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Coustan D.R.,Brown University | Coustan D.R.,Women and Infants Hospital of Rhode Island
Clinical Chemistry | Year: 2013

BACKGROUND: Gestational diabetes mellitus, defined as diabetes diagnosed during pregnancy that is not clearly overt diabetes, is becoming more common as the epidemic of obesity and type 2 diabetes continues. Newly proposed diagnostic criteria will, if adopted universally, further increase the prevalence of this condition. Much controversy surrounds the diagnosis and management of gestational diabetes. CONTENT: This review provides information regarding various approaches to the diagnosis of gestational diabetes and the recommendations of a number of professional organizations. The implications of gestational diabetes for both the mother and the offspring are described. Approaches to self-monitoring of blood glucose concentrations and treatment with diet, oral medications, and insulin injections are covered. Management of glucose metabolism during labor and the postpartum period are discussed, and an approach to determining the timing of delivery and the mode of delivery is outlined. SUMMARY: This review provides an overview of current controversies as well as current recommendations for gestational diabetes care. © 2013 American Association for Clinical Chemistry.


Wenstrom K.D.,Women and Infants Hospital of Rhode Island | Carr S.R.,Women and Infants Hospital of Rhode Island
Obstetrics and Gynecology | Year: 2014

Since the first human fetal surgery was reported in 1965, several different fetal surgical procedures have been developed and perfected, resulting in significantly improved outcomes for many fetuses. The currently accepted list of fetal conditions for which antenatal surgery is considered include lower urinary tract obstruction, twin-twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, neck masses occluding the trachea, and tumors such as congenital cystic adenomatoid malformation or sacrococcygeal teratoma when associated with developing fetal hydrops. Until recently, it has been difficult to determine the true benefits of several fetal surgeries because outcomes were reported as uncontrolled case series. However, several prospective randomized trials have been attempted and others are ongoing, supporting a more evidence-based approach to antenatal intervention. Problems that have yet to be completely overcome include the inability to identify ideal fetal candidates for antenatal intervention, to determine the optimal timing of intervention, and to prevent preterm birth after fetal surgery. Confronting a fetal abnormality raises unique and complex issues for the family. For this reason, in addition to a maternal-fetal medicine specialist experienced in prenatal diagnosis, a pediatric surgeon, an experienced operating room team including a knowledgeable anesthesiologist, and a neonatologist, the family considering fetal surgery should have access to psychosocial support and a bioethicist. © 2014 by The American College of Obstetricians and Gynecologists.


Buster J.E.,Women and Infants Hospital of Rhode Island
Fertility and Sterility | Year: 2013

Female sexual dysfunctions (FSDs) range from short-term aggravations to major emotional disturbances adversely affecting family and workplace. This review highlights diagnosis and management of the four most widely diagnosed FSDs. It initially focuses on hypoactive sexual desire disorder (HSDD) as a driving force at the heart of all other FSDs; nothing happens without sexual desire. Successful resolution of HSDD frequently facilitates resolution of other disorders. Central to understanding HSDD is the impact of aging female sexual endocrinology and its effect on both prevalence and expression patterns of FSD. Advances in this field have enabled introduction of some the most effective treatments yet described for HSDD. Sexual arousal disorder, though commonly affected by the same factors as HSDD, is heavily associated with psychotropic drugs and mood elevators. Orgasmic disorder is frequently the downstream result of other sexual dysfunctions, particularly HSDD, or the result of a major psychosexual trauma. Successful management of the underlying disorder often resolves orgasmic disorder. Sexual pain disorder is frequently the result of a gynecologic disorder, such as endometriosis, that can be substantially managed through successful treatment of that disorder. This article ends with the article's most important note: how to initiate the conversation. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Stuckey A.,Women and Infants Hospital of Rhode Island
Clinical Obstetrics and Gynecology | Year: 2011

Breast cancer is a worldwide problem affecting more than 1 million women annually. Currently, best care for women with breast cancer involves a multidisciplinary approach requiring a broad understanding of epidemiologic, genetic, prognostic, and predictive factors. This study will discuss the epidemiology and risk factors associated with breast cancer. © 2011, Lippincott Williams & Wilkins.


Coustan D.R.,Women and Infants Hospital of Rhode Island
Scandinavian Journal of Clinical and Laboratory Investigation | Year: 2014

Previous approaches to diagnosing gestational diabetes mellitus (GDM) have included 50 g, 75 g and 100 g glucose challenges, lasting 1-3 hours, with 1 or 2 elevations required. Thresholds were validated by their predictive value for subsequent diabetes, or were the same thresholds used in non-pregnant individuals. None were based on their prediction of adverse pregnancy outcomes. Diagnostic paradigms vary throughout the world, making comparisons impossible and severely limiting communication among investigators. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study collected outcome data on > 23,000 pregnancies recruited prospectively in nine countries after a blinded 75 g, 2-hour oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Primary outcomes (LGA, PCS, neonatal hypoglycemia, high cord C-peptide), and most secondary outcomes (e.g. preeclampsia, preterm birth, shoulder dystocia and birth injury), were significantly, directly and continuously related to each of the three plasma glucose measurements. The International Association of Diabetes in Pregnancy Study Groups (IADPSG) developed recommendations for the use of a 75 g, 2-h OGTT, ≥ 1 elevation diagnosing GDM, with thresholds: fasting plasma glucose ≥ 5.1 mmol/L (92 mg/dL) , 1 h ≥ 10 mmol/L (180 mg/dL) and 2 h ≥ 8.5 mmol/L (153 mg/dL). These have generated wide discussion and are currently being considered throughout the world. They are pregnancy outcome-based; the 75 g glucose load will bring consistency to GTTs; universal adoption will lead to consistency of diagnostic criteria worldwide; studies of treatment at similarly mild levels of glycemia have demonstrated improvement in outcomes; use of a single abnormal value will obviate the confusion arising when one elevated value is encountered. The primary argument against the recommendations is that prevalence of GDM will rise to 16-18 %, increasing health care costs. Balanced against this is the world-wide epidemic of obesity, prediabetes and diabetes. © 2014 Informa Healthcare.


Patent
Brown University and Women And Infants Hospital Of Rhode Island | Date: 2013-05-17

The invention is directed to the synthesis and use of nitrofuran compounds, especially Nifurtimox, as medicaments to treat cancer, especially neuroblastoma, and to inhibit angiogenesis. The invention also provides compositions, unit dosage forms, and kits comprising the compounds.


Patent
Women And Infants Hospital Of Rhode Island and INC Research | Date: 2012-08-26

Described herein are compounds, pharmaceutical compositions and methods for inhibiting the expression of a vitamin D receptor target gene, inhibiting interactions between the vitamin D receptor and at least one vitamin D receptor coactivator, for treating cancer in a subject, and for inhibiting angiogenesis in a subject.


Keszler M.,Brown University | Keszler M.,Women and Infants Hospital of Rhode Island
Current Opinion in Pediatrics | Year: 2015

Purpose of review Sustained inflation performed shortly after birth to help clear lung fluid and establish functional residual capacity in preterm infants is gaining popularity, but definitive evidence for its effectiveness is lacking. Although there is a sound physiologic basis for this approach, and much preclinical experimental evidence of effectiveness, the results of recent animal studies and clinical trials have been inconsistent. Recent findings The most recent data from a multicenter randomized trial suggest a modest benefit of sustained inflation in reducing the need for mechanical ventilation in extremely-low-birth-weight infants. However, the impact may be more modest than earlier retrospective cohort comparisons suggested. The trend toward more airleak and a higher rate of intraventricular hemorrhage is worrisome. Sustained inflation may be ineffective unless some spontaneous respiratory effort is present. Several on-going trials should further clarify the putative benefits of sustained inflation. Summary Delivery room sustained inflation is an attractive concept that holds much promise, but widespread clinical application should await definitive evidence from on-going clinical trials, © 2015 Wolters Kluwer Health, Inc.


Patent
Women And Infants Hospital Of Rhode Island | Date: 2011-06-17

Described herein are novel approaches for regenerating injured or defective lung epithelium for the treatment of respiratory disorders using, in part, cord blood-derived hematopoietic stem cells. The methods and uses described herein relate to the administration of or use of hematopoietic stem cells, specifically those isolated or enriched from umbilical cord blood, to a subject in need thereof having a respiratory disorder, such as BPD, or any disorder characterized by insufficient or defective or injured lung epithelium or lung vasculature.


Patent
Women And Infants Hospital Of Rhode Island | Date: 2014-11-14

Disclosed herein are methods for preventing or treating a lung disorder using, in part, mesenchymal stem cells derived from umbilical cord tissue. The methods and uses described herein relate to the administration of or use of mesenchymal stem cells, specifically those isolated and/or enriched from umbilical cord tissue, to a subject in need thereof having a lung disorder.

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