Gestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk population.

AIMS: In populations at high risk of gestational diabetes mellitus (GDM), screening every pregnant woman by an oral glucose tolerance test (OGTT) is very demanding. The aim of this study was to determine the value of the fasting capillary glucose (FCG) as a screening test for GDM. METHODS: FCG was measured by a plasma-correlated glucometer in 1465 pregnant women who underwent a one-step diagnostic 75-g OGTT for universal screening of GDM. RESULTS: One hundred and ninety-six (13.4%) women had GDM as defined by the criteria of the American Diabetes Association. The area under the receiver operating characteristic curve (AUC) of the FCG was 0.83 (95% confidence interval 0.80-0.86). A FCG threshold of 4.7 mmol/l (at an acceptable sensitivity of 86.0%) independently could rule-out GDM in 731 (49.9%) women, while the FCG could rule-in GDM (100% specificity) in 16 (1.1%) additional women; therefore, approximately half of the women would not need to continue with the cumbersome OGTT. CONCLUSIONS: Screening using a FCG significantly reduces the number of OGTTs needed for the diagnosis of GDM. Wider assessment, particularly in low-risk populations, would confirm the potential value of the FCG as a screening test for GDM.

Predicting proteinuria in hypertensive pregnancies with urinary protein-creatinine or calcium-creatinine ratio.

OBJECTIVE: Evaluate the value of random urinary protein-creatinine (PrCr) and calcium-creatinine (CaCr) ratios to predict 24-h proteinuria in hypertensive pregnancies. STUDY DESIGN: Spot urine samples were collected before routine 24-h urine collections from consecutive pregnant women with hypertension (n=83). Reliability of spot urinary PrCr and CaCr to detect significant proteinuria (>or=300 mg/day) using 24-h urine protein as 'gold-standard' was assessed by receiver-operating characteristic (ROC) curve. RESULTS: Fifty-one patients (61.4%) had significant proteinuria (45 pre-eclampsia, 5 superimposed pre-eclampsia, 1 renal hypertension). Area under ROC curve to predict proteinuria was 0.82 (95% confidence interval (CI) 0.73 to 0.92, P<0.001) for PrCr and 0.55 (95% CI 0.43 to 0.68, P=0.2) for CaCr. A cutoff value of >0.19 for PrCr best predicted significant proteinuria with sensitivity, specificity, positive and negative predictive values and likelihood ratios (positive and negative), respectively, of 80.4, 68.8, 80.4, 68.8%, 2.57 and 3.51. CONCLUSION: Spot urinary PrCr predicts total urinary protein excretion in hypertensive pregnancies.

Need for measurement of bone mineral density in patients of prostate cancer before and after orchidectomy: role of quantitative computer tomography.

BACKGROUND: Androgen deprivation therapy is the first-line systemic treatment of prostate cancer, orchidectomy remaining the most common mode in view of cost-effectiveness and better compliance. Accelerated bone loss is common after orchidectomy, which exacerbates osteoporosis already common in this patient-population. We studied the need of periodic measurement of bone mineral density after orchidectomy. MATERIAL AND METHODS: Fifty five patients of adenocarcinoma prostate opting for orchidectomy were prospectively studied. Follow up ranged from 6 to 18 months. Lumbar spinal (L1-L3) trabecular bone mineral density (BMD) was measured with quantitative computed tomography (QCT) at baseline and every 6 months after orchidectomy, and compared with preoperative values. RESULTS: Mean (+/- SD) age of the patients was 69.9 +/- 7.9 years and BMD 115.7 +/- 35.7 mg/cm2 with T-score -1.89 +/- 1.26 and Z-score 0.30 +/- 1.30. Thirty three percent patients were osteoporotic at baseline, as defined by a T-score <-- 2.5. Fall of BMD six months after orchidectomy was statistically significant (12.1%, p = 0.0001) increasing the proportion of osteoporotics to 49%. Twenty four patients completing 12 months follow up, were separately analyzed and showed similar fall in BMD in first 6 months of follow up (13%) and further 8% loss in next six months. Ten patients were followed up for 18 months, and these did not show significant loss of BMD beyond 12 months (p = 0.9). CONCLUSIONS: Osteoporosis is common in hormone-naive population affected by prostate cancer and orchidectomy leads to accelerated exacerbation of this bone loss. Periodic measurement of BMD using QCT after ADT would help in early detection of osteoporosis.

Type 2 diabetes mellitus among children and adolescents in Al-Ain: a case series.

To characterize the features of type 2 diabetes mellitus among children and adolescents in Al-Ain, the records of every child with diabetes attending a teaching hospital in the city from January 1990 to December 2001 were retrospectively examined. Of 96 young people newly diagnosed with diabetes mellitus, 11 were identified as type 2. The clinical characteristics were: pubertal onset, female preponderance, obesity, strong family history of type 2 diabetes mellitus, high plasma glucose at presentation, adequate beta cell reserve and serum pancreatic islet cell antibody negativity. This case series adds to the evidence that type 2 diabetes mellitus is emerging among children in our region.

Gestational diabetes mellitus prevalence: Effect of the laboratory analytical variation.

AIMS: To highlight the effect of laboratory analytic variation, assessed by glucose (a) total analytic laboratory error (TAEL) present in one index laboratory and (b) total recommended allowable error (TAEa) universally applicable to all laboratories, on the prevalence of gestational diabetes mellitus (GDM). METHODS: 2337 pregnant women underwent a 75-g oral glucose tolerance test (OGTT) for universal GDM screening. Since the true value of every laboratory result fluctuates within a range, the glucose TAEL and TAEa were used to define a lower and an upper diagnostic threshold (95% confidence interval, CI) for the three glucose OGTT cut-offs of the criteria of the American Diabetes Association, ADA (2003); the Canadian Diabetes Association, CDA (2013) and the International Association of Diabetes and Pregnancy Study Groups, IADPSG (2010). RESULTS: For the ADA, CDA and IADPSG criteria, respectively, the GDM prevalence [95% CI, (glucose TAEL) (glucose TAEa)] was 13.3% [(8.0-21.8) (6.3-25.9)], 30% [(17.3-53.1) (14.3-61.3)] and 45.3% [(27.0-71.0) (22.3-79.2)]. Using the lower and higher assigned OGTT glucose thresholds for TAEL, respectively, among the different criteria, either 200 (8.6%)-601 (25.7%) additional or 122 (5.2%)-426 (18.3%) fewer women would be identified with GDM (p<0.0001). CONCLUSIONS: Independent of the diagnostic criteria, any reported GDM prevalence can potentially vary between one half to two times even for laboratories meeting recommended quality specifications. To avoid misclassifying women with GDM substantially, individual laboratories can significantly reduce this disparity by improving analytic performance. All physicians must ensure that their laboratory meets acceptable quality standards for optimal patient care.

Gestational diabetes: differences between the current international diagnostic criteria and implications of switching to IADPSG.

AIMS: To highlight the differences between eight international expert panel diagnostic criteria (either current or outdated but in use) for the diagnosis of gestational diabetes mellitus (GDM) and implications of switching to the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criterion. METHODS: 2337 pregnant women underwent a 75-g oral glucose tolerance test as part of a universal screening protocol. The GDM prevalence and number of women classified differently were compared between the criteria of the American Diabetes Association (2003); Australasian Diabetes in Pregnancy Society (1998); the Canadian Diabetes Association, CDA (2003 & 2013); the European Association for the Study of Diabetes (1996); IADPSG (2010); the New Zealand Society for the Study of Diabetes (2004) and the World Health Organization (1999). RESULTS: The prevalence varied from 9.2% to 45.3% with the different criteria. The IADPSG compared a) best with CDA 2013 [356(15.2%) women classified differently, (kappa, k=68.3%)] and b) worst with CDA 2003 [843 (36.1%) women classified differently, (k=21.8%)]; p<0.001.Switching to IADPSG from the original criteria would increase the prevalence 1.5-4.9 times. CONCLUSIONS: In 2015, the various international guidelines for GDM continue to show major discrepancies in the prevalence and the women classified dissimilarly. A consensus on a single global guideline would be a giant leap forward.

Childhood and adolescent diabetes mellitus in Arabs residing in the United Arab Emirates.

In 9 years (1990-1998), 40 Arab patients between the ages of 0 and 18 years had newly diagnosed diabetes mellitus (DM) at the Al-Ain hospital, United Arab Emirates (UAE). In this cohort, 35 patients had Type 1 DM while the remaining five patients had features of early onset Type 2 DM. For Type 1 DM patients, the mean age at diagnosis of was 9.2+/-4.1 years. At presentation, their mean plasma glucose was 27.6+/-11/mmol with 28 (80%) patients having diabetic ketoacidosis (DKA), both being much higher than generally reported in the West. The mean insulin requirement increased from 0.84+/-0.27 U/kg per 24 h (0-9-year group) to 1.02+/-0.33 U/kg per 24 h (10-18-year group), P=0.055. The home glucose monitoring and the glycaemic control of these Type 1 DM patients were sub-optimal with 28% of patients having recurrence of DKA. Among the Type 2 DM patients, four (80%) were obese with a positive family history of Type 2 DM. All of them initially responded to diet and oral hypoglycaemic drugs. Public education about DM in childhood and prevention of adolescent obesity remain major public health challenges in the UAE.

Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins.

In populations with a high incidence of gestational diabetes (GDM), any form of oral glucose testing for screening or diagnosis excessively strains the health care system. We investigated the value of glycated proteins as potential screening tests in 430 pregnant women, i.e. protein corrected fructosamine (cFRUC) and hemoglobin A1c (HbA(1c)) both alone and in combination for a GDM diagnosis confirmed by the 'gold standard' 100-g oral glucose tolerance test (OGTT). Two cut-off values were used for each test, the upper to rule in and the lower to rule out GDM. At the lower cut-off values for cFRUC of 210 micromol/l and HbA(1c) of 5%, the sensitivities achieved were 92.2 and 92.1% while the negative predictive values were 88.9 and 86.9%, respectively. The upper cut-off values did not achieve acceptable positive predictive values to be useful for ruling in GDM. Screening of our multiethnic, high-risk pregnant population with a combination of cFRUC and HbA(1c) on a single fasting sample would have avoided the cumbersome OGTT (by ruling out GDM) in 37.9% women with only a 3.9% misclassification rate. This potentially simpler approach, though not universally applicable, would be clinically useful and more acceptable to patients in selected high-risk populations.

Transient diabetes insipidus and hypopituitarism after pituitary apoplexy: a rare association with pericardial effusion and painless thyroiditis.

Pituitary apoplexy in a 38-year-old male patient with acromegaly who presented with pericardial effusion, anterior pituitary dysfunction, and diabetes insipidus is described. With corticosteroid therapy, there was good initial recovery of pituitary function and regression of pericardial effusion. On withdrawal of corticosteroids, he developed painless thyroiditis, with transient thyrotoxicosis. Subsequently, the pituitary function tests remained normal for a year, but later he gradually developed hypogonadotropic hypogonadism, hypocortisolism, growth hormone deficiency, and progressive pituitary atrophy, resulting in empty sella syndrome.

Human prostatic endocrine-paracrine (APUD) cells. Distributional analysis with a comparison of serotonin and neuron-specific enolase immunoreactivity and silver stains.

Prostatic endocrine-paracrine (PEP) cells from the prostates of 25 radical cystectomy specimens were studied using serotonin and neuron-specific enolase immunocytochemistry and argyrophil and argentaffin silver stains. Three populations of PEP cells were identified as follows: (1) serotonin-positive only, (2) serotonin-positive and argyrophil-positive (the largest population), and (3) serotonin-positive, argyrophil-positive, and argentaffin-positive. Neuron-specific enolase immunoreactivity correlated closely with serotonin immunoreactivity. The entire PEP cell cytoplasm was serotonin and neuron-specific enolase immunoreactive, while the silver stains only stained the granulated cytoplasm. The PEP cells were present in all areas of all prostates with a surprisingly large number in the large periurethral ducts with somewhat fewer PEP cells in the prostatic urethra and smaller ducts and ductules. The peripheral acini generally contained the smallest number of PEP cells. Prostatic endocrine-paracrine cells were of the open (luminal extension), closed, and dendritic types.

On some novel aspects of consanguineous marriages.

Consanguineous marriages, often viewed as incestuous and objectionable, are more widespread than commonly perceived. They integrate multiple facets of human adaptation: economic, cultural and genetic. The widely touted explanation for the origin and persistence of consanguinity is that it provides many socioeconomic benefits; however, this view may be too simplistic. The bias against consanguinity may preclude an objective understanding of this sociobiological puzzle. Inbreeding increases the speed of selection of beneficial recessive and co-dominant alleles, e.g. those that protect against diseases. In populations endemic with malaria, the prevalence of consanguineous marriages and the frequency of alleles protective against malaria are both very high. Thus, consanguinity could theoretically increase the relative fitness of a population under specific ecological conditions; sometimes, the overall genetic benefits may exceed genetic costs of inbreeding. We discuss some recent evidence from studies on inbreeding along with the reasons responsible for the mating strategy found in some human populations. We contend that a better appreciation of our inherent biases and potential genetic benefits of inbreeding in specific ecological conditions would help us to appreciate the wider picture of consanguinity.

Pheochromocytoma of urinary bladder.

Pheochromocytoma of urinary bladder are rare tumors. They present with nonspecific clinical signs and symptoms, so imaging plays an important role in diagnosing and localizing the tumor. We present two cases of bladder pheochromocytoma, one of them presented with vague abdominal pain and the other with hematuria. Biphasic CT in both the cases showed hypervascular intravesical mass suggestive of bladder pheochromocytoma. The lesions were confirmed biochemically or on postoperative histopathology. A brief review of the imaging in bladder pheochromocytoma is also presented.

Serum leptin: a marker of prostate cancer irrespective of obesity.

INTRODUCTION: High expression of leptin receptors have been observed in the prostate cancer in various clinical studies; however the association of serum leptin with carcinoma prostate remains unresolved. We studied association, between serum leptin and carcinoma prostate in Asian (Indian) population and its association with obesity. MATERIAL AND METHODS: 30 prospective cases of cancer prostate and 30 age matched controls were included in this study. Body mass index (BMI) was estimated and categorized in 4 groups by WHO criteria. Waist hip ratio (WHR) was calculated and divided into three groups. Serum leptin was estimated by sandwich ELISA technique (DRG leptin ELISA kit, Marburg, Germany). RESULTS: Both the groups were comparable for age, WHR and BMI. Serum leptin was significantly higher in patients with cancer prostate as compared to controls (median 14.18 ng/ml vs. 1.63 ng/ml; p< 0.001). The level of leptin was found to have positive correlation with BMI and WHR in controls (r=0.485, p=0.007; r=0.314, p=0.091, respectively) however, no correlation was observed in patients with cancer prostate (r=0.071, p=0.711; r=0.067, p=0.725, respectively). There was no correlation between leptin and PSA. The serum leptin level was not related to the Gleason's score and stage of the carcinoma. CONCLUSIONS: This study shows that Prostate cancer is associated with raised serum leptin which is independent of obesity and serum PSA. It hints the role of leptin in pathogenesis of this tumor. It may not be a surrogate marker of aggressiveness. For validation, further studies including a large patient population is required.