Lipid profile and glycosylated hemoglobin status of gestational diabetic patients and healthy pregnant women

AIM

Lipid profile and glycosylated hemoglobin level changes in gestational diabetes. The extent to which this alteration takes place is still not clearly documented.

MATERIALS AND METHODS

To add a clear answer to this question, lipid profile parameters, and glycosylated hemoglobin status were determined in patients with gestational diabetes mellitus and compared to healthy pregnant women (controls).

RESULTS

Fasting plasma glucose levels, plasma glucose levels 1 hour, and plasma glucose levels 2 hours after 75 gm oral glucose administration (oral glucose tolerance test) were significantly higher in patients with gestational diabetes as compared to controls. Glycosylated hemoglobin was significantly higher in gestational diabetes than in controls. It was observed that there was a significant increase in serum cholesterol and serum triglyceride level in cases with gestational diabetes when compared to healthy pregnant women.

CONCLUSION

The results of our study suggest that abnormal glucose levels, glycosylated hemoglobin, serum cholesterol, and serum triglycerides play an important role in pathophysiology of gestational diabetes, and therefore, extensive studies are required. Early diagnosis of gestational diabetes will decrease adverse neonatal and maternal outcomes.

Assessments of population exposure to environmental pollutants using air quality measurements during Commonwealth Games-2010

During the "Commonwealth Games" 2010 (CWG-2010) in Delhi, the Indian government has implemented an ambitious project "System of Air quality Forecasting And Research (SAFAR)" for monitoring and forecasting air-quality scenario. Using high-precision spatio-temporal measurements of criteria pollutants from the SAFAR network, the number of cases are estimated for total, cardiovascular and respiratory mortalities and hospital admissions. In a thinly populated airport area, the excess number of cases for total mortality show ∼10 for PM2.5 and 25 for PM10, whereas, ∼110 for PM2.5 and ∼300 for PM10 in most populous Delhi University (DU) area. Cardiovascular mortality in airport area show ∼5 and <10 for PM2.5 and PM10, respectively, but, in DU area show ∼55 for PM2.5 and ∼140 for PM10. In DU locality, respiratory mortality shows ∼7 and ∼20 for PM2.5 and PM10 and, hospital admissions show ∼11 and ∼30 for PM2.5 and PM10, respectively. In airport area, excess cases of respiratory mortality and hospital admission tends to one for exposure to PM2.5 or PM10 levels indicating effective exposure is the key factor for health hazards. As public health gains, low air pollution levels were observed before the CWG due to effective washout by monsoonal rain and during CWG under policy-induced air quality measures could increase the life expectancy as against to post-CWG period. These results are important for the megacities in developing world as the SAFAR project is internationally recognized by the Global Urban Research Meteorology and Environment of the World Meteorological Organization.

Evaluating population exposure to environmental pollutants during Deepavali fireworks displays using air quality measurements of the SAFAR network

Indian government has implemented a state of art project "System of Air quality Forecasting And Research (SAFAR)" for assessing the air-quality scenario in Delhi during "Commonwealth Games-2010" which is operational in Delhi. Using a high resolution data of the SAFAR network, we estimate the excess numbers of cases for total, cardiovascular and respiratory mortalities and hospital admissions with the air-quality response to population attributable-risks due to emissions from fireworks displays (Deepavali-2010). The ratios of numbers of excess cases for fireworks displays (Deepavali) to those of non-Deepavali period (CWG-2010) vary from 1.75 to 3.5 for PM(2.5) and from 3 to 8 for PM(10) at monitoring stations in study area except in an airport. These ratios approach to 1 for PM(2.5) or PM(10) in airport area which can be attributed to restrictions on fireworks displays and eventually a very low population exposure. The numbers of excess cases for PM(2.5) and PM(10) during extreme emissions by fireworks displays are about 2-fold to those of non-Deepavali period. The SAFAR is recognized by the Global Urban Research Meteorology and Environment of the World Meteorological Organization and thus results would likely to provide episodic limits for developing countries in common line with the air-quality standards set for developed world for pollutant levels due to emissions from the fireworks displays when population of country celebrates traditional festivals collectively.

Minimized perfusion circuits: an alternative in the surgical treatment of Jehovah’s Witnesses

Objectives:

Jehovah’s Witnesses present a challenge to cardiac surgeons, as quality of care is not only defined by mortality and morbidity, but also by the avoidance of blood transfusions. Over the last years, minimized perfusion circuits (MPC) have contributed substantially to the achievement of this goal in our clinic. Presented is a retrospective analysis of our experience.

Methods:

Twenty-nine Jehovah’s Witnesses, aged 69 ± 10 years, have undergone cardiac surgery with a MPC in our institution since 2005. The ROCsafe (Reservoir Optional Circuit) MPC was used in most of these patients (n=27) as it offers the unique possibility of a speedy integration of a reservoir in the event of a major air leak, thereby, negligating any safety concerns.

Results:

There was no in-hospital or 30-day postoperative mortality. Mean ICU stay was 1.6 ± 2 days with a mean intubation time of 11.3 ± 9.1 hrs. Postoperative complications included one myocardial infarction with accompanying low cardiac output, one stroke, one transient delirium, one idiopathic thrombocytopenia and three re-operations (one sternal infection, one postoperative bleeding and one delayed tamponade). The mean postoperative hospital stay was 9.9 ± 2.3 days. Mean decrease in hemoglobin was 2.1 ± 1.3 g/dl during cardiopulmonary bypass and 3.4 ±1.4 g/dl at discharge. The lowest postoperative hemoglobin level was 9.3 ±1.8 (Range 6-12.9).

Conclusions:

These encouraging results emphasize the role MPCs can play in optimizing the quality of patient care. We hope that this report can serve as a stimulus for similar experiences.

Academic environment in a newly established dental school with an enquiry-based curriculum: perceptions of students from the inaugural cohorts

INTRODUCTION

Established in 2007, Peninsula Dental School offers a highly innovative, enquiry-based, student-led, patient-centred curriculum. It is one of the first dental schools in UK to be based exclusively in a primary care setting. This study was carried out to evaluate the academic environment at Peninsula Dental School and to identify differences between expectations of new entrants and perceptions of senior cohorts.

METHODS

This was a cross-sectional survey utilising an online questionnaire based on Dundee Ready Educational Environment Measure (DREEM). The subjects were 234 dental students from all years in this enquiry-based Bachelor of Dental Surgery programme.

RESULTS

The response rate to the questionnaire was 56.42% with an equal gender distribution of the participants. The overall mean DREEM score of the four cohorts was 143.58 (SD ± 20.84), and the mean score for individual items was 2.87 (SD ± 0.41). The reliability of the DREEM data as a whole was strong (α = 0.93). The difference in questionnaire means for the new entrants and the senior cohorts was not significant (P > 0.05). The ANOVA results showed that there were no significant effects of age, gender or ethnicity on the mean DREEM scores. The MANOVA results showed a significant effect of ethnicity with regard to perceptions of teachers and atmosphere.

CONCLUSIONS

An enquiry-based, student-centred curriculum at the Peninsula Dental School provides a positive academic environment for the students.

Mössbauer investigations of crystalline and quasicrystalline Al3(Mn, Fe) compounds

(57)Fe Mössbauer and magnetic measurements are reported on Taylor phase compounds T-Al(3)(Mn,Fe), which can be seen as complex metallic alloys. The orthorhombic unit cell contains 156 atoms. These investigations are further extended to Al(71)Mn(19)Fe(10) crystallizing as a decagonal quasicrystal. Common to both structures are layers, which are oriented perpendicular to the b axis in the crystalline or to the periodic axis in the quasicrystalline compound, allowing the formation of characteristic building blocks. At low temperatures for all samples spin glass behavior is observed with freezing temperatures T(f) increasing with Fe content. Above T(f) the (57)Fe Mössbauer spectra were analyzed by a superposition of two subspectra with intensity ratio around 75:25, which can be allocated to Fe substituted on Mn sites surrounded either by Al and Mn or solely by Al with Mn only at the edge of the nearest neighbor shell. For both subspectra quadrupole splitting and center shift do not change significantly with Fe content and with structure. Below T(f) broad hyperfine field distributions with non-vanishing contributions at zero hyperfine field are present. Magnetic and electrostatic hyperfine interactions are governed by length scales which are determined by the very similar interatomic configurations forming the T-Al(3)Mn phase as well as the decagonal compound. The presence of long range atomic order is of less importance.

Comparative analysis of Shwachman-Diamond syndrome to other inherited bone marrow failure syndromes and genotype-phenotype correlation

Our knowledge of the phenotypes of inherited bone marrow failure syndromes (IBMFSs) derives from case reports or case series in which only one IBMFS was studied. However, the substantial phenotypic overlap necessitates comparative analysis between the IBMFSs. Shwachman-Diamond syndrome (SDS) is an IBMFS that the appreciation of what comprises its clinical phenotype is still evolving. In this analysis we used data on 125 patients from the Canadian Inherited Marrow Failure Study (CIMFS), which is a prospective multicenter population-based study. Thirty-four cases of SDS patients were analyzed and compared to other patients with the four most common IBMFSs on the CIMFS: Diamond Blackfan anemia, Fanconi anemia (FA), Kostmann/severe congenital neutropenia and dyskeratosis congenita (DC). The diagnosis of SDS, FA and DC was often delayed relative to symptoms onset; indicating a major need for improving tools to establish a rapid diagnosis. We identified multiple phenotypic differences between SDS and other IBMFSs, including several novel differences. SBDS biallelic mutations were less frequent than in previous reports (81%). Importantly, compared to patients with biallelic mutations, patients with wild type SBDS had more severe hematological disease but milder pancreatic disease. In conclusion, comprehensive study of the IBMFSs can provide useful comparative data between the disorders. SBDS-negative SDS patients may have more severe hematological failure and milder pancreatic disease.

Genetic analysis of inherited bone marrow failure syndromes from one prospective, comprehensive and population-based cohort and identification of novel mutations

INTRODUCTION

Inherited bone marrow failure syndromes (IBMFSs) often have substantial phenotypic overlap, thus genotyping is often critical for establishing a diagnosis.

OBJECTIVES AND METHODS

To determine the genetic characteristics and mutation profiles of IBMFSs, a comprehensive population-based study that prospectively enrols all typical and atypical cases without bias is required. The Canadian Inherited Marrow Failure Study is such a study, and was used to extract clinical and genetic information for patients enrolled up to May 2010.

RESULTS

Among the 259 primary patients with IBMFS enrolled in the study, the most prevalent categories were Diamond-Blackfan anaemia (44 patients), Fanconi anaemia (39) and Shwachman-Diamond syndrome (35). The estimated incidence of the primary IBMFSs was 64.5 per 10(6) births, with Fanconi anaemia having the highest incidence (11.4 cases per 10(6) births). A large number of patients (70) had haematological and non-haematological features that did not fulfil the diagnostic criteria of any specific IBMFS category. Disease-causing mutations were identified in 53.5% of the 142 patients tested, and in 16 different genes. Ten novel mutations in SBDS, RPL5, FANCA, FANCG, MPL and G6PT were identified. The most common mutations were nonsense (31 alleles) and splice site (28). Genetic heterogeneity of most IBMFSs was evident; however, the most commonly mutated gene was SBDS, followed by FANCA and RPS19.

CONCLUSION

From this the largest published comprehensive cohort of IBMFSs, it can be concluded that recent advances have led to successful genotyping of about half of the patients. Establishing a genetic diagnosis is still challenging and there is a critical need to develop novel diagnostic tools.