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Biomedical subjects

F Mimouni

Publications and source records attributed to F Mimouni.

At least 73 records · Page 4Linked to original sources
PubMed1990

Spontaneous abortions in repeat diabetic pregnancies: a relationship with glycemic control.

In previous studies, we reported a high rate of spontaneous abortions in insulin-dependent diabetic pregnancies. Abortions were associated with poor first-trimester glycemic control. We hypothesized that improvement of glycemic control from one pregnancy to the other would improve fetal outcome and that deterioration of glycemic control would increase the likelihood of abortion. We studied prospectively 43 insulin-dependent diabetic women (White class B-RF) with two consecutive pregnancies, recruited before 9 weeks' gestation. Preprandial and 90-minute postprandial blood glucose concentrations were measured at each weekly visit. Glycohemoglobin A1 was measured at 9 weeks' gestation. Twenty women had two successful pregnancies and 15 had an abortion followed by a successful pregnancy (abortion-no abortion); the sample sizes for other sequences (no abortion-abortion, N = 5; and abortion-abortion, N = 3) were too small to allow for analysis. Glycohemoglobin A1 concentrations were stable in the sequence no abortion-no abortion (9.7 +/- 0.5 versus 9.8 +/- 0.4%, mean +/- SEM; not significant), whereas in the sequence abortion-no abortion, there was a significant decrease in glycohemoglobin A1 values from the nonsuccessful to the successful pregnancy (10.7 +/- 0.6 versus 9.3 +/- 0.4%; P = .01). Similarly, in the sequence abortion-no abortion, there was a significant decrease in mean postprandial blood glucose from first to second pregnancy (166 +/- 13 versus 135 +/- 11 mg/dL; P = .04), whereas in the sequence no abortion-no abortion, mean postprandial blood glucose did not change significantly (160 +/- 14 versus 144 +/- 11 mg/dL; not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1989

The prevalence of high insertion of scrotum, hydrocele and mobile testis in the newborn infant (36-42 weeks gestation).

The prevalence of some minor abnormalities of the male genitalia was studied in 271 boys born over a period of 2 months. The scrotal insertion on the ventral side of the penis was determined in an objective manner by measuring the ratio of the ventral and dorsal length of the unstretched penis. A scrotal insertion ratio of less than 0.48 defined high insertion of the scrotum which was found in 2.7% of our newborn infants. This anatomical finding has an important clinical significance for the performance of early circumcision. The prevalence of hydrocele in all male newborn infants was 57.9%. Extravaginal (communicating) type was present in 86% of all infants, intravaginal (noncommunicating) in 9.5%, while both types of hydrocele in the same neonate was observed in 4.5%. The relatively high frequency of mobile testes (22%) is of interest. The natural history of this entity is not fully understood and the question of follow-up remains open.

Anthropometry↗
PubMed1989

Alloxan-induced diabetes mellitus in the pregnant ewe: metabolic and cardiovascular effects on the mother and her fetus.

Diabetes mellitus was acutely produced in nine pregnant sheep by the intravenous administration of alloxan 40 mg/kg in the maternal inferior vena cava. Maternal and fetal plasma concentrations of glucose, lactate, beta-hydroxybutyrate, insulin, glucagon, and PaO2, oxygen content, and pH were determined before and at days 1, 3, and 5 after the injection of alloxan. Two animals aborted between days 1 and 3 after alloxan administration. In the other animals, significant changes occurred from baseline to day 5: maternal hyperglycemia (56.8 +/- 5.2 vs. 227.3 +/- 54.6 mg/dl; p less than 0.01), maternal hypoinsulinemia (6.2 +/- 3.5 vs. 1.0 +/- 0.4 microU/ml, p = 0.016); maternal hyperketonemia (beta-hydroxybutyrate: 0.79 +/- 0.27 vs. 4.69 +/- 2.64 mmol/L, p less than 0.01); fetal hyperglycemia (17.0 +/- 2.6 vs. 86.0 +/- 16.2 mg/dl, p less than 0.001); fetal hyperinsulinemia (8.4 +/- 4.5 vs. 19.2 +/- 6.4 microU/ml, p less than 0.001); fetal hyperketonemia (beta-hydroxybutyrate: 0.03 +/- 0.03 vs. 0.06 +/- 0.02 mmol/L, p less than 0.05); fetal hypoxemia (arterial PO2: 21.6 +/- 1.8 vs. 18.0 +/- 2.8 mm Hg, p less than 0.05, and oxygen content: 7.1 +/- 0.5 vs. 4.5 +/- 1.9 vol/dl, p less than 0.02). Thus alloxan administered in the pregnant ewe can produce major metabolic and endocrine derangements acutely simulating those occurring in human insulin-dependent diabetic pregnancy.

Animals↗
PubMed1989

Biphasic intrauterine growth in insulin-dependent diabetic pregnancies.

Early fetal growth delay (7-14 weeks of gestation) has been reported in insulin-dependent diabetic (IDD) pregnancies and in several animal models. Macrosomia is a classic feature of the infant of the IDD mother. We hypothesized therefore that a biphasic pattern of fetal growth exists in IDD pregnancies. We compared fetal growth measurements [biparietal diameter (BPD) and abdominal circumference (AC)] obtained sonographically from 106 IDD pregnancies (Class B-RT) to similar data obtained from 117 normal, nondiabetic patients. The goals for diabetic glycemic control were: fasting blood sugar less than or equal to 100 mg/dl and postprandial blood sugar less than 140 mg/dl. From one to five ultrasonographic measurements were performed at varying gestational ages in all study patients. For data analysis, one examination from each pregnancy was randomly selected by computer. Gestational age (GA) was calculated from last menstrual period and corroborated by infant physical examination (Ballard score) at birth. BPD growth pattern was biphasic in the diabetic group, described by a cubic equation: BPD = 4.99 - 0.567GA + 0.037(GA)2 - 0.0005(GA)3, R2 = 0.935. Such a biphasic pattern did not exist in the control population [BPD = -3.0323 + 0.473(gestation) - (-0.0040)(gestation)2, R2 = 0.9173]. Early growth delay was greater in fetuses that subsequently developed macrosomia (p less than 0.01). Similar results were found for AC measurements. We conclude that fetal growth delay occurs in the first half of the IDD pregnancy, followed by a phase of increased growth. The mechanism of the early growth delay is unclear. We speculate that early growth delay may be due to a "toxic" effect of glucose or other metabolite; and subsequent increased growth relates to fetal hyperinsulinism which develops from weeks 15 to 20 of gestation.

Diabetes Mellitus, Type 1↗
PubMed1989

Macrosomia in infants of insulin-dependent diabetic mothers.

The purpose of the present study was to evaluate factors affecting the rate of macrosomia and related complications in a population of infants of insulin-dependent diabetic mothers. The following factors were hypothesized to be predisposing to macrosomia: increased maternal weight gain during gestation, increased number of births until infant No. 3, white race, increased maternal age, poor glycemic control from the 20th week of gestation, and increased insulin dose. Advance White classification and increased duration of diabetes were predicted to be inversely related. In addition, macrosomia was hypothesized to predispose to selected adverse perinatal outcomes including premature labor, birth asphyxia, birth injury, hypoglycemia, polycythemia, and respiratory distress syndrome. From 1978 to 1986, 127 pregnancies were prospectively studied, 86 of the total number of women were entered prior to 10 weeks' gestation, and 41 were entered after 10 weeks' gestation. Patients monitored blood glucose at least twice daily with glycemic control achieved by "split-dosage" regimens of insulin. Glycohemoglobin was measured monthly. Pregnancy dating was based on the date of the last menstrual period and the Ballard score of the infant at birth. Macrosomia was defined as a birth weight greater than the 90th percentile of the intrauterine growth curves of Lubchenco. Of the babies born to mothers with insulin-dependent diabetes, 43% were large for gestational age and 57% were appropriate for gestational age.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1989

Parathyroid hormone and calcitriol changes in normal and insulin-dependent diabetic pregnancies.

In pregnancy, an increase in serum calcitriol and parathyroid hormone concentrations has been reported in several studies, though the increase in parathyroid hormone remains controversial. In magnesium deficiency states, parathyroid hormone and calcitriol secretion may be decreased. Because magnesium deficiency may occur in insulin-dependent diabetic patients, mainly because of urinary magnesium losses, we hypothesized that serum parathyroid hormone and calcitriol do not increase in the diabetic pregnancy. We studied, in a prospective longitudinal manner, 35 nondiabetic and 199 insulin-dependent diabetic pregnancies. In diabetic women, the goals of glycemic control were fasting blood glucose below 100 mg/dL and postprandial blood glucose less than 140 mg/dL. Serum magnesium, calcium, parathyroid hormone (whole molecule; ie, 1-84 fragment), and calcitriol were measured three times: 1) 8-12 weeks, 2) 22-28 weeks, and 3) 32-38 weeks' gestation. In normal women, serum parathyroid hormone did not change significantly over pregnancy, and a wide scatter of values was observed. Serum calcitriol increased significantly with advancing gestation. In diabetic women, serum parathyroid hormone had a narrow scatter, but values were within the low-normal range. During the third trimester there was no increase, and even a decrease, in serum calcitriol concentrations. Diabetics had, throughout pregnancy, significantly reduced serum magnesium concentrations when compared with controls. Their serum calcium and ionized calcium concentrations were similar to those of controls, except in the third trimester, when diabetic women had significantly lower serum calcium and ionized calcium concentrations than controls. We speculate that mineral metabolism abnormalities in diabetic pregnancies might be due to relative magnesium and/or insulin deficiency.

Adult↗
PubMed1989

Serum phosphate concentration. Effect on serum ionized calcium concentration in vitro.

We examined the effects of variations of serum phosphate levels on serum ionized calcium concentrations in vitro. A single donor serum sample was divided into 25 aliquots stored in tubes sealed with carbon dioxide and divided into 5 subsets of tubes. The pH was altered in 4 of the 5 subsets by adding various concentrations of hydrochloric acid or sodium hydroxide. The pH levels studied ranged from 7.09 to 7.63. The phosphate concentration was altered in each subset by adding various concentrations of a phosphate buffer. The phosphate concentrations studied ranged between 0.81 and 3.58 mmol/L. There was an inverse relationship between ionized calcium and phosphate at all pH levels studied. The ionized calcium concentration correlated inversely with pH. We suggest that in addition to factors well known to influence serum ionized calcium concentration (such as protein, bicarbonate, and pH values), serum phosphate concentration also plays an important role.

Calcium↗
PubMed1988

Serum ionized calcium concentrations in normal neonates.

Adult serum ionized calcium (iCa) concentrations are higher when using the newer, highly sensitive, ion-selective electrodes compared with older electrodes. Currently used neonatal normative ranges were established using older electrodes and not under standardized conditions or age. Thirty term infants, carefully screened to exclude confounding factors that could affect serum iCa concentration, were studied at birth and 2 and 24 hours of age for serum iCa concentrations. Mean concentrations declined from 1.45 mmol/L (5.82 mg/dL) at birth to 1.33 mmol/L (5.34 mg/dL) at 2 hours to 1.23 mmol/L (4.92 mg/dL) at 24 hours. The 95% confidence limits at 24 hours ranged from 1.10 to 1.36 mmol/L (4.40 to 5.44 mg/dL). Using newer ion-selective electrodes, normal neonatal ranges for iCa concentrations during the first 24 hours of age are higher than published references.

Calcium↗
PubMed1988

Jaundice in neonates with sickle cell disease. A case-control study.

This matched, case-control study was conducted on 68 neonates with sickle cell disease (SCD) to test the hypothesis that SCD contributes to neonatal jaundice. Previous uncontrolled studies have suggested that SCD leads to a high rate of neonatal jaundice. After matching, two neonates without SCD born in the same year were selected for each patient with SCD by use of random numbers. Matching factors were gestational age, sex, birth weight, and race. Serum bilirubin concentrations and the presence or absence of clinical jaundice were recorded. Information on factors potentially influencing the rate of neonatal jaundice was obtained for the first three days of life: maternal drug, alcohol, and tobacco usage, intrauterine infection, Apgar scores, highest infant hematocrit, culture-proved sepsis, blood group incompatibilities, hemorrhages, and presence of red blood cell sickling. We found no increase in the rate of clinical jaundice and no increase in the bilirubin concentration in either the entire group of patients with SCD, or in the subgroups with either homozygous or S-hemoglobin C disease, compared with their respective controls. We conclude that SCD probably is not a significant factor predisposing to neonatal jaundice.

Anemia, Sickle Cell↗
PubMed1988

In vitro effects of magnesium on ionized calcium concentration in serum.

Hypermagnesemic neonates, born to mothers receiving magnesium (Mg) sulfate before delivery, have elevated ionized calcium (iCa) concentrations in serum. We hypothesized that this elevation might be due in part to competition of Mg with calcium (Ca) bound to proteins or complexed to salts. Serum and its ultrafiltrate were obtained from five placental blood samples. The iCa concentration was measured in both serum and its ultrafiltrate at five incremental Mg concentrations (delta Mg) up to 6.58 mmol/L. In both serum and ultrafiltrate, incremental iCa (delta iCa) correlated significantly with delta Mg. By multiple regression analysis, delta ica in serum correlated positively with delta Mg in serum and negatively with albumin concentration in serum. Thus, iCa concentration in serum is increased in vitro by hypermagnesemia; it appears that Mg may compete with Ca bound to albumin and complexed to salts.

Blood↗
PubMed1988

Perinatal asphyxia in infants of insulin-dependent diabetic mothers.

Infants of diabetic mothers are thought to be at risk for perinatal asphyxia. We hypothesized that the following are significant risk factors for perinatal asphyxia: poor third-trimester glycemic control, diabetic vascular disease (nephropathy, retinopathy) appearing in pregnancy, pregnancy-associated hypertension, smoking, prematurity, fetal macrosomia, and maternal hyperglycemia and hypoglycemia within 6 hours preceding delivery. We prospectively studied 162 infants born to 149 diabetic mothers (White classes B through R-T). Perinatal asphyxia was defined clinically as fetal distress during labor (late decelerations, persistent fetal bradycardia, or both), 1-minute Apgar score less than or equal to 6, or intrauterine fetal death. Forty-four infants (26.7%) had perinatal asphyxia. The presence of perinatal asphyxia did not correlate with third-trimester glycemic control, pregnancy-associated hypertension, smoking, fetal macrosomia, or maternal hypoglycemia before delivery, but it did correlate significantly with nephropathy appearing in pregnancy, maternal hyperglycemia before delivery, and prematurity. We speculate that (1) the appearance of diabetic vasculopathy (nephropathy) during pregnancy is accompanied by placental vascular disease and subsequently by fetal compromise and (2) in pregnancy complicated by diabetes, maternal and subsequently fetal hyperglycemia before delivery leads to fetal hypoxemia.

Adult↗
PubMed1988

Bone mineral content: data analysis.

We reviewed the literature related to intrauterine bone mineral content (BMC) curves and the expression of BMC measurements in infants. From this review, it appears that the curves developed by Greer and by Minton for the radius are extremely similar and that both should be used as the reference curve. It also appears that expression of assessment results in terms of BMC and bone width (BW) permits an evaluation of growth of bone mass versus growth of size of the bone scanned. Although the BMC/BW ratio might be a useful but unproved conceptual adjunct, expression of photon absorptiometry results in terms of the BMC/BW ratio alone does not confer any specific advantage and theoretically could mask important specific information about bone mass and size.

Bone Development↗