Birth weight classification in gestational diabetes: is there an ideal chart?

Introduction: Gestational diabetes mellitus (GDM) is associated to increased rates of large for gestational age newborns and macrosomia. Several charts are used to classify birth weight. Is there an ideal chart to classify newborns of GDM mothers?Methods: We evaluated adequacy of birth weight of 332 neonates born to GDM mothers at Hospital de Clínicas de Porto Alegre, Brazil. Newborns were classified according to gestational age as small (SGA), adequate or large (LGA) based on four charts: Alexander, Pedreira, INTERGROWTH 21st Project and SINASC-2012. The latter was built using data from a large national registry of 2012, the Born Alive National Surveillance System (Sistema de Informações de Nascidos Vivos – SINASC), which included 2.905,789 birth certificates. Frequencies of SGA and LGA and Kappa agreement were calculated.Results: In non-gender adjusted curves, SGA rates (95% confidence interval) varied from 8% (5-11) to 9% (6-13); LGA rates, from 11% (8-15) to 17% (13-21). For males, SGA rates varied from 3% (1-6%) to 6% (3-11%), and LGA rates, from 18% (13-24%) to 31% (24-38%); for female, SGA rates were from 3% (1-7%) to 10% (6-16%) and LGA rates, from 11% (6-16%) to 19% (13-26%). Kappa results were: ALEXANDER vs. SINASC-2012: 0.80 (0.73-0.88); INTERGROWTH 21st vs. SINASC-2012 (adjusted by sex): 0.62 (0.53-0.71); INTERGROWTH 21st vs. PEDREIRA: 0.71 (0.62-0.79); SINASC-2012 (by sex) vs. PEDREIRA: 0.86 (0.79-0.93).Conclusions: Misclassification has to be taken into account when evaluating newborns of GDM mothers, as LGA rates can almost double depending on the chart used to classify birth weight

Vitamin D deficiency increases the risk of adverse neonatal otcomes in gestational diabetes

Background: Gestational diabetes mellitus (GDM) and vitamin D deficiency have been associated with increased risk of adverse perinatal outcomes but the consequences of both conditions simultaneously present in pregnancy have not yet been evaluated. Our objective was to study the influence of vitamin D deficiency in neonatal outcomes of pregnancies with GDM. Methods: 184 pregnant women with GDM referred to specialized prenatal monitoring were included in this cohort and had blood sampled for 25-hydroxyvitamin D measurement. Vitamin D was measured by chemiluminescence and deficiency was defined as < 20 ng/mL. Participants were followed until puerperium and adverse neonatal outcomes were evaluated. Results: Newborns of women with vitamin D deficiency had higher incidences of hospitalization in intensive care units (ICU) (32 vs 19%, P = 0.048), of hypoglycemia (any, 17.3 vs 7.1%, P = 0.039 requiring ICU, 15.3 vs 3.6%, P = 0.008), and were more frequently small for gestational age (SGA) (17.3 vs 5.9%, P = 0.017). After adjustment, relative risk (RR) for hypoglycemia requiring ICU was 3.63 (95%CI 1.09±12.11) and for SGA was 4.32 (95%CI 1.75± 10.66). The incidence of prematurity, jaundice and shoulder dystocia was no statistically different between groups. Conclusions: In this cohort of pregnant women with GDM, vitamin D deficiency was associated with a major increase in the incidence of adverse neonatal outcomes such as SGA newborns and neonatal hypoglycemia

Sind ALTE Zwiebellandsorten die NEUEN Sorten für den ökologischen Landbau?

Eine abnehmende Sortenvielfalt ist die spürbare Folge der steigenden Nachfrage nach bekannten Hybridsorten. Unsere Ergebnisse haben gezeigt, dass Zwiebellandsorten im Ertrag nicht schlechter als Hybridsorten sind. Eine Landsorte war hinsichtlich Qualität und Lagerfähigkeit sogar besser

Control of Brain State Transitions with a Photoswitchable Muscarinic Agonist

Reproducció del document publicat a:https://doi.org/10.1002/advs.202005027The ability to control neural activity is essential for research not only in basic neuroscience, as spatiotemporal control of activity is a fundamental experimental tool, but also in clinical neurology for therapeutic brain interventions. Transcranial-magnetic, ultrasound, and alternating/direct current (AC/DC) stimulation are some available means of spatiotemporal controlled neuromodulation. There is also light-mediated control, such as optogenetics, which has revolutionized neuroscience research, yet its clinical translation is hampered by the need for gene manipulation. As a drug-based light-mediated control, the effect of a photoswitchable muscarinic agonist (Phthalimide-Azo-Iper (PAI)) on a brain network is evaluated in this study. First, the conditions to manipulate M2 muscarinic receptors with light in the experimental setup are determined. Next, physiological synchronous emergent cortical activity consisting of slow oscillations—as in slow wave sleep—is transformed into a higher frequency pattern in the cerebral cortex, both in vitro and in vivo, as a consequence of PAI activation with light. These results open the way to study cholinergic neuromodulation and to control spatiotemporal patterns of activity in different brain states, their transitions, and their links to cognition and behavior. The approach can be applied to different organisms and does not require genetic manipulation, which would make it translational to humans

Epidemiology and individual, household and geographical risk factors of podoconiosis in ethiopia: results from the first nationwide mapping

Although podoconiosis is one of the major causes of tropical lymphoedema and is endemic in Ethiopia its epidemiology and risk factors are poorly understood. Individual-level data for 129,959 individuals from 1,315 communities in 659 woreda (districts) were collected for a nationwide integrated survey of lymphatic filariasis and podoconiosis. Blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests. A clinical algorithm was used to reach a diagnosis of podoconiosis by excluding other potential causes of lymphoedema of the lower limb. Bayesian multilevel models were used to identify individual and environmental risk factors. Overall, 8,110 of 129,959 (6.2%, 95% confidence interval [CI] 6.1-6.4%) surveyed individuals were identified with lymphoedema of the lower limb, of whom 5,253 (4.0%, 95% CI 3.9-4.1%) were confirmed to be podoconiosis cases. In multivariable analysis, being female, older, unmarried, washing the feet less frequently than daily, and being semiskilled or unemployed were significantly associated with increased risk of podoconiosis. Attending formal education and living in a house with a covered floor were associated with decreased risk of podoconiosis. Podoconiosis exhibits marked geographical variation across Ethiopia, with variation in risk associated with variation in rainfall, enhanced vegetation index, and altitude

Diabetes e Gestação: Perfil Clínico e Laboratorial em Pré-Natal de Alto Risco

Introdução: O diabetes é complicação clínica frequente na gestação e sua prevalência vem aumentando nos últimos anos.Objetivo: Analisar a frequência dos tipos de diabetes na gestação, as características clínicas das gestantes e alguns desfechos materno-fetais, em pré-natal de alto risco.Método: Estudo retrospectivo de revisão dos prontuários eletrônicos de mulheres com diabetes e gestação atendidas no período de janeiro 2009 a junho 2010 no Hospital de Clínicas de Porto Alegre (HCPA).Resultados: Nesse período, 173 gestantes foram atendidas no ambulatório de gestação e diabetes, no total de 1459 consultas. O diabetes gestacional ocorreu em 84% das gestantes, 8% apresentaram diabetes tipo 2, 6%, diabetes tipo 1 e 2%, outros tipos. As mulheres com diabetes gestacional apresentaram HbA1c inferior às demais. A maioria das pacientes iniciou o pré-natal após o primeiro trimestre. A taxa geral de cesariana foi de 56%, tendo sido mais frequente no diabetes tipo 1. O recém-nascido foi considerado pequeno para a idade gestacional em 9% dos casos, e grande em 13%, sem diferença entre os tipos de diabetes. Nas mulheres com diabetes gestacional, o peso do recém-nascido correlacionou-se positivamente com o índice de massa corporal, glicemia de jejum ao diagnóstico e HbA1c da mãe.Conclusão: O diabetes associado à gestação é motivo frequente de atendimento no pré-natal especializado do HCPA, sendo a maioria diabetes gestacional. Nesses casos, obesidade e pior controle glicêmico associaram-se com o peso fetal aumentado. As gestantes chegam tardiamente ao centro de tratamento, com controle metabólico aquém do recomendado

Birth weight classification in gestational diabetes: is there an ideal chart?

Introduction: Gestational diabetes mellitus (GDM) is associated to increased rates of large for gestational age newborns and macrosomia. Several charts are used to classify birth weight. Is there an ideal chart to classify newborns of GDM mothers? Methods: We evaluated adequacy of birth weight of 332 neonates born to GDM mothers at Hospital de Clínicas de Porto Alegre, Brazil. Newborns were classified according to gestational age as small (SGA), adequate or large (LGA) based on four charts: Alexander, Pedreira, INTERGROWTH 21st Project and SINASC-2012. The latter was built using data from a large national registry of 2012, the Born Alive National Surveillance System (Sistema de Informações de Nascidos Vivos – SINASC), which included 2.905,789 birth certificates. Frequencies of SGA and LGA and Kappa agreement were calculated. Results: In non-gender adjusted curves, SGA rates (95% confidence interval) varied from 8% (5-11) to 9% (6-13); LGA rates, from 11% (8-15) to 17% (13-21). For males, SGA rates varied from 3% (1-6%) to 6% (3-11%), and LGA rates, from 18% (13-24%) to 31% (24-38%); for female, SGA rates were from 3% (1-7%) to 10% (6-16%) and LGA rates, from 11% (6-16%) to 19% (13-26%). Kappa results were: ALEXANDER vs. SINASC-2012: 0.80 (0.73-0.88); INTERGROWTH 21st vs. SINASC-2012 (adjusted by sex): 0.62 (0.53-0.71); INTERGROWTH 21st vs. PEDREIRA: 0.71 (0.62-0.79); SINASC-2012 (by sex) vs. PEDREIRA: 0.86 (0.79-0.93). Conclusions: Misclassification has to be taken into account when evaluating newborns of GDM mothers, as LGA rates can almost double depending on the chart used to classify birth weight