Glucose tolerance and insulin secretion in pregnancy

The authors have studied the behaviour of plasma glucose, insulinaemia and insulin-glucose ratio in 2 groups of pregnant women with BMI values > or = or <26, respectively. Each group was divided into 3 subgroups on the basis of an oral glucose tolerance test (OGTT) response: GIGT (gestational impaired glucose tolerance), GD (gestational diabetes), and C (normal controls). Data from non-obese pregnant women demonstrate that both basal and OGTT-stimulated glucose levels were significantly different in all subgroups. The total insulin amount in the GIGT and GD subgroups is quite similar to or greater than the controls, but with a significant reduction of the insulin-glucose ratio. In GD also an absolute deficiency of insulin rise at 30 min during the glucose load, as in subjects with Type 2 diabetes mellitus (T2DM), was observed. The behaviour of these parameters in obese pregnant women seems to be similar, even though with some significant differences: in these subjects, there is a less clear-cut differentiation among all subgroups, and the appearance of gestational diabetes is not accompanied by a significant decrease of insulin secretion at 30 min. Our data seem to demonstrate that insulin resistance with an inadequate hyperinsulinaemia is a common factor for the alterations of carbohydrate metabolism during pregnancy. Only in the non-obese patients with gestational diabetes, is there an absolute defect of early insulin response to the glucose load, as it is seen in T2DM.     

Negative effect of lockdown on juvenile idiopathic arthritis patients

Clinical Rheumatology - The aim of this study is to evaluate a possible negative action of lockdown, during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, in the...     

Importance of using soluble derivatives in assessing bilirubin interference: the example of gamma-glutamyltransferase

In assessing possible in vitro interference from bilirubin on analytical methods, different results are to be expected from using either unconjugated (uB) or conjugated (cB) bilirubin as test materials, because of their different solubilities. In vitro interference of a synthetic soluble bilirubin derivative (ditauro-bilirubin, dtB) on gamma-glutamyltransferase activity measurement has been studied, in comparison with uB. In three out of five analytical methods/systems for the measurement of the enzyme activity, significantly higher (negative) interference was observed in the presence of the soluble derivative. Whichever the mechanism for the observed effect, the opportuneness of using soluble derivatives in order to assess bilirubin interference is pointed out: pathological serum specimens, submitted for laboratory investigations, are indeed frequently loaded with soluble bilirubin conjugates.     

Ibuprofen, acetaminophen, and placebo treatment of febrile children

A double-blind, parallel-group, triple-dummy-designed, single-oral-dose study compared the efficacy, tolerability, safety, and dose-response of 5 mg/kg (n = 32) and 10 mg/kg (n = 28) ibuprofen suspension, 10 mg/kg acetaminophen elixir (n = 33), and placebo liquids (n = 34) in 127 children (2 to 11 years of age) with fever (101 degrees to 104 degrees F). Blood samples, oral temperatures, pulse, blood pressure, and respiration were obtained before and 1/2, 1, 2, 3, 4, 5, 6, and 8 hours after the dose was administered. The study was terminated early if oral temperature was greater than 104 degrees F or if it increased 1 degree F above baseline. All agents were well tolerated and more effective than placebo (p less than 0.05) for fever control. Ibuprofen, 10 mg/kg, was favored over 10 mg/kg acetaminophen (p less than 0.05). For temperatures greater than 102.5 degrees F, a dose-response relationship for 5 and 10 mg/kg ibuprofen was demonstrated in terms of percentage of fever reduction and in terms of the initial 2-hour rate of decrease in temperature. Antipyretic efficacy for temperatures greater than 102.5 degrees F was 10 mg/kg ibuprofen greater than 5 mg/kg greater than 10 mg/kg acetaminophen greater than placebo. All treatments were well tolerated. No significant clinical or laboratory abnormalities were noted. Ibuprofen suspension may be a safe and effective antipyretic in children.     

Change-related expectations and commitment to change of nurses: the role of leadership and communication

portoghese i., galletta m., battistelli a., saiani l., penna m.p. & allegrini e. (2012) Journal of Nursing Management  20, 582–591 Change-related expectations and commitment to change of nurses: the role of leadership and communication Aim The purpose of this study was to test a theoretical model linking the impact of expectations on commitment to change and to explore whether change-related communication is a mediating variable between leader–member exchange and expectations. Background Expectations for change outcomes are an important condition to increase nurses’ commitment to change. To understand the role of leadership and communication in expectations development is crucial to promote commitment to change. Method A predictive, non-experimental design was used in a random sample of 395 nurses. Structural equation modelling was used to analyse the hypothesized model. Results Positive expectations had a direct effect on affective commitment to change, whereas negative expectation had a direct effect on continuance commitment to change. Leader–member exchange and communication influenced nurse’s expectations about change. Communication partially mediated the relationship between Leader–member exchange and expectations. Conclusion These findings suggested that nurses’ expectation about change were strongly linked to commitment to change. Furthermore, the enhancement of communication and relationship with leader contributed to the development of positive and negative expectations. Implications for nursing management Strategies to promote commitment to change include developing positive expectations about change outcomes and building high-quality leadership style oriented to the communication.