Neath Port Talbot Hospital (Welsh: Ysbyty Castell Nedd Port Talbot) is a general hospital located in Port Talbot, Wales. It is managed by Swansea Bay University Health Board.
Background:The 75-g oral glucose tolerance test (OGTT) remains the optimal diagnostic test for use in pregnancy but needs to be performed in the clinical setting. The GTT@home OGTT device offers the potential to enable patients to perform the test at home using capillary blood samples. Objective:This study aimed to determine the accuracy of the GTT@home device compared to the routine National Health Service laboratory reference method using blood samples during an OGTT from pregnant women at high risk of developing gestational diabetes mellitus (GDM). Methods:A total of 65 women (aged >18 y), at high risk for GDM (per the National Institute for Health and Care Excellence guidelines) were recruited for this performance evaluation. Following an overnight fast, participants went for a 75-g OGTT. Fasting and 2-hour capillary glucose levels were measured using the GTT@home device with corresponding venous samples measured in the laboratory. Results:The complete data for analysis was available for 61/65 devices. The overall bias for the GTT@home device was +0.16 mmol/L. Correlation analysis of the clinical performance of the two methods using a surveillance error grid showed 79.8% of results in the lowest, 16.9% in the "slight, lower" and 2.4% in the "slight, higher" risk categories. Only 0.8% were "moderate, lower" risk, and none were in any higher risk categories. There was agreement in the classification in 54/61 cases. The GTT@home device under-classified 2 cases and over-classified 5 cases. Conclusions:The GTT@home device worked well in a controlled, antenatal clinical setting. Differences in classification observed were generally due to small differences in glucose values close to the diagnostic cut-offs. The GTT@home device shows promise for home testing of glucose tolerance in pregnant women.
A man in his 50s with insulin-treated type 2 diabetes mellitus presented with a 1-day history of severe abdominal pain, nausea and vomiting, 15 days after initiation of tirzepatide. On admission, he was severely dehydrated with profound high-anion gap metabolic acidosis (pH 6.8), marked hyperglycaemia and ketosis, consistent with severe diabetic ketoacidosis (DKA), requiring intensive therapy unit admission. He had been treated with insulin for over 10 years, with preserved renal function (estimated glomerular filtration rate 80 mL/min/1.73 m2), haemoglobin A1c of 61 mmol/mol and no previous history of DKA. Tirzepatide 2.5 mg once a week was commenced, and a telephone review 6 days after the first dose confirmed mild bloating with preserved oral intake and continued insulin use. Following the second dose, gastrointestinal symptoms progressed, resulting in complete inability to tolerate food or fluids for 24 hours prior to admission. During this period, the patient reduced his basal insulin glargine dose from 40 to 20 units for 3 days due to fear of hypoglycaemia. This case highlights the importance of reinforcing sick-day rules and continuation of basal insulin when initiating tirzepatide in insulin-treated patients.
Adequate access to radiation personal protective equipment (RPPE) is crucial for surgical team safety, minimizing exposure to ionizing radiation during intraoperative fluoroscopy. The British Orthopaedic Association (BOA) recommends radiation protective gowns be wrap-around style with high axillary coverage. This study assessed RPPE stock levels across Welsh hospitals with Trauma & Orthopaedics (T&O) higher surgical trainees. A nationwide stocktake was conducted in January 2025 across Welsh hospitals hosting T&O higher surgical trainees. Data were collected on the number of orthopaedic theatres, daily surgical lists, and available RPPE, including gown style, thickness, size distribution, and thyroid guard availability. Data from 11 hospitals showed orthopaedic theatres per hospital ranged from 1 to 6, with daily surgical lists between 1 and 6. RPPE stock levels varied widely: tabard (open-sided) gowns ranged from 12 to 35 per hospital, wrap-around gowns from 1 to 22, and thyroid guards from 2 to 22. Gown thickness and size availability were inconsistent, with shortages of small and medium sizes in some hospitals. One hospital had no access to wrap-around gowns, and another 4 had fewer than 5 available. Overall, only 29.4% of RPPE stock consisted of BOA-recommended wrap-around gowns. There is significant variability in RPPE stock across Wales, with many hospitals lacking BOA-recommended protection. More than half of surveyed hospitals had limited access to wrap-around gowns and thyroid shields, potentially compromising occupational safety. Ensuring appropriate gown fit and standardizing RPPE provision across hospitals is essential to improve radiation safety for orthopaedic teams.
INTRODUCTION:Gestational diabetes mellitus (GDM) is common in pregnancy and is increasing in prevalence. It is associated with an increased risk of maternal and perinatal complications if not diagnosed and managed early. Most guidelines suggest making a diagnosis of GDM using an oral glucose tolerance test (OGTT) between 24 and 28 weeks of pregnancy at which stage there still is an increased risk of complications. Increased beta-cell secretory product concentrations have been observed prior to changes in glycaemia and can potentially be used as an early marker to diagnose and assess risk of developing GDM. METHODS:The study was a prospective, longitudinal cohort study. OGTTs were carried out at visit one: 16-18 weeks and visit two: 24-28 weeks gestation in pregnant women with at least one risk factor for GDM [Body Mass Index >30 kg/m2, previous macrosomic baby (>4.5 kg), previous GDM, first degree relative with type 2 diabetes mellitus (T2DM)]. Blood sampling was performed at fasting, 30 min, 1 and 2 hours following a 75-g oral glucose load. Samples were analysed for glucose, total and intact proinsulin, insulin and C-peptide. Hormonal concentrations at visit 1 were compared between those that remained normal glucose tolerant (NGT) and those that progressed to GDM at visit 2 using receiver operator characteristic (ROC) area under the curve (AUC) to assess for discrimination between the two groups. RESULTS:Unfortunately, a smaller than planned sample size was recruited due to the start of COVID-19 pandemic midway through the study. 83 pregnant women had OGTT at visit 1. Of these, 12 reached the threshold for GDM at visit 1 and were excluded. In total, data from 66 patients were included for analysis (5 Did Not Attend). Visit 1 hormone comparisons were carried out between 51 who remained NGT and 15 who progressed to GDM at visit 2. There were no significant differences at each time point in ROC AUC between the two groups for total and intact proinsulin and insulin. However, there were significant differences observed in C-peptide ROC AUC at 30 (p=0.041) and 60 min (p=0.003) between the two groups. CONCLUSIONS:This study did not demonstrate significant increase in early proinsulin concentrations in patients that developed GDM. However, there were differences in C-peptide concentrations. The COVID-19 pandemic restricted the recruitment of patient numbers and further studies in a larger cohort will be needed to validate these findings. TRIAL REGISTRATION NUMBER:ISRCTN16416602.
