Maltase-glucoamylase modulates gluconeogenesis and sucrase-isomaltase dominates starch digestion glucogenesis.

OBJECTIVES: Six enzyme activities are needed to digest starch to absorbable free glucose; 2 luminal α-amylases (AMY) and 4 mucosal maltase-glucoamylase (MGAM) and sucrase-isomaltase (SI) subunit activities are involved in the digestion. The AMY activities break down starch to soluble oligomeric dextrins; mucosal MGAM and SI can either directly digest starch to glucose or convert the post-α-amylolytic dextrins to glucose. We hypothesized that MGAM, with higher maltase than SI, drives digestion on ad limitum intakes and SI, with lower activity but more abundant amount, constrains ad libitum starch digestion. METHODS: Mgam null and wild-type (WT) mice were fed with starch diets ad libitum and ad limitum. Fractional glucogenesis (fGG) derived from starch was measured and fractional gluconeogenesis and glycogenolysis were calculated. Carbohydrates in small intestine were determined. RESULTS: After ad libitum meals, null and WT had similar increases of blood glucose concentration. At low intakes, null mice had less (f)GG (P = 0.02) than WT mice, demonstrating the role of Mgam activity in ad limitum feeding; null mice did not reduce fGG responses to ad libitum intakes demonstrating the dominant role of SI activity during full feeding. Although fGG was rising after feeding, fractional gluconeogenesis fell, especially for null mice. CONCLUSIONS: The fGNG (endogenous glucogenesis) in null mice complemented the fGG (exogenous glucogenesis) to conserve prandial blood glucose concentrations. The hypotheses that Mgam contributes a high-efficiency activity on ad limitum intakes and SI dominates on ad libitum starch digestion were confirmed.

[Perinatal outcomes of patients with gestational diabetes diagnosed by three different methods]. / Resultados perinatales de pacientes con diabetes gestacional diagnosticada con tres métodos diferentes.

BACKGROUND: Gestational diabetes is one of the most common diseases during pregnancy. Despite this situation, there is still no consensus on methods for screening and diagnosis of this disease. OBJECTIVE: To assess perinatal outcomes of patients with gestational diabetes diagnosed using three different methods. PATIENTS AND METHODS: Clinical observational, longitudinal, randomized trial at the National Institute of Perinatology Isidro Espinosa de los Reyes. We included all patients admitted to the Institute for a period of three months without pregestational diabetes. Patients were screened for gestational diabetes with an oral load of 50 g of glucose. Patients with a positive screen were randomized by a computer program that randomly chose patients and made a curve according to the criteria of the American Diabetes Association 75 g or 100 g and another group with 75 g according to the criteria of the World Health Organization. Patients with gestational diabetes were followed throughout pregnancy until its reclassification in the puerperium. RESULTS: Screening was performed in 863 patients and 87 were diagnosed with gestational diabetes. Perinatal outcomes were similar in patients with gestational diabetes diagnosed using different methods, but there was a higher frequency of pregnancy-induced hypertension in patients diagnosed with the curves of the American Diabetes Association 75 and 100 g compared with the curve of the World Health Organization. CONCLUSIONS: The American Diabetes Association diagnostic method as the World Health Organization are acceptable forms to diagnose gestational diabetes.

Bilateral ovarian krukenberg tumor in a full-term pregnancy.

Objective. Krukenberg tumors in pregnancy are very rare and their management can present a dilemma for the obstetrician gynecologist. Case Report. We present the case of a G3P2002 who presented to us and the 38 weeks gestation with bilateral massive Krukenberg tumors. Despite at surgery and chemotherapy she died 3 months postpartum. Conclusion. Early detection followed by surgery and chemotherapy could possibly result in a favorable outcome with such patients.

Utility of the pulsatility index of the uterine arteries and human chorionic gonadotropin in a series of cases of placenta accreta.

The conservative management of retained placenta accreta has been proposed as an alternative option in selected cases. Three patients under conservative management of placenta accreta were followed using the pulsatility index of the uterine arteries and the ß fraction of human chorionic gonadotropin to determine the degree of vascularity between the uterus and the placenta. In this series of cases of conservative management of placenta accreta, the pulsatility index of the uterine arteries showed a better correlation with the uteroplacental circulation than serum ß fraction of human chorionic gonadotropin.

[Disputes and history of fetal heart monitoring]. / Controversias e historia del monitoreo cardiaco fetal.

The concept of fetal heart monitoring to determine the fetal wellbeing state has been employed for almost 300 years, but in the last 50 years it has observed drastic changes due to the incorporation of the electronic devices that has started controversy since the moment of its description and point of start. The purpose of this article is to mention the key points and controversial moments in the history of the cardiotocography