Impaired microvascular reactivity in gestational diabetes is associated with altered glycemic parameters.

OBJECTIVES: To assess microvascular reactivity and glycemic parameters in GDM compared to age and GA matched controls. METHODS: This study involved 21 GDM patients and 31 controls. Microvascular reactivity was assessed using LDF and PORH. Microvascular parameters; PORHmax , PORHpeak , and time to peak perfusion (Tp) were recorded after the release of 3 minutes' upper arm occlusion. HOMA-IR was performed to evaluate insulin resistance. RESULTS: Average age and GA for subjects were 32.9 years and 29.2 weeks. Mean FBG and a 2-hour postprandial for GDM and controls were 4.87 ± 0.71 vs 3.99 ± 0.59 mmol/L; P < 0.001 and 9.50 ± 1.8 vs 5.67 ± 1.0 mmol/L; P < 0.001. Fasting insulin (13.88 ± 18.9 vs 8.37 ± 11.0 µLU/mL; P = 0.031) and HOMA-IR (3.14 ± 4.6 vs 1.52 ± 2.2; P = 0.004) were higher in GDM. Tp was prolonged in GDM (16.27 ± 4.3 vs 13.86 ± 2.1 seconds; P = 0.011). Positive correlations were seen between Tp and FBG and 2-hour postprandial levels. CONCLUSION: Tp was prolonged in GDM compared to age-matched controls, indicating impaired microvascular reactivity.

Abnormal microvascular reactivity with hypercholesterolaemia in pregnancy.

BACKGROUND: Post-occlusive skin reactive hyperaemia (PORH) is a model used to assess microvascular reactivity. This study aims to compare PORH response among pregnant hypercholesterolaemic patients with age and gestational age-matched controls. METHODS: This cross sectional study involved 17 hypercholesterolaemic, pregnant women and 20 pregnant controls entering their early third trimester. Laser Doppler fluximetry (LDF) was used to measure skin perfusion. The process of PORH was performed by occluding the upper arm with an occlusion cuff at 200 mmHg for 3 minutes. Skin perfusion was recorded before, during, and after occlusion release. Baseline perfusion, time to achieve peak perfusion (Tp), peak perfusion after occlusion release (PORH(peak)), and maximum change in perfusion due to occlusion (PORH(max)) were recorded. RESULTS: Serum total cholesterol (TC) was significantly different (P < 0.001) between the 2 groups: 7.25 (SEM 0.18) mmol/L for hypercholesterolaemic women and 5.54 (SEM 0.15) mmol/L for the control group. There were no significant differences in their baseline, PORH(peak), and PORH(max). However, Tp in the hypercholesterolaemic group was significantly increased (P = 0.024) compared with the controls at 14.9 (SEM 0.6) seconds and 13.1 (SEM 0.5) seconds, respectively. CONCLUSION: Pregnant hypercholesterolaemic patients showed an abnormal microvascular reactivity response. Tp with ischemia was significantly increased compared with normocholesterolaemic controls.

Huge uterine fibroid in a postmenopausal woman associated with polycythaemia: a case report.

Uterine fibroid or leiomyoma is the commonest benign uterine tumour. Its occurrence in the postmenopausal age group is rare and if enlargement of the fibroid noted during this time, the diagnosis of leiomyosarcoma is provisional until proven otherwise. A case of a postmenopausal woman with a huge uterine fibroid associated with polycythaemia is presented whereby the mass was noted to increase in size within 2 years. The patient was otherwise well except for the growing uterine mass. She had venesection done to treat her polycythaemia and later underwent surgery for total abdominal hysterectomy and bilateral salpingoophoorectomy. The histopathology report confirmed leiomyoma of uterus with no evidence of sarcomatous changes. It was suggested that large uterine myoma may cause secondary polycythaemia by three postulated mechanisms, i.e. presence of hypoxia suggesting shunting within the tumour, second, the uterine fibroid was compressing the ureters resulting in inappropriate excessive production of erythropoietin by the kidneys, and third, the tumour itself may have been producing the erythropoietin.

Sexual function in menopausal women in Kelantan, Malaysia.

OBJECTIVES: The aim of the study was to document sexual function in Kelantanese postmenopausal women. METHOD: A semi-structured questionnaire in Malay language was administered to 326 women (mean age of 57.1+/-6.58 (S.D.) years) residing in Kelantan. The subjects comprised of naturally menopaused, healthy women. RESULTS: Of the total respondents, 70% (n=227) were with a spouse at the time of the study. Of these, more than two-thirds reported a decrease in sexual activity following menopause. Varying degree of dyspareunia was reported by 44% of the women. A small fraction (8.8%) reported inability of the vagina to stretch sufficiently to enable the complete penetration of an erect penis. Of the total married respondents, vaginal secretion during sexual intercourse was decreased in 52.4%, did not change in 31% but increased in 1.3% of the women following menopause. Sexual desire was reportedly decreased or absent in two-thirds of the total respondents (n=326). CONCLUSION: It appears that sexual function significantly decreases during menopause. This may be due to dyspareunia, poor lubrication, loss of sexual desire, and the spouse's health status and ageing itself. Although declining sexual function was recognised by nearly two-thirds of the women, more than half did not take any action to improve their sexual function. Of those who did, they used hormonal therapy, traditional, alternative medicine or practiced healthy lifestyle or a varied combination of above self-help actions.