Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial

AIMS

Gestational diabetes mellitus (GDM) is the most common type of hyperglycaemia in pregnancy. GDM is a risk factor of adverse perinatal outcomes, with the incidence rate increasing proportionally to the level of maternal dysglycaemia. Therefore, glycaemic control plays an important role in management of GDM. The aim of this study was to assess the efficacy of flash glucose monitoring (FGM) in GDM.

MATERIALS AND METHODS

This was a non-blinded, randomised controlled trial, that recruited 100 pregnant women diagnosed with GDM between 24 and 28 weeks of gestation at the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw. After meeting the inclusion criteria patients were randomly allocated to the study group (FGM, n = 50) or control group (self-monitoring of blood glucose-SMBG, n = 50). Clinical and laboratory results were assessed at four follow-up visits. The primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes.

RESULTS

There was no significant difference in mean glycaemia between the groups (p = 0.437) Compared to the control group, the study group significantly reduced their fasting (p = 0.027) and postprandial glycaemia (p = 0.034) during the first 4 weeks following GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09, 95% CI 0.47-2.57). Incidence of fetal macrosomia was significantly higher in SMBG as compared to FGM group (OR 5.63, 95% CI 1.16-27.22).

CONCLUSIONS

Study results indicate that FGM has an impact on glycaemic control, dietary habits and incidence of fetal macrosomia in patients with GDM. Trial registration clinicaltrials.gov ID: NCT04422821.

Impact of lockdown on changes in lifestyle, including changes in consumtion of selected groups of food products among the inhabitatns in the Mazowieckie Region

The aim of the study was to assess the lifestyle of a selected group of inhabitants of the Mazowieckie Voivodeship before the pandemic and to analyse the impact of lockdown on changes in lifestyle, including changes in the consumption of selected food products that are a source of vitamins and minerals. In August 2020, a survey was conducted based on a proprietary questionnaire. It was shown that during the lockdown period, 24.7% of women and 27.1% of men made changes in their lives. The changes concerned working hours, nature of work, hours of sleep, number of meals consumed and diet. The analysis of the diet showed a decrease in the consumption of vegetables, fruits and legumes in some respondents, which, with low frequency of consumption, may lead to a deficiency of dietary fibre, vitamin C, folic acid, polyphenols and potassium. The consumption of fish, spreadable fats, salt, sugar and drinks was not compliant with the recommendations of healthy eating. Public education about healthy lifestyles is essential to prevent complications from COVID-19.

Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

Background

Maternal weight during pregnancy may affect both, the course of pregnancy and the anthropometric parameters of the newborn. The steadily growing problem of excessive weight in reproductive-age women is associated with the risk for gestational obesity and its negative consequences for the infant.

Objectives

The aims of the study were to analyze the following: (i) maternal weight gain as compared to the pre-pregnancy BMI, and (ii) the link between maternal weight and other environmental factors versus neonatal size.

Material and methods

The study was conducted among 94 women in singleton term pregnancy, who delivered at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw. The American Institute of Medicine criteria for the recommended weight gain were followed. Multivariate logistic regression model and multiple regression analysis were used for statistical analysis.

Results

Normal weight gain was observed in only one-third of the subjects, while excess weight gain was detected in as many as 42.5% of the women. Active smokers were at a 4-fold higher risk for excess weight gain as compared to nonsmokers (OR 4.13, 95% CI 1.19 - 14.34, p = 0.026). Infants born to mothers with insufficient weight gain (24.5% of the mothers) were lighter by 302 g (p=0.0405) and shorter by 2.4 cm (p=0.0025) as compared to those born to mothers with normal weight gain.

Conclusions

Maternal weight gain in most of our subjects was not compliant with the current recommendations, regardless of the pre-pregnancy BMI. Inadequate pregnancy weight gain negatively affects the anthropometric parameters of the newborn.

Folic acid supplementation in pregnancy and prevention of fetal neural tube defects

INTRODUCTION

Folic acid deficiency in very early pregnancy significantly increases the risk for neural tube defects in the developing fetus. Due to very high demands for folic acid in pregnancy, adequate supply is not possible without dietary supplements.

AIM OF THE STUDY

Evaluation of the frequency and adequacy of folic acid supplementation before and during pregnancy among women from the Warsaw region of Poland.

MATERIAL AND METHODS

The study was conducted among 100 pregnant women using direct interviewing. Chi-square test was used to analyze the relationship between selected parameters and folic acid supplementation.

RESULTS

Folic acid before pregnancy was supplemented by 42% of the respondents. In pregnancy, the number almost doubled (83%), but most women did not start the supplementation until 5-6 weeks of gestation. Before pregnancy, almost all subjects used single folic acid preparations, whereas during pregnancy they used vitaminmineral preparations for expectant women.

CONCLUSIONS

The realization of the Primary Prevention Program of Neural Tube Defects leaves much to be desired. Over half of the women do not supplement folic acid before conception, and the supply in pregnancy is initiated too late to meet the assumptions of the prevention program.

Dietary intake of DHA during pregnancy: a significant gap between the actual intake and current nutritional recommendations

Background

Docosahexaenoic acid (DHA) is indispensable to ensure proper development of the fetal central nervous system and pregnancy duration. Daily intake of DHA should be at least 100 mg higher as compared to the pre-pregnancy values.

Objectives

The aim of the study was to evaluate DHA intake during pregnancy and compare it to the current recommendations.

Material and methods

A total of 100 pregnant women presenting for labor at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw, were included in the study. DHA intake from the following sources: fish and eggs, and DHA preparations collected based on the questionnaire was investigated.

Results

Low dietary DHA intake (median: 60 mg/day) was observed. The values were only slightly higher (median: 90 mg/day) after DHA preparations were taken into consideration because only 28% of the pregnant women used DHA preparations. Overall, 92% of the subjects consumed <200 mg of DHA a day, which was the result of insufficient fish consumption (mean: 15 g/day). Only 10% of the respondents ate fish twice a week, in which case the DHA dietary intake was statistically significantly higher (median: 160 mg/day) (p=0.0232). Total median dietary DHA and EPA intake in the study population was 79 mg/day.

Conclusions

The diet of pregnant women is largely deficient as far as DHA intake is concerned. Importantly, it is not possible to comply with current recommendations without dietary supplementation.

Fungal brain abscess caused by "Black Mold" (Cladophialophora bantiana) - A case report of successful treatment with an emphasis on how fungal brain abscess may be different from bacterial brain abscess

Background:

Central nervous system infection with Cladophialophora bantiana (Black Mold) is rare. It carries a high mortality rate, that is more than 70%, despite multimodal therapy.

Case Description:

We present a rare case of “black mold” fungal brain abscess that was successfully treated with good patient outcome. The case is unusual because there were two fungal brain abscesses located bilaterally symmetrically in the mesial frontal lobes, and the response to different treatment strategies was well documented by over 25 magnetic resonance imaging (MRI) scans. Initial attempts to treat these lesions by repeated surgical excision and systemic amphotericin B was followed by continued growth rather than resolution. We realized that the application of treatment principles learned from bacterial brain abscess may not transpose intuitively to the treatment of fungal brain abscess. Therefore, a new treatment strategy was adopted that avoided further attempts at resection in favor of long-term oral voriconazole and repeated intracavitary aspiration and instillation of amphotericin B on an outpatient basis. Without further resection, the lesions stabilized and the aspirates eventually sterilized, however, the enhancing capsule never resolved on MRI scans. All treatment was stopped after 1 year. The apparently sterilized lesions have been followed for an additional 3 years without further growth, and the patient remains functionally, intellectually, and behaviorally normal.

Conclusion:

We conclude that, in the case of fungal abscess, it may be preferable to sterilize the lesion in situ rather than attempting to achieve resolution on imaging studies by repeated surgical resection of the capsule which can be counterproductive. This strategy accepts that the capsule may be important to the patient's immune defense against the fungus. Helping that defense barrier with intracapsular and systemic antifungal agents, rather than capsular removal, may be the better strategy for patients in whom early aggressive resection has failed. The basis for the apparent differences in the response of fungal versus bacterial brain abscess to surgical resection is discussed in the light of pathological findings from this and other cases.

An analysis of a community-acquired pathogen in a Kentucky community: methicillin-resistant Staphylococcus aureus

CONTEXT

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been reported in patients with recognized predisposing risk factors in several cities in the United States and across the world. Reviewing risk factors in adult patients with CA-MRSA in Kentucky has not been reported.

OBJECTIVE

To determine the risk factors of 15 patients with CA-MRSA in Louisville KY, to compare the sensitivities of each pathogen and to recommend management.

SETTING

An infectious diseases private practice in Louisville, KY.

MATERIALS AND METHODS

This is a case series of patients with CA-MRSA. The disease course for each patient was reviewed for risk factors, such as participation in physical contact sports and prison exposure. The antimicrobial sensitivities of each pathogen were also reviewed. Recommendations were produced from the information obtained.

RESULTS

A total of 15 patients were reviewed. Five patients had a family member or significant-other with a current CA-MRSA infection. Three had traditional risk factors (healthcare workers). All of the isolates were susceptible to vancomycin and resistant to oxacillin. All of the isolates tested for trimethoprim/sulfamethoxazole (TMP/SMX), tetracycline, and rifampin were sensitive. A majority (83%) of those tested for clindamycin and only 50% of those tested for levofloxacin were sensitive. All isolates tested for cefazolin were resistant.

CONCLUSIONS

An emerging risk factor for acquiring an MRSA skin and soft tissue infection is having a significant-other with a current diagnosis of CA-MRSA. After incision and drainage, a review of the antimicrobial sensitivities indicates that oral treatment may be adequate for a selection of cases.

Reduction in tuberculin skin-test conversion rate after improved adherence to tuberculosis isolation

The rate of purified protein derivative (PPD) conversion in workers at our hospital increased to 1.7% in 1991. After implementation of mandatory respiratory isolation of patients with community-acquired pneumonia, the rate dropped to 0.6%. This policy may protect workers in institutions where the majority of patients with pneumonia have risk factors for tuberculosis.

Tuberculosis in Kentucky: current recommendations for empiric therapy

Current guidelines for empiric therapy for pulmonary tuberculosis depend on the presence of INH or INH and rifampin resistance (MDRTB) in the community. The objective of this study was to determine the susceptibility of MTB in Kentucky and to consider which therapeutic modality for empiric therapy should be followed. The total number and rate of pulmonary tuberculosis was analyzed and compared to national trends. Data of susceptibility were analyzed based on INH and rifampin resistance. There were 4753 cases of TB in Kentucky between 1984 and 1994. Data of susceptibility were available from 1989 through 1994. Total number of MTB decreased by 14% in 1994 from 1993 but resistance to INH doubled from 3.2% to 7.6%. MDRTB increased from 1.2% to 3.2%. INH resistance > 4% on initial isolates was recorded in Allen, Bell, Estill, Fleming, Jefferson, Kenton, Knott, Oldham, Rowan, and Wolfe counties. Outbreak of MDRTB was documented in Estill County. There was no HIV infection documented in this group. In the rest of the state, INH resistance was < 4%. In counties with INH resistance < 4%, empiric therapy for TB should include 3 drugs: INH and rifampin for 6 months and PZA added for the first 2 months. In counties with INH resistance > 4%, empiric therapy should include 4 drugs: INH, rifampin, PZA, ethambutol or streptomycin. In Estill County with documented MDRTB, empiric therapy should include 5 to 6 drugs: INH, rifampin, PZA, ethambutol, streptomycin, and amikacin. If INH and rifampin resistance is present, the therapy should include at least 3 drugs to which the organism is sensitive. This regimen should be continued until sputum cultures become negative. Further therapy should be continued with 2 drugs for 1 year. HIV infected patients constitute a separate category and therapy for them should be individualized.