Gestational diabetes management: a multidisciplinary treatment algorithm

Effective treatment of gestational diabetes is important as an attempt to avoid unfavorable maternal and fetal outcomes. The objective of this paper is to describe the available therapies to optimize gestational diabetes treatment and to suggest a multidisciplinary approach algorithm. Nutrition therapy is the first option for the majority of these pregnancies; light to moderate physical activity is recommended in the absence of obstetrical contraindications. Medical treatment is recommended if glycemic control is not achieved or if excessive fetal growth is detected by ultrasound. Insulin is the standard treatment although oral antidiabetic drugs have recently been considered an effective and safe option. The monitoring of gestational diabetes treatment includes capillary glucose measurements and evaluation of fetal abdominal circumference by ultrasound performed around the 28th gestational week.     

Clinical significance of anti-dsDNA antibody isotypes: IgG/IgM ratio of anti-dsDNA antibodies as a prognostic marker for lupus nephritis

The objective of this paper is to investigate the association between patterns of anti-dsDNA antibody isotypes and specific clinical manifestations (categorized in renal, musculoskeletal, cutaneous, hematological, pulmonary, neurological and cardiac). Sera of 202 systemic lupus erythematosus (SLE) patients, 33 patients suffering from other autoimmune diseases and 115 healthy blood donors were analysed for anti-dsDNA antibodies by IgG-, IgA- and IgM-specific ELISA, Farr-assay and CLIF. A subset of 24 SLE patients was investigated in a longitudinal study over a period of one to six years. Disease activity of 105 SLE patients was measured according to the ECLAM score. In the cohort of SLE patients 63% were positive for the IgG class, 40% for the IgA and 57% for the IgM class specific anti-dsDNA ELISA. Sensitivity (79%) and specificity (99%) for the diagnosis of SLE appeared to be highest for the ELISA measuring all isotypes of anti-dsDNA antibodies. The concentrations of anti-dsDNA isotypes showed a strong correlation with disease activity. Analysing the relationship between IgG, IgA and IgM anti-dsDNA antibody isotypes and clinical manifestation, we found a significant association of the IgM isotype with cutaneous involvement and of the IgG isotype with lupus nephritis. The IgG/IgM ratio of anti-dsDNA antibodies represented a significant parameter to distinguish patients with lupus nephritis from those without renal involvement. In the longitudinal study, a continuous ratio under 0.8 was associated with absence of renal involvement throughout the investigated period. In conclusion, the evaluation of anti-dsDNA isotypes provides a diagnostic tool to define subsets within SLE patients with different clinical manifestations. In particular, the IgG/IgM ratio of anti-dsDNA antibodies could be used as a prognostic marker for lupus nephritis during the course of the disease.     

Selective blockage of initiation of host protein synthesis in RNA-virus-infected cells.

Poliovirus mRNA and mRNA transcribed from vesicular stomatitis virus and reovirus genomes efficiently direct protein synthesis in vivo under experimental conditions where the initiation of host protein synthesis is selectively blocked. The selective blockage of host peptide chain initiation after exposure to hypertonic medium indicates that the translation of viral mRNA is more efficiently initiated than is the translation of host mRNA. It further suggests that virus directed suppression of host protein synthesis could proceed by a mechanism involving a nonspecific decrease in the rate of peptide chain initiation. Exposure of infected cells to hypertonic medium provides a unique tool with which to study early events in the infectious cycle by permitting the efficient unmasking of virus-specific poly-peptide synthesis.     

Comparative analysis between hard- and soft-filament toothbrushes related to plaque removal and gingival abrasion

OBJECTIVE: The aim of this split-mouth, examiner-blind study was to compare the dental plaque removal and incidence of gingival abrasion associated with the use of hard- and soft-filament toothbrushes. METHODOLOGY: The test group consisted of 20 non-dental students, mean age 25 years. After a three-day period of plaque accumulation following the use of a disclosing solution, the Quigley-Hein Plaque Index was recorded, while the presence of gingival abrasion was measured from photographs. Pairs of quadrants 1-3 and 2-4 were allocated to supervised brushing with hard- or soft-filament toothbrushes for 30 seconds, limited to the buccal aspects of the teeth. Plaque levels and gingival abrasion were again assessed. Initial and final values of the plaque index and the mean number of abrasions were compared with the Friedman and Wilcoxon tests (p < or = 0.05). RESULTS: Plaque indices were reduced significantly from a baseline of 4.12 in both groups to 1.21 after the use of hard-filament toothbrushes, and to 1.67 after the use of soft-filament toothbrushes. The use of hard-filament toothbrushes resulted in a significantly higher mean number of lesions when compared to the soft-filament toothbrushes; 11.6 and 7.9, respectively (p = 0.018). CONCLUSION: Hard-filament toothbrushes remove more plaque than soft filament brushes, but also cause a higher number of gingival abrasions.     

Oral and pharyngeal dysphagia

A severe impairment of nutrition frequently occurs with morphological alterations in the oral cavity and the pharynx as well as with neurogenic disorders of the swallowing articulation. Complications like frequent aspirations are life-threatening. If the natural protection reflex for the respiratory tract, the cough reflex, does not work because of a reduced tracheal sensitivity, swallowing disorders often remain unrecognized. The ability of swallowing must be examined particularly with stroke-patients and weakened old patients. With radiological and endoscopic evaluations, oropharyngeal dysphagias can be assessed in detail. A wide spectrum of surgical measures and exercise treatment can clearly improve the life quality of the patients even if the aim, to make a complete and safe oral nutrition possible again, is not reached in every case.