Contraception in diabetic women: an Italian study.

Over 1 year, a survey on contraception and obstetric history was performed on a cohort of 667 Caucasian fertile diabetic women (446, type 1 and 201, type 2) living in Italy. RESULTS: Of these women, 30.4% used hormonal contraceptives, 12.0% intra-uterine device (IUD), 10.7% declared they used no contraception, 47.0% only utilised barrier and/or natural methods. However, irrespective of their previous contraceptive strategy, 7.2% of all the studied population was surgically sterilized during caesarean section. HORMONAL CONTRACEPTION: Of these women, 60.4% was prescribed by a gynaecologist, 11.2% by a diabetologist, 15% by both of them and 13.4% by others. The proportion using oral contraception was similar among types 1 and 2 women (29.4% versus 27.8%, chi(2) = ns). SMOKING HABITS: Of women taking hormonal contraception, 30.0% were smokers. EDUCATIONAL LEVEL: University graduates (37.1%), high school leaves (32.2%), secondary school (28.2%) and primary school leaves (15.5%) used oral contraceptives (OC). OBSTETRIC HISTORY: The mean number of deliveries was 1.14 +/- 1.1, of miscarriages was 1.3 +/- 0.7 and of induced abortions 0.17 +/- 0.5. Planning of at least one pregnancy was reported in 29.4% of patients.

Investigating helminth eggs and Salmonella sp. in stabilization ponds treating septage.

Sludge management arises as a relevant problem after being accumulated in primary ponds of septage treatment plants. One of the most attractive options for sludge disposal is its use in agriculture and then specific guidelines regarding hygienic quality must be fulfilled. This study aimed at evaluating the storage time needed to inactivate Ascaris eggs and Salmonella in sludge accumulated in a primary pond treating septage. Raw septage exhibited very low concentrations of viable Ascaris eggs, thus experiments with Ascaris suum eggs spiking were conducted. The concentration of Ascaris eggs in the solids accumulated at the bottom of the pond was 20 eggs/g of total solids (g TS) at the time of pond closure. Although it decreased, some eggs remained viable (0.59 mean viable eggs/g TS) up to 20 months of in-pond storage of the biosolids. Salmonella survival was studied after developing an analytical method that inhibited the native flora. Sludge was seeded with Salmonella enteritidis. An equation adequately describing Salmonella die-off in biosolids subjected to 115 days of in-pond storage/dewatering, was found to be represented by the regression: y = log MPN Salmonella/g TS = 6.67 x t(-0.086), with t = storage time elapsed in days. The initial concentration was 7.0 x 10(6) MPN/g TS and the removal efficiency was 99%.

Isolation of Salmonella sp. in sludge from septage treatment plant.

Waste stabilization ponds (WSP) are an often-used option to treat faecal sludges collected from on-site sanitation systems. Since agricultural use is one of the most attractive options for sludge disposal, specific guidelines on the hygienic sludge quality must be fulfilled, such as for viable helminth eggs and Salmonella sp. Although Salmonella isolation methods are well known for other types of samples, they are not suitable for faecal sludge. The reason can be attributed to the co-existence of a native bacterial sludge flora masking Salmonella development, especially if this bacteria is present at low concentrations. In order to select the best methodology for Salmonella recovery from septage sludge, different culture media were assayed at different incubation periods and temperatures. The proposed methodology for Salmonella recovery from sludge can be summarised as follows: (1) enrichment in Rappaport-Vassiliadis broth at 43 degrees C, 48 hours, and (2) isolation in XLD agar at 40 degrees C, 24 hours. Identification of suspected colonies by biochemical tests: TSI, LIA, urease and serological confirmation with Group O Antigen.

Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional insulin therapy.

We evaluated the outcome of pregnancies followed between 1990 and 2000 in 93 women with type 1 diabetes, treated with conventional intensive insulin therapy (n=68) or continuous subcutaneous insulin infusion (n=25). We evaluated metabolic control (fasting and 1-hour post-prandial plasma glucose and HbA1c levels), spontaneous or induced abortions, time and mode of delivery, maternal outcome (pregnancy-induced hypertension, preeclampsia, placental insufficiency, hydramnios, hypoglycemic coma, ketoacidosis) and fetal outcome (weight, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal distress, asphyxia, hyaline membrane disease, polycythemia, shoulder dystocia, malformations). Patients treated with insulin pump more frequently had background retinopathy and clinical neuropathy. No significant differences were observed between the two groups in metabolic control and maternal outcome. Glycemic control, non-optimal in the prepregnancy state, improved significantly during pregnancy, as shown by the progressive reduction in HbA1c levels. As regards fetal outcome, no differences were observed between the two groups in morbidity and especially in malformation rate. Patients with malformed babies did not have optimal metabolic control at conception. Thus, maternal and perinatal outcomes were comparable in patients treated with insulin pump and continuous subcutaneous insulin therapy, and depended on metabolic control. In patients in higher White's class and with more unstable glycemia, we achieved metabolic control and outcomes comparable with those of women of lower White's class and more stable glycemic values using the insulin pump. Our data suggest that insulin pump therapy is useful in problematic, complicated cases of women who want a baby.

Atorvastatin for the management of Type 2 diabetic patients with dyslipidaemia. A mid-term (9 months) treatment experience.

Dyslipidaemia, particularly increased triglycerides (TG) and low HDL-cholesterol (HDL-C), represents an important risk factor for Type 2 diabetes (T2DM) macrovascular complications. Our aim was to evaluate the effects of atorvastatin in a population of T2DM patients according to their cardiovascular risk: evidence of myocardial or coronary lesions (group A); evidence of familiar hypercholesterolaemia (group B); evidence of stable cardiovascular risk (group C). The mean age was 64+/-7 yr, mean disease duration 9.5+/-3 yr, the mean body mass index (BMI) 27.7+/-1.3 kg/m2, mean HbA1c 8+/-0.6%; total cholesterol 256+/-24 mg/dl in group A, 298+/-30 and 244+/-31 in groups B and C, respectively (p<0.05 B vs. A and C). Moreover, mean HDL-C values were about 45+/-7 mg/dl, TG 225+/-20 mg/dl, systolic and diastolic blood pressure 144+/-7 mm Hg and 84+/-8 mm Hg, respectively; fibrinogen values 330+/-23 mg/dl and microalbuminuria 58+/-9 mg/l. Lipid profile improved significantly during the treatment with personalised doses of atorvastatin (generally 10 mg/day) designed to achieve the therapeutic goals: the reduction of total cholesterol, TG (p<0.01), LDL-cholesterol (LDL-C) (p<0.01) and an increase of HDL-C were measured. The treatment with atorvastatin induced significant reduction of microalbuminuria and fibrinogen levels (p<0.01). Moreover, in the subgroup of patients with hypertension, diastolic blood pressure values were reduced without modification of antihypertensive treatment. This preliminary study suggests that the management of hypercholesterolaemia with atorvastatin in T2DM patients may be useful both for the primary and secondary prevention of chronic complications of T2DM.

Undiagnosed coeliac disease and risk of autoimmune disorders in subjects with Type I diabetes mellitus.

AIMS/HYPOTHESIS: We tested the hypothesis that silent coeliac disease is more frequent than expected in both patients with Type I (insulin-dependent) diabetes mellitus and their first-degree relatives. We evaluated how the presence of other autoimmune disorders in diabetic patients and their first-degree relatives is related to silent, unrecognized coeliac disease. METHODS: Sera from 491 subjects with Type I diabetes, 824 relatives and 4,000 healthy control subjects were screened for anti-endomysial antibodies and all those subjects who tested positive for anti-endomysial antibodies underwent intestinal biopsy. RESULTS: We found that the prevalence of coeliac disease was 5.7 % among the diabetic patients and 1.9 % among the relatives, values significantly higher than those found among the control subjects (p < 0.0001; p < 0.001). The prevalence of autoimmune disorders in diabetic patients with coeliac disease was significantly higher than in subjects with Type I diabetes alone (p < 0.0001). The prevalence of autoimmune disorders in the relatives with coeliac disease was significantly higher than in those who tested negative for anti-endomysial antibodies (p = 0.01). CONCLUSION/INTERPRETATION: This report provides further confirmation of the high prevalence of undiagnosed coeliac disease among diabetic patients and their relatives. This interesting new finding is the increased presence of other autoimmune diseases in these patients, as well as in their relatives with a delayed diagnosis for coeliac disease. Patients newly diagnosed with coeliac disease showed excellent compliance with the gluten-free diet. This should encourage policymakers to consider introducing an easy-to-use screening programme for diabetic patients and their relatives into everyday clinical practice, in order to prevent coeliac-associated symptoms and the onset of additional, more serious auto-immune disorders.

Viabilidad de huevos de helmintos en biosólidos

El trabajo consistió en determinar el tiempo de almacenamiento (deshidratación natural en zona de clima templado) necesario para que los lodos acumulados en las lagunas de sedimentación, pudiesen ser utilizados en la agricultura sin riesgo sanitario, para lo cual se estudio la viabilidad de los huevos de helmintos a través del tiempo. Dado que la concentración de huevos de helmintos parásitos en los lodos de la localidad de Alcorta, prov. de Santa Fe, fue baja (1-2 huevos/g MS) se decidio adicionar huevos de Ascaris artificialmente, para estudiar su viabilidad

Viabilidad de huevos de helmintos en biosólidos

El trabajo consistió en determinar el tiempo de almacenamiento (deshidratación natural en zona de clima templado) necesario para que los lodos acumulados en las lagunas de sedimentación, pudiesen ser utilizados en la agricultura sin riesgo sanitario, para lo cual se estudio la viabilidad de los huevos de helmintos a través del tiempo. Dado que la concentración de huevos de helmintos parásitos en los lodos de la localidad de Alcorta, prov. de Santa Fe, fue baja (1-2 huevos/g MS) se decidio adicionar huevos de Ascaris artificialmente, para estudiar su viabilidad