Serum Fructosamine and Glycosylated Hemoglobin in Monitoring the Glycemic Control in Gestational Diabetes Mellitus

Background: Diabetes mellitus complicates 1%-2% of all pregnancies, and associates with high perinatal morbidity. Gestational diabetes mellitus (GDM) is treatable condition, and women who have adequate glycemic control during pregnancy can effectively decrease the adverse outcomes of GDM. Objectives: This study was designed to compare the serum fructosamine, and the glycosylated hemoglobin (HbA1c), in monitoring the glycemic control in GDM. Patients and Methods: 1516 women with GDM included, and were advised for dietary modification to achieve proper glycemic control. If the target glucose levels were not reached by the diet regimen or by the dietary modification, insulin was prescribed for the studied women. The average values of the pre- and post-prandial glucose levels were calculated, and the insulin doses were adjusted to achieve the target glucose values during the antenatal visits. HbA1c, and fructosamine were measured to assess the glycemic control for the studied women. Results: The fructosamine, and the HbA1c were significantly high in the uncontrolled GDM compared to controlled group, and there was positive significant correlation between fractuosamine, and HbA1c in monitoring the glycemic control in GDM (r = 0.93, and P = 0.001). The Odds ratio (OR), and relative risk (RR) analysis for the current pregnancy outcome showed that the polyhydramnios (OR 3.8;RR 3.7), the cesarean delivery (OR 1.7;RR 1.4), the fetal macrosomia (OR 6.4;RR 6.3), the fetal anomalies (OR 6.5;RR 6.4), and the (IUFD) intrauterine fetal death (OR 8.7;RR 8.6) were significantly high in uncontrolled GDM group. In addition, the (NND) neonatal death (OR 11.6;RR 11.4), the neonatal intensive care unit (NICU) admission (OR 3.1;RR 2.9), the neonatal hyperbilirubinemia (OR 3.7;RR 3.6), the transient tachypnea of the newborn (OR 3.1;RR 2.9), and the neonatal hypoglycemia (OR 3.5;RR 3.4) were significantly high in uncontrolled GDM group. Conclusion: Fructosamine assay is simple, reliable, useful indicator for the glycemic control in GDM over the last 2 - 3 weeks, and poor glycemic control in GDM increases the risk of adverse maternal and neonatal outcomes.

Letter to the editor“regarding case report of chronic cornual ectopic pregnancy presenting as large cornual mass after in vitro fertilization-embryo transfer”

We read the Yang et al,published case report in Laparoscopic,Endoscopic and Robotic Surgery.2019.https://doi.org/10.1016/j.lers.2019.09.001,with great interest.Yang et al,in the introduction mentioned that the cornual ectopic pregnancy is defined as a pregnancy that is abnormally located in the proximal portion of the fallopian tube,lying within the muscular wall of the uterus.

Comparison of transvaginal cervical length and modified Bishop's score as predictors for labor induction in nulliparous women

Objective: To compare the transvaginal cervical length (TVCL) to the modified Bishop's score for prediction of successful labor induction in nulliparous women. Methods: A total of 210 nulliparous women who were diagnosed as premature rupture of membranes were recruited in this comparative prospective study, which was carried out in the Obstetrics and Gynecology Department of Ain Shams University, Egypt over two years for labor induction. The studied women were examined by trans-vaginal ultrasound for measurement of the cervical length (CL) and vaginally to calculate the modified Bishop's score, followed by induction of labor. Collected data were analyzed to compare the TVCL to the modified Bishop's score for prediction of successful labor induction in nulliparous women. The success of induction process was defined as vaginal birth after the induction of labor. Results: One hundred and forty-three women of studied women had CL <28 mm;122 of them delivered vaginally (P=0.030). One hundred and forty-six women of studied women had modified Bishop's score >4;128 of them delivered vaginally (P=0.006). The CL <28 mm was significantly more specific with more positive predictive value as predictor of successful labor induction compared to modified Bishop's score. Induction to delivery time was significantly shorter in women with CL <28 mm than women with CL ≥28 mm (P=0.02;95% confidence interval: 4.9-8.4). In addition, induction to delivery time was significantly shorter in women with Bishop's score >4 than women with Bishop's score of 曑4 (P=0.01;95% confidence interval: 1.6-4.5). Conclusions: Both TVCL and the modified Bishop's score are complementary tools in pre-induction cervical assessment before induction of labor, while the TVCL at <28 mm is significantly more specific with more positive predictive value as predictor of successful induction than the modified Bishop's score.

Evaluation of infertile women: Mini-review

Evaluation of infertility indicated for women failed to conceive after one year of unprotected intercourse and for women over 35 years failed to conceive after 6 mo of unprotected intercourse, because the fertility decline as women approach 40 years. Evaluation of infertile couple should begin with semen analysis of male partner. If the semen analysis is within normal range, evaluation then move on to female partner. Evaluation of the infertile woman should be carried in cost-effective manner to identify the causes of infertility using the least invasive methods. Methods of evaluation of infertile women include: 1) history and physical examination;2) evaluation of the male partner;3) documentation of ovulation;4) evaluation of the ovarian reserve;5) evaluation of cervical causes of infertility;6) evaluation of uterine causes of infertility;7) documentation of the tubal patency;and 8) exclusion of peritoneal causes of infertility. Evaluation of infertile couple should include evaluation of both partners. Semen analysis for the male partner, followed by documentation of ovulation and evaluation of genital tract patency. PCT is not used as routine evaluation of infertile women. Laparoscopy is not used as routine evaluation of infertile women unless there is suspected peritoneal factors of infertility or endometriosis or tubal occlusion. Ovarian reserve should only be done for infertile women with diminished response to external gonadotropins (not routine).

Management of 634 Consecutive Patients with Chronic Pilonidal Sinus: A Nine-Year Experience of a Single Institute

Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.

Serum Ferritin: Is It an Independent Predictor of Reduced Bone Mineral Density among Elderly Women?

Aim: In vitro studies have shown that iron promotes osteoclast differentiation and bone-resorbing activity by enhancing mitochondrial biogenesis, whereas it suppresses osteoblastogenesis. In postmenopausal women, serum ferritin increases by 2 - 3 times due to the lack of a major mechanism of iron excretion, while menstrual blood decreases. Based on this observation, it has been hypothesized that in addition to estrogen deficiency, increased iron as a result of menopause could contribute to bone loss in postmenopausal women. So our aim was to investigate the association between serum ferritin levels and bone mineral density (BMD) in elderly women at various skeletal sites. Methods: Retrospective analysis of the medical records of 71 postmenopausal women having a mean age of (66 ± 7) years (range 60 - 83 years) was done. The collected data included age of menopause, past medical history, smoking habits, physical activity, and medication use. BMD was measured at the lumbar spine and femur by dual-energy X-ray absorptiometry, and other biochemical markers including, serum ferritin, 25 hydroxyvitamin D3, serum alkaline phosphatase, and parathyroid hormone were assayed. Results: We found that serum ferritin levels are significantly related to BMD of the total hip and lumbar vertebrae [with a p value of (0.01) and ( Conclusion: This study suggests a positive association between serum ferritin levels and BMD in elderly women without hematologic disorders. Further study is warranted to verify the effects of iron on bone metabolism.

Diagnostic Accuracy of PremaQuick versus Actim Partus in Prediction of Preterm Labor in Symptomatic Women within 14 Days

Background: Preterm labor (PTL) remains a major source of neonatal morbidity, and mortality. Currently the trans-vaginal cervical length (TVCL), and/or cervico-vaginal fetal fibronectin (fFN) are the common diagnostic tools used for prediction of PTL. Consequently, many women and their fetuses are exposed unnecessarily tocolysis and hospital admission. Objectives: This study was designed to compare the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days. Patients and Methods: Two-hundred and twenty women (220) were included in this comparative prospective study and classified into two groups: 110 women with threatened preterm labor (TPTL) in the study group, and 110 controls (no TPTL). Women included in the study were subjected to: through history, collection of the cervico-vaginal fluid (CVF) samples for assessment by PremaQuick and Actim Partus tests, followed by trans-vaginal cervical length (TVCL) assessment. Studied women managed according to the hospitals protocol, with follow-up weekly in the obstetrics outpatients’ clinic after discharge from the hospital until delivery. The main outcome measures the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days of admission. Results: PremaQuick test was significantly more specific with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (95.5% and 89.6%;respectively) compared to CL 25 mm (56.3% and 54.6%;respectively), (P = 0.02 and 0.03;respectively). In addition, PremaQuick test was significantly more sensitive with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (39.8% and 89.6%;respectively) compared to Actim Partus (13.9% and 55.5%;respectively), (P = 0.001 and 0.01;respectively). The Odds ratio and the relative risk for prediction of PTL in symptomatic women within 14 days were significantly high for PremaQuick compared to the CL 25 mm, and Actim Partus. Conclusion: PremaQuick test seems to be the best complementary test to the CL 25 in prediction of PTL in symptomatic women within 14 days. PremaQuick test compensates the low specificity and low PPV of the CL 25 mm in prediction of PTL.

Attitude (Acceptance) of the COVID-19 Vaccine among Adult Kuwait Oil Company Workers

Objective: To measure the acceptance of a coronavirus disease 2019 (COVID-19) vaccine among the sector of the oil company adult population in Kuwait and assess its determinants. Subjects and Methods: A cross-sectional email study enrolled adults working for Kuwait oil companies (n = 1689;aged ≥21 years). Acceptance of a COVID-19 vaccine was considered if participants selected the options and received the vaccine, definitely or probably will accept vaccination against COVID-19 once a vaccine is available.” A modified Poisson regression was used to investigate the associations and calculate the adjusted prevalence ratios (aPRs) and their 95% confidence intervals (CIs). Results: In total, 92.5% (1563/1689) of the participants were willing to accept COVID-19 vaccines once available. No difference in sex was observed in the willingness to accept a COVID-19 vaccine (92.5 vs. 92%, p 0.5). Responders who believed vaccines in general to have health-related risks were less likely to get vaccinated (aPR = 0.39, 95% CI: 0.35 - 0.44). In addition, participants who received the influenza vaccine were more willing to have a COVID-19 vaccine (aPR = 1.44, 95% CI: 1.31 - 1.58). Acceptance of the vaccine against COVID-19 increased as the self-perceived chances of contracting the infection increased (p < 0.001). Conclusion: Overall, 92.5% of the study participants demonstrated a willingness to be vaccinated against COVID-19. However, we found that public health authorities should address several factors influencing the level of acceptance.

Omega-3 Fatty Acids and Risk of Atrial Fibrillation: A Case Report and Literature Review

Omega-3 fatty acids are one of the most used food supplements. However, atrial fibrillation has been recently presented as a rare adverse drug event following ingestion of high doses of this food supplement.

Late Life Vascular Risk Factors and Their Association with Dementia and Alzheimer’s Disease

Background:Epidemiological studies have demonstrated associations between higher levels of vascular risk factors in midlife and later development of dementia,particularly Alzheimer’s disease(AD).However,in elderly subjects with dementia,some studies have shown that these associations may decrease or even reverse.Therefore,the study aimed to find the association between late life cardiovascular risk factors and neurodegenerative dementia in general and AD in particular.Methods:It is a retrospective case control study using electronic medical records that included elderly patients that were reviewed in Ahmadi hospital geriatric clinic,Kuwait,from the period of 1/7/2019 to 1/2/2020.Two hundred and three(203)elderly patients with neurodegenerative dementia(study group)were recruited for this retrospective study and compared to two hundred and one(201)controls with normal cognition for the presence of vascular risk factors.Results:The study included 404 subjects.Age ranged from 60 to 107 years(mean age 78.79,±8.13 SD).AD was found to be the most prevalent type of dementia in the study group,as 49.3%(100/203)of the demented patients were diagnosed with AD.No significant statistical association was found between vascular risk factors and dementia(P>0.05),except for obesity which showed a negative association(P<0.001).Regarding AD,no statistical significance was found between AD and diabetes,hyperlipidemia,smoking nor atrial fibrillation.On the other hand,the authors found obesity and hypertension more prevalent in the normal cognition group(negative association with P value<0.001,0.05 respectively).Conclusions:The results of the study support an emerging concept that,while elevated levels of vascular risk factors in midlife increase the risk of development of dementia and AD later in life,once dementia begins,these associations may be diminished or reversed in the elderly.