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    Diabetes care 09/2013; 36(9):e165. DOI:10.2337/dc13-0936
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    ABSTRACT: Collagen atrophy is a major factor in skin ageing. A strong correlation exists between skin collagen loss and oestrogen deficiency caused by the menopause. Skin ageing is associated with a progressive increase in extensibility and a reduction in elasticity. With increasing age, the skin also becomes more fragile and susceptible to trauma, leading to more lacerations and bruising. Furthermore, wound healing is impaired in older women. Oestrogen use after the menopause increases collagen content, dermal thickness and elasticity, and it decreases the likelihood of senile dry skin. Large-scale clinical trials are necessary to help make informed recommendations about postmenopausal oestrogen use and its role in preventing skin ageing.
    Best practice & research. Clinical obstetrics & gynaecology 07/2013; 27(5). DOI:10.1016/j.bpobgyn.2013.06.004

  • International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2013; 122(1):80–81. DOI:10.1016/j.ijgo.2013.02.021
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    ABSTRACT: OBJECTIVE: To determine whether clinical risk assessment for gestational diabetes mellitus (GDM) may preclude the need for universal screening with an oral glucose tolerance test (OGTT) in situations of economic restraint. METHODS: Women with either GDM (n=119) or normal glucose tolerance (n=1249) were recruited from centers among 11 Mediterranean countries between August 1, 2010, and May 31, 2011. Outcome measures included anthropomorphic and biological data, obstetric outcomes, and infant outcomes. RESULTS: Significant risk factors for GDM included maternal age of 30years or more; elevated body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters); elevated diastolic blood pressure; previous history of macrosomia; and family history of diabetes mellitus. These factors each had high specificity but low sensitivity for predicting GDM; however, when used in combination, sensitivity increased but specificity fell. Fasting blood glucose (FBG) level had high sensitivity (73.9%) and specificity (90.2%) for predicting GDM. Sensitivity was further increased by combining FBG measurement with maternal age and BMI (96.6%). CONCLUSION: Use of a composite model to prescreen women for GDM risk may reduce the need for universal screening with the OGTT among centers facing health-cost pressures.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 12/2012; 120(3). DOI:10.1016/j.ijgo.2012.10.016
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    ABSTRACT: New diagnostic criteria have recently been proposed that will result in a higher proportion of individuals being diagnosed as suffering from gestational diabetes mellitus (GDM) than previously. The present circum-Mediterranean study sets out to identify the relevance of the new criteria in this population. The study was a prospective, non-interventional, multicentre study in the Mediterranean region. A convenient sample of 1,368 pregnant women was recruited. All participants underwent a 75 g oGTT subdivided into five different glycaemic categories. The women's anthropomorphic and biological data, together with obstetric and infant outcomes, were collected. There was a threefold increase in diagnosis using the new criteria. Most of the biological characteristics generally associated with GDM showed high specificity and low sensitivity values. The biological characteristics, including maternal age, BMI and FBG, showed a progressive increase as a function of maternal glycaemia with moderate sensitivity and specificity values. Using these latter characteristics in combination ensures that 72.3 % of the GDM population would be correctly identified, while an oGTT would only be required in 18.7 % of the population. The progressive relationship of increasing glycaemia to adverse characteristics suggests that the new IADPSG criteria are reasonable provided that dietary advice is given to all pregnant women. In situations of economic restraints, it appears possible to screen Mediterranean women for GDM risk using a composite model using FBG >5.0 mmol/l combined with the performance of an oGTT in women with a low FBG but who are overweight and aged >30 years.
    Acta Diabetologica 09/2012; 49(6). DOI:10.1007/s00592-012-0427-9

  • International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2010; 110(1):75-6. DOI:10.1016/j.ijgo.2010.02.017
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    ABSTRACT: Conjoined twinning is a relatively rare event in any community, with a rate of 1.58 per 100,000 maternities reported in the EUROCAT database. The present study reviews the historical records for conjoined twins born in a closed Central Mediterranean archipelago population with particular reference to the last three decades. While the natural monozygotic twinning rates in the Maltese Islands corresponds to that reported from other communities, the incidence of conjoined twinning in the Maltese Islands has been shown by the present study to be significantly 2.5-times higher than that reported by the remaining EUROCAT contributors. The rate reported from the Maltese Islands by this review is 3.98 per 100,000 maternities.
    Journal of Obstetrics and Gynaecology 10/2009; 29(7):599-604. DOI:10.1080/01443610903082500
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    ABSTRACT: Endometrial adenocarcinoma has been associated with prolonged oestrogen exposure causing endometrial hyperplasia and adenocarcinoma. Metabolic disorders and nutritional factors may contribute towards obesity and the increased adipose production of oestrogen. The study confirms the association between endometrial carcinoma risk and diabetes mellitus and increased total fat intake. It further relates the malignancy to a prolonged natural oestrogen exposure period and confirms the protective role of past pregnancies.
    Experimental and Clinical Endocrinology & Diabetes 09/2008; 117(2):78-82. DOI:10.1055/s-2008-1078732
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    ABSTRACT: Gestational diabetes is often compounded by hypertensive disease of pregnancy. Women diagnosed as suffering from gestational diabetes were subdivided into two groups: those found to be suffering from some form of hypertension during their pregnancy [n = 78]; and those who did not develop hypertension [n = 345]. The maternal characteristics and perinatal outcome of the two groups were statistically correlated. The results show that obesity was the only statistically significant correlate, and that obstetric outcome more often required planned delivery by induction of labour or caesarean section. The infant was more likely to be delivered prematurely. While the perinatal morbidity did not show any significant differences, this was only because of the more active intervention policy in these women.
    Experimental and Clinical Endocrinology & Diabetes 07/2008; 116(6):329-32. DOI:10.1055/s-2007-1004524
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    ABSTRACT: Pregnancy complicating homozygous beta thalassaemia is a rare entity. Two cases are described, I of which was further complicated by thrombocytopenia due to secondary hyperslenism. These cases are discussed in the light of current management of homozygous haemoglobinopathies.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 06/2008; 24(1):45 - 48. DOI:10.1111/j.1479-828X.1984.tb03321.x
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