Objective: Gestational diabetes mellitus is an important risk factor for neonatal hypoglycemia. Although placenta and placenta weight-to-birth ratio are considered to have a role in the pathophysiology of neonatal morbidities, including hypoglycemia, their relation to infants of diabetic mothers is not completely elucidated yet. Therefore, this study aimed to investigate the association of placenta weight and the placenta weight-to-birth weight ratio with neonatal hypoglycemia and early morbidities. Methods: This prospective observational study was conducted with infants born to mothers diagnosed with GDM, with a gestational age of ≥35 weeks. Demographic and clinical data, including maternal age, maternal HbA1c, mode of delivery, gestational age, birth weight, sex, and neonatal morbidities such as hypoglycemia and perinatal asphyxia, were recorded. Blood glucose levels were measured at predefined time points: at birth (within the first 30 minutes) and at the 1st, 2nd, 6th, and 24th hours of life. Associations between placenta weight, placenta weight-to-birth weight ratio (PBWR), and neonatal outcomes were evaluated using Pearson or Spearman correlation analyses and multiple linear regression models adjusting for potential confounders, including gestational age, birth weight, maternal glycemic control (HbA1c), and mode of delivery, with statistical significance set at p < 0.05. Results: This study included 98 mother–infant dyads. Although placenta weight showed a weak inverse correlation with blood glucose levels within the first 30 minutes (r = -0.204, p = 0.044), neither placenta weight nor the placenta weight-to-birth weight ratio demonstrated a statistically significant association with overall neonatal hypoglycemia in our cohort (adjusted effect estimate: 1.0, 95% CI (0.99-1.00), p = 0.99). In multiple linear regression models adjusting for covariates, gestational age (beta = -0.21, p = 0.036) and birth weight (beta = 0.50, p < 0.001) were independent predictors of placenta weight, whereas gestational age was the sole independent predictor of PBWR (beta = -0.27, p = 0.011). Neither placenta weight nor PBWR significantly predicted neonatal hypoglycemia or subsequent glucose levels (p > 0.05). Conclusion: This study shows that placenta weight and the placenta-to-birth weight ratio are correlated with gestational age and birth weight, but they are not significantly associated with early neonatal glycemic adaptation or hypoglycemia in pregnancies with GDM. Hence, additional research with larger sample sizes is required to clarify the influence of placenta weight on infants of mothers with gestational diabetes.
Background: Central congenital hypothyroidism (CCH) is an uncommon but potentially underdiagnosed condition, particularly in infants born to mothers with autoimmune thyroid disease. Case Presentation: We report a case of central congenital hypothyroidism in a preterm baby born to a mother with hyperthyroidism, diagnosed three years prior to conception. She developed thyrotoxicosis at 30 weeks of pregnancy requiring Lugol’s iodine, carbimazole and propranolol. She subsequently developed pre-eclampsia and went into preterm Labour at 31 weeks of gestation. Her Thyroid Stimulating Hormone (TSH) receptor antibody levels were high, while anti-peroxidase and anti-thyroglobulin antibodies were negative. The cord TSH level at birth was very low. Subsequently, regular thyroid function tests continued to show very low TSH with normal Thyroxine (T4) levels. At one month of life, the child was started on Levothyroxine. TSH receptor antibodies were positive. He was noted to have constipation and an umbilical hernia during this review. The diagnosis of CCH was made. After initiation of therapy, T4 levels have normalized. Discussion / Conclusion: CCH is a rare condition, and the risk is significantly increased in infants born to mothers with Grave’s disease. In Grave’s disease, patients may have TSH-blocking antibodies that bind to TSH receptors but do not initiate intracellular signaling, resulting in hypothyroidism. This case highlights the importance of monitoring T4 and TSH levels in infants born to women with Grave’s disease.
Background: A 14-year-old male with recurrent clival chordoma, an infrasellar mass, underwent a repeat endonasal resection that was complicated by a CSF leak secondary to puncture of the dura and arachnoid near the posteroinferior pituitary gland, and postoperative DI that was initially thought to be transient however, recurred 7 days after cessation of DDAVP therapy. Our objective is to highlight a case of endonasal resection of clival chordoma which resulted in permanent, but partial, central DI in the pediatric setting. Clinical Presentation: In this patient, his CDI initially responded to desmopressin in the inpatient setting, which contributed to the premature conclusion that his CDI would remain transient. However, upon endocrinology follow-up, he continued to have severe thirst and increased urination and work up also included a serum osmolality of 294 MIU/KG, serum sodium of 142 mmol/L, urine specific gravity of 1.008, and urine osmolality of 339 MIU/KG, consistent with a partial central DI. Conclusion: CDI is a known complication of suprasellar masses as well as endonasal resection of these masses, however, this is poorly described in the literature surrounding pediatric patients being treated for infrasellar clival chordomas. This patient’s recurrence of partial CDI indicates a potential gap in care for patients who undergo endonasal infrasellar clival chordoma resection, as they may be underdiagnosed with permanent partial DI. We propose that these patients should be closely followed by an endocrinologist to screen for possible pituitary complications and that increased data should be collected in the pediatric setting regarding postoperative outcomes.
Objective: To investigate the impact of an instructional program based on the Transformational-Generative (TG) Theory on improving the writing skills of eleventh-grade female students in Jordan. This may lead to designing an instructional program to improve the writing skills of secondary school students. Methods: The study sample consisted of 76 female students, purposefully selected from a school affiliated with the Directorate of Education in the University District. Through random assignment, the experimental group (11/A), comprising 39 students, was taught using the program based on the TG Theory. In contrast, the control group (11/B), consisting of 37 students, received instruction through the conventional curriculum. To achieve the objectives of the study, the researchers developed a teacher's guide based on the TG Theory, a list of writing skills and their criteria, and a writing test administered to both groups before and after instruction. To answer the research questions, descriptive statistical methods, multivariate analysis of covariance (MANCOVA), and ANCOVA were employed. Results: There are statistically significant differences between the mean scores of both groups on the writing test, attributed to the effectiveness of the program based on the TG Theory in favor of the experimental group. Except for "style" and "rhetoric" dimensions, there are statistically significant differences between the mean scores of both groups across other writing test dimensions in favor of the experimental group. Conclusions: The researchers recommend designing instructional activities grounded in the TG Theory to enhance writing and other Arabic language skills among students of all grade levels.
