Zwei konsekutive komplikationslose Schwangerschaften einer Typ-1-Diabetikerin unter Insulin Lispro

Zusammenfassung. q Hintergrund: Die Stoffwechselkontrolle bei Typ-1-Diabetikerinnen in der Schwangerschaft ist im Hinblick auf die Inzidenz von Fehlbildungen und Schwangerschaftskomplikationen bedeutsam. Gerade bei jungen Typ-1-Diabetikerinnen ist das schnell wirkende Insulin Lispro sehr beliebt, jedoch für die Anwendung während einer Schwangerschaft aufgrund von Hinweisen auf ein möglicherweise erhöhtes Fehlbildungsrisiko derzeit noch nicht zugelassen. q Fallbeschreibung: Wir untersuchten retrospektiv den Fall einer 34-jährigen Typ-1-Diabetikerin, III. Gravida, III. Para, welche die zweite und dritte Schwangerschaft unter Insulin Lispro austrug. Neben einer Befragung der Patientin und der behandelnden Ärzte erfolgte die Auswertung der Mutterpässe und Kinder-Untersuchungshefte (U1, U2) sowie unserer Ambulanzakte nebst Blutzuckerdokumentationen. Im Gegensatz zu der ersten, nicht unter Lispro-Therapie ausgetragenen Schwangerschaft (vorzeitige Plazentalösung, Hüftgelenkdysplasie) wurden in den beiden folgenden Schwangerschaften trotz kontinuierlicher Lispro-Therapie keinerlei Auffälligkeiten beobachtet. HbA_1c-Werte zwischen 4,9 und 5,9% belegten unter dieser Medikation eine gute Blutzuckereinstellung während der beiden Schwangerschaften. q Schlussfolgerung: Der von uns dokumentierte Fall unterstützt die Hypothese, dass das von den Patientinnen aufgrund seiner Eigenschaften hoch geschätzte Insulin Lispro in der Schwangerschaft sicher und effektiv eingesetzt werden kann und eine sehr gute Stoffwechseleinstellung erlaubt. Um eine zuverlässige Risikobewertung vornehmen zu können, sind eine sorgfältige Dokumentation und Metaanalyse weiterer entsprechender Fälle erforderlich. Abstract. q Background: Glucose control is mandatory in pregnant women with type 1 diabetes to keep the incidence of malformations and complications low. Insulin Lispro is a new and popular fast-acting insulin analog used for intensified insulin therapy. Although popular among young patients, this drug has not been licensed for use in pregnancy due to a possibly increased risk of fetal malformations. q Case Report: Retrospectively, the case of a 34-year-old woman with diabetes type 1, gravid III and para III, which carried her second and third child full time under Lispro treatment, was analyzed. We performed an interview of the patient and her doctors. Additionally, the pregnancy documents along with the examination documents of the children, our patient files, and the blood glucose documentation were investigated. Contrary to the first pregnancy which was carried out in the absence of Lispro (hip dysplasia I°), both subsequent pregnancies were completely normal despite continuous Lispro therapy. HbA_1c values in the range of 4.9-5.9% showed an adequate glucose control throughout these pregnancies. q Conclusion: This case supports the hypothesis that insulin Lispro which is highly popular among young patients can safely and effectively be used in pregnancies. In order to be able to adequately assess possible risks associated with this application, additional cases need to be documented and analyzed.     

Optic disc oval ness,refractive error and axial length of Hong Kong Chinese

Myopic crescent, refractive error and axial length were previously investigated in Hong Kong Chinese subjects. The myopic crescent was found to correlate with axial length and myopic refraction. In this study, three groups of Hong Kong Chinese with different degrees of myopia were assessed for optic disc ovalness, refractive error and axial length. The axial length was significantly correlated with the degree of myopia, indicating that the myopia was axial in nature. The regression line shows that 0.44 mm of axial elongation would give about one dioptre of increase in myopia. The elliptical ratio of the optic disc was defined as the maximal disc diameter divided by the minimal disc diameter. All three groups showed an oval disc with vertical axis greater and an increased ovalness for the high myopic group with an elliptical ratio from 1.11 in low myopia to 1.29 in high myopia. There is a small amount (about four degrees) of temporal rotation of this vertical oval orientation, which is independent of the amount of myopia. This result shows an association between axial elongation of the globe and optic disc ovalness, in addition to the previously described temporal myopic crescent. Therefore, in myopic subjects, a vertically oval disc may be associated with a myopic refraction rather than glaucoma.     

Artificial neural network for predicting intracranial haemorrhage in preterm neonates

Intraventricular haemorrhage (IVH) incidence is used to assess peri-/neonatal therapy, and to make intra-and inter-hospital quality assessments. Unbiased assessment is complicated by the amount of confounding factors. Is an artificial neural network (ANN) able to early and accurately forecast the occurrence of severe IVH in an individual patient? Is it superior to classic multiple logistic regression? We conducted an observational study on pre-existing routine data. Admission data were available from 890 preterm neonates (gestational age < 32 weeks, birthweight < 1500 g). Patients were randomly assigned to either a training, or a validation set (50%/50%). Using the training set data an ANN was trained. A second predictive model was developed by stepwise multiple logistic regression analysis. Using the validation set input data both models delivered estimates of the probability for severe IVH to occur in each individual patient. Receiver operating characteristic (ROC) curves were used to compare prognostic performance. The optimal ANN processed 13 input variables, whereas stepwise logistic regression analysis only identified five independent predictor variables. The area under the ROC curve was 0.935 for the ANN and 0.884 for the logistic regression model (p= 0:001). Adjusted for 95%, 90%, 85%, 80% and 75% specificity, the sensitivity of the ANN was significantly superior to that of the logistic regression model. Due to its ability to give an accurate prognosis based solely on admission data, a trained ANN qualifies as a tool for local quality control.     

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