Evaluation of "point of care" devices in the measurement of low blood glucose in neonatal practice

BACKGROUND: Low blood glucose in newborns is difficult to detect clinically. Hence a reliable "point of care" device (glucometer) for early detection and treatment of low glucose is needed. OBJECTIVE: To evaluate the performance of five readily available glucometers for the detection of low blood glucose in newborn infants. METHOD: Glucostix measurements were taken for newborns with risk factors using a Reflolux S (Boehringer) glucometer. If the initial reading was low (< 2.6 mmol/l), further measurements were taken with two other glucometers (phase I, Advantage and Glucotrend (Roche); phase II, Elite XL (Bayer) and Precision (Abbott)), and plasma glucose was measured in the laboratory (Aeroset; Abbott). RESULTS: Over 10 months, 101 specimens were collected from 71 newborns (57 in phase I; 44 in phase II). The Advantage glucometer usually overestimated blood glucose with a mean difference of 1.07 mmol/l (p < 0.01) at all low glucose ranges. The Glucotrend, Precision, and Elite XL glucometers performed better; the mean differences were not significantly different from the laboratory measured value (0.17 mmol/l (p = 0.37); -0.12 mmol/l (p = 0.13), and 0.24 mmol/l (p = 0.13) respectively). For detection of glucose concentrations < 2.6 mmol/l, the Precision glucometer had the highest sensitivity (96.4%) and negative predictive value (90%). For lower glucose concentrations (< 2.0 mmol/l), the Glucotrend glucometer performed even better (sensitivity 92.3%, negative predictive value 96.3%). CONCLUSION: Point of care devices should have good precision in the low glucose concentration range, sensitivity, and accuracy for early detection of neonatal hypoglycaemia. None of the five glucometers was satisfactory as the sole measuring device. The Glucotrend and Precision glucometers have the greatest sensitivity and negative predictive value. However, confirmation with laboratory measurements of plasma glucose and clinical assessment are still of the utmost importance.     

Cord blood acid-base status at delivery after successful external cephalic version

BACKGROUND: This study was designed to evaluate whether cord blood acidosis is more likely in infants born after successful external cephalic version. METHODS: This retrospective cohort study included 89 singleton deliveries with successful version performed over a 2-year period. Their cord blood acid-base parameters were compared to 89 pregnancies with spontaneous cephalic presentation (control group). RESULTS: There was no significant difference between the version and control groups in birthweight and Apgar scores. There was no difference between the version and control groups in cord arterial pH (7.26 vs. 7.26), arterial pCO(2) (7.04 vs. 7.09 kPa), arterial pO(2) (2.34 vs. 2.59 kPa), arterial base excess (-5.59 vs. -5.64 mmol/L), venous pH (7.32 vs. 7.33), venous pCO(2) (5.73 vs. 5.63 kPa), venous pO(2) (3.86 vs. 3.84 kPa), or venous base excess (-5.03 vs. -5.12 mmol/L). There was also no significant difference in the number of fetuses with cord arterial pH <7.20 between the two groups. CONCLUSION: Neonates delivered after successful external cephalic version are not more likely to be born with acidosis. Our study provides further support for the safety of external cephalic version for term breech pregnancies.     

The Efficacy of Test Tube Warming Devices Used During Oocyte Retrieval for IVF

PURPOSE: To investigate whether commonly used test tube warming devices maintain a constant temperature in follicular fluid aspirates. METHODS: By using a digital thermocouple, temperature was measured and comparisons were made between an analog dry block heater, a digital dry block heater, and a thermostatic test tube heater. RESULTS: For small fluid volumes, temperature in the block heaters increased above 37 degrees C after being in the block for over 2 min. The thermostatic heater maintained a constant temperature, but this was below the factory setting of 36.9 degrees C. Temperature maintenance was influenced by fluid volume in each tube. CONCLUSIONS: One of the key factors in the handling of gametes and embryos is the maintenance of constant temperature. Test tube warming devices require verification of their ability to maintain fluid at the desired temperature. Temperature may vary with fluid volume and the type of test tube warming device used.     

External cephalic version induced fetal cerebral and umbilical blood flow changes are related to the amount of pressure exerted

OBJECTIVE: To correlate the applied pressure during external cephalic version with the changes in fetal middle cerebral arterial and umbilical arterial flow before and after the procedure. DESIGN: A prospective observational study over a two-year period. SETTING: External cephalic version was performed in a university hospital. POPULATION: Sixty-nine women with singleton breech-presenting pregnancy at or above 36 weeks of gestation undergoing external cephalic version. METHODS: During external cephalic version, the operator wore a pair of pressure-sensing gloves which had thin piezo-resistive sensors positioned on the palmar surface. During each version procedure, real-time pressure readings were recorded from all sensors, and then analysed with a computer program. The amount of pressure applied over time was presented by pressure-time integral. The pulsatility indices of both fetal middle cerebral artery and umbilical artery before and after external cephalic version were measured. The changes of pulsatility indices of both middle cerebral artery and umbilical artery were presented as a ratio of the post-external cephalic version pulsatility indices to pre-external cephalic version pulsatility indices, denoted by middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio, respectively. The statistical correlation between pressure-time integral and middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio are analysed using Pearson's correlation test. MAIN OUTCOME MEASURES: Changes in pulsatility indices of fetal middle cerebral and umbilical arteries and fetal heart rate after external cephalic version. RESULTS: The overall success rate of external cephalic version was 77%. There was a significant negative correlation between pressure-time integral and both middle cerebral artery pulsatility index ratio (P= 0.001) and umbilical artery pulsatility index ratio (P= 0.012). When women were categorised according to placental site, pressure-time integral was negatively correlated with middle cerebral artery pulsatility index ratio only when the placenta was posteriorly located (P= 0.003), and with umbilical artery pulsatility index ratio only when the placenta was laterally located (P= 0.03). CONCLUSIONS: The greater the force applied during external cephalic version, the greater the reduction in pulsatility indices of middle cerebral artery and umbilical artery, indicating an increase in blood flow through these arteries. The increase in cerebral blood flow after external cephalic version is more prominent when the placenta is lying posteriorly, while the increase in umbilical flow is more prominent when the placenta is lying laterally. These findings suggest that the vascular changes probably represent a direct effect of force exerted on the fetal head and the placenta.     

Waiting time and doctor shopping in a mixed medical economy

Waiting time generally acts as a rationing mechanism in the public health care system. In theory, patients who have a higher valuation of time are more likely to seek alternative care (i.e. doctor shopping) if there is a parallel private sector than those who have weaker time preference. However, the existing settings of many health care systems do not allow patients to reveal their preference of such. The data presented in this study suggest a positive association between patients' expressed value of time and doctor shopping behaviour in Hong Kong. Patients who were assigned longer waiting times relative to their expected horizon were more likely to seek private alternative care.     

Morphology of cerebral lesions in the Eker rat model of tuberous sclerosis

Tuberous sclerosis (TSC) is an autosomal dominant disorder, caused by mutations of either the TSC1 or TSC2 gene. Characteristic brain pathologies (including cortical tubers and subependymal hamartomas/giant astrocytomas) are thought to cause epilepsy, as well as other neurological dysfunction. The Eker rat, which carries a spontaneous germline mutation of the TSC2 gene (TSC2^+/–), provides a unique animal model in which to study the relationship between TSC cortical pathologies and epilepsy. In the present study, we have analyzed the seizure propensity and histopathological features of a modified Eker rat preparation, in which early postnatal irradiation was employed as a second hit stimulus in an attempt to exacerbate cortical malformations and increase seizure propensity. Irradiated Eker rats had a tendency toward lower seizure thresholds (latencies to flurothyl-induced seizures) than seen in non-irradiated Eker rats (significant difference) or irradiated wild-type rats (non-significant difference). The majority of irradiated Eker rats exhibited dysplastic cytomegalic neurons and giant astrocyte-like cells, similar to cytopathologies observed in TSC lesions of patients. The most prominent features in these brains were hamartoma-like lesions involving large eosinophilic cells, similar to giant tuber cells in human TSC. In some cells from these hamartomas, immunocytochemistry revealed features of both neuronal and glial phenotypes, suggesting an undifferentiated or immature cell population. Both normal-appearing and dysmorphic neurons, as well as cells in the hamartomas, exhibited immunopositivity for tuberin, the protein product of the TSC2 gene.     

Modulation of human GABAA and glycine receptor currents by menthol and related monoterpenoids

Effects of common monoterpenoid alcohols and ketones were investigated on recombinant human gamma-aminobutyric acid A (GABAA; alpha1beta2gamma2s) and glycine (alpha1 homomers) receptors expressed in Xenopus oocytes. GABA currents were enhanced by coapplications of 10-300 microM: (+)-menthol>(-)-menthol>(-)-borneol>(-)-menthone=camphor enantiomers>carvone enantiomers, with menthol acting stereoselectively. By contrast, thujone diastereomers inhibited GABAA receptor currents while glycine currents were only markedly potentiated by menthol. Positive modulation by (+)-menthol was explored given its pronounced effects (e.g., at 100 microM, GABA and glycine EC20 responses increased by 496+/-113% and 135+/-56%, respectively). (+)-Menthol, 100 microM, reduced EC50 values for GABA and glycine from 82.8+/-9.9 to 25.0+/-1.8 microM, and from 98.7+/-8.6 to 75.7+/-9.4 microM respectively, with negligible effects on maximal currents. This study reveals a novel neuroactive role for menthol as a stereoselective modulator of inhibitory ligand-gated channels.     

Macrophage accumulation and renal fibrosis are independent of macrophage migration inhibitory factor in mouse obstructive nephropathy

BACKGROUND AND AIM: The progression of renal injury, initiated by either an immune or non-immune insult, is closely associated with the accumulation of leucocytes and fibroblasts in the damaged kidney. Macrophage migration inhibitory factor (MIF) regulates leucocyte activation and fibroblast proliferation in vitro. Studies have identified a pathological role for MIF in immune-initiated renal injury in the rat. In this study, we examined the role of MIF in obstructive nephropathy, where renal injury is initiated by a non-immune insult. METHODS AND RESULTS: Unilateral ureteric ligation was performed on MIF wildtype (+/+) and MIF deficient (-/-) mice. Groups of five mice were killed at days 0, 1, 5 or 10 after obstruction, and kidneys were examined via immunohistochemistry and northern blotting. In MIF +/+ mice, expression of the MIF protein increased in obstructed kidneys compared to normal control kidneys. Interstitial macrophage and T cell accumulation was significantly increased in obstructed kidneys at day 5 and 10, but was unaffected by MIF deficiency. Osteopontin and macrophage colony stimulating factor (M-CSF) mRNA expression in obstructed kidneys were equally increased in both genotypes, indicating that expression of these chemokines is not influenced by MIF. No difference was detected in the development of renal fibrosis in obstructed MIF +/+ and MIF -/- kidneys, as assessed by myofibroblast accumulation and proliferation and expression of profibrotic molecules (transforming growth factor-beta 1(TGF-beta1) and collagen). CONCLUSION: These results demonstrate that MIF expression is increased in obstructive nephropathy without affecting kidney leucocyte accumulation or the development of renal fibrosis. This suggests that the progression of renal injury in obstructive nephropathy is independent of MIF.