scholarly journals Gestational Diabetes Mellitus: Clinical Characteristics and Perinatal Outcomes in a Multiethnic Population of North Italy

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
M. Caputo ◽  
V. Bullara ◽  
C. Mele ◽  
M. T. Samà ◽  
M. Zavattaro ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Clinical Characteristics ◽  
Insulin Treatment ◽  
Dietary Habits ◽  
Nutrition Transition ◽  
Previous History ◽  
Perinatal Outcomes ◽  
Nutritional Intervention ◽  
Maternal Complications ◽  
History Of

Aim. To evaluate clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasians born in Italy and High Migration Pressure Countries (HMPC) women with GDM living in Piedmont, North Italy. Methods. We retrospectively analyzed data from 586 women referring to our unit (2015–2020). Epidemiological (age and country of origin) and clinical-metabolic features (height, weight, family history of DM, parity, previous history of GDM, OGTT results, and GDM treatment) were collected. The database of certificates of care at delivery was consulted in relation to neonatal/maternal complications (rates of caesarean sections, APGAR score, fetal malformations, and neonatal anthropometry). Results. 43.2% of women came from HMPC; they were younger p < 0.0001 and required insulin treatment more frequently than Caucasian women born in Italy (χ2 = 17.8, p = 0.007 ). Higher fasting and 120-minute OGTT levels and gestational BMI increased the risk of insulin treatment (OGTT T0: OR = 1.04, CI 95% 1.016–1.060, p = 0.005 ; OGTT T120: OR = 1.01, CI 95% 1.002–1.020, p = 0.02 ; BMI: OR = 1.089, CI 95% 1.051–1.129, p < 0.0001 ). Moreover, two or more diagnostic OGTT glucose levels doubled the risk of insulin therapy (OR = 2.03, IC 95% 1.145–3.612, p = 0.016 ). We did not find any association between ethnicities and neonatal/maternal complications. Conclusions. In our multiethnic GDM population, the need for intensive care and insulin treatment is high in HPMC women although the frequency of adverse peripartum and newborn outcomes does not vary among ethnic groups. The need for insulin therapy should be related to different genetic backgrounds, dietary habits, and Nutrition Transition phenomena. Thus, nutritional intervention and insulin treatment need to be tailored.

scholarly journals A study of feto-maternal outcome in bleeding per vaginum in first trimester of pregnancy

2020 ◽  
Vol 9 (3) ◽  
pp. 1191
Author(s):  
Jaydeep J. Bhatu ◽  
Darshil S. Prajapati
Keyword(s):  
Vaginal Bleeding ◽  
Local Population ◽  
Previous History ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Maternal Complications ◽  
History Of ◽  
Threatened Abortion ◽  
Degree Of Association ◽  
In Pregnancy

Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.

scholarly journals Pregnancy with previous caesarean section: an overview of adverse fetomaternal sequelae

2018 ◽  
Vol 7 (5) ◽  
pp. 1817 ◽  
Author(s):  
Joyita Bhowmik ◽  
Amit Kyal ◽  
Indrani Das ◽  
Vidhika Berwal ◽  
Pijush Kanti Das ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Previous History ◽  
Successful Outcome ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Medical College ◽  
Increased Risk ◽  
Fetal Complications ◽  
History Of

Background: The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. The purpose of this study was to evaluate adverse maternal and fetal complications associated with pregnancies with history of previous caesarean section.Methods: A cross-sectional, observational study carried out over a period of 1 year from 1st June 2016 to 31st July 2017 in Medical College Kolkata. 200 antenatal patients with previous history of 1 or more caesarean sections were included. In all cases thorough history, complete physical and obstetrical examination, routine and case specific investigations were carried out and patients were followed till delivery and for 7 days thereafter. All adverse maternal and fetal complications were noted.Results: Out of 200 women, 30 candidates were tried for VBAC, of them 20 (66.66%) had successful outcome. Most common antenatal complication was APH (5.5%) due to placenta praevia followed by scar dehiscence. There were 12 cases (6.66%) of PPH and 6 cases (3.33%) of scar dehiscence in the study group. 3 cases required urgent hysterectomy due to placenta accreta. 42 out of 196 babies required management in SNCU immediately or later after birth.Conclusions: Women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counselling for trial of labor and proper antepartum and intrapartum monitoring of patients are key to reducing the cesarean section rates and maternal complications.

Bilateral diabetic papillopathy developed after starting insulin treatment. Potential toxic effect of insulin? A case report

2020 ◽  
pp. 112067212098438
Author(s):  
Marco Mafrici ◽  
Laura Toscani ◽  
Umberto Lorenzi
Keyword(s):  
Diabetic Retinopathy ◽  
Optic Nerve ◽  
Insulin Therapy ◽  
Rare Case ◽  
Insulin Treatment ◽  
Brain Magnetic Resonance Imaging ◽  
Diabetic Patients ◽  
Ischemic Optic Neuropathy ◽  
History Of ◽  
Hypoglycemic Therapy

Background: Diabetic papillopathy is a complication of diabetes. It presents with edema, uni or bilateral and vascular alteration of the anterior optic nerve. Often this complication is observed in patients with severe diabetic retinopathy, but is rarely observed in isolated form. Some authors believe that diabetic papillitis is a particular form of non-arteritic anterior ischemic optic neuropathy (NAION). But there is important evidence that confers an inflammatory component to diabetic papillopathy. We report in this work a rare case of isolated acute bilateral diabetic papillopathy developed in a diabetic patient after adding the insulin to the oral hypoglycemic therapy. Case presentation: Male patient, 49-years-old, diabetic type 2, with altered glycemia at follow up, with clinical history of HbA1c 8% to 12% in the last 2 years, on oral hypoglycemic therapy for 10 years. He never had a history of diabetic retinopathy. At the last check-up, this patient presented bilateral papillopathy, without reduction of visual acuity bilaterally. The patient reports he added 10 days before the insulin therapy to the oral hypoglycemic therapy, under medical supervision. Hematochemical and serological tests were requested, which excluded the presence of inflammatory and infectious diseases. The brain magnetic resonance imaging (MRI) with gadolinium excluded the hypothesis of optic neuritis or intracranial hypertension. Cardio-circulatory tests were normal. Fluorescein angiographic examinations and optical coherence tomography (oct) confirmed the bilateral edema and the thickening of optic nerve without other retinal damage. Therefore he was diagnosed with bilateral diabetic papillopathy. Then, diabetologists added pump insulin treatment to the oral hypoglycemic therapy. After 2 months, his blood sugar levels and HbA1C improved and papillopathy regressed. Conclusion: We have reported a rare case of bilateral acute diabetic papillopathy associated with the addition of insulin to the oral hypoglycemic therapy. A randomized control study with diabetic patients, would be useful to verify the possible injuries of the optic nerves during the delicate transition to insulin therapy.

scholarly journals Perioperative risk factors for occurrence of myasthenia gravis after thymectomy in patients with thymoma

2020 ◽  
Vol 31 (4) ◽  
pp. 519-526
Author(s):  
Xin Zhang ◽  
Bin Li ◽  
Jianyong Zou ◽  
Chunhua Su ◽  
Haoshuai Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myasthenia Gravis ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Previous History ◽  
Tumour Resection ◽  
History Of ◽  
Independent Risk Factors ◽  
The Relationship

Abstract OBJECTIVES The goal of this study was to identify the relationship between clinical characteristics and the occurrence of postoperative myasthenia gravis (PMG) in patients with thymomas and to further identify the relationship between PMG and prognosis. METHODS Thymoma patients who had surgery at the First Affiliated Hospital of Sun Yat-sen University between July 2004 and July 2016 were reviewed and those who had no previous symptoms of myasthenia gravis were selected for further investigation. In total, 229 patients were included in the study; their clinical characteristics were gathered and analysed. RESULTS Among the 229 patients, 19 (8.3%) had PMG. The time between the operation and the onset of myasthenia gravis was 134 days on average (range 2–730 days). Patients experiencing PMG showed a lower rate of complete thymoma resection (73.7% vs 91.4%; P = 0.014) and total thymectomy (63.2% vs 82.9%; P = 0.035) compared with those who did not. Univariable and multivariable logistic regression revealed that thymomectomy [odds ratio (OR) 2.81, 95% confidence interval (CI) 1.02–7.77; P = 0.047] and incomplete tumour resection (OR 3.79, 95% CI 1.20–11.98; P = 0.023) were associated with the occurrence of PMG. Multivariable Cox regression showed that the PMG was not related to overall survival (P = 0.087). CONCLUSIONS This study revealed that incomplete tumour resection and thymomectomy were independent risk factors for PMG in thymoma patients with no previous history of myasthenia gravis.

scholarly journals A meta-analysis of 2019 novel corona virus patient clinical characteristics and comorbidities

2020 ◽  
Author(s):  
Subodh Sharma Paudel
Keyword(s):  
High Risk ◽  
Clinical Characteristics ◽  
English Language ◽  
Meta Analysis ◽  
Previous History ◽  
Female Ratio ◽  
Number Of Patients ◽  
New Variant ◽  
History Of ◽  
Male To Female

Abstract IntroductionBeing a new variant of coronavirus, detailed information regarding the virulence, its clinical characters, high risk individuals are yet to be defined. This study was done with the objective of finding out clinical features of corona infection and also studies what are the comorbidities that are associated with it.MethodsThis is a single arm meta-analysis in which relevant data were derived from searches in PubMed. It includes study papers which were written in English language and their completely published article is found. Seven articles published from 24th Jan to 16th March, 2020 are included in this study. ResultsThe total number of patients was 1786 with 1044 males and 742 females with male to female ratio of 1.4:1. The median age of patients was 41 years). Fever was present in 88.8% cases. Dry Cough in 68% followed by fatigue in 33%. Hypertension (15.8%) is the most common comorbidity followed by cardio and cerebrovascular condition (11.7%). ConclusionPatients often presented with symptoms of fever, dry cough, lethargy and fatigue, muscle pain, productive cough. Similarly, patients with previous history of HTN, DM, COPD, cardio and cerebrovascular condition, immune-deficient states are at high risk of developing into the severe COVID-19 infection.

scholarly journals EP09 COVID-19 and rheumatic disease clinical characteristics and outcomes of rheumatic disease patients hospitalised with COVID-19: a single centre experience

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Myrto Cheila ◽  
Ali Elrashid ◽  
Nicola Erb ◽  
Karen Douglas ◽  
Christos Koutsianas
Keyword(s):  
Case Report ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
Fatal Outcome ◽  
Previous History ◽  
True Incidence ◽  
Viral Spread ◽  
Increased Risk ◽  
History Of

Abstract Case report - Introduction There is limited evidence on the outcomes of COVID-19 in patients with rheumatic diseases. Since severe COVID-19 is characterised by hyperinflammation, the effects of a pre-existing inflammatory state and immunomodulatory treatments on the disease’s course are of great interest. Even though patients in this group are perceived of being at higher risk for severe disease, most of the relevant observational studies have had controversial results. We aimed to investigate the clinical characteristics and outcomes of patients with a history of rheumatic disease and COVID-19 related admission in our centre. Case report - Case description We conducted a retrospective observational study of COVID-19 RT-PCR positive admissions of patients coded as having rheumatic disease in the Dudley Group NHS Foundation Trust between April 1st and June 24th, 2020. Data were extracted from the patient clinical notes and electronic medical records and were captured and analysed on MS Excel. Among 613 COVID-19 related admissions, 19 (3.1%) patients were coded as having comorbid rheumatic disease. 8 cases were excluded from further analysis as, upon records review, they had osteoarthritis or a history of gout. Thus, the true incidence of comorbid rheumatic disease among COVID-19 related hospitalisations was even lower at 11/613 (1.8%). The mean age of the patients was 80.5 ± 8.06 years, 9/11 (81.8%) were female and 8/11 (73%) were Caucasian. In the vast majority the diagnosis was that of Rheumatoid Arthritis (9/11, 81.8%), while one patient had Polymyalgia Rheumatica and another Systemic Lupus Erythematosus. Only a quarter of the patients had moderate (2, 18%) or high (1, 9%) disease activity on their most recent outpatient visit. In terms of antirheumatic medication, 5 (45%) patients were on regular Prednisolone (20% &lt;5mg, 80% 5-10mg), 8 (72%) were on cs DMARDs and only 1 (9%) on bDMARDs. A substantial proportion of the patient cohort also suffered with other comorbidities. 8/11 (72.7%) patients had arterial hypertension, 5 (45.4%) had a history of cardiovascular disease, 3 (27.3%) obesity (BMI 30+), 3 (27.3%) previous history of cancer, 2 (18.2%) COPD, 2 (18.2%) CKD, 1 (9%) Interstitial lung disease, 1 (9%) Diabetes, 1 (9%) Cerebrovascular disease and 1 (9%) immunodeficiency. During their admission, 7 (63.6%) patients required supplemental oxygen therapy. Unfortunately, 5/11 (45.5%) patients had a fatal outcome. Case report - Discussion In our cohort, the percentage of patients with rheumatic diseases among inpatients with confirmed COVID-19 infection was low (∼1.8%). Potential explanations for this observation could be a beneficial effect of concomitant antirheumatic treatment (steroids and/or DMARDs) in controlling hyperinflammation, but also rheumatic disease patients’ increased risk awareness and thus increased compliance with viral spread mitigation measures (‘shielding’) as per Government guidelines. We also note the low rate of biologic DMARD use with only 1 (9%) inpatient having received Rituximab for RA. Case report - Key learning points The incidence of rheumatic disease among COVID-19 related admissions in our centre was exceptionally low. Per recently published reports from worldwide registries, older age and multiple comorbidities appear to drive the risk for hospitalisation, need for oxygen supplementation and fatal outcome. Better understanding of the effect of DMARDs on COVID-19 severity requires further investigation, perhaps with SARS-CoV-2 antibody studies, but our observations appear to be reassuring.

scholarly journals Chocolate consumption and risk of gestational diabetes mellitus: the Japan Environment and Children’s Study

2019 ◽  
Vol 122 (8) ◽  
pp. 936-941 ◽  
Author(s):  
Jia-Yi Dong ◽  
Takashi Kimura ◽  
Satoyo Ikehara ◽  
Meishan Cui ◽  
Yoko Kawanishi ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Lower Risk ◽  
Dietary Habits ◽  
Smoking Status ◽  
Economic Status ◽  
Previous History ◽  
Dietary Factors ◽  
Drinking Status ◽  
History Of ◽  
Prospective Association

AbstractThe association of chocolate consumption with risk of gestational diabetes has not been examined. We aimed to investigate the prospective association between chocolate consumption and risk of gestational diabetes in a large birth cohort in Japan. A total of 97 454 pregnant women with a median gestational age of 12 weeks were recruited from January 2011 to March 2014. Data on demographic information, disease history, socio-economic status, lifestyle and dietary habits were obtained at the study enrolment. Dietary intake during the past 12 months before study enrolment was assessed through a semi-quantitative FFQ. The logistic regression was used to obtain the OR of gestational diabetes in relation to chocolate consumption. Among 84 948 women eligible for the analysis, 1904 cases of gestational diabetes (2·2 %) were identified during the period of pregnancy. After controlling for potential confounding factors including age, smoking status, drinking status, education level, occupation, pre-pregnant BMI, depression, previous history of macrosomia babies, parity, physical activity and dietary factors, women in the highest quartile of chocolate consumption, compared with those in the lowest quartile, had a significantly lower risk of developing gestational diabetes (OR 0·78, 95 % CI 0·67, 0·90; P for trend = 0·002). Stratified analyses suggested that the association was not significantly modified by pre-pregnancy BMI, age, parity, smoking status or drinking status. The present prospective cohort study provided evidence that chocolate consumption was associated with a significant lower risk of gestational diabetes in Japanese women.

scholarly journals Study on prevalence of prelabour rupture of membranes and its maternal and fetal outcomes

2021 ◽  
Vol 10 (11) ◽  
pp. 4163
Author(s):  
Mamatha Poondru ◽  
R. Kala ◽  
A. Kumar
Keyword(s):  
Risk Factors ◽  
Tamil Nadu ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Previous History ◽  
Active Management ◽  
Normal Vaginal Delivery ◽  
Maternal Complications ◽  
Cross Sectional ◽  
History Of

Background: The aim is to study the prevalence of prelabour rupture of the membranes (PROM), to identify risk factors, mode of delivery, and its maternal and fetal effects.Methods: This was a cross-sectional study conducted in the department of obstetrics and gynaecology at Government Head Quarters Hospital, Cuddalore, Tamil Nadu, with a duration of 6months (January 2020 – June 2020). The study was conducted on 800 pregnant women between 28-42 weeks of gestational age consecutively and those who met the inclusion and exclusion criteria were taken into study.Results: The prevalence of PROM was 27.9% (tPROM 24.6% and PPROM 3.2%). Most of the cases were primigravida (74%). Risk factors associated with PROM were low socioeconomic state (63.2%), urinary tract infection (UTI) (7.2%), vaginal infections (5.8%), and previous history of PROM (3.1%). Most of the patients were delivered by lower segment caesarean section (LSCS) (55.2%), normal vaginal delivery (39.9%) and forceps delivery (4.9%). The most common indication for LSCS was fetal distress (43.9%). Misoprostol induction was associated with more failed induction (2 times) than syntocinon. Maternal complications were post-partum haemorrhage (PPH) (8%), fever (6.7%), wound infection (6.2%), manual removal of placenta (4.4%), and puerperal sepsis (0.9%). Neonatal complications were neonatal intensive care unit (NICU) admissions (14%), respiratory distress syndrome (RDS) (11%), neonatal sepsis (2.6%). Maternal (54.5%) and neonatal (90%) morbidity were more in prolonged PROM >24 hours.Conclusions: Antenatal screening for genitourinary infections especially in cases of the previous history of abortions and PROM should be done. Oxytocin is the preferred method of induction over misoprostol in this study. Active management in term PROM cases can reduce the cesarean section rate.

scholarly journals Patients with a Previous History of Malignancy Undergoing Lung Cancer Screening: Clinical Characteristics and Radiologic Findings

2016 ◽  
Vol 11 (9) ◽  
pp. 1447-1452 ◽  
Author(s):  
Darragh F. Halpenny ◽  
Jane D. Cunningham ◽  
Niamh M. Long ◽  
Ramon E. Sosa ◽  
Michelle S. Ginsberg
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Clinical Characteristics ◽  
Previous History ◽  
Lung Cancer Screening ◽  
Radiologic Findings ◽  
History Of

scholarly journals Planned versus emergency cesarean delivery with previous one cesarean section: a prospective observational study

2018 ◽  
Vol 7 (10) ◽  
pp. 4223
Author(s):  
Partha P. Sharma ◽  
Dipak K. Giri ◽  
Surendra N. Bera
Keyword(s):  
Blood Transfusion ◽  
Cesarean Section ◽  
Prospective Observational Study ◽  
Previous History ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Maternal Complications ◽  
Risk Pregnancy ◽  
Emergency Cesarean ◽  
History Of

Background: Women presents with previous history of cesarean section (CS) is a ‘high risk pregnancy’ and requires regular antenatal check-ups. Planned CS at term done for perinatal interest. Post cesarean pregnancy admitted through emergency required direct CS, for those not fit for vaginal birth as per different guidelines. Main objective of this study is to know neonatal and maternal outcome at term for planned versus emergency CS with previous one CS.Methods: Planned or emergency CS were done in 1003 pregnant women at term with previous one CS and outcome of both neonatal and maternal were noted. Emergency CS done in failed VBAC women were excluded from the study.Results: Planned CS before onset of labor were done in 22.93% and emergency CS in 77.07% in the present study. A significant number of women has undergone planned CS in cephalo-pelvic disproportion (45.21%), contracted pelvis (24.34%) and fetal growth restriction (6.95%) where P=0.000. Scar tenderness (20.18%), fetal distress (16.04%) and cephalo-pelvic disproportion (15.52%) were major indications for emergency CS. Maternal complications in the emergency CS group were pyrexia (P=0.000) and blood transfusion, required in 1.81% (P=0.000). There were two maternal death and hysterectomy required in 0.38% in the emergency CS compared to 1.30% in the planned CS (P=0.274). Neonatal complications were significant(P=0.018) in the emergency CS group. Common complications were jaundice (2.84% versus 1.73%, P=0.489), sepsis (0.25% versus 0.86%, P=0.487) and early neonatal death (2.97% versus 0.86%, P=0.119) in emergency CS compared to planned CS.Conclusions: Neonatal morbidity and mortality were significant in the emergency CS, compared to planned CS. Pyrexia and blood transfusion were significant maternal morbidity in the emergency CS group.

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