Background-Stress hyperglycemia in patients with acute myocardial infarction has been associated with increased mortality. Most studies looked at the relationship between admission glucose (AG) and outcome; limited information is available about the clinical significance of fasting glucose (FG

OBJECTIVETo compare the efficacy and safety of glyburide versus metformin and their combination for the treatment of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODSIn this prospective randomized controlled study, we randomly assigned patients with GDM at 13-33 weeks gestation and whose blood glucose was poorly controlled by diet to receive either glyburide or metformin. If optimal glycemic control was not achieved, the other drug was added. If adverse effects occurred, the drug was replaced. If both failed, insulin was given. The primary outcomes were the rate of treatment failure and glycemic control after the first-line medication according to mean daily glucose charts. RESULTSGlyburide was started in 53 patients and metformin in 51. In the glyburide group, the drug failed in 18 (34%) patients due to adverse effects (hypoglycemia) in 6 (11%) and lack of glycemic control in 12 (23%). In the metformin group, the drug failed in 15 (29%) patients, due to adverse effects (gastrointestinal) in 1 (2%) and lack of glycemic control in 14 (28%). Treatment success after second-line therapy was higher in the metformin group than in the glyburide group (13 of 15 [87%] vs. 9 of 18 [50%], respectively; P = 0.03). In the glyburide group, nine (17%) patients were eventually treated with insulin compared with two (4%) in the metformin group (P = 0.03). The combination of the drugs reduced the need for insulin from 33 (32%) to 11 (11%) patients (P = 0.0002). Mean daily blood glucose and other obstetrical and neonatal outcomes were comparable between groups, including macrosomia, neonatal hypoglycemia, and electrolyte imbalance. CONCLUSIONSGlyburide and metformin are comparable oral treatments for GDM regarding glucose control and adverse effects. Their combination demonstrates a high efficacy rate with a significantly reduced need for insulin, with a possible advantage for metformin over glyburide as first-line therapy.

The development of anaemia during hospitalization for AMI is frequent and is associated with an increased long-term mortality.

The roles of sympathetic and parasympathetic nerves in the secretion of saliva from submandibular glands of rats have been tested by electrical stimulation of either nerve for 1 h unilaterally in separate animals. The flows of saliva thereby induced and their protein content were monitored. Structural changes in each gland were assessed by light- and electron microscopy and compared with the unstimulated contralateral control gland, and the extent of the changes was determined morphometrically. Sympathetic nerve stimulation induced a relatively low flow of saliva that was rich in protein and was accompanied by extensive degranulation from both acinar and granular duct cells. In contrast parasympathetic nerve stimulation induced a considerable flow of saliva that had a low protein content and no detectable degranulation occurred from the secretory cells. It is possible, therefore, that some protein in parasympathetic saliva may have arisen from a non-granular pathway.

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OBJECTIVE -Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis. However, few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infarction.RESEARCH DESIGN AND METHODS -We prospectively studied the relationship between fasting glucose and long-term mortality in patients with AMI. Fasting glucose was determined after an Ն8 h fast within 24 h of admission. The median duration of follow-up was 24 months (range 6 -48). All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score.RESULTS -In nondiabetic patients (n ϭ 1,101), compared with patients with normal fasting glucose (Ͻ100 mg/dl), the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose (first tertile 1.5 [95% CI 0.8 -2.9], P ϭ 0.19; second tertile 3.2 [1.9 -5.5], P Ͻ 0.0001; third tertile 5.7 [3.5-9.3], P Ͻ 0.0001). The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added (0.8 Ϯ 0.02-0.85 Ϯ 0.02, P ϭ 0.004). Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction. Elevated fasting glucose did not predict mortality in patients with diabetes (n ϭ 462).CONCLUSIONS -Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI. Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction. Fasting glucose is not a useful prognostic marker in patients with diabetes. Diabetes Care 30:960 -966, 2007R ecent studies have emphasized the prognostic value of high blood glucose levels in patients with acute myocardial infarction (AMI) (1-6). Previous investigations focused on the relationship between random blood glucose on admission and outcome. We have previously shown that elevated fasting glucose concentrations are superior to admission glucose levels in predicting 30-day mortality in patients with AMI (7). However, few data on the relationship between fasting glucose and long-term outcome are available.Knowledge of mortality predictors in AMI can be used to generate predictive models that can aid clinicians' decisions making, in particular in identifying patients who are at high or low risk of death (8). Such risk assessment methods have been developed for acute coronary syndromes (9 -11). Whether glucose levels can be used to improve the predictive ability of such risk models is not known.Heart failure has been shown to promote insulin resistance and glucose intolerance (12,13), raising the possibility that the association between stress hyperglycemia and adverse outcome is partly mediated through the acute reduction in left ventricular systolic performance. However, the relationship between infarct size or left ventricular dysfunction and the degree of stress hyperglycemia remains...

We assessed the efficacy of a screening protocol for postpartum anaemia diagnosis and treatment in the maternity ward. A prospective non-randomized before-and-after anaemia screening protocol implementation study during two consecutive periods was conducted. Women who were scheduled for vaginal birth were tested for haemoglobin (Hb) before delivery. During the first period (June 29–October 10, 2015; N = 803) Hb was measured postpartum for women with anaemia-related symptoms, postpartum haemorrhage, or pre-delivery severe anaemia (Hb < 8 g/dL; “symptoms” group). During the second period (October 11, 2015–January 27, 2016; N = 755) Hb was also measured in all women with pre-delivery anaemia [i.e., Hb < 10.5 g/dL] (“screening” group). The primary outcomes were the rates of women with (1) postpartum anaemia diagnosis (Hb < 10 g/dL) and (2) administration of parenteral iron sucrose (indicated for postpartum Hb ≤ 9.5 g/dL). The detection rate of postpartum anaemia was higher in the screening group compared with the symptoms group (140 (19%) versus 100 (12%), OR adjusted 2.2 95%CI [1.6–3.0], respectively). The iron sucrose treatment rate was also higher (110 (15%) versus 88 (11%), OR adjusted 2.0 95%CI [1.4–2.7], respectively). A total of 122 women were diagnosed with moderate-severe anaemia in the screening group, 27 of whom (22%) were diagnosed solely due to the screening protocol. The results demonstrated that a routine screening of women with predelivery anaemia for postpartum anaemia led to increased anaemia diagnosis and consequently better medical care.

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