St Thomas' Hospital

About: St Thomas' Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Pregnancy. The organization has 12105 authors who have published 15596 publications receiving 624309 citations. The organization is also known as: St Thomas's Hospital & St. Thomas's.

HbA1c Levels Are Genetically Determined Even in Type 1 Diabetes: Evidence From Healthy and Diabetic Twins

Abstract: HbA(1c), a measure of blood glucose regulation, reflects glucose levels in the preceding months. In diabetes, HbA(1c) levels predict the risk of microvascular complications. The aim of this study was to determine whether genetic factors could influence HbA(1c) levels in normal subjects and type 1 diabetic patients. We performed a classical twin study of HbA(1c) in healthy nondiabetic female twins and 42 monozygotic (MZ) and 47 dizygotic (DZ) pairs. Interclass correlations (r) were higher in MZ (r = 0.77) compared with DZ (r = 0.53) twin pairs, suggesting a substantial genetic effect; this was confirmed by quantitative genetic model fitting. Additive genetic effects (heritability) explained 62% (95% CI 47-75) of population variance in HbA(1c); the remainder was attributable to the influence of unique environment (23% [15-36]) and age (14% [5-28]). Multivariate modeling showed that genetic factors also have a substantial influence on fasting glucose levels (51%). However, HbA(1c) heritability could not be explained by genes in common with fasting glucose. In the patients with type 1 diabetes, HbA(1c) levels were correlated in 33 MZ twins concordant for diabetes (r = 0.68; P < 0.001) but also in 45 MZ twins discordant for the disease (r = 0.52; P < 0.001). These significant correlations for HbA(1c) in both concordant and discordant pairs indicate a diabetes-independent familial effect. Thus, HbA(1c) levels are largely genetically determined and independent of the genes influencing fasting glucose. Even in type 1 diabetes, familial (i.e., diabetes-independent) factors influence protein glycation, implying that familial factors may explain, in part, the risk for microvascular complications, as indicated by high HbA(1c) levels.

Risk factors and effective management of preeclampsia

Abstract: Preeclampsia, a hypertensive disorder of pregnancy is estimated to complicate 2%-8% of pregnancies and remains a principal cause of maternal and fetal morbidity and mortality. Preeclampsia may present at any gestation but is more commonly encountered in the third trimester. Multiple risk factors have been documented, including: family history, nulliparity, egg donation, diabetes, and obesity. Significant progress has been made in developing tests to predict risk of preeclampsia in pregnancy, but these remain confined to clinical trial settings and center around measuring angiogenic profiles, including placental growth factor or newer tests involving metabolomics. Less progress has been made in developing new treatments and therapeutic targets, and aspirin remains one of the few agents shown to consistently reduce the risk of developing preeclampsia. This review serves to discuss recent advances in risk factor identification, prediction techniques, and management of preeclampsia in antenatal, intrapartum, and postnatal patients.

Quality of life and disease severity are correlated in children with atopic dermatitis.

Abstract: Summary Background Atopic dermatitis (AD) in children may affect their daily activities and normal development. It can have a negative impact on the child's behaviour. Little is known about the quality of life (QOL) in children and its relationship to disease severity, especially from a community-based study. Objectives To document the impact of AD on children's QOL and its relationship to disease severity. Methods The targeted population, before recruitment, comprised children with AD aged 5–10 years from a primary care setting. Their general practitioners identified potential patients and the U.K. diagnostic criteria for AD were used to verify the diagnosis. Eczema severity was assessed using the SCORAD (SCORing Atopic Dermatitis) index. The Children's Dermatology Life Quality Index (CDLQI) was used to quantify the impact of AD on children's QOL. These two parameters were evaluated on two occasions 6 months apart. The Spearman correlation coefficient and multiple regressions were used in statistical analysis. Results Of the 116 children attending the first QOL assessment visit, 78 (mean age 8·6 years, 44 girls and 34 boys) were able to complete the CDLQI. Of these 78 children, 71 (91%) attended the second visit, and were included in the analysis. The children's QOL was affected in 65 (92%) and 55 (77%) children attending the first and second visits, respectively. The CDLQI was significantly correlated with the SCORAD at the first and second visits (r = 0·52, P < 0·001 and r = 0·59, P < 0·001, respectively). Each unit change in the SCORAD was associated with a 0·12 (95% confidence interval 0·04–0·19, P = 0·004) unit change in the children's QOL. Conclusions We have shown a positive correlation between children's QOL and disease severity on cross-sectional and over time observation. This highlights the impact of AD on children's life. It also draws attention to the long-term effect on children's behaviour and development. In addition, these findings may imply that the CDLQI could be used as an extra measure of disease assessment in clinical practice and research studies.