By T. Yasmin. Miami University of Ohio.

The stability of azadirachtin has been studied extensively under various storage conditions ampicillin 500mg line topical antibiotics for acne side effects. Studies on increasing the half-life of azadirachtin using chemicals ampicillin 500 mg online going off antibiotics for acne, fatty acids, oils, surfactants and organic solvents have been reported in the literature [47, 118, 119]. This is due to the lack of sophisticated technology for the commercial production of plant tissue culture products and the consequent ex- pense of available production methods. The development of large-scale cultiva- tion processes is complicated because of several specifc characteristics of plant cells. Bioreactors are considered to be the key step towards the commercial pro- duction of secondary metabolites by plant cell technology. They offer optimal conditions for large-scale, plant-derived metabolite production for commercial manufacture [124, 125]. On-line measurement of process parameters such as temperature, pH, dissolved oxygen, carbon dioxide and other gases is possible during bioreactor operations. Hence, effcient control of parameters that affect growth and product synthesis can be achieved using the signals from the sen- sors mentioned above and various control strategies in the bioreactors. Srivastava the advantages, transfer from shake fask to pilot plant-scale bioreactor level is a problem because of the slow growth of plant cell/tissue, low shear resistance, and tendency towards cell/tissue aggregation. The choice and design of a biore- actor is therefore determined by factors like shear environment, oxygen trans- fer capacity, mixing mechanism, foaming, maintenance of aseptic conditions for long fermentation periods and capital investment. Different bioreactor op- erating strategies can be used in plant cell/tissue cultures to enhance secondary metabolite production. The fed-batch process is one such effective approach to improve the yield and productivity of the bioactive compounds from plant cell cultures [126–128]. Application of continuous culture with and without cell re- cycling can also be adopted to overcome the limitations of batch and fed-batch processes and for improvement of yield and volumetric productivity [14]. Not many studies have been carried out on azadirachtin production in bio- reactors, but among them, a few are suspension culture studies carried out on Azadirachta indica for azadirachtin production by Raval et al. There has been an attempt in litera- ture to develop a mathematical model for growth and azadirachtin production from suspension cultures of Azadirachta indica [73]. This helped in the design of suitable bioreactor strategies (fed-batch and continuous cultivation) for the large-scale production of azadirachtin with an additional advantage of mini- misation of the time required for process optimisation. Successful hairy root cultures of Azadirachta indica have been established for enhanced azadirachtin production in the literature [19, 93], but bioreactor studies have not yet been reported. At present, the demand for azadirachtin is greater than its supply; however, due to the variability of azadirachtin content in seeds it is diffcult to depend solely on mass production from natural resource. Thus, in order to fulfl the increasing demand of biopesticides, other alternatives have been investigated. Together with genetic and biochemical engineering tools, increasing biopesticide (azadirachtin) de- mand in the market can be met successfully using a process that is continuous, economical and independent of natural resources. Hence, plant cell culture technology has been considered as an attractive alternative source. Research into azadirachtin production from plant cell/tissue cultures is still in its initial stages and there is a long way to go towards a commercially viable process for azadirachtin production. Knowledge of the biosynthetic pathway of azadirachtin in plants is not yet intricately described and understood. Infor- mation is needed at a cellular and molecular level before an effcient alternative Chapter 12 In Vitro Azadirachtin Production 251 for the large-scale commercial production of azadirachtin can be achieved. De- spite the various biotechnological advances made in the production technology of azadirachtin to date, efforts are still required in terms of scale up in bioreac- tors for plant cell/tissue cultivations to economically produce azadirachtin on a large scale. Chemicals Evaluation, Environmental Protection, Pacifc Region, Environment Canada. Fukuzaki T, Kobayashi S, Hibi T, Ikuma Y, Ishihara J, Kanoh N, Murai A (2002) Org Lett 4:2877 7. Stockigt J, Obtiz P, Flakenhagen H, Lutterbach R, Endress R (1995) Plant Cell Tiss Org Cult 43:914 59. In: Zait- lin M, Day P, Hollaender A (eds) Biotechnology in Plant Science: Relevance of Agri- culture in the Eighties. Sakamoto K, Iida K, Sawamura K, Hajiro K, Yoshikawa T, Furuya T (1993) Phyto- chemistry 33:357 91. Joshi M, Thengane S (1996) Potential application of in vitro methods for propagation of neem (Azadirachta indica A.

The design of hybrid ligands has provided a basis for modulating the sequence- selective binding behavior and/or tailoring the hybrid ligands for mixed-sequence recognition purchase ampicillin 500mg with mastercard antibiotics effective against strep throat. Cancer chemotherapy care plans handbook order ampicillin 500mg on-line antibiotic resistance of staphylococcus aureus, Published by Jones and Bartlett publishers, 2001, 1. Introduction Obesity is closely linked to a variety of metabolic disorders, including insulin resistance, atherosclerosis and type 2 diabetes (Eriksson, 2007). On the other hand, adiponectin is a major anti-inflammatory adipocytokine that plays a pivotal role in the improvement of glucose and lipid metabolism and the prevention of atherosclerosis and inflammation (Yamauchi et al. In patients with insulin resistance, obesity or type 2 diabetes, serum adiponectin levels are reduced (Arita et al. Adipose tissue has been found to suffer chronic hypoxia during the development of obesity (Brook et al. Hypoxic conditions can be induced by the addition of certain chemicals called ‘hypoxia mimetics’, such as the carcinogenic transition metal cobalt (Vincent et al. The effects of CoCl2 and hypoxia on gene expression were investigated using 8-day differentiated adipocytes. The total protein in the supernatant was assayed using a Bio-Rad protein assay reagent (Bio-Rad Lab. The expression of adiponectin was not observed in 0 day, but drastically increased in the 8 day differentiated-adipocytes (Fig. After the cells were treated, protein contents were measured by using a Bio-Rad protein assay reagent. Treatment with CoCl2 markedly suppressed the expression of 148 Medicinal Chemistry and Drug Design adiponectin in a CoCl2 dose- and time-dependent manner. Discussion It is well known that obesity, especially visceral fat accumulation, is closely related to a variety of metabolic disorders, including insulin resistance, atherosclerosis and type 2 diabetes (Fox et al. Additionally, it has been reported that adipose tissue suffers chronic hypoxia during above process (Brook et al. Relationship of plasma extracellular-superoxide dismutase level with insulin resistance in type 2 diabetic patients. Expression of extracellular superoxide dismutase during adipose differentiationin 3T3-L1 cells. The role of mitochondria in the regulation of hypoxia-inducible factor 1 expression during hypoxia. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Update on adipocyte hormones: regulation of energy balance and carbohydrate/lipid metabolism. Interstitial pH and pO2 gradients in solid tumors in vivo: high-resolution measurements reveal a lack of correlation. Adipose expression of tumor necrosis factor-α: direct role in obesity-linked insulin resistance. Plasma concentrations of a novel, adipose- 156 Medicinal Chemistry and Drug Design specific protein, adiponectin, in type 2 diabetic patients. Perturbations in maturation of secretory proteins and their association with endoplasmic reticulum chaperones in a cell culture model for epithelial ischemia. Mammalian mitogen-activated protein kinase signal transduction pathways activated by stress and inflammation. Transcriptional regulation of the rat vascular endothelial growth factor gene by hypoxia. Hypoxia-inducible factor-1 mediates transcriptional activation of the heme oxygenase-1 gene in response to hypoxia. Regulation by cytokines of extracellular superoxide dismutase and other superoxide dismutase isoenzymes in fibroblasts. Effects of hypo- and hyperoxia on transcription levels of five stress genes and the glutathione system in liver of Atlantic cod Gadus morhua. Novel modulator for endothelial adhesion molecules: adipocyte-derived plasma protein adiponectin. Requirement of fibroblast growth factor 10 in development of white adipose tissue.

If this contagion has taken effect ampicillin 500mg low cost bacteria for kids, then the whole living body is in consequence seized with it discount 500 mg ampicillin overnight delivery virus 79. Immediately after the moment of contagion the formation of the venereal disease in the whole of the interior begins. In that part of the sexual organs where the infection has taken place, nothing unnatural is noticed in the first days, nothing diseased, inflamed or corroded; so also all washing. The spot remains healthy according to appearance, only the internal organism is called into activity by the infection (which occurs usually in a moment), so as to incorporate the venereal miasma and to become thoroughly diseased with the venereal malady. On the other hand, are not the chronic miasmas disease- parasites which continue to live as long as the man seized by them is alive, and which have their fruit in the eruption originally produced by them (the itch-pustule, the chancre and the fig-wart, which in turn are capable of infecting others and which do not die off of themselves like the acute miasmas, but can only be exterminated and annihilated by a counter-infection, by means of the potency of a medicinal disease quite similar to it and stronger than it (the anti- psoric), so that the patient is delivered from them and recovers his health? This is therefore manifestly a chancre ulcer which acts vicariously for the internal malady, and which has been produced from within by the organism after it has become venereal through and through, and is able through its touch to communicate also to other men the same miasma; i. Now, if the entire disease thus arising is again extinguished through the internally given specific remedy, then the chancre also is healed and the man recovers. But if the chancre is destroyed through local applications* before the internal disease is healed, - and this is still a daily practise with physicians of the old school, - the miasmatic chronic venereal remains in the organism as syphilis, and it is aggravated, if not then cured internally, from year to year until the end of manÕs life, the most robust constitution being unable to annihilate it within itself. Only through the cure of the venereal disease, which pervades the whole internal of the body (as I have taught and practiced for many years), the chancre, its local symptom, will also simultaneously be cured in the most effective manner; and this is best without the use of any external application for its removal - while the merely local destruction of the chancre, without any previous general cure and deliverance of man from the internal disease, is followed by the most certain outbreak of syphilis with its sufferings. The itch disease is, however, also the most contagious of all chronic miasmata, far more infectious than the other two chronic miasmata, the venereal chancre disease and the figwart disease. To effect the infection with the latter there is required a certain amount of friction in the most tender parts of the body, which are the most rich in nerves and covered with the thinnest cuticle, as in the genital organs, unless the miasma should touch a wounded spot. But the miasma of the itch needs only to touch the general skin, especially with tender children. The disposition of being affected with the miasma of itch is found with almost everyone and under almost all circumstances, which is not the case with the other two miasmata. No other chronic miasma infects more generally, more surely, more easily and more absolutely than the miasma of itch; as already stated, it is the most contagious of all. It is communicated so easily, that even the physician, hurrying from one patient to another, in feeling the pulse has unconsciously * inoculated other patients with it; wash which is washed with wash infected with the itch; new gloves which had been tried on by an itch patient, a strange lodging place, a strange towel used for drying oneself have communicated this tinder of contagion; yea, often a babe, when being born, is infected while passing through the organs of the mother, who may be infected (as is not infrequently the case) with this disease; or the babe receives this unlucky infection through the hand of the midwife, which has been infected by another parturient woman (or previously); or, again, a suckling may be infected by its nurse, or, while on her arm, by her caresses or the caresses of a strange person with unclean hands; not to mention the thousands of other possible ways in which things polluted with this invisible miasma may touch a man in the course of his life, and which often can in no way be anticipated or guarded against, so that men who have never been infected by the psora are the exception. We need not to hunt for the causes of infection in crowded hospitals, factories, prisons, or in orphan houses, or in the filthy huts of paupers; even in active life, in retirement, and in the rich classes, the itch creeps in. The hermit on Montserrat escapes it as rarely in his rocky cell, as the little prince in his swaddling clothes of cambric. Nothing is seen on the skin during the first days; it remains unchanged, and, according to appearance, healthy. There is no eruption or itching to be noticed on the body during these days, not even on the spot infected. The nerve which was first affected by the miasma has already communicated it in an invisible dynamic manner to the nerves of the rest of the body, and the living organism has at once, all unperceived, been so penetrated by this specific excitation, that it has been compelled to appropriate this miasma gradually to itself until the change of the whole being to a man thoroughly psoric, and thus the internal development of the psora, has reached completion. Only when the whole organism feels itself transformed by this peculiar chronic-miasmatic disease, the diseased vital force endeavors to alleviate and to soothe the internal malady through the establishment of a suitable local symptom on the skin, the itch-vesicles. So long as this eruption continues in its normal form, the internal psora, with its secondary ailments, cannot break forth, but must remain covered, slumbering, latent and bound. Usually it takes six, seven or ten, perhaps even fourteen days from the moment of infection before the transformation of the entire internal organism into psora has been effected. Then only, there follows after a slight or more severe chill in the evening and a general heat, followed by, perspiration in the following night, (a little fever which by many persons is ascribed to a cold and therefore disregarded), the outbreak of the vesicles of itch, at first fine as if from miliary fever, but afterwards enlarging on the skin* - first in the region of the spot first infected, and, indeed, accompanied with a voluptuously tickling itching - which may be called unbearably agreeable (Grimmen), which compels the patient so irresistibly to rub and to scratch the vesicles of itch, that, if a person restrains himself forcibly from rubbing or scratching, a shudder passes over the skin of the whole body. This rubbing and scratching indeed satisfies somewhat for a few moments, but there then follows immediately a long- continued burning of the part affected. Late in the evening and before midnight this itching is most frequent and most unbearable. The itching not only compels the patient to rub, but on account of its violence, as before mentioned, to rub and scratch open the vesicles; and the humor pressed out furnishes abundant material for infecting the surroundings of the patient and also other persons not yet infected. The extremities defiled even to an imperceptible degree with this lymph, so also the wash, the clothes and the utensils of all kinds, when touched, propagate the disease. Only this skin symptom of the psora which has permeated the whole organism (and which as more manifestly falling under the cognizance of the senses has the name of itch), only this eruption, as well as the sores which later arise from it and are attended on their borders with the itching peculiar to psora, as also the herpes which has this peculiar itching and which becomes humid when rubbed (the tetter), as also the tinea capitis - these alone can propagate this to other persons, because they alone contain the communicable miasma of the psora. But the remaining secondary symptoms of the psora, which in time manifest themselves after the disappearance or the artificial expulsion of the eruption, i. They are, so far as we know, just as little able to transfer the psora to others, as the secondary symptoms of the venereal disease are able to infect other men (as first observed and taught by J. When the itch-eruption has only lately broken out and is not yet widely spread on the skin, nothing of the general internal malady of the psora is as yet to be noticed in the state of the patient.

The tremor passed over into convulsive shaking cheap 250mg ampicillin fast delivery antibiotics for uti in puppies, bloody matter was discharged from his nose and his ears order 250mg ampicillin fast delivery virus 57, he also coughed up blood, and he died on the 23d day amidst convulsions. The fourth day he was seized with epilepsy, foaming at the mouth, while the limbs were strangely contorted. But when the physician enquired more particularly, the mother confessed that the little boy had some vesicles of itch on the sole of the foot, which had soon yielded to lead ointment; the child, as she said, had no other sign of the itch. Another surgeon, through frequent blood-lettings and many medicines, effected that he remained free from epilepsy for four weeks, but soon afterwards the epilepsy returned while he was taking his noonday nap, and the patient had two or three fits in the nights; at the same time he was attacked with a very severe cough and suffocating catarrh, especially during the nights, when he expectorated a very fetid fluid. At last, after much medicine, the disease increased so much that he had ten fits at night and eight during the day. Nevertheless he never in these fits either clenched his thumbs or had foam at his mouth. During his nightly attacks he remains in the deepest sleep without awaking, but in the morning he feels as if bruised all over. The only warning of a fit consists in his rubbing his nose and drawing up his left foot, but then he suddenly falls down. In the same place the author mentions also a woman whose fingers contracted from an itch driven out by external means; she suffered of them a long time. He became insane, sang or laughed where it was unbecoming, and ran until he sank to the ground from exhaustion. From day to day he became more sick in soul and in body, until at last hemiplegy came on and he died. The intestines were found grown together into a firm mass, studded with little ulcers full of protuberances, some of the size of walnuts, which were filled ,with a substance resembling gypsum. Artificial irritants applied to the skin and a strong emetic brought back the itch again; when the eruption extended over the whole body all the former accidents disappeared. Who, after reading even the few cases described, would hesitate to acknowledge that the Psora, as already stated, is the most destructive of all chronic miasmas? Who would be so stolid as to declare, with, the later allopathic physicians, that the itch-eruption, tinea and tetters are only situated superficially upon the skin and may, therefore, without fear, be driven out through external means since the internal of the body has no part in it and retains its health? If the examples here adduced by me from both the older and from modern non-Homoeopathic writings have not yet enough convincing proof, I should like to know what other examples (even my own not excepted) could be conceived of as more striking proofs? How often (and I might say almost always) have opponents of the old school refused all credence to the observations of honorable Homoeopathic physicians, because they were not made before their own eyes and because the names of the patients were only indicated with a letter; as if private patients would allow their names to be used! And do I not prove my point in a manner most indubitable and most free from partisanship through the experience of so many other honest practitioners? The man who, from the examples given and from innumerable others of a like nature, is not willing to see the exact opposite of that assertion blinds himself on purpose and works intentionally for the destruction of mankind. Or are they so little instructed as to the nature of all the miasmatic maladies connected with diseases of the skin that they do not know that they all take a similar course in their origin? And that all such miasmas become first internal maladies of the whole system before their external assuaging symptom appears on the skin? We shall more closely elucidate this process, and in consequence we shall see that all miasmatic maladies which show peculiar local ailments on the skin are always present as internal maladies in the system before they show their local symptom externally upon the skin; but that only in acute diseases, after taking their course through a certain number of days, the local symptom, together with the internal disease, is wont to disappear, which then leaves the body free from both. In chronic miasmas, however, the outer local symptom may either be driven from the skin or may disappear of itself, while the internal disease, if uncured, neither wholly nor in part ever leaves the system; on the contrary, it continually increases with the years, unless healed by art. I must here dwell the more circumstantially on this process of nature, because the common physicians, especially of modem days, are so deficient in vision; or, more correctly stated, so blind that although they could, as it were, handle and feel this process in the origin and development of acute miasmatic eruptional diseases, they nevertheless neither surmised nor observed the like process in chronic diseases, and therefore declared their local symptoms as secondary growths and impurities existing merely externally on the skin, without any internal fundamental disease, and this as well with the chancre and the fig-wart as with the eruption of itch, and fore - since they overlooked the chief disease or perhaps even boldly denied it - by a mere external treatment and destruction of these local ailments they have brought unspeakable misfortunes on suffering humanity. With respect to the origin of these three chronic maladies, as in the acute, miasmatic eruptional diseases, three different important moments are to be more attentively considered than has hitherto been done: First, the time of infection; secondly, the period of time during which the whole organism is being penetrated by the disease infused, until it has developed within; and thirdly, the breaking out of the external ailment, whereby nature externally demonstrates the completion of the internal, development of the miasmatic malady throughout the whole organism. When the smallpox or the cowpox catches, this happens in the moment when in vaccination the morbid fluid in the bloody scratch of the skin comes in contact with the exposed nerve, which then, irrevocably, dynamically communicates the disease to the vital force (to the whole nervous system) in the same moment. After this moment of infection no ablution, cauterizing or burning, not even the cutting off of the part which has caught and received the infection, can again destroy or undo the development of the disease within. The same is the case, not to mention several other acute miasmas, also when the skin of man is contaminated with the blood of cattle affected with anthrax. If, as is frequently the case, the anthrax has infected and caught on, all ablutions of the skin are in vain; the black or gangrenous blister, nearly always fatal, nevertheless, always comes out after four or five days (usually in the affected spot); i.

Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries generic 250mg ampicillin otc antimicrobial 3-methyleneflavanones. Avery’s Diseases of the Newborn buy ampicillin 500 mg line antibiotic 5440, 8th Edition, Philadelphia, Elsevier Inc, 2005: 1145-79. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Early versus late erythropoietin for preventing red blood cell transfusion in pre- term and/or low birth weight infants. Thereafter, tissue cysts are formed within host ce- lls being the cause of recrudescent disease in immunocompromised patients. In patients with normal immune response, no further episodes of parasitemia may be expected. Accordingly, transplacental transmission is only possible during the acute stage of infec- tion. The most dangerous period for the fetus ranges between 10 and 24 weeks’ gestation, and infections during the first trimester of pregnancy are the most severe. Toxoplasmosis is widely spread around the world and the burden of the disease is high. Prophylactic measures (avoid to each fresh meats or fresh pork sausage except if these have been previously frozen, thoroughly washing of fresh vegetable, avoid cats and especially cat feces, do not manipulate soils without wearing gloves). Serological control at the second and third trimester of pregnancy is recommended. It is necessary to confirm recent infection in the mother by means of avidity of the IgG antibody. Low avidity (,20%) suggests infection in the last few months; in contrast, high avidity (. Serological tests (IgG and IgM) should be performed at 1, 2, 4, 6, 9, and 12 months. Infants born to mothers with syphilis refer to a newborn whose mo- ther has positive serological tests for syphilis independently of the clinical stage of the di- sease. The inci- dence of the disease has decreased markedly in the past years due to the use of condoms and the wide use of antibiotics, but continues to be an endemic disease in some Eastern European countries and Central America. Detection of the typical chancre associated with regional lymphadenopathy in early primary syphilis. Diagnosis is frequently established by serological tests during control of pregnancy. These are the most important tests for the diagnosis and control of treatment of syphilis in pregnancy. In patients with latent infections of after reinfection, decrease of antibody titers is gradual with persistence of low titers for more than 2 years. With regard to treat- ment, the following clinical forms should be differentiated: 1) multiorgan involvement (hydrops, hepatitis, pemphigous, etc. Infection is diagnosed in the presence of a fourfold increase of serum ti- ters in comparison with maternal titers. Radiographic studies long bones to assess the presence of periostitis and osteochondritis. The Herxheimer reaction may occur in patients with systemic involvement, and it may be advisable to increases the doses of penicillin progressively: 1. Strict isolation measures should be implemented in infants with syphilitic pem- phigous. Exclusive bone disease or asymptomatic with positive serology, penicillin G procaine 50. Asymptomatic infants born to mothers with syphilis should be treated in the following conditions: • Infants born to mothers treated before or during pregnancy whose serum titers do not decrease up to ¼ of the previous pre-treatment value in 3 months. The fetus may become affected in women who experience a primary infection during pregnancy. Infants with high viral load, infection of the nervous system, or severe thrombocytopenia, attempts have been made with i.

It is clear that the progression from two to three di- mensions has brought with it a variety of new options for storing and processing image data and displaying anatomical structures cheap ampicillin 500 mg with mastercard virus 32 removal. Nowadays cheap ampicillin 500 mg with visa antimicrobial hypothesis, this technology provides ultrasound with multiplanar capabilities that were previously reserved for computed tomography and magnetic resonance imaging. In order to reduce the number of unnecessary invasive diagnostic procedures and to increase detection rate of chromosomal abnormalities, se- veral markers have been recommended. The reduction of other common factors as cause of perinatal mortality explains that congenital defects are now the first cause of perinatal mortality in many parts of the world. This is the case of the prophylactic administration of folic acid to reduce the appearance of neural tube defects. The aim of the secondary pre- vention is the early prenatal detection of defect, making possible the early termination of pregnancy. Naturally it is there in that kind of prevention, where the ultrasonography has a fundamental role. Finally in the tertiary prevention, the objective is only the treatment and social adaptation of the malformed child. In the case of secondary prevention it is important to distinguish between screening test, whose main objective is the identification of pregnancies at risk, through first level test or detection test, from the diagnostic methods that achieve prenatal diagmosis of the con- genital defects using second level tests. In the case of congenital defects for chromoso- mopathies, the first level will be the biochemical and sonographic test, meaning diagnostic test will be the amniocentesis o villus sampling. But in the case of malformations, the ul- trasonography is at the same time the detection test and the diagnostic test. If possible, it is advisable to make three sonographic examinations during pregnancy: at 10-14 weeks (for detection of gross malformations and markers of aneuploidies), at 20-22 weeks (for detailed study of fetal anatomy, and detection of the majority of malforma- tions), and at 34-36 weeks (for study of fetal growth). The 20-22 weeks’examination is specially important because in this moment up to 75% of fetal malformations can be observed. In pregnancies of high risk for congenital defects the number of malformations is three times the registered in the low risk. But in the low risk there is accumulated the 85% of malformations, in front of the 15% in the high risk. It is due to the fact the vast majority of the pregnant women are in the low risk group. The result obtained depends also of the quality of the equipment used and the working conditions. It is necessary look for other anomalies and carry out complementary test (cyto- genetic, immunological or biochemical studies). As most of the fetuses with chromosomal abnormalities have struc- tural malformations, the so called genetic ultrasound is used for first and second trimester scanning for special markers, which are used in calculation alone or with maternal bio- chemical screening, for detection of chromosomal abnormalities. This echolu- cent zone is observed by ultrasound during first trimester (nuchal translucency) and se- cond trimester (nuchal fold) of pregnancy. Normally it resolves in the second trimester, and if not nuchal fold or cystic hygroma develops. Both, nuchal translucency and nuchal fold are suggestive of chromosomal defects, whereas cystic hygroma is considered a congenital malformation of variable expression in terms of both morphology and chronology. From a psychopathological point of view, nuchal fluid comes from the paracervical lym- phatic system, which drains into the internal jugular vein. Spontaneous resolution of the nuchal fluid is more likely to occur in euploid fetuses, although it has also been described in aneuploid ones. Benaceraf et al in the year 1995 were the first to describe the increase of the nuchal fold as a second trimester marker of T21. In addition, it has a prognostic value in perinatal evolution, with an increased incidence of perinatal morbidity and mortality, and is often associated with structural defects. The calipers should be placed at the outer edger of the fetal calvarium and the outer edger of the skin. Nuchal fold has a sensitivity of 4 to 75% for trisomy 21with false positive rate of #2%.