Background
Medullary thyroid carcinoma (MTC) has varying clinical course with familial cases (fMTC) diagnosed earlier than sporadic MTC (spMTC).
Methods
A total of 273 MTCs (familial: n = 110 40.3%, ...males: 38.5%) were followed for 1‐35 years (median 5.0 years). Fifty one of the familial cases were operated because of positive findings at genetic screening. Disease extent at diagnosis and follow‐up was recorded.
Results
Mean age at diagnosis was: fMTC = 33.85 ± 16.5 years (range 4‐74) and spMTC = 52.6 ± 14.0 years (range 16‐81, P < .001). This difference remained when genetic screening cases were excluded. fMTCs had more frequently multifocality, smaller size, and more favorable stage at diagnosis (stages I and II: 60.9% vs 47.9%, stage III: 30.0% vs 23.9%, stage IV: 9.1% vs 28.9%, P = .01). fMTC had lower preoperative and postoperative calcitonin, more frequently remission (59.1% vs 47.2%) and less frequently progressive disease (8.2% vs 35.0%, P < .001). After excluding genetic screening cases, no difference in stage at diagnosis was observed. Outcome was more favorable in fMTC compared to sporadic (P = .002); the 10‐year probability of lack of progression of disease differed significantly between fMTCs and spMTCs (86.4% vs 65.0%, P < .001).
Conclusion
After excluding genetic screening cases, although stage at diagnosis is similar, disease outcome remains worse in sporadic compared to fMTCs.
Purpose
The objective of this retrospective study was to compare glycemic control, pregnancy outcomes, and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with (a) insulin ...detemir and (b) insulin neutral protamine Hagedorn (NPH).
Methods
A total of 192 women with GDM were included in the analysis. Ninety-eight women received detemir, while 94 women received NPH. Data regarding medical history, glycemic control, and time and mode of delivery, as well as neonatal outcomes, were recorded.
Results
Baseline characteristics were comparable between the two groups. There were no differences with respect to the week of insulin initiation, total insulin dose, duration of insulin therapy, daily insulin dose/weight in early and late pregnancy, or the number of insulin injections per day
.
Maternal overall weight gain during pregnancy and weight gain per week did not differ either. The detemir group had slightly lower HbA1c levels at the end of gestation median: det 5.2% (33 mmol/mol) vs NPH 5.4% (36 mmol/mol),
p
=0.035). There were no cases of hypoglycemia or allergic reactions in the two groups. There were also no differences regarding neonatal outcomes according to the available data, given that data in some cases were missing.
Conclusion
The use of insulin detemir was found to be equally effective and safe compared to NPH in women with GDM.
To analyze the relationship between smoking and the risk of GDM, as well as with the OGTT profile during pregnancy.
A total of 7437 pregnant women were studied. OGTT was performed at the 3rd ...trimester. Women were categorized as non-smokers (A), as those who ceased smoking at pregnancy (B), and as smokers (C).
5434 (73.1%) women were group A, 1191 (16%) group B and 812 (10.9%) group C. The rates of GDM among the groups were: A 33.7%, B 34.2%, C 34.2% (ns). However, the number of individuals requiring insulin treatment was significantly different: A 39.2%, B 47.5%, C 50.6% (p < 0.001). Regarding OGTT, fasting glucose levels were significantly higher in group C (89 ± 13 vs 86 ± 12 mg/dl) compared to A, whereas 3-h glucose values were significantly lower (104 ± 33 vs 112 ± 32 mg/dl) (p < 0.001). Group B demonstrated intermediate glucose concentrations. Similar findings were observed in women without GDM. In women with GDM, higher 1-h glucose levels were measured in group C (210 ± 31 vs 205 ± 28 mg/dl) compared with A (p = 0.024). Further, group C sub-analysis found that those who smoked more than 10 cigarettes showed significantly lower 3-h glucose levels (111 ± 31 vs 128 ± 40 mg/dl) compared to those who smoked less than 10 (p = 0.006). HbA1c in women with GDM was higher in group C (4.6 ± 0.6 vs 4.5 ± 0.6%) compared with A (p = 0.027).
The present study did not show any correlation between smoking and GDM risk. However, OGTT profile and HbA1c differed according to smoking status in women with and without GDM.
Abstract Purpose To evaluate whether there is an association between age at menarche (AAM) and the risk of gestational diabetes mellitus (GDM). Methods A retrospective cohort study was conducted, ...including 5390 pregnant women who were screened for GDM at Alexandra Hospital in Athens, Greece over a 15-year period (2000–2014). Maternal age, pre-pregnancy body mass index (BMI), height, family history of type 2 diabetes mellitus, parity, educational and smoking status, and AAM were recorded. The results were expressed as odds ratios (OR) with a 95% confidence interval (95% CI). Results Pregnant women with GDM experienced earlier menarche compared to normoglycemic women (12.9 ± 1.5 vs 13.1 ± 1.6, p < 0.001, respectively). The OR for a woman with AAM <12 years to develop GDM was 1.08 (95% CI 1.03–1.14), while the OR to be obese was 1.70 (95% CI 1.50–1.90). The multivariate logistic regression analysis showed that AAM is a risk factor for GDM. However, that effect was lost after adjusting for BMI. Conclusion Early AAM may be associated with an increased risk of GDM. Therefore, it can be used to identify high-risk women and implement preconception interventions for GDM prevention. Future studies should be conducted to confirm these findings.
Societal Healing in Rwanda LORDOS, ALEXANDROS; IOANNOU, MYRIA; RUTEMBESA, EUGÈNE ...
Health and human rights,
06/2021, Letnik:
23, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The genocide against the Tutsi in Rwanda left the country almost completely devastated, with tremendous consequences for mental health, social cohesion, and livelihoods. In the aftermath of such ...extreme circumstances and human rights violations, societal healing should be conceptualized and approached based on a multisystemic framework that considers these three sectors—mental health, social cohesion, and livelihoods—as well as their interactions. The aims of the present study are twofold: (1) to review evidence on multisystemic healing initiatives already applied in Rwanda using fieldwork notes from interviews and focus groups, alongside relevant scholarly and gray literature, and (2) to propose ascalable multisystemic framework for societal healing in Rwanda that builds on existing innovations. Within a participatory action research methodology, we used a grounded theory approach to synthesize fieldwork findings and compare them with literature to generate a set of principles for multisystemic recovery in Rwanda. Recognizing the strengths and limitations of the current mental health system and other initiatives, including sociotherapy and collaborative livelihood projects, we propose a scalable and rights-based multisystemic approach for recovery and resilience that would target mental health, social cohesion, and sustainable livelihoods within an integrative cross-sectoral framework, thus reducing the risk of post-genocide conflict.
To compare the risk of severe adverse pregnancy complications in women with preexisting diabetes.
Multinational, prospective cohort study to assess the prevalence of newborns free from major ...congenital malformations or perinatal or neonatal death (primary end point) following treatment with insulin detemir (detemir) versus other basal insulins.
Of 1,457 women included, 727 received detemir and 730 received other basal insulins. The prevalence of newborns free from major congenital malformations or perinatal or neonatal death was similar between detemir (97.0%) and other basal insulins (95.5%) (crude risk difference 0.015 95% CI -0.01, 0.04; adjusted risk difference -0.003 95% CI -0.03, 0.03). The crude prevalence of one or more congenital malformations (major plus minor) was 9.4% vs. 12.6%, with a similar risk difference before (-0.032 95% CI -0.064, 0.000) and after (-0.036 95% CI -0.081, 0.009) adjustment for confounders. Crude data showed lower maternal HbA
during the first trimester (6.5% vs. 6.7% 48 vs. 50 mmol/mol; estimated mean difference -0.181 95% CI -0.300, -0.062) and the second trimester (6.1% vs. 6.3% 43 vs. 45 mmol/mol; -0.139 95% CI -0.232, -0.046) and a lower prevalence of major hypoglycemia (6.0% vs. 9.0%; risk difference -0.030 95% CI -0.058, -0.002), preeclampsia (6.4% vs. 10.0%; -0.036 95% CI -0.064, -0.007), and stillbirth (0.4% vs. 1.8%; -0.013 95% CI -0.024, -0.002) with detemir compared with other basal insulins. However, differences were not significant postadjustment.
Insulin detemir was associated with a similar risk to other basal insulins of major congenital malformations, perinatal or neonatal death, hypoglycemia, preeclampsia, and stillbirth.
Aims/hypothesis
The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational ...(pre-existing) diabetes mellitus.
Methods
A systematic literature review was completed to identify all outcomes reported in prior studies in this area. Key stakeholders then prioritised these outcomes using a Delphi study. The list of outcomes included in the final COS were finalised at a face-to-face consensus meeting.
Results
In total, 17 outcomes were selected and agreed on for inclusion in the final COS. These outcomes were grouped under three domains: measures of pregnancy preparation (
n
= 9), neonatal outcomes (
n
= 6) and maternal outcomes (
n
= 2).
Conclusions/interpretation
This study identified a COS essential for studies evaluating prepregnancy care for women with pregestational diabetes. It is advocated that all trials and other non-randomised studies and audits in this area use this COS with the aim of improving transparency and the ability to compare and combine future studies with greater ease.
Abstract Aims Recently a relationship between circadian clock function and the risk for type 2 diabetes (T2D) has been shown. BMAL1 is a key component of the mammalian molecular clock. Two SNPs in ...the BMAL1 gene have been identified to confer T2D susceptibility. In the present study we investigated for the first time the association between the BMAL1 gene and the risk for GDM, in a Greek population. Methods We studied 185 women with GDM and 161 non-diabetic controls for BMAL1 polymorphisms. For BMAL1 mRNA expression, peripheral leukocytes were harvested from 20 GDM and 20 control women, harboring different genotypes for the tested polymorphisms, using real-time quantitative PCR. Results The minor allele (A) of the BMAL1 rs7950226 (G > A) polymorphism was found to be significantly associated with an increased risk of GDM ( P = 0.025). Analysis of the second BMAL1 rs11022775 (T > C) polymorphism, showed that the C-allele frequency was strongly increased in women with GDM ( P = 4.455e−06). The CC genotype was also significantly overrepresented in GDM vs. controls ( P = 0.00001). Additionally, the rs7950226G/rs11022775C and rs7950226A/rs11022775C haplotypes were also found to be associated with increased susceptibility to GDM. Furthermore, the expression levels of BMAL1 mRNA were significantly lower in GDM patients than in controls. Conclusion These data suggest that the impairment of the BMAL1 clock gene expression is closely associated with GDM susceptibility.
PDF
