Incidence of gestational diabetes mellitus in Bahrain from 2002 to 2010.

OBJECTIVE: To determine the incidence and trends of gestational diabetes mellitus (GDM) in Bahrain from 2002 to 2010, and to investigate 2 possible risk factors within the affected population. METHODS: In a retrospective survey, data on maternal body weight and age were collected from women who gave birth in government maternity units in Bahrain and who were screened for GDM during pregnancy using the 2-step approach and criteria of the US Expert Committee on the diagnosis and classification of diabetes. RESULTS: Among 49 552 pregnant women, 4982 (10.1%) were diagnosed with gestational diabetes. The Cox-Stuart test for trend analysis suggested that there was an increase in the incidence of gestational diabetes from 7.2% in 2002 to 12.5% in 2010 (P<0.01). For the period 2006-2010, maternal age, and weight at onset of pregnancy and at time of delivery were positively associated with risk of GDM with an odds ratio (95% confidence interval) of 1.094 (1.081-1.107), 1.081 (1.001-1.104), and 1.027 (1.013-1.040), respectively. CONCLUSION: A combination of increasing maternal weight, maternal age, and incidence of GDM among women in Bahrain indicates a significant future burden on health services.

Cord blood stem cells.

The discovery that stem cells (SCs) can be obtained from umbilical cord blood instead of the more controversial source of embryonic SC's, has renewed interest on the new, exciting therapeutic potentials of this technology. Several therapeutic targets have been cited as candidates for treatment such as, malignant blood disease, hematological disorders, complex neurological illnesses, genetic and autoimmune diseases, benign and malignant blood diseases, skeletal anomalies, and the ultimate promise of using this technique in delaying the process of human aging. Parallel to this rise in popularity of SC research, SC banking has become a growing commercial enterprise. This review will attempt to present a concise account on the present status of the uses of SC in general, and cord blood (CB) in particular. An evaluation of the debate on the claims, and counter-claims in commercializing CB banking has been summarized.

Small cell neuroendocrine carcinoma of the endometrium, a rare aggressive tumor.

This is a report of a young infertile woman with a history of 8 years amenorrhea, who presented with history of vaginal bleeding of 2 months duration. Investigations revealed a small cell neuroendocrine carcinoma of the endometrium, which penetrated half of the thickness of uterine wall. We have described the clinical progress and management of this rare and highly malignant cancer. A review of the pathological types and behavior of clear cell neuroendocrine carcinoma is presented.

Paraplegia in a puerperal woman due to spinal metastasis from papillary carcinoma of the thyroid gland.

We present an unusual case of paraplegia which occurred on the second postnatal day. Investigations revealed a spinal mass at D-7 level. Histopathology of the tumor showed it to be a spinal metastasis from a solitary thyroid malignant nodule. The patient had laminotomy and biopsy, followed later by total thyroidectomy. She also had radiotherapy and radio-iodine ablation. We discuss the therapeutic modalities of such a condition.

Sickle cell disease in pregnancy. Obstetric and anesthetic management perspectives.

Recent advances in the pathophysiology, clinical investigations, and management of sickle hemoglobinopathies enables all physicians to better manage these disease states and their sequelae. Patients with sickle cell disease SCD are living longer and are thus more likely to contract unrelated diseases that require surgery and anesthesia. Patients with SCD continue to be a challenge to all branches of medicine particularly in obstetrics, surgery and anesthesia; however, the armamentarium of new knowledge and practice places a different perspective on the care of this old disease. In general, the literature to date suggests that neither prophylactic transfusion of pregnant sicklers nor the selection of an anesthetic in labor have a major impact on patient outcome; however, perioperative management can greatly affect the consequences. A thorough knowledge of the impact of the disease on clinical status can determine how, when, and why to manage parturients with SCD.

Unusual presentation of an abdominoinguinal schwannoma.

Schwannoma is a rare, benign peripheral nerve sheath tumor of uncertain origin. This report describes a retroperitoneal cellular schwannoma that extended into the inguinal region. Surgical dissection of a tumor in this site requires an abdominopelvic approach. Histology revealed nodules of pale epithelioid cells separated by fascicles of spindle cells. With immunohistochemistry, no actin was seen. Neurospecific vimentin confirmed the presence of nerve cells. The tumor was completely removed, and as of 6 months later there had been no recurrence. Schwannoma are extremely difficult or even impossible to diagnose preoperatively. If clinicians are faced with an inguinal swelling or herniation and a coexisting abdominal mass, they should perhaps consider radiologic studies that better identify the origin.

Obstetric, neonatal and anesthetic considerations for preterm labor and delivery.

Preterm birth is a continuing obstetric problem that contributes significantly to the incidence of perinatal death and long-term handicap. In this context, various studies have shown preterm births account for between 69% and 83% of neonatal deaths. Despite this, the incidence of preterm birth has remained static for many years. One explanation for this is that the management of preterm labor has altered very little in the past 30 years. Strategies aimed at reducing the incidence of preterm birth include the identification of risk factors that increase the likelihood of preterm delivery. Treatment is then designed to target those risk factors and limit their effect. Although perinatal mortality has declined, mostly due to the improved management of very low birthweight babies rather than prevention of preterm labor, efforts to prevent preterm birth have been largely unsuccessful so far and preterm birth still represents a major health care problem to both developed and developing countries.

Unusual presentation of a deep pelvic abscess in a young girl.

Although the clinical features of appendicitis in children are well established, diagnosis can be compounded when a young girl having just had menarche presents with unusual and untoward symptoms. The gynecological and surgical diagnoses and subsequent findings will be discussed in detail, along with the respective management regimens. Pelvic abscesses in particular will be discussed relative to accessing problems.

Screening for gestational diabetes by measuring fasting plasma glucose levels.

OBJECTIVES: (a) To test the sensitivity and specificity of measuring fasting plasma glucose levels (FPG) as a screening test for gestational diabetes mellitus (GDM). (b) To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test (GCT) for predicting GDM. METHODS: One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26-32 weeks gestation, giving a 13.5% incidence of GDM (using the Third International Workshop cutoff values of 7.8 mmol /l). All patients also had an FPG estimation followed by the three-hour oral glucose tolerance test (oGTT). Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves (ROC) were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. RESULTS: FPG levels of 5.6 mmol /l and 5.4 mmol /l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. CONCLUSION: Using FPG levels at a cutoff value of ≥ 5.5 mmol /l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT.

Septic postpartum ovarian vein thrombosis.

This report describes the clinical findings and outcome of a patient suffering from septic postpartum ovarian vein thrombosis. Treatment modalities are well described and range from hysterectomy and thrombectomy to the use of vena cava filters in combination with anticoagulation and antibiotics. Defervescence with a combination infusion of tissue plasminogen and heparin were used. This treatment approach has been found particularly successful in cases of ilio-femoral, hepatic, renal and vena caval thromboses.