Gestational Diabetes in General Practice

The role of the general practitioner in the diagnosis and management of the gestational diabetic is defined. Recognition of this condition is important for improving the perinatal mortality; as is advice regarding steroid contraception; and as a means of predicting the development of overt diabetes. Methods of diagnosis are briefly commented upon.S. Afr. Med. J., 48, 417 (1974

Silent Abruption of the Posteriorly Inserted Placenta

Four illustrative cases of severe, but 'silent', abruptio placentae are presented. Apart from variable degrees of vaginal bleeding, low backache was the only other constant symptom. In each instance the abruption was of a posteriorly imbedded placenta. The significance of posterior placental abruption is emphasised and an approach to its clinical management suggested

Gestational diabetes in general practice

The role of the general practitioner in the diagnosis and management of the gestational diabetic is defined. Recognition of this condition is important for improving the perinatal mortality; as is advice regarding steroid contraception; and as a means of predicting the development of overt diabetes. Methods of diagnosis are briefly commented upon.S. Afr. Med. J., 48, 417 (1974)

The antenatal detection of asymptomatic disease

A prospective study was introduced to establish the role of the antenatal clinic as an 'early detection unit' for the screening of asymptomatic disease not specifically related to pregnancy. Patients were screened for diabetes, iron deficiency, carcinoma of the cervix, asymptomatic urinary tract infection, and vaginal disease. Four racial groups, Black, Coloured, Indian, and White, were studied. In terms of time, cost and practicability, it was found that antenatal visits could be used for screening purposes. Screening for conditions known to be prevalent among certain racial groups increases the rate of detection. Screening for asymptomatic disease during pregnancy, can be introduced easily into private practice with a minimal involvement of cost and time for both patient and doctor. The long-term benefit of the early detection and treatment of disease is discussed.S. Afr. Med. J., 48, 178 (1974)

Metabolic Effect of Conjugated Oestrogens (USP) on Lipids and Lipoproteins

A study was undertaken to investigate the eff!!ct of conjugated oestrogens (USP) on the lipid profile of postmenopausal women. Twenty unselected menopausal women were treated for on!! year with cyclically administered oral conjugated oestrogens. Lipid studies were performed before, during and after treatment. The results showed that conjugated oestrogens had a slightly depressant effect on plasma cholesterol, b!!ta-lipoproteins, and pre-beta-lipoproteins, in both normal and hyperlipidaemic subjects. Plasma triglycerides were slightly raised during treatment in normal women, but depressed in those with baseline hypertriglyceridaemia values. None of these changes was of statistical significance. The apparent protective effect of endogenous oestrogen in the premenopause is probably related to its ability to maintain a normal lipid balance, rather than to reduce an abnormal one. This may be mediated through the known depressant effect that oestrogens have on the release of lipoprotein lipase. As a result, the breakdown of large lipid molecules to smaller particles, which could be more easily absorbed by the intima of the larger blood vessels, will be prevented

Asymptomatic Vaginal Disease in Pregnancy

Asymptomatic Trichomonas vagina/is, candidiasis and Haemophi/us vagina/is were found to affect approximately 20% of women attending an antenatal clinic for the first time. Eight patients (1,4%) had asymptomatic gonorrhoea. Clinical features, such as pruritus and the appearance of a discharge, were frequently misleading, whereas examination of routine Papanicolaou smears enabled the correct diagnosis to be made in most cases. The need for the early recognition and treatment of asymptomatic vaginal disease in pregnancy is commented upon.S. Afr. Med. J., 48, 803 (1974)

Transplacental haemorrhage and the mode of placental delivery

A study was undertaken to determine whether the incidence and degree of transplacental haemorrhage would be affected by the following methods of placental  delivery: Brandt-Andrew's manoeuvre, spontaneous or natural delivery, and manual removal. A total of 445 patients were studied, 10-1% of whom were found to have had evidence of a clinically significant foeto-maternal haemorrhage. Except for manual removal, foeto-maternal transfer was not affected by the method of handling of the third stage

Advances in hormone replacement therapy: making the menopause manageable

The importance of the results of some large, randomized controlled trials (RCTs) on Hormone Replacement Therapy (HRT) has modified the risk/benefit perception of HRT. Recent literature review supports a different management

Effectiveness of Compounded Bioidentical Hormone Replacement Therapy: An Observational Cohort Study

<p>Abstract</p> <p>Background</p> <p>Bioidentical Hormone Replacement Therapy (BHRT) is believed it to be a safer and equally effective alternative to Conventional Hormone Therapy for the relief of menopausal symptoms; however, data are needed to support these claims. The objective of this study is to evaluate the effectiveness of compounded BHRT provided in six community pharmacies.</p> <p>Methods</p> <p>This was an observational cohort study of women between the ages of 18-89 who received a compounded BHRT product from January 1, 2003 to April 30, 2010 in six community pharmacies. Data included patient demographics, comorbidities, therapeutic outcomes, and hormone therapies. Women self-rated menopausal symptoms as absent, mild, moderate, or severe. Descriptive statistics were used to characterize the patient population, BHRT use, and adverse events. Patient symptom severity was compared at baseline and 3 to 6 months follow-up using the Wilcoxon signed-rank test.</p> <p>Results</p> <p>Women (n = 296) receiving BHRT at Oakdell Pharmacy had a mean (standard deviation) age of 52 (9) years. The most common BHRT dosage forms utilized were topical (71%) and oral (43%). Compounded BHRT regimens were generally initiated at low doses regardless of route. Women experienced a 25% decrease in emotional lability (p < 0.01), a 25% decrease in irritability (p < 0.01), and a 22% reduction in anxiety (p = 0.01) within 3 to 6 months. These women also experienced a 14% reduction in night sweats (p = 0.09) and a 6% reduction in hot flashes (p = 0.50).</p> <p>Conclusions</p> <p>This study demonstrates that compounded BHRT improves mood symptoms. Larger studies are needed to examine the impact on vasomotor symptoms, myocardial infarction and breast cancer.</p

Profiling Insulin Like Factor 3 (INSL3) Signaling in Human Osteoblasts

Abstract BACKGROUND: Young men with mutations in the gene for the INSL3 receptor (Relaxin family peptide 2, RXFP2) are at risk of reduced bone mass and osteoporosis. Consistent with the human phenotype, bone analyses of Rxfp2(-/-) mice showed decreased bone volume, alterations of the trabecular bone, reduced mineralizing surface, bone formation, and osteoclast surface. The aim of this study was to elucidate the INSL3/RXFP2 signaling pathways and targets in human osteoblasts. METHODOLOGY/PRINCIPAL FINDINGS: Alkaline phosphatase (ALP) production, protein phosphorylation, intracellular calcium, gene expression, and mineralization studies have been performed. INSL3 induced a significant increase in ALP production, and Western blot and ELISA analyses of multiple intracellular signaling pathway molecules and their phosphorylation status revealed that the MAPK was the major pathway influenced by INSL3, whereas it does not modify intracellular calcium concentration. Quantitative Real Time PCR and Western blotting showed that INSL3 regulates the expression of different osteoblast markers. Alizarin red-S staining confirmed that INSL3-stimulated osteoblasts are fully differentiated and able to mineralize the extracellular matrix. CONCLUSIONS/SIGNIFICANCE: Together with previous findings, this study demonstrates that the INSL3/RXFP2 system is involved in bone metabolism by acting on the MAPK cascade and stimulating transcription of important genes of osteoblast maturation/differentiation and osteoclastogenesis