Synchronized Chaos First October 2026 Issue: One Sky, A Thousand Windows

Image c/o Rostislav Kralik

First, the announcements.

Our regular contributor Rui Carvalho invites readers and contributors to submit poetry to the next annual Nature Writing Contest.

Our contest, Nature 2025-2026, is a new opportunity that we, as organizers, create to reach the rest of the world. Every Contest is a challenge for authors participating and to people that make it happen. This year we invite all authors to write poetry about:
(i) Flowers;
(ii) Trees and wind;
(iii) Water;
(iv) Nature Conservation;
(v) Turtles;
(vi) Love for people and nature;
(vii) Hope and Happiness.

Rules and submission information here.

Image c/o Petr Kratochvil

Next, the Naji Naaman Literary Prizes are now open for 2027.

Naji Naaman Foundation for Gratis Culture (FGC) announced that competition for Naji Naaman literary prizes for 2027 (25th picking season) is already open. Prizes will be awarded to authors of the most emancipated literary works (in content and style) aiming to revive and develop human values.

Literary manuscripts (thoughts, poems, stories, etc.) of 40 pages at most, in all languages and dialects, typeset, with the curriculum vitae and an artistic photography of the author, should be sent to Maison Naaman pour la Culture (by e-mail: info@najinaaman.org) before the end of January 2027. Manuscripts written in languages other than English, French, Spanish or Arabic must be accompanied by a translation or résumé in one of the aforesaid languages. Prizes will be announced before the end of June 2027. Works (in full or in part) published in the free of charge prizes’ yearbook will become (only for the aforesaid publishing purpose) the property of the publishing house.

Laureates will bear the lifetime free of charge honorary title of member of Maison Naaman pour la Culture (MNAC).

Now for our current issue: One Sky, A Thousand Windows.

Image c/o Vera Kratochvil

What strikes you first, reading through this chorus of voices, is how many different things a single species can hold in its heart at once. Here are poets and scholars, memoirists and critics, from Uzbekistan to Serbia, from Bangladesh to Greece, from America to Ukraine — and each one is looking out at the same sky through a different window.

Open any one of them and you find a whole world.


I. The Trouble with Names

Milena Pčinjski begins with a complaint that cuts to the bone: society reduces people to titles, professions, categories, ready-made identities — and in doing so, misses the whole person standing there. Shah Jehan Ashrafi knows this firsthand; her speaker loses her established identity and is forced into anonymity, hardship, social invisibility, but refuses to disappear. Mustafa Abdulmalek Al-Sumaidi writes about the sheer burden of selfhood, the dissociation that comes from carrying a self the world keeps misreading. And Blue Chynoweth, in poems built from fractured family memory and deliberately disrupted language, suggests that even understanding where you came from can feel impossible — ancestry, motherhood, America, all shards you try to reassemble.

Türkan Ergör’s piece is a philosophical poem on what it means to be human during one’s finite lifespan. Elmaya Jabbarova’s poem celebrates the astonishing growth of human knowledge while affirming her belief in the divine.

Shovon Ahmed, a 23-year-old Bangladeshi entrepreneur, outlines his career built on defending truth and human dignity through digital reputation management and by co-founding WikiGenius, a verified online encyclopedia aimed at combating misinformation. Raxmatullayeva Dilnavoz Ziyodulla kizi discusses possibilities for the use of artificial intelligence in Uzbekistan, Yusufjonova Sabriya highlights both the promise and the drawbacks of our reliance on digital technologies, and Nilufar G’ulomjon qizi Hamroqulova outlines what she sees as human skills that artificial intelligence cannot replace.

Image c/o Gerd Altmann

Duane Vorhees searches for a self that is not simply prescribed by pain or history. Dr. Shpresa Fundo Gjergji offers an allegory for the quiet, difficult work of knowing yourself — and discovering that the stability you once searched for outside was inside you all along. Mark Young’s artworks explore geography, identity, movement, and the instability of belonging, as if to ask: can you ever really settle into a name? And Patrick Sweeney’s pieces move between everyday tenderness and barely managed dread — the voice of diaspora poetry that holds multiple worlds, multiple languages, multiple selves in one throat.

Shah Jehan Ashrafi returns to the theme from another angle: the tension between serving others and losing yourself in their reflections, and the quiet, profound longing for wholeness. Alex S. Johnson’s interview celebrates Molly Marie Kent’s creation of The Supreme as an exuberant act of self-liberation — using metal, sexuality, fantasy, occult symbolism, literature, and community to turn personal identity into art and art into a shared space of empowerment.


II. The Water That Will Not Be Held

Maja Milojkovic compares love to water held in the hands of fate. Water cannot be permanently contained — it finds cracks, escapes, falls, flows, and eventually rises again. Dr. HC Rozalia Aleksandrova sees water as more than a physical element: it is a symbol of life, consciousness, purity, and universal love. And Mahbub Alam compares tears to ocean waves, showing grief not as weakness but as an active, cleansing force — water that washes rather than drowns.

Love arrives in many forms across these pages. Nidia Amelia García celebrates the love of a special cat — the small, steady presence that asks for nothing but your lap. Priyanka Neogi highlights how being loved and treated kindly can transform a person’s inner life and motivate them to grow. Menda Vreto’s poem concerns compassion, empathy, and the lasting impact of small acts of kindness. Milka J. Šolaja writes about the purity, vulnerability, and intensity of unspoken love — some emotions so profound that saying them aloud can never fully capture them.

Image c/o Omar Sahel

Katica Protić depicts the emotional aftermath of being hurt by love yet still hopes for human connection despite her fear. Philip Butera traces a transformative, unfulfilled love — someone who reshapes the speaker’s identity so completely they become unrecognizable to themselves, yet the relationship never solidifies into mutual possession. The speaker is left suspended in a state of permanent longing. Egamnazarova Shahina Shakhriyor qizi’s poem is about being sought but not yet seen and trusting that a sudden meeting — whether with God, with a loved one, or with one’s true self — will come in its own time, unforced.

Hani Al-Fahham sees love as a candle that burns the self into immortal wax — the beloved is both the fire that wounds and the snow that conceals. The speaker falls endlessly through myth, memory, and the mundane, from the ancient sorrows of Layla and Othello all the way down to boxes of milk and cheese from Denmark. Sayani Mukherjee describes love as a spiritual and creative force — overwhelming, inspiring, and painful — and the poem itself is the speaker’s offering, their gift back. Elisa Mascia casts love in the language of sacred waiting and cosmic reunion. Jacques Fleury contributes a sensual and elegant love poem set under the Caribbean sky.

And then there is Valentina Pavlović, who sounds a warning dressed as a love poem: love’s window does not stay open forever.


III. What Survives

Ahmed Miqdad expresses the horror and sorrow of a civilian losing his entire family in a sudden wartime attack — the kind of loss that breaks language before it breaks the heart. Eva Lianou Petropoulou knows this: her poems illustrate how tragedy can strip language of its meaning, and how we have to go looking for it again, word by word.

Image c/o Erfaulet Bridge

Saeed Koushan asks what survives political violence. Not buildings. Not records. But gardens, seeds, slow gestures, nicknames. Quiet dignity outlasting the wreckage. Christopher Bernard’s seventh installment of Otherwise is a moral fable about the awakening of conscience, the necessity of resistance, and the power of forbidden stories to prove that another world is possible. Tetyana Hrytsan-Chonka transforms personal images of Ukraine — eyes, hands, water, birds, flowers, dawn, children, the earth — into symbols of a wounded but still living homeland. Anil Kumar Mishra’s poem offers an indictment of how humans consume what they claim to love, especially nature.

Ken Poyner’s pieces use absurdity, dark humor, and miniature fictional worlds to examine social boundaries, inequality, repression, and human desire. Wanchen Cao describes the pain of victim-blaming after social rejection and mistreatment. Others break you and then call you broken; they load you and then avoid you for being heavy; they hollow you out, and then say you are empty and therefore unworthy. Raida Jirjees’ book review reads Chaucer’s The Miller’s Tale not as a bawdy medieval comedy but as a moral anthropology disguised as farce, where the jokes are partly on the audience. Fhen M.’s Dante-inspired poem does a deep dive into the corruption and damage caused by lying. Sushant Thapa urges us to not weaponize religion, but instead use faith to inspire us towards reason, self-awareness, and the capacity to choose better.

Abigail George traces apartheid’s violence through blood and bone — surfacing as rage, addiction, loss — and asks whether art and memory can turn that inheritance into something bearable, even luminous. Tiago Pereira’s dense, symbolic poem reads like a mythic narrative of loss, guilt, and missed intervention. MK Kuol’s poems examine power, dependence, and the meaning of rescue—but from opposite moral perspectives. Amb. Dr Tomasz Laczek laments humanity’s trajectory toward self-destruction, balanced by a glimmer of hope for redemption. Aziza Xasamova meditates on despair at human cruelty, arriving at a quiet, religious trust that darkness is not final — it is simply the necessary prelude to a justice only God can deliver. The sun goes down because it must rise again.

Soumen Roy traces a solitary inner journey from confusion and frozen grief, through a farewell and a moment of perspective, toward a hard-won peace where the self merges into something limitless. Abstract Kojwach writes a raw, poetic elegy — a meditation on grief, estrangement, creative legacy, and survival.

Image c/o Linnaea Mallette

Other writers assert personal and cultural dignity and survival through literature. Nurillayeva Parichehra Baxodir qizi’s essay argues that literary devices shape the meaning, emotional intensity, depth, and rhythm of Uzbek writer Abdulla Oripov’s poetry. A. Iwasa reviews Olympia Books to Prisoners’ minizines and their work to bring literature into the hands of those who often lack access to it. Umurbaev Rustam Shakirjanovich’s writing highlights strides Uzbekistan and other nations are taking towards gender equality. Mahfuza Sharipova illustrates how Pirimqul Qodirov’s Ona Lochin Vidosi presents Timurid women as complex, influential human beings rather than merely beautiful princesses or wives of rulers.


IV. The Weight of a Day

Noah Berlatsky humorously captures the cycles of frustration that can derail an entire day — the small absurdities that accumulate until you don’t recognize yourself. J.K. Durick explores the unglamorous nature of grown-up struggles and the lack of any roadmap for how lives will unfold. Delsa López Lorenzo sends up a metaphorical poem about unfulfilled creativity, sacrificed dreams, and the conflict between artistic or spiritual aspirations and material pleasure. J.J. Campbell’s poems paint a portrait of a speaker worn down but still watching — failed by family, by the economy, by his own body, by the American promise — and he carries an exhausted clarity about all of it. Paul Tristram’s poems share a tough-love spirituality: no sentimentality, no magical fixes. The voice is weathered, direct, unsentimental about human pettiness, and deeply committed to growth through pain, honest self-confrontation, and the slow, grueling work of becoming whole.

Bill Tope’s short tale of adolescent sexual exploration shows us what love isn’t before illustrating sincere caring. Olive Springman explores a similar theme, highlighting the contrast between the romantic myths people are taught about love and the awkward, accidental, imperfect reality of desire and human connection. Brian Barbeito writes about watching versus doing, artifice versus sincerity, and the strange call of older, physical ways of making things — all set against a backdrop of rain and remembered books. Dr. Rozalia Aleksandrova argues that poetry is not merely art but a tool of spirituality — a medium through which humanity can learn harmony, wisdom, and corrective ideas. Yeon Myung-ji’s piece is a surreal meditation on imagination, transformation, desire, and the mysterious process by which ordinary life becomes poetry.

Anthony Ward offers a lyrical, stream-of-consciousness meditation on fate, free will, time, and mortality — the great unanswerables that shadow every ordinary Tuesday. Mesfakus Salahin weaves together a paradox: that love, beauty, and death are not opposites but inseparable companions. In Tanja Ajtic’s piece, life’s an endless cycle of death, renewal, repetition, and transformation, with each morning a fresh reincarnation. Eleanor Hill’s poem suggests letting life in through the cracks — the moments we didn’t plan, the mess we didn’t clean up, the love we feel even when we think we haven’t earned it.

Image c/o Rostislav Kralik

Dr. Jernail S. Anand’s essay suggests that neither following imagination and passion nor reason and practicality will give a person all they need to navigate life. Rather than suggesting a blended approach, the essay suggests that may not be possible and offers sympathies for the human condition. Alan Catlin contributes a dense, allusive poem that moves through collapsing layers of American mythology, culture, and language.


V. The Body, Home, and the Land

Yashin Ortikov Kahramonjonovich discusses the importance of careful observation in diagnostic medicine. Rustamova Sevinch Shuxrat qizi describes ways to detect and prevent preeclampsia.

Nilufar Anvarova celebrates the crisp and colorful beauty of fall while acknowledging the impermanence of the season and the decay it represents. In Shannon Scoates‘ poem, night’s a mystical, nurturing force using silence, moonlight, stars, and nature to soothe troubled hearts and restore inner peace. Ananya S. Guha’s piece weaves together time, memory, loss, and the commodification of innocence, using the natural changes in the fall month of October as a central symbol. Zlatan Demirović’s piece is a reflective poem about old age, memory, lost youth, and the mysterious relationship between time and existence, told with the force of the Mediterranean maestral breeze.

Ibrahim Honjo works through a series of contrasts — between the natural world and human nature, between beauty and brutality. Sava Wallaert’s poem is about being stranded in a season of emotional and spiritual drought, the world stripped of color, water, and meaning, and to see things finally start to turn at the solstice. Christina Chin’s haiku uses gentle descriptions to celebrate the beauty of both natural and artificial flowers. Marian Dziwisz offers a defense of the rowan, a tree the speaker feels is undervalued in poetry compared to more “classical” trees like the linden or willow.

Image c/o Omar Sahel

Graciela Noemi Villaverde meditates on love of homeland, belonging, memory, and the intimate relationship between a people and their land — the way a country can live inside you like a second pulse. Munisa Azimova celebrates the strength and resilience of the Uzbek people. Saidqulova Nozima discusses the early poetry of G’afur G’ulom, one of Uzbekistan’s most important twentieth-century writers — poems of energy, progress, industry, patriotism — and defends studying an early, ideologically marked collection not for its polish but for what it reveals about the roots of a major literary voice.

And so we arrive where we began — standing under the same sky, looking through a thousand windows. The voices gathered here do not agree with one another. Some celebrate technology; others mourn what it takes. Some speak of love as water that escapes no matter how tightly you hold it; others speak of it as a fire that consumes. Some write from the wreckage of war; some from the ordinary frustration of a Tuesday morning. Some have learned to bend under the weight of grief; others have learned to stand straight under the weight of joy.

But listen to what they share: every single one of them insists that there is more to being human than the categories we are given. The titles, the labels, the ready-made identities — these are the windows, not the sky. What matters is what happens when you look through. The old man on the Dalmatian coast, stirred by the maestral breeze, remembering a youth he cannot hold. The woman who refuses to disappear. The entrepreneur building a tool against misinformation. The cat asleep in a lap. The poet who discovers the stability she was looking for was inside her all along.

One Sky, a Thousand Windows is not a title that tames these contradictions. It is an invitation to hold them. To read the scholar on artificial intelligence alongside the poet on unspoken love; the researcher on preeclampsia alongside the elegy for a lost family; the celebration of fall’s beauty alongside the acknowledgment of the decay it represents. The sky does not choose which window to shine through. It simply shines. And what we do with the light — whether we write a poem, plant a garden, refuse to vanish, or carve meaning out of silence — that is what makes us human. That is what survives.

Poetry from Olive Springman

Grace

All the lies of love and war you have been taught 

You have been taught 

That you will fall gracefully in love 

And be caught by a cushion of satin spun lust

But It is not a mating dance but a stumble of genitalia     

That trip over each other perpetually 

Trying to find smooth edges in which to tenderly intertwine 

And if not this anticlimactic circling 

Then we will lock eyes one day 

i’ve tripped suddenly

Into you by chance or sudden epiphanic vision of fate

And our thread will become undone 

and we will sew our seams together 

And when I lift the lacy veil off your powered face

We are young and this is the first time I saw you

And what happens so briefly in passing is now so clear 

Hair whipping about her collarbone       

Jewelry clinking 

Hands clutching history books 

We will go through alter aisles 

In low rise jeans and studded belts 

In robish wraps of cream colored lace 

Through bustling high school hallways 

Always 

In grace 

Poetry from Wanchen Cao

Weight

Wanchen Cao

When the baby was born
she was so light
she brought a pure
hope
for this world

Later, someone placed
a stone on her back
then one person after another
the weight on her back
grew into a small mountain
they said

Growing up means learning to be heavy
learning to carry the weight
so she carried the small mountain
and kept walking
but her back grew heavier and heavier

She grew used to silent endurance
used to being strong
the bitter stones
cut her all over
still she walked on
protecting that dwindling hope

Until one day
she leaned against a great tree
for the first time
she wanted to put down the mountain on her back

But the tree said
you are too heavy
no one will love someone so heavy
please leave

She looked at the stones on her back
not one
of them
had she put there herself

Emptiness

Wanchen Cao

You reach out both hands
what are you hoping for
what are you trying to grasp
emptiness is the heaviest thing
sinking  falling
pressing out the last tear

Suppose you were on an uninhabited planet
with nothing, not a thread of clothing
nothing but boundless
emptiness
soundless
emptiness
unshakable
emptiness
and so you reach out both hands
what are you hoping for
what are you trying to grasp

But not even the wind
will brush past
until someone
walks out of the dark
the only one left behind
on this uninhabited planet

You reach out both hands
what are you hoping for
what are you trying to grasp
the feeling of being touched
warm and soft

You open your chest
to show him the wasteland inside
an emptiness where not a blade of grass grows
there was once a sea there
once a sky full of stars
and a very careful heart

But later
they were taken away one by one
no one returned them
only scabbed-over emptiness remained

He bends down
as though inspecting
a vessel already broken
taps it with his knuckles
only a dull, hollow sound
as though the whole planet
were sinking inside it

You reach out both hands
what are you hoping for
what are you trying to grasp
even a name
you could remember
even a simple greeting

But he draws back his hand
takes a step away
glances at you with distaste
and leaves you with these words—

A hollow person
does not deserve to be loved

Wanchen Cao is a Chinese poet and creative writing researcher pursuing a PhD in Creative Writing (Poetry) at the University of Dundee, following an MA in Creative Writing at the University of Southampton. She is the author of Seven O’Clock, and her poetry has appeared in Jiangnan, Poetry Monthly, Young Poet, and Yangtze Poetry.

Poetry from Ken Poyner

ADVENTURE

There is a child sleeping under the lone tree set apart from the approaching woods.  It is no child Quibble knows.  He balances his head on his backpack.  Perhaps a runaway from a town or two over.  Left to join the circus.  Left to serve in the foreign legion.  Left to become a cabin boy in imagination’s navy.  He is dressed well enough.  He appears well fed, sufficiently groomed.  Perhaps the boy just wanted adventure, to see what is around the corner.  There is no corner.  All is one straight line.  Quibble hurries to hide before the child wakes up.

BOUNDARIES

When he came to pick up my daughter for their first date, I was adamant that he come in and show himself.  No barking the horn at curbside.  No quick flick of a tentacle from the base of the porch.  I wanted a few moments alone with him.  Of course, I am no expert on the clicks, color schemes, and arm flourishes that my daughter in part understands.  But I needed him to grasp, if only as a dim register of emotion, that getting free of his tank was one thing, dating my daughter was another.  No stray suction marks.

CAPITALIZING POVERTY

We employ the unemployed by having them move the stones in the stream – first, from near end to far end, then far end to near end.  It is a job, not welfare.  What is worrisome is that, over time, it seems there are ever fewer stones in the stream.  We postulate that, some nights, citizens go to the water and fetch stones, hiding them in their backrooms and garages.  Rumor is, when stones in the stream are nearly gone and there is almost no work for the unemployed, hoarders will offer to sell their purloined stones dearly to the town.

UNAPPLIED LITERACY

He leaves the bookstore with his two purchased books in the burlap sack he brought with him, making sure no one sees him going in or out.  As some neighbors have begun to see through this subterfuge, in his truck he places the sack in a Thole’s Hardware canvas bag.  The smarter neighbors see through this; but it is not them he has to hide his spurious literacy from.  He can still read behind closed doors, sneak into town to buy books, even harbor a library card slipped secretly in his wallet.  But people talk, plot against his unequal aspirations.

WHAT VOLCANOES WANT

The volcano has not spoken in years.  Two possible conclusions come of this:  we no longer need to feed it virgins, or devouring our virgins has kept it docile.  These are debated wherever citizens gather to dull their senses.  One scion proposes we experiment by lengthening the time between rituals.  From seasonal, change to equinox.  No eruption, adjust to annual.  Then once a decade.  The issue could be solved for future generations.  Our men lament there could be less a rush of women seeking ineligibility.  Then again, perhaps any suffering will appease a volcano, even that of once privileged men. 

Poetry from Alan Catlin

“I was out in the blue American night”

according to Ocean Vuong without great

expectations, without a computer, without

new shoes in which to climb the High Peaks

where the lodges of a confederation of tribes

once lived, where the TB patients came to die

emulating Keats without the words to ratify

immortality. Ghost warriors accompany us

into fogbows, bent arrow pathways lined with

the carcasses of wild game who fought the French

during the primitive wars. Echoes of their

chants fill the valleys with sounds like post

industrial death metal, bargain basement Ebonics

texts, Hank Williams inflected after hours blues.

Blaze Starr

A celestial event, red star at night, death

star in the morning sky. Son of the morning star,

lie me down by the river where the ghost ponies go, 

where cavalry charges go to die. Circle the wagons

boys, they’re riding Shetland ponies. A strippers

delight, a kingfisher’s prize before a bullet laid

him down. You know what they say down South: “if it 

keeps on raining levees gonna break. Mean old

levee taught me to weep and moan.” Unlike Gypsy

Rose who wrote mysteries while living at February

House with Auden, Lincon Kirstin, Salvador and Gala,

Carson McCullers and the Bowles’ among others.

As long as they paid the rent and didn’t act out who 

cared where the money came from.

The Moonstone

among the Provincetown cabanas

where the jaded sorcerers hide their

magic veils for costume parties made

popular during the plague years. 

The moon rocks are falling from holes

in the ceiling where the wormholes end.

Ice agents are demanding passports

to receive admittance to places no one

ever returns from. The future will be

dictated by false starts and alternative facts

that expire once the cult’s government

lease expires. No wonder tough guys 

don’t dance.

Moonstruck

during a total eclipse. Perfect weather

for sleepwalking or banana fishing: 

obstacles may be treacherous like 

black holes in the sand, quicklime

on the boardwalk. Even the heads of

the view masters have splinters and

the nightbirds are confused when feral

animals go where the wild things are

when the shit hits the fan. Galoshes are

mandatory during messy weather

and breakwater jetties are aswarm

with jelly fish, men of war with tarnished

armor and sidearms that only fire blanks.

Now that the red tide has advanced past

the boardwalk it’s time to abandon

the concrete bunkers that once represented

the last lines of defense. Now we know

how the French felt when the Maginot Line

was breached, why the captain always

goes down with the ship. 

Double Feature Movie Matinees

and the Kraken Wakes! Science fiction

or foreign policy? Ask your AI

misinformation disseminator. Have you

fed a triffid today? Is your Midwich

cuckoo? Fall into the rabbit hole

where truth, reason and logic go to die.

Where the Red Queen screams, “Off with

their heads.” And all her whims become 

law just like in real life. Has anyone

inquired after the health of the Red King?

Is his head intact and still in place?

As a John Wyndham heroine once said,

“How do we know where we are going,

If we don’t know where we are?”

Essay from Rustamova Sevinch Shuxrat qizi

THE IMPORTANCE OF MODERN BIOMARKERS IN THE EARLY DETECTION AND PREVENTION OF PREECLAMPSIA

4th-year student, Group Med-01U

Faculty of Medicine

Kimyo International University in Tashkent

Rustamovasevinch698@gmail.com

Abstract: Preeclampsia is a multifactorial obstetric syndrome that develops during the second half of pregnancy and increases the risk of serious maternal and fetal complications. Because clinical manifestations often appear after the pathological process has already progressed, early detection remains an important area of modern obstetrics. In recent years, biomarkers reflecting placental angiogenic activity, particularly placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and their ratio, as well as pregnancy-associated plasma protein A (PAPP-A), placental protein 13 (PP13), and other laboratory parameters, have been extensively investigated. This article reviews the pathogenesis of preeclampsia, the biological basis of relevant biomarkers, their diagnostic and prognostic significance, and their potential role in clinical practice. According to contemporary international recommendations, combined assessment of clinical risk factors, blood pressure, uterine artery pulsatility index, and PlGF in the first trimester can be used for risk stratification of preterm preeclampsia. In pregnancies at 20–36+6 weeks with suspected preeclampsia, PlGF-based or sFlt-1/PlGF-based tests may provide additional information to clinical assessment. However, biomarkers have limitations in predicting all cases of preeclampsia and should not be interpreted as independent diagnostic criteria.

Keywords: preeclampsia; pregnancy; biomarker; placental growth factor; PlGF; sFlt-1; sFlt-1/PlGF; PAPP-A; placenta; angiogenesis; early diagnosis; obstetrics.

INTRODUCTION

Preeclampsia is one of the major hypertensive disorders of pregnancy and may have serious consequences for maternal and fetal health. Clinically, it may present with hypertension accompanied by dysfunction of the kidneys, liver, hematological system, central nervous system, or placenta. Severe cases may be complicated by eclampsia, HELLP syndrome, placental abruption, fetal growth restriction, preterm birth, and adverse perinatal outcomes.

An important feature of preeclampsia is that pathological changes in placentation and the maternal vascular system may develop before clinical manifestations become apparent. Therefore, an approach based only on blood pressure and proteinuria may be insufficient for detecting the earliest stages of the disease.

In recent years, the role of biomarkers in the detection of preeclampsia has been extensively investigated. In particular, angiogenic and antiangiogenic factors such as PlGF and sFlt-1 have attracted substantial scientific interest.

RELEVANCE OF THE TOPIC

The relevance of preeclampsia is associated with its potential risks to the mother and fetus, its heterogeneous clinical course, and the difficulty of predicting the disease before clinical manifestations appear.

Traditional clinical assessment includes blood pressure, urinary protein, platelet count, liver and kidney function, and fetal status. However, disruption of placental angiogenic balance may occur before clinical signs become evident.

Therefore, the use of biomarkers to identify pathological processes before clinical manifestations is a promising area of modern obstetrics.

AIM OF THE STUDY

To analyze the biological and clinical significance of modern biomarkers used for early detection and risk assessment of preeclampsia, evaluate their advantages and limitations, and describe their potential role in obstetric practice.

MATERIALS AND METHODS

This article was prepared as a literature review. Scientific information was identified using PubMed, clinical recommendations from international professional organizations, and medical guidelines.

The review included systematic reviews, meta-analyses, and clinical recommendations addressing early detection of preeclampsia, angiogenic biomarkers, PlGF, sFlt-1, the sFlt-1/PlGF ratio, PAPP-A, PP13, first-trimester screening, and prediction of preeclampsia risk.

Particular attention was given to contemporary sources published during 2021–2026, while earlier fundamental studies were also considered where necessary to explain the biological significance of biomarkers.

PATHOGENETIC BASIS OF PREECLAMPSIA

Impaired placental invasion and abnormal uteroplacental circulation play important roles in the development of preeclampsia. In normal pregnancy, trophoblast cells remodel the uterine spiral arteries, transforming them into vessels capable of providing adequate blood flow.

In preeclampsia, this remodeling may be incomplete. As a result, placental hypoxia, oxidative stress, and endothelial dysfunction may develop.

Subsequently, placental production of angiogenic and antiangiogenic factors changes. In particular, increased sFlt-1 and decreased PlGF adversely affect normal endothelial function.

sFlt-1 binds PlGF and vascular endothelial growth factor, reducing their biological activity. This contributes to impaired angiogenesis and endothelial stability and plays an important role in the development of hypertension, proteinuria, and multiorgan dysfunction in preeclampsia.

PLACENTAL GROWTH FACTOR — PlGF

Placental growth factor is a proangiogenic protein involved in angiogenesis. During normal pregnancy, its concentration changes according to gestational age.

In preeclampsia, placental dysfunction may lead to reduced PlGF concentrations. Therefore, PlGF has been investigated as an important biomarker of placental dysfunction in preeclampsia.

However, PlGF should not be interpreted in isolation. Gestational age, clinical condition, and laboratory methodology may affect the result.

sFlt-1 BIOMARKER

Soluble fms-like tyrosine kinase-1 is an antiangiogenic factor that plays an important role in the pathogenesis of preeclampsia.

sFlt-1 binds PlGF and vascular endothelial growth factor and reduces their vascular protective effects. Consequently, endothelial dysfunction increases.

Increased sFlt-1 concentrations have been reported in numerous studies of preeclampsia. Therefore, combined assessment of sFlt-1 and PlGF may provide more clinically useful information than either biomarker alone.

sFlt-1/PlGF RATIO

The sFlt-1/PlGF ratio is one of the most extensively studied angiogenic markers in modern preeclampsia assessment. It reflects two opposing biological processes: increased antiangiogenic activity and decreased proangiogenic activity.

NICE recommendations provide gestational-age-specific thresholds for the Elecsys sFlt-1/PlGF test. At 20–33+6 weeks, a value of 33 or lower can be used to help rule out preeclampsia, whereas a value above 85 can support the diagnosis. From 34 weeks to delivery, the corresponding thresholds are 33 and 110.

At 24–36+6 weeks, an sFlt-1/PlGF ratio of 38 or lower can help rule out development of preeclampsia in the short term, while a value above 38 can help assess the risk of developing preeclampsia within the following four weeks. These thresholds should be interpreted according to the relevant test system and clinical context.

SIGNIFICANCE OF PAPP-A

Pregnancy-associated plasma protein A is a laboratory marker widely used in first-trimester prenatal screening.

A recent meta-analysis included 22 studies and data from 33,651 pregnant women. It found that first-trimester PAPP-A concentrations were lower among women who subsequently developed preeclampsia compared with controls. The authors considered PAPP-A a potentially useful marker for early risk stratification of preeclampsia.

Nevertheless, PAPP-A alone does not have sufficient accuracy to diagnose preeclampsia. It is more appropriately interpreted together with clinical and ultrasound parameters.

PLACENTAL PROTEIN 13

Placental protein 13 has also been investigated as a potential early biomarker of preeclampsia.

A meta-analysis of 17 observational studies including 40,474 pregnant women reported a pooled sensitivity of 0.62 and specificity of 0.84 for PP13. These findings indicate potential value, but large prospective studies are still needed before routine clinical implementation.

COMBINED FIRST-TRIMESTER SCREENING

The ability to predict preeclampsia using a single biomarker is limited. Therefore, contemporary approaches emphasize multicomponent risk assessment.

ISSHP recommendations indicate that, at 11–14 weeks, clinical risk factors, blood pressure, uterine artery pulsatility index, and PlGF may be combined to assess the risk of preterm preeclampsia. At the same time, no first- or second-trimester test can reliably predict all cases of preeclampsia.

A combined approach can therefore be summarized as: maternal characteristics + blood pressure + uterine artery Doppler + PlGF → individualized risk assessment.

CLINICAL ROLE OF BIOMARKERS

The main purpose of biomarkers in preeclampsia is not simply to determine whether disease is present. They may help identify women at increased risk, assess the probability of preeclampsia in clinically suspicious cases, estimate short-term risk, support decisions about monitoring intensity, and in some settings reduce unnecessary inpatient observation.

According to NICE, PlGF-based tests used together with standard clinical assessment can help rule in or rule out preterm preeclampsia in women with suspected disease.

LIMITATIONS OF BIOMARKERS

Despite their promising potential, modern biomarkers cannot be regarded as universal diagnostic tools. First, biomarker concentrations depend on gestational age. Second, analytical methods and thresholds may differ between laboratory systems. Third, multiple pregnancy, chronic hypertension, kidney disease, and other clinical conditions may influence biomarker concentrations.

Although many promising biomarkers are being investigated, large prospective studies and external validation are required before their clinical utility can be fully established.

DISCUSSION

Early detection of preeclampsia cannot be reduced to identifying a single laboratory biomarker. The multifactorial pathogenesis of the disease requires assessment of several biological processes.

PlGF and sFlt-1 currently have substantial clinical relevance among angiogenic biomarkers, and their ratio may be particularly useful for assessing the probability of preeclampsia.

In the first trimester, combining clinical risk factors, blood pressure, uterine artery Doppler, and PlGF may improve risk stratification for early-onset disease. However, this approach cannot identify every case of preeclampsia.

Future research may focus on integrating biomarkers with artificial intelligence, clinical risk factors, ultrasound data, and genetic or metabolic parameters. Before such models are introduced into routine practice, external validation in diverse populations and assessment of clinical utility are required.

RESULTS

The literature review yielded the following main findings:

1. Placental angiogenic imbalance may develop before the clinical onset of preeclampsia.

2. Reduced PlGF and increased sFlt-1 are associated with the pathophysiology of preeclampsia.

3. The sFlt-1/PlGF ratio may be clinically useful for assessing short-term risk in women with suspected preeclampsia.

4. PAPP-A and PP13 are promising biomarkers under investigation for first-trimester risk assessment, but evidence is insufficient to use them as independent diagnostic tools.

5. Combined assessment of clinical risk factors, blood pressure, uterine artery Doppler, and PlGF provides a more comprehensive risk stratification approach.

6. Biomarkers cannot completely replace clinical examination, blood pressure monitoring, urine testing, and assessment of fetal status.

7. Contemporary international recommendations emphasize the use of biomarkers together with clinical assessment.

CONCLUSION

Early detection of preeclampsia is an important component of modern obstetric strategies aimed at reducing maternal and fetal complications. Placental dysfunction and imbalance between angiogenic and antiangiogenic factors play important roles in the pathogenesis of preeclampsia.

PlGF, sFlt-1, and the sFlt-1/PlGF ratio are among the most extensively studied biomarkers reflecting these pathological processes. PAPP-A and PP13 remain promising areas for first-trimester risk assessment.

Preeclampsia cannot be fully predicted using a single biomarker. The most appropriate approach is an integrated assessment of clinical risk factors, blood pressure, uterine artery Doppler findings, and laboratory biomarkers.

PRACTICAL SIGNIFICANCE

Early identification of women at risk of preeclampsia can support individualized antenatal surveillance. In women with clinical risk factors, early risk assessment, intensified follow-up, and biomarker testing when clinically indicated may be appropriate.

At 20–36+6 weeks, in pregnancies with suspected preeclampsia, PlGF- or sFlt-1/PlGF-based tests may provide additional information to clinical assessment. Test results should always be interpreted together with the woman’s overall clinical condition.

References

1. American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia. Practice Bulletin No. 222. Obstetrics & Gynecology. Reaffirmed 2026.

2. International Society for the Study of Hypertension in Pregnancy. The 2021 ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension. 2021.

3. National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. NICE Guideline NG133.

4. National Institute for Health and Care Excellence. PLGF-based testing to help diagnose suspected preterm pre-eclampsia. HealthTech Guidance HTG630.

5. Danielli M, et al. Blood biomarkers to predict the onset of pre-eclampsia: A systematic review and meta-analysis. Heliyon. 2022;8(11):e11226. doi:10.1016/j.heliyon.2022.e11226.

6. Tzanaki I, Makrigiannakis A, Lymperopoulou C, et al. Pregnancy-associated plasma protein A as a first trimester serum biomarker for preeclampsia screening: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2025;38(1):2448502. doi:10.1080/14767058.2024.2448502.

7. Bucher V, Mitchell AR, Gudmundsson P, et al. Prediction of adverse maternal and perinatal outcomes associated with pre-eclampsia and hypertensive disorders of pregnancy: a systematic review and meta-analysis. EClinicalMedicine. 2024;76:102861.

8. Tiruneh SA, Vu CT, Moran LJ, et al. Externally validated prediction models for pre-eclampsia: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology. 2024;63(5):592–604.

9. Kuc S, et al. Evaluation of serum biomarkers and uterine artery Doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstetrical and Gynecological Survey.

10. Predictive performance of placental protein 13 for screening preeclampsia in the first trimester: a systematic review and meta-analysis.

11. Meta-analysis on first-trimester blood count parameters and the neutrophil-to-lymphocyte ratio as a potential method for preeclampsia screening. 2024.

12. Clinical interpretation and implementation of the sFlt-1/PlGF ratio in the prediction, diagnosis and management of preeclampsia.

13. Preeclampsia prediction via machine learning: a systematic literature review. 2025. doi:10.1080/20476965.2024.2435845.

14. International Society for the Study of Hypertension in Pregnancy. Guidelines and recommendations for hypertensive disorders of pregnancy.

Sevinch Rustamova Shuxrat qizi was born on October 13, 2005, in Muborak District, Kashkadarya Region, Uzbekistan. She is currently a fourth-year student at Kimyo International University in Tashkent, studying General Medicine in the Med-01U group.

Alongside her medical education, Sevinch has a deep passion for poetry and creative writing. She has participated in several international Olympiads and literary projects. Her poems and creative works have been published in international anthologies in Egypt and Qatar.

In 2025, she also participated in an international literary anthology in Türkiye, where she presented her creative works and delivered a speech on an international platform. Her scientific articles and theses have been published in various reputable scientific journals, and she actively participates in national conferences, academic forums, and scholarly events.

Sevinch combines her interests in medicine, science, poetry, and literature, aspiring to contribute to both the scientific and cultural spheres through her knowledge, creativity, and continuous pursuit of personal and professional development.

Essay from Yusufjonova Sabriya

Digital Innovations and Their Impact on Human Life


The wave of digital innovations entering our lives does not seem to be coming to an end anytime soon. While technologies have created numerous conveniences for people, they have also opened the door to new opportunities in human history. The concept of being “thousands of kilometers away” has, as before, been erased from
people’s minds; regardless of the distance, they can communicate with their loved ones and continue their work. According to the U.S. Federal Reserve and time-use studies, the opportunity to work remotely has given employees hundreds of additional hours each year by reducing the time spent commuting. Their arrival has
fundamentally changed our lives: thanks to technologies in medicine, many human lives have been saved and treatments for numerous diseases have been discovered; in education, the ability to gain knowledge regardless of distance has increased people’s access to learning; and conveniences have also begun to appear in our
everyday lives.


Despite all the advantages created by technologies, many problems have also begun to emerge. The growing dependence on phones and similar gadgets can disconnect people from the outside world, weaken their connections with loved ones, and negatively affect human psychology. The use of household appliances in everyday life has also encouraged laziness among people, while physical inactivity
has contributed to problems associated with excess weight. According to data from the World Health Organization, nearly 45 percent of the world’s population suffers from excess weight, and one of the main contributing factors is inactivity in the digital age. In the medical field, the use of ultraviolet radiation for examination and
treatment can also lead to certain skin diseases in people.


Furthermore, the greatest loss would be for technology to surpass humanity. The dominance of technology created by human beings over the only conscious species in the world—humankind—would mean that life itself had completely lost its meaning and was coming to an end. As we know, they are merely lifeless and emotionless pieces of metal.


Although technologies create thousands of opportunities for us, the problems arising because of them are also numerous. In conclusion, following moderation in their use can prevent such problems. In other words, they should simply be regarded as helpful household tools. Using them wisely and preventing dependence on them is the most appropriate path.


“It is frightening when technology surpasses humanity; it shows that we are winning a victory over our own intellect.”
— Albert Einstein