Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland.

AIMS: Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement. METHODS: Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths. RESULTS: Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely <37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues. CONCLUSIONS: This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.

Nicorandil-induced penile ulceration - surgical excision: case series and review of literature.

Nicorandil, a nicotinamide ester, is used in the prevention of angina pectoris. There is now a well-established association of perianal ulceration and the use of the drug. However, in the recent years, there have been reports of penile skin, vulval and even vaginal ulcers caused by nicorandil. We report three cases of nicorandil-induced penile ulcers which were surgically managed, and present a review of current literature.

Purple urine bag syndrome: a truly harmless sign?

Purple urine bag syndrome is an uncommon condition that describes the purple discolouration of a catheter bag and tubing. It mainly affects patients with limited mobility who have long-term catheters. Although benign in nature per se, its presence can alarm both patient and practitioner unfamiliar with the syndrome. Here, we describe two cases of asymptomatic patients who both presented to outpatient clinic with the characteristic purple discolouration of their long-term catheters and tubing. The report discusses the pathophysiology of the syndrome and initial investigation and management. Although the syndrome is considered benign, it may signify occult urine tract infection. This should not be ignored even if the patient is asymptomatic, given the likely co-morbidities of the patients affected. Healthcare professionals - particularly urologists and geriatricians - need to be aware of this unusual syndrome so as to initiate appropriate investigation and possible treatment as soon as possible.