Recommendations for the practice of travel medicine.

Travel Medicine has emerged as a distinct entity over the last two decades in response to a very substantial increase in international travel and is now forging its own identity, remit and objectives for care of the traveller. Crucial to the formation of any speciality is the definition of recommendations for its practice. This is particularly important and needed for travel medicine as it overlaps with and forms part of day-to-day work in a number of different medical specialities. This document defines a set of recommendations for the practice of travel medicine from the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow. Their objective is to help raise standards of practice and achieve greater uniformity in provision of services, better to protect those who travel. As travel medicine moves towards applying for speciality status, these standards will also contribute to that process.

Maternal serum triglyceride, glucose tolerance, and neonatal birth weight ratio in pregnancy.

OBJECTIVE: To determine the value of measuring serum triglyceride (TG) levels early in pregnancy for predicting late-gestation glucose tolerance and neonatal birth weight ratio (BWR) (birth weight corrected for gestational age). RESEARCH DESIGN AND METHODS: The relationships between morning nonfasting TG measured early in pregnancy (gestational age 12 +/- 6 weeks [mean +/- SD]) and glucose tolerance measured by a 3-h 50-g oral glucose tolerance test (OGTT) late in pregnancy (gestational age 30 +/- 3 weeks) and BWR were investigated in 388 women attending routine antenatal care. The data were analyzed for all women in addition to subgroups of Australian/Western European-born (n = 246) and Asian-born (n = 97) women. RESULTS: Morning nonfasting TG positively correlated with the OGTT glucose area under the curve (OGTT-GAUC) (r = 0.23, P < 0.0001) in all subjects. This correlation was stronger in the subset of subjects who had TG measured between 9 and 12 weeks of gestation (r = 0.35, P = 0.0001) and was particularly strong in Asian-born women who had TG measured within this period (r = 0.71, P < 0.0001). Mean TG and the 2- and 3-h OGTT values were higher in Asian-born subjects compared with Australian/Western European-born subjects (P = 0.004, P < 0.0001, and P = 0.02, respectively). TG correlated positively with BWR in all subjects (r = 0.12, P = 0.02), in Asian-born subjects (r = 0.23, P = 0.02), and in subjects with gestational diabetes mellitus (GDM) (r = 0.60, P = < 0.001). CONCLUSIONS: TG, if measured between 9 and 12 weeks of gestation, has moderate predictive value for subsequent glucose tolerance in pregnancy. TG is also predictive of BWR in GDM subjects. Further studies are warranted to investigate the role of early TG measurement in the screening and management of GDM. Metabolic heterogeneity exists between Asian-born and Australian/Western European-born women, the significance of which is still unclear and warrants further study.

Using donor sclera to create a flap in glaucoma filtering procedures.

We report a surgical technique in which donor sclera is used to create a flap in glaucoma filtering procedures. This simple technique is helpful when the sclera is too thin to safely and effectively form an adequate scleral flap. The use of donor sclera allows the procedure to continue as a guarded procedure and prevents early postoperative hypotony.

Amniotic fluid insulin values in women with gestational diabetes as a predictor of emerging diabetes mellitus.

Amniotic fluid insulin levels were estimated in 30 women with insulin-dependent diabetes, 216 with gestational diabetes and 27 with normal glucose tolerance. Results were correlated with birth-weight, incidences of fetal macrosomia and neonatal hypoglycaemia, and the risk of the mothers with gestational diabetes developing diabetes mellitus on follow-up. The women with prepregnancy diabetes had significantly higher amniotic fluid insulin values and showed a significant correlation between raised liquor insulin values (> 97th percentile) and hypoglycaemia in the infant (p = 0.039). In the gestational diabetic pregnancies there were highly significant associations between elevated liquor insulin values and macrosomia (p < 0.0045) and birth-weight (p < 0.00004), and a weak correlation with neonatal blood glucose levels (p = 0.042). Women with gestational diabetes who later developed permanent diabetes mellitus had higher mean amniotic fluid insulin levels than those whose glucose tolerance remained normal on follow-up (p < or = 0.0072) and more of them had a level greater than the 97th percentile than those whose glucose tolerance remained normal (odds ratio 6.48, 95% confidence interval 1.51-27.8, p = 0.0094). However a high amniotic fluid insulin level was of less clinical value for detection of women destined to develop diabetes (7 of 25, 28%) than was the need for insulin therapy during pregnancy (18 of 39, 46%).

Repair of a disinserted scleral flap in trabeculectomy.

We report a surgical technique for repair of a disinserted scleral flap involving the use of two 10-0 nylon sutures, which are placed through the base of the scleral flap, and through and out of the peripheral cornea. These two sutures create a water-tight flap at the repaired hinged area. The procedure may thus continue as a trabeculectomy, permitting postoperative staged argon-laser suture lysis as well.

Complementation between alleles at the ovarian tumor locus of Drosophila melanogaster.

The (ovarian tumor) otu gene resides at 23.2 on the genetic map of the X chromosome and near 7F1 on the cytological map. This germ line-expressed locus behaves as if it encodes a gene product which is required during certain steps in the transformation of oogonia into functional oocytes. On the basis of their ovarian morphologies 17 ethyl methane sulfonate (EMS)-induced mutants have been distributed among three developmental classes as follows: quiescent (eight), oncogenic (four), and differentiated (five). The otu13 and otu14 alleles interact to yield fertile females, and many other heteroallelic combinations show partial complementation. Since many mutant alleles interact beneficially, the functional product of the otu gene may be a multimer. We conclude, from an analysis of heteroallelic interactions and dosage effects, that the abnormal phenotypes observed are graded consequences of reduced levels of functional gene product and that the minimum concentration required for development increases as oogenesis proceeds.

Nonstressed antepartum cardiotocography in patients undergoing elective cesarean section--fetal outcome.

In a prospective study of 409 patients monitored with nonstressed antepartum cardiotocography and delivered by elective cesarean section, cardiotocography was requested for 170 because of clinical indications. This group had higher incidences of abnormal cardiotocography (p less than 0.001), fetal growth retardation (p less than 0.001) and neonatal deaths (p less than 0.025) than had the group without such requests, suggesting that clinicians effectively selected the high-risk pregnancy for testing of fetal well-being. Cardiotocographic evidence of critical reserve was found in 17 of 170 patients (10%) tested for a clinical indication and in none of the 239 patients in the control group. Patients with abnormal cardiotocography results had significantly higher incidences of cord arterial blood pH less than 7.26 (p less than 0.05) and Apgar scores of less than 6 at 1 minute (p less than 0.001), showing that an abnormal cardiotocogram is indicative of a fetus at risk of having hypoxia.

Cytophotometric evidence for the transformation of oocytes into nurse cells in Drosophila melanogaster.

A small proportion of ovarian chambers from females homozygous for the otu7 (for ovarian tumor) mutation contain an "oocyte" that in its nuclear morphology resembles a nurse cell. Such transformed oocytes also appear in colchicine-poisoned wild type ovaries. Cytophotometric estimates demonstrate that these oocytes have undergone 3-4 additional DNA replications, but that they lag behind the adjacent nurse cells by an average of 1.3 replication cycles. It follows that, under certain circumstances, the definitive oocyte can switch to the nurse cell developmental pathway and therefore that a mechanism normally exists for preventing the further replication of its DNA. In the case of otu7, oocytes sometimes restart their endocyclic DNA replications and produce paired, polytene, homologous chromosomes.

Giant polytene chromosomes from the ovaries of a Drosophila mutant.

The chromosomes of the ovarian nurse cells of Drosophila melanogaster fall apart during their cycles of endoreduplication. However, chromosomal synapsis occurs in the pseudonurse cells produced in certain mutant females. The resulting polytene chromosomes undergo developmental changes that are strikingly different from those recorded for the giant chromosomes of the larval salivary gland cells.