Comparative analysis of 2-week glycaemic profile of healthy versus mild gestational diabetic pregnant women using flash glucose monitoring system: an observational study.

OBJECTIVE: To compare glycaemic profiles in women with mild gestational diabetes (GDM) and those with a healthy pregnancy. DESIGN: Observational study. SETTING: Hospital-based. POPULATION: Healthy nonpregnant, healthy pregnant, and women with GDM, diagnosed by oral glucose tolerance test. METHODS: Nine nonpregnant women, 33 healthy pregnant women, 29 pregnant women with GDM between 24 and 36 weeks' gestation, received ambulatory glucose profile (AGP) monitoring for a 2-week period. AGP values were compared in the three groups: 100 days (9600 data points) for nonpregnant women, 396 days (33 792 data points) for healthy pregnant women, and 348 days (34 408 data points) for women with GDM. RESULTS: Mean glucose values for fasting and postmeals were highest in nonpregnant healthy women and lowest in healthy pregnant women (P < 0.001). Women with mild GDM had significantly higher blood glucose values than did healthy pregnant women, though still within the target range. Blood glucose values >160 mg/dl were observed in 41.4% (12/29) in the GDM group compared with 18.2% in women with a healthy pregnancy. The maximum peak of day and night time glucose was respectively 234 and 215 mg/dl in women with GDM compared with 183 and 171 mg/dL in the control group. Glycaemic variability as measured by interquartile range was higher in GDM pregnancies. CONCLUSIONS: Although the blood glucose level remained within the target levels in women with mild GDM, glycaemic variability and mean blood glucose levels were significantly higher among women with GDM than among women with a healthy pregnancy. TWEETABLE ABSTRACT: Average blood glucose levels and glycaemic variability are significantly higher in women with GDM than in women with a healthy pregnancy.

Characterization of bipolar disorder patient-specific induced pluripotent stem cells from a family reveals neurodevelopmental and mRNA expression abnormalities.

Bipolar disorder (BD) is a common neuropsychiatric disorder characterized by chronic recurrent episodes of depression and mania. Despite evidence for high heritability of BD, little is known about its underlying pathophysiology. To develop new tools for investigating the molecular and cellular basis of BD, we applied a family-based paradigm to derive and characterize a set of 12 induced pluripotent stem cell (iPSC) lines from a quartet consisting of two BD-affected brothers and their two unaffected parents. Initially, no significant phenotypic differences were observed between iPSCs derived from the different family members. However, upon directed neural differentiation, we observed that CXCR4 (CXC chemokine receptor-4) expressing central nervous system (CNS) neural progenitor cells (NPCs) from both BD patients compared with their unaffected parents exhibited multiple phenotypic differences at the level of neurogenesis and expression of genes critical for neuroplasticity, including WNT pathway components and ion channel subunits. Treatment of the CXCR4(+) NPCs with a pharmacological inhibitor of glycogen synthase kinase 3, a known regulator of WNT signaling, was found to rescue a progenitor proliferation deficit in the BD patient NPCs. Taken together, these studies provide new cellular tools for dissecting the pathophysiology of BD and evidence for dysregulation of key pathways involved in neurodevelopment and neuroplasticity. Future generation of additional iPSCs following a family-based paradigm for modeling complex neuropsychiatric disorders in conjunction with in-depth phenotyping holds promise for providing insights into the pathophysiological substrates of BD and is likely to inform the development of targeted therapeutics for its treatment and ideally prevention.

Validity and reproducibility of a food frequency questionnaire focused on the Mediterranean diet for the Quebec population.

BACKGROUND AND AIMS: Validated dietary assessment methods specific to population and food habits are needed to conduct randomized clinical trials evaluating the efficacy of the Mediterranean diet in primary and secondary prevention of cardiovascular disease. Therefore, the aim of our study was to assess the reproducibility and the relative validity of a French language semi-quantitative food frequency questionnaire (FFQ) focused on the Mediterranean diet within the population of Quebec. METHODS AND RESULTS: Fifty-three participants aged 19-86 years with and without coronary heart disease were recruited, and randomized in 3 groups in a crossover design where the sequence of administration of two FFQs and a dietary record (DR) differed in each group. The FFQ includes 157 food items and was designed to measure food intake over one month. It was administered twice 3-5 weeks apart to assess reproducibility and was compared to a 12-day DR to assess validity. For reproducibility (n = 47), intraclass correlation coefficients (ICCs) for energy and 33 nutrients ranged from 0.38 to 0.91 (mean 0.63). For validity, the Pearson's correlation coefficients between the DR and the FFQ pre-DR ranged from 0.26 to 0.84 (mean 0.55) and ICCs ranged from 0.25 to 0.84 (mean 0.54). As for the DR and the FFQ post-DR, the Pearson's correlation coefficients ranged from 0.36 to 0.83 (mean 0.55) and the ICCs ranged from 0.36 to 0.83 (mean 0.53). CONCLUSION: This FFQ demonstrates good reproducibility and validity for most key nutrients of the Mediterranean diet for the Quebec population.

Comparison of Hysterosalpingography and Combined Laparohysteroscopy for the Evaluation of Primary Infertility.

Background Hysterosalpingography (HSG) is a useful screening test for the evaluation of female infertility. Laparoscopy has proven role in routine infertility work up but role of hysteroscopy in an infertile patient with normal HSG for additional information is a subject of debate. Hysteroscopy permits direct visualization of the cervical canal and the uterine cavity and thereby helping in the evaluation of shape, and cavitary lesion. Objective To detect uterine abnormalities in infertile women by various approaches i.e. HSG and hysteroscopy and evaluating the role of combining hysteroscopy with laparoscopy for the evaluation of tubo-uterine factor for primary infertility. Method One twenty eight infertile women were evaluated and HSG was performed as a basic test for evaluation of tubes and uterine cavity. Women were subjected to combined laparoscopic and hysteroscopic examination on evidence of HSG abnormalities. In absence of any HSG abnormality, women were subjected to ovulation induction for three to six months and if they did not conceive during this period they were undertaken for combined laparo-hysteroscopic evaluation. Result The positive predictive value of HSG for detecting the intrauterine abnormalities was 70% among 126 patients where the hysteroscopy could be performed successfully. The diagnostic accuracy of HSG for intrauterine abnormalities revealed false negative rate of 12.96%. The most frequent pathologies encountered by laparoscopy were tubal and/or peritoneal and were found in 68% (87/128) of women. Total 64.06% infertile women had some abnormality on laparoscopy. This detection rate has been increased from 64.06% to 71.86% on including the concomitant hysteroscopy. Conclusion HSG is a good diagnostic modality to detect uterine as well as tubal abnormalities in infertile patient. HSG and hysteroscopy are complementary to each other and whenever the patient is undertaken for diagnostic laparoscopy for the infertility, hysteroscopy should be combined to improve the detection rate of abnormalities especially in communities where there is enormous risk of pelvic infection.

Blood transfusion in obstetrics.

Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. Most of the donated blood is processed into components: packed red cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate. Various alternatives to blood transfusion exist and include autotransfusion, pre-autologous blood storage, use of oxygen carrying blood substitutes and intraoperative cell salvage. Despite the risks associated with transfusions, obstetricians are frequently too aggressive in transfusing blood and blood products to their patients. Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines.

Metallicity and ferromagnetism in nanosystem of charge ordered Nd0.5Sr0.5MnO3.

The fascinating phenomenon of destabilization of charge/orbital order in Nd0.5Sr0.5MnO3 with the reduction of grain size is critically investigated. Based on our magnetic and transport experiments followed by a theoretical analysis, we analyze various possible mechanisms and try to delineate a universal scenario behind this phenomenon. We revisit this issue carefully and discuss various evidences from experiments in nano and bulk manganites on the absence of correlation between size reduction and pressure effects on manganites. We propose a phenomenological model based on enhanced surface disorder to explain the appearance of weak ferromagnetism and metallicity in nanosize Nd0.5Sr0.5MnO3 system. All evidence seems to suggest that the transport is mediated through the surface via enhanced density of states in the nanometric grains. We provide theoretical support for this by performing an ab-initio electronic structure calculation as well as from a recent numerical simulation and argue that the mechanism is likely to be general in all nanosize charge ordered manganites.

Fetomaternal outcome in pregnancy with severe thrombocytopenia.

OBJECTIVES: STo study the feto-maternal outcome in pregnancy with severe thrombocytopenia. MATERIALS AND METHODS: It was an observational study involving 1150 pregnant women with term gestation in labour, who were screened for thrombocytopenia. Ninety-four subjects (8.17%) were found to have thrombocytopenia i.e. platelet count < 1,50,/000/mm3, out of which 47 subjects (group A) had platelet count of less than 50.000/mm3 Simultaneously, 47 term pregnant women (group B) having a normal platelet count i.e. > 1.5 lac/mm3 formed the control group. All the subjects were followed during labour and postpartum period for any feto-maternal outcome. RESULTS: Significant history of bleeding tendencies like prolonged bleeding from wound site, easy bruisability and menorrhagia (p = 0.023) was evident in the study population. Abruptio placentae and early onset pregnancy induced hypertension (PIH) in previous gestations was more commonly found in the study population. Anemia and PIH were significantly more in group A. Incision site oozing during cesarean section was significantly more in group A. Moderate thrombocytopenia was more in neonates of study group (p = 0.014), but without any bleeding complications in neonates. CONCLUSIONS: Careful surveillance is required in these high risk patients for earlier detection and treatment of complications so as to decrease the fetomaternal morbidities.

Isolated fallopian tube torsion in early pregnancy presenting as resolving appendicular lump.

Isolated fallopian tube torsion (IFTT) is a rare clinical entity, especially in pregnancy. It is frequently misdiagnosed as acute appendicitis or ovarian torsion. We present an unusual case of IFTT occurring in early pregnancy, which was detected when patient presented for medical termination of pregnancy in family planning clinic. This case report highlights sub acute presentation of IFTT in early pregnancy which clinically presented as resolving appendicular lump.

Clinical outcome of levonorgestrel intra-uterine system in idiopathic menorrhagia.

AIMS: To evaluate the efficacy, acceptability and side effects of levonorgestrel intrauterine system in patients with idiopathic menorrhagia. METHODS: A prospective, non-randomized clinical study in which 42 women between the age of 35-55 years complaining of menorrhagia with or without irregular cycle were recruited during one year period. The women were followed up at 3, 6, 12, 24 and 36 months after insertion. RESULTS: The reduction in mean blood loss was found to be statistically significant with a p value of < 0.001 for all the follow-up periods. CONCLUSION: The present study projects levonorgestrel intrauterine system as an effective patient friendly device with a high degree of compliance and worth considering as a viable alternative to surgery for the management of menorrhagia due to dysfunctional uterine bleeding in developing countries like India.

Antibacterial properties of the skin mucus of the freshwater fishes, Rita rita and Channa punctatus.

OBJECTIVES: The skin mucus of Rita rita and Channa punctatus was investigated to explore the possibilities of its antibacterial properties. MATERIALS AND METHODS: Skin mucus was extracted in acidic solvents (0.1% trifluoroacetic acid and 3% acetic acid) and in triple distilled water (aqueous medium). The antibacterial activity of the mucus extracts was analyzed, using disc diffusion method, against five strains of bacteria--the Gram-positive Staphylococcus aureus and Micrococcus luteus; and the Gram negative Escherichia coli, Pseudomonas aeruginosa and Salmonella typhi. RESULTS: In both Rita rita and Channa punctatus, the skin mucus extracted in acidic solvents as well as in aqueous medium show antibacterial activity against Staphylococcus aureus and Micrococcus luteus. Nevertheless, the activity is higher in acidic solvents than that in aqueous medium. The acidic mucus extracts of Rita rita, show antibacterial activity against Salmonella typhi as well. CONCLUSIONS: The results suggest that fish skin mucus have bactericidal properties and thus play important role in the protection of fish against the invasion of pathogens. Fish skin mucus could thus be regarded as a potential source of novel antibacterial components.

Trial of labour after previous caesarean section: the predictive factors affecting outcome.

A prospective observational study was conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, India on 300 pregnant women with one previous caesarean section fulfilling the eligibility criteria for trial of labour, to study the predictive factors and the outcome of trial of labour. The data obtained were analysed according to mode and outcome of labour and was then subjected to statistical analysis. The success rate of trial of labour was found to be 53.6%. Favourable Bishop's score (p = 0.000), spontaneous onset of labour (p = 0.005) and history of previous delivery after caesarean (p = 0.007) were significantly associated with a successful outcome of trial of labour. Higher chances of vaginal delivery were found with breech as an indication of previous caesarean section, i.e. 67.1% as compared to 39% with non-progress of labour as an indication.

Kinetic arrest of the ferromagnetic state in Mn[Formula: see text]GaC and Ni[Formula: see text]MnGa composite mixtures.

The kinetics of the ferromagnetic to antiferromagnetic transition in Mn[Formula: see text]GaC can be arrested and its magnetic properties can be tuned by mixing a small amount ([Formula: see text] 10%) of Heusler Ni[Formula: see text]MnGa to Mn[Formula: see text]GaC. A detailed study of magnetic properties of composite mixtures of Mn[Formula: see text]GaC and Ni[Formula: see text]MnGa with different antiperovskite to Heusler ratio, reveals that the ferromagnetic Ni[Formula: see text]MnGa polarizes magnetic spins of the antiperovskite phase by creating a magnetic strain field in its vicinity. The Heusler phase acts as a defect centre whose influence on the magnetic properties of the majority antiperovskite phase progressively diminishes, creating a distribution of transition temperatures. Such strong interaction between the two phases of the mixture allows for tunability and control over the properties of such magneto-structurally transforming materials.

Non-equilibrium magnetic response of canonical spin glass and magnetic glass.

Time and history dependent magnetization has been observed in a wide variety of materials, which are collectively termed as the glassy magnetic systems. However, such systems showing similar non-equilibrium magnetic response can be microscopically very different and they can be distinguished by carefully looking into the details of the observed metastable magnetic behavior. Canonical spin glass (SG) is the most well studied member of this class and has been extensively investigated both experimentally and theoretically over the last five decades. In canonical SGs, the low temperature magnetic state obtained by cooling across the SG transition temperature in presence of an applied magnetic field is known as the field cooled (FC) state. This FC state in canonical SG is widely believed as an equilibrium state arising out of a thermodynamic second order phase transition. Here, we show that the FC state in canonical SG is not really an equilibrium state of the system. We report careful dc magnetization and ac susceptibility measurements on two canonical SG systems, AuMn (1.8%) and AgMn (1.1%). The dc magnetization in the FC state shows clear temperature dependence. In addition, the magnetization shows a distinct thermal hysteresis in the temperature regime below the SG transition temperature. On the other hand, the temperature dependence of ac susceptibility has clear frequency dispersion below SG transition in the FC state prepared by cooling the sample in the presence of a dc-bias field. We further distinguish the metastable response of the FC state of canonical SG from the metastable response of the FC state in an entirely different class of glassy magnetic system namely magnetic glass, where the non-equilibrium behavior is associated with the kinetic-arrest of a first order magnetic phase transition.

Acute effects of exercise on cerebrovascular response and cognitive performance in individuals with stable coronary heart disease.

BACKGROUND: Individuals with coronary heart disease (CHD) exhibit cognitive deficits and cerebrovascular dysfunctions, and are at higher risk of developing dementia. Cognitive function in individuals with CHD has never been studied during acute aerobic exercise. Given the increasing popularity of training at high peak power output (PPO), its impact on cerebrovascular and cognitive functions in individuals with CHD should be further studied. METHOD: Thirty-eight individuals with CHD and 16 healthy controls completed two exercise bouts at 30% and 70% of their individualized PPO on an ergocycle while performing a cognitive task including non-executive and executive conditions. Variations of oxy- deoxy-hemoglobin, and total hemoglobin concentrations were measured on left prefrontal cortex at both PPO using near-infrared spectroscopy. RESULTS: Cognitive task performances were equivalent between groups at all intensity levels. Individuals with CHD exhibited larger variation of deoxyhemoglobin in the executive condition and larger variation in total hemoglobin concentration in all task conditions compared to healthy controls at 70% of PPO. CONCLUSION: Exercising at high intensity seems to have a larger impact on cerebral blood volume in CHD patients compared to healthy age-matched controls. Higher exercise intensity has negative impacts on cerebral blood volume variations during a cognitive task in CHD patients and could potentially lead to other neurocognitive dysfunctions. Other studies are needed to determine if a cognitive task administered during an exercise test could help identify individuals with CHD at higher risk of developing cognitive decline.

CD4+ T cell tolerance to parenchymal self-antigens requires presentation by bone marrow-derived antigen-presenting cells.

T cell tolerance to parenchymal self-antigens is thought to be induced by encounter of the T cell with its cognate peptide-major histocompatibility complex (MHC) ligand expressed on the parenchymal cell, which lacks appropriate costimulatory function. We have used a model system in which naive T cell receptor (TCR) transgenic hemagglutinin (HA)-specific CD4+ T cells are adoptively transferred into mice expressing HA as a self-antigen on parenchymal cells. After transfer, HA-specific T cells develop a phenotype indicative of TCR engagement and are rendered functionally tolerant. However, T cell tolerance is not induced by peptide-MHC complexes expressed on parenchymal cells. Rather, tolerance induction requires that HA is presented by bone marrow (BM)-derived cells. These results indicate that tolerance induction to parenchymal self-antigens requires transfer to a BM-derived antigen-presenting cell that presents it to T cells in a tolerogenic fashion.

Role of Bone Marrow Examination in the Evaluation of Infections: Clinico-Hematological Analysis in a Tertiary Care Centre.

OBJECTIVE: Bone marrow examination (BME) is an important modality for investigation of case of pyrexia of unknown origin (PUO). However, its yield in the diagnosis of infections has not been extensively studied and its role has not been well established. The aim of the study was to investigate the usefulness of BME and to evaluate the etiological and clinico-hematological profile in cases of bone marrow infections. MATERIAL AND METHOD: This was a retrospective study where bone marrow cases were retrieved and a review of bone marrow findings with an infectious etiology from July 2014 to June 2018 was done. Detailed history, clinical examination and hematological parameters at presentation were recorded. Clinico-hematological correlation using descriptive statistics was performed. RESULTS: The study included 55 cases, on analysis of which the maximum number of infections were those of leishmaniasis accounting for 35%, followed by HIV (29%) and tuberculosis (15%). Other etiological agents included fungal infections (histoplasmosis and aspergillosis), Enteric fever, Scrub typhus, parvovirus, falciparum malaria and filariasis. The most common clinical presentation was fever (80%) and the most common clinical finding was splenomegaly (66%). CONCLUSION: Bone marrow examination is an important diagnostic tool to delineate etiological diagnosis in infectious conditions, particularly those presenting with PUO. Moreover, it is particularly important if urgent diagnosis is required or if alternate diagnostic modalities have not revealed a reason for PUO.

Spin phonon coupling in Mn doped HoFeO3 compounds exhibiting spin reorientation behaviour.

An investigation has been carried out on the spin phonon coupling in a series of isostructural polycrystalline orthorhombic (Space group Pnma) compounds HoFe1-X Mn X O3 (x ⩽ 0.6) exhibiting spin reorientation below Néel temperature (T N), using magnetization, neutron diffraction, and Raman scattering techniques. Mn doping leads to an anomalous increase in the spin reorientation temperature (T SR), shifting it close to room temperature from T SR ~ 60 K for x = 0 sample, and concomitant lowering of T N. The T SR is absent in samples for x ⩾ 0.5. The magnetic structure undergoes a transition at T SR from Γ4 → Γ1 in the Mn doped compounds as against Γ4 → Γ2 observed in HoFeO3 sample. In the region T < T N an anomalous softening of Raman phonon modes viz., B 2g(5) and B 3g(3), identified with the stretching motion and breathing mode, respectively, of Fe/Mn-O6 octahedra, is observed in compounds exhibiting spin-reorientation behaviour, indicating a spin-phonon coupling in these compounds. A quadratic correlation between the deviation of phonon frequency and variation of antiferromagnetic moment (Δω [Formula: see text] M 2) is observed in these compounds. The temperature evolution of the M2+ mode obtained from the analysis of neutron diffraction data based on symmetry adapted mode decomposition of the Pnma structure further corroborates the mode softening observation.

Possible glass-like random singlet magnetic state in 1T-TaS2.

Two-dimensional layered transition-metal-dichalcogenide compound 1T-TaS2 shows the rare coexistence of charge density wave (CDW) and electron correlation driven Mott transition. In addition, atomic-cluster spins on the triangular lattice of the CDW state of 1T-TaS2 give rise to the possibility of the exotic spin-singlet state in which quantum fluctuations of spins are strong enough to prevent any long range magnetic ordering down to the temperature absolute zero (0 K). We present here the evidences of a glass-like random singlet magnetic state in 1T-TaS2 at low temperatures through a study of temperature and time dependence of magnetization. Comparing the experimental results with a representative canonical spin-glass system Au(1.8%Mn), we show that this glass-like state is distinctly different from the well established canonical spin-glass state.