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Singh BM, Kumari-Dewat N, Ryder A, Parry E, Klaire V, Matthews D, Bennion G, Jennens H, Ritzenthaler BME, Rayner S, Shears J, Ahmed K, Sidhu M, Viswanath A, Warren K. Digital health and inpatient palliative care: a cohort-controlled study. BMJ Support Palliat Care 2023:spcare-2023-004474. [PMID: 37491147 DOI: 10.1136/spcare-2023-004474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES End of life has unacceptable levels of hospital admission and death. We aimed to determine the association of a novel digital specific system (Proactive Risk-Based and Data-Driven Assessment of Patients at the End of Life, PRADA) to modify such events. METHODS A cohort-controlled study of those discharged alive, who died within 90 days of discharge, comparing PRADA (n=114) with standard care (n=3730). RESULTS At 90 days, the PRADA group were more likely to die (78.9% vs 46.2%, p<0.001), had a shorter time to death (58±90 vs 178±186 days, p<0.001) but readmission (20.2% vs 37.9%, p<0.001) or death in hospital (4.4% vs 28.9%, p<0.001) was lower with reduced risk for a combined 90-day outcome of postdischarge non-elective admission or hospital death (OR 0.45, 95% CI 0.27-0.74, p<0.001). Tightening criteria with 1:1 matching (n=83 vs 83) showed persistent significant findings in PRADA contact with markedly reduced adverse events (OR 0.15, 95% CI 0.02-0.96, p<0.05). CONCLUSIONS Being seen in hospital by a specialist palliative care team using the PRADA tool was associated with significantly improved postdischarge outcomes pertaining to those destined to die after discharge.
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Affiliation(s)
- Baldev Malkit Singh
- Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Research Institute for Health Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Nisha Kumari-Dewat
- Community Nursing, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Adam Ryder
- Departmenet of Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Emma Parry
- Academic Unit of Primary Care, Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- School of Medicine, Keele University, Keele, UK
| | - Vijay Klaire
- Digital Innovation Unit, Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Dawn Matthews
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Gemma Bennion
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Hannah Jennens
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Benoit M E Ritzenthaler
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Sophie Rayner
- Department of Palliative Medicine, Derriford Hospital, Plymouth, UK
| | - Jean Shears
- Departmenet of Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Mona Sidhu
- Lea Road Medical Practice, Wolverhampton, UK
| | - Ananth Viswanath
- Department of Diabetes and Endocrinology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Kate Warren
- Digital Innovation Unit, Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Public Health, Wolverhampton City Council, Wolverhampton, UK
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Kurri N, Tyagi B, Kaushik A, Gupta N, Agarwal AK, Singh BM. Role of Itolizumab in the Treatment of COVID-19 Patients, Admitted to ICU at a Tertiary Care Hospital. J Assoc Physicians India 2022; 70:11-12. [PMID: 37355865 DOI: 10.5005/japi-11001-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND Clinical studies have correlated severe deterioration of COVID-19 patients due to excessive and uncontrolled production of cytokines. There is a pressing need to explore therapies, which could prevent the cytokine storm rather than terminating it. AIMS AND OBJECTIVES The aim of the study is to evaluate the effect of itolizumab on clinical outcomes of patients with moderate-severe COVID-19 disease admitted to ICU. The primary aim of the current study is to find out any mortality benefit in 14 days. The secondary aim is to assess the morbidity outcomes in terms of reduction in inflammatory markers and also the duration of hospital stays to assess the prognostication. MATERIALS AND METHODS It is a retrospective case-control study in which laboratory-confirmed COVID-19 patients admitted to ICU were taken. A total of 62 patients were recruited, 31 patients received itolizumab (cases/treatment group) and 31 patients didn't receive itolizumab (designated as controls). RESULTS Among the total patients recruited, 68% of the study population was male and 32% were female. A total of 12 patients expired among cases and 13 expired among controls. Overall mortality in both groups was noted to be almost similar. The control group showed mortality at lower computed tomography (CT) scores compared to the cases. There is a significant reduction in inflammatory markers, like interleukins-6 (IL-6) and D-dimer in cases compared to the control group. CONCLUSION In conclusion, treating patients with cytokine storms before they require intubation/mechanical ventilation is crucial to preventing deaths. Itolizumab has shown no clinical benefit in critically ill COVID-19 patients, however, timely initiation of itolizumab therapy may serve as a key therapeutic option in preventing the mortality and morbidity outcomes in moderate-severe COVID-19 patients.
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Affiliation(s)
| | | | | | | | | | - B M Singh
- Professor, SMS & R Sharda Hospital, Greater Noida, Uttar Pradesh, India
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3
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Gupta P, Tripathi A, Agrawal T, Narayan C, Singh BM, Kumar M, Kumar A. Synergistic protective effect of picrorhiza with honey in acetaminophen induced hepatic injury. Indian J Exp Biol 2016; 54:530-536. [PMID: 28577513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rhizome of picrorhiza along with honey prevents hepatic damage and cure the acetaminophen (paracetamol) induced hepatotoxicity by modulating the activity of hepatic enzymes. Here, we studied the in vivo effects of Picrorhiza kurroa and honey on acetaminophen induced hepatotoxicity Balb/c mice model. Hepatic histopathological observations of acetaminophen fed (day-6) group showed more congestion, hemorrhage, necrosis, distorted hepatic architecture and nuclear inclusion. Such damages were recompensed to normal by picrorhiza or honey alone or both in combinations. We observed increased activity of SGPT and SGOT in injured liver tissues, and that too was compensated to normal with picrorhiza or honey alone or both in combinations. We observed 1.27 and 1.23-fold enhanced activity of SGPT in serum and liver lysate, respectively while SGOT showed 1.66 and 1.11 fold enhanced activity. These two enzymes are signature enzymes of liver damage. Thus, our results support that honey may be used with drug picrorhiza due to its synergistic role to enhance hepatoprotective and hepatoregenerative ability along with allopathic drugs to mitigate the hepatotoxic effects.
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Gillani SMR, Nevill A, Singh BM. Provision of structured diabetes information encourages activation amongst people with diabetes as measured by diabetes care process attainment: the WICKED Project. Diabet Med 2015; 32:865-71. [PMID: 25764229 DOI: 10.1111/dme.12737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with diabetes have better outcomes if they actively participate in their care. Patient-focused interventions can be effective in activating patients. Yet there is no known trial to evaluate the impact of the provision of individualized diabetes-specific information on patient activation and diabetes care outcomes. METHODS In a randomized controlled trial, all people (n = 14 559) with diabetes within the local health economy were recruited and cluster randomized into two groups with the active group mailed a structured personalized report containing information on all nine of their diabetes care processes, whereas the control group received standard care. Differences in their Failed Process Score (FPS) were compared at three months. RESULTS At three months, the FPS score (1.25 ± 1.87 vs. 1.35 ± 1.97, P < 0.01) and the change in FPS score (0.48 ± 1.55 vs. 0.42 ± 1.49, P < 0.02) were significantly better in those mailed a structured personalized report. A dichotomized FPS score [good attainment (GA) vs. poorer attainment], was significantly better in those mailed (χ2 = 10.0, P < 0.05) and using a binary logistic regression analysis adjusting for all demographic factors and the baseline FPS, the relative effect of mailing compared with non-mailing on three-month GA category was OR 1.14 (95% CI 1.04-1.25, P < 0.01). CONCLUSIONS Provision of structured and individualized information to people with diabetes can positively influence the level of patient activation, promote better engagement and open the potential to improve other crucial diabetes outcomes.
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Affiliation(s)
- S M R Gillani
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK
| | | | - B M Singh
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK
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Gillani SMR, Singh BM. A simple method for introducing care planning into specialist diabetes clinics. The WICKED project. Pract Diab 2014. [DOI: 10.1002/pdi.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- SMR Gillani
- Wolverhampton Diabetes Centre; New Cross Hospital; Wolverhampton UK
| | - BM Singh
- Wolverhampton Diabetes Centre; New Cross Hospital; Wolverhampton UK
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Gillani SMR, Holland MR, Sidhu M, Singh BM. A case control study of use of the Failed Access Score for determination of failed access to structured diabetes care: the WICKED project. Practical Diabetes 2014. [DOI: 10.1002/pdi.1843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Raghavan RP, Baskar V, Buch H, Singh BM, Viswanath AK. Consultant delivered seven-day health care: results from a medical model on a diabetes base ward. Practical Diabetes 2014. [DOI: 10.1002/pdi.1832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gillani SMR, Nayak AU, Thiruvenkatasamy K, Baskar V, Singh BM, Viswanath A. A method to validate the accuracy of a centralised district diabetes register. Practical Diabetes 2013. [DOI: 10.1002/pdi.1780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Manjunatha RS, Manjunatha NP, Baskar V, Headon MP, Singh BM, Viswanath AK. Quality assurance in the diabetic retinopathy screening programme: evaluating the benefit of universal regrading of the normal primary grade. Diabet Med 2012; 29:287-8. [PMID: 21824184 DOI: 10.1111/j.1464-5491.2011.03402.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Though type 1 diabetes (T1D) is described to be a disease of acute onset, there is strong evidence for a period of subclinical hyperglycaemia leading up to diagnosis. We describe two clinical cases with a prolonged and insidious onset of T1D, where neurological complications were present at the time of diagnosis. In both, there was an initial rapid and debilitating progression in neurological as well as other microvascular complications, but with a subsequent stabilization in complications over the next few years. These rare and unusual cases illustrate the variable nature of the natural history of T1D as well as its microvascular complications.
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Affiliation(s)
- P Narendran
- Department of Diabetes, University Hospital Birmingham NHS Foundation Trust, Birmingham, B15 2TT, UK.
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11
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Abstract
BACKGROUND Exenatide, a GLP-1 analogue, is used in combination with oral anti-diabetic agents in type 2 diabetes and obesity, and promotes weight loss. Exenatide use in combination with insulin in insulin-treated type 2 diabetes and obesity is unlicensed in the UK and outcomes are unclear. AIMS To assess the effectiveness of exenatide in insulin-treated type 2 diabetes with obesity. DESIGN AND METHODS This prospective study included 174 consecutive patients with insulin-treated type 2 diabetes and obesity initiated on exenatide in our out-patient, between October 2007 and November 2008. Weight, BMI, HbA1c, serum fructosamine, total cholesterol, HDL-cholesterol and insulin doses were recorded at baseline, 3, 6 and 12 months. Side effect profiles were recorded. RESULTS Fourteen patients discontinued exenatide before 3 months of initiation, because of side effects, and were excluded. Data were analysed on remaining 160 people all of whom completed 6 months and 57 completed 12 months treatment. Mean weight loss was 10.7 +/- 5.7 kg and 12.8 +/- 7.5 kg (P < 0.001) at 6 and 12 months. Insulin doses dropped significantly (mean 144 +/- 90 U/day at baseline to 51 +/- 55 U/day and 55 +/- 53 U/day at 6 and 12 months). At 3 months, 25% came off insulin. There was little change in HbA1c. CONCLUSION Exenatide therapy in insulin-treated type 2 diabetes and obesity was associated with very significant reductions in weight and insulin doses. Exenatide should be considered in people with type 2 diabetes on insulin and have obesity, weight gain and poor glycaemic control.
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Affiliation(s)
- U A Nayak
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, WV10 0QP, UK.
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Mahto R, Venugopal H, Vibhuti VS, Mukherjee A, Cherukuri V, Healey B, Baskar V, Buch HN, Singh BM. The effectiveness of a hospital diabetes outreach service in supporting care for acutely admitted patients with diabetes. QJM 2009; 102:203-7. [PMID: 19153084 DOI: 10.1093/qjmed/hcn174] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with diabetes have increased frequency of hospital admissions and longer lengths of stay compared to patients without diabetes. Our specialist diabetes inpatient service was reconfigured to deliver a proactive diabetes outreach service to improve the overall care of this population. AIMS To ascertain the effect of a structured diabetes outreach service to acutely admitted patients with diabetes on avoidable admissions, delayed discharges and appropriate diabetes related follow-up plans. METHODS Audits were carried out before and 4 months after the introduction of a diabetes outreach service. The proportion of patients under care of the diabetes team, avoidable admissions, delayed discharges and existence of effective follow-up plans were compared pre- and post-implementation of this outreach service. RESULTS The number of inpatients with diabetes fell by 35% (83 on a typical day pre-outreach vs. 53 post-outreach) despite a similar number of total medical admissions in that month (1449 vs.1459). This was due to a reduction in those admitted with diabetes related (13 vs. 5) and general medical (29 vs. 10) problems whilst numbers requiring other specialist care (41 vs. 39) remained unchanged. The proportion of patients under the care of diabetes team rose (23% vs. 73%) while those with avoidable admissions (18% vs. 7%), delayed discharges (17% vs. 2%) and inappropriate discharge plans (65% vs. 11%) all fell. CONCLUSION This reformatted service was associated with a marked improvement in a number of parameters relevant to inpatient care.
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Affiliation(s)
- R Mahto
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton.
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13
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Jahagirdar VR, Strouhal P, Holder G, Gama R, Singh BM. Thyrotoxicosis factitia masquerading as recurrent Graves' disease: endogenous antibody immunoassay interference, a pitfall for the unwary. Ann Clin Biochem 2008; 45:325-7. [PMID: 18482926 DOI: 10.1258/acb.2007.007163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antibody interference in immunoassays is an underestimated problem, which has the potential to cause patient harm and waste health-care resources. We report a case where thyroglobulin antibodies generated a false-positive thyroglobulin result delaying the diagnosis of thyrotoxicosis factitia masquerading as recurrent Graves' disease. A high index of clinical suspicion and good laboratory-clinician communication underpins effective clinical and laboratory strategies to detect potentially erroneous laboratory results due to endogenous antibody interference in immunoassays.
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Affiliation(s)
- V R Jahagirdar
- Department of Diabetes and Endocrinology
- Department of Clinical Chemistry
| | - P Strouhal
- Department of Radiology, New Cross Hospital, Wolverhampton WV10 0QP, UK
| | - G Holder
- Department of Clinical Biochemistry, University Hospital Birmingham, Birmingham B29 6JB, UK
| | - R Gama
- Department of Clinical Chemistry
- Research Institute, Wolverhampton University, West Midlands WY1 1SB, UK
| | - B M Singh
- Department of Diabetes and Endocrinology
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Kriplani A, Singh BM, Lal S, Agarwal N. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet 2007; 97:190-4. [PMID: 17382331 DOI: 10.1016/j.ijgo.2007.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 01/14/2007] [Accepted: 01/16/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrel-releasing intrauterine system for menorrhagia. METHODS Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. RESULTS The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days (P=0.01) and PBAC score (P=0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean+/-SD rise in hemoglobin concentration was 1.06+/-1.7 g/dL (P=0.000). Endometrial thickness was decreased by 3.4+/-3.53 mm (P=0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. CONCLUSION Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.
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Affiliation(s)
- A Kriplani
- Department of Obstetrics and Gynecology, All-India Institute of Medical Sciences, New Delhi, India.
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15
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Singh PK, Iqbal N, Beach P, Buch HN, Singh BM. Nurse-led management of uncontrolled hypertension in those with diabetes and high vascular risk. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/pdi.1062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
AIMS To determine the utility of estimated glomerular filtration rates (eGFR) in predicting renal risk over and above currently available strategies that incorporate serum creatinine and microalbuminuria in a diabetes population. METHODS Cross-sectional study of 4548 diabetic individuals attending a single centre over an 18-month period. Glomerular filtration rates were estimated using the Modification of Diet in Renal Disease (MDRD) equation. Microalbuminuria was measured using spot morning urine for albumin:creatinine ratio (ACR). SPSS was utilized for statistical analysis. RESULTS Of the 4303 subjects with complete data, 373 (9%), 2634 (61%), 1197 (28%) and 99 (2%) individuals, respectively, had eGFR > 90, 90-60, 60-30 and < 30 ml/min per 1.73 m(2), respectively. Of those with clinically meaningful renal disease (eGFR < 60 ml/min per 1.73 m(2)), only 42% and 45%, respectively, were identified as at risk by clinical strategies utilizing serum creatinine and urine ACR individually. Even using the two together, 38% of the patients at risk would still not have been identified, since they had normal values of both. CONCLUSION Current strategies utilizing serum creatinine and urine ACR are insufficient for the detection of renal disease in diabetes. Clinicians should consider monitoring GFR estimates in addition to assessing blood pressure, serum creatinine and urine albumin excretion in order to assess renal status and risk in adults with diabetes.
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Affiliation(s)
- V Baskar
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
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17
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Abstract
AIM The morbidity and mortality from cardiovascular complications in diabetes reputedly differ with ethnicity. We have evaluated the prevalence of hypertension and vascular complications amongst Afro-Caribbean (AC), Caucasian (C) and Indo-Asian (IA) ethnic subgroups of a district's diabetes population to estimate the impact of ethnic origin as an independent risk variable. METHODS Of the 6485 registered adult individuals, 6047 had ethnic data available and belonged to one of the three ethnic groups described (AC 9%, C 70% and IA 21%). Statistical analyses were performed using spss version 11.5. RESULTS Results are presented as mean +/- s.d. or percentage. IAs were younger (AC 63 +/- 13, C 61 +/- 15 and IA 57 +/- 13 years), were less obese (body mass index 30 +/- 8, 29 +/- 9, 28 +/- 6 kg/cm2) and had lower systolic blood pressure (155 +/- 25, 149 +/- 24, 147 +/- 24 mmHg) and lower prevalence of hypertension (82%, 74% and 68%) compared with C, who had lower values than AC (all p < 0.01). Relative to C group, the AC group had higher prevalence of hypertension and microvascular complications but lower macrovascular disease burden, while the IA group had lower hypertension and macrovascular complications but with comparable microvascular disease burden [microvascular (51%, 44% and 46%; p < 0.01) and macrovascular (33%, 40% and 32%; p < 0.001)]. On logistic regression, this effect of ethnic origin on diabetic complications was found to be significant and independent of other risk variables. CONCLUSION Hypertension and diabetic complication rates were different amongst ethnic subgroups. On logistic regression, it was found that the difference in distribution of age and diabetes duration largely accounted for this difference, although ethnic origin remained an independent risk factor.
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Affiliation(s)
- V Baskar
- Wolverhampton Diabetes Centre, Wolverhampton, UK.
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18
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Singh BM, Kriplani A, Bhatla N. Uterocervical laceration during induction of labour with intravaginal misoprostol in a woman with idiopathic thrombocytopenic purpura. J OBSTET GYNAECOL 2005; 25:75-6. [PMID: 16147707 DOI: 10.1080/01443610400026067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- B M Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
BACKGROUND Microalbuminuria screening to identify patients at risk of diabetic nephropathy is widely accepted. AIM To investigate whether blood-pressure-based strategies can identify such patients without the need for microalbuminuria testing. METHODS Spot urine for albumin/creatinine ratios was performed in all patients over an 18-month period. The performance of four combinations of clinical models, based on existing triggers for anti-hypertensive intervention (prior use and/or existing systolic BP exceeding 140 or 160 mmHg and/or dipstick proteinuria exceeding 1+ or 2+) was evaluated at microalbuminuria thresholds of 3.5 and 10 mg/mmol. The models were ranked 1 to 4, based on their escalating relative strengths in predicting need for intervention. RESULTS Of 3748 patients, 1257 (34%) or 739 (20%) exceeded microalbuminuria thresholds of 3.5 or 10 mg/mmol. All four models predicted microalbuminuria risk (areas under ROC curves 0.60-0.77, all p < 0.001). The models (1-4) identified 2220, 2465, 2803 or 2937 for intervention, respectively, irrespective of microalbuminuria status, and missed 368, 232, 194 or 126 at 3.5 mg/mmol and 164, 87, 81 or 45 at 10 mg/mmol. DISCUSSION Clinical models using routinely measured parameters reduced the target population for microalbuminuria screening by 60-80%, missing 3-10% of patients with albumin/creatinine ratios exceeding 3.5 mg/mmol or 1-4% of those exceeding 10 mg/mmol.
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Affiliation(s)
- V Baskar
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
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20
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Abstract
CASE REPORT A case of primary hypothyroidism in a pre-pubertal girl presenting with vaginal bleeding and unilateral ovarian cyst is reported. The cyst resolved spontaneously after the institution of thyroid hormone therapy. CONCLUSION Watchful expectancy is recommended when an ovarian cyst is found in association with primary hypothyroidism and precocious puberty.
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Affiliation(s)
- B M Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Janak Puri, 110058 New Delhi, India.
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Abstract
We describe a unique case of spontaneous resolution of hyperparathyroidism in a lady with combined parathyroid adenoma and prolactinoma, raising the possibility of underlying multiple endocrine neoplasia (MEN) 1 syndrome. We also discuss the mechanism and natural history of such spontaneous remission.
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Affiliation(s)
- V Baskar
- Department of Medicine, New Cross Hospital, Wolverhampton, United Kingdom.
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Sayami P, Singh BM, Singh Y, Timila R, Shrestha U, Sayami G, Chaudhari JK. RETROSPECTIVE ANALYSIS OF BREAST CANCER CASES AND SURGICAL TREATMENT IN A PERIOD OF TEN YEARS. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Retrospective analysis of 321 cases of breast cancer diagnosed in T. U Teaching Hospitalin a period of 10 years, from May, 1991 to April, 2000 was carried out. There were317 cases (98.8%) females and 4 cases males (1.2%). The youngest patient was 22year old female and oldest patient was 92 year old female. The most common agegroup according to frequency was in forties (34.6%) followed by in thirties (25.5 %).Mean duration of symptoms before coming to doctor was 8.3 months and mean size oftumor was 6 cm. Out of 317 females, 310(97.2%) were married and average numberof children was 3. Out of 289 cases diagnosed as malignancy with fine needle aspirationcytology (FNAC) 279 (96.5%) was also diagnosed as malignancy in biopsy and theremaining 10 cases as non malignant diseases were diagnosed as malignancy in biopsywith a false negative rate of 3.5%. The histological types of breast cancer cases wereInfiltrating Ductal Carcinoma 280 cases (87.2%), Medullary Carcinoma 11 cases(3.4%), Infiltrating Lobular Carcinoma 5 cases (1.6%), Mucinous Carcinoma 4 cases(1.2%), Sarcoma 4 cases (1.2%), Squamous Cell Carcinoma 4 cases (1.2%), PapillaryCarcinoma 3 cases (0.9%), Tubular Carcinoma 2 cases, Adenosquamous Carcinoma2 cases (0.6%), Intraductal Carcinoma 2 cases (0.6%) and Non-Hodgkins Lymphoma1 case. Out of 305 operated cases, the types of operation performed was ModifiedRadical Mastectomy in 208 cases (68 %) and palliative mastectomy in 72 cases (23.5%),only lumpectomy in 24 cases (7.9%) and others in 2 cases. Among 246 cases withavailable axillary lymph node biopsy, there was metastatic diseases in 146 cases (60%)of cases. The Breast cancer was diagnosed in advanced stages in 63% of cases. StageIIIA (24%), Stage IIIB (21.5%) and Stage IV (17.4%). Breast cancers were diagnosedin advanced stages in below 40 age group in 65 out of 90 cases (72.2 % ) comparedto137 out of 231 cases ( 59.3 % ) in above 40 age group.Key Words: Breast cancer, Advanced stage, FNAC, Surgery.
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Abstract
AIMS To determine whether conventional dipstick tests for proteinuria accurately identified patients with diabetic nephropathy and whether repeat testing for elevated albumin excretion and screening for urinary tract infection was required as part of the screening process for microalbuminuria. METHODS Random urine for albumin/creatinine ratio (ACR) was measured in all patients over a 6-month period. Patients who had a positive test (>3.5 mg/mmol) were requested to provide two further samples for re-testing and a mid-stream urine specimen to screen for asymptomatic bacteriuria. The evaluation of accuracy of dipstick proteinuria was carried out in the samples collected over a fixed 2-week period. RESULTS Dipstick vs. ACR--Of 221 samples collected, 142 were negative, 58 had 1+ and 21 had 2+ or more for dipstick proteinuria. At a threshold of 2+, the majority (81%) had ACR in the overt nephropathy range (>30 mg/mmol) and none had it below 10 mg/mmol, whereas at 1+, only 28% had ACR in the overt nephropathy range and 19% even had normoalbuminuria. Repeat Testing--Of the 1832 patients who had microalbuminuria measured, 673 had a positive test and 248 returned repeat samples. Eighty-one patients returned two samples, of which 16 had discordant results, and 161 patients gave three samples, of which only 23 were false positives. The majority of these 39 patients had low-grade microalbuminuria (ACR 3.5-10 mg/mmol) in their first sample. The absolute benefit of repeat testing was only to 3.4% of the population who screened positive, while in a further 2.3% (two-sample responders) there was potential for confusion because of discordant results. Infection Screening--Of the 248 samples, only 31 had evidence of urinary infection. CONCLUSION Dipstick proteinuria of 1+ does not necessarily represent significant nephropathy. There is little or no benefit in repeat testing outside of the low microalbuminuria range but compliance to such testing is poor. Screening for asymptomatic bacteriuria as part of microalbuminuria screening is of questionable value.
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Affiliation(s)
- V Baskar
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
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Koirala RR, Singh BM, Koirala B, Rana A, Shad SK, Sayami P, Gurung G, Jha R, Sharma GP. Closed Mitral Valvotomy During Pregnancy. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abstract
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Singh BM, Sayami P, Sharma GP. Empyema Necessitatis Presented as Breast Abscess. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
abstract
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Wen Y, Skidmore JC, Porter-Turner MM, Rea CA, Khokher MA, Singh BM. Relationship of glycation, antioxidant status and oxidative stress to vascular endothelial damage in diabetes. Diabetes Obes Metab 2002; 4:305-8. [PMID: 12190993 DOI: 10.1046/j.1463-1326.2002.00212.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To examine the inter-relationships of various microvascular pathogenic mechanisms in diabetic patients. METHODS Patients with diabetes (n = 18) and non-diabetic subjects (n = 18) were studied. RESULTS Blood markers of glycaemic control and glycation differed between the two groups (glucose 10.9 +/- 7.6 vs. 4.7 +/- 0.63 mmol/l, p < 0.01; HbA1c 7.0 +/- 1.3 vs. 4.5 +/- 0.3%, p < 0.001; glycated LDL 8.8 +/- 2.5 vs. 6.1 +/- 1.2%, p < 0.001) but plasma antioxidant status did not. LDL oxidation resistance, measured as lag time to maximum oxidation initiated by copper ions, was decreased in diabetes (58. +/- 14.3 vs. 76.3 +/- 21.5 min, p < 0.01). Both soluble intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), markers of endothelial dysfunction, were significantly higher in diabetes (ICAM 491 +/- 128 vs. 403 +/- 131 micro g/l, p < 0.05; VCAM 546 +/- 157 vs. 393 +/- 106 micro g/l, p < 0.01). Linear correlations were significant between HbA1c and lag time of LDL oxidation (r = -0.39, p < 0.05), ICAM (r = 0.40, p < 0.05) and VCAM (r = 0.38, p < 0.05). LDL oxidizability correlated with vitamin C (r = 0.51, p < 0.01) but not any adhesion molecule. In multivariate analysis, both ICAM and VCAM correlated with HbA1c only (r(2) = 0.16, F = 6.3, p < 0.01; r(2) = 0.14, F = 5.4, p < 0.01 respectively). CONCLUSION In diabetes, glycation, tissue oxidation and endothelial function are all abnormal and predisposing to microvascular complications but interrelationships are complex with glycation appearing most direct.
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Affiliation(s)
- Y Wen
- School of Health Sciences, University of Wolverhampton, Wolverhampton, UK
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Abstract
AIMS To evaluate the influence of addition of rosiglitazone to insulin therapy over a 24-week period in massively obese patients with poorly controlled Type 2 diabetes taking large doses of insulin. METHODS Eight massively obese patients (median body mass index (BMI) 42 kg/m2) with Type 2 diabetes who were on large doses of insulin (median daily dose of 204 U) and/or had poor glycaemic control (median HbA1c of 8.1% (upper limit for normal 5.5%)) were treated over a 24-week period with the combination of insulin and maximum doses of rosiglitazone. Outcomes monitored were changes in weight, BMI, HbA1c, dose of insulin and development of side-effects. RESULTS At the end of 24 weeks there was a median weight gain of 3 kg (P < 0.01), a fall in median HbA1c from 8.1% to 6.7% (16% reduction from baseline) (P < 0.01) and a reduction in median insulin dose from 204 U/day to 159 U/day (P < 0.01) (23% reduction from baseline). Peripheral oedema was the only significant side-effect and was seen in five patients. CONCLUSIONS Combination of insulin and rosiglitazone is effective in massively obese patients with Type 2 diabetes, though there is a high incidence of peripheral oedema.
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Affiliation(s)
- H N Buch
- Wolverhampton Diabetes Centre, New Cross Hospital, UK
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Wen Y, Sahni A, Rea CA, Zhang XH, Khokher MA, Singh BM. Differential antioxidant status among Indo-Asians compared with caucasians with and without diabetes. Wolverhampton Diabetes Research Group. Diabetes Care 2000; 23:254-5. [PMID: 10868841 DOI: 10.2337/diacare.23.2.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Shackleton S, Lloyd DJ, Jackson SN, Evans R, Niermeijer MF, Singh BM, Schmidt H, Brabant G, Kumar S, Durrington PN, Gregory S, O'Rahilly S, Trembath RC. LMNA, encoding lamin A/C, is mutated in partial lipodystrophy. Nat Genet 2000; 24:153-6. [PMID: 10655060 DOI: 10.1038/72807] [Citation(s) in RCA: 478] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The lipodystrophies are a group of disorders characterized by the absence or reduction of subcutaneous adipose tissue. Partial lipodystrophy (PLD; MIM 151660) is an inherited condition in which a regional (trunk and limbs) loss of fat occurs during the peri-pubertal phase. Additionally, variable degrees of resistance to insulin action, together with a hyperlipidaemic state, may occur and simulate the metabolic features commonly associated with predisposition to atherosclerotic disease. The PLD locus has been mapped to chromosome 1q with no evidence of genetic heterogeneity. We, and others, have refined the location to a 5.3-cM interval between markers D1S305 and D1S1600 (refs 5, 6). Through a positional cloning approach we have identified five different missense mutations in LMNA among ten kindreds and three individuals with PLD. The protein product of LMNA is lamin A/C, which is a component of the nuclear envelope. Heterozygous mutations in LMNA have recently been identified in kindreds with the variant form of muscular dystrophy (MD) known as autosomal dominant Emery-Dreifuss MD (EDMD-AD; ref. 7) and dilated cardiomyopathy and conduction-system disease (CMD1A). As LMNA is ubiquitously expressed, the finding of site-specific amino acid substitutions in PLD, EDMD-AD and CMD1A reveals distinct functional domains of the lamin A/C protein required for the maintenance and integrity of different cell types.
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Affiliation(s)
- S Shackleton
- Division of Medical Genetics, Departments of Medicine and Genetics, University of Leicester, Leicester, UK
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Pawar BK, Walford S, Singh BM. Type 1 diabetes mellitus in a routine diabetes clinic: the association of psycho-social factors, diabetes knowledge and glycaemic control to insulin regime. Diabetes Res Clin Pract 1999; 46:121-6. [PMID: 10724090 DOI: 10.1016/s0168-8227(99)00077-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In controlled trials intensified diabetes therapy including multiple insulin injection regimes has been shown to improve glycaemic and microvascular disease outcomes in insulin dependent diabetes but this is not clear in routine outpatient practice. We undertook a pragmatic cross sectional study of 200 patients with Type 1 diabetes aged 18-50 years. There were 108 on two insulin injections/day (conventional) and 92 on four injections/day (multiple) with no significant difference for age, sex, social class, body mass index, diabetes duration, hypoglycaemia rate or complications prevalence. The relationship of insulin injection regime used with diabetes knowledge, psychological factors and glycaemic control outcomes was evaluated. Percent glycated HbA1c concentrations (normal range < 5.5%) were worse in the multiple injection group (7.5 +/- 1.7 vs. 6.8 +/- 1.4%, P < 0.001) (mean +/- SD). Their scores for diabetes knowledge (72.5 +/- 8.2 vs. 69.0 +/- 9.8, P < 0.01) were better but treatment satisfaction (29.9 +/- 5.1 vs. 28.5 +/- 6.1, ns) and well-being (49.1 +/- 10.7 vs. 46.5 +/- 12.7, ns) scores were not. Parameters of perceived locus of control were (multiple v conventional): personal (self), 24.5 +/- 5.0 vs. 22.3 +/- 5.9, P < 0.05; medical (doctor), 11.8 +/- 5.1 vs. 10.8 +/- 5.8, ns; situational (chance), 7.9 +/- 5.1 vs. 8.9 +/- 5.9, ns. In multiple regression of HbA1c versus multiple variables only insulin regime (P < 0.001) was significant. We conclude that in routine clinical practice the use of intensive insulin regimes are associated with worse glycaemic control despite patients being marginally more knowledgeable and self directed.
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Affiliation(s)
- B K Pawar
- Wolverhampton Diabetes Centre, New Cross Hospital, UK
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Abstract
This study was performed to determine the prevalence of hypovitaminosis D (HD) and hypovitaminosis D associated with secondary hyperparathyroidism (HD-SHPT) among Indo-Asians attending rheumatology clinics in Wolverhampton. A cross-sectional survey of 98 clinic attenders and 36 normal controls subjects was undertaken. The groups were matched for age, gender, and body mass index. There was a high prevalence of vegetarianism, and milk consumption was low in both groups. Clinical scores for musculoskeletal pain, gait, and muscle strength were all significantly worse in clinic attenders (p < 0.001). Comparing clinic attenders with controls, 25-OH-vitamin D levels were 6.6 +/- 3.9 vs. 8.2 +/- 4.8 microg/L (p < 0.01) and the prevalence of HD (<8 microg/L) was 78% vs. 58% (p < 0.05), but neither parathyroid hormone levels (53 +/- 60 vs. 50 +/- 18 ng/L, n.s.) nor HD-SHPT prevalence (22% vs. 33%, n.s.) were significantly different. Routine biochemical tests were not discriminant, but none of the controls and 10 of 98 (10%) clinic attenders had elevated alkaline phosphatase levels: 6 with HD and 3 with HD-SHPT. Vitamin D deficiency has an extremely high prevalence among Indo-Asians in the U.K., particularly in those attending rheumatology clinics. Detection of HD and HD-SHPT is only possible using measurements of 25-OH-vitamin D and PTH.
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Affiliation(s)
- E Serhan
- Department of Rheumatology, New Cross Hospital, Wolverhampton, United Kingdom.
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Pickstock PG, Singh BM. Assessing dependency in insulin-treated patients with diabetes supported by a community nursing service. Diabetes Care 1998; 21:1567. [PMID: 9727910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Affiliation(s)
- D C Rees
- MRC Molecular Haematology Unit, Institute of Molecular Medicine, Oxford, United Kingdom
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Abstract
High-frequency in vitro multiplication of disease-free clones of ginger (Zingiber officinale Rosc.) was obtained by culturing small and active buds of ginger on MS medium supplemented with 2 mg/l Kin and 20 g/l sucrose. An average of 7.7 shoots per bud was obtained on this medium after 4 weeks of culture. A high multiplication rate of well-developed plantlets (7.0 shoots per bud) with a 6.8-cm shoot length and a 7.0-cm root length was also obtained on MS medium containing 2.0 mg Kin, 2.0 mg NAA and 20 g sucrose per liter. The multiplication rate did not decrease even up to 28 months of subculture on the same medium. A simple method of successfully transferring more than 95% of tissue-cultured plants into pots was also standardized. In vitro-derived plants performed well under field conditions, were morphologically identical to the mother plants and were free from ginger yellows (Fusarium oxysporum f. sp. zingiberi). Well-developed rhizomes obtained from the tissue-cultured plants did not rot during storage of up to 6 months, thus indicating that the method is also effective in checking storage rot caused by F. oxysporum f. sp. zingiberi.
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Affiliation(s)
- T R Sharma
- Biotechnology Centre, Himachal Pradesh Krishi Vishvavidyalaya, Palampur-176062, India, , , , , , IN
| | - B M Singh
- Biotechnology Centre, Himachal Pradesh Krishi Vishvavidyalaya, Palampur-176062, India, , , , , , IN
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Rees DC, Luo LY, Thein SL, Singh BM, Wickramasinghe S. Nontransfusional iron overload in thalassemia: association with hereditary hemochromatosis. Blood 1997; 90:3234-6. [PMID: 9376610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Singh BM, McNamara C, Wise PH. High variability of glycated hemoglobin concentrations in patients with IDDM followed over 9 years. What is the best index of long-term glycemic control? Diabetes Care 1997; 20:306-8. [PMID: 9051377 DOI: 10.2337/diacare.20.3.306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine variability of long-term glycemic control in patients with IDDM. RESEARCH DESIGN AND METHODS A retrospective analysis of HbA1 among 122 IDDM patients followed over 9 years. RESULTS Annual group mean HbA1 ranged from 8.4 to 9.3% with large standard deviations (1.7-2.0%), indicating marked variability among individuals. Fluctuations of more than +/- 1% HbA1 occurred in 50% of the patients year to year, and over 9 years the minimum-maximum range was > 3 and > 5% HbA1 in 55 and 11% of patients, respectively. In any one year, 22-43% of patients had HbA1 < 8%, but over 9 years only 3.3% were consistently < 8%. Groups divided according to baseline HbA1 of < 8, 8-10, and > 10% were significantly separated over 9 years by frequency distribution analysis of individual mean HbA1 but were indistinguishable when analyzed by individual HbA1 interquartile range (measure of variability). CONCLUSIONS High variability of long-term glycemic control is a marked feature of IDDM, the extent of which may be relevant to microvascular risk.
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Affiliation(s)
- B M Singh
- Department of Endocrinology, Charing Cross Hospital, London, U.K
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Sharma TR, Singh BM. In vitro microrhizome production in Zingiber officinale Rosc. Plant Cell Rep 1995; 15:274-277. [PMID: 24185791 DOI: 10.1007/bf00193735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/1994] [Revised: 06/15/1995] [Indexed: 06/02/2023]
Abstract
Microrhizomes of Zingiber officinale were successfully produced from tissue culture derived shoots by transferring them to liquid MS medium supplemented with 1 mg/l BAP, 2 mg/l calcium pantothenate, 0.2 mg/l GA3 and 0.05 mg/l NAA for shoot proliferation. After 4 weeks of incubation, the medium was replaced with microrhizome induction medium, consisting of MS salts supplemented with 8 mg/l BAP and 75 g/l sucrose. Microrhizome formation started after 20 d of incubation in stationary cultures at 25+1 ° in the dark. Microrhizomes with 1-4 buds and weighing 73.8 to 459 mg each were harvested after 50-60 d. After storage for 2 months in moist sand at room temperature, 80% of the microrhizomes sprouted producing roots and shoots.
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Affiliation(s)
- T R Sharma
- Biotechnology Centre, Himachal Pradesh Krishi Vishvavidyalaya, 176062, Palampur, India
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Krentz AJ, Singh BM, Wright AD, Nattrass M. Effects of autonomic neuropathy on glucose, fatty acid, and ketone body metabolism following insulin withdrawal in patients with insulin-dependent diabetes. J Diabetes Complications 1994; 8:105-10. [PMID: 8061346 DOI: 10.1016/1056-8727(94)90059-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It has been postulated that sympathetic denervation due to autonomic neuropathy may protect against the development of diabetic ketoacidosis in patients with insulin-dependent diabetes. We tested this hypothesis by withdrawing exogenous insulin from five men with established insulin-dependent diabetes and severe symptomatic autonomic neuropathy. Six men also with insulin-dependent diabetes of more than 5-years duration but no clinical evidence of neuropathy served as controls. Normoglycemia was maintained during the night before the study using a variable intravenous insulin infusion that was terminated at 0800 h the following morning (time 0 min). During a 600-min observation period following termination of the insulin infusion the rise (mean +/- SEM) in blood glucose concentration between 0 min and 600 min was comparable between the autonomic neuropathy and control groups (8.2 +/- 1.3 versus 8.3 +/- 1.1 mmol/L; p > 0.1). The rise in plasma nonesterified fatty acids was significantly less for the autonomic neuropathy patients (0.96 +/- 0.06 versus 1.65 +/- 0.14 mmol/L; p < 0.01) with a similar trend for the rise in total ketone body concentration (2.74 +/- 0.85 versus 3.72 +/- 0.38 mmol/L). Capillary pH at 600 min, however, was not significantly different between the groups (23 +/- 2 versus 20 +/- 1 mmol/L). In conclusion, plasma fatty acids and ketone body concentrations rise less rapidly following withdrawal of insulin in patients with insulin-dependent diabetes and autonomic neuropathy suggesting that such patients may have a degree of protection against the development of diabetic ketoacidosis.
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Affiliation(s)
- A J Krentz
- Diabetic Clinic, General Hospital, Birmingham, United Kingdom
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Khanna R, Singh BM. Diagnostic characteristics of child psychiatric service utilizers. Indian J Psychiatry 1994; 36:88-90. [PMID: 21743676 PMCID: PMC2972466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sex, age and diagnostic characteristics of a consecutive series of first contact children seen over a period of one year at a psychiatric center was analyzed Most of (he referrals were for male adolescents. "No diagnosis on Axis I" was quite common, especially in the younger age group; most of them had mental retardation. "Hysteria " was uncommon, and this was the only category which was slightly more common in girls. Manic depressive psychosis was the most common disorder among adolescents.
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Affiliation(s)
- R Khanna
- Rakesh Khanna, MD, Associate Professor of Psychiatry, In-charge Child and Adolescent Psychiatry Unit, Central Institute of Psychiatry, Kanke, Ranchi - 834 006
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Singh BM, Prescott JJ, Guy R, Walford S, Murphy M, Wise PH. Effect of advertising on awareness of symptoms of diabetes among the general public: the British Diabetic Association Study. BMJ 1994; 308:632-6. [PMID: 8148713 PMCID: PMC2539721 DOI: 10.1136/bmj.308.6929.632] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the impact of posters advertising symptoms of diabetes on public knowledge of these symptoms. DESIGN Structured street interviews of members of the general public before, at the end of, and 10 weeks after a campaign advertising the main symptoms of diabetes. SETTING Basingstoke and Wolverhampton. SUBJECTS Three samples of 1000 members of the general public were interviewed. Samples were selected randomly but stratified to match the local population's age (20-75), sex, social class, and racial characteristics. MAIN OUTCOME MEASURES Knowledge of symptoms of diabetes; perceived seriousness of diabetes; and induction of anxiety about symptoms in the target population. RESULTS Advertising significantly raised knowledge (without prompting) of symptoms: thirst, 245 before v 411 at end of campaign (P < 0.0001) v 341 after (P = 0.0012 v before); polyuria, 72 v 101 (P = 0.0211) v 92 (P = 0.5169); lethargy, 180 v 373 (P < 0.0001) v 298 (P < 0.0001); knowledge of weight loss and visual disturbance was unaffected. The number of subjects lacking knowledge of any symptoms was reduced from 550 to 388 (P < 0.0001). The perceived seriousness of diabetes was unaffected (mean 7.6 in each phase on a scale of 1 (not) to 10 (very). Before advertising, 449 (45%) claimed to have one or more symptoms of diabetes, but this number fell at the end of the campaign (403; P = 0.0419) and 10 weeks afterwards (278; P < 0.0001). CONCLUSIONS An advertising campaign raised public knowledge of diabetes symptoms without inducing fear of diabetes or anxiety about symptoms. Its potential for achieving earlier detection of non-insulin dependent diabetes should be evaluated.
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Affiliation(s)
- B M Singh
- Department of Endocrinology, Charing Cross Hospital, London
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Sharma TR, Singh BM, Chauhan RS. Production of disease-free encapsulated buds of Zingiber officinale Rosc. Plant Cell Rep 1994; 13:300-2. [PMID: 24193770 DOI: 10.1007/bf00233325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/1993] [Revised: 11/11/1993] [Indexed: 05/07/2023]
Abstract
Shoot buds of ginger were successfully encapsulated in 4% sodium alginate gel. Encapsulated buds were germinated in vitro to form roots and shoots. In vitro germination (emergence of sprouts) of encapsulated buds ranged from 16.7% to 81.8% on different media after 5 weeks of incubation. Normal plantlets with an average shoot length of 2.3 cm and 1.7 cm root length were successfully transplanted into unsterilized soil without any hardening process. These plantlets showed no symptoms of ginger yellows disease and the causal fungal pathogen failed to grow out on culture media (used as a diagnostic test).
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Affiliation(s)
- T R Sharma
- Biotechnology Centre, Himachal Pradesh Krishi Vishvavidyalaya, 176062, Palampur, India
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Singh BM, Vashisht S, Bachani D. Variations in blood pressure of adolescents in relation to sex and social factors in a rural area of Haryana. Indian J Public Health 1994; 38:14-7. [PMID: 7883307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Adolescent students of a rural block were studied to find out variation in blood pressure in relation to sex, caste and socioeconomic status. Females had significantly higher mean values of blood pressure; both systolic and diastolic. There was significant variation in systolic blood pressure amongst adolescents of various socio- economic classes. Prevalence of systolic hypertension (95 percentile) was higher in adolescents of upper middle social class and diastolic hypertension in Prestige castes. It is suggested that screening for hypertension should be done at school leaving age and high risk adolescents should be advised about periodic check-up, proper diet, salt restrictions and exercise so that frank hypertension could be prevented in adulthood.
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Affiliation(s)
- B M Singh
- Dept. of P&S.M, Lady Hardinge Medical College, New Delhi
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Singh BM, Gostout CJ. Endoscopic hemiclip treatment for gastrointestinal bleeding. Gastrointest Endosc 1994; 40:127-8. [PMID: 8163129 DOI: 10.1016/s0016-5107(94)90000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Singh BM, Krentz AJ, Nattrass M. Insulin resistance in the regulation of lipolysis and ketone body metabolism in non-insulin dependent diabetes is apparent at very low insulin concentrations. Diabetes Res Clin Pract 1993; 20:55-62. [PMID: 8344130 DOI: 10.1016/0168-8227(93)90023-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The insulin sensitivity of intermediary metabolism was studied in 8 non-obese men with well-controlled diet-treated non-insulin dependent diabetes (NIDDM) using a low dose incremental insulin infusion (basal, 0.005 and 0.01 U/kg h-1). Results were compared to 8 healthy male control subjects matched (NIDDM vs. controls, mean +/- S.E.M.) for age (56 +/- 3 vs. 54 +/- 3 years, NS) and body mass index (24.6 +/- 0.7 vs. 25.3 +/- 0.5 kg/m2, NS). Basal fasting concentrations of insulin (4.7 +/- 0.8 vs. 3.2 +/- 0.8 mU/l, NS), glucose, total ketone bodies (TKB), and non-esterified fatty acids (NEFA) were not significantly different between the groups but glycerol concentrations were significantly elevated in NIDDM patients (0.072 +/- 0.007 vs. 0.049 +/- 0.003 mmol/l, P < 0.05). During incremental insulin infusion, plasma insulin concentrations rose to 12.8 +/- 1.5 vs. 10.0 +/- 1.0 mU/l in NIDDM patients vs. control and metabolite concentrations fell significantly (P < 0.001). Significant linear dose-response relationships were found between plasma insulin (log) and glucose, TKB (log), NEFA, and glycerol concentrations by analysis of variance applied to regression (all P < 0.001). For glucose and TKB (log), the group regression lines were parallel but were significantly right-shifted in the NIDDM group (P < 0.001). In contrast, the relationships of insulin (log) and both glycerol and NEFA concentrations converged over the observed range of insulin concentrations. Significant displacement of glycerol and NEFA dose-response relationships were found in NIDDM patients at an insulin concentration of 5 mU/l (P < 0.001) but not at 12.5 mU/l.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B M Singh
- Diabetic Clinic, General Hospital, Birmingham, UK
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Marks SJ, Bennett MD, Zisfein J, Singh BM. Nosocomial stroke. J Stroke Cerebrovasc Dis 1993; 3:112-4. [PMID: 26487256 DOI: 10.1016/s1052-3057(10)80236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nosocomial stroke occurs during hospitalization for unrelated problems. Increased understanding of this relatively ignored entity may provide the key to improved stroke prophylaxis for the hospitalized patient at risk and provide clues to the precipitants of stroke in the general population. We compared nosocomial stroke to stroke occurring outside the hospital in a mixed prospective and retrospective analysis of 372 consecutive strokes occurring over 2 years. We excluded nosocomial stroke associated with cardiac bypass surgery, carotid endarterectomy, and cerebral angiography for cerebrovascular disease because of the known associations of these procedures with stroke. Of our 372 strokes, 47 were nosocomial. There were no significant age and sex differences between nosocomial stroke and stroke admissions. Nosocomial stroke patients were significantly more likely than stroke admission patients to be normotensive (p = 0.001), diabetic (p = 0.01), and have cardiac disease (p = 0.03). Nosocomial stroke patients were significantly less likely to have brain hemorrhages (p = 0.001), lacunar infarcts (p = 0.03), or infarcts of undetermined cause (p = 0.047). Half of the nosocomial stroke patients died versus 11% of stroke admission patients. Nosocomial stroke differs in stroke type, associated diseases, and prognosis from stroke occurring outside the hospital.
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Affiliation(s)
- S J Marks
- From the Departments of Neurology, New York Medical College, Valhalla, NY
| | - M D Bennett
- From the Departments of Neurology, New York Medical College, Valhalla, NY
| | - J Zisfein
- New York Medical College, Lincoln Hospital Campus, Bronx, NY, U.S.A
| | - B M Singh
- From the Departments of Neurology, New York Medical College, Valhalla, NY
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Abstract
Four hundred and six white caucasian patients with diabetes mellitus (243 male, mean age 54 +/- 16 (SD) years) were screened for haemochromatosis. Four patients had a fasting transferrin saturation > 62% and all were HLA A3 positive. Two were probable homozygotes for haemochromatosis and two heterozygotes. Homozygote haemochromatosis prevalence in this diabetic population was therefore 2/406 (0.0049) which is identical to that reported in the general population. These findings do not support a genetic relationship between the two conditions.
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Affiliation(s)
- B M Singh
- Department of Endocrinology, Charing Cross Hospital, London, UK
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Robertson DA, Singh BM, Hale PJ, Nattrass M. Effects of morbid obesity on insulin clearance and insulin sensitivity in several aspects of metabolism as assessed by low-dose insulin infusion. Metabolism 1992; 41:604-12. [PMID: 1640847 DOI: 10.1016/0026-0495(92)90052-c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity is associated with impaired insulin action in glucose disposal, but not necessarily in other aspects of intermediary metabolism or insulin clearance. Sixteen morbidly obese and 14 normal-weight subjects (body mass index, 51.2 +/- 11.5 v 22.1 +/- 2.2 kg.m-2; mean +/- SD) were studied with sequential, low-dose, incremental insulin infusion with estimation of glucose turnover. In obese patients, basal plasma insulin was higher (10.5 +/- 3.8 v 2.4 +/- 3.0 mU.L-1, P less than .001) and remained elevated throughout infusion (F = 492, P less than .001), as did C-peptide (F = 22.7, P less than .001). Metabolic clearance rate for insulin (MCRI) at the highest infusion rate was similar (1,048 +/- 425 v 1,018 +/- 357 mL.m-2.min-1, NS). Basal hepatic glucose production in obese subjects was less than in normal-weight subjects (270 +/- 108 v 444 +/- 68 mumol.m-2.min-1, P less than .01), as was the basal metabolic clearance rate for glucose (MCRG, 77 +/- 26 v 108 +/- 31 mL.m-2.min-1, P less than .05). Insulin infusion caused blood glucose to decrease less in the obese patients (1.4 +/- 0.5 v 1.9 +/- 0.5 mmol.L-1, P less than .05); hepatic glucose production was appropriately suppressed in them by hyperinsulinemia, but their insulin-mediated glucose disposal was reduced (1.67 [0.79] v 4.45 [2.13] mL.m-2.min-1/mU.L-1, P less than .01). Concentrations of nonesterified fatty acids (NEFA), glycerol, and ketones were elevated throughout the insulin infusions in obese patients, despite the higher insulin concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
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