Anthropometric Measurements to Predict NICU Admission for Infants of Diabetic Mothers

Aim: Can NICU admission of IDM be predicted by anthropometric measurements like birth weight, lenght, head circumference (HC), mid upper arm circumference (MUAC) or triceps skin fold thickness (TSFT). Method: Eighty-six-term IDMs were analyzed prospectively. MUAC, HC and TSFT were measured within 48 hours of life. Prenatal-natal-postnatal problems; NICU admission; maternal characteristics, HbA1c were recorded. Results: Mean birth weight, gestational age were 3453.3±582.4g and 38.0±0.97weeks. 63.9% of IDMs was admitted to NICU. 56.3% hospitalized due respiratory problems; 32,7 % required endotracheal intubation. Mean MUAC, TSFT, HC and MUAC/HC ratio were 11.2±1.1 cm, 7.1±2.2 mm, 35.0±1.8 cm and 0.32±0.03 cm respectively for all. Although there was no significant relation between NICU admission and MUAC (p=0.071), TSFT and MUAC/HC were significantly higher in babies admitted to NICU (p=0.006 for TSFT, p<0.001 for MUAC/HC). HC was significantly low in babies followed in NICU (P<0.001). With increment of TSFT, MUAC/HC and HbA1c, NICU admission increases positively, but HC affects NICU admission negatively (OR for TSFT:1.6, OR for MUAC/HC: 2.1, OR for HbA1c: OR for HC:0,3). Mechanic ventilation requirement is affected positively by TSFT (p=0.008, OR:1.5) and affected negatively by HC (p=0.004, OR:0.6). Conclusion: This preliminary study showed; TSFT, HC and MUAC/HC ratio are helpful criterias to predict NICU admission risk for IDMs and might be helpful for risk assesment in limited settings. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 72-78

Abdominal skin subcutaneous fat thickness over the gestational period in Korean pregnant women: a descriptive observational study

Purpose: Although insulin is usually injected into the abdominal subcutaneous fat, in pregnancy women tend to avoid abdominal injections due to concern about fetal damage. Prior studies have been limited to only measuring skin-subcutaneous fat thickness (S-ScFT) at one site at specific pregnancy points. This study aimed to measure S-ScFT across several abdominal sites and over the gestational period in Korean pregnant women. This can identify which site would be relatively safe for subcutaneous injection during pregnancy. Methods: Healthy women over 24 weeks of pregnancy in Korea were invited to voluntarily participate in this descriptive study. For the 142 women, S-ScFT of 12 sites in the abdomen were measured by ultrasound, several times over the pregnancy. Each incidence was treated as a case and a total of 262 cases were analyzed.Results: The mean S-ScFT during pregnancy was 1.14±0.47 cm (1.25±0.54 cm at 24+0–27+6 weeks; 1.17±0.48 cm at 28+0–31+6 weeks; 1.09+0.40 cm at 32+0–35+6 weeks; and 1.06±0.47 cm at 36+0–40 weeks of pregnancy). Most S-ScFT were thicker than 10 mm. But S-ScFTs in the lateral abdomen and some sites were suboptimal (<6 mm), especially in the pre-pregnancy underweight body mass index group, who had a high rate of suboptimal thickness (27.1% overall and 33.9% in the lateral side). Conclusion: The whole abdomen seems to be appropriate for subcutaneous injection in most pregnant Korean women, with a 4 to 5-mm short needle. However, for the lateral abdomen, making the skin fold might be needed for fetal safety.

Case Series of Irritated Giant Acrochordons Arising from Skin Folds

BACKGROUND: Acrochordons are pedunculated papules or nodules with a soft consistency and smooth contour, sometimes apparently growths often hang on thin stalk, with the most acrochordons size was 2–5 mm. Occasionally, due to frictions of the pedicle, acrochordon can become inflamed, tender, and even gangrenous. CASE PRESENTATION: We report a case series of three giant acrochordons, first case, 19-year-old female come to my OPD clinic with a big mass on her left vagina, with pain and hot while being touched, and fever. On examination big nodule on the right labia mayor was found, with diameter 20 × 20 cm, short stalk, firm, warmed, and pain sensation while touched, with several excoriated skin surface. Second case, 23-year-old female presented in my OPD with a mass in her left vagina, associated with pain and several bleeding spots while being touched, with diameter of 5 × 5 cm. Third case, 31-year-old female consulted to OPD clinic with a year of history having a mass on her right buttock, which gradually increases in size and causing a light pain. On examination, short pedunculated nodule was found at the right buttock, diameter 10 × 6 cm, oval shape, firm, and several excoriated plaques. All cases were diagnosed as giant acrochordons and were performed excision. The previous studies state that the larger lesions of acrochordons in the groin or upper thighs maybe associated with diabetes mellitus and obese individuals. Due to the twisting or strangulated of the pedicle, all three cases of giant acrochordons become inflamed, tender, irritated, infarction, and even gangrenous. In general, it was advised to have the acrochordons removed, particularly in the skin fold of axillae, groin, or vagina, since they will gradually develop in size. CONCLUSION: Giant acrochordons usually relate to the growth hormone like activity. Hence, they may associate with endocrine disorder. It may occasionally become inflamed, tender, and even gangrenous due to frictions. General principle is to have the acrochordons removed, particularly in skin fold area.

Association between marginally low birth weight and obesity-related outcomes indirect effects via ADHD and abnormal eating

Background: Evidence of the association between children born with marginally low birth weight (MLBW) and obesity-related outcomes was controversial, and our study aimed to examine the role of attention deficit hyperactivity disorder (ADHD) and/or abnormal eating in these associations. Methods: A retrospective cohort study consisting of 677 Chinese children was conducted. Obesity-related outcomes (BMI, waist circumference, skin fold thickness, body fat, blood pressure, lipids and blood glucose), behaviour problems (ADHD and eating behaviour) and birth weight were collected. Mediation analyses were used to explore whether ADHD and/or abnormal eating was an intermediary factor in the MLBW-OB relationship. Results: The children with MLBW tended to have higher skin fold thickness, triglycerides, fasting blood glucose, waistline, body fat and abdominal obesity risks. Birth weight was negatively related to obesity-related outcomes, and the associations were mediated, partially, by increased risk of ADHD or abnormal eating behaviour after adjustment for BMI z-score. Furthermore, lower birth weight predicted higher waist circumference indirectly through emotional overeating caused by ADHD (β: -0.10; 95% CI: -0.19, -0.01). Conclusion: Our study suggests the hypothetical role of ADHD and abnormal eating as underlying mechanisms in the association between MBLW and obesity-related outcomes, which provides novel scientific evidence for interventions of childhood development.

Study on effect of hair coat color on various reproductive attributes of Cholistani service bulls

The objective of the present study was to assess the possible effect of hair coat color on various orchidometric, seminal and andrological attributes of black-coated and brown-coated Cholistani service bulls. Adult Cholistani bulls (n= 8) were grouped as black-spotted (n= 4) and brown-spotted (n=4). Semen collection was performed once weekly (2 ejaculates/collection) using artificial vagina (AV) throughout the study period (October-May). Semen samples were evaluated for various physical attributes. Body weight and orchidometric attributes of the bulls were attained using calipers. Blood sampling was performed twice weekly and serum testosterone level was deduced through automated analyzer. The scrotal circumference, Scrotal Skin Fold Thickness and Paired Testicular Volume were significantly higher (P<0.05) in black-spotted Cholistani bulls as compared to brown-spotted bulls. Similarly, the ejaculatory volume (5.8±0.1 mL) and individual sperm motility (63.3±1.4%) were significantly higher (P<0.05) in black-spotted bulls. Percentage of live spermatozoa, and spermatozoa with normal morphology and acrosome was also higher in black-spotted bulls though statistically non-significant (P>0.05). Amongst post-thaw seminal attributes, percentage of live spermatozoa, and spermatozoa with normal morphology and acrosome were significantly higher (P<0.05) in black-spotted bulls. Similarly, serum testosterone level in black-spotted Cholistani bulls (6.9±0.3 ng/mL) was significantly higher (P<0.05) compared to brown-spotted bulls (5.4±0.3 ng/mL). The black-spotted Cholistani service bulls showed substantially better orchidometric and seminal attributes allied with higher serum level of testosterone.

Circulating irisin levels in preadolescents and adolescents born preterm

Introduction. Prematurity is associated with increased cardiometabolic risk later in life. The adipomyokine irisin has been acknowledged as a modulator of energy metabolism and insulin sensitivity. The aim of this study was to investigate circulating levels of irisin and their relation to anthropometric measurements and cardiometabolic phenotype in a population of preterm-born children vs. full-term-born peers. Methods. A total of 160 children (87 born preterm aged 8.1-14.8 years and 73 born full-term of similar age and gender distribution) were studied. Arterial blood pressure, anthropometry, body composition assessments with dual energy X-ray absorptiometry (DXA) and skin fold measurements were performed. Blood biochemistry and circulating levels of irisin, insulin, cortisol, leptin, and adiponectin were also determined. Results. The preterm group had higher diastolic blood pressure, triceps skin fold, subscapular skin fold (SSF) and abdominal skin fold measurements and more central adiposity than the full-term group. Irisin was significantly lower (p=0.002), whereas leptin was higher (p=0.03), in the preterm than the full-term group. Irisin correlated positively with gestational age (r=0.19, p=0.01), birthweight (r=0.23, p=0.003) and high-density lipoprotein cholesterol (r=0.20, p=0.01), and negatively with SSSF (r=-0.25 p=0.003) and chronological age (r=-0.21, p=0.008). Conclusion. Lower levels of irisin and a slightly unhealthy adiposity and cardiometabolic pattern were detected in preterm-born children in comparison to their full-term-born peers. Whether low irisin levels in preadolescents and adolescents born prematurely could be of prognostic value for the development of cardiometabolic sequelae later in life remains to be further studied.

French Bulldogs differ to other dogs in the UK in propensity for many common disorders: a VetCompass study

Background The French Bulldog is a highly popular dog breed but is linked with many serious health issues. A holistic view of breed health in French Bulldogs would assist efforts to appreciate the overall health strengths and weaknesses in the French Bulldog and to take appropriate steps to mitigate these. Based on random sampling of French Bulldogs and non-French Bulldogs under primary veterinary care during 2016 within the VetCompass Programme, a cohort study design was used to estimate the one-year (2016) period prevalence of the most commonly diagnosed disorders in each group. Risk factor analysis used multivariable logistic regression modelling methods. Results The analysis included 2,781 French Bulldogs and 21,850 non-French Bulldogs. French Bulldogs were younger (1.51 years, IQR 0.86 – 2.77 vs. 4.48 years, IQR 1.94 – 8.14) (p < 0.001) and lighter (12.45 kg, IQR 11.00 – 14.03 versus 13.80 kg, IQR 8.10 – 25.12) (p < 0.001) than non-French Bulldogs. Of 43 common specific-level disorders across both groups, French Bulldogs had significantly increased adjusted odds of 20/43 (46.5 %) disorders and significantly reduced adjusted odds of 11/43 (25.6 %) disorders compared to non-French Bulldogs. Highly predisposed disorders in French Bulldogs included stenotic nares (OR 42.14; 95 % CI 18.50 to 95.99; p < 0.001), Brachycephalic Obstructive Airway Syndrome (OR 30.89; 95 % CI 20.91 to 45.64; p < 0.001), aural discharge (OR 14.40; 95 % CI 9.08 to 22.86; p < 0.001), skin fold dermatitis (OR 11.18; 95 % CI 7.19 to 17.40; p < 0.001) and dystocia (OR 9.13; 95 % CI 5.17 to 16.13; p < 0.001). At a grouped-level of diagnostic precision, French Bulldogs had increased adjusted odds of 12/32 (37.5 %) disorders and reduced adjusted odds of 6/32 (18.8 %) disorders compared to non-French Bulldogs. Conclusions These results identified ultra-predispositions with worryingly higher odds in French Bulldogs for several disorders, suggesting that the health of French Bulldogs has diverged substantially from, and may be lower than, the health of the wider non-French Bulldog population. Many of these predispositions are closely associated with the conformational extremes that define the French Bulldog breed. Shifting the typical conformation of the French Bulldog population towards a more moderate phenotype is proposed as a logical opportunity to reduce the serious health issues endemic in the French Bulldog breed.

Unnecessary Chest Tube for a Hemodialytic Patient with Multiple Trauma: A Case Report

Background Pneumothorax (PTX) is a life-threatening condition that overdiagnosis could result in increases in mortality and morbidity of patients, this overdiagnosis would be increased if physicians do not manage the patient classically and do not pay attention to the physical exam and history of the patient. Case presentation: A-71-year old man was admitted to the emergency department due to multiple trauma. His vital signs were stable and in examination, there were two lacerations on his scalp with venous bleeding source and galea transaction; there were also some abrasions all over his body including his thorax. In the physical exam, there was no sucking lesion, decreases in respiratory sounds in auscultation or chest deformity but he had little right hemithorax rib tenderness. In more evaluations, there was a suspected visceral line of pleura in his CXR and no plural sliding movement was seen in E-FAST by the operator. Due to the inconsistency in physical exam and radiologic findings we decided to take a chest CT-scan before the insertion of the chest tube that indicated no PTX for him and the suspected visceral line in CXR was skin fold of a permacath for hemodialysis. Conclusions Several conditions could mimic findings of PTX in CXR that every physician should know and pay attention to them besides special attention to the history taking and physical examination to reduce the mortality and morbidity of patients.

Assessment of Nutritional Status between Children with Autism Spectrum Disorder and Normal Children of Bangladesh

Background : Autism is one of the fastest spreading neuro-developmental disorders in the worldwide.Children with Autism spectrum disorder may be risk of suboptimal development which leads to increases morbidity, poor physical activity and performances. The aim of present study was to compare nutritional status between children with Autism spectrum disorder and normal children of Bangladesh. Materials and methods: It was cross-sectional and observational study. The study population was Group A consists of 100 normal Bangladeshi children and Group B consists of 100 Bangladeshi children with Autism spectrum disorder, aged between 02 and 18 years collected by convenient sampling. Height, weight, triceps skin fold thickness, suprailiac skin fold thickness and Body Mass Index (BMI) were analyzed. Results: Children with autism spectrum disorder had statistically significant lower height and weight; thicker triceps and suprailiac skin fold, were mostly under weight as compared to normal children. Conclusion: The results of this study provide the baseline information about nutritional status of normal children and children with autism spectrum disorder in Bangladesh which will help to monitor nutritional growth of children. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 55-59

Effects of Insulin on Gestational Pima Indian Heritage Females

Diabetes and obesity reach epidemic proportions all over the world, while the effects of insulin resistance and its consequences are gaining prominence. The article derives the effects of insulin on gestational Pima Indian heritage females with minimum 21 years old. It is identified herein that mean insulin level for gestational women (GW) is positively linked with glucose level (P=0.0055), while it is negatively linked with age (P=0.0095). Mean insulin level for GW is independent of pregnancies (P=0.1866) and diabetes pedigree function (DPF) (P=0.5321), while it is partially positively linked with their joint interaction effect Pregnancies*DPF (P=0.0864). It is positively linked with blood pressure (BP) (P<0.0001) and triceps skin-fold thickness (TST) (P<0.0001), while it is negatively linked with the joint interaction effects BP*TST (P<0.0001) and DPF*TST (P<0.0001). In addition, mean insulin level is negatively linked with body mass index (BMI) (P=0.0001), while it is positively partially linked with the interaction effect BMI*DPF (P=0.1312). Variance of insulin level is positively linked with pregnancies (P=0.0184) and age (P=0.0027), while it is negatively linked with their joint interaction effect Pregnancies*Age (P=0.0418). Also variance of insulin level is partially negatively linked with BMI (P=0.0738) and glucose level (P=0.1439), while it is partially positively linked with their joint interaction effect BMI*Glucose (P=0.1472). Further, variance of insulin level is negatively linked with DPF (P=0.0309). It is concluded that for GW, insulin level increases with the increase of glucose level, BP, TST, and the interaction effects Pregnancies*DPF & BMI*DPF, and it decreases with the increase age, BMI, and the interaction effects BP*TST & DPF*TST. GW should be careful on her glucose level, BMI, BP & TST.