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.

Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia

Background: Preeclampsia is a multisystem disorder causing vascular endothelial damage and leads to leakage of lactate dehydrogenase (LDH) into maternal serum. This study evaluated the serum LDH levels in severe preeclamptic women to detect any correlation with adverse pregnancy outcomes.Methods: A prospective cohort study compared LDH levels of 68 severe preeclamptic women with 68 normotensives in the third trimester, matched for age, parity, and gestational age. The preeclamptic women were followed up until delivery to assess the maternal and neonatal outcomes. Data were analyzed with SPSS for Windows version 23. The level of significance was set at p<0.05.Results: Both groups were comparable in their characteristics. The mean LDH level for severe preeclamptic group (717.40 IU/L) was higher than for the normotensive group (162.90 IU/L) and this was significant (p=0.001). Cesarean delivery was less likely when LDH was >600 compared to ?600 (OR 0.31; p=0.049) indicating a potential protective effect. The likelihood of IUGR (OR 3.14; p=0.045), IUFD (OR 6.48; p=0.028), stillbirth (OR 7.06 p=0.007), perinatal mortality (OR 4.84; p=0.004) and low birth weight <2500 gm (OR 3.77; p=0.025) were all significantly higher with LDH levels >600 IU/L.Conclusions: Maternal serum LDH levels were found to be significantly increased in pregnant women with severe preeclampsia compared to their normotensive counterparts, and elevated levels >600 IU/L in the third trimester was associated with adverse perinatal outcomes.

Meta-analysis of effectiveness of community-based interventions in improving physical activity in youth with intellectual disability

Background and Objectives@#The effects of home or community-based interventions in increasing physical activity in youth with intellectual disabilities are yet to be known. Such information is important in designing the care for this population because of their increased susceptibility to lifestyle diseases that affect their quality of life. This study aimed to determine the effectiveness of home or community-based interventions in increasing physical activity levels in youth with intellectual disabilities. @*Methodology@#Eight databases were searched to identify intervention studies available in English that investigated the effects of home or community-based interventions on physical activity levels in youth with intellectual disabilities. Data were analyzed using descriptive statistics and meta-analysis using a random effects model. Effect sizes were calculated as standardized mean differences with 95% confidence intervals. @*Results@#Six randomized controlled trials were included in this review. Home or community-based interventions had a small effect in improving physical activity levels in youth with intellectual disabilities. These effects did not reach statistical significance for physical activity levels (d = 0.33; CI = -0.11 to 0.78; p = 0.14), number of steps per unit of time (d = 0.23; CI = -0.23 to 0.68; p = 0.32), and time spent inactive (d = 0.15; CI = -0.29 to 0.60; p = 0.50). @*Conclusion@#Home or community-based interventions may be effective in increasing physical activity levels in youth with intellectual disabilities. Further research with homogeneous outcome measures and larger sample sizes need to be conducted to build on the results of this review.

Pacientes oncológicos: um olhar sobre as dificuldades vivenciadas pelos familiares cuidadores / Pacientes oncológicos: una mirada sobre las dificultades vivenciadas por los familiares cuidadores / Oncology patients: a glance about the difficulties lived by the caretaking relatives

Os pacientes oncológicos freqüentemente precisam de ajuda contínua em sua vida diária. Geralmente um dos familiares se encarrega dessas atividades, dedicando-se por um longo período a esses cuidados. O objetivo da pesquisa consiste em fazer um levantamento das dificuldades vivenciadas pelos familiares cuidadores de pacientes oncológicos e verificar as técnicas de suporte apontadas pela literatura para eles. A coleta de dados foi realizada por meio da aplicação de uma entrevista estruturada na residência de 16 familiares cuidadores de pacientes oncológicos, no mínimo há 4 meses, não importando sexo, idade e grau de instrução. A análise seguiu uma proposta qualitativa e quantitativa. Dos resultados obtidos pode-se afirmar que os familiares cuidadores de pacientes oncológicos são pessoas propensas a adoecer com maior facilidade, o que pode lhes acarretar em sofrimento psíquico, bem como mobilizar seus conteúdos relacionados à morte. Esses cuidadores apresentam uma mudança abrupta em sua vida, bem como em sua rotina. Alguns deles relatam já perceber alguns sintomas psicossomáticos. Conclui-se que é extremamente importante a esses familiares procurem reservar um tempo para cuidar de si podendo assim dedicar-se melhor aos cuidados para com o paciente e desfrutar dos aspectos positivos dessa função.

The patients with cancer quite often need a continuous help in their everyday life. Usually, one of the relatives is put in charge of these activities, dedicating him/ herself for a long period to such cares. The purpose of this research is to make a survey of the difficulties experienced by the caretaking relatives of oncology patients and check the support techniques presented in literature to them. The data were collected through interviews with 16 relatives that take care of patients with cancer for at least 4 months, without considering sex, age or instruction level. The analysis followed a qualitative and quantitative proposal. From the results found, we can be sure that the relatives that take care of patients with cancer are people prone to get sick easily, what may cause a psychic suffering to them and thoughts about death. These caretakers present a sudden change in their life as well as in their daily routine. Some of them reported that they have already identified some psychosomatic symptoms. We concluded that it is extremely important that these relatives try to take some time to take care of themselves. Doing that, they will be able to dedicate themselves to their relatives with cancer in a more effective way and enjoy the positive aspects of their duty.

Los pacientes oncológicos frecuentemente necesitan ayuda continua en su vida diaria. Generalmente uno de sus familiares se encarga de esas actividades, dedicándose por un largo periodo a esos cuidados. El objetivo de la pesquisa consiste en hacer un levantamiento de las dificultades vivenciadas por los familiares cuidadores de pacientes oncológicos y verificar las técnicas de soporte apuntadas por la literatura. La recolección de datos fue realizada por medio de la aplicación de una entrevista estructurada en la residencia de 16 familiares cuidadores de pacientes oncológicos, hace por lo menos 4 meses, no importando sexo, edad y nivel de instrucción. El análisis siguió una propuesta cualitativa y cuantitativa. De los resultados obtenidos se puede afirmar que los familiares cuidadores de pacientes oncológicos son personas propensas a enfermarse con más facilidad, lo que puede provocarles sufrimiento psíquico, así como movilizar contenidos relacionados a la muerte. Esos cuidadores presentan un cambio abrupto en su vida, así como también en su rutina. Algunos de ellos relatan percibir algunos síntomas psicosomáticos. Se concluye que es extremamente importante que esos familiares busquen reservar un tiempo para cuidar de si, permitiendo dedicarse mejor a los cuidados para con el paciente y disfrutar de los aspectos positivos de esa función.

The feasibility of a porcine model of acute coronary occlusion and reperfusion using off-pump coronary artery bypass grafting

We developed an open-chest porcine model of acute coronary occlusion and surgical reperfusion, and attempted to prevent intra-operative ischaemic ventricular fibrillation (VF) by a Retrograde Intracoronary Glyceryl trinitrate (RIG) infusion into the occluded vessel. Five Yorkshire pigs (weight 50 +/- 1.1 kg), randomized into 3 groups, underwent median sternotomy under general anaesthesia. One pig (Group 1, control) underwent sternotomy and pericardiotomy only. Four pigs underwent acute left anterior descending (LAD) coronary occlusion. Two pigs were not reperfused (Group 2). Two pigs underwent surgical reperfusion (Group 3) via left internal mammary artery (LIMA) grafting to the LAD using the Off-Pump Coronary Artery Bypass (OPCAB) technique. Ischaemic injury was assessed using 7-lead electrocardiography (ECG) and transthoracic/epimyocardial echocardiography (ECHO). Group 1: transient intraoperative hypotension and VF occurred. Successful resuscitation and 10-week survival (until sacrifice) with normal left ventricular (LV) function was achieved. Group 2: there were ECG and ECHO evidence of acute LV ischaemic dysfunction in both pigs. The surviving pig had persistent anterior hypokinesis at 8 1/2 months. The other died intra-operatively following progressive ischaemic LV dysfunction despite resuscitative attempts. Group 3: the surviving pig had normal LV function at 8 months. Initial anterior LV akinesis normalized within 7 days. The other developed post-occlusion haemodynamic instability and died intra-operatively despite reperfusion. In this porcine model, acute LAD artery occlusion modified by the novel RIG infusion technique, followed by surgical reperfusion (OPCAB) is feasible. This model would facilitate further development of OPCAB surgical expertise and understanding of the pathophysiology of ischaemia-reperfusion injury.

HLA-B5 and B21 antigens in aortoarteritis.

The distribution of class I HLA antigens (HLA-A, B) were determined in 50 patients of Aortoarteritis in an Indian population. This included 29 females and 21 males. The difference in antigen frequency was observed between patients and controls with reference to HLA-A19, B5 and B21 antigens. A decreased frequency of HLA-A19 was observed in the patients as compared to controls (14% vs 33.25%, X2 = 6.81, P less than 0.025). Of the B locus antigens, an increased frequency of HLA B5 was observed in the patients as compared to controls (48% vs 29.5%, X2 = 6.2, P less than 0.025). HLA-B21 was also increased in the patients as compared to the controls (18% vs 6.5%, X2 = 6.67, P less than 0.025). These data suggest the involvement of genetic factor (s) in the aetiopathogenesis of this disease. Further, the observations indicate that HLA-B5 and B21 may be associated with Aortoarteritis.