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Background: Estimation of HbA1c in gestational diabetes mellitus patients is not being recommended by any societies/guidelines as studies regarding the role of HbA1c for monitoring of euglycemic control and predicting the maternal and perinatal outcomes in GDM patients (unlike overt diabetes) are conflicting and sparse.Methods: This was a prospective study with an aim to evaluate the role of HbA1c estimation in late pregnancy (early and late third trimester) for prediction of pregnancy outcomes in GDM patients. 53 patients with GDM (diagnosed before third trimester) were recruited for the study. HbA1c levels were estimated in late pregnancy (at 28-32 weeks and again repeated at 37 - 39 weeks or at the time of delivery). Correlation of HbA1c levels in third trimester with maternal and perinatal outcome was studied in patients with gestational diabetes mellitus and cut off taken was 5.8%.Results: Of the total 53 patients 54.7% had HbA1c levels <5.8% and 45.3% had HbA1c ≥5.8% done at 28-32 weeks. Also when HbA1c levels done at 37-39 weeks POG/ at the time of delivery, 52.8% patients had <5.8% and 47.2% had HbA1c ≥5.8%. Approximately one-fourth of the patients had HbA1c ≥ 5.8% even with normal blood sugar levels (euglycemic) control. There was statistically significant increased incidence of polyhydramnios, LGA (large for gestational age babies) and increased mean birth weight in patients with HbA1c ≥ 5.8%, done in late pregnancy. However there was no statistically significant difference in the incidence of preterm labour, gestational hypertension or preeclampsia, urinary tract infections, vulvovaginal infections, caesarean deliveries and postpartum haemorrhage in patients with HbA1c ≥5.8% compared to patients with HbA1c <5.8%.Conclusions: The study revealed that in patients of GDM with HbA1c levels ≥5.8% done in third trimester was statistically significantly associated with increased incidence of polyhydramnios, large for gestational age babies and increased mean birth weight when compared to patients with HbA1c <5.8%.
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Introduction: Metabolic syndrome (MS) is diagnosed in an individual if any three of the five risk factors formetabolic syndrome are present. These five risk factors are elevated waist circumference, blood pressure,fasting blood glucose, serum triglyceride and lowered high density lipoprotein. Although the long term naturalevolution of MS has been reported yet there is insufficient research on the changes in risk factors of MSafter one year of diagnosis.Objective: To evaluate changes in risk factors of metabolic syndrome after one year of its identification inyoung college going students of an urban Northern India populationMaterial and method: Height, weight, body mass index and various risk factors for metabolic syndromesuch as waist circumference, blood pressure, fasting blood sugar, triglycerides and High Density Lipoproteinwere assessed at baseline and after one year. International Physical Activity Questionnaire was used toobjectively assess physical activity levels of the participants.Results: Out of 88 participants, 16 participants were diagnosed with MS at baseline but after one year thenumber reduced to 8.Percentage decrease in triglyceride levels (13.5%) was maximum followed by decline in waist circumference(8.9%) fasting blood glucose showed an increase by 6.6%. However, HDL, blood pressure, weight and BMIshowed no significant change after one year.70.6% of participants showed reduction in WC followed by reduction in fasting blood glucose of and triglyceridelevels of 66.7% participants. Elevation of HDL levels was observed in 38.5% of the participants. Thus therewas least improvement in HDL in the study population after one year. The increase in IPAQ physical activityscores after one year as compared to baseline was not statistically significant but the total sitting andaverage sitting time showed a statistically significant decline after one year.Conclusion: The incidence of MS shows a 49.7% decline after one year even when no specific dietary orphysical activity advise is given to the participants. Although mean values of triglycerides showed the largestdecrease after one year yet decline in waist circumference was seen in maximum percentage of participants.There was least improvement in HDL in the study population after one year.
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Background: Obesity is associated with an increased risk of atherosclerosis, which can be mediated by an increase in angiogenesis and inflammation. The objective of the present study was to explore the relationship between BMI and levels of VEGF, a circulating biomarker of angiogenesis.Methods: 225 healthy volunteers in the age group of >18 years formed the subjects of the study. Individuals with any acute or chronic illness including history of HT, DM, and smoking, alcohol or drug abuse or on any long term medication were excluded from the study. Anthropometric measurements were taken, and BMI calculated. Blood samples were taken, and serum levels of VEGF were estimated using commercially available ELISA kits. Student’s ‘t’ test was done for comparison and correlation was assessed using Pearson’s method.Results: A statistically significant difference in the levels of VEGF was found in subjects with BMI < 25 kg/m2 as compared to subjects with BMI > 25 kg/m2 (p<0.001). A significant positive correlation was found between the levels of VEGF and BMI in both males and female subjects of the study group (r=0.68 and 0.73 respectively).Conclusions: The positive correlation of levels of VEGF with BMI in the healthy subjects of the study group may be related to the expansion of adipose tissue and to the concomitant formation of new vessels to support tissue deposition. These factors may predispose an individual to an increased risk of atherosclerotic damage later in life. VEGF may therefore, have a potential as a biomarker for the prediction of cardiovascular risk and estimation may allow intervening with lifestyle modifications and nutritional changes before the disease is manifested and pharmacotherapy is required.
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Objective: WHO recommends Ringer’s lactate (RL) and Normal Saline (NS) for rapid intravenous rehydration in childhood diarrhea and severe dehydration. We compared these two fluids for improvement in pH over baseline during rapid intravenous rehydration in children with acute diarrhea. Design: Double-blind randomized controlled trial Setting: Pediatric emergency facilities at a tertiary-care referral hospital. Intervention: Children with acute diarrhea and severe dehydration received either RL (RL-group) or NS (NS-group), 100 mL/kg over three or six hours. Children were reassessed after three or six hours. Rapid rehydration was repeated if severe dehydration persisted. Blood gas was done at baseline and repeated after signs of severe dehydration disappeared. Outcome Measures: Primary outcome was change in pH from baseline. Secondary outcomes included changes in serum R E S E A R C H P A P E R INDIAN PEDIATRICS 963 VOLUME 49__DECEMBER 16, 2012 electrolytes, bicarbonate levels, and base-deficit from baseline; mortality, duration of hospital stay, and fluids requirement. Results: Twenty two children, 11 each were randomized to the two study groups. At primary end point (disappearance of signs of severe dehydration), the improvement in pH from baseline was not significant in RL-group [from 7.17 (0.11) to 7.28 (0.09)] as compared to NS-group [7.09 (0.11) to 7.21 (0.09)], P=0.17 (after adjusting for baseline serum Na/ Cl). Among this limited sample size, children in RL group required less fluids [median 310 vs 530 mL/kg, P=0.01] and had shorter median hospital stay [38 vs 51 hours, P=0.03]. Conclusions: There was no difference in improvement in pH over baseline between RL and NS among children with acute diarrhea and severe dehydration.
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The diseased gallbladder is one of the commonest specimens submitted to the surgical pathology laboratory in North India. Obesity is associated with a linear increase in gallstone formation. It has been observed that the plasma lipoprotein profile of patients with gallstones differs markedly from that of healthy subjects. Serum lipid profile was done by enzyme kit method. All the gallstones received were categorized morphologically and examined biochemically. The age range of 200 cases was 13 to 77 years with a mean of43.75 +/- 13.39 years. There were 171 females (85.5%) and 29 males (14.5%) with male to female ratio of 1: 5.8. The stones containing both cholesterol and bile pigments were the most common (129 cases, 84.87%); while pure cholesterol stones were seen in 23 cases (11.50%) and pigment stones were infrequent (1 case, 0.65%). On lipidogram of patients in the study group, mean serum total cholesterol was 155.50 +/- 43.03 mg/dL, mean serum triglycerides was 100.49 +/- 45.23 mg/dL, mean HDL cholesterol was 46.71 +/- 15.20 mg/dL, mean LDL cholesterol was 87.94 +/- 36.85 mg/dL and mean VLDL cholesterol was 20.84 +/- 11.97 mg/dL. Serum total cholesterol values were significantly higher in patients older than 39 years as compared to patients < or =39 years (161.44 +/- 42.32 mg/dL vs. 145.79 +/- 32.96 mg/dL, p < 0.05). But the observed mean values in both of these subgroups were within the normal range i.e. <200 mg/dL. No significant difference was observed in the mean serum triglyceride values between male and female patients. The findings of this study did not indicate any role of serum lipid profile in the formation of gallstones. However the higher mean values of serum total cholesterol and serum triglycerides in patients older than 39 years of age may be explained by increasing age.