Outcome of COVID-19 infections in patients with adrenal insufficiency and excess

Background: Information on clinical outcomes of coronavirus disease 19 (COVID-19) infection in patients with adrenal disorders is scarce. Methods: A collaboration between the European Society of Endocrinology (ESE) Rare Disease Committee and European Reference Network on Rare Endocrine Conditions via the European Registries for Rare Endocrine Conditions allowed the collection of data on 64 cases (57 adrenal insufficiency (AI), 7 Cushing's syndrome) that had been reported by 12 centres in 8 European countries between January 2020 and December 2021. Results: Of all 64 patients, 23 were males and 41 females (13 of those children) with a median age of 37 and 51 years. In 45/57 (95%) AI cases, COVID-19 infection was confirmed by testing. Primary insufficiency was present in 45/57 patients; 19 were affected by Addison's disease, 19 by congenital adrenal hyperplasia and 7 by primary AI (PAI) due to other causes. The most relevant comorbidities were hypertension (12%), obesity (n = 14%) and diabetes mellitus (9%). An increase by a median of 2.0 (IQR 1.4) times the daily replacement dose was reported in 42 (74%) patients. Two patients were administered i.m. injection of 100 mg hydrocortisone, and 11/64 were admitted to the hospital. Two patients had to be transferred to the intensive care unit, one with a fatal outcome. Four patients reported persistent SARS-CoV-2 infection, all others complete remission. Conclusion: This European multicentre questionnaire is the first to collect data on the outcome of COVID-19 infection in patients with adrenal gland disorders. It suggests good clinical outcomes in case of duly dose adjustments and emphasizes the importance of patient education on sick day rules.Metabolic health: pathophysiological trajectories and therap

SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals

Non-invasive prenatal detection for trisomy 2: What women want and are willing to pay

Objective To investigate the attitude among pregnant women regarding non-invasive prenatal testing (NIPT) for detecting trisomy 21 (T21) and to quantify their willingness to pay for NIPT. Methods A questionnaire was administered to pregnant women who received counselling for first-trimester screening (FTS) in two hospitals and nine midwife practices in the Netherlands. Results A total of 147 women completed the questionnaire, yielding a response rate of 43%. If NIPT for detecting T21 were available, 81% stated they would choose to have this test, and 57% of women who elected not to undergo FTS in their current pregnancy would perform NIPT if available. Willingness to pay for NIPT was correlated with age and income, but not education level. The price that participants were willing to pay for NIPT was similar to the current price for FTS. Conclusion The pregnant women in our study had a positive attitude regarding NIPT for T21, and more than half of the women who rejected prenatal screening would receive NIPT if available. Practice implications Due to the elimination of iatrogenic miscarriage, caregivers should be aware that informed decision-making can change with respect to prenatal screening with the introduction of NIPT. Keywords: Prenatal screening, Non-invasive prenatal testing (NIPT), Non-invasive testing, Informed decision-making, Willingness to pay, Trisomy 21, Down syndrom

Fetal and Neonatal Alloimmune Thrombocytopenia: Management and Outcome of a Large International Retrospective Cohort

Research into fetal development and medicin

Low-Dose versus Standard-Dose Intravenous Immunoglobulin to Prevent Fetal Intracranial Hemorrhage in Fetal and Neonatal Alloimmune Thrombocytopenia: A Randomized Trial

Developmen

Herbivore exclusion and active planting stimulate reed marsh development on a newly constructed archipelago

Wetlands provide vital services on which human societies depend. As they have been rapidly degrading due to anthropogenic impacts worldwide, wetland restoration is increasingly applied. When a return to the original state of a wetland is constrained, forward-looking restoration can provide a new way to enhance an ecosystem's ecological integrity. However, the direction in which new ecosystems will develop is strongly coupled to the initial environmental conditions and may benefit from active decisions on (future) management. To improve the natural values of a degrading freshwater lake in the Netherlands, a forward-looking restoration project was initiated in lake Markermeer in 2016, involving the construction of a 700-ha archipelago called the “Marker Wadden”. This archipelago should provide new habitat to higher trophic levels in the lake's food web through the development of currently missing Common reed ( Phragmites australis ) dominated marshlands with gradual land-water transitions. However, the restoration project faces strong grazing pressure by Greylag geese ( Anser anser ) that possibly inhibit reed establishment. Here, we aimed to unravel the effect of herbivory by Greylag geese (using exclosures) and the introduction of reed rhizomes on early vegetation development and carbon dynamics on the bare soils of this new ecosystem in a manipulative field experiment. Our results showed that excluding herbivores strongly increased reed-vegetation cover, density and maximum height, but only when reed rhizomes were actively introduced. Spontaneous vegetation development on bare soils was limited, and colonization by Broadleaf cattail ( Typha latifolia ) dominated over reed. Net ecosystem exchange of carbon and ecosystem respiration were strongly linked to vegetation development, with highest methane emissions in the most densely vegetated plots. We conclude that the establishment of reed marshes can strongly benefit from excluding herbivores and the introduction of reed, and that otherwise other vegetation types may establish more slowly in newly created wetlands. This illustrates how active management of vegetation development has the potential to benefit novel ecosystems.</p

Data from: Nature development in degraded landscapes: how pioneer bioturbators and water level control soil subsidence, nutrient chemistry and greenhouse gas emission

Data from: Nature development in degraded landscapes: how pioneer bioturbators and water level control soil subsidence, nutrient chemistry and greenhouse gas emission Published in Pedobiologia This datafile originates from a laboratory study in which we studied the effect water level and two soil bioturbators on soil subsidence, soil crack formation, nutrient chemistry and greenhouse gas emission. The laboratory experiment that ran in 2018, used soils from a newly constructed archipelago (the Marker Wadden, the Netherlands) that was constructed to enhance the natural values of a deteriorating freshwater lake. This dataset contains data on soil subsidence, soil cracks, nutrients and greenhouse gas fluxes obtaind from the experiment described above

Women's Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term

Objective We assessed experience and preferences among term women undergoing induction of labor with oral misoprostol or Foley catheter. Study Design In 18 of the 29 participating hospitals in the PROBAAT-II trial, women were asked to complete a questionnaire within 24 hours after delivery. We adapted a validated questionnaire about expectancy and experience of labor and asked women whether they would prefer the same method again in a future pregnancy. Results The questionnaire was completed by 502 (72%) of 695 eligible women; 273 (54%) had been randomly allocated to oral misoprostol and 229 (46%) to Foley catheter. Experience of the duration of labor, pain during labor, general satisfaction with labor, and feelings of control and fear related to their expectation were comparable between both the groups. In the oral misoprostol group, 6% of the women would prefer the other method if induction is necessary in future pregnancy, versus 12% in the Foley catheter group (risk ratio: 0.70; 95% confidence interval: 0.55-0.90; p = 0.02). Conclusion Women's experiences of labor after induction with oral misoprostol or Foley catheter are comparable. However, women in the Foley catheter group prefer more often to choose a different method for future inductions