Chromosomal microarray mapping suggests a role for BSX and Neurogranin in neurocognitive and behavioral defects in the 11q terminal deletion disorder (Jacobsen syndrome).

We performed a prospective analysis on 14 11q- patients to determine the relationship between the degree of cognitive impairment and relative deletion size. Seventeen measures of cognitive function were assessed. All nine patients with a deletion of at least 12.1 Mb had severe global cognitive impairment, with full-scale IQ <50, whereas all five patients with smaller deletions,

Role of hyperglucagonemia in maintenance of increased rates of hepatic glucose output in type II diabetics.

Elevated rates of basal hepatic glucose output (bHGO) are significantly correlated with the fasting serum glucose (FSG) level in subjects with non-insulin-dependent diabetes mellitus (NIDDM). This observation suggests that bHGO is a major determinant of the severity of the diabetic state in these subjects. In addition, basal glucagon levels (bGL) are higher in these diabetics than in control subjects, despite the concurrent basal hyperglycemia and hyperinsulinemia, two factors known to suppress glucagon secretion. Although bGL is responsible for sustaining two-thirds of bHGO in normal humans, its role in sustaining elevated rates of bHGO in NIDDM has not been previously defined. To this end, we have studied 13 normal and 10 NIDDM subjects; mean FSG levels were 90 +/- 2 and 262 +/- 21 mg/dl, respectively (P less than .001). The mean fasting serum insulin and glucagon levels were higher in the diabetics than in the controls: 17 +/- 2 vs. 9 +/- 1 microU/ml (P less than .01) and 208 +/- 37 vs. 104 +/- 15 pg/ml (P less than .01), respectively. On separate days, HGO was assessed isotopically (with 3-[3H]glucose) in the basal state and during infusion of somatostatin (SRIF) (600 micrograms/h) alone and in conjunction with replacement infusions of glucose and insulin. The results demonstrate that bHGO is higher in diabetics than in controls (145 +/- 12 vs. 89 +/- 3 mg X m-2 X min-1, P less than .01); during infusion of SRIF alone, HGO was suppressed by 25% (P less than .05) and 34% (P less than .05) of the basal value in controls and diabetics, respectively; when the studies were repeated with glucose levels held constant at or near the FSG level by the glucose-clamp technique, the pattern and degree of HGO suppression was similar to that obtained by infusion of SRIF alone; during isolated glucagon deficiency (SRIF + insulin, 5 mU X m-2 min-1, with serum glucose maintained at basal level), HGO was suppressed by 71 +/- 8% of the basal value in controls (P less than .001) and by 58 +/- 7% in diabetics (P less than .001); and when isolated glucagon deficiency with similar hyperglycemia was created in control subjects, HGO was suppressed by 87% of the basal value.(ABSTRACT TRUNCATED AT 250 WORDS)

Health care needs of Indochinese refugee teenagers.

Although 50% of Indochinese refugees are under 18 years of age, previous studies have emphasized the prevalence of parasites, anemia, tuberculosis, and hepatitis, with few addressing age-related health care needs. In this study the specific health care needs of 80 Indochinese refugee teenagers, evaluated during a 4-year period, were determined. The Centers for Disease Control's suggested screening measures were used, and it was found that 52% had positive purified protein derivative skin tests, 38% lacked immunizations, 35% had stool specimens positive for parasites (prevalence and number of parasites greatest among Cambodians), 14% had blood tests positive for hepatitis B surface antigen, and 10% were anemic. Additional evaluations showed that 19% had hemoglobinopathies, 14% were in or below the fifth percentile for height and weight, 12% had goiters, 12% had skin disorders, 8% had positive hepatitis B surface antigen, 5% had visual defects, 5% had hearing loss, 5% had psychosomatic illness, and 4% had idiopathic scoliosis. Although suggested Centers for Disease Control screening measures may be adequate for younger Indochinese children, these data suggest that additional studies are necessary for teenagers. For the sexually active adolescent, identification of and counseling for hepatitis antigenemia and hemoglobinopathies are crucial. In addition, early identification of emotional and physical problems during screening may enhance assimilation into a new society and facilitate completion of the psychosocial tasks of adolescence.

Demonstration of heterogeneity in gestational diabetes by a 400-kcal breakfast meal tolerance test.

To evaluate the metabolic basis of gestational glucose intolerance (gestational diabetes), the response of normal pregnant women (N=6) and lean (N=23), and obese (N=12) gestational diabetics to the physiologic challenge of a 400-kcal mixed meal breakfast tolerance test was studied. Obese patients with gestational diabetes were more hyperglycemic than the lean gestational diabetics in both the fasting and postprandial periods. Women with gestational diabetes had a more prolonged glycemic response and a later insulin response to meal stimulation than normal control subjects. Fasting and postprandial insulin levels were higher in the obese gestational diabetes group, whereas those of lean subjects fell below the values of the control group. The percent specific binding of insulin to red blood cell receptors was lower in both gestational diabetes groups than in control subjects, with the most marked decrease in the obese group. Mean fasting plasma levels of total cholesterol and triglyceride and plasma glucagon levels during the meal tolerance test were not significantly different among the three groups. Obese gestational diabetics had significantly larger infants and placentas than lean gestational diabetics. These findings, taken together, suggest that the pathophysiology of gestational diabetes differs between obese and lean patients. Lean gestational diabetics appear to develop glucose intolerance on the basis of relative insulin deficiency in contrast to obese gestational diabetics who manifest glucose intolerance characterized by insulin resistance, hyperinsulinemia, and decreased insulin binding to red blood cell receptors.

Moderate caloric restriction in obese women with gestational diabetes.

The effect of moderate caloric restriction on weight gain during pregnancy and fetal outcome in 22 obese women with gestational diabetes mellitus was assessed. A new tool was used to assess dietary compliance in an outpatient setting. The authors observed that obese gestational diabetics gained less weight during pregnancy than ten normal pregnant women or 31 lean women with gestational diabetes. Paradoxically, the placentas of obese gestational diabetics were larger (P not significant), and infants of these mothers were significantly heavier than those of normal women or lean women with gestational diabetes (P less than .03). The authors suggest that the currently recommended daily caloric allowances for normal women may be excessive for obese gestational diabetics who are not prone to ketosis but have a complex metabolic problem characterized by hyperinsulinemia and insulin resistance.

Observations related to chronologic and gynecologic age in pregnant adolescents.

A low chronologic age (less than or equal to 15 years) and low gynecologic age (less than or equal to 2 years) have been considered factors that increase medical complications among adolescent pregnant women. Gynecologic age (GA) is defined in this study as age in years at conception minus age at menarche. Two hundred twelve consecutive pregnant teenagers were followed prospectively in the Teen OB Clinic at the University of California, San Diego Medical Center, between August 1978 and July 1981. The clinic population consisted of 37.3 percent Whites, 35.8 percent Hispanics, 20.8 percent Blacks, and 6.1 percent other (mostly Indochinese). Sixty-eight percent of the patients were funded by MediCal. The patient population was divided by chronological age (CA) at conception into those 15 years or less or 16 years or older. A low chronological age was found to be a significant risk factor for premature rupture of membranes. Teenagers with a low gynecologic age (less than or equal to 2) had a lower mean pre-pregnancy weight and body mass index (Kg/M2) than teenagers with a higher gynecologic age. In this study, we did not find that a low CA or GA was correlated with a higher frequency of pregnancy-induced hypertension, prenatal medical problems, obstetrical problems at labor or delivery, or an excessive number of low-birthweight infants.

Routine screening for gestational diabetes in white, black, and Mexican-American teenagers.

This study assesses the frequency of gestational diabetes in a multiethnic teenage pregnancy clinic. One hundred thirty-seven women age 12-18 years were screened with a 1-hour 50-gm glucola test at 24-34 weeks gestation. Screening tests were positive in 5.8% of these teenagers, of whom half were obese. Gestational diabetes was documented in two primiparas (1.4%). Maternal weight gain was excessive in 54%, and 8.7% of the total group had macrosomic infants. We conclude that gestational diabetes should be screened for in all young pregnant women with the screening test recommended by the Second International Workshop-Conference on Gestational Diabetes.

Clinical observations of Mexican-American, Caucasian, and black pregnant teenagers.

Few data are available on the prenatal health problems and postnatal outcomes of Mexican-American pregnant teenagers. Our study population consisted of 199 consecutive Caucasian, Mexican-American, or Black pregnant adolescents, ages 11-19 years, followed prospectively at the University of California San Diego Medical Center Teen Obstetric Clinic from 1978 to 1981. The patients included 79 Caucasians, 76 Mexican-Americans, and 44 Blacks. Mexican-American adolescents were shorter, less likely to be cigarette smokers, and delivered heavier babies than their non-Hispanic peers. More than 50% of the teenagers in all three groups gained more than the recommended upper limit of 12 kg during the pregnancy, but excessive gain was most pronounced in the Mexican-American group. Black pregnant adolescents were more likely to be anemic and had a higher frequency of goiter. It is recommended that data concerning Hispanic mothers and infants be analyzed separately from data of Caucasian and Black adolescents to more accurately define their pregnancy problems.

Is repeat pregnancy in adolescents a "planned" affair?

This study assessed whether girls who become pregnant more than once do so for different reasons than girls who are pregnant for the first time. Girls in group 1 (G1) were pregnant for the first time (n = 104, 69%) and those in group 2 (G2) were pregnant for the second time or more (n = 46, 31%). About 60% of the girls in G2 had living children at home, but they were more likely than those in G1 to state that they became pregnant because they wanted a baby (G2 44%, G1 21%; p less than 0.01) and, conversely, girls in G1 were more likely than those in G2 to state that the pregnancy was an accident and "just happened" (G1 61%, G2 37%; p less than 0.01). Many girls who become pregnant more than once appear to do so intentionally.

PIP: The reasons for becoming pregnant reported by teenagers who registered for prenatal care at the University of California San Diego (UCSD) Teen OB Clinic between May 1984 and July 1987 were investigated. 150 consecutive pregnant adolescents 12-19 years old were interviewed by a pediatrician at their first prenatal visit. Group 1 (G1) girls were pregnant for the first time; and group 2 (G2) for a second time or more. Nearly all girls were from the lower socioeconomic classes. Girls in G1 were slightly younger than the girls in G2 (p 0.0002). Only 11% of G1 and only 15% of G2 were married. 55% of G1 compared to 35% of G2 were full-time students (p 0.01). About half of G2 were at home, unemployed, and not in school. At the time of conception about 14% of G1 and 2% of G2 (p 0.01) lived with both parents. 60.6% of G1 stated that the pregnancy was unplanned vs. 37% of G2 (p 0.01). 43.5% of G2 were pregnant because they wanted a baby vs. only about 20% of G1 (p 0.01). About 60% of G2 (27 girls) already had at least one living child at home. About 8% of G1 intended to place the baby for adoption, while none of G2 reported considering adoption (p 0.025). About 41% of G1 and 46% of G2 planned to care for their baby with the father of the baby. 26% of G2 intended to care for their infant alone vs. 7% of G1 (p 0.005). The fathers in both groups were older than the girls by an average of 4-5 years. G2 was further divided into two groups: current planned pregnancy (20 girls; 44%) and current unplanned pregnancy (26 girls; 56%). 14 girls of the planned group (70%) and 13 girls of the unplanned group (50%) already had living children. 4 girls of the planned group and 13 girls of the unplanned group reported a previous induced abortion. Girls in G2 presented for prenatal care at an earlier gestational age (17.1 weeks) than those in G1 (20.4 weeks) (p 0.04).