Prediction of pre-eclampsia in diabetic pregnant women

Background & objectives: Gestational or preexisting diabetes is one of the risk factors of pre-eclampsia. Both are responsible for higher maternal and fetal complications. The objective was to study clinical risk factors of pre-eclampsia and biochemical markers in early pregnancy of women with diabetes mellitus (DM)/gestational diabetes mellitus (GDM) for the development of pre-eclampsia. Methods: The study group comprised pregnant women diagnosed with GDM before the 20 wk of gestation and DM before pregnancy and the control group had age-, parity- and period of gestation-matched healthy women. Sex hormone-binding globulin (SHBG), insulin-like growth factor-I (IGF-I) and 25-hydroxy vitamin D [25(OH)D] levels and the polymorphism of these genes was evaluated at recruitment. Results: Out of 2050 pregnant women, 316 (15.41%) women (296 had GDM and 20 DM before pregnancy) were included in the study group. Of these, 96 women (30.38%) in the study group and 44 (13.92%) controls developed pre-eclampsia. Multivariate logistic regression analysis indicated those who belonged to the upper middle and upper class of socio-economic status (SES) were likely to be at 4.50 and 6.10 times higher risk of developing pre-eclampsia. The risk of getting pre-eclampsia among those who had DM before pregnancy and pre-eclampsia in their previous pregnancy was about 2.34 and 4.56 times higher compared to those who had no such events, respectively. The serum biomarkers [SHBG, IGF-I and 25(OH)D] were not found to be useful in predicting pre-eclampsia in women with GDM. To predict risk of development of pre-eclampsia, the fitted risk model by backward elimination procedure was used to calculate a risk score for each patient. Receiver operating characteristic (ROC) curve for pre-eclampsia showed that area under the curve was 0.68 (95% confidence interval: 0.63-0.73); P<0.001. Interpretation & conclusions: The findings of this study suggested that pregnant women with diabetes were at a higher risk for pre-eclampsia. SES, history of pre-eclampsia in previous pregnancy and pre-GDM were found to be the risk factors.

Role of FNAC In Diagnosis of Non-Thyroidal Head and Neck Lesions.

Fine needle aspiration cytology (FNAC) is of particular relevance in head and neck lesions because of easy assessibility, excellent patient compliance, miminally invasive nature of procedure and helping to avoid surgery in non-neoplastic lesions, inflammatory conditions and also some tumors. The study was conducted on 160 patients presenting with non-thyroidal head and neck swellings. Swellings arising from lymphnodes formed largest group 110 (68.75%) cases, salivary gland origin leisions comprised of 15(9.3%) cases and miscellaneous lesions 35 (21.8%) patients. Aspiration was satisfactory in 153 (95.63%) and unsatisfactory in 7 (4.40%) patients. The cytodiagnostic yield was 147 (91.87%) cases in the study. In 46 patients surgical intervention and histopathological examination (HPE) of the specimen was undertaken. The sensitivity of FNAC compared with HPE where available in diagnosing lymphnode lesions was 83.33%, salivary gland lesions was 100% and miscellaneous swellings was 95.83%. The overall sensitivity in the study in diagnosing non-thyroidal head and neck lesion was 93.47%. No major complication was recorded.

Infarction in Fibroadenoma Breast During Pregnancy with Skin Necrosis and Fungation.

A 35 year old multigravida in the 24th week of gestation presented with history of swelling left breast of 2 years duration. The swelling rapidly increased in size during the pregnancy & underwent spontaneous necrosis of skin with fungation & haemorrhage. Fine needle aspiration cytology showed a diagnosis of fibroadenoma. Lumpectomy was performed in the emergency & histopathology of specimen revealed infarction in fibroadenoma. Patient delivered a normal healthy baby and is alright at 6 month follow up.