First trimester uric acid level: a reliable marker for gestational diabetes mellitus

Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy.

Detection Of Virulence Factors In Clinical Isolates Of Enterococci In A Tertiary Care Hospital Of Southern Maharashtra.

Background & Objective: Enterococcus is one of the notorious organism causing nosocomial infections. Several virulence factors have been described from enterococci that enhance their ability to colonize patient’s tissue, increase resistance to antibiotics and aggravate the infection outcome. Therefore the study was carried out to investigate virulence factors among the enterococci isolated from different clinical samples. Methodology: Total 154 enterococcus species were isolated and were identified by conventional bacteriological method as well as by Vitek-2 compact system. The presence of certain virulence factors namely hemolysin, haemagglutination, gelatinase production and biofilm formation were detected and data was statistically analyzed. Results: E. faecalis was the commonest isolate (147) followed by E. faecium (7). Maximum number of isolates were from urine 65(42.20%) followed by pus 58(37.66%). The results of detection of virulence factors revealed 15.58% strains with gelatinase production, 34.41% with haemagglutination property, 35.71% showed hemolysin production and 55.84% strains showed biofilm production by microtitre assay plate method. Conclusion: All the markers studied are the potential virulence markers for the enterococci. Biofilm formation is the crucial virulence factor that enhances the ability of pathogen to cause severe infections. Inhibiting the action of such virulent factors or blocking biofilm formation may provide alternative method of therapy.

Primary tuberculous myositis: a rare clinical entity.

Summary: Primary tuberculous myositis without underlying pathology has been sparingly reported in medical literature. We report a case of primary tuberculous myositis of left upper arm in a seven-year-old boy. He presented with gradually increasing swelling on the medial aspect of the left arm. Ziehl Neelsen staining of pus collected revealed acid fast bacilli morphologically resembling Mycobacterium tuberculosis and the same was grown on the culture. Histopathological findings were consistent with tuberculosis. The results were confirmed by Genotype MTBDRpluse line probe assay. He was treated with standard four-drug regimen to which he responded well with complete resolution of the lesion.

Amniotic Fluid Lamellar Body Count as a Predictor of Fetal Lung Maturity.

Assessment of fetal lung maturity can be done with various biochemical tests on amniotic fluid. In the present study, lamellar body count (LBC) was compared with the traditional shake bubble test (SBT), as LBC is a simple, reliable and cost-effective method to predict fetal lung maturity. This was a prospective study conducted on 50 patients with known last menstrual period (LMP), gestational age >28 weeks presenting in active phase of labor with intact membranes. Amniotic fluid was collected either through vaginal route or through amniocentesis and SBT and LBC were conducted on all samples. Newborns were watched for signs of respiratory distress syndrome (RDS). Fourteen babies developed RDS. i.e., one out of 34 babies with positive SBT, seven out of 10 with intermediate SBT, all six with negative SBT developed RDS. The LBC varied between 3,000-28,000/ml among the 14 babies with RDS. i.e., all cases with RDS had LBC <30,000/ml. This study showed that LBC with cut-off value of 30,000/ml to predict fetal lung maturity is superior to all other tests in terms of technique and cost-effectiveness.