Highlights of this issue
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## Screening for gestational diabetes: Is it necessary?

The primary goal of controlling abnormal glucose levels in pregnancy is to decrease the chance of a woman having a baby who is large for gestational age (LGA). There is little scientific evidence that screening for, and subsequent treatment of, gestational diabetes mellitus has any benefit for the mother or her child, and international authorities differ on their recommendations for screening. Christian Ouzilleau and colleagues retrospectively evaluated the charts of 300 consecutive high-risk women whose screening test, with an oral glucose load, showed evidence of glucose intolerance and compared them with the charts of 300 women whose plasma glucose levels were normal. After the exclusion of 6 women with gestational diabetes mellitus who were treated with insulin, it was found that plasma glucose levels were only poorly correlated with birth weight and that LGA neonates were better explained by other factors.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/168/4/393/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/168/4/393/F1)

Figure. Photo by: Corbis/Magma

In a related commentary, Mathew Sermer discusses the results of this study and places them in the larger context of current recommendations from national bodies.

See pages [403](http://www.cmaj.ca/lookup/volpage/168/403?iss=4) and [429](http://www.cmaj.ca/lookup/volpage/168/429?iss=4)

## Leaving hospital against medical advice

In the contract between physician and patient, the competent patient retains ultimate authority and may accept or refuse medical recommendations. Between 1% and 2% of patients discharge themselves from hospital against medical advice (AMA). It is possible that such an “early” discharge might lead to adverse health consequences that necessitate readmission. In an inner city hospital in Toronto, Stephen Hwang and colleagues prospectively studied 97 consecutive admitted patients who left a general medical service AMA and attempted to determine rates and predictors of readmission. Although a significant risk of readmission was seen in patients who left hospital AMA, it was difficult to determine which factors were associated with readmission.

See page [417](http://www.cmaj.ca/lookup/volpage/168/417?iss=4)

## HPV infection and clearance

Human papillomavirus (HPV) has been detected in 99.7% of cervical cancers worldwide, and nearly one in 4 women aged 20–24 years in Ontario is infected with HPV. Despite this, the incidence of cervical cancer in infected women is relatively low. The virus often becomes latent, or clears with time. John Sellors and colleagues extended a previous study and determined annual incidence rates in 253 Ontario women who had originally tested negative for HPV. They also determined clearance rates in 54 women who had previously tested positive. Incident infection was associated with the number of sexual partners in the past year and, at one year, over half of the infected women had cleared the infection.

See page [421](http://www.cmaj.ca/lookup/volpage/168/421?iss=4)

## Diagnosis and management of epilepsy

A witnessed epileptic seizure is one of medicine's most dramatic events. Epilepsy is common, affecting 7 in 1000 people, and may adversely affect a patient's education, employment, social relationships and self-worth. The differential diagnosis of paroxysmal seizure-like events is broad and includes both benign and life-threatening disorders. Warren Blume discusses conditions that mimic epilepsy, how one might make a definitive diagnosis of a primary seizure disorder and the necessary steps in seizure investigation and management.

See page [441](http://www.cmaj.ca/lookup/volpage/168/441?iss=4)

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/168/4/393/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/168/4/393/F2)

Figure. Photo by: Digital Stock