council (NHMRC). Dr Petra Verburg University of Groningen; and Robinson Research Institute The University of Adelaide petra.verburg@adelaide.edu.au


Vallat W.,Lyell McEwin Hospital
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia | Year: 2013

Cerebral amyloid angiopathy as a cause of recurrent small cortical strokes is under-recognised. These patients need haemosiderin-sensitive MRI to make a diagnosis and intensive antiplatelet treatment is dangerous. Copyright © 2013 Elsevier Ltd. All rights reserved.


Khurram A.,Royal Adelaide Hospital | Kleinig T.,Royal Adelaide Hospital | Kleinig T.,Lyell McEwin Hospital | Leyden J.,Lyell McEwin Hospital
Stroke | Year: 2014

BACKGROUND AND PURPOSE - : It has been previously found noted that 15% to 20% of subarachnoid hemorrhage (SAH) is nonaneurysmal. Nontraumatic convexity SAH (cSAH) is increasingly recognized. Data concerning incidence and associations are scant. METHODS - : We identified all SAH-coded cases from South Australian public hospitals between January 2005 and July 2011. Electronic discharge summaries were reviewed, and cases of cSAH were ascertained. Clinical and radiological features were recorded, and pathogenesis was assigned. RESULTS - : Of 742 cases with SAH, 41 (6%) cases were cSAH, giving a minimum population annual incidence of 5.1 per million (95% confidence interval, 3.7-7.0). Median age was 70 years (interquartile range, 48-79). Commonest causes were cerebral amyloid angiopathy (39%), reversible cerebral vasoconstriction syndrome (17%), cerebral venous sinus thrombosis (10%), large-vessel stenotic atherosclerosis (10%), and posterior reversible encephalopathy syndrome (5%). No cause was identified in 20% (mostly elderly patients with incomplete evaluation). Most (63%) presented with transient neurological symptoms. Many (49%) were misdiagnosed as transient ischemic attacks and treated inappropriately with antithrombotics. CONCLUSIONS - : cSAH comprises a significant proportion of SAH. Commonest causes are cerebral amyloid angiopathy in the elderly and reversible cerebral vasoconstriction syndrome in the young, but differential diagnosis is broad. Misdiagnosis is common and leads to potentially harmful treatments. © 2014 American Heart Association, Inc.


Grieger J.A.,Lyell McEwin Hospital | Grzeskowiak L.E.,Lyell McEwin Hospital | Clifton V.L.,Lyell McEwin Hospital
Journal of Nutrition | Year: 2014

Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. Preconception dietary patterns have not been assessed in relation to perinatal outcomes. The objectives of this study were to identify associations between maternal dietary patterns in the 12 mo before conception on fetal growth and preterm delivery. Preconception food frequency data were collected retrospectively in 309 women. Dietary patterns were derived using factor analysis. Perinatal outcomes were collected at delivery with birth weight data calculated into percentiles to assess small and large for gestational age and preterm delivery at <37 wk. Three dietary patterns were identified: 1) high-protein/fruit (characterized by fish, meat, chicken, fruit, and some whole grains); 2) high-fat/sugar/ takeaway (takeaway foods, potato chips, refined grains); and 3) vegetarian-type (vegetables, legumes, whole grains). A 1-SD increase in the scores on the high-protein/fruit pattern was associated with decreased likelihood of preterm birth (adjusted OR: 0.31; 95% CI: 0.13, 0.72; P = 0.007), whereas the reverse direction was apparent for the high-fat/sugar/takeaway pattern (adjusted OR: 1.54; 95% CI: 1.10, 2.15; P = 0.011). A 1-SD increase in the scores on the high fat/sugar/takeaway pattern was also associated with shorter gestation (adjusted regression coefficient: 22.7; 95% CI: 24.3, 21.1; P = 0.001) and birth length (adjusted regression coefficient: 20.5; 95% CI: 20.8, 20.1; P = 0.004). Nutrition before pregnancy is associated with perinatal outcomes. A dietary pattern containing several protein-rich food sources, fruit, and some whole grains is associated with reduced likelihood for preterm delivery, whereas a dietary pattern mainly consisting of discretionary items is associated with preterm delivery, shorter birth length, and earlier gestation. Poor dietary behaviors in the periconceptional period could be altered to promote behavior change in dietary intake to improve perinatal outcomes and the long-term health of the child. © 2014 American Society for Nutrition.


Crowley P.,Lyell McEwin Hospital
Australian Prescriber | Year: 2015

Drug therapy for alcohol dependence should only be used in conjunction with a comprehensive treatment plan. Naltrexone and acamprosate have well established efficacy and are first-line treatments. Naltrexone is recommended for patients aiming to cut down their alcohol intake who do not have severe liver disease or an ongoing need for opioids. Acamprosate is recommended for those who have achieved and wish to maintain abstinence. Disulfiram is no longer considered first-line treatment due to difficulties with compliance and toxicity. Although baclofen and topiramate have evidence of benefit, they are not registered for alcohol dependence and should only be considered in specialist practice. © 2015, Australian Government Publishing Service. All Rights Reserved.

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