Sajita Setia

Insulin sensitivity and insulin secretion at birth in intrauterine growth retarded infants

Aim: To study insulin sensitivity, secretion and relation of insulin levels with birth weight and ponderal index in intrauterine growth retarded (IUGR) infants at birth. Methods: We studied 30 IUGR and 30 healthy newborns born at term by vaginal delivery in Jipmer, Pondicherry, India. Cord blood was collected at the time of delivery for measurement of plasma glucose and insulin. Results: When compared with healthy newborns, IUGR newborns had lower plasma glucose levels (mean 2.3±0.98 versus 4.1±0.51 mmol/L, p<0.001); lower plasma insulin levels (mean 4.5±2.64 versus 11.03±1.68 µU/L, p<0.001); higher insulin sensitivity calculated using G/I ratio (mean 11.6±5.1 versus 6.7±0.31, p<0.001), HOMA IS (mean 5.5±6.0 versus 0.53±0.15, p<0.001), and QUICKI (mean 0.47±0.12 versus 0.34±0.02, p<0.001); and decreased pancreatic &bgr;‐cell function test measured as I/G (mean 0.10±0.037 versus 0.15±0.006, p<0.001). A positive correlation was identified between insulin levels and birth weight in both the healthy control group (r2 = 0.17, p = 0.024) and IUGR group (r2 = 0.13, p = 0.048). However correlation of insulin levels with ponderal index was much more confident in both healthy control (r2 = 0.90, p<0.001) and IUGR groups (r2 = 0.28, p = 0.003). Insulin status correlated both with birth weight and ponderal index more confidently in control group than in IUGR group. Conclusion: At birth, IUGR infants are hypoglycaemic, hypoinsulinaemic and display increased insulin sensitivity and decreased pancreatic &bgr;‐cell function. Insulin levels correlate with ponderal index much more confidently than with birth weight.Abbreviations: G/I, glucose to insulin ratio; HOMA IS, homeostasis model assessment estimate of insulin sensitivity; I/G, insulin to glucose ratio; IUGR, intrauterine growth retardation; QUICKI, quantitative insulin sensitivity check index; SGA, small for gestational age.

Retinopathy in preeclampsia: association with birth weight and uric acid level.

Purpose: In a retrospective study of patients with preeclampsia and patients with pregnancy-induced hypertension (PIH) who delivered at term, the association of retinopathy with various clinical and laboratory manifestations and fetal birth weight was evaluated. Methods: Medical records of patients with preeclampsia and patients with PIH who delivered at term between January 2003 and December 2004 were reviewed. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic blood pressure (BP), fetal birth weight, and various biochemical parameters. Multivariable linear regression was used for statistical analysis. P ≤ 0.05 was considered significant. Results: Forty patients were included in the preeclampsia group (study group) as well as in the PIH group (control group). Severity of retinopathy was found to be inversely related to fetal birth weight (P = 0.044) and positively related to serum uric acid level (P = 0.022) in the preeclampsia group. All other variables in the preeclampsia group including systolic BP (mean, 154.6 mmHg; P = 0.792) and diastolic BP (mean, 105.7 mmHg; P = 0.102) were found to have no significant association with retinopathy. In the PIH group, none of the parameters analyzed were significantly associated with ocular changes. Conclusions: The severity of retinopathy in preeclampsia is directly related to the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy might be independent of systemic BP.

Fulminant hepatic failure in an infant with severe dengue infection

Fulminant hepatic failure due to dengue infection is rare, although mild liver dysfunction is common. Here we report a fatal case of fulminant hepatitis in an infant infected with dengue 3 serotype. Attention must be given to the use of hepatotoxic drugs in some cases of dengue especially in infants.

Formulation of questions followed by small group discussion as a revision exercise at the end of a teaching module in biochemistry

Undergraduate medical students get fewer opportunities to clarify their doubts and to reinforce their understanding of concepts after lecture classes. There is no information available in the literature that addresses the question of usefulness of prior formulation of questions followed by small group discussion by undergraduate medical students as a revision exercise. The purpose of this work is to evaluate the effect of formulation of objective type short answer questions by undergraduate medical students followed by small group discussion on the answers of the questions prepared as a revision exercise on their understanding of the topic “amino acid metabolism” and the retention of the gain after 15 days. At the end of a regular teaching module on the topic of amino acid metabolism, undergraduate medical students were asked to prepare 16 objective type short answer questions on the various aspects of the topic as homework. Small group discussions involving 12–14 students in each group and lasting one hour were conducted on the questions and answers prepared by them in the presence of a faculty member. The effects on low, medium, and high achievers were evaluated with multiple choice questions by pre‐test and post‐tests before and after the group discussion. Formulation of questions was highly effective in improving understanding on the topic for all the students. The overall mean post‐test scores after the formulation of questions (12.6) and after the small group discussion that followed (14.7) were significantly higher than the mean pre‐test score (8.5). For high achievers, the gain from formulation of questions was higher than the gain from small group discussion. Small group discussion was highly effective for all students. The gain from small group discussion was higher among the low and medium achievers in comparison with the high achievers. The gain from the exercise was retained among the low, medium, and high achievers after 15 days. In conclusion, formulation of short answer questions followed by small group discussion on the answers of the questions prepared by the undergraduate medical students is an effective revision exercise for improving their understanding on a selected topic.

Fetal birthweight and diastolic blood pressure: Association with retinopathy in severe preeclampsia

Purpose To find the association of retinopathy in preeclampsia with fetal birthweight and systolic and diastolic blood pressure (BP) in patients with mild and severe preeclampsia. Methods Medical records of patients with preeclampsia who delivered at term between January 2002 and December 2006 were included in the study Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic BP, and fetal birthweight. Multivariable linear regression was used for statistical analysis. p value ≤0.05 was considered significant. Results The patients were divided into two groups: mild preeclampsia (MP) and severe preeclampsia (SP). The MP had 156 patients and SP had 104 patients. The mean systolic BP in MP and SP was 147.2 mmHg and 164.6 mmHg, while the mean diastolic BP in MP and SP was 98.6 mmHg and 112.7 mmHg. Severity of retinopathy was inversely associated with fetal birthweight (p=0.022) in SP, while it was insignificant in the MP (p=0.082). Low birthweight was due to intrauterine growth retardation of the fetus. Diastolic BP in the SP showed significant correlation with retinopathy (p=0.041). The systolic (p=0.55) and diastolic BP (p=0.248) in MP and systolic BP (p=0.803) in SP were insignificantly correlated with the retinopathy. Conclusions Retinopathy in preeclampsia may indirectly indicate the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy is more closely related with diastolic BP rather than systolic BP and the significance of this correlation increases in severe preeclampsia.

Comparison of the clinical presentation and visual outcome in open globe injuries in adults and children over 30 months

Purpose. To compare the clinical presentation and final visual outcome of open globe injuries in children and adults in a referral hospital over a 30-month period. Methods. This is an institutional-based prospective study of open globe injuries cases presenting in the emergency department between July 2003 and December 2005. Patients were divided in 2 groups: group 1, children (2–15 years), and group 2, adults (>15 years). All the patients were admitted and emergency surgical interventions were undertaken. The clinical features at presentation and the final visual acuity are compared. Chi-square and Fisher exact tests were used for statistical analysis. Results. Ninety and 84 patients were included in group 1 and group 2, respectively. The most common places of injuries were home or while playing outdoor games in group 1 (67%) and workplace in group 2 (53.5%). The presenting features were significantly more grave in group 2. These included poor presenting visual acuity (p=0.012), vitreous prolapse (p=0.002), presence of relative afferent pupillary defect (p=0.001), and incidence of endophthalmitis (p=0.004). Time interval between injury and surgical intervention (p=0.018) was better in group 2. Other features, such as presence of hyphema, uveal tissue prolapse, cataract, intraocular foreign body, and length or location of laceration were similar in both groups. The final visual outcome was similar in the groups (p = 0.21), with approximately half of the patients achieving vision of 20/60 or better in each group. Conclusions. The majority of injuries in children and adults occurred in their homes or workplaces, respectively. Although the clinical presentations of open globe injuries were significantly more grave in adults than in children, the final visual outcomes were similar.

Microbial cultures in open globe injuries in southern India

Purpose:  To determine the risk factors leading to positive intraocular culture in patients with open globe injury.