European Journal of Molecular & Clinical Medicine

The outcome of neonates with neonatal seizures has changed in recent years due to improved prenatal care, better obstetrical care and intensive neonatal care. Neonates with seizures are at an increased risk of mortality, and the survivors are at risk of neurological sequelae as developmental delay, epilepsy and cognitive impairment.Present study was aimed to study etiology, clinical type and short outcome of neonatal seizures in term babies at tertiary care hospital. Material and Methods: Present study was retrospective observational study, conducted in neonates admitted with diagnosis of neonatal seizure (Clinically apparent convulsions, history of convulsions or who developed convulsions during hospitalization), admitted in NICU. Results: Among 74 cases, majority of neonates were born to mothers of 21-25 years age (37.84 %) & 26-30 years age (32.43 %), were male neonates (56.76 %), had gestational age 37-40 weeks (55.41 %), had birthweight of 2.5-4 kg (51.35 %) & were delivered vaginally (71.62 %). Among majority of neonates common type of seizure was subtle seizures (47.3 %) followed by focal clonic type (24.32 %), generalised tonic (13.51 %), multifocal clonic (8.11 %), myoclonic (4.05 %) & focal tonic (2.7 %).  Among neonates with seizures, common etiology noted was birth asphyxia/hypoxic ischemic encephalopathy (29.73 %) followed by hypoglycemia (17.57 %), septicemia (17.57 %), hypocalcemia (10.81 %) & 11 neonatal seizures were of idiopathic etiology (14.86 %). Majority neonates were discharged uneventfully (82.43 %) while 4 neonates (5.41 %) took discharge against medical advice. Mortality was noted in 12.16 % (majority had septicemia/ intraventricular hemorrhage, with low birth weight). Conclusion: Birth asphyxia/hypoxic ischemic encephalopathy, hypoglycemia, septicemia & hypocalcemia were major causes of neonatal seizures. Common clinical type was subtle seizure and short outcome was good of neonatal seizures

A common metabolic issue in new born is neonatal hypoglycemia, which is more prevalent in conditions including preterm, sepsis, and for small gestational age. New born without obvious risk factors may experience episodes of asymptomatic hypoglycemia.
Material and Methods: In a tertiary care facility, a hospital-based prospective study was carried out for a period of six months from August 2022 to January 2023. In the study, 104 new-borns who had successive deliveries were taken into account. At 3 hours, 12 hours, and 36 hours after birth, their babies have tested for plasma glucose levels. Using the SPSS (version 21) statistical program, the plasma glucose values were analysed statistically using descriptive and inferential statistics.
Results: The incidence of asymptomatic hypoglycemia among new-borns weighing more than two kgs was 18.3%. The risk factors such as male gender, Low birth weight babies, caesarean delivery small for gestational age was significantly associated with asymptomatic hypoglycaemia. Blood glucose levels was significantly lower in SGA babies and caesarean birth babies.
Conclusion: In neonates, asymptomatic hypoglycemia occurs quite frequently. In order to recognise asymptomatic hypoglycemia and implement preventative interventions to stop the transition to symptomatic hypoglycemia and its consequences later in life, strict monitoring and close attention are required

Background: Hypoglycemia is an endocrine emergency that can alter the patient’s mental status, resulting in lethargy, confusion and organ dysfunction. The present study was conducted to assess clinical characterisation of severe hypoglycaemia in hospitalized patients.
Materials & Methods: 74 patients presenting to emergency with hypoglycaemia of both genders were selected. Causes of hypoglycaemia were identified A blood glucose concentration was determined by Accu-Check Gluco-stix. Hypoglycaemia was defined as a capillary blood glucose of 70 mg/dL or less.
Results: Out of 74 patients, males were 34 and females were 40. The mean HGT was 42.5, pulse rate was 87.2 beats per minute, systolic blood pressure was 134.2 mm Hg, diastolic blood pressure was 80.6 mm Hg and GCS was 10.4. Common causes of hypoglycaemia were OHA in 34, OHA+ insulin in 12, insulin in 10, others in 6, skipped meal in 7 and alcohol in 5 cases. The difference was significant (P< 0.05). Common clinical features were anorexia in 45, fever in 68, syncope in 42 and others in 21. The difference was significant (P< 0.05).
Conclusion: Common causes of hypoglycaemia were OHA, OHA+ insulin, insulin, others, skipped meal and alcohol. Common clinical features were anorexia, fever, syncope and others.

Background: Using continuous glucose monitoring, compare glycemic variability (GV) indices between patients with fibrocalculous pancreatic diabetes (FCPD) and type 2 diabetes mellitus (T2D) (CGM).
Methods: We calculated GV indices in 61 patients with FCPD and T2D who were matched for HbA1c and diabetes duration. The CGM-derived measures of GV (SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [percent CV]) and hypoglycemia (time spent below 70mg/dL, AUC below 70mg/dL, glycemic risk assessment diabetes equation hypoglycemia, Low Blood Glucose Index), and hyperglycemia (time spent above 180mg/dL at night [TSA > 180], AUC above 180mg/dL [AUC > 180], glycemic risk assessment diabetes equation hyperglycemia, High Blood Glucose Index [HBGI], and J index).The relationship between GV indices and HbA1c, diabetes duration, and demographic and biochemical data was also investigated.
Results: Except for M value, all of the CGM-derived GV parameters (SD, MAGE, CONGA, MODD, and percent CV) were substantially greater in the FCPD group than in the T2D group (P<0.05). The FCPD group had significantly greater levels of hyperglycemia (TSA >180, AUC >180, HBGI, and J index) than the T2D group (P<0.05). The levels of hypoglycemia in the two groups were not significantly different. In both groups, all hyperglycemia markers had a favourable connection with HbA1c.
Conclusions: T2D is linked to lower GV, whereas FCPD is linked to higher GV. Higher postprandial glycemic excursions were discovered in patients with FCPD, which could have treatment implications.

BACKGROUND: Gestational Diabetes mellitus (GDM) is defined as Glucose
Intolerance, the valuesof plasma glucose falling in the range of Diabetes which is
observed and detected for the first
timeduringsecondorthirdtrimesterofpregnancy.GDMisquite
oftenassociatedwithhighermaternalandneonatalmorbiditiesin theshort andlong-term
andpredisposesbothwomen andchildto laterdevelopment of type 2 Diabetes
OBJECTIVE OF THE STUDY: the objective of our study is
tocomparematernalandneonataloutcomesinGDMpatientswhoareonmetforminandinsulin.
MATERIALS &METHODS: the study on evaluation of metformin versus insulin
therapy in themanagement of gestational diabetes was conducted in dept. of OBG Adesh
Institute of
MedicalSciences,Ambalaafterobtaininginstitutionalethicalcommitteeclearanceforaperiod
ofoneyearfromJanuary 2021 to December 2021 in the age group of 26-35 years.
Maternal and neonatal outcomesrecorded include: maternal: incidence of pre-eclampsia,
PIH, neonatal outcomes include: macrosomia,birth weight, the incidence of small for
gestational age, prematurity, Apgar score at the age of 5 min,hypoglycaemia. We also
compared the mode of delivery (spontaneous, assisted or caesarean section)between the
two groups. RESULTS & CONCLUSIONS: It is quite evident from in our study
thattherewerenostatisticallysignificantdifferencesinboththegroupswithrespecttomaternalc
omplications, mode of delivery and neonatal complications. In our study, we found that
the oral antidiabetic medication metformin is equally effective as insulin in the treatment
of GDM patients andwithout higher risks for maternal or neonatal complications.
However, further randomized clinicalstudies with large number of patients and with
long-term follow-up of children is needed to
determinetheroleofMetforminasanalternativetreatmenttoinsulinin GDMpatients

Background:Recently, a number of publications have raised concern about the rising
prevalence of diabetes mellitus in Telangana. The International Diabetes Federation has
named Saudi Arabia among the top 10 countries with the highest prevalence of diabetes
Objective of the Study: To observe and evaluate the incidence and complications seen in
infants of diabetic mothers.
Materials and Methods: It is a prospective observational time bound study conducted
Yashoda Hospital, Telangana, India from December 2019 to November 2020. All live
babies born to mothers with GDM or pregestational DM were enrolled in study.
Maternal history and complications during labour were recorded. APGAR scores
assessed. Investigation for glucose estimation, PCV, serum calcium, serum bilirubin was
sent. Chest X ray was done in babies with respiratory distress. 2D ECHO, USG
abdomen, USG cranium were done in all babies after stablisation.
Results: 70 neonates were born to diabetic mothers. 2 IUD and 6 still born were
excluded from study and 62 neonates were evaluated. 2 neonates died.70.96% were
term babies and 29 % preterm. 40 infants (64.5%) were born to GDM mothers, 20
(32.3%) to mothers with type 2 DM and 2(3.2%) to type 1 DM. 16.2% were LGA while
12.9% were SGA. Hypocalcemia was seen in 4 neonates (6.7%). Hyperbilirubinemia
was seen in 4 (13.3%). Sepsis was seen in 8 neonates. CHDs were seen in 42.9%, most
common being ASD/PFO 21.3%. VSD was seen in 10.7%, PDA in 7.1% and septal
hypertrophy in 3.5%. One case had pyloric atresia and one had RDS. Association
between HbA1c levels and complications like macrosomia, hypoglycemia, congenital
anomalies was not significant in our study.
Conclusion: Neonates born to diabetic mother are at a high risk of developing
complications like hypoglycemia, hypocalcemia and cardiac defects.

BACKGROUND: Gestational Diabetes mellitus (GDM) is defined as Glucose
Intolerance, the valuesof plasma glucose falling in the range of Diabetes which is
observed and detected for the first
timeduringsecondorthirdtrimesterofpregnancy.GDMisquite
oftenassociatedwithhighermaternalandneonatalmorbiditiesin theshort andlong-term
andpredisposesbothwomen andchildto laterdevelopment of type 2 Diabetes
OBJECTIVE OF THE STUDY: the objective of our study is
tocomparematernalandneonataloutcomesinGDMpatientswhoareonmetforminandinsulin.
MATERIALS &METHODS: the study on evaluation of metformin versus insulin
therapy in themanagement of gestational diabetes was conducted in dept. of OBG Adesh
Institute of
MedicalSciences,Ambalaafterobtaininginstitutionalethicalcommitteeclearanceforaperiod
ofoneyearfromJanuary 2021 to December 2021 in the age group of 26-35 years.
Maternal and neonatal outcomesrecorded include: maternal: incidence of pre-eclampsia,
PIH, neonatal outcomes include: macrosomia,birth weight, the incidence of small for
gestational age, prematurity, Apgar score at the age of 5 min,hypoglycaemia. We also
compared the mode of delivery (spontaneous, assisted or caesarean section)between the
two groups. RESULTS & CONCLUSIONS: It is quite evident from in our study
thattherewerenostatisticallysignificantdifferencesinboththegroupswithrespecttomaternalc
omplications, mode of delivery and neonatal complications. In our study, we found that
the oral antidiabetic medication metformin is equally effective as insulin in the treatment
of GDM patients andwithout higher risks for maternal or neonatal complications.
However, further randomized clinicalstudies with large number of patients and with
long-term follow-up of children is needed to
determinetheroleofMetforminasanalternativetreatmenttoinsulinin GDMpatients

Background: The primary objective was to compare time taken until resolution of
acidosis in standard dose insulin infusion group and low dose insulin infusion group.
The secondary objectives were to compare the time taken until decline in blood glucose
till 250 mg/dl in both the groups, to compare the proportion of children developing
Hypoglycemia in both the groups, to compare the proportion of children developing
Hypokalemia in both the groups, to compare the episodes of treatment failures in both
the groups.
Materials and Methods: This study was conducted from March 2017 to August 2018,
atMamatha Medical College,Khammam with aim to compare efficacy and safety of low
dose insulin infusion against standard dose insulin infusion in children with diabetic
ketoacidosis. All consecutive children 12 years of age or younger, admitted with
diagnosis of Diabetic Ketoacidosis were enrolled for the study. Children who present
with symptomatic cerebral edema were excluded from the study. Cases were enrolled
after valid consent obtained from the parents. Among 34 eligible cases, 30 were
randomized equally into two groups and 4 cases were excluded due to symptomatic
cerebral edema. Total 30 cases 15 in each group completed the study and were available
for data analysis.
Results: In our study mean age in standard dose insulin infusion group was 8.30+/- 2.57
years and in low dose insulin infusion group was 6.83+/- 2.67 years. After fast breathing
(93.3%), vomiting (90%), and pain abdomen (76.6%), polyurea (76.6%), polydypsia
(73.7%), fever (56.7%), altered sensorium (53.3%), were the predominant presenting
complaints of DKA. Signs of dehydration (100%) were the most common presenting
signs of DKA followed by acidotic breathing (93%) and tachycardia (86%). In our
study, most common precipitating causes of DKA, infection (46.7%), followed by
unknown cause (26.7%), and dose omitted (23.3%), and insufficient dose (3.3%).
Family history was present in 16.7% patients. Malnutrition was present in 40% cases of
DKA.
Conclusion: To conclude, the time taken to resolution of acidosis is similar in standard
dose insulin infusion group and low dose insulin infusion group and time taken to
decline blood glucose till 250 mg/dl or less is similar in both the groups. Incidence of
hypoglycemia and hypokalemia comparatively less in low dose insulin infusion group.
Treatment failure was not found in both the groups.