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To compare fetomaternal outcomes between GDM pregnant women with twin versus singleton pregnancies and then between women with GDM versus non-GDM twin pregnancies.We performed a retrospective study including GDM pregnant women with both twin and singleton pregnancies followed in our tertiary center between 2011 and 2018. The fetomaternal characteristics of each group were compared. We then compared women with GDM twin pregnancy followed at our institution between 2011 and 2018 to non-GDM twin pregnant women giving childbirth in 2018.A total of 1127 GDM pregnant women were evaluated: 42 with twin pregnancy and 1085 with singleton pregnancy. Preeclampsia (14.3% vs. 3.3%, p 0.001) and cesarean delivery (76.2% vs. 36.9%, p 0.001) were more frequent among women with twin pregnancy. Neonatal morbidity was also more common among neonates delivered from twin pregnant women, including preterm labor (73.8% vs. 7.8%, p 0.001), hypoglycemia (6% vs. 4.8%, p = 0.043), hyperbilirubinemia (33.3% vs. 9.0%, p 0.001), RDS (28.6% vs. 2.7%, p 0.001), admission in NICU (32.1% vs. 4.5%, p 0.001) and SGA (19.0% vs. 11.0%, p = 0.001). Overall there were no significant differences in fetomaternal morbidity parameters between GDM (n = 42) versus non-GDM (n = 83) twin pregnancies, although SGA infants were more frequent in the latter group (33.9% vs. 19.0%, p = 0.014).In GDM pregnant women, twin pregnancy seems to be associated with an increased prevalence of neonatal morbidity when compared to singleton pregnancy. On the other hand, in twin pregnancy, diagnosis of GDM does not seem to be associated with poorer fetomaternal outcomes. GDM seems to be protective for the occurrence of SGA neonates in twin pregnancies.

To evaluate the association between the dimension of deviation from appropriate gestational weight gain (GWG) and adverse maternofetal outcomes in women with gestational diabetes mellitus (GDM).We performed a multicentric retrospective study based on the Portuguese GDM Database. Women were classified as within GWG, insufficient (IGWG) or excessive (EGWG) than the Institute of Medicine recommendations. EGWG and IGWG were calculated for each prepregnancy BMI category. Large-for-gestational-age (LGA) and macrosomia were defined as a birthweight more than the 90th percentile for the gestational age and newborn weight greater than 4000 g, respectively. Logistic regression models (adjusted odds ratio [aOR] plus 95% confidence interval [95%CI]) were derived to evaluate the association between EGWG or IGWG and adverse maternofetal outcomes.A total of 18961 pregnant women were included: 39.7% with IGWG and 27.8% with EGWG. An EGWG over 3 kg was associated with a higher risk of LGA infants (aOR 1.95, 95%CI 1.17-3.26) and macrosomia (aOR 2.01, 95%CI 1.23-3.27) in prepregnancy normal weight women. An EGWG greater than 4 kg was associated with a higher risk of LGA infants (aOR 1.67, 95%CI 1.23-2.23) and macrosomia (aOR 1.90, 95%CI 1.38-2.61) in obese women. In overweight women, an EGWG above 3.5 kg was associated with a higher risk of LGA infants (aOR 1.65, 95%CI 1.16-2.34), macrosomia (aOR 1.85, 95%CI 1.30-2.64), preeclampsia (aOR 2.40, 95%CI 1.45-3.98) and pregnancy-induced hypertension (aOR 2.21, 95%CI 1.52-3.21). An IGWG below -3.1 kg or -3kg was associated with a higher risk of small-for-gestational-age [SGA] infants in women with normal (OR 1.40, 95%CI 1.03-1.90) and underweight (OR 2.29, 95%CI 1.09-4.80), respectively.Inappropriate gestational weight gain seems to be associated with an increased risk for adverse maternofetal outcomes, regardless of prepregnancy BMI. Beyond glycemic control, weight management in women with GDM must be a focus of special attention to prevent adverse pregnancy outcomes.KEY MESSAGESThe dimension of deviation from appropriate gestational weight gain was associated with an increased risk for adverse maternofetal outcomes among women with gestational diabetes.Weight management must be a focus of special attention in women with gestational diabetes to prevent adverse pregnancy outcomes.

Introduction Faster insulin aspart (fASP) is the new formulation of insulin aspart (ASP) with a left-shifted pharmacokinetic profile, allowing better control of early postprandial hyperglycemia and a reduction in the risk of late post-meal hypoglycemia. However, it can be associated with more frequent infusion set changes. The purpose of this study is to evaluate efficacy and safety one, three, and six months after starting fASP in continuous subcutaneous insulin infusion (CSII) systems. Methods This is a retrospective study that included adults with type 1 diabetes mellitus, users of CSII ≥3 months, who started fASP. Exclusion criteria included less than one month of follow-up after the intervention, concomitant initiation of pharmacological therapy, pre-conception period, and non-use of continuous glucose monitoring. Results A total of 77 individuals were included, of which 52 (67.5%) were female, aged 39.87 ± 13.10 years, with a mean time under CSII of 7.30 ± 3.58 years and a median follow-up time after transition to fASP of six months. There was a trend to a global glycemic control improvement at six months after starting fASP: numeric increase in time in range (56.40 ± 12.62% vs 60.15 ± 13.53%, p=0.148), reduction in time above range (37.76 ± 13.05% vs 34.67 ± 14.94%, p=0.557), time below range (6.00 (5.00)% vs 4.50 (5.25)%, p=0.122), and mean glucose (174.29 ± 25.14 mg/dL vs 167.00 ± 25.30 mg/dL, p=0.207). There was a reduction in body mass index (BMI) at six months after switching to fASP (25.08 (4.59) kg/m

To clarify whether mild first trimester hyperglycaemia (characteristic of early-onset GDM) is associated with higher incidence of congenital malformations and other adverse fetomaternal outcomes compared to women with second trimester hyperglycaemia (later-onset GDM). We analyzed the Portuguese National GDM database, containing data collected between 2011 and 2017. Two study groups were defined: Group 1—Women with GDM diagnosed during the first trimester (with fasting glycemia ≥ 92 and

We sought to prospectively assess the impact of intermittently scanned continuous glucose monitoring (isCGM) initiation in the glycaemic control and quality of life (QoL) in type 1 diabetes mellitus (T1DM) patients followed in real-live conditions.Prospective, observational, cohort, single-centre and single-arm study conducted between September 2018 and March 2020, enrolling adults with T1DM with at least one year of diagnosis, interested in using isCGM. After training at isCGM initiation, CGM metrics and QoL were assessed at baseline and 12 months.Thirty-six individuals (55.6% male) were included; median age at inclusion was 49.0 (43.5-62.5)years and the mean(±SD) duration of T1DM was 25.5 ± 12.0 years. Median (interquartile range) HbA1c decreased from 7.6(7.0-8.7)% to 7.4(6.8-7.7)% at 12 months (p = 0.02), driven by the subgroup of individuals with baseline HbA1c ≥ 7.5%. The number of scans per day increased from 7.0(5.5-10.0) to 10.0(7.0-14.0) but no correlation was found between the number of daily scans and CGM metrics. Total daily insulin dose remained unchanged, however the proportion of basal insulin decreased, and the proportion of bolus insulin increased over time. Multiple QoL subscales scores improved significantly, including disease-burden subscale for which TIR proved to be a significant predictive factor.isCGM improved both glycaemic control, namely time in range, time below range and glycaemic variability, as well as QoL scores in the long term. The increase of the bolus insulin proportion suggests a behavioural change. However, the appraisal of our results must consider our substantial rate of drop-out limiting the external validity of our findings.

Eutrophication and global climate change gather advantageous conditions for cyanobacteria proliferation leading to bloom formation and cyanotoxin production. In the Azores, eutrophication is a major concern, mainly in lakes where fertilizers and organic matter discharges have increased nutrient concentration. In this study, we focused on understanding the influence of environmental factors and lake characteristics on (i) cyanobacteria diversity and biomass and (ii) the presence of toxic strains and microcystin, saxitoxin, anatoxin-a, and cylindrospermopsin cyanotoxin-producing genes. Fifteen lakes from the Azores Archipelago were sampled seasonally, environmental variables were recorded in situ, cyanobacteria were analyzed with microscopic techniques, and cyanotoxin-producing genes were targeted through conventional PCR. Statistical analysis (DistLM) showed that lake typology-associated variables (lake&rsquo, s depth, area, and altitude) were the most explanatory variables of cyanobacteria biomass and cyanotoxin-producing genes presence, although trophic variables (chlorophyll a and total phosphorus) influence species distribution in each lake type. Our main results revealed higher cyanobacteria biomass/diversity, and higher toxicity risk in lakes located at lower altitudes, associated with deep anthropogenic pressures and eutrophication scenarios. These results emphasize the need for cyanobacteria blooms control measures, mainly by decreasing anthropogenic pressures surrounding these lakes, thus decreasing eutrophication. We also highlight the potential for microcystin, saxitoxin, and anatoxin-a production in these lakes, hence the necessity to implement continuous mitigation protocols to avoid environmental and public health toxicity events.

The Azores are oceanic islands located in the Northern Atlantic Ocean and are particularly rich in aquatic systems, ranging from freshwater, brackish, marine and thermal habitats. Due to the increase in local anthropogenic pressures and global warming, several azorean lakes began to reveal signs of eutrophication that led to the implementation of monitoring programmes and management strategies on the most impacted lakes. Later, the Water Framework Directive (2000/60/EC) demanded the establishment of biomonitoring programmes for European freshwater ecosystems and the limited Azorean monitoring programmes were extended to a larger set of lakes. Since the establishment of the aquatic systems monitoring programme in the Azores archipelago, lakes have been regularly sampled, producing innumerous unpublished records of cyanobacteria that are difficult to access. Here we present the occurrences of cyanobacteria in Azorean lakes that result from 22 years of phytoplankton monitoring in a total of 1948 cyanobacteria occurrences from 968 phytoplankton sampling events on Azorean lakes done between 1996 and 2018 as part of regional inland aquatic ecosystems monitoring programmes. Forty two cyanobacteria taxa were identified in those events, 28 species and 14 at genus level. This information is crucial for conservation, biodiversity studies and lake management, as some of the cyanobacteria species present are bloom-forming and have the ability to produce toxins. This will also allow for the identification of invasive species and possible targeted control and mitigation programmes, according to the species present in the Azorean lakes.

Fetal goiter is a rare disorder not expected to be found during a healthy woman's pregnancy. It can be a prenatal manifestation of congenital hypothyroidism due to thyroid dyshormonogenesis and it can lead to serious perinatal complications. A vascularized fetal neck mass was detected at 29 weeks' gestation of a healthy primigravida. Magnetic resonance was suggestive of goiter causing airway deviation without polyhydramnios. Maternal thyroid function was normal and thyroid antibodies were negative. Two intra-amniotic levothyroxine infusions were performed at 32 and 33 weeks. Serial imaging control showed no progression of the mass. Elective caesarean section was performed at 38 weeks. The male newborn was admitted to the intensive care unit due to cardiorespiratory insufficiency with pulmonary hypertension. Hormonal assays revealed primary congenital hypothyroidism and ultrasonography confirmed diffuse goiter. Levothyroxine was started. Currently, he is 6 years old with adequate growth and normal psychomotor development. Genetic study found a heterozygous mutation in the TPO gene. info:eu-repo/semantics/publishedVersion

Dissertação de Mestrado, Biodiversidade e Biotecnologia, 20 de fevereiro de 2018, Universidade dos Açores. Foi utilizado neste estudo um registo sedimentar datado do Holoceno para reconstruir a variabilidade climática passada. Registos paleolimnológicos das peças de Cladocera foram utilizados para a reconstrução climática e ambiental da lagoa do Caveiro, ilha do Pico. Os Cladocera ocupam um nível trófico intermédio nas cadeias alimentares aquáticas, respondem quer a alterações bottom-up (alterações nos produtores primários) quer a alterações top-down (alterações na predação). Várias espécies de Cladocera têm óptimos ambientais e respondem a alterações no clima. Os resultados foram divididos em comunidade sub-fóssil e comunidade fóssil. As comunidades fósseis foram caracterizadas em cinco fases, as primeiras quatro fases indicam que a evolução da lagoa teve influências naturais, como erupções vulcânicas, alterações climáticas e desabamentos. Enquanto a quinta fase foi maioritariamente influenciada por pressões antropogénicas (e.g. desflorestação, introdução de espécies invasoras). Nos últimos anos a riqueza taxonómica da lagoa diminuiu, com proliferação de espécies bentónicas e reduzida abundância de espécies planctónicas. As projecções climáticas para os Açores, supõem um aumento de eventos de precipitação severos no Inverno e aumento dos períodos de aridez no Verão, que poderão acelerar o assoreamento da lagoa do Caveiro. No futuro, espera-se que a lagoa continue a registar valores de riqueza taxonómica baixos e dominância de espécies bentónicas. ABSTRACT: In this study we used a sedimentary record of the Holocene to reconstruct the past climate variability. Paleolimnological records of Cladocera remains were used for the climatic and environmental reconstruction of Caveiro lake, in Pico island. Cladocera occupy an intermediate trophic level in aquatic food webs, they respond to bottom-up (changes in primary producers) and top-down (changes in predation) changes of food web. Various species of Cladocera have environmental optimums and respond to changes in the climate. The results were divided in sub-fossil and fossil communities. The fossil communities were characterized in five phases, the first four phases indicate natural influence in the evolution of the lake, such as volcanic eruptions, climate change and landslides. While the fifth phase, was mostly influenced by anthropogenic pressures (e.g. deforestation, invasive species introduction). In the last years taxonomic richness in the lagoon decreased, with proliferation of benthic species and reduced abundance of planktonic species. The climatic projections for the Azores, suggest an increase in severe precipitation events in winter and dry periods in summer, which could accelerate the silting of Caveiro lake. In the future, the lake is expected to continue to register low taxonomic richness values and dominance of benthic species.

The DIABTel system, a Web-based telemedicine application, integrates a whole communication system (glucometer, insulin pump, wireless hand-held assistant) for medical remote advice. We sought to evaluate, in terms of glycemic control, the DIABTel system in a randomized crossover clinical study.Ten patients with type 1 diabetes [5 women, age 40.6 (21-62) years, diabetes duration 14.7 (3-52) years] were included. During the 4-week active phase, data sent by patients were analyzed by the physician and modifications of the basal rate and bolus were advised in the following 24 hours. During the control phase, patients sent glucose data without any feedback from the medical center.The mean numbers of daily glucose values and bolus sent by patients during the active period were 4.46 +/- 0.91 and 4.58 +/- 0.89, respectively. The personal digital assistant functionalities used more frequently by patients were (times per week) data visualization (8.1 +/- 6.8), data download from the insulin pump (6.8 +/- 3.3), and synchronization with the telemedicine server (8.5 +/- 4.9). After the experimental phase, serum fructosamine decreased significantly (393 +/- 32 vs 366 +/- 25 micromol/liter; p0.05) and hemoglobin A1c (HbA1c) tended to decrease (8.0 +/- 0.6 vs 7.78 +/- 0.6; p = 0.073), whereas no changes were observed during the control phase. The number of treatment modifications proposed and performed by the patients correlated with the change observed in HbA1c during the active phase (r = -0.729, p = 0.017).The DIABTel system, a telemedicine system that includes a wireless personal assistant for remote treatment advising, allows better glycemic control in pump-treated patients with type 1 diabetes. To our knowledge, this is the first study that demonstrates improved glycemic control with the use of a telemedicine system that incorporates insulin delivery data.

In 1987, it was created the first portuguese Diabetic Foot Clinic in Oporto, at the Hospital Geral de Santo António. The distinction between neuropathic and ischaemic foot was the key stone to reduce drastically the rate of major amputations in the first two years of activity. Since then and until 1995 the rate of major amputations had stabilised around 8%. The aim of the present study was to evaluate if there was any change in the last three years. A retrospective study was performed reviewing the clinical files of 843 new patients between 1998 and 2000. The 593 patients who presented with a foot ulcer with or without infection were selected: 60.4% with neuropathic foot and 39.6% with ischaemic one. Overall, 31 of the 593 patients with ulcer or infection were treated with major amputation (5.2%). There was a statistical difference between the major amputation outcome among the two types of foot (p0.001). Necrosis showed to carry a poor prognosis (30.7% in ischaemic foot vs 8,3% in neuropathic, p = 0.024). There was no further statistical significance for age, sex, type or duration of diabetes as risk factors for major amputation. This retrospective study has showed a slight reduction in the rate of major amputations since 1995. Poor prognosis was related to necrosis and ischaemic foot. Further improvement requires harder investment in patients' education, as well as in alerting the primary health care physicians, for the most unpredictable catastrophic complication of diabetes.