Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes

Optimal glycaemic control before and during pregnancy improves both maternal and fetal outcomes. This article summarizes the recently published guidelines on the management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units produced by the Joint British Diabetes Societies for Inpatient Care and available in full at www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Hyperglycaemia following steroid administration can be managed by variable rate intravenous insulin infusion (VRIII) or continuous subcutaneous insulin infusion (CSII) in women who are willing and able to safely self-manage insulin dose adjustment. All women with diabetes should have capillary blood glucose (CBG) measured hourly once they are in established labour. Those who are found to be higher than 7 mmol/l on two consecutive occasions should be started on VRIII. If general anaesthesia is used, CBG should be monitored every 30 min in the theatre. Both the VRIII and CSII rate should be reduced by at least 50% once the placenta is delivered. The insulin dose needed after delivery in insulin-treated Type 2 and Type 1 diabetes is usually 25% less than the doses needed at the end of first trimester. Additional snacks may be needed after delivery especially if breastfeeding. Stop all anti-diabetes medications after delivery in gestational diabetes. Continue to monitor CBG before and 1 h after meals for up to 24 h after delivery to pick up any pre-existing diabetes or new-onset diabetes in pregnancy. Women with Type 2 diabetes on oral treatment can continue to take metformin after birth.

Development of a Novel Wearable Ring-Shaped Biosensor

We report on the preliminary results obtained out of a wearable module designed to be encompassed within a ring-shaped system aimed at providing healthcare services. The module is composed of two sensors for the measuring of Galvanic Skin Response (GSR) and Heart Rate Variability (HRV). A first device validation was carried out by involving four subjects who were asked to perform tasks providing different stress-related statuses. A comparison of physiological parameters measured by the module with those measured by a commercial HRV-GSR sensor chosen as gold standard was made. Two out of the three HRV parameters and all of the GSR parameters measured with the module resulted consistent (mostly differing less than 10%) with the same parameters measured by the gold standard. The work reported in this paper set a milestone for the realization of a system exploiting sensor fusion to provide active ageing, stress detection, activity recognition and e-health services has been achieved.

Development and testing of a new cognitive technological tool for episodic memory: A feasibility study

Cognitive Rehabilitation Therapy refers to any systemic therapy specifically designed to enhance cognitive performance. Recent studies have shown that physical exercise is beneficial for cognitive activity in patients with degenerative diseases. Therefore, the objective of the present study is to provide training for cognitive functions that take advantage of the physical activity in the execution of the task. A feasibility study concerning the application of a new bioengineering technique in cognitive rehabilitation is presented and it divided into two parts. The first one aims at developing a new cognitive tool, called SmartTapestry (ST), for motor and cognitive rehabilitation. The second part aims at understanding its technical viability and its level of sensitivity in measuring the same cognitive domains covered by the standardized tests. The hypothesis of this study is that, despite the introduction of this new variable, the proposed system has the same sensitivity of the traditional tests. The results suggest a good correlation between the two approaches and that SmartTapestry can train the same cognitive functions of traditional cognitive tasks.

Feasibility study on the assessment of auditory sustained attention through walking motor parameters in mild cognitive impairments and healthy subjects

Dementia and other cognitive disorders affect more than 35 million people worldwide. Over the last years, cognitive training tools were used to improve the brain functioning, thus to slow down the cognitive decline. Recently, research studies have demonstrated that aerobic exercise could play an important restorative role toward cognitive impairments. Therefore, the aim of this work is to present an innovative sensorized approach which combines aerobic exercise and traditional cognitive tools for daily training.

Cross-Talk between Inflammation, Coagulation/Fibrinolysis and Vascular access in Hemodialysis Patients

This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels. The study was performed in 50 CKD patients undergoing regular HD, 11 with a central venous dialysis catheter (CVC) and 39 with an arteriovenous fistula (AVF), and in 25 healthy controls. Compared to controls, CKD patients presented with significantly higher levels of CRP, s-IL2R, IL-6 and D-dimers, and significantly lower levels of PAI-1. The tPA/PAI-1 ratio was significantly higher in CKD patients. We also found statistical significant correlations in CKD patients between D-dimers levels and inflammatory markers: CRP, albumin, s-IL2R and IL-6. When comparing the two groups of CKD patients, we found that those with a CVC presented statistically significant lower levels of hemoglobin concentration and albumin, and higher levels of CRP, IL-6, D-dimers and tPA. Our results showed an association between fibrinolytic/endothelial cell function and increased inflammatory markers in CKD patients. The increased levels of D-dimer, tPA and inflammatory markers in CKD patients using a CVC, led us to propose a relationship between the type of VA chosen for HD, and the risk of thrombogenesis.

Ambiguity in a masculine world: Being a BRCA1/2 mutation carrier and a man with prostate cancer

OBJECTIVE

Increased risk of prostate cancer (PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes.

METHODS

Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a framework approach. "Masculinity theory" was used to report the impact of having both a BRCA1/2 mutation and PCa.

RESULTS

Eleven of 15 eligible men were interviewed. The umbrella concept of "Ambiguity in a Masculine World" was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as "on the back burner" but "a bonus" enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical "ideal" masculine responses such as stoicism and control while creating new "masculinities" when faced with the vicissitudes of having 2 gendered conditions.

CONCLUSION

Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.

A prospective multicentre study of healthcare provider preference in rapid HIV testing kits: Determine versus INSTI

Rapid HIV testing may circumvent the practical barriers to HIV testing in several settings. User preference of the testing kits available has been relatively underexplored. We examined healthcare provider (HCP) ratings of two validated rapid testing kits in clinical practice. From 1 July to 1 December 2012 we prospectively recruited HCPs (clinic nurses) from three outpatient clinics linked to Lausanne University Hospital, Lausanne, Switzerland. The HCPs had experience in taking blood samples but varying experience in rapid HIV testing. Participating HCPs performed rapid HIV testing using Determine™ Combo (DETE) or INSTI™ (INSTI), according to a predefined randomization sequence, and rated practical aspects of each test using a Likert scale. Seventeen HCPs of 23 approached (74%) were eligible and agreed to participate, performing a total of 336 HIV tests. Globally, the testing procedure was rated as easy or very easy by 97% (DETE) to 99% (INSTI) of tests performed. Among experienced HCPs, DETE was rated easier than INSTI for kit storage (p < 0.001) and blood collection ( P = 0.012) while INSTI was rated easier than DETE for blood application ( P = 0.001) and test interpretation ( P = 0.005). Among less experienced HCPs, both tests performed equally with the exception of test interpretation ( P < 0.001) and overall ease of use ( P = 0.05) in favour of INSTI. Of all HCPs, 94% stated they would recommend INSTI over DETE based on the time to result, ease of test interpretation and overall ease of use. Rapid HIV testing was considered easy to perform, even by inexperienced nursing staff. Whilst both tests were considered easy to use, the HCPs in this study preferred INSTI to DETE overall, due to rapid time to result, ease of test interpretation and general ease of use.

Modificación simplificada de la técnica de Zancolli para la corrección de la garra cubital

Objetivos: Estudiar los resultados obtenidos con la técnica de Chevallard, versión simplificada de la técnica de Zancolli, para corregir la deformidad de la mano en garra secundaria a una parálisis cubital.

Material y método: Estudio retrospectivo (enero 2006-diciembre 2013) de 16 pacientes (16 manos) que fueron intervenidos quirúrgicamente por deformidad en garra de la mano secundaria a parálisis del nervio cubital. Siguiendo los criterios de Brand, los pacientes fueron evaluados a las 6 semanas, 3 meses, 6 meses y al año.

Resultados: Los resultados al año de la intervención fueron: excelentes en el 18,75% (3 pacientes); buenos en el 75% (12 pacientes) y malos en el 6,25% (un paciente). Este último requirió una nueva intervención para solucionar la recidiva de la garra.

Conclusión: La técnica simplificada de Zancolli, o técnica de Chevallard, permite corregir fácilmente la deformidad de la mano en garra secundaria a una parálisis cubital, no hipotecando una ulterior intervención en el caso de recidiva.

VALIDATION OF SATELLITE PRECIPITATION (TRMM 3B43) IN ECUADORIAN COASTAL PLAINS, ANDEAN HIGHLANDS AND AMAZONIAN RAINFOREST

Precipitation monitoring is of utmost importance for water resource management. However, in regions of complex terrain such as Ecuador, the high spatio-temporal precipitation variability and the scarcity of rain gauges, make difficult to obtain accurate estimations of precipitation. Remotely sensed estimated precipitation, such as the Multi-satellite Precipitation Analysis TRMM, can cope with this problem after a validation process, which must be representative in space and time. In this work we validate monthly estimates from TRMM 3B43 satellite precipitation (0.25° x 0.25° resolution), by using ground data from 14 rain gauges in Ecuador. The stations are located in the 3 most differentiated regions of the country: the Pacific coastal plains, the Andean highlands, and the Amazon rainforest. Time series, between 1998 – 2010, of imagery and rain gauges were compared using statistical error metrics such as bias, root mean square error, and Pearson correlation; and with detection indexes such as probability of detection, equitable threat score, false alarm rate and frequency bias index. The results showed that precipitation seasonality is well represented and TRMM 3B43 acceptably estimates the monthly precipitation in the three regions of the country. According to both, statistical error metrics and detection indexes, the coastal and Amazon regions are better estimated quantitatively than the Andean highlands. Additionally, it was found that there are better estimations for light precipitation rates. The present validation of TRMM 3B43 provides important results to support further studies on calibration and bias correction of precipitation in ungagged watershed basins.

Ethanol production from olive stone hydrolysates by xylose fermenting microorganisms

Olive stones are the main solid byproducts obtained from olive oil production and from table olives production. As a lignocellulosic material, the use of olive stones for ethanol and other chemicals production has been proposed, particularly under the biorefinery concept. As part of such a process, this work deals with the fractionation of the lignocellulosic material by dilute acid autoclave pretreatment at 2% sulfuric acid, 130°C, 60 min and 1:1 liquid to solid ratio. Moreover, the work addresses the fermentation of the liquors obtained after pretreatment. The released sugars are composed mainly by xylose and other hemicellulosic sugars. The fermentation performance of three xylose-fermenting microorganisms, e.g. two Escherichia coli species and Scheffersomyces stipitis, are compared. The study analyzes in a first step the microorganism behavior on synthetic liquors, with a similar composition to that of the real liquors. Finally, and taken into account the results from the previous steps, the real liquor obtained from olive stones pretreatment is fermented. Results show that E. coli MM160 is the best ethanol producer out of the three microorganisms studied. Globally, the pretreatment produced a liquor containing 140 g hemicellulosic sugars/l and requiring firstly dilution by 50% and a detoxification step by overliming. The fermentation of this liquor by E. coli MM160 results in a 25 g ethanol/l solution equivalent to 50 g ethanol/kg olive stone, in spite of 20 g acetic acid/l also present. These results confirm both olive stones and E. coli MM160 as promising feedstock and microorganism for ethanol production.

The electrocardiogram of anaesthetized southern sea lion (Otaria flavescens) females

OBJECTIVES

The goal of this study was to characterize for the first time the electrocardiogram (ECG) of the southern sea lion (SSL) Otaria flavescens.

ANIMALS, MATERIALS AND METHODS

Thirteen wild SSL females were captured at Isla de Lobos (Uruguay) and anaesthetized with isoflurane. Electrocardiographic recording was performed on anaesthetized animals at ventral recumbence following standardized procedures.

RESULTS

The ECG recordings showed normal sinus rhythm. Amplitude and duration of P and T waves, QRS complex, PR interval, QT interval and ST segment (STS) were determined for all animals in all leads. QT corrected was determined in lead II. P wave polarity was consistent among animals (positive in LI, LII, LIII and AVF leads and negative in AVL and AVR leads for all animals), but T wave polarity did not present any constant pattern among animals, being either positive, negative or biphasic in different leads and different animals. The PR interval (0.15 ± 0.2 s) was similar to the allometric prediction for most of mammalian species including humans. The STS were normal in 10 of the SSL but showed STS depression in three of the animals. Almost all animals had a negative electrical axis (-30° to -120°), with one exception that showed a positive electrical axis (120°). Mean eupnoeic heart rate was 104.61 ± 10.06 (range = 88-120) beats per minute.

CONCLUSIONS

This study was the first ECG description for this species, and provides valuable information for cardiac monitoring during anaesthesia.