Incorporating reproductive system history data into cardiovascular nursing research to advance women's health.

The lack of sex-specific variables, such as reproductive system history (RSH), in cardiovascular research studies is a missed opportunity to address the cardiovascular disease (CVD) burden, especially among women who face sex-specific risks of developing CVD. Collecting RSH data from women enrolled in research studies is an important step towards improving women's cardiovascular health. In this paper, we describe two approaches to collecting RSH in CVD research: extracting RSH from the medical record and participant self-report of RSH. We provide specific examples from our own research and address common data management and statistical analysis problems when dealing with RSH data in research.

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. DESIGN: Prospective observational study. PATIENTS AND MEASUREMENTS: In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. CONCLUSION: The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

Are Physical and Depressive Symptoms Different Between Women and Men With Heart Failure?: An Exploration Using Two Analytic Techniques.

BACKGROUND: Adults with heart failure (HF) experience a constellation of symptoms; however, understanding of gender differences in HF symptoms remain elusive. The aim of this study was to determine whether there are gender differences in physical and depressive symptoms and symptom patterns in HF using 2 different analytic techniques. METHODS: We performed a secondary analysis of combined data from 6 studies of adults with HF. Physical symptoms were measured with the HF Somatic Perception Scale, and depressive symptoms were measured with the Patient Health Questionnaire-9. First, we performed propensity matching with the nearest neighbor to examine the average treatment effect for HF Somatic Perception Scale and Patient Health Questionnaire-9 in the matched sample of women and men. Next, we used the entire data set in a latent class mixture model to determine patterns of symptoms. Finally, we calculated predictors of class membership with multinomial logistic regression. RESULTS: The sample (n = 524, 86.5% systolic HF) was 37% women with a mean age of 58.3 ± 13.9 years and mean number of years with HF of 6.9 ± 6.9. Three hundred sixty-six participants were matched on propensity scores; there were no significant gender differences in symptom scores between matched women (n = 183) and men (n = 183). Among all 524 participants, 4 distinct latent classes of symptom patterns indicate that many patients with HF are fatigued, some have more depressive symptoms, and others have significantly more edema or cough. Gender did not predict membership to any symptom pattern. CONCLUSIONS: There were significant gender differences in sociodemographics, health behaviors, and clinical characteristics, but not HF symptoms or symptom patterns, using either analytic technique.

Sex differences in the impact of physical frailty on outcomes in heart failure.

BACKGROUND: Physical frailty is strongly related to adverse outcomes in heart failure (HF), and women are more likely to be physically frail than men; however, it is unknown if this sex difference affects outcomes. OBJECTIVES: To determine if there are sex differences in the associations between physical frailty and health-related quality of life (HRQOL) and clinical outcomes in HF. METHODS: We conducted a prospective study of adults with HF. Physical frailty was assessed using the Frailty Phenotype Criteria. HRQOL was assessed using the Minnesota Living with HF Questionnaire. One-year clinical events (all-cause death or cardiovascular hospitalization or emergency department visit) were ascertained. We used generalized linear modeling to quantify associations between physical frailty and HRQOL, and Cox proportional hazards modeling to quantify associations between physical frailty and clinical events, adjusting for Seattle HF Model scores. RESULTS: The sample (n = 115) was 63.5 ± 15.7 years old and 49% women. Physical frailty was associated with significantly worse total HRQOL among women (p = 0.005) but not men (p = 0.141). Physical frailty was associated with worse physical HRQOL among both women (p < 0.001) and men (p = 0.043). There was a 46% higher clinical event risk for every one-point increase in physical frailty score among men (p = 0.047) but not women (p = 0.361). CONCLUSIONS: Physical frailty is associated with worse overall HRQOL among women and higher clinical event risk among men, indicating a need to better understand contributors to sex-specific health differences associated with physical frailty in HF.

Pulmonary mixed squamous and glandular papilloma: diagnostic challenges of a rare lesion when the clock is ticking. How to avoid interpretation mistakes.

Pulmonary mixed squamous and glandular papillomas (MSCGPs) are rare, benign neoplasms with peculiar clinical and histological features. However, on occasion, they can present certain characteristics that overlap with other neoplasms including carcinomas. Recognising these features is hence important for treatment purposes. Molecular studies can sometimes help in further characterisation, although they should not guide the diagnosis which ultimately relies on morphology.We report a challenging case of MSCGP with unusual features, received during intraoperative consultation. We highlight the subtle morphological features to help avoid overcalling a benign lesion as malignant.

Coexistence of two missense mutations in the KRAS gene in adenocarcinoma of the lung: a possible indicator of poor prognosis.

Background: KRAS mutations are present in up to 30% of patients with lung adenocarcinoma. The two most common KRAS mutations in non-small cell lung cancer (NSCLC) are G12C (~40%) and G12V (~22%). We describe the case of a 63-year-old Asian male patient with a very aggressive lung adenocarcinoma harbouring two coexisting missense mutations in the same exon. Methods: The patient presented with a 6 cm spiculated lung mass and bilateral mediastinal lymphadenopathy on imaging. A cytology sample was obtained from EBUS-TBNA of mediastinal lymph nodes, and mutation screening was performed by next-generation sequencing using the Ion Torrent Cancer Hotspot panel. Results: Cytological examination and immunocytochemistry confirmed the presence of metastatic lung adenocarcinoma. The molecular analysis revealed the coexistence of two missense mutations: c.34G > T; p.(Gly12Cys) and c.38G > T; A; p.(Gly13Asp) in exon 2 of the KRAS gene. The two independent variants were confirmed on Integrative Genomic Viewer (IGV), suggesting molecularly independent clones. The patient was treated with palliative care and died within two months of the diagnosis. Conclusions: The present case showed aggressive clinical behaviour. It is questionable whether this aggressive course was due to the coexistence of multiple mutations or to a specific single mutation. Data in the literature regarding the outcome of polyclonal KRAS polyclonal lung adenocarcinomas are scarce, but some evidence seems to indicate that specific mutations may have prognostic value, possibly depending on the disease setting.

Short-Term Effects of Cholecalciferol Supplementation on cFGF23 Levels in Children with Chronic Kidney Disease and Vitamin D Insufficiency.

Data on the effect of vitamin D supplementation on fibroblast growth factor 23 (FGF23), in chronic kidney disease (CKD) are scarce. In a prospective interventional study, the effect of vitamin D supplementation on cFGF23 (C-terminal FGF23) levels in children with CKD stages 2-4 was examined. Forty-one children with CKD and vitamin D insufficiency were administered 600,000 units of cholecalciferol over 3 d; 88% of patients achieved sufficiency at 8 wk. Significant increase in serum cFGF23 and phosphate levels was observed in CKD stage 2 after supplementation, but not in CKD stages 3 and 4. There was no correlation of the change in cFGF23 level with baseline or change in bone health parameters (calcium, phosphate, parathormone or alkaline phosphatase) or with change in flow-mediated dilatation (FMD) of the brachial artery. It is concluded that cholecalciferol supplementation increases serum calcium and reduces PTH, but does not adversely affect FGF23 levels in CKD.

Prenatal phenotypic spectrum of full trisomy 18 in an Indian cohort.

Trisomy 18 or Edward syndrome is a chromosomal disorder due to the presence of an extra chromosome 18. We describe the phenotype of five fetuses at different gestational ages, each highlighting a different aspect of trisomy 18. The clinical spectrum included increased nuchal translucency, fetal hydrops, congenital malformations of the central nervous system, congenital heart disease, radial ray defects, and characteristic facial gestalt. We made a comparison of prenatal ultrasonography and the autopsy findings. The fetal autopsy defined the craniofacial and digit anomalies better compared with sonography. The facial features of tall forehead, hypoplastic nares, microstomia, micrognathia, low set abnormal ears along with clenched hands, and short hallux are typical for trisomy 18 and help in planning the targeted cytogenetic or molecular tests. The diagnosis was established by either fluorescence in situ hybridization or quantitative fluorescent polymerase chain reaction or chromosomal microarray in the patients. This communication emphasizes the importance of detailed assessment for craniofacial and limb anomalies on prenatal ultrasonography which can prompt an early evaluation for trisomy 18.

Exocrine and endocrine functions and pancreatic volume in patients with pancreatic trauma.

INTRODUCTION: Injury to the pancreas may lead to significant morbidity and mortality. We aim to assess pancreatic endocrine and exocrine functions and evaluated morphological regenerations of pancreas following partial pancreatectomy in patients with pancreatic trauma. METHODS: The study was performed between June 2016 and December 2017. Endocrine functions were assessed at the time of admission and at 6 months follow-up with 75 g oral glucose tolerance test (OGTT), serum insulin and C-peptide levels and HbA1c estimation and exocrine functions were assessed with fecal elastase test. Pancreatic volumetry was done with imaging scan at 1 month and 6 months post discharge. RESULTS: Twenty patients were studied with a median age of 30 years (range18-48) at the time of injury. All the patients were normoglycemic on admission; only one patient who underwent pancreatic resection developed diabetes mellitus at follow-up. Eight patients (40%) were found to be prediabetic by American Diabetes Association (ADA) criteria. Eleven patients (55%) had pancreatic exocrine insufficiency. Pancreatic volume increment, from the mean pancreatic volume of 48.65 to 54.29 cm3, was noted in patients who underwent partial pancreatectomy. CONCLUSIONS: Patients with pancreatic trauma may develop biochemical endocrine and exocrine insufficiencies following pancreatic resection. Pancreatic volume increment requires further research in a larger study.

Rapid design of inclusive wireless technologies: A participatory workshop process.

Wireless technology products and services play a significant role in our everyday lives. Great advances in design features have improved the accessibility and utility of these technologies for older adults and people with disabilities. Yet, there is still opportunity to ensure upcoming designers of wireless technologies consider how their design helps or hinders their product's potential users. In this paper, we describe the evolution of a series of half-day participatory design workshops intended to expose student designers to real-world problem-solving alongside experts in the fields of aging and disability services and end users. Workshop attendees rapidly worked through an inclusive design process identifying and defining problems, considering the design requirements to meet the needs of various individuals, and finally designing and refining concepts to solve those problems. We describe the design of the workshops, iterations intended to improve on the experience, and our recommendations for conducting similar workshops.

Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure.

BACKGROUND: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. METHODS: We prospectively enrolled adults with class I-IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. RESULTS: The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81-11.84], P=0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non-physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non-physically frail men. CONCLUSIONS: Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.

Changes in ß-Cell Function in Offspring of Type-2 Diabetic Patients, as per Fasting and Two-Hour Plasma Glucose Levels.

Background The changes in ß-cell function in high-risk populations who are apparently in the normal glucose tolerant stage are still under investigation for designing earlier prevention strategies. This study analyzes changes in ß-cell function and insulin sensitivity across fasting and two-hour glucose categories spanning normal glucose tolerance (NGT) to impaired glucose tolerance (IGT), in offspring of subjects with type-2 diabetes mellitus (T2DM) compared to the controls without a known family history of T2DM. Methods Offspring of T2DM patients (cases) and individuals without a family history of T2DM (controls) were the subjects for this cross-sectional study. All participants underwent a 75 g oral glucose tolerance test and blood samples were collected for plasma glucose, insulin, C-peptide and proinsulin, at zero, 30, 60, and 120 minutes.  Results A total of 358 cases (age 23.0 ± 10.8 years, 54% males) and 287 controls (age 28.4 ± 8.10 years, 65% males) were the subjects of this study. Cases and controls were divided into subgroups based on fasting and two-hour glucose categories spanning NGT to IGT. Compared to the reference category of controls (< 80 mg/dL for fasting glucose and < 84 mg/dL for two-hour glucose), cases with IGT had ~60% decline in both ß-cell compensation (as measured as disposition index {0-120}) and insulin sensitivity (as measured as whole-body insulin sensitivity index {0-120}); adjusted for age, gender, and body mass index. From lower to higher fasting and two-hour glucose categories, there was a continuous and significant decline in ß-cell compensation in both cases and controls. Significant reduction in first-phase insulin secretion, as measured as insulinogenic (0-30) index, was only observed among two-hour glucose categories, not among the fasting glucose categories. In the transition from late NGT cases to IGT cases, there was a significant decline in ß-cell compensation, first-phase insulin secretion (more prominent than a decline in overall ß-cell secretion) and the changes in whole-body insulin sensitivity were not statistically significant. Conclusions The decline in ß-cell compensation was continuous and significant in offspring of subjects with type-2 diabetes and controls without a known family history of diabetes from early normal glucose tolerant ranges to impaired glucose tolerant ranges. Compared to the strictest glucose controlled category of controls, approximately 60% decline was observed in ß-cell compensation and insulin sensitivity, in impaired glucose tolerant offspring of subjects with type-2 diabetes mellitus.

Comparison of 4DMRI and 4DCT for the preoperative evaluation of patients with primary hyperparathyroidism.

BACKGROUND: Minimally invasive parathyroid surgery is the standard of care in patients with Primary Hyperparathyroidism (PHPT) which requires accurate preoperative localization. Of all the available imaging modalities, 4DCT is considered the best modality for localization, however it entails the risk of ionizing radiation. To circumvent this 4DMRI was evaluated for parathyroid lesion localization. PURPOSE: To evaluate and compare the accuracy of 4DCT and 4DMRI in the localization of parathyroid Lesions. MATERIALS AND METHODS: In this ethically approved observational diagnostic study, 135 patients (age range: 10-75 years, male: female ratio - 1:2.1) with clinically and biochemically suspected PHPT were recruited. Of these, 56 patients underwent both 4DCT and 4DMRI. Six patients with positive imaging who didn't undergo surgery were excluded. A total of 50 patients with 61 proven parathyroid lesions were included for analysis. 48 patients had surgical and histopathological findings for the confirmation of imaging findings. RESULTS: Both 4DCT and 4DMRI correctly detected 59/61 lesions in 48 patients. There was one false positive and two true negatives. In addition, 2 (3.22 %) lesions which were not detected by 4DCT and 4DMRI were found on surgery. The sensitivity of both 4DCT and 4DMRI was 96.7 %; specificity was 66.6 % and accuracy was 95.2 %. CONCLUSION: 4DMRI and 4DCT had similar accuracy for the detection of parathyroid lesions. However, 4DMRI has the advantage of lack of exposure to ionizing radiation, which can be beneficial in younger patients.

Gender differences in the prevalence of frailty in heart failure: A systematic review and meta-analysis.

OBJECTIVES: This study quantitatively synthesized literature to identify gender differences in the prevalence of frailty in heart failure (HF). BACKGROUND: The intersection of frailty and HF continues to garner interest. Almost half of patients with HF are frail; however, gender differences in frailty in HF are poorly understood. METHODS: We performed a literature search to identify studies that reported prevalence of frailty by gender in HF. Random-effects meta-analysis was used to quantify the relative and absolute risk of frailty in women compared with men with HF, overall, and by Physical and Multidimensional Frailty measures. Meta-regression was performed to examine the influence of study age and functional class on relative risk in HF. RESULTS: Twenty-nine studies involving 8854 adults with HF were included. Overall in HF, women had a 26% higher relative risk of being frail compared with men (95% CI = 1.14-1.38, z = 4.69, p < 0.001, I2 = 76.5%). The overall absolute risk for women compared to men with HF being frail was 10% (95% CI = 0.06-0.15, z = 4.41, p < 0.001). The relative risk of frailty was slightly higher among studies that used Physical measures (relative risk = 1.27, p < 0.001) compared with studies that used Multidimensional measures (relative risk = 1.24, p = 0.024). There were no significant relationships between relative risk and either study age or functional class. CONCLUSIONS: In HF, frailty affects women significantly more than men. Future work should focus on elucidating potential causes of gender differences in frailty in HF.

Prevalence of non-alcoholic fatty liver disease and factors associated with it in Indian women with a history of gestational diabetes mellitus.

AIMS/INTRODUCTION: This study aims to evaluate the prevalence of and factors associated with non-alcoholic fatty liver disease (NAFLD) in Indian women with prior gestational diabetes mellitus (GDM) diagnosed using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. MATERIALS AND METHODS: This cross-sectional study (2018-2019) enrolled women with and without prior GDM. Study participants underwent detailed assessments, including relevant medical, obstetric and demographic details; 75-g oral glucose tolerance test with glucose and insulin estimation at 0, 30 and 120 min; and other relevant biochemical and anthropometric measurements. NAFLD status was defined by ultrasonography. RESULTS: We evaluated a total of 309 women (201 and 108 with and without prior GDM, respectively) at a mean age of 31.9 ± 5.0 years and median of 16 months (interquartile range 9-38 months) following the index delivery. The prevalence of NAFLD was significantly higher in women with prior GDM (62.7% vs 50.0%, P = 0.038; grade 2 and 3 disease, 13.9% vs 6.5%). On logistic regression analysis (fully adjusted model), the odds of NAFLD were 2.11-fold higher in women with prior GDM (95% confidence interval 1.16-3.85, P = 0.014). Overweight/obesity, metabolic syndrome, prediabetes and homeostasis model of assessment of insulin resistance (a measure of insulin resistance) were positively associated with NAFLD, whereas the Matsuda index (a measure of insulin sensitivity) showed a negative association with NAFLD. CONCLUSIONS: The prevalence of NAFLD is high in women with prior GDM. Such women also have a high burden of cardiometabolic risk factors. Future studies should evaluate the intermediate and long-term hepatic and cardiovascular risk, and the impact of lifestyle interventions in reducing morbidity in such women.

Efficacy of vitamin D supplementation in asthmatic children with vitamin D deficiency: A randomized controlled trial (ESDAC trial).

BACKGROUND: Vitamin D supplementations for asthma control had shown inconsistent results. We aimed to study efficacy and safety of vitamin D supplementation in asthmatic children who were vitamin D deficient. METHODS: This double-blind, randomized controlled trial enrolled asthmatic children of 4-12 years of age who had 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL. The participants were randomized to receive either vitamin D orally 1000 IU/d for 9 months or similar-looking placebo. The primary outcomes were the proportion of children having the Childhood Asthma Control Test (CACT) score of ≥20 at the end of the treatment and adverse effects. RESULTS: The trial included 250 children (125 in each group) with a mean age of 8.1 ± 2.3 years and 180 boys. The baseline parameters were similar between the groups, including CACT score (21.7 ± 4.2 vs 21.9 ± 3.6, vitamin D vs placebo). At the end of the study, the proportion of asthmatic children who had CACT score ≥ 20 was similar between vitamin D and placebo group (93.6% vs 92.0%, P = .625). The number of exacerbations of asthma and side effect profile was also identical between the groups. 25(OH)D levels increased significantly in the vitamin D group (18.06 ± 7.11 vs 12.03 ± 5.98 ng/mL, P < .001). The results did not change when we did subgroup analysis for children with baseline CACT score < 20 and 25(OH)D levels at the end of the study ≥20 ng/mL. CONCLUSION: Vitamin D supplementation in asthmatic children with vitamin D deficiency did not improve control of asthma.

Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia - A prospective randomised controlled study.

BACKGROUND AND AIMS: To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies. METHODS: A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2% Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent t-test and visual analogue scale (VAS) scores were compared by the Mann-Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0). RESULTS: Opioid consumption in both groups was comparable, for the first two post-operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group. CONCLUSIONS: As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA.

Glycemic profile of women with normoglycemia and gestational diabetes mellitus during early pregnancy using continuous glucose monitoring system.

AIM: We studied women between 8 and 20 weeks of gestation with the aim of evaluating and comparing those having normoglycemia and GDM according to WHO 2013 criteria. METHODS: In this cross-sectional study (2017-2019), eligible pregnant women underwent a 75-g OGTT, followed by placement of a CGMS. RESULTS: Women (n = 96, 58 with normoglycemia and 38 with GDM) were enrolled at 14.0 ± 3.2 weeks of gestation. Mean preprandial, 1-h and 2-h postprandial and peak glucose values were significantly higher in women with GDM. Peak glucose value was achieved 60.0 ± 12.3 and 64.3 ± 11.6 min after meal in the normoglycemia and GDM group, respectively. 24-h mean glucose (5.8 ± 0.6 vs. 5.3 ± 0.4 mmol/L), mean daytime glucose (6.0 ± 0.6 vs. 5.5 ± 0.4 mmol/L) and mean nocturnal glucose (5.4 ± 0.7 vs. 5.0 0 ± 0.5 mmol/L) were significantly higher in women with GDM. Total time spent in range was significantly lower in the GDM group compared to the normoglycemia group (92.1 vs. 98.2%). CONCLUSIONS: This study highlights differences in glycemic patterns between women with normoglycemia and GDM in the context of a South Asian population where burden of GDM is high but good quality data in early pregnancy are limited.

Changing Trend in Vitamin D Status from 2008 to 2016: An Experience from a Tertiary Care Institute in North India.

BACKGROUND: Serum 25-hydroxyvitamin D (25(OH)D) assays have become readily available in India over the past decade. A large number of cross-sectional studies have been performed on the vitamin D status and the prevalence of vitamin D deficiency (VDD) in India. However, seasonal and long-term trends in serum 25(OH)D levels have been reported less frequently. AIM: To determine the seasonal and year-wise variation in vitamin D status at a tertiary care hospital in north India. MATERIALS AND METHODS: Using hospital records, the data on serum 25(OH) D assays performed in its endocrinology laboratory between 2008 and 2016 were obtained. For analysis of seasonal trends, the months of a year were divided into following seasons: March to June (summer season), July to October (rainy season), and November to February (winter season). VDD was defined as serum 25(OH)D concentration <20 ng/mL. RESULTS: A total of 26,339 assays of serum 25(OH)D were analyzed in the study. The year-wise assay numbers increased steadily from 2008 to peak in the year 2012, followed by a decline and a second smaller peak in the year 2016. The mean serum 25(OH)D concentration increased from 19.1 ± 16.4 ng/mL in 2008 to 21.7 ± 17.1 ng/mL in 2016 (P = 0.02). Between 2008 and 2016, the prevalence of VDD decreased from 71.9% to 54.3% in females, and from 56.7% to 52.1% in males. The levels in rainy season were significantly higher as compared to winters and summers (P < 0.05 for both). Hypervitaminosis D (serum 25(OH)D >100 ng/mL) and vitamin D toxicity (serum 25(OH)D >150 ng/mL) were seen in 319 (1.2%) and 27 (0.1%) assays, respectively. CONCLUSIONS: This study provides data on seasonal and year-wise trends in vitamin D status over a long period of time at a tertiary care hospital in north India. A long-term trend toward improving vitamin D status, especially in females, was noted in the study. The prevalence of VDD was found to decrease in the analyzed samples during the study period.