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Free polysaccharides (glycogen) and acid polysaccharides (hyaluronic acid) can be removed by their appropriate enzyme and thus specifcally demonstrated generic 300mg combivir overnight delivery. A negative periodic acid-Schif reaction does not necessarily mean absence of any carbohydrates (Hotchkiss buy combivir 300 mg amex, 1948) purchase combivir 300mg fast delivery. Cantral reactions: A number of control reactions are necessary to purchase combivir 300mg line determine whether only unsubstituted glycol groups were oxidized by periodic acid and to ascertain t at a. In contvol l, the treatment with periodic acid is deleted and therefore the Schif reaction should be negative. If it is positive, the previously present aldehydes can be inactivated by exposure to cen per cent sodium bisulphite for 15 minutes. In control 2, glycol and amino groups are acetylated, and thus made unsus? ceptible to oxidation by periodic acid. For this purpose the sections are taken from distilled water into a mixture of 13. In control 3, the acetylated hydroxyl, but probably not the acetylated amino groups are deacetylated. The deacetylated groups are then again available for the periodic acid-Schif reaction. The Schiff reagent : the Schif reagent is specifc for aldehydes with which it gives a red reaction. The reagent is prepared by treatment of basic fuchsin (parafuchsin) (formula 1, in Fig. The product is colourless, but it is not the leucoderivative of fuchsin as is often erroneously believed. In the presence of aldehydes it does not merely regain its colour, but a new dye is formed. From the chemical constitution, it can be seen that it is a basic dye, like the original fuchsin. However, in contrast to fuchsin it is stable and is not discoloured by sulphurous acid. The Schifs reagent is stable only at strong acid reaction and with excess of S02? Anything which removes S02 (open bottles) or reduces the acidity of the reagent or oxidises it, may cause destruction of the N-sulphinic acid of the para? fuchsin-leuco-sulphonic acid causing restitution of the original fuchsin and reddening of the reagent. It is therefore most important to remove carefully all trace of the reagent with sulphurous acid after the reaction, and before the slides are washed in water. Periodic acid-Schif reaction (Set 139) : the pigments in the livers and the heart showed a positive reaction. The dark granules in the livers were less distinctly reddened than the pale granules. It is difcult to say whether this was due to a less intense reaction or due to the difculty of recog? nizing a red discolouration in the darker granules. In the skin the granules had a slightly reddish tinge in formalin but not in alcohol fxed tissue. In the eye some of the granules, particularly those in the iris, showed a slight reddish discolouration, while others gave a negative reaction. Direct Schif reaction 15 minutes and 3 days (Control 1, Sets 140 and 141) : Nore of the pigment showed any change on either 15 minutes or 3 days exposure to the Schifs reagent when treatment with periodic acid was deleted. Acetylation-periodic acid-Schif (Control 2, Set 142) : the periodic acid-Schif reaction was inhibited by acetylation. Acetylation-deacetylation-periodic acid-Schif (Control 3, Set 143) : Deacetylation restored the reaction that was seen before acetylation. Diastase-periodic acid-Schif (Set 144) : the pigment granules in livers and heart were still positive, however, the removal of glycogen from the liver cells made the reddened pigment more outstanding in the otherwise unstained tissue. Diastase-acetylation-periodic acid-Schif (Set 145): the periodic acid-Schif reaction was inhibited. Diastase-acetylation-deacetylation-periodic acid-Schif (Set 146) : Apart from removal of glycogen, diastase did not interfere with the above reactions. Bromination-periodic acid-Schif (Set 147) : Bromination (technique as in Set 135) intensifed the periodic acid-Schif reaction of the pigments in livers and heart. It caused a stronger reddening of the tissue and particularly the nuclei, while the pigments in skin and eye remained negative. Blocking of Aldeh de Groups : y Blocking of aldehyde groups is used to aid their identifcation. Of the substances suitable for this reaction, phenylhydrazine and aniline chloride were used in the present experiments. Periodic acid-phenylhydrazine-Schif (Set 148) : A 30 minute exposure to 5 per cent phenylhydrazine after periodic acid oxidation completely prevented the periodic acid-Schif reaction. Periodic acid-aniline chloride-Schif (Set 149) : A 2 hour exposure to 1 M aniline chloride after periodic acid oxidation inhibited the periodic acid-Schif reaction, except for a slight reddening of sarcosporidia in the heart and the membrana descementi in the eye. This reaction may be blocked by prior bromination, but not by acetylation (Lillie, 1954). Performic acid-Schif (Set 150) : Due to the bleaching action of performic acid, the number of granules in the livers was reduced, particularly in the alcohol fxed sections, and there were no granules in the alcohol fxed heart. The remaining paler granules in the livers and the granules in the formalin fxed heart gave a weak positive reaction. In the dark granules in the liver and in the pigment of skin and eye a positive reaction was not recognizable. Diastase-performic acid-Schif (Set 151) : Treatment with diastase (technique as in Set 144) before the performic acid? Schif reaction did not alter the latter. In the skin, the granules had disappeared completely in alcohol fxed sections and were pale brown in formalin fxed tissue.
While palpita? suggesting atrial fbrillation combivir 300mg for sale, atrial futter purchase combivir 300 mg fast delivery, or tachycardia tions are usually benign order combivir 300 mg overnight delivery, they are occasionally the symptom with variable block; and (3) "pounding in the neck' or neck of a life-threatening arrhythmia purchase combivir 300 mg with amex. The converse is also Palpitations associated with chest pain suggest ischemic true; in one study, 54% of patients with supraventricular heart disease, or if the chest pain is relieved by leaning tachycardia were initially wrongly diagnosed with panic, forward, pericardia! A disproportionate number of ciated with light-headedness, presyncope, or syncope sug? these misdiagnosed patients are women. Palpitations that occur regularly with exertion ing a cardiovascular cause for the palpitations. If a benign etiology for these concerning symptoms cannot be ascertained at the initial visit, then. Clinical Findings ambulatory monitoring or prolonged cardiac monitoring in the hospital might be warranted. Symptoms Noncardiac symptoms should also be elicited since the Although described bypatients in a myriad of ways, guid? palpitations may be caused by a normal heart responding ing the patient through a careful description of their palpi? to a metabolic or infammatory condition. Weight loss sug? tations may indicate a mechanism and narrow the gests hyperthyroidism. Pertinent questions include the age vomiting or diarrhea that leads to electrolyte disorders and hypovolemia. Hyperventilation, hand tingling, and ner? vousness are common when anxiety or panic disorder is the cause ofthe palpitations. Palpitations: Patients at high riskfor a A family history of palpitations or sudden death sug? cardiovascularcause. Chagas disease may cause palpitations Family history of significant arrhythmias and acute myocarditis. Personal orfamily history of syncope or resuscitated sudden death History of myocardial infarction (and likely scarred myocardium) B. Physical Examination Physical examination findings Structural heart disease such as dilated or hypertrophic Rarely does the clinician have the opportunity to examine cardiomyopathies a patient during an episode ofpalpitations. The clinician should also look for signs ofhyperthy? roidism (eg, tremulousness, brisk deep tendon refexes, or. Differential Diagnosis fine hand tremor), or signs of stimulant drug use (eg, dilated pupils or skin or nasal septal perforations). In a study of patients who associated with ventricular ectopy or escape beats that may went to a university medical clinic with the chief complaint be experienced as palpitations by the patient. The presence ofleft atrial valvular heart diseases, such as aortic regurgitation or ste? enlargement as suggested by a terminal P-wave force in V1 nosis, atrial or ventricular septal defect, cardiomyopathy, more negative than 0. This is then followed by inpatient continu? caffeine, pseudoephedrine, and illicit ephedra can precipi? ous monitoring if serious arrhythmias are strongly sus? tate palpitations, as can prescription medications, including pected despite normal findings on the ambulatory digoxin, phenothiazines, theophylline, and beta-agonists. A single-lead, lightweight, continuously recording ambulatory adhesive patch monitor (Zio Patch) After ambulatory monitoring, most patients with palpita? has been shown to be superior to 24-hour Holter tions are found to have benign atrial or ventricular ectopy monitoring. If not, Acute and chronic lower extremity edema present impor? or in very symptomatic patients, a trial of a beta-blocker tant diagnostic and treatment challenges. A three-session course of cognitive? ties can swell in response to increased venous or lymphatic behavioral therapy that includes some physical activity has pressures, decreased intravascular oncotic pressure, proven effective for patients with benign palpitations with increased capillary leak, and local injury or infection. For treatment of specifc atrial or Chronic venous insuffciency is by far the most common ventricular arrhythmias, see Chapter 10. Other causes of lower extremity edema include cellulitis, musculoskeletal disorders (Baker. Comparison of 24-hour Holter monitoring Normal lower extremity venous pressure (intheerect posi? with 14-day novel adhesive patch electrocardiographic moni? tion: 80 mm Hg in deep veins, 20-30 mm Hg in superfcial toring. Emergency management of palpitations in the sure to elevated venous pressure by the postcapillary elderly: epidemiology, diagnostic approaches, and therapeutic venules in the legs leads to leakage of fibrinogen and options. These changes account for the brawny, palpitations (from the National Hospital Ambulatory Medical Care Survey). The sensation of "heavy legs" is the most frequent symptom of chronic venous insufciency, followed by itching. Other causes of a painfl, swollen calf include ruptured popliteal cyst ("pseudothrombophlebitis"), calf strain or. Skin findings: hyperpigmentation, stasis dermati? tis, lipodermatosclerosis, atrophie blanche, trauma, and cellulitis. An ulcer located over the medial malleolus is a hallmark Step 1: Calculate risk factor score of chronic venous insufficiency but can be due to other causes. Shallow, large, modestly painful ulcers are charac? Score 1 point for each teristic of venous insufciency, whereas small, deep, and Untreated malignancy more painful ulcers are more apt to be due to arterial insuf? Paralysis, paresis, or recent plaster immobilization ficiency, vasculitis, or infection (including cutaneous diph? theria). Recently bedridden for > 3 days dueto major surgery within 4 weeks When an ulcer is on the foot or above the mid-calf, causes other than venous insufciency should be considered. Localized tenderness along distribution of deep venous system Entire leg swelling C. Diagnostic Studies Swelling of one calf> 3 em more than the other Most causes of lower extremity swelling can be demon? (measured 10 em below tibial tuberosity) stratedwith color duplex ultrasonography. Treatment tom of nephrotic syndrome or volume overload caused by Treatment of lower extremity edema should be guided by renal failure or cirrhosis. Some patients with cirrhosis have first enhance sodium retention through increased secre? pulmonary hypertension without lung disease. There is a tion of renin and angiotensin and then result in acute kid? spectrum of skin findings related to chronic venous insuf? ney injury and oliguria. Instead, the most effective treatment fciency that depends on the severity and chronicity of the involves (1) leg elevation, above the level of the heart, for disease, ranging from hyperpigmentation and stasis der? 30 minutes three to four times daily, and during sleep; (2) matitis to abnormalities highly specific for chronic venous compression therapy; and (3) ambulatory exercise to insufficiency: lipodermatosclerosis (thick, brawny skin; in increase venous return through calf muscle contractions. They the entire leg or of one leg 3 em more than the other sug? should be put on with awakening, before hydrostatic forces gests deep venous obstruction. General Considerations required to control moderate to severe edema associated with ulcer formation. This range includes sion stockings (12-18 mm Hg atthe ankle) are effective in a mean and 2 standard deviations, thus encompassing 95% preventing edema and asymptomatic thrombosis associ? of a normal population (normal diurnal temperature ated with long airline fights in low to medium-risk per? variation is 0.
In fact 300mg combivir with amex, antibiotic therapy will increase the duration of intestinal carriage of the Salmonella generic combivir 300 mg amex, and is contraindicated cheap 300mg combivir otc. Certain conditions increase the risk of salmonellosis: hemolytic anemia discount 300mg combivir, malignancy, immunosuppression, achlorhydria and ulcerative colitis. In fact, antibiotic therapy increases the duration of intestinal carriage of these organisms. Shaffer 212 o Campylobacter jejuni?induced diarrhea is more common than diarrhea from either Salmonella or Shigella. Campylobacter attaches to the mucosa and releases an enterotoxin that destroys the surrounding epithelia. Clinically, there is often a prodrome of constitutional symptoms along with headache and generalized malaise. A prolonged diarrheal illness follows often with a biphasic character, with initial bloody diarrhea, slight improvement, then increasing severity. The illness usually lasts less than one week, although symptoms can persist for a longer period, and relapses occur in as many as 25% of patients. Staphylococcus aureus produces a heat-stable, odorless and tasteless enterotoxin that is generated in poorly refrigerated desserts and seafoods. Ingestion of the preformed enterotoxin causes nausea, vomiting and profuse diarrhea within 4 to 8 hours. Clostridium perfringens produces a preformed toxin from spores that germinate in contaminated meats cooked at less than 50?C. Symptoms are diarrhea and crampy abdominal pain without vomiting, beginning 8 to 24 hours after the meal. The vomiting syndrome is always associated with ingestion of rice and is caused by a preformed toxin that is elaborated when rice is left to cool unrefrigerated. Infectious Gastroenteritis the organisms responsible for bacterial gastroenteritis exert their predominant effects by invading and destroying the intestinal epithelium or by producing various enterotoxins. Treatment is based on restoring fluid and electrolyte balance and maintaining intravascular volume. Even though fluid and electrolyte + transport is impaired, glucose transport is intact. After a 24 to 48-hour incubation period, the disease begins with upper abdominal pain followed by watery diarrhea. Explosive, watery diarrhea is the cardinal manifestation, along with abdominal cramps, nausea and vomiting. After ingestion, Shigella dysenteriae organisms attack the colon, sparing the stomach and small bowel. Shigella organisms adhere to and then, penetrate the mucosal surface, multiply within the epithelial cells, moving laterally through the cytoplasm to adjacent cells by filopodium-like protrusions. Shigella organisms rarely penetrate below the intestinal mucosa, and almost never invade the bloodstream. Even a small inoculum of 200 organisms (as contrasted with Salmonella, which requires greater than 107 organisms) will lead to crampy abdominal pain, rectal burning, fever, multiple small-volume bloody mucoid bowel movements. Extraintestinal complications include respiratory symptoms, meningismus, seizures, the hemolytic uremic syndrome, arthritis and rashes. It has become more readily detected in fecal specimens because of the use of selective growth media and a cold enrichment technique. The spectrum of illness ranges from simple gastroenteritis to invasive ileitis and colitis that must be distinguished from Crohn disease or ulcerative colitis. Enterocolitica causes diarrheal illness in adults, including the elderly, and frequently in children, often less than 5 years of age. Children over 5 years of age develop mesenteric adenitis and associated ileitis, which mimic acute appendicitis. Yersinia is less likely to cause First Principles of Gastroenterology and Hepatology A. If it does, Yersinia is an acute diarrheal episode followed two to three weeks later by joint symptoms and a rash (erythema nodosum). There is no evidence that antibiotics alter the course of the gastrointestinal infection. Ingestion of this organism results in severe crampy abdominal pain and fever, followed within 24 hours by bloody diarrhea that lasts five to seven days. Since the organism is shed in the stool for only a short period of time, early stool collections are critical for the diagnosis. In severe cases with possible toxic megacolon, systemic antibiotics may be in order. Approximately 1,700 serotypes and variants of Salmonella are potential pathogens for humans. A dose of approximately 102?109 organisms is required to produce clinical illness. Salmonella organisms invade the mucosa of the small intestine and particularly the colon. This form of gastroenteritis produces nausea and vomiting followed by abdominal cramps and diarrhea that lasts three to four days and then gradually subsides. In 10% of cases bacteremia of the Salmonella organism occurs, and in approximately 5% there are disseminated infections to bones, joints and meninges. The pathogenic mechanism of this diarrhea is unclear; adherence of the organism to the intestinal epithelial cell seems to cause intestinal damage. There is no indication for specific treatment except for neonates in a nursery epidemic when oral nonabsorbable aminoglycosides are used. Associated symptoms include abdominal cramps, nausea, bloating, urgency, fever and malaise. Ten percent of cases persist longer than one week, approximately 2% longer than one month, and very few beyond three months.
Furthermore buy discount combivir 300 mg online, arsenic impaired stimulation and proliferation of human lymphocytes in vitro discount combivir 300mg without prescription. Recent studies suggest that apoptosis may be an important mechanism for arsenic-induced immunosuppression discount combivir 300mg without a prescription. Experimental animal studies have demonstrated the developmental toxicity of trivalent and pentavalent arsenic buy 300 mg combivir with amex, monomethylarsonic acid and dimethylarsinic acid. Limited human data suggest that exposure to high concentrations of arsenic in drinking-water during pregnancy may increase fetal and neonatal mortality. In humans, arsenic is a chromosomal mutagen (an agent that induces mutations involving more than one gene, typically large deletions or rearrangements). Elevated frequencies of micronuclei, chromosomal aberrations and aneuploidy were detected in the peripheral lymphocytes or urothelial cells, or both, of people exposed to elevated levels of arsenic. In mammalian cells, arsenic caused various types of chromosomal mutations and aneuploidy. In combination with many genotoxic agents, including ultraviolet light, arsenic was a synergistic co-mutagen. Arsenate was approximately one order of magnitude less genotoxic than arsenite, dimethyl arsinic acid and monomethylarsonic acid induced genotoxicity at millimolar concentrations. Methylarsenous acid and dimethylarsinous acid are intermediary metabolites in the methylation of arsenic. Their genotoxicity has not been fully established, but recent results implicate a major role for these metabolites and reduced (reactive) oxygen species in the induction of urinary bladder cancer in rats. There is sufficient evidence in experimental animals for the carcinogenicity of dimethyl arsinic acid. There is limited evidence in experimental animals for the carcinogenicity of sodium arsenite, calcium arsenate and arsenic trioxide. There is inadequate evidence in experimental animals for the carcinogenicity of sodium arsenate and arsenic trisulfide. Taken together, the studies on inorganic arsenic provide limited evidence for carcino genicity in experimental animals. In: Procee dings of an International Seminar on Arsenic in the Environment and its Incidence on Health, Santiago, Universidad de Chile, pp. In: International Conference on Arsenic Pollution of Ground Water in Bangladesh: Causes, Effects and Remedies, Dhaka, Dhaka Community Hospital Trust, pp. Physiochemical characteristics of drinking water in endemic blackfoot disease areas. Arsenic concentration in drinking water, hair, nails, urine, skin-scale and liver tissue (biopsy) of the affected people. Biochemistry, 30, 6283?6289 Dhaka Community Hospital Trust and School of Environmental Studies (1998) International Con ference on Arsenic Pollution of Groundwater in Bangladesh: Causes, Effects and Remedies, Dhaka Dhar, R. In: Proceedings of an International Seminar on Arsenic in the Environment and its Incidence on Health, Santiago, Universidad de Chile, pp. A method of deter mining whether an element is essential or nonessential in human tissue. In: Post Conference Report: Experts?Opinions, Recommendations and Future Planning for Groundwater Problem of West Bengal, Calcutta, School of Environmental Studies, Jadavpur University, pp. Reanalysis and follow-up of chromosomal aberrations in workers exposed to arsenic. In: International Seminar Proceedings (91?99) on Arsenic in the Environ ment and its Incidence on Health, Santiago, Universidad de Chile, pp. Metals by Plasma Emission Spectrometry, American Water Works Association Smedley, P. Characterization of hamster liver arsenite and methylarsonic acid methyltrans ferase activities in vitro. The marmoset and tamarin, but not the rhesus, monkeys are deficient in methyl transferases that methylate inorganic arsenic. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal respon sibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not neces sarily reflect the views/opinions of the publishers. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies? and device or material manufacturers? printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all mate rial reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or uti lized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopy ing, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. Bakuchiol: A Retinol-Like Functional Compound, Modulating Multiple Retinol and Non-Retinol Targets. Curcumin in Cosmetics: Biochemical Basis for Skin Repair with Use of Topical Curcumin. Presumably the public wishes access, and many gov ernmental regulatory teams concur that the toxicologic risk to the public justifes such marketing. Chapters in this edition generally provide more quantitative placebo (vehicle) controlled data than was previously available. We suspect that societal and legal forces will continue to push dermatologic science in this direction? much to the beneft of the consumer.
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A survey of pharmacy customers found that 72% of respondents had used complementary medicines within the previous 12 months; 61% used prescription medicines daily and 43% had used these concurrently 300 mg combivir amex. Multivitamins purchase 300 mg combivir with mastercard, fsh oils purchase combivir 300mg without prescription, vitamin C combivir 300mg line, glucosamine and probiotics were the fve most popular complementary medicines. Of the medications used, approximately 42% potentially necessitated additional patient monitoring or could be considered inappropriate for patients with diabetes. Clinical manifestations include menstrual dysfunction, infertility, hirsutism, acne, obesity and glucose intolerance. General practice management of type 2 diabetes 2016?18 107 In practice Lifestyle modifcation is the foundation of management. The principles are similar to those for diabetes prevention (ie weight control and ideally weight loss, support for a balanced individual healthy eating plan, increased physical activity). Continuation or initiation of metformin therapy should be considered only following full disclosure to the patient and under specialist supervision. Sulphonylureas may be associated with adverse neonatal outcomes and are thus best avoided65,230?233 All pregnant women with diabetes should be encouraged to achieve optimal glycaemic control. Women should be advised of the need for advice, education and support to achieve optimal glycaemic control before pregnancy. Pre-pregnancy counselling should include assessment of diabetes complication status, review of all medications and commencement of folic acid (5 mg). Poor glycaemic control at conception and early in pregnancy is associated with increased risk of congenital malformations and frst trimester miscarriages. General practice management of type 2 diabetes 2016?18 109 Women with pre-gestational diabetes (types 1 and 2) are more prone to the complications of pregnancy such as higher rates of pre-eclampsia prematurity and caesarean section. Deferring pregnancy should be a recommendation until glycaemic control is optimal. Women should be reassured that any reduction in HbA1c towards the individualised target is likely to reduce the risk of congenital malformations. The risk of fetal abnormalities increases with higher HbA1c levels at the time of conception and during the frst trimester. Patients with active moderate to severe non-proliferative retinopathy or with proliferative retinopathy who have not had an ophthalmological assessment within the preceding six months should undergo testing prior to pregnancy to see if the retinopathy is stable enough for pregnancy. Similarly, renal function should be tested if this has not been done within the preceding three months. In pregnancy Specialist endocrine and obstetric referral for multidisciplinary shared care is considered best practice. Safety and risks of medications before and during pregnancy Consideration of the safety of current therapies should be undertaken ideally before pregnancy is planned or urgently once pregnancy is confrmed. Metformin Metformin is not associated with an increase in congenital malformation or early pregnancy loss, but remains a category C classifed drug (refer to Table 14 for further information). Insulin Rapid-acting insulin analogues aspart and lispro are safe to use during pregnancy. There is insuffcient evidence about the use of the long-acting insulin analogues (glargine General practice management of type 2 diabetes 2016?18 111 category B3). Detemir insulin (a long-acting insulin analogue) is now classifed as category A drug in pregnancy. Patients already stabilised on insulin glargine may have this therapy continued in preference to switching to human insulin, but the B3 category rating needs to be discussed with the woman. Table 14 provides advice on antihypertensive agents to be avoided before and during pregnancy. Antihypertensive agents to be reviewed pre-conception and during pregnancy243 Antihypertensive agent Category in pregnancy* Advice Angiotensin-converting enzyme D Contraindicated inhibitors Angiotensin receptor blocker D Contraindicated Calcium channel blocker C Avoid (except nifedipine)? Insulin therapy will need regular review and titration to achieve glycaemic goals. General practice management of type 2 diabetes 112 2016?18 Close surveillance for new diabetes complications and monitoring of existing complications should occur routinely. Ultrasound screening at 10?13 weeks? gestation (with biochemistry) for trisomies, and at 18?20 weeks for congenital cardiac and other malformations, is advised. Pregnant women with diabetes should be offered ultrasound monitoring of fetal growth and amniotic fuid volume every four weeks from 28 to 36 weeks. Re-establishing glycaemic management goals, re-assessment of complications and timely contraceptive advice are also appropriate in the postnatal period. The prevalence is also affected by maternal factors such as history of previous gestational diabetes, ethnicity, advanced maternal age, family history of diabetes, pre-pregnancy weight and high gestational weight gain. Potential maternal complications during pregnancy and delivery include pre-eclampsia and higher rates of caesarean delivery, maternal birth injury, postpartum haemorrhage. For the neonate, complications can include macrosomia (large for gestational age) growth restriction, birth injuries, respiratory distress, hypoglycaemia and jaundice. A recent Cochrane review247 determined that increased levels of screening and management have not been clearly linked to improved health outcomes. This study reported a correlation between increasing maternal glucose levels at 24?32 weeks? gestation and a range of adverse maternal and fetal outcomes. General practice management of type 2 diabetes 114 2016?18 There is still a need for further studies to clearly outline the evidence of the benefts and risks of altering diagnostic criteria, including the health economic costs of any such consensus for change. Care should be taken in approaching these targets as most blood glucose monitors have a 5?10% margin of error and risks of maternal hypoglycaemia need to be considered. Close cooperation with the obstetric team is advised to monitor maternal and fetal welfare.