What proportion of adult allergy referrals to secondary care could be dealt with in primary care by a GP with special interest?

Background: The concept of a General Practitioner with Special Interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialised treatment closer to the patient’s home and reducing hospital waiting times. Given the patchy and inadequate provision of allergy services in the UK the introduction of GPwSIs might reduce the pressure on existing specialist services. Objectives: This study assessed what proportion of referrals to a specialist allergy clinic could be managed in a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of advice on allergen avoidance; ability to assess suitability for desensitisation). Methods: 100 consecutive GP referrals to a hospital allergy clinic were reviewed to determine whether patients could be seen in a community-based clinic led by a general practitioner with special interest (GPwSI) allergy. The documentation relating to each referral was independently assessed by three allergy specialists. The referrals were judged initially on the referral letter alone and then re-assessed with the benefit of information summarised in the clinic letter, to determine whether appropriate triage decisions could be made prospectively. The proportion of referrals suitable for a GPwSI was calculated and their referral characteristics identified. Results: 29 % referrals were judged unanimously appropriate for management by a GPwSI and an additional 30 % by 2 of the 3 reviewers. 18 % referrals were unsuitable for a GPwSI service because of the complexity of the presenting problem, patient co-morbidity or the need for specialist knowledge or facilities. Conclusions and clinical relevance: At least a quarter, and possibly half, of allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on more complex cases and reducing the waiting time for first appointments

Visceral fat mass as a novel risk factor for predicting gestational diabetes in obese pregnant women

Objective To develop a model to predict gestational diabetes mellitus incorporating classical and a novel risk factor, visceral fat mass. Methods Three hundred two obese non-diabetic pregnant women underwent body composition analysis at booking by bioimpedance analysis. Of this cohort, 72 (24%) developed gestational diabetes mellitus. Principal component analysis was initially performed to identify possible clustering of the gestational diabetes mellitus and non-GDM groups. A machine learning algorithm was then applied to develop a GDM predictive model utilising random forest and decision tree modelling. Results The predictive model was trained on 227 samples and validated using an independent testing subset of 75 samples where the model achieved a validation prediction accuracy of 77.53%. According to the decision tree developed, visceral fat mass emerged as the most important variable in determining the risk of gestational diabetes mellitus. Conclusions We present a model incorporating visceral fat mass, which is a novel risk factor in predicting gestational diabetes mellitus in obese pregnant wome

Metformin versus placebo in obese pregnant women without diabetes mellitus

Background: Obesity is associated with increased risk of adverse pregnancy outcomes. Lifestyle intervention studies have not improved outcome. Metformin improves insulin sensitivity and leads to less weight gain. Methods: Our double-blind placebo-controlled trial randomized non-diabetic pregnant women with a body mass index >35 kg/m2 to metformin or placebo from 12-18 weeks’ gestation until delivery. Primary outcome was median neonatal birth weight z-score reduction by 0.3 standard deviations (equivalent to a 50% reduction in incidence of large-for-gestational-age neonates from 20% to 10%). Secondary outcomes included maternal gestational weight gain and incidence of gestational diabetes, and preeclampsia, as well as adverse neonatal outcomes. Women were randomized, by computer generated random numbers, to either daily metformin 3.0 grams (n=225) or to placebo (n=225). Analysis was by intention to treat. Results: Fifty women withdrew consent, leaving 202 in the metformin group and 198 in the placebo group. There was no significant difference in median neonatal birth weight z-score (metformin: 0.05, IQR -0.71 to 0.92; placebo: 0.17, IQR -0.62 to 0.89; p=0.655). In the metformin group, compared to placebo, median maternal gestational weight gain was lower (4.6 kg, IQR 1.3-7.2 vs. 6.3 kg, IQR 2.9-9.2, p<0.0001) and incidence of preeclampsia was lower (3.0% vs 11.3%; odds ratio 0.24, 95% CI 0.10-0.61; p=0.001), incidence of side effects was higher; there were no significant differences in gestational diabetes, large for gestational age neonates and adverse neonatal outcomes. Conclusions: In non-diabetic women with BMI >35 kg/m2, antenatal administration of metformin reduces maternal weight gain but not neonatal birth weight. (ClinicalTrials.gov number, NCT01273584

Metformin use in obese mothers is associated with improved cardiovascular profile in the offspring

BACKGROUND: Maternal obesity increases the risk for pregnancy complications and adverse neonatal outcome and it has also been associated with long lasting adverse effects in the offspring, including increased body fat mass, insulin resistance and increased risk for premature cardiovascular disease. Lifestyle interventions in pregnancy have produced none or modest effects in reducing adverse pregnancy outcomes in obese mothers. Metformin use in Obese Pregnant women trial was associated with reduced adverse pregnancy outcomes and had no effect on birthweight. However, the long-term implications of metformin on the health of offspring remain unknown. OBJECTIVE: The purpose of this study was to assess whether prenatal exposure to metformin can improve the cardiovascular profile and body composition in the offspring of obese mothers. STUDY DESIGN: In 151 children from the Metformin use in Obese-Pregnant women trial we measured body composition, peripheral blood pressure and arterial pulse wave velocity. Central hemodynamics (central blood pressure and augmentation index) were estimated using the Vicorder device. Left ventricular cardiac function and structure were assessed by echocardiography. RESULTS: Children were 3.9±1.0 years of age and 77 were exposed to metformin prenatally. There was no significant difference in peripheral blood pressure, arterial stiffness and body composition apart from gluteal and tricep circumferences which were lower in the metformin group (p<0.05). The metformin, compared to the placebo group, had lower central hemodynamics (mean adjusted decrease - 0.707mmHg for aortic systolic blood pressure, -1.65mmHg for aortic pulse pressure and -2.68% for augmentation index, p<0.05 for all) and lower left ventricular diastolic function (adjusted difference in left atrial area -0.525cm2, in isovolumic relaxation time -0.324msec and in pulmonary venous systolic wave 2.97cm/s, p<0.05 for all). There were no significant differences in metabolic profile between the groups. CONCLUSION: Children of obese mothers who were prenatally exposed to metformin, compared to those exposed to placebo, have lower central hemodynamic and cardiac diastolic indices. These results suggest that administration of metformin in obese pregnant women may potentially have a beneficial cardiovascular effect for their offspring

Enhancing radial distribution system performance by optimal placement of DSTATCOM

In this paper, A novel modified optimization method was used to find the optimal location and size for placing distribution Static Compensator in the radial distribution test feeder in order to improve its performance by minimizing the total power losses of the test feeder, enhancing the voltage profile and reducing the costs. The modified grey wolf optimization algorithm is used for the first time to solve this kind of optimization problem. An objective function was developed to study the radial distribution system included total power loss of the system and costs due to power loss in system. The proposed method is applied to two different test distribution feeders (33 bus and 69 bus test systems) using different Dstatcom sizes and the acquired results were analyzed and compared to other recent optimization methods applied to the same test feeders to ensure the effectiveness of the used method and its superiority over other recent optimization mehods. The major findings from obtained results that the applied technique found the most minimized total power loss in system ,the best improved voltage profile and most reduction in costs due power loss compared to other methods

ORGANIC FERTILIZATION AND NATURAL SUBSTANCES TREATMENTS AFFECTS CHEMICAL CONSTITUENTS OF GUAR PLANTS

This experiment was conducted at the Floriculture Nursery, Faculty of Agriculture, Minia University during the two successive seasons to study the effect of compost at rates (0, 25, 2.50 and 3.75 ton/fed.) and natural substances i.e. vitamins (ascorbic acid at 50 and 100 ppm, ?-tocopherol at 10, 20 ppm and thiamine, at 25 and 50 ppm) and active yeast at 2.5 and 5 g/l. and their interaction on some chemical constituents of guar plants. The results indicated that, Addition of compost caused an increase in guaran %, Photosynthetic pigments, Total carbohydrates (%) N, P and K (%) and Protein (%). The maximum level in all previous traits was for the plants growing in the soil fertilized with the highest level of compost (3.75 t/fed.). Using the treatments of vit. C at 50 ppm followed by 5 g/l. active yeast, then vit. E at 10 ppm gave the highest values of all previous traits. The interaction between the two main factors (A×B) was significant for guaran %, photosynthetic pigments, total carbohydrates %, N and P %., The highest values were obtained from the interaction treatments of 3.75 ton/fed., compost in combination with active yeast at 5 g/l. and vit. C at 50 ppm. On the other hand, the interaction between compost, active yeast and vitamins treatments was not significant for protein content (%). We conclude that supply guar plants with compost at 3.75 ton/fed., and spraying plants with either active yeast at 5 g/l. or ascorbic acid (vit. C) at 50 ppm to improve the values of some chemical constituents under investigation condition

ORGANIC FERTILIZATION AND NATURAL SUBSTANCES TREATMENTS AFFECTS CHEMICAL CONSTITUENTS OF GUAR PLANTS

This experiment was conducted at the Floriculture Nursery, Faculty of Agriculture, Minia University during the two successive seasons to study the effect of compost at rates (0, 25, 2.50 and 3.75 ton/fed.) and natural substances i.e. vitamins (ascorbic acid at 50 and 100 ppm, ?-tocopherol at 10, 20 ppm and thiamine, at 25 and 50 ppm) and active yeast at 2.5 and 5 g/l. and their interaction on some chemical constituents of guar plants. The results indicated that, Addition of compost caused an increase in guaran %, Photosynthetic pigments, Total carbohydrates (%) N, P and K (%) and Protein (%). The maximum level in all previous traits was for the plants growing in the soil fertilized with the highest level of compost (3.75 t/fed.). Using the treatments of vit. C at 50 ppm followed by 5 g/l. active yeast, then vit. E at 10 ppm gave the highest values of all previous traits. The interaction between the two main factors (A×B) was significant for guaran %, photosynthetic pigments, total carbohydrates %, N and P %., The highest values were obtained from the interaction treatments of 3.75 ton/fed., compost in combination with active yeast at 5 g/l. and vit. C at 50 ppm. On the other hand, the interaction between compost, active yeast and vitamins treatments was not significant for protein content (%). We conclude that supply guar plants with compost at 3.75 ton/fed., and spraying plants with either active yeast at 5 g/l. or ascorbic acid (vit. C) at 50 ppm to improve the values of some chemical constituents under investigation condition

GLUTAMINE SUPPLEMENTATION: EFFECTS ON GROWTH HORMONE AND TIME-TRIAL PERFORMANCE AFTER PROLONGED EXERCISE

Dietary glutamine supplementation has been proposed as a potential aid to athletic performance.&nbsp; The purpose of the investigation was to determine if glutamine supplementation might improve cycling performance, perhaps by stimulating growth hormone release, in athletes consuming a high-carbohydrate diet.&nbsp; Six trained young adult men participated in two four-day supplementation trials.&nbsp; In both trials, the subjects underwent an identical carbohydrate-loading regimen of controlled diet (75% carbohydrate) and exercise.&nbsp; The only difference in the trials was whether the subjects ingested dietary supplements of glutamine or glucose placebo.&nbsp; During the first three days of each trial, the diets were supplemented with either glutamine or glucose placebo at a dosage of 150 mg/kg body weight (~10.4 g/d).&nbsp; On the fourth day, the supplements were dissolved in a sports drink (4 g/L).&nbsp; The sports drink initially contained a 6% solution of carbohydrate.&nbsp; On the fourth day the subjects ingested 7 ml/kg of the supplemented sports drink 2 h before exercise, 5 ml/kg 1 h before exercise, and 3 ml/kg after 15, 30, 45, 60, and 90 min of exercise.&nbsp; The total amount of glutamine supplement or placebo consumed on the fourth day was 108 mg/kg or about 7.4 g, of which 3.3 g were consumed before and 4.1 g during exercise.&nbsp; On the fourth day, subjects completed 90 min of cycle ergometry, divided into six 15-min periods, each of which included in sequence 12 min @75% VO2max, 1 min @ 120% VO2max, and 2 min @ 50% VO2max.&nbsp; The 90 min exercise session was immediately followed by 15 min of rest and then a final 20-km time trial at ~85% VO2max.&nbsp; Plasma concentrations of glycerol and free fatty acids and serum growth hormone concentrations were measured before and during exercise, and time-trial performance was recorded.&nbsp; Times (± SEM) to complete the 20-km performance rides were 31.03 ± 0.58 min for the placebo trial and 30.93 ± 0.60 min for the glutamine trial and were not significantly different (P&gt;0.05).&nbsp; There were also no significant effects on serum growth hormone or on plasma glycerol or free fatty acids attributable to glutamine supplementation at any sampling time.&nbsp; In summary, we found no evidence that glutamine supplementation in moderate dosages has any effect on circulating growth hormone, glycerol, or free fatty acids or on time-trial performance in athletes who consume a high-carbohydrate die

Heavy Metals Can either Aid or Oppose the Protective Function of the Placental Barrier

BACKGROUND: In developing countries, toxic heavy metals are a threatening catastrophe to human health, particularly in the vulnerable group of pregnant mothers and their fetuses. Fortunately, the placenta can be a protective barrier to the fetuses. AIM: To explore the relationship between serum lead, cadmium and arsenic levels in pregnant mothers and their newborns, to address the placental barrier in this situation. METHODS: A cross-sectional study was conducted on 100 pregnant mothers at the time of labour and their newborns. Serum cadmium, lead, and arsenic levels were measured using the Inductively Coupled Plasma Mass Spectrometry. RESULTS: All the studied heavy metals concentrations showed a significant elevation in the maternal blood relative to the cord blood. There was a significant association between the maternal lead and both fetal lead and arsenic. Meanwhile, a negative but insignificant correlation was recorded between the maternal cadmium and each of the fetal cadmium, lead, and arsenic. CONCLUSION: The study findings indicated a weak relation between maternal and fetal blood heavy metals, except for the influence of maternal lead, so it can be assumed that the placental barriers are partially protective against those toxic pollutants, putting into consideration the influence of their different natures