Frequency of impaired glucose tolerance and diabetes mellitus in subjects with fasting blood glucose below 6.1 mmol/L [110 mg/dL]

The diagnosis of diabetes mellitus by the available criteria is controversial and relies heavily on fasting glucose results. This cross-sectional study in 2010-2011 aimed to measure the frequency of impaired glucose tolerance and diabetes mellitus in 127 subjects having fasting blood glucose < 7.0 mmol/L and to measure the agreement between different standard diagnostic criteria. Subjects presenting to a laboratory for analysis of fasting blood glucose for excluding diabetes meilitus underwent a 2-hour 75 g oral glucose challenge. A total of 40.6% of subjects with fasting blood glucose from 5.6-6.0 mmol/L had abnormal glucose regulation on the basis of the gold standard glucose challenge. Agreement between American Diabetes Association and World Health Organization diagnostic criteria was only fair [kappa =: 0.32]. Abnormalities of glucose metabolism including impaired glucose

Evaluation of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in diagnosis of growth hormone deficiency in short-stature children

Growth Hormone Deficiency [GHD] is conventionally diagnosed and confirmed by diminished peak Growth Hormone [GH] levels to provocative testing. Serum Insulin-like growth factor-1 [IGF-1] and insulin-like growth factor binding protein-3 [IGFBP-3] are under the influence of GH and reflect the spontaneous endogenous GH secretion. Owing to the absence of a circadian rhythm, it is possible to take individual measurements of IFG-1 and IGFBP-3 assays with Exercise and L-Dopa stimulation tests in the diagnosis of growth hormone deficiency in short stature children using ITT as gold standard. This validation study was conducted at Department of Chemical Pathology and Endocrinology, AFIP, Rawalpindi, from November 2005 to October 2006. Fifty-two short stature children were included in the study. Basal samples for GH levels and simultaneous IGF-1 and IGFBP-3 measurements were obtained and afterwards all children were subjected to sequential exercise and L-Dopa stimulation tests. Insulin Tolerance Test [ITT] was performed one week later with all the necessary precautionary measures. On the basis of ITT results, children were divided into two groups, i.e., 31 growth hormone deficient and 21 Normal Variant Short Stature [NVSS]. The diagnostic value of exercise stimulation test remained highest with sensitivity 90.3%, specificity 76.0%, Positive Predictive Value [PPV] 84.84%, Negative Predictive Value [NPV] 84.2% and accuracy 84.6%. The conventional L-Dopa stimulation had sensitivity 96.7%, specificity 38.0%, PPV 69.7%, NPV 88.8% and accuracy 73.0%. The serum IGF-1 and IGFBP-3 levels were positively correlated with post ITT peak GH levels [r=0.527, r=0.464 respectively, both p<0.001]. The diagnostic value of IGF-1 had sensitivity 83.87%, specificity 76.2%, PPV 83.87%, NPV 76.2% and accuracy 80.76%. The diagnostic value of IGFBP-3 had sensitivity 54.83%, specificity 90.47%, PPV 89.47%, NPV 57.57% and accuracy 69.23%. With combined use of IGF-1 and IGFBP-3 diagnostic value had sensitivity 69.35%, specificity 83.33% PPV 86%, NPV 64.81% and accuracy 75%. Growth Hormones provocative tests still remain the most useful investigations for the diagnosis of GHD. Measurements of IGF-1 and IGFBP-3 have shown comparable diagnostic performance with growth hormone stimulation tests and are valuable for patients' convenience and ease of performance and can be useful in the initial workup of short stature

Comparison of maxillary arch dimensions between unilateral cleft lip and palate and non cleft infants

The objectives of the study were to investigate the effects of unilateral cleft lip and palate on maxilla, for which our study compared the maxillary dimensions of both unilateral cleft lip and palate and non cleft infants. The study was performed in the Orthodontics department, children hospital, Lahore and the study design was Cross sectional Analytical. The sample consisted of ninety children, thirty with unilateral cleft lip and palate and sixty without cleft lip and palate. Comparison of arch width between cleft and non cleft infants showed the width to be slightly more in the cleft infants but the difference was not statistically significant. Comparison of anterioposteior length and rotation of the right and left maxillary segments showed significantly different values. This research contradicted the hypothesis that cleft lip and palate causes deficits in growth and volume in the maxillary region and supports the viewpoint of bony dislocation of the major and minor cleft segments