The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Felice Faizal

Felice Faizal

Evaluation of Perinatal Outcome in Women with Impaired Glucose Homeostasis During Pregnancy

Background: Glucose tolerance testing in pregnancy identifies many women with glycaemic responses that exceed normal range but that do not meet the threshold required to diagnose Gestational Diabetes Mellitus. It is controversial whether maternal hyperglycemia less severe than in diabetes is associated with increased risk of adverse pregnancy outcome or not. Materials and methods: All women were subjected to Glucose Challenge Test(GCT) with 50 gram glucose either at first visit or between 24-28 weeks on the basis of risk profile. High risk cases were screened at first visit and the rest between 24-28 weeks. Patients with a GCT value ≥200mg/dl were not subjected for GTT and were diagnosed as GDM.Value of GCT <140 mg/dl was taken as normal. Irrespective of GCT result, women were subjected to Oral Glucose Tolerance Test (OGTT) as recommended by WHO with 75 gram glucose using WHO criteria. Study group was identified with 4 categories with abnormal glucose homoeostasis as defined by the following criteria:

1. Abnormal GCT (>140 mg/dl) with normal OGTT;
2. Normal GCT with only Impaired Fasting Glucose(IFG) in OGTT;
3. Normal GCT with Gestational Glucose Intolerance(GGI);
4. Patients diagnosed as GDM:
a. If fasting is >126mg/dl;
b. If 2hr OGTT ≥ 140mg/dl & ≤ 199 mg/dl;
c. If value of either GCT or OGTT >200 mg/dl.
The control group comprised of women with normal GCT and normal OGTT. In all the above groups, adverse prenatal outcome and maternal outcomes were evaluated by the primary and secondary outcome measures.
Results: There were 10 cases (15.3%) of hypertensive disorder of pregnancy in the study group (3 cases of gestational hypertension in abnormal GCT, 3 cases of pre eclampsia in each GGI and GDM and 1 antepartum eclampsia in GGI category) and 2 cases in control group (3%) (p=0.03). There were 2 cases of Fetal Growth Reduction (FGR) and 5 cases of Premature Rupture Of Membranes(PROM) in both study and control group. There was 1 case of cholestasis of pregnancy in study group. Term inductions were 11 and 13 in the study and control group respectively.Within the study group number of cases induced were more in GGI(n=7) and GDM(n=4) category. There were 14 caesarean sections (21.5%) and 2 (3%) instrumental deliveries among the study group. However there were 6 caesarean sections (9.2%) and no instrumental deliveries among control groups .The rate of elective LSCS is more in GDM (n=5) vs other 3 categories and the difference is significant (p=0.04) The overall number of LSCS (14 cases) was significantly higher in GDM.
Conclusion: Cases with abnormal glucose homeostasis of lesser degree than GDM, like only abnormal GCT, IFG and GGI also were observed to have adverse maternal outcomes than controls, in form of hypertensive disorders of pregnancy, significantly higher LSCS rates, and increased risk of macrosomia. Instead of 2 step procedure, single step screening cum diagnostic test with 75 gm OGTT for diagnosing GDM could be an option to be universally practiced.

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Pleomorphic Adenoma of Three Different Sites: a Consecutive Case Series

Background: Pleomorphic adenomas are benign salivary gland tumors predominantly arising from the superficial lobe of the parotid gland and rarely from the small salivary glands located at various locations including parotid, lacrimal duct, lip, floor of the mouth etc. Surgical excision of the tumor mass is the treatment of choice with utmost care taken to preserve the facial nerve in cases involving the parotid gland. Case details: This case series highlights three consecutive cases of pleomorphic adenoma arising from three different locations. Conclusion: Pleomorphic adenoma is the commonest salivary gland tumor characterized by diverse histomorphological features and can occur at any site where salivary tissue is present. Careful histopathological analysis should be done in all tumors arising especially in the head and neck region.

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Extragonadal Germ Cell Tumors in Children and Adolescents - a 20 Year Study

Germ cell tumors (GCTs) are rare neoplasms which are seen in all age groups and both sexes. GCTs in the pediatric age group show considerable variation from their adult counterparts in relation to site, histological type, clinical and radiological features and response to treatment. Extragonadal gcts are much more common in the pediatric age group with the most common sites being sacrococcygeal region, head and neck, retroperitoneum and mediastinum. Unusual sites like the vagina and urinary bladder have also been reported. Therefore, the varied presentations and different treatment options should be considered

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How Rich is Platelet Rich Plasma? A Simple Preparation Method of PRP and Its Quality According to Various Classification Systems

Background: platelets are a rich source of various growth factors and hence platelet rich plasma (PRP) is being used therapeutically in the field of dermatology, orthopaedics and dentistry with promising results. However, methods of preparation of PRP vary with many commercial kits also available. Scoring systems like DEPA score, PAW system and sports medicine criteria score help in determining the quality of the final product and guide therapy. Here we test a simple two step method for preparation of PRP and score it according to the abovementioned criteria while comparing it with the commercial kits analysed in literature. Methods: 10 ml whole blood was collected in 1.5 ml ACD solution from 100 healthy willing participants and analysed for platelet concentration. Sample was then centrifuged at 1600 rpm X 4 minutes in a calibrated laboratory centrifuge and supernatant was collected in a sterile tube using a sterile syringe. The supernatant was further concentrated for platelets by centrifuging at 3600 rpm X 10 minutes to form a platelet pellet at the bottom. All but 1 ml supernatant (Platelet deficient plasma) was discarded and the platelet pellet was suspended again to form platelet rich plasma. Platelet count was estimated in this sample as done with the whole blood sample. The results were compared and analysed using statistical methods to determine the efficacy of concentrating platelets by this method. Results: The tested method gave a final concentration of more than four times the baseline concentration with approximately 30% efficiency of capture and 80% purity. This was comparable to majority of the commercial systems tested in literature at a fraction of the cost. The scores according to various classification systems were determined and reported. Conclusion: Every platelet rich plasma prepared for therapeutic purposes should be classified according to any of the available scoring systems to determine its suitability for the purpose and to maintain uniformity in the quality of the product. The proposed two step method of preparation yields satisfactory quality of PRP by utilizing services of a basic laboratory at a fraction of the cost of commercial systems thereby enabling smaller medical institutions to utilize PRP therapy.

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