Assessment of risk factors and glycosylated haemoglobin in early pregnancy as predictors of diabetes in pregnancy

Background: The aim of the study was to determine the performance of history of risk factors and universal HBA1c testing as screening tools for diabetes mellitus in the first trimester of pregnancy using OGTT as a gold standard.Methods: A prospective cross-sectional study conducted between 8 and 13±6 weeks in 305 consecutive pregnancies in the antenatal clinics of the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH) between January and August 2020. Each woman had oral glucose tolerance test (OGTT), and glycosylated haemoglobin (HBA1c) levels estimation. Multivariate logistic regression analysis was carried out with history of risk factors and HBA1c level as independent variables and OGTT as the dependent variable for the assessment of their predictive performances.Results: The prevalence of DM was 28.85%, 2.62% and 31.48% for GDM, pre-gestational and for both respectively. Family history of DM was associated with high specificity (91.4%) and negative predictive value (NPV) of 68.7% but low sensitivity (9.4%) and positive predictive value (PPV) (33.3%). The receiver operator characteristic curve for HBA1c revealed a significant area under the curve value: 0.653 (CI: 058-0.72), p<0.01. The optimal cut-off for HBA1c from Youden index was 5.25%. HBA1c levels had high specificity (88.5%) and NPV (75.2%) with low sensitivity (36.5%) and PPV (59.3%). Multivariate logistic regression analysis showed HbA1c as the only independent predictor of GDM (p=0.0001).Conclusions: The high prevalence of diabetes (31.48%), underscores the need for universal screening in early pregnancy. The high NPV and specificity of the risk factors for GDM and HBA1c levels better predict pregnancies that are not likely to develop GDM, but they are not suitable for diagnosis because of the low sensitivity and PPV.

Aproximándose al link perdido: pointing y lenguaje como intencionalidad compartida / Approaching the missing Link: pointing and language as shared intentionality

Los humanos se comunican a través de un sistema distinto a otros seres vivos. Este artículo tiene como objetivo responder dos preguntas fundamentales sobre este sistema, el lenguaje humano; 1) ¿qué es lo que hace al lenguaje humano tan diferente de otras formas de comunicación? y 2) ¿qué nos ha llevado a desarrollar un sistema tan particular? Usando evidencia teórica y empírica, mostraremos como el lenguaje humano es único, ya que es una parte intrínseca de las habilidades cognitivas, y ya que la motivación comunicativa es fundamentalmente distinta a otras formas de comunicación entre seres vivos. Este sistema particular se ha desarrollado como el resultado de la aparición de habilidades cognitivo-sociales y de motivaciones sociales de comunicación, ambas manifiestas originalmente a través del acto de pointing (señalar), el cual aceptamos como un precursor del sistema de lenguaje humano más complejo. Esta proposición encuentra soporte tanto filo - como ontogenéticamente. Sobre el final, presentamos una hipótesis comprobable, sobre la evolución del lenguaje, basada en la intencionalidad compartida la cual de ser acertada daría aún mayor soporte a las ideas planteadas en este artículo.

Humans communicate in a system unlike any other living things. This article aims to answer two fundamental questions about this system, human language; 1) what is it that makes human language so different from other forms of communication? and 2) what has led us to develop such a particular system? Using theoretical and empirical evidence, we show that human language is unique in that it is intrinsically part of cognitive skills and motivation for communication, unlike other forms of communication between living things. This particular system has been developed as a result of the appearance of social cognitive skills and social motivations for communication, both manifested originally through the act of pointing, which we accept as a precursor to the more complex system of human language. This proposal is supported both phylo - and ontogenetically. At the end, we present a testable hypothesis for the evolution of language on the basis of shared intentionality, that given positive evidence for this hypothesis would further support the ideas presented in this article.