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Aims: Gestational diabetes (GDM) is associated with the development of postpartum (PP) glucose intolerance. Plasma glycated CD59 (pGCD59) is an emerging biomarker for the detection of hyperglycaemia. The aim of this study was to assess the ability of PP pGCD59 to predict the development of PP GI as defined by the 2 h 75 g OGTT using the ADA criteria, in a cohort of women diagnosed with prior GDM in the index pregnancy using the 2 h 75 g OGTT at 24–28 weeks of gestation according to the World Health Organization (WHO) 2013 criteria. Methods: Of the 2017 pregnant women recruited prospectively 140 women with gestational diabetes had samples for pGCD59 taken PP at the time of the OGTT. The ability of pGCD59 to predict the results of the PP OGTT was assessed using nonparametric receiver operating characteristic (ROC) curves. Results: Women with PP glucose intolerance had significantly higher PP pGCD59 levels compared to women with normal glucose tolerance PP (3.8 vs. 2.7 SPU). PP pGCD59 identified women who developed glucose intolerance PP with an AUC of 0.80 (95% CI: 0.70–0.91). A PP pGCD59 cut‐off value of 1.9 SPU generated a sensitivity of 100% (95% CI: 83.9–100), specificity of 16.9% (95% CI: 9.8–26.3), positive predictive value of 22.1% (95% CI: 21.0–22.6), and negative predictive value of 100% (95% CI: 87.4–100). PP fasting plasma glucose generated an AUC of 0.96 (95% CI: 0.89–0.99) for the identification of PP glucose intolerance. Conclusion: Our study found that PP pGCD9 may be a promising biomarker to identify women not requiring PP glucose intolerance screening using the traditional OGTT. While the diagnostic accuracy of pGCD59 is good, fasting plasma glucose remains a better test for the identification of PP glucose intolerance. [ABSTRACT FROM AUTHOR]

Aim: Many challenges exist in determining true rates of adherence to antihypertensive medications among individuals in a clinic setting. For the first time, we aimed to compare patient‐reported antihypertensive adherence with objective evidence using mass spectrometry spot urinalysis in a tertiary referral clinic setting. Methods: A prospective observational single‐centre cohort study was performed in a tertiary referral hypertension clinic, encompassing antihypertensive initiation and persistence. Patients were referred with apparent treatment‐resistant hypertension or for suspected secondary causes. Participants completed a self‐reported assessment of antihypertensive adherence and provided a spot urine sample. The presence of antihypertensive medications and/or their respective metabolites was evaluated using high‐performance liquid chromatography tandem mass spectrometry. Patients were determined to be adherent if they demonstrated both self‐reported adherence and objective mass spectrometry evidence. Results: Of all 105 eligible participants initially recruited, 73 (69.5%) met the eligibility criteria. Only 27.4% (95% confidence interval 0.2‐0.4) of participants demonstrated true adherence to their self‐reported antihypertensives, despite 75.3% (0.6‐0.8) reporting adherence. Greatest medication adherence was achieved with angiotensin II receptor blockers (61%), with calcium‐channel blockers and mineralocorticoid antagonists demonstrating least adherence (38%). Conclusion: In patients attending a tertiary hypertension clinic, the combined use of spot urine mass spectrometry and self‐reporting identifies higher rates of nonadherence when compared to either modality alone. Both techniques should be combined for more accurate detection of medication adherence. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to assess the clinical performance and user acceptance of capillary blood samples prepared remotely using the MiniCollect® capillary blood collection device as an alternative to blood collection by venepuncture for glycated haemoglobin (HbA1c) analysis. Methods: Following written informed consent, a cross‐sectional study was conducted in individuals aged ≥18 years with any type of diabetes who routinely self‐monitor their blood glucose. Eligible participants recruited whilst attending their routine clinical appointments were required to provide a venous blood sample, prepare a capillary blood sample at home (remotely) and complete a bespoke questionnaire. HbA1c in whole blood collected in ethylenediaminetetraacetic acid was determined by capillary electrophoresis on the Sebia Capillary's 3 Tera analyser following standard operating procedure. Results: HbA1c results from both venous and capillary collection demonstrated good agreement. Passing‐Bablok regression: y = 0 + 1x (p = 0.18), Spearman correlation r = 0.986, p < 0.0001. The Bland–Altman difference plot provided a mean difference of 0.3 mmol/mol (2.2%). Over half of the participants found the MiniCollect device easy to use. The majority of participants were in favour of the remote capillary blood collection service and would use it if routinely available. Conclusion: The home collection of capillary blood for HbA1c determination is a valuable and convenient alternative to standard venous blood collection as it provides an opportunity to support routine HbA1c monitoring, whilst mitigating the transmission of SARS‐CoV‐2. This service would additionally allow individuals to attend clinic visits with a HbA1c value, ensuring optimal continuance of patient care for individuals with diabetes. [ABSTRACT FROM AUTHOR]

Blood cultures should be performed in non‐specifically unwell older adults following nonspecific presentations. Prompt diagnosis and commencement of targeted antimicrobial therapy are essential in older patients with A. defectiva IE. [ABSTRACT FROM AUTHOR]

Advances in genomics and 18F‐DOPA PET‐CT imaging have transformed the management of infants with Congenital Hyperinsulinism. Preoperative diagnosis of focal hyperinsulinism permits limited pancreatectomy with improved clinical outcomes while knowledge of the molecular etiology informs genetic counseling and provides a more accurate recurrence risk to families. [ABSTRACT FROM AUTHOR]

Summary: Objective: To describe clinical practice experience of 11C‐Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone‐producing adenomas (APA) in primary aldosteronism (PA). Context: Accurate lateralization of APA in the setting of PA offers the potential for surgical cure and improved long‐term cardiovascular outcomes. Challenges associated with AVS, the current gold standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralization, including the application of novel molecular PET tracers such as 11C‐Metomidate. Design: Clinical Service Evaluation/Retrospective audit. Patients: Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with 11C‐Metomidate PET/CT prior to final clinical decision on surgical vs medical management. Measurements: All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. 11C‐Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy. Results: We describe the individual lateralization and clinical outcomes for 15 patients with PA. Conclusion: 11C‐Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision‐making for PA within a multidisciplinary hypertension clinic. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effects of β-adrenoreceptor antagonists (β-blockers) on the aldosterone-renin ratio (ARR) in the context of antihypertensive polypharmacy in chronic hypertension. To determine the optimal duration of β-blocker withdrawal required to normalize the ARR. Design A prospective, longitudinal study design was employed investigating two groups whom either remained on or withdrew from β-blocker therapy. Methods Hypertensive individuals taking β-blockers and a combination of thiazide diuretics, α1-blockers, calcium channel antagonists and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were recruited and followed over 10-12 weeks. β-Blockers were withdrawn at the first visit. Blood pressure (BP) was measured at each visit and blood drawn serially for measurement of plasma renin activity (PRA), direct renin concentration (DRC) and aldosterone. BP was optimized by maximizing non-renin-suppressing antihypertensives. Main outcomes were ARR, DRC, PRA and aldosterone. Plasma renin activity was calculated from angiotensin I measured using radioimmunoassay (RIA), DRC was measured using chemiluminescent immunoassay assay, and aldosterone was measured using both RIA and Chemilluminescence Assay (CIL). Results False-positive ARR for primary aldosteronism ( PA) occurred in 31% of patients taking β-blockers. ARR returned to normal following β-blocker withdrawal resulting from an increase in the DRC and PRA without affecting aldosterone. The optimum time for β-blocker withdrawal was 2 weeks when using DRC and 3 weeks for PRA. β-Blocker withdrawal did not adversely affect blood pressure. Conclusion Raised ARR consequent to β-blocker therapy causes false-positive screening for PA. Where β-blockers can be safely withdrawn, this effect is reversed within 2-3 weeks depending on whether DRC or PRA is used to calculate ARR. [ABSTRACT FROM AUTHOR]