Fetal Growth Spurt and Pregestational Diabetic Pregnancy

OBJECTIVE - To assess the timing of fetal growth spurt among pre-existing diabetic pregnancies (types 1 and 2) and its relationship with diabetic control. To correlate fetal growth acceleration with factors that might influence fetal growth. RESEARCH DESIGN AND METHODS - This retrospective study involved all pregestational diabetic pregnancies delivered at a tertiary obstetric hospital in Australia between 1 January 1994 and 31 December 1999. Pregnancies with major congenital fetal anomalies, multiple pregnancies, small-for-gestational-age pregnancies (90th centile for gestation) were compared with babies with normal birth weights. RESULTS- A total of 101 diabetic pregnancies were included. Diabetic mothers, who had LGA babies, had significantly higher prepregnancy body weight and BMI (P < 0.05). There were no differences in maternal age or parity among the two groups. There were also no differences in the first-, second-, and third-trimester HbA(1c) levels between the two groups. The abdominal circumference z-scores were significantly higher for LGA babies from 18 weeks and thereafter. The differences increased progressively as the gestation advanced. Maximum difference was noted in the third trimester (30-38 weeks). CONCLUSIONS - Fetal growth acceleration in LGA fetuses of diabetic mothers starts in the second trimester, from as early as 18 weeks. In this study, glucose control did not appear to have a direct effect on the incidence of LGA babies, and such observation might result from the effects of other confounding factors.

Present and future pharacotherapy for heart failure

The pharmacotherapy currently recommended by the American College of Cardiology and the American Heart Association for heart failure (HF) is a diuretic, an angiotensin-converting enzyme inhibitor (ACEI), a β-adrenoceptor antagonist and (usually) digitalis. This current treatment of HF may be improved by optimising the dose of ACEI used, as increasing the dose of lisinopril increases its benefits in HF. Selective angiotensin receptor-1 (AT1) antagonists are effective alternatives for those who cannot tolerate ACEIs. AT1 antagonists may also be used in combination with ACEIs, as some studies have shown cumulative benefits for the combination. In addition to being used in Stage IV HF patients, in whom it has a marked benefit, spironolactone should be studied in less severe HF and in the presence of β-blockers. The use of carvedilol, extended-release metoprolol and bisoprolol should be extended to severe HF patients as these agents have been shown to decrease mortality in this group. The ancillary properties of carvedilol, particularly antagonism at prejunctional β-adrenoceptors, may give it additional benefits to selective β1-adrenoceptor antagonists. Celiprolol and bucindolol are not the β-blockers of choice in HF, as they do not decrease mortality. Although digitalis does not reduce mortality, it remains the only option for a long-term positive inotropic effect, as the long-term use of the phosphodiesterase inhibitors is associated with increased mortality. The calcium sensitising drug levosimendan may be useful in the hospital treatment of decompensated HF to increase cardiac output and improve dyspnoea and fatigue. The antiarrhythmic drug amiodarone should probably be used in patients at high risk of arrhythmic or sudden death, although this treatment may soon be superseded by the more expensive implanted cardioverter defibrillators, which are probably more effective and have fewer side effects. The natriuretic peptide nesiritide has recently been introduced for the hospital treatment of decompensated HF. Novel drugs that may be beneficial in the treatment of HF include the vasopeptidase inhibitors and the selective endothelin-A receptor antagonists but these require much more investigation. However, disappointing results have been obtained in a large clinical trial of the tumour necrosis factor α antagonist etanercept, where no likelihood of a difference between placebo and etanercept was observed. Small clinical trials with recombinant growth hormone to thicken ventricles in dilated cardiomyopathy have given variable results.

Single-nucleotide polymorphism in the CD14 promoter and periodontal disease expression in a Japanese population

It has been reported that there is a relationship between a single-nucleotide polymorphism (SNP) in the promoter region of the CD 14 gene at position -159 (C-->T) and infectious diseases. The aim of the present study was to test the hypthesis that expression of this SNP correlates with periodontal disease in a Japanese population. The CD14 genotype was determined in 163 subjects with periodontitis and in 104 age- and gender-matched control subjects without periodontitis. The genotype distribution and allele frequency within the periodontitis patients were not significantly different from those of control subjects. There was, however, a significant difference in the genotype distribution between young patients (< 35 yrs) and older patients (greater than or equal to 35 yrs). These findings suggest that CD14-159C/T polymorphism is not related to the development of periodontitis in a Japanese population, but that, within the periodontitis subjects, expression of the SNP may be related to early disease activity.

Aging per se does not influence glucose homeostasis - In vivo and in vitro evidence

OBJECTIVE - To assess the effect of age on glucose metabolism by examining 1) glucose metabolism in young and middle-aged subjects when total or regional adiposity is taken into account and 2) in vitro glucose transport in adipose tissue explants from young and middle-aged women paired for total and abdominal adiposity. RESEARCH DESIGN AND METHODS - Study 1: body composition, subcutaneous abdominal and visceral adipose tissue areas, and fasting and oral glucose-stimulated glucose and insulin were measured in 84 young and 81 middle-aged men and in 110 young and 91 middle-aged women. Study 2: glucose uptake in subcutaneous abdominal and visceral adipose tissue explants were measured in eight young and eight middle-aged women. RESULTS - Study 1: young and middle-aged men showed similar subcutaneous abdominal tissue area, whereas fat mass and visceral adipose tissue were greater in middle-aged than in young men (P < 0.01). Fat mass and subcutaneous and visceral adipose tissue areas were greater in middle-aged as compared with young women (P < 0.01). Fasting plasma glucose and the glucose response to an oral glucose tolerance test were significantly higher in middle-aged than in young men and women (P < 0.001). Statistical control for visceral adipose tissue area eliminated the difference seen in glucose response in men and women. Study 2: glucose transport in subcutaneous and omental adipose tissue did not differ between young and middle-aged women. CONCLUSIONS - 1) Visceral obesity, more than age per se, correlates with glucose intolerance in middle-aged subjects; 2) aging does not influence in vitro adipose tissue glucose uptake.

Vicarious dissonance: Attitude change from the inconsistency of others

Three studies support the vicarious dissonance hypothesis that individuals change their attitudes when witnessing members of important groups engage in inconsistent behavior. Study 1, in which participants observed an actor in an induced-compliance paradigm, documented that students who identified with their college supported an issue more after hearing an ingroup member make a counterattitudinal speech in favor of that issue. In Study 2, vicarious dissonance occurred even when participants did not hear a speech, and attitude change was highest when the speaker was known to disagree with the issue. Study 3 showed that speaker choice and aversive consequences moderated vicarious dissonance, and demonstrated that vicarious discomfort-the discomfort observers imagine feeling if in an actor's place-was attenuated after participants expressed their revised attitudes.

ASD explained for peers, parents, and professionals

Can the parent of a child with autism or Asperger Syndrome ever really comprehend the experiences of their child? As a greater number of cases are identified and more is understood about these conditions, autism and Asperger Syndrome seem to be increasingly commonly understood terms. Despite the clear definitions provided by diagnostic criteria for the conditions (e.g., American Psychiatric Association [APA], 1994), it often remains difficult for professionals, parents and other carers, particularly those who are newcomers to this field, to truly understand the complexities of these conditions with respect to the day-to-day influences upon the affected individual.

The effects of parental sensitivity and involvement in caregiving on mother–infant and father–infant attachment in a portuguese sample

In the present longitudinal study, we investigated attachment quality in Portuguese mother–infant and in father–infant dyads, and evaluated whether attachment quality was related to parental sensitivity during parent–infant social interaction or to the amount of time each parent spent with the infant during play and in routine caregiving activities (e.g., feeding, bathing, play). The sample consisted of 82 healthy full-term infants (30 girls, 53 boys, 48 first born), and their mothers and fathers from mostly middle-class households. To assess parental sensitivity, mothers and fathers were independently observed during free play interactions with their infants when infants were 9 and 15 months old. The videotaped interactions were scored by masked coders using the Crittenden’s CARE-Index. When infants were 12 and 18 months old, mother–infant and father–infant dyads were videotaped during an adaptation of Ainsworth’s Strange Situation. Parents also described their level of involvement in infant caregiving activities using a Portuguese version of the McBride and Mills Parent Responsibility Scale. Mothers were rated as being more sensitive than fathers during parent–infant free play at both 9 and 15 months. There also was a higher prevalence of secure attachment in mother–infant versus father–infant dyads at both 12 and 18 months. Attachment security was predicted by the amount of time mothers and fathers were involved in caregiving and play with the infant, and with parents’ behavior during parent–infant free play.

Um Novo Factor de Risco para Endocardite Infecciosa

A implantação de piercings corporais tem sido uma prática cada vez mais comum nas últimas décadas, sobretudo entre os mais jovens. No entanto, não se trata de um procedimento inócuo, podendo apresentar complicações tão graves como a endocardite infecciosa, que pode surgir em indivíduos com ou sem cardiopatia de base. Neste artigo relatamos o caso de uma endocardite pós piercing numa jovem com pacemaker definitivo, tendo havido necessidade de intervenção cirúrgica. Fazemos igualmente uma revisão dos casos de endocardite pós piercing descritos na literatura. Agora que as recomendações da American Heart Association para a profilaxia de endocardite infecciosa estão mais restritas, discutimos a necessidade de inclusão dos piercings corporais nos procedimentos a merecerem terapêutica profiláctica nos indivíduos de alto risco.

Correlação sorológica eletrocardiográfica para a doença de Chagas em populações rurais não selecionadas do Rio Grande do Sul

O trabalho analisa 4.758 correlações sorológicas eletrocardiográficas feitas em populações rurais não selecionadas de 17 municípios da Zona Sul do Rio Grande do Sul. A sorologia baseou-se na reação de fixação de complemento para doença de Chagas e os ECG foram interpretados segundo critérios da American Heart Association. 330 ECG alterados pertenciam aos 803 indivíduos soropositivos (41,1%) e 1.287 aos 3.955 soronegativos (32,5%). O gradiente de 8,5% a favor dos positivos mostrou-se significativo a nível de p < 0,001. As alterações acompanhadas por diferenças significativas entre positivos e negativos foram justamente aquelas consideradas características de miocardiopatia chagásica (BCRD, HBDAE, extrassistolia ventricular, alterações de ST eTe áreas de necrose e/ou fibrose. Estes fatos permitem concluir que a infecção pelo Trypanosoma cruzi é fator importante de agressão miocárdica numa parcela significativa da população rural da área endêmica de doença de Chagas no Rio Grande do Sul.