Role of Nutritional Habits during Pregnancy in the Developing of Gestational Diabetes: A Single-Center Observational Clinical Study

(1) Background and Objective: Excessive gestational weight gain is associated with serious complications such as pre-eclampsia, fetal macrosomia and a more frequent need for cesarean section. The aim of this study is to develop a simple screening model that includes maternal age, BMI and nutritive habits in the second trimester in order to predict the risk of GDM in the population of pregnant women in the territory of the Republic of Serbia. (2) Materials and Methods: This single-center, prospective and case-control study was performed in the University Clinical Center "Dr. Dragisa Misovic Dedinje", Belgrade, Serbia and included 54 women with singleton pregnancies during the second trimester from July 2023 to November 2023. We used basic demographic and socio-epidemiological data, as well as data of the present comorbidities and previous pregnancies/births. The Serbian version of the Nutritive Status Questionnaire (NSQ) was used to estimate the nutritive habits in GDM (n = 22) and non-GDM groups (n = 32). (3) Results: We observed less frequent vegetable and fruit consumption in the GDM group in comparison with the non-GDM group; meat and chicken intake was 2-3 times per week in both groups; meat products were consumed 2-3 times per week in the GDM group and 2-3 times per month in the non-GDM group; milk products were consumed once a day in 31.8% of GDM patients and twice per day in 24.1% of non-GDM patients. Sweets (cakes, ice creams, biscuits) were consumed very often (2-3 times per week) in the GDM group (36.4%), while in the non-GDM group this habit was less frequent (26.7%). Cronbach alpha and internal consistency for this instrument were very good (Cronbach alpha = 0.87). (4) Conclusions: We have found that a non-adequate intake of fruits/vegetables, dairy and whole grain, as well as an excessive intake of sugar/artificially sweetened beverages and dairy, was associated with a higher risk of gestational diabetes mellitus (OR = 0.04; 95% CI).

Brief report comparing the Scale of Emotional Development - Short (SED-S) with other scales for emotional development

BACKGROUND

Different instruments were devised for assessing emotional development (ED) level in persons with an intellectual disability (ID), that is, the Scale of Emotional Development - Short (SED-S), the Scheme for Appraisal of Emotional Development (SAED), the Scale for Emotional Development - Second Revision (SED-R2 ) and the Schaal voor Emotionele Ontwikkeling - Lukas (SEO-Lukas). The aim of this study was to compare the level of emotional functioning as assessed with the SED-S with the SAED, SED-R2 and SEO-Lukas.

METHODS

Emotional development was measured in adults with ID with the SED-S (N = 186) and the SAED (n = 85), the SED-R2 (n = 50) and the SEO-Lukas (n = 51). Correlation analysis and Cohen's kappas were calculated between the SED-S and the three respective scales. Internal consistencies (Cronbach's alpha) of the four scales were determined.

RESULTS

The SED-S results correlated most with the SEO-Lukas (γ = 1; кω = 0.936) followed by the SAED (γ = 0.809; кω = 0.343) and least by the SED-R2 (γ = 0.665; кω = 0.182). The stage of ED assessed with the SED-S was lower than the ED results measured with the SAED, but higher than with the SED-R2 and most similar to the SEO-Lukas. Cronbach's alphas were high, ranging from 0.853 to 0.975.

CONCLUSIONS

Given the respective differences between the scales, the SED-S may equalise the results as compared with previous versions.

Surgical Technique: Laparoscopic Gastric Sleeve Resection in Super-Obese Patients

Laparoscopic gastric sleeve (LGS) resection in super-obese patients (BMI > 50 kg/m²) is a challenging procedure. We have developed a unique approach and technique for LGS with no buttress stapling and without oversewing. After 102 operations there have been no leaks and late complications.

Suicide in Serbia

BACKGROUND

Suicide remains a significant public health problem worldwide. The aim of this study was to assess the mortality trend of suicide in Serbia for the years 1991-2014.

METHODS

Data on persons who died of suicide and self-inflicted injury (site codes E950-E959 revision 9 and X60-X84 revision 10 of the International Classification of Diseases to classify death, injury and cause of death) were obtained from the Statistical Office of the Republic of Serbia. The age standardized rate was calculated by direct method (per 100,000 persons, using Segi's World population as standard population). Average annual percentage change (AAPC) with the corresponding 95% confidence interval (CI) was computed for trend using the joinpoint regression analysis.

RESULTS

Total 33,930 (24,016 men and 9914 women) suicide deaths occurred in Serbia during the observed period, with the average annual age-standardized mortality rate being 12.7 per 100,000 inhabitants (19.5 per 100,000 in men and 6.7 per 100,000 in women). Suicide mortality in all age groups was higher among men than women. In both genders, suicide rates were highest in the oldest age group. Significantly decreased trend in suicide mortality was recorded continuously from 1991 to 2014 (AAPC=-1.9%, 95%CI -2.2 to -1.6). The most frequently used suicide method in both genders was hanging, strangulation or suffocation with 61.2% off all suicides. Changes in mortality rates were significant both for suicide by firearms, air guns and explosives (AAPC=-1.5% (AAPC=-1.5% in men and -3.1%-3.1% in women) and for suicide by hanging, strangulation, and suffocation (AAPC=-1.2% (AAPC=-1.2% in men and -3.0%-3.0% in women). In men, nonsignificant increase in suicide by firearms, air guns and explosives observed during the period 1991-1997 (by +6.1% per year) was followed by a significant decrease until 2014 (by -3.1% per year). The significantly increased mortality in suicide by firearms, air guns, and explosives was observed in older men (aged 40-69 years and 80 years and over).

LIMITATIONS

The low rate of autopsies in Serbia, as well as the accuracy, reliability and comparability of the suicide mortality data is always a question.

CONCLUSIONS

Downward trend in suicide mortality occurred in Serbia in last two decades. However, suicide rates are still very high in Serbia compared with the rates of suicides in developed countries. Particularly worrisome is the increase in mortality in older men, especially due to firearm suicides, air rifles, and explosives. Thus, additional efforts in the prevention of suicide are very important.

EMortality from cancer of the lung in Serbia

PURPOSE

To estimate the death rates for lung cancer and their secular trends in the population of Serbia, excluding the autonomous province of Kosovo and Metohia, over the 1991-2009 period.

METHODS

A descriptive epidemiological method was employed. Trend of the lung cancer mortality rates was estimated using joinpoint linear regression analysis. An average annual percentage of change (AAPC) was computed for trend using linear models assuming a Poisson distribution, and the corresponding 95% confidence interval (CI).

RESULTS

The mortality rate from lung cancer in Serbia ranks as the highest in the world, and it has been increasing continuously from 1991 (AAPC = + 1.9; 95% CI=1.7-2.2). A significant increase in mortality was present in both the male population (AAPC = + 1.4; 95% CI=1.2-1.6), and the female population (AAPC = + 3.9; 95% CI=3.6-4.3). However, a significant decline in lung cancer mortality in men was seen in some age groups. In young men (35-39 and 40-44 years age groups), lung cancer death rates decreased continuously from 1991, by - 5.1% and - 2.6% per year, respectively. Among men in the 45-49 years age group, a marked increase of lung cancer mortality was observed from 1991 to 1998 (by + 6.5% per year), followed by significant decrease (- 1.9% per year). Among women, only in the youngest age group (35-39 years) a declining trend was present (- 0.6% per year), yet without significance.

CONCLUSION

Lung cancer mortality rates in Serbia indicate the importance of consistent application of measures of primary and secondary prevention that have been proven effective in other countries.

New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology

BACKGROUND AND PURPOSE

CAS carries an inherent risk of distal cerebral embolization, precipitating new brain ischemic lesions and neurologic symptoms. Our purpose was to evaluate the frequency of new ischemic lesions found on DWI after protected CAS placement and to determine its association with plaque morphology.

MATERIALS AND METHODS

Fifty patients (mean age 65.13 ± 7.08 years) with moderate and severe internal carotid artery stenosis underwent CAS with distal filter protection. Fibrolipid and fibrocalcified plaque morphology was determined by sonography according to the relative contribution of echogenic and echolucent material, and by multisection CT using plaque attenuation. There were 46.81% of patients with fibrolipid and 53.19% with fibrocalcified plaques. DWI was performed before and 24 hours after CAS.

RESULTS

Seven (14.89%) patients showed new lesions. Four (8.51%) had 6 new lesions inside the treated vascular territory. Three had a single lesion and 1 patient had 3 lesions (mean: 1.5 ± 1). Most lesions (66.66%) were subcortical, with a mean diameter of 9 mm (range 5-15 mm). All lesions occurred in the area supplied by the middle cerebral artery and were clinically silent. A significant relationship was found between plaque morphology and the appearance of new lesions. Patients with fibrolipid plaques had a significantly higher number of new lesions compared with patients with fibrocalcified plaques (P = .041). The absolute risk of new lesions in the fibrolipid group was 18.18%.

CONCLUSIONS

New ischemic lesions were observed in the treated vascular territory in 8.51% of patients. The appearance of new ischemic lesions was significantly related to the plaque morphology. Fibrolipid plaques were associated with higher numbers of new lesions.

Nutrition and prostate cancer

PURPOSE

since an association between prostate cancer and some foods or food groups like meat, milk and dairy products, tomato foods, and allium vegetables, has been suggested, we analyzed the possibility that some food items or some food groups could be related to prostate cancer in some other way and not only through their nutrients. The purpose of this study was to test some hypotheses about diet as risk factor for prostate cancer.

METHODS

this case-control study comprised 101 cases of prostate cancer and 202 hospital controls individually matched for age (± 2 years), hospital admission and place of residence. Dietary information of 150 food items was obtained by a quantitative history approach.

RESULTS

multivariate logistic regression analysis indicated as risk factors for prostate cancer high intake of fruit, processed meat, fish (most frequently canned) and butter. High intake of chicken, potato and rice exhibited a protective effect.

CONCLUSION

these results support the hypothesis that consumption of meat and fat play a role in the development of prostate cancer. The findings that consumption of processed meat only (not fresh) and fish increased the risk of prostate cancer, as well as the protective effect of chicken, potato and rice consumption should be corroborated by other investigators.

Arginase activity and magnesium levels in blood of children with diabetes mellitus

Under physiological conditions insulin controls the metabolism of carbohydrates, lipids and proteins. Diabetes mellitus is a metabolic disease characterized by a disturbance in the intermediary metabolism of glucose and glucose-induced insulin release. Arginase (L-arginine amidinohydrolase, EC 3.5.3.1) modulates nitric oxide synthase activity by regulating intracellular L-arginine availability. In diabetes mellitus, a decrease in nitric oxide bioavailability is a central mechanism for endothelial dysfunction. The aim of our study was to assess arginase activity in the blood of children with diabetes mellitus. Blood arginase activity, serum glucose (14.155 +/- 4.197 mmol/L; p < .001) and blood HbA1c (11.222 +/- 3.186 %; p < .001), were significantly higher in diabetic children than in healthy controls, whereas the magnesium (Mg2+) level, a cofactor of many enzymes, was significantly lower (0.681 +/- 0.104 micromol; p < .001). In diabetic children, arginase activity, hyperglycemia (r = 0.143), and the HbA1, level (r = 0.381) showed a positive correlation between but a negative correlation between Mg2+ and arginase activity (r= -0.206). The higher arginase activity and the lower Mg2+' levels in diabetic children could be a consequence of reduced insulin action and increased protein catabolic processes in these pathophysiological conditions. The inverse directions of arginase activity and serum Mg2+ levels are in agreement with this concept.

Inflammatory cytokines and malnutrition as related to risk for cardiovascular disease in hemodialysis patients

Malnutrition and inflammation are associated with end-stage renal disease (ESRD). Interleukin (IL)-6 and tumor necrosis factor alpha (TNF-alpha) powerfully predict death from cardiovascular disease. The aim of our study was to establish an association between markers of inflammation and parameters of malnutrition in patients on hemodialysis. The study population consisted of 42 hemodialysis patients with different parameters of malnutrition. Blood samples were taken after an overnight fast, and plasma lipid profiles (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) were measured by using conventional enzymatic methods. Serum urea and creatinine levels were also measured by routine procedures. Plasma high-sensitivity C-reactive protein level (hs-CRP), TNF-alpha, and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA). Standard Doppler echo examinations were used to determine plaque on carotid arteries, and end-diastolic diameter (EDD) and ejection fraction (EF) were measured by echocardiography. Malnourished patients exhibited significantly greater evidence of cardiovascular disease and carotid plaques. Factor (principal component) analysis indicated 6 latent factors with 67.5% of the variance explained within all investigated parameters. Cluster analysis was used to distinguish the inflammatory markers and the nutritional markers from other parameters and to visualize similarities between variables. In summary, this cross-sectional study in hemodialysis patients found a high prevalence of malnutrition, inflammation, carotid plaques, and cardiovascular disease. Malnourished dialysis patients are more often found with cardiovascular disease and carotid plaques. In addition, these patients have higher levels of inflammatory cytokines, which may partly explain the elevated risk for atherosclerotic vascular disease.

Alterations in the proportions of skeletal muscle proteins following a unilateral lesion to the substantia nigra pars compacta of rats

It is well established that mammalian skeletal muscles exhibit a considerable degree of plasticity and one of the main determining factors of this plasticity is the activity pattern and duration of motoneurone discharge. Lesions to the right substantia nigra pars compacta (SNpc) of six adult rats were made to determine whether altered output from the SNpc ultimately leads to a change in the expression of proteins in contralateral skeletal muscles. After 4 months, altered motor performance was identified by the administration of amphetamine. After 7 months, 30-70% of dopaminergic cells in the SNpc had been destroyed. The protein content of muscles was then quantified from densitometric scans of gels, and expressed as a % of the amount of actin (the protein used as a reference in this study). The lesion affected the expression of different protein isoforms in the fast- and slow-twitch muscles. In slow-twitch soleus muscles, the lesion decreased the proportion of alpha-tropomyosin and increased the proportion of beta-tropomyosin. In the fast-twitch extensor digitorum longus muscles, the lesion increased the proportion of the fast isoform of troponin-T1f, and decreased the proportions of the two isoforms of myosin light chain. This study establishes a connection between the chronic effects of a lesion to the SNpc, with a loss of dopaminergic neurones, impaired motor performance, and altered expression of proteins in skeletal muscle. The implication of these results is that the altered motor function observed in Parkinson's disease may be associated with alterations to the expression of skeletal muscle proteins.

Trends and patterns of tuberculosis: interpretations and prospects of tuberculosis control in Vojvodina, Yugoslavia, 1987-2000

AIM

To assess the trends and pattern of tuberculosis in Vojvodina, Yugoslavia.

METHODS

Using a retrospective design, data on 393 diagnosed TB cases were investigated for the years 1987, 1993 and 2000.

RESULTS

TB case notification has been increasing in Vojvodina. The number of reported TB cases was 146 in 1987, 101 in 1993 and 146 in 2000; cases were predominantly in the age group 20-39 years (44.5%) in 1987, compared to the 40-59 year age group in 1993 and 2000 (38.6% and 45.9%, respectively). The majority of patients belonged to lower socio-economic groups. Manifestations of TB such as cough, weight loss and exhaustion were common. With the increasing trend of alcoholism from 1987 to 2000, delays in reporting were noticed. TB-related mortality was 1.4% in 1987 and 4.1% in 2000. Resistance to TB drugs among previously treated cases was 2.7% in 1987, 0.9% in 1993 and 2.7% in 2000. With respect to the increasing resistance, the levels of detection and surveillance were poor. The implementation of the DOTS strategy remained fairly low.

CONCLUSION

TB is a chronic problem in Vojvodina. Prompt community-oriented actions need to be taken to improve case detection and cure rates through DOTS.

Cardiovascular risk factors and prevalence of coronary heart disease in type 2 (non-insulin-dependent) diabetes

The relationship between cardiovascular risk factors and the prevalence of coronary heart disease was examined in 152 Type 2 diabetic patients (65 men, 87 women) aged 35-54 years and in 105 randomly selected control subjects (46 men, 59 women). Coronary heart disease, defined by symptoms and ECG abnormalities, was 1.2 times higher in male and 3.4 times higher in female diabetic patients than in the controls. In logistic regression analysis (including diabetes, age, body mass index, triglycerides, HDL-cholesterol, non-HDL-cholesterol and hypertension) diabetes showed an independent, significant association to coronary heart disease in women, whereas hypertension was independently related to coronary heart disease in men.