Maternal glucose tolerance status influences the risk of macrosomia in male but not in female fetuses

OBJECTIVE

To elucidate whether the risk of macrosomia, large for gestational age (LGA) and small for gestational age (SGA) is influenced by maternal body mass index and glucose tolerance differently in male and female fetuses.

METHODS

A population study was conducted in 16 general hospitals from the Spanish National Health Service that included 9270 consecutive women with singleton pregnancies and without a former diagnosis of diabetes mellitus who delivered 4793 male and 4477 female newborns. Logistic regression analyses were performed to predict the effect of body mass index (BMI) category and glucose tolerance on macrosomia, large for gestational age newborns (LGA) and small for gestational age newborns (SGA) Separate analyses according to foetal sex were carried out for each outcome. The results were adjusted for maternal age, gestational age and pregnancy-induced hypertension.

RESULTS

There were significant differences between males and females in the percentage of infants who had macrosomia, LGA or SGA. Maternal BMI category was positively associated with the risk of macrosomia and LGA in both male and female newborns. In addition, there was a negative association between maternal BMI and SGA that only reached significance in males. In contrast, gestational diabetes was only a predictor of macrosomia exclusively in male fetuses (OR 1.67, 95% CI 1.12 to 2.49)

CONCLUSIONS

There is sexual dimorphism in the risk of abnormal birth weight attributed to maternal glucose tolerance status. A closer surveillance of foetal growth might be warranted in pregnant women with abnormal glucose tolerance carrying a male fetus.

[Diagnostic errors and temporal stability in bipolar disorder]

INTRODUCTION

The diagnosis of bipolar disorder is frequently modified during the course of the illness.

MATERIAL AND METHODS

Diagnostic changes and associated errors are described for 1,153 patients diagnosed as bipolar disorder, aged over 18 years and with at least ten follow-up visits. Data was extracted from a clinical registry of out-patient care specialized in Psychiatry and psychiatric hospitalizations of 25,152 patients representative of an urban area of 240,000 inhabitants. Limit for diagnostic stability was established as the maintenance of the bipolar disorder diagnosis in at least 75% of the visits.

RESULTS

A total of 158 (46.1 %) out of 342 patients diagnosed as having a bipolar disorders in the first visit kept this diagnostic constant in subsequent evaluations. Infradiagnostic initial error was committed with 108 stable patients who were not diagnosed in the first visit. 184 patients diagnosed in the first visit with bipolar disorder had less than 75 % concordant diagnosis along the follow-up and could be considered as initial overdiagnosis. Two hundred and nine out of the 443 patients who were diagnosed as bipolar disorder in their last visit did not keep stability criteria in their follow-up and could be considered therefore as final overdiagnosis. Thirty two stable patients not diagnosed in their last visit could be considered as infradiagnosis final error. Diagnosis from schizophrenia spectrum (F2) appears in one of every four psychiatric visits of the patients included in this study. Overlap was seen in three other categories: anxiety disorders (F4), personality disorders (F6) and substance abuse disorders.

CONCLUSION

Initial course of bipolar disorder causes difficulties in the diagnosis.

[Endoscopic treatment of recurrent tracheoesophageal fistula]

Repermeabilization of the tracheoesophageal fistula (RTE) is one of the major complications of the esophageal atresia with tracheal fistula. We present the long term results of our technique based on broncoscopic treatment with fibrin glue and diathermia.

MATERIAL AND METHODS

A retrospective study of 10 children with RTE treated from 1993 to 2006, their ages ranging from 14 days-old to 4 years-old; there were 4 patients from other hospitals. One of the patients involved had a superior congenital fistula that had not been noticed during open surgery. Broncoscopic procedure was performed using rigid instrumentation. The fistula was sealed with fibrin glue; the last seven patients in the series received previous diathermia with an uretheral catheter. Clinical and radiological follow up took place in all children. Endoscopic evaluation was performed in 6 of them. Follow-up time vary from 1 to 13 years and the number of sessions was limited to 3 per patient.

RESULTS

Closure of the fistula was confirmed in 9 cases (90%) who required a whole number of 15 sessions (Mean: 1.5). The group who received diathermia needed 9 sessions (Mean: 1.2). There were no major complications.

DISCUSSION

Surgery reparation of RTE is often related to serious complications. Therefore, many groups have tried to develop several broncoscopic techniques using different materials. Scientific reviews have not pointed out a definitive option since they involve isolated patients with no long term evolution. Taking this report into account we believe that the application of diathermia and fibrin glue ought to be considered the first choice treatment for the RTE.

Pharmacological compliance and acceptability of lansoprazole orally disintegrating tablets in primary care

OBJECTIVE

To evaluate the pharmacological compliance of patients treated with lansoprazole orally disintegrating tablets (LODT) in Primary Care (PC) and their acceptability of this formulation.

RESEARCH DESIGN AND METHODS

A multicenter, observational, cross-sectional study involving 433 PC physicians that included 433 patients aged at least 18 years, either diagnosed with gastroesophageal reflux disease (GERD) or taking LODT to prevent NSAID-induced gastric ulcers. Compliance with LODT treatment was assessed with the Haynes-Sackett self-reported test. Acceptability was based on global patient assessment, rating the drug's organoleptic characteristics and properties recorded with a self-administered 15-item ad hoc questionnaire with 2 and 5-point Likert-type scales.

RESULTS

423 patients (mean age 50.6 years, SD = 13.4) were evaluable for the main endpoint. Of these, 57.16% were men and 53.5% were treated with 30 mg doses of LODT for an average of 37.8 days (SD = 35.5). Compliance was achieved by 92.4% of the patients, mean percentage of compliance was 93.3. Demographical and clinical variables had no effect on compliance. Treatment with LODT was assessed as 'acceptable' or 'highly acceptable' by 91.7% of the sample. One adverse reaction, not serious, was reported by one patient (0.2%).

CONCLUSIONS

In this observational study, compliance with lansoprazole orally disintegrating tablets was very high. Patients reported that this formulation improved their compliance. LODT was clearly preferred to previous medication and the drug was well tolerated.

Possibilistic approach for biclustering microarray data

Biclustering has emerged as an important method for analyzing gene expression data from microarray technology. It allows to identify groups of genes which behave similarly under a subset of conditions. As a gene may play more than one biological role in conjunction with distinct groups of genes, non-exclusive biclustering algorithms are required. In this paper we propose a new method to obtain potentially-overlapping biclusters, the Possibilistic Spectral Biclustering algorithm (PSB), based on Fuzzy Technology and Spectral Clustering. We tested our method on S. cerevisiae cell cycle expression data and on a human cancer dataset, validating the obtained biclusters using known classifications of conditions and GO Term Finder for functional annotations of genes. Results are available at http://decsai.ugr.es/ approximately ccano/psb.

Epidemiology and outcome of primary community-acquired bacteremia in adult patients

We conducted this study to determine the associated factors and outcomes of community-acquired primary bacteremia (PB), to describe the most frequently isolated microorganisms, the antibiotic resistance pattern, and to guide the most appropriate antibiotic treatment. A total of 1,640 community-acquired bacteremia cases in nonneutropenic adults were consecutively enrolled from January 2003 to May 2006 and prospectively followed up. Nonconditional logistic regression methods were used with PB and death as dependent variables. Secondary bacteremia (SB) was present in 1,440 patients, and 200 (12%) cases were PB. The independent factors associated with PB were male sex (OR 1.69, 95%CI 1.27-2.25, P = 0.001) and an ultimately or rapidly fatal prognosis for an underlying disease (OR 2.48, 95%CI 1.84-3.34, P = 0.001). The most frequently isolated microorganisms in PB were E. coli and other enterobacteria (26 and 22%, respectively) and S. aureus (15%). There were 28 and 37% ciprofloxacin-resistant E. coli strains in SB and PB, respectively (P = 0.2). Mortality was significantly higher in PB cases (13 vs 8%, P = 0.04). The independent factors associated with mortality in PB were ultimately or rapidly fatal prognosis of underlying disease (OR 2.1, 95%CI 1.41-3.13, P = 0.001), lack of fever at the moment of bacteremia (OR 2.38, 95%CI 1.18-4.76, P = 0.02) and incorrect empirical antibiotic therapy (OR 2.01, 95%CI 1.22-3.33, P = 0.006). The initial empiric antibiotic treatment was more frequently incorrect in PB than in SB, and this was a predictive factor for mortality in PB. The resistance pattern of E. coli, other enterobacteria and S. aureus in every setting should guide the most appropriate empirical treatment for PB.

La artrodesis de las cuatro esquinas con placa circular

Objetivo: La artrodesis de las cuatro esquinas del carpo fue descrita inicialmente para el tratamiento del colapso avanzado del carpo e incluye la extirpación del escafoides y la fusión de los huesos semilunar, piramidal, hueso grande y ganchoso. Se ha utilizado la fijación con placas circulares con el objetivo de conseguir una fijación estable inmediata. El propósito de este estudio es evaluar la efectividad de estas placas en esta artrodesis mediocarpiana y valorar sus indicaciones así como ciertas consideraciones técnicas.

Material y métodos: En este estudio se ha incluido una serie de 20 pacientes intervenidos para practicar una artrodesis de las cuatro esquinas con placa SpiderÒ que presentaban un estadio II ó III de proceso degenerativo avanzado del carpo. También se ha utilizado esta técnica para otras indicaciones como las lesiones osteocondrales de la cabeza del hueso grande, necrosis avascular de la cabeza del hueso grande, artrosis mediocarpiana o inestabilidad mediocarpiana. El seguimiento medio ha sido de 18 meses (R= 8-25).

Resultados y conclusiones: Se ha conseguido el 100% de consolidaciones, y una importante disminución del dolor en todos los casos, manteniéndose una flexión palmar postquirúrgica de 34º (R= 12-45º); una flexión dorsal de 29º (R= 12-45º); una desviación radial postoperatoria de 12º (R= 0-16º) y una desviación cubital de 17º (R= 0-20º). Se apreció un aumento de la fuerza de agarre tras la cirugía y todos los pacientes volvieron a sus actividades previas.

Esta técnica quirúrgica ofrece una fijación estable inmediata que permite una movilización precoz tras la cirugía. Es importante el relleno de injerto de escafoides o cresta iliaca en los espacios entre los huesos a artrodesar.

Does mixing affect the setting of injectable bone cement? An ultrasound study

Experimental calcium sulphate bone cement has been tested by ultrasounds to characterise its progressive setting through the evolution of several acoustic properties. The acoustic impedance z(t), the density rho (t) and the speed of sound c(t) versus the curing time have been monitored during the viscous-to-solid transition of the cement as a function of different mixing conditions. Injectability tests were also performed and the results have been related to the acoustic properties measured previously. It has been observed that further mixing after cement's constituency, and before the initial setting time of the cement, drastically affects both the characteristic setting times and the injectability of the cement.

[Techniques of bariatric surgery: analysis of 78 cases]

OBJECTIVES

Bariatric surgery has demonstrated its efficacy in weight loss and in reducing the comorbidities in the morbid obesity patient. The objectives of this study were to analyze the effectiveness and complication of the Scopinaro and gastric bypass techniques as well as the results from open surgery verses laparoscopy.

DESIGN

Retrospective study from 1999-2005.

SUBJECT AND METHODS

78 patients with morbid obesity were operated. 50 patients underwent open surgery and 28 underwent laparoscopy. Gastric bypass was performed in 54 patients, Scopinaro was performed in 20 patients and Vertical Banded Gastroplasty (VBG) was performed in 3 patients. The follow up time was between 6 and 60 months. The results obtained with Scopinaro and gastric bypass were compared as well as the results from open surgery verses laparoscopy.

RESULTS

The percentage of patients with a percent of excess weight loss under 50% in two years was of 5% and 13%, and the excess weight loss over 75% was of 55% ad 40% in the gastric bypass and the Scopinaro technique respectively. All the comorbidities improved. The average stay was decreased in the case of laparoscopy. The non-nutritional complications were increased for most cases in open surgery with the emphasis in eventrations, infections of the wound and respiratory complications. The nutritional complications were superior with Scopinaro's technique.

CONCLUSIONS

Based on our study, we would recommend the performance of gastric bypass for laparoscopy due to the reduced average stay and less nutritional and surgical complications. The literature results vary and therefore we consider necessary further control and random studies to correctly establish these comparisons.

[Solitary costal plasmacytoma: a rare cause of subacute demyelinating polyradiculoneuropathy]

INTRODUCTION

The solitary plasmacytoma (SP) is a non-frequent, localized variant of multiple myeloma with a single bone lesion and earlier appearance. Polyradiculoneuropathy is the most frequent neurological manifestation. We report the case of a young male who developed a subacute demyelinating polyradiculoneuropathy as the initial symptomatology of a costal SP, which constitutes an extremely infrequent association, given age and site of the lesion.

CASE REPORT

A 32-year old, previously healthy, man presented with a one month history of progressive symmetrical paraparesis and paresthesias in feet. The neurological examination revealed 4/5 paraparesis, global arreflexia and hypopalesthesia in legs. Cerebrospinal fluid examination revealed elevated proteins (83 mg/dl) with normal cell count and glucose content. Investigations showed high levels of beta(2)-microglobulin (3 mg/l), and a monoclonal IgG lambda gammapathy. The chest X-ray and thoracic CT revealed an osteolytic lesion in the left third rib. Nerve conduction studies showed sensitive and motor polyneuropathy with secondary axonal degeneration. Bone marrow biopsy was normal. Second and third left ribs were excised, revealing a pathologic diagnosis of plasmacytoma. The patient became asymptomatic after corticosteriod administration lesion excision and local radiotherapy. Conclusions. Subacute demyelinating polyradiculoneuropathy can be due to multiple causes. SP can be one of its etiologies and occur at infrequent ages and localizations.