Screening for Gestational Diabetes during the COVID-19 Pandemic-Current Recommendations and Their Consequences.

Gestational diabetes mellitus (GDM) is recognized as one of the most common medical complications of pregnancy that can lead to significant short-term and long-term risks for the mother and the fetus if not detected early and treated appropriately. Current evidence suggests that, with the use of appropriate screening programs for GDM, those women diagnosed and treated have reduced perinatal morbidity. It has been implied that, when screening for GDM, there should be uniformity in the testing used and in further management. This paper summarizes and compares current screening strategies proposed by international bodies and discusses application in the context of the COVID-19 pandemic.

Clinical frailty score as an independent predictor of outcome in COVID-19 hospitalised patients.

PURPOSE OF THE STUDY: We explored potential predictive variables associated with outcomes using baseline clinical parameters of 500 hospitalised patients with COVID -19 in a single centre, UK. METHODS: Retrospective study collecting demographic and clinical characteristics of patients admitted at Southend University Hospital from 20th February to 7th May 2020. RESULTS: The mean age of the cohort admitted to hospital with Covid-19 was 69.4 and 58% were over 70. Comorbidities were more frequently observed in non-survivors, whose mean Clinical Frailty Scale was significantly higher (5 vs 3) than survivors, p < 0.001. In addition, mean C-reactive protein was significantly higher. CONCLUSION: Older and frailer patients with high inflammatory markers were at risk of poor outcomes. Integrated frailty and age-based risk stratification is essential, in addition to monitoring saturation /FiO2 ratio (SFR) and inflammatory markers throughout the disease course to allow for early intervention to improve patient outcomes. A frailty-based risk-stratification approach, rather than age may prove more valuable when considering interventions in patients with multiple comorbidities.

The Association between Insulin Resistance and Proliferative Retinopathy in Type 1 Diabetes.

INTRODUCTION: Little is known about the relationship between insulin resistance and proliferative diabetic retinopathy in type 1 diabetes. The aim of this article is to explore the relationship between sight-threatening proliferative diabetic retinopathy and insulin resistance. METHODS: This was a cross-sectional study that included 167 type 1 diabetes patients. Insulin resistance was assessed using eGDR (estimated glucose disposal rate) formula. Diabetic retinopathy was assessed by ophthalmoscopy using Early Treatment Diabetic Retinopathy classification. The association between eGDR and proliferative diabetic retinopathy was assessed in uni- and multivariate models using stepwise logistic regression of covariates. The contribution of individual predictors in the final regresion model was examined using Wald statistic. RESULTS: Significantly lower eGDR's values were observed in patients with proliferative diabetic retinopathy: 5.5 vs. 7 (p = 0.002). The results remained significant (p < 0.001) after adjusting for multiple covariates (sex, diabetes duration, body mass index, HDL cholesterol, LDL cholesterol, triglycerides, smoking). eGDR variable was retained in the final model of stepwise logistic regression (p < 0.001) and showed the strongest association with proliferative diabetic retinopathy (Wald= 12.73). CONCLUSIONS: In type 1 diabetes patients insulin resistance was the most important independent risk factor associated with diabetic proliferative retinopathy.

Precursor and interstitial Cajal cells in the human embryo liver.

Interstitial Cajal Cells (ICCs) were only proven in human adult hepatic tissue. The immune phenotypes of various cell types in the human embryonic liver (HEL) are scarcely described. It was hypothesized that in HEL ICCs are present and distinctive to the precursor/progenitor cells populations. It was aimed and performed a qualitative study of HEL by use of antibodies against CD117/c-kit, CD31, CD34, CD90, CD105, DOG1, Ki67, and adiponectin. Five human embryos of 23-29 mm were used. Blasts and hematopoietic cells were comprising the two major cell populations in late stage embryos. The general population of blasts in the HEL was CD34-/CD105, although scarce CD117/c-kit+ and CD90+ such cells were found. Hematopoietic precursors were Ki67+. Adiponectin-positive plasmalemmas were found mostly in blasts. Endothelia were CD31+/CD34+. Interstitial cells with moniliform prolongations were found; such cells were scarcely CD117/c-kit+ but consistently DOG1+. They were diagnosed as ICCs but based on the morphology of their prolongations they can be equally viewed as being telocytes (TCs). Further studies should better correlate the precursor cell-types and immune phenotypes during human liver organogenesis. Liver ICCs and/or TCs should be also investigated in the human fetal liver.