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Total glycosylated hemoglobin has been evaluated postpartum using a colorimetric (thiobarbituric acid: TBA) method in 50 mothers of large-for-gestational-age (LGA) infants ( > 90th percentile by weight). 30 women without potential risk factors for chemical diabetes who gave birth to appropriate-for-gestational-age (AGA) infants formed the control group. When compared to the control mothers, mean total glycosylated hemoglobin (TBA color) levels were significantly higher in the mothers of LGA infants (p < 0.01). 4 of the latter had an abnormal oral glucose tolerance test (GTT) done within 5 days postpartum and significantly elevated glycosylated hemoglobin compared to mothers of LGA infants with normal GTT (p < 0.001). Furthermore, a significant linear correlation was found for mothers of LGA infants between TBA color levels and each of the following: fasting serum glucose (p < 0.001), 1-hour serum glucose (p < 0.001), 2-hour serum glucose (p < 0.001), and infant birth weight (p < 0.05). Analysis of TBA color levels early postpartum might be an alternative method for detecting unsuspected chemical diabetes in pregnancy.

Summary: This study aims to review current knowledge on equine fetal sexing with special reference to the authors field experience using the non-invasive transabdominal approach. Early gender determination performed transrectally by identifying the genital tubercle is specific with a small time frame; it is best performed from day 59 until 68. The examiner has to be experienced to scan the right planes for finding the genital tubercle in either sex. Advanced sex determination can be performed transrectally from 90 up to 140 days of gestation, afterwards reaching the fetus hindquarters transrectally is almost impossible and the transabdominal alternative has to be chosen. External genitalia and gonads have to be found and good knowledge of fetal anatomy is required. For more advanced gestation, the importance of representing the gonads and especially outlining their B-Mode echotexture and vascularisation by Doppler sonography increases. For the transrectal approach for gender determination, mares have to be calm and relaxed, so the use of sedation and smooth muscle relaxants might be necessary and the risk of perforating the rectum has to be taken into consideration. Transabdominal examination shows high acceptance in mares and bears a low risk, sedation is not necessary and movement of mare and fetus can be compensated easily by moving the ultrasound probe along the abdomen. Equine fetal sex determination is a tool in equine reproductive medicine which becomes more important and interesting for breeders in order to plan the mare s future breeding prospects. With enough time, patience, practice and good equipment it can be performed by practitioners easily as an additional service for clients. The method to be selected depends on the stage of gestation and on fetal presentation. If movements of the fetus prevent the accomplishment of sex determination, the examination should be repeated later. Advantages of gender determination during advanced gestation by transabdominal ultrasound other than economical reasons are the accomplishment of a check up on pregnancy and fetal well-being, great acceptance by the clients and a good way to perform gestation control in ponies and small horses, although this may take more time for preparation and examination.Keywords: mare / fetal gender determination / transrectal ultrasonography / transabdominal sonography / reproduction Citation: Tönissen A., Martinsson G., Otzen H., Schürmann K., Schütze S., Ertmer F., Kassens A., Sielhorst J., Brehm R., Sieme H. (2015) To perform fetal gender determination in the mare by ultrasound during early and advanced gestation. Pferdeheilkunde 31,[153][154][155][156][157][158]

Objectives: Anaemia is a major cause of mortality and transfusion in children in Low- and Middle-Income Countries (LMICs), however current diagnostics are slow, costly, and frequently unavailable. Point-of-care haemoglobin tests (POC(Hb)Ts) could improve patient outcomes and use of resources by providing rapid and affordable results. We systematically reviewed the literature to investigate what, where and how POC(Hb)Ts are being used by health facilities in LMICs to diagnose childhood anaemia, and to explore challenges to their use. Methods: We searched a total of nine databases and trial registries up to 10th June 2022 using the concepts: anaemia, POC(Hb)T, LMIC and clinical setting. Adults >21 years and literature published >15 years ago were excluded. A single reviewer conducted screening, data extraction and quality assessment (of diagnostic studies) using QUADAS-2. Outcomes including POC(Hb)T used, location, setting, challenges and diagnostic accuracy were synthesised. Results: Of 626 records screened, 41 studies were included. Evidence is available on the use of 15 POC(Hb)Ts in hospitals (n=28, 68%), health centres (n=9, 22%) and clinics/units (n=10, 24%) across 16 LMICs. HemoCue (HemoCue AB, Angelholm, Sweden) was the most used test (n=31, 76%). Key challenges reported were overestimation of haemoglobin concentration, clinically unacceptable limits of agreement, errors/difficulty in sampling, environmental factors, cost, inter-observer variability, and supply of consumables. Five POC(Hb)Ts (33%) could not detect haemoglobin levels below 4g/dl. Diagnostic accuracy varied, with sensitivity and specificity to detect anaemia ranging from 24.2-92.2% and 70-96.7%, respectively. Conclusions: POC(Hb)Ts have been successfully utilised in health facilities in LMICs to diagnose childhood anaemia. However, limited evidence is available, and challenges exist that must be addressed before wider implementation. Further research is required to confirm accuracy, clinical benefits, and cost-effectiveness.

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