Perinatal outcome of infants born to diabetic mothers in a developing country-comparison of insulin and oral hypoglycemic agents

Objective

To study the perinatal outcomes of infants born to mothers with gestational diabetes treated with insulin or oral hypoglycemic agents in a developing country.

Design

Prospective observational cohort study.

Setting

Tertiary-care perinatal center in southern India.

Participants

Babies born to mothers with gestational diabetes.

Methods

Maternal details were obtained and physical examination was performed on the neonates. Babies were given hourly feeds soon after birth and blood glucoses checked at 1, 3, 5, 9 and 12 hours of life; hematocrit and calcium levels were also measured. Perinatal outcomes were compared between mothers who required insulin or an oral hypoglycemic agent for treatment of diabetes.

Results

Of the 10,394 mothers who delivered during the study period, 574 (5.5%) were diagnosed to have gestational diabetes. 137 were treated with insulin and 141 with oral hypoglycemic agents. 44 (15.8%) babies were born preterm, 97 (35%) were large for gestational age, 13 (4.7%) were small for gestational age and 9 (3.2%) were macrosomic. Hypoglycemia was seen in 26 (9.3%) babies, congenital anomalies in 15 (5.4%) and birth injuries in 7 (2.5%). There was no difference between the two groups in any of the outcomes except for hyperbilirubinemia, which was more in the insulin group (13.7% vs 6.5%, P=0.04).

Conclusions

There was no difference in the perinatal outcome whether the mother received insulin or an oral hypoglycemic agent for treatment of gestational diabetes other than the increased incidence of hyperbilirubinemia in the insulin group     

Pb2+ uptake by Lampito mauritii by in vivo bioelectrochemistry

In vivo bioelectrochemistry has been carried out for Lampito mauritii using a carbon fibre electrode (8–12 μm in diameter and 0.5 mm long) and differential pulse voltammetry (DPV) to identify and estimate the concentration of metal ions. The DPV of the post-clitellar region shows a well-defined peak at ?0.38 V/SCE which is attributed to Pb²⁺. This identification received further support by injecting Pb²⁺ into the first segment of the dissected worm, which increases the peak at ?0.38 V. The absorption rate of Pb²⁺ by the segmented worm is evaluated by in vivo bioelectrochemistry. The concentration of Pb²⁺ in this species is estimated at 446 ppm which is far above the toxicity levels for humans.     

Artefactual skin disease in children and adolescents

As in adults, artefactual skin disease in children and adolescents has heterogenous presentations with multifactorial aetiology. We report a series of 32 young patients aged 8-16 years. There were 24 females and 8 males. In over half of the cases the lesions were on the head and neck. The types of lesions encountered included physical injury producing grazing, erosions and deep ulcers, chemical and thermal burns, hair cutting and shaving and skin painting. We discuss the approach that we believe should be taken with these patients, emphasizing the role of dermatology-psychiatry liaison in their management. Of great importance is the avoidance of confrontation of the patient but the clear exposition of the nature of the problem to the parents. The major aim should be to have the family accept the need for expert psychiatric assistance.     

Whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting: <Emphasis Type="Italic">A Feasibility Trial</Emphasis>

Objective  

To determine the feasibility and safety of whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting.     

CO2 adsorption performance of template free zeolite A and X synthesized from rice husk ash as silicon source

In this work, zeolite NaA (RA) and NaX (RX) have been successfully synthesized using rice husk ash and it is a low cost synthesis process and it does not produce environmental hazards. Sodium silicate (SS) is extracted from rice husk ash which is an alternative silica source for zeolite synthesis. The zeolites are prepared by using a SS silica source extracted from the rice husk ash, and it has been used as an adsorbent for the CO₂ adsorption process which may help in controlling the global warming problems. The zeolites are synthesized by a hydrothermal method without using any organic templating agent. FESEM and TEM micrographs revealed that the synthesized zeolites RA and RX have “Ice cube” and octahedral morphology respectively. From the N₂ sorption studies, the BET surface area of the synthesized zeolites have been found and are 106.25 m² g⁻¹ and 512.79 m² g⁻¹ respectively. The maximum CO₂ adsorption capacities of zeolite RA and RX are 2.22 and 2.45 mmol g⁻¹, respectively at a temperature of 297.15 K. The recorded data are fitted by using non-linear adsorption isotherm models of Langmuir, Freundlich and Toth isotherm models. The fitted isotherm models are observed to be a type I adsorption isotherm according to the IUPAC classification criterion.

In this work, zeolite NaA (RA) and NaX (RX) have been successfully synthesized using rice husk ash as source and it is a low cost synthesis process and it does not produce any environmental hazards.     

Identification of 4-(5-amino-2-furyl)thiazole (AFT) as a reductive metabolite of the carcinogen 4-(5-nitro-2-furyl)thiazole (NFT)

The chemical synthesis of 4-(5-amino-2-furyl)thiazole (AFT)and its formation during the in vitro reductive metabolism of4-(5-nitro-2-furyl)thiazole (NFT) by rat liver tissues on anaerobicincubation with NADPH were examined. AFT was synthesized bycatalytic reduction of NFT with 5% palladium on activated carbon.Purified AFT, a pale yellow powder, melted at 105^°C andhad an extinction coefficient of 16.3 mM ^–1cm^–1at 297 nm in methanol. The proton n.m.r. spectrum, i.r. andmass spectra were consistent with the assigned structure. Analysisof the ethyl acetate extract, following incubation of NFT withrat liver tissue preparations, revealed a metabolite whose chromatographicand mass spectral characteristics were the same as those obtainedwith synthetic AFT, thus establishing the structural identityof the metabolite as AFT. These data shows that AFT is formedon reduction and could act as a precursor for the formationof 1-(4-thiazolyl)-3-cyano-1-propanone as postulated earlier.     

Expression of N-acetyltransferase (NAT) in cultured human uroepithelial cells

To determine which of the N-acetyltransferase (NAT) alleles[monomorphic (NAT1) or polymorphic (NAT2)] are expressed inthe target cells for arylamine carcinogenesis, namely normalhuman uroepithelial cells, cDNA was prepared from cellular RNAand amplified by polymerase chain reaction (PCR), using upstreamprimer 1 comprising the 5’ end (nt 47–68) and eitherdownstream primers 2 (nt 908-889) or 3 (nt 953–931) correspondingwith the 3’end. With primers 1 and 2, selective for NAT1,a characteristic 861 bp DNA fragment was obtained, whereas withprimers 1 and 3, selective for NAT2, a characteristic 907 bpfragment was formed. Similarly, the PCR-amplified cDNA productsfrom the SV40-immortalized human uroepithelial cell line werealso found to contain both NAT1 and NAT2. Restriction fragmentlength polymorphism (RFLP) analysis with HincII (digesting NAT2to produce 659 bp and 248 bp fragments) and HindIII (digestingNAT1 to produce a 786 bp fragment) further confirmed the authenticityof the NAT alleles. Furthermore, the NAT genotypes of 38 individualswere determined by PCR amplification of lymphocyte DNA and subsequentRFLP analysis using TaqI, KpnI and BamHI. The genotypes werecompared to their in vivo acetylator phenotypes which were determinedby measuring 5-acetylamino-6-formylamino-3-methyluracil and1-methylxanthine in urine following administration of caffeine.A good correlation between the genotype and phenotype was obtainedin the study population and the frequency of NAT2 allele distributionwas M1 > wild-type > M2 > M3. These results suggestthat susceptibility to arylamine-indueed bladder cancer mightbe influenced by both hepatic and bladder NAT and that the NATgenotype might be a useful biomarker for screening high riskindividuals for bladder cancer resulting from exposure to arylamines.