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Carrier Screening For Inherited Genetic Conditions
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Whitney Bender, Lorraine Dugoff
Clinical features: This disorder is caused by an inability to break down specific amino acids. The disease is associated with ketonuria within 48 hours of life that, if left undiagnosed and untreated, can progress to lethargy, dystonia, seizures, cerebral edema, and death. It is named for the characteristic maple syrup smell of urine in those with the disorder.
Shoulder dystocia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, James S. Smeltzer
Maternal obesity is not preventable but is treatable. Past blanket proscriptions against excessive weight gain were obviously misguided. A woman who starts pregnancy 50 kg overweight already has caloric reserves that are the equivalent of 200 days of a normal diet. Her ideal weight gain is in the range of 5–10 kg. Moreover, fat exacerbates the normal gestational resistance to insulin and thus provides the fetus excess glucose. A balanced diet emphasizing complex carbohydrates, moderate portion size, distribution of calories throughout the day, and high fiber intake (22) would seem prudent. These women should know that the objective is not to lose weight, but to limit heavy intake of simple sugars and provide the fetus with appropriate nutrition. The urine should be checked for ketones if weight gain is not adequate, and calories should be increased or distributed more favorably if ketonuria is present.
The patient with acute endocrine problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
DKA is a triad of hyperglycaemia, hyperketonaemia and metabolic acidosis, thus, the diagnostic criteria are: Ketonaemia ≥3 mmol/L or significant ketonuria.Blood glucose >11 mmol/L or known diabetes mellitus.Bicarbonate (HCO3) <15 mmol/L and/or venous pH <7.3.
The incidence of biliary sludge in first trimester pregnancies with hyperemesis gravidarum and its effect on the course of hyperemesis gravidarum
Published in Journal of Obstetrics and Gynaecology, 2022
Aylin Saglam, Iris Derwig, Mekin Sezik, Sibel Cigdem Tuncer, Mustafa D. Ozcil, Burcu Kasap, Mesut Misirlioglu, Ender Alkan, Namık Ozkan
Serum levels of sodium, potassium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglyceride and cholesterol were tested in the first trimester in both groups. Serum triglyceride and cholesterol level measurements were carried out after 12 hours of overnight fasting. The presence of ketones in the urine was also tested in the study group, and ketonuria was graded as 1+, 2+ and 3+ by dipstick urine testing. Gestational age at delivery and neonatal birthweight were recorded. Low birthweight was defined as birthweight <2500 g, and small for gestational age (SGA) was considered when birthweight was <10th centile, using the Foetal Medicine Foundation online Birth Weight Assessment Calculator (https://fetalmedicine.org/research/assess/bw). Preterm delivery (PTD) was defined as all deliveries before 37 + 0 weeks of gestation.
Growing role of SGLT2i in heart failure: evidence from clinical trials
Published in Expert Review of Clinical Pharmacology, 2022
Ajay Varadhan, Katarina Stephan, Rahul Gupta, Apurva V. Vyas, Purva Ranchal, Wilbert S. Aronow, Nael Hawwa, Gregg M. Lanier
Diabetic ketoacidosis (DKA) is the most common, yet serious, hyperglycemic emergency in diabetic patients; its clinical presentation is a triad of hyperglycemia (blood glucose level >11 mmol/l), acidosis (venous bicarbonate <15 mmol/l) and ketonuria/ketonemia. A meta-analysis of recent clinical trials that involved >60,000 participants with T2DM demonstrated that SGLT2i were statistically associated with an increased risk of developing DKA vs. control (OR 2.13, 95% CI 1.38–3.27) [75]. Despite this confirmed association, it is generally still considered a rare occurrence. It should also be noted that ketoacidosis was not increased in patients who received SGLT2i compared to the placebo group in DAPA-HF or in the EMPEROR trials. Patients with T1DM or T2DM undergoing SGLT2i therapy should be informed that they should undergo evaluation of ketonuria/ketonemia should they experience nausea, vomiting or general feeling of being unwell.
Effectiveness of Ketogenic Diets on the Survival of Adult Oncological Patients
Published in Nutrition and Cancer, 2021
A prospective observational study by Schmidt et al evaluated 16 patients with multiple types of solid tumors, with advanced or metastatic disease, without the possibility of other therapeutic options. The patients underwent a diet low in carbohydrates (<70 g/day) and high in fat. Only five patients completed 12 weeks of KD, whom presented disease stability at the end of the study, but no improvement. Three other patients had stable levels of ketonuria, but discontinued the diet for 6-8 weeks due to disease progression (33). Tan-Shalaby et al studied 17 patients with different types of advanced cancer, without concomitant CT. Patients consumed 20- 40 g of carbohydrates daily for 16 weeks and were evaluated by FDG-PET at week 4, 8 and 16 of the study. At 4 weeks, 45% of the patients presented disease progression. At 16 weeks, 36% of all patients had stable disease or a reduction of it. Only four patients completed the 16 weeks of treatment, who were diagnosed with non-small cell lung cancer (NSCLC) or melanoma. Despite describing beneficial effects in patients who completed the protocol, this study did not have a control group, in addition to having a small sample of patients (34).