Anti-aging effect of nifuroxazide on skin changes of aged male rat models via modulating immunoreactivity of IL-6/NF-κB/Caspase-3

PURPOSE

To evaluate nifuroxazide's (NIF's) anti-aging characteristics in a skin-aging rat model for the first time in order to create effective preventive measures and anti-aging skin therapies.

MATERIALS AND METHODS

Thirty randomly selected aged male rats were assorted into three equal groups; aged control group, treated NIF I, aged rats were treated with NIF (10mg/kg, orally once daily for 14 consecutive days), and treated NIF II, aged rats were treated with NIF (20mg/kg, orally once daily for 14 consecutive days). Skin samples were obtained from the dorsal skin of the aged male rats and processed for tissue biochemical MDA, histological (Hx&E and Masson's Trichrome stains), and immunohistochemical (IL-6, NF-κB, and caspase-3) analysis.

RESULTS

Group I aged male albino rat skin illustrated evident distorted epidermis and dermis, disorganization of collagen fibers with marked multiple spaces of collagen fibers loss in the dermis, marked reduction of total epidermal thickness and mean area percent of collagen fibers, elevated tissue MDA level and strong positive IL-6, NF-κB, and caspase-3 immune reaction. The anti-aging benefits of NIF on skin aging are demonstrated by a marked improvement in histological alterations in the form of a well-organized epidermis and dermis, most collagen fibers in the dermis appear closely packed, significant elevation of total epidermal thickness and mean area percent of collagen fibers, a significant decrease of tissue MDA level, and immunoexpression of the inflammatory markers, IL-6, and NF-κB, and the apoptotic marker caspase-3.

CONCLUSIONS

This study found that group III, which received 20mg/kg of NIF, experienced more pronounced and noticeable improvements in skin aging than group II, which received 10mg/kg of NIF.

Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results

BACKGROUND

Bile duct injury (BDI) is one of the serious complications of cholecystectomy procedures, which has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigation. The standard treatment of major BDI is hepaticojejunostomy (HJ). Surgical outcomes depend on many factors, including the severity of the injury, the surgeons' experiences, the patient's condition, and the reconstruction time. The authors aimed to assess the impact of reconstruction time and abdominal sepsis control on the reconstruction success rate.

METHODS

This is a multicenter, multi-arm, parallel-group, randomized trial that included all consecutive patients treated with HJ for major post-cholecystectomy BDI from February 2014 to January 2022. Patients were randomized according to the time of reconstruction by HJ and abdominal sepsis control into group A (early reconstruction without sepsis control), group B (early reconstruction with sepsis control), and group C (delayed reconstruction). The primary outcome was successful reconstruction rate, while blood loss, HJ diameter, operative time, drainage amount, drain and stent duration, postoperative liver function tests, morbidity and mortality, number of admissions and interventions, hospital stay, total cost, and patient QoL were considered secondary outcomes.

RESULTS

Three hundred twenty one patients from three centres were randomized into three groups. Forty-four patients were excluded from the analysis, leaving 277 patients for intention to treat analysis. With univariate analysis, older age, male gender, laparoscopic cholecystectomy, conversion to open cholecystectomy, failure of intraoperative BDI recognition, Strasberg E4 classification, uncontrolled abdominal sepsis, secondary repair, end-to-side anastomosis, diameter of HJ (< 8 mm), non-stented anastomosis, and major complications were risk factors for successful reconstruction. With multivariate analysis, conversion to open cholecystectomy, uncontrolled sepsis, secondary repair, the small diameter of HJ, and non-stented anastomosis were the independent risk factors for the successful reconstruction. Also, group B patients showed decreased admission and intervention rates, decreased hospital stay, decreased total cost, and early improved patient QoL.

CONCLUSION

Early reconstruction after abdominal sepsis control can be done safely at any time with comparable results for delayed reconstruction in addition to decreased total cost and improved patient QoL.

Remote temperature sensing with a low-threshold-power erbium-doped fiber laser

A temperature sensor realized by a single-wavelength erbium-doped fiber laser is demonstrated in this work. The configuration of the laser cavity is linear, comprising a physical mirror at one end, and the other end is formed by a combination of a fiber Bragg grating and random distributed Rayleigh feedback of a 30 km single-mode fiber. As a result of erbium amplification, the laser has low threshold pump power at 10.6 mW. Additionally, the laser has good stability with power fluctuations of less than 0.37 dB over a 30 min duration. With this fiber laser, a temperature sensor with sensitivity of 10.6 pm/°C can be realized for a temperature range from 30°C-90°C. The sensitivity value is comparable with those obtained with Raman-based fiber lasers, albeit with the requirement of lower threshold pump power.

Pancreatic Pseudocyst Dilemma: Cumulative Multicenter Experience in Management Using Endoscopy, Laparoscopy, and Open Surgery

BACKGROUND

Pancreatic pseudocyst (PP) is the commonest cystic lesion of the pancreas. Internal drainage of PPs can be accomplished by traditional open or recently by minimally invasive laparoscopic or endoscopic approaches. We aimed to evaluate and compare the clinical outcomes after endoscopic, laparoscopic, and open drainage.

METHODS

Seventy-one patients with PP underwent endoscopic (n = 35), laparoscopic (n = 4), and open surgical drainage (n = 32). The primary outcome was the success rate. The secondary outcomes were the estimated blood loss, operative time, opioid requirement, morbidity and mortality, length of hospital stay, and recurrence rate.

RESULTS

The primary success rate was significantly higher for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups. There were no significant differences in the morbidity, mortality, requirement of blood transfusion, reinterventions, and recurrence rate between the groups. Endoscopic drainage revealed significantly lower blood loss, operative time, opioid requirement, and hospital stay in comparison to open and laparoscopic drainage.

CONCLUSION

Minimally invasive therapeutic techniques, whether endoscopic or laparoscopic for treatment of PP could be considered valuable, competitive, and promising alternatives for open surgery. Moreover, it is less invasive with less hospitalization and rapid return to work.

Effect of periampullary diverticulum on technical success and complications of endoscopic retrograde cholangiopancreatography: Single center experience

Context: The incidence of the periampullary duodenal diverticulum (PAD) varies widely from 1 to 32.8%. Although it is usually asymptomatic, its association with various pathological conditions such as choledocholithiasis increased the incidence of complications and cannulation failures after endoscopic retrograde cholangiopancreatography (ERCP) has been well recognized in various studies. Aim: The aim of this study was to investigate and compare the success rate, difficult cannulation, and complications between patients with and without PAD. Settings and Design: A prospective observational study. Subjects and Methods: The study includes 1022 consecutive patients who underwent an ERCP during the period from June 2010 to June 2015. The patients were divided into 2 groups according to the presence (Group A, 114 patients) or absence (Group B, 908 patients) of PAD. Statistical Analysis Used: SPSS version 16. Results: Successful cannulation was achieved in up to 90.4% and 95.9% in Groups A and B, respectively (P = 0.12). The difficulty at attempting this goal was different between the groups (33.3% vs. 16%, P < 0.001). Duodenal perforation and recurrent biliary stones formation were the only significant post-ERCP complications between both groups. Multivariate logistic regression analysis showed 3 significant variables (abnormal papilla, the presence of diverticula, and stricture) with odds ratios indicating a difficult cannulation attempt. Conclusion: The finding of a PAD should not be considered an obstacle to a successful biliary cannulation, but requires more skills. However, it is associated with difficult cannulation, prolonged cannulation and procedure time, decreased the rate of successful stone removal, and increased the incidence of primary and recurrent biliary stones formation.

Energy-Aware Manufacturing Using Information Technology Tools

This manuscript discusses the implementation of information technology tools; specifically, computerized Knowledge Based Systems (KBS), in managing the energy flows, conversions, and expenditures within manufacturing environments; including renewable energy sources (namely, landfill gas). The study presents actual KBS embodiments in energy auditing, modeling, and optimization. Additionally, the text presents how IT tools can be used at a system level to integrate sustainability planning within manufacturing planning. The developed tool also addresses the question “how energy-efficient are renewable energy sources” using a novel simulation platform based on hybrid scheme.

Enhanced glucose uptake via GLUT4 fuels recovery from calcium overload after ischaemia-reperfusion injury in sevoflurane- but not propofol-treated hearts

BACKGROUND

So far, no study has explored the effects of sevoflurane, propofol, and Intralipid on metabolic flux rates of fatty acid oxidation (FOX) and glucose oxidation (GOX) in hearts exposed to ischaemia-reperfusion.

METHODS

Isolated paced working rat hearts were exposed to 20 min of ischaemia and 30 min of reperfusion. Peri-ischaemic sevoflurane (2 vol%) and propofol (100 µM) in the formulation of 1% Diprivan(®) were assessed for their effects on oxidative energy metabolism and intracellular diastolic and systolic Ca(2+) concentrations. Substrate flux was measured using [(3)H]palmitate and [(14)C]glucose and [Ca(2+)] using indo-1AM. Western blotting was used to determine the expression of the sarcolemmal glucose transporter GLUT4 in lipid rafts. Biochemical analyses of nucleotides, ceramides, and 32 acylcarnitines were also performed.

RESULTS

Sevoflurane, but not propofol, improved the recovery of left ventricular work (P=0.008) and myocardial efficiency (P=0.008) compared with untreated ischaemic hearts. This functional improvement was accompanied by reduced increases in post-ischaemic diastolic and systolic intracellular Ca(2+) concentrations (P=0.008). Sevoflurane, but not propofol, increased GOX (P=0.009) and decreased FOX (P=0.019) in hearts exposed to ischaemia-reperfusion. GLUT4 expression was markedly increased in lipid rafts of sevoflurane-treated hearts (P=0.016). Increased GOX closely correlated with reduced Ca(2+) overload. Intralipid alone decreased energy charge and increased long-chain and hydroxyacylcarnitine tissue levels, whereas sevoflurane decreased toxic ceramide formation.

CONCLUSIONS

Enhanced glucose uptake via GLUT4 fuels recovery from Ca(2+) overload after ischaemia-reperfusion in sevoflurane- but not propofol-treated hearts. The use of a high propofol concentration (100 µM) did not result in similar protection.

Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006

INTRODUCTION

Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown.

METHODS

The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older.

RESULTS

In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations.

CONCLUSION

The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.

Persistence with weekly alendronate therapy among postmenopausal women

INTRODUCTION

Although clinical trials indicate that oral bisphosphonates reduce osteoporotic fracture risk, compliance with bisphosphonate therapy in practice is suboptimal, with 1-year discontinuation rates exceeding 50%.

METHODS

We conducted a retrospective cohort study among female members of a large integrated health care delivery system (Kaiser Permanente of Northern California), age 45 years and older, to determine their persistence with weekly alendronate (defined as continuous use, allowing for a refill gap of 60 days), predictors of discontinuation, and subsequent osteoporosis therapy. We also examined the effect of varying the refill gap from 30 to 120 days on the discontinuation rate. From 2002 through 2003, we identified 13,455 women (age 68.8+/-10.4 years) who initiated weekly oral alendronate therapy.

RESULTS

Using a 60-day refill gap, the 1-year discontinuation rate was 49.6% [95% confidence interval (CI) 48.8-50.4%]; this increased to 58.0% (CI 57.2-58.8%) with a 30-day gap and decreased to 42.2% (CI 41.1-43.0%) with a 120-day gap. Among those who discontinued therapy, about one-third restarted alendronate or another osteoporosis drug within 6 months. Baseline factors associated with alendronate discontinuation included prior bone mineral density testing [adjusted odds ratio (OR) 0.64, CI 0.60-0.69], prior postmenopausal hormone therapy (OR 0.78, CI 0.73-0.84), prior high-dose oral glucocorticoid therapy (OR 1.26, CI 1.05-1.51), prior gastrointestinal diagnoses (OR 1.21, CI 1.09-1.36), and high number of therapeutic classes of prescriptions filled in the prior year (OR 1.21, CI 1.10-1.32), although the final model had limited explanatory power.

CONCLUSIONS

We conclude that apparent discontinuation rates are high within 1 year after treatment initiation, although a subset of women appears to restart bisphosphonate or other osteoporosis therapy. Because intermittent use and/or poor adherence is common, discontinuation rates based on data from administrative databases are sensitive to the refill gap length. In addition, we identified no clinical factors highly predictive of discontinuation.

Epidermoid cyst in a solitary testis: A case for non-surgical management

This is a case report of a 71-year-old man who presented with an incidental finding of a mass in a solitary right testis. A scrotal ultrasound scan showed the typical features of a testicular epidermoid cyst. Tumour markers were not elevated and the patient was managed non-operatively. On reviewing the literature, we found no previous report on the non-operative management of testicular epidermoid cysts

Microvascular complications in South African patients with long-duration diabetes mellitus

OBJECTIVE

To determine the prevalence of microvascular complications in South African black and Indian patients with long-duration diabetes mellitus (DM).

DESIGN

A retrospective analysis was undertaken of clinical records of 219 DM patients (132 black, 87 Indian) with long-duration DM (over 10 years) attending a diabetes clinic in Durban. Data recorded on each subject included demographic details (age, gender, ethnic group, type of diabetes, age of onset and duration of diabetes), presence of retinopathy, markers of nephropathy and biochemical variables. The prevalence of complications and the clinical and biochemical parameters were evaluated for type 1 and type 2 diabetes and for each ethnic group.

RESULTS

Of the 219 patients, 47 had type 1 DM (36 blacks, 11 Indians) and 172 were classified as type 2 DM (96 blacks, 76 Indians). The mean age of onset of DM was later in blacks than Indians, both for type 1 (P < 0.05) and type 2 DM (P < 0.01). In patients with type 1 DM, the prevalence of retinopathy was 53.2% (blacks 55.6%, Indians 45.5%), persistent proteinuria was found in 23.4% (blacks 25%, Indians 18.2%) and hypertension in 34%. No ethnic difference was found except for the prevalence of hypertension which was higher in blacks than Indians (41.7% v. 9.1%, P < 0.5). Onset of retinopathy from time of diabetes diagnosis occurred earlier in blacks than Indians (13.0 +/- 4.6 yrs v. 18.0 +/- 4.6 yrs, P < 0.05). For the type 2 DM group, retinopathy was found in 64.5% (black v. Indian 68.8 v. 59.2%) and persistent proteinuria in 25% (black v. Indian 30.2 v. 18.4%). Hypertension was observed in 68% and was more prevalent in blacks (84.4 v. 47.4%, P < 0.01) There was an earlier onset of retinopathy (P < 0.05) and hypertension (P < 0.01) from time of diabetes diagnosis in blacks than Indians. In the type 1 DM group retinopathy was associated with a significantly longer duration of diabetes (P < 0.05) and higher glycated haemoglobin (HbA1) (P < 0.05). For type 2 DM subjects there was a significant association between retinopathy and longer duration of diabetes (P < 0.05) and higher systolic blood pressure (P < 0.05).

CONCLUSION

This study has shown that there is a high prevalence of microvascular complications in South African patients with long-duration diabetes mellitus.

Rhabdomyolysis and HMG-CoA reductase inhibitors

OBJECTIVE

To review rhabdomyolysis and discuss the role of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) and their interactions with other agents in precipitating this condition, and to present case reports of statin-induced rhabdomyolysis.

DATA SOURCE

Relevant clinical literature was accessed using MEDLINE (January 1985-October 2000). The following search terms were used: rhabdomyolysis, adverse events, drug interactions, statins, and HMG-CoA reductase inhibitors.

DISCUSSION

Rhabdomyolysis occurs when extensive muscle damage results in the release of cellular contents into systemic circulation. Major complications include acute renal failure, cardiac abnormalities, and compartment syndrome. Treatment of rhabdomyolysis is supportive, with the primary aim of preventing renal and cardiac complications. Statin monotherapy or combination therapy may result in myopathy, which rarely progresses to rhabdomyolysis. The mechanism for drug interactions with the statins involves their property of lipid or water solubility. This characteristic determines the degree of hepatoenteric or renal metabolism of the statins. All statins except pravastatin undergo metabolism via the cytochrome P450 enzyme system. Other pharmacologic agents that are also metabolized via this pathway may interact with the statins and cause rhabdomyolysis. The risk of statin-induced rhabdomyolysis is increased significantly when statins are used concomitantly with such drugs as fibrates, cyclosporine, macrolide antibiotics, and azole antifungals.

CONCLUSIONS

Rhabdomyolysis is a rare but clinically important adverse event of statin monotherapy or combination therapy. Thorough understanding of this condition may help prevent or minimize adverse health outcomes in patents receiving statin therapy.

Healthy eating for rural low-income toddlers: caregivers' perceptions

Caregivers exert a powerful influence on young children's eating habits. This qualitative study used focus groups to assess nutritional needs and barriers in establishing healthy eating habits in toddlers. Three focus groups were conducted with rural, low-income caregivers, 2 with men and 1 with women, in 3 rural Michigan counties. Four major themes emerged: (a) barriers to providing healthy meals, (b) division of responsibility, (c) mealtime behavior, and (d) desired nutrition education. The major barriers identified were work schedules; cost of food; inadequate time to shop, plan, and prepare nutritious meals; or a combination thereof. Caregivers expressed concern for the nutritional well-being of their toddlers. The perceived needs and perceptions of low-income caregivers need to be considered when providing nutrition education. Findings from this study provided the basis for developing a nutrition education intervention for low-income parents of young children.

Development and testing of the patient expectations and satisfaction with prenatal care instrument

Addressing consumer needs requires the development of a valid means of specifically measuring pregnant women's satisfaction with prenatal care. This study's purpose was to develop items for, to pilot-test, and to examine the structural validity of the Patient Expectations and Satisfaction with Prenatal Care (PESPC) instrument. Extant literature and information obtained from focus groups were used in the development. The PESPC was pilot-tested with a sample of 114 pregnant women receiving prenatal care. To structurally validate the PESPC, data collected from 587 women who participated in a cross-sectional, self-administered survey were used. Structural equation modeling and confirmatory factor analysis were used to develop and cross-validate the PESPC. The PESPC was found to be structurally valid, and the subscales of Expectations and Satisfaction demonstrated acceptable levels of internal consistency.

HLA class II antigens in South African Blacks with type I diabetes

Type 1 diabetes mellitus is poorly characterised in many African communities, including South Africa, where little is known of the disease epidemiology. This study aimed to identify the HLA class II alleles associated with type 1 diabetes in a group of Zulu subjects in Durban, KwaZulu-Natal by PCR-SSP. The HLA alleles associated with type 1 diabetes included HLA-DQB*0302 (P<0.0001), DRB1*O9 (P<0.0001), DRB1*04 (P=0.002), DRB1*0301 (P=0.003), DQB*02 (P=0.004) and DQA*03 (P=0.035). Estimated haplotypes positively associated with type 1 diabetes included HLA-DRB1 *0301-DQA*0501, DRB1*04-DQA*03, DRB1*04-DQB*0302, DRB1*0301-DQB*0201, DQA*0501-DQB*0201 and DQA*03-DQB*0302. These findings are similar to those reported from Zimbabwe and other populations with type 1 diabetes.

Application of the new ADA criteria for the diagnosis of diabetes to population studies in sub-Saharan Africa. American diabetes association

AIMS

To examine the implications for epidemiological studies of the American Diabetes Association (ADA) recommendation that the fasting blood glucose at a lowered level becomes the main diagnostic test for diabetes on cross-sectional-based data from sub-Saharan Africa.

METHODS

Data from 11 surveys conducted in rural, peri-urban and urban Cameroon (n = 1804), South Africa (n = 3799) and Tanzania (n = 10013) which measured fasting (ADA criteria) and 2-h blood glucose concentrations during a standard 75 g OGTT (old WHO criteria) were analysed.

RESULTS

The prevalence of diabetes was higher in eight of the 11 surveys when applying the new ADA compared to the old WHO criteria. With the exception of one population (Mara, Tanzania) the absolute difference in prevalence between the two classifications tended to be small (< 2%). There was considerable variation in the categorization of individuals using the ADA and old WHO criteria. The level of agreement between the two ranged from fair to good (Kappa statistic 0.17-0.86). The prevalence of impaired fasting glycaemia (IFG) was lower than that of impaired glucose tolerance (IGT) in 10 of the surveys and the agreement between the two was fair, < or = 0.26 in all the surveys.

CONCLUSIONS

Although the use of the new ADA fasting criteria for prevalence surveys is an attractive and practical option, particularly in Africa, further information is required on the characteristics and prognosis of individuals classified as IFG or diabetic by the fasting criteria, prior to wide adoption of the ADA criteria. Ideally measurement of both fasting and two low glucose concentrations should remain the standard for epidemiological studies.

Satisfaction and adequacy of prenatal care utilization among rural low-income women

This study was designed to describe adequacy and satisfaction with prenatal care in a group of rural low-income women (n = 60) and to determine whether either was correlated with birth outcomes. Despite less than adequate prenatal care in 50% of the women, they were satisfied with their care, and outcomes for infants were good. When compared with women who received adequate prenatal care, there were no differences between the two groups. Tailoring prenatal care to individual needs, including care provided by certified nurse midwives with fewer prenatal visits, could be cost-effective without sacrificing quality. It is time to reexamine the recommended prenatal visit structure and care delivery in this country.

Recipient and provider perspectives of barriers to rural prenatal care

Barriers to prenatal care have been linked to inappropriate service usage and poor health outcomes of mothers and infants. This study describes barriers to prenatal care, as identified by low-income recipients and providers of prenatal care in a small rural county in the Midwest. A prospective survey design and focus group were used. An unexpected finding occurred. Almost half of the recipients identified no barriers to prenatal care; however, these women still received less than adequate prenatal care. Providers identified the attitudinal barrier of women as not valuing prenatal care, but the women did not. Some women were found to need information about availability and eligibility for Medicaid and other services. Issues surrounding prenatal care for rural women are complex and subtle. Community health nursing can inform and influence community leaders and members about prenatal care services for rural low-income women.

Transient impaired glucose tolerance in South African Indians does not carry a risk for progression to NIDDM

OBJECTIVE

To evaluate the significance of transient impaired glucose tolerance (IGT) in terms of the risk of progression to NIDDM and the serum insulin response during oral glucose tolerance test (OGTT) in a prospective study on the natural history of IGT in South African Indians.

RESEARCH DESIGN AND METHODS

This is a report on 87 subjects who formed part of a 4-year prospective study in 128 subjects classified with IGT at baseline (year 0) using World Health Organization criteria for glucose tolerance. Subjects were reexamined at years 1 and 4. At year 1, based on OGTT results, the subjects were divided into three groups: transient IGT (normal glucose tolerance [trIGT], n = 40), persistent IGT (pIGT, n = 47), and diabetes (n = 41). Analysis was performed on the 87 subjects who were classified as IGT at year 0, but who had not progressed to NIDDM by year 1 of the study At baseline (year 0), a modified OGTT was performed; between years 1 and 4, the OGTT included timed midtest samples for plasma glucose and serum insulin. Analysis of predictive factors for progression to diabetes or reversion to normal glucose tolerance was undertaken using year 0 as baseline.

RESULTS

By year 4, 72 subjects (82.8%) completed the study Of the 32 subjects in the trIGT group, none (0%) had progressed to NIDDM, 11 (34.4%) had reverted to IGT (N-IGT), and 21 (65.6%) had persisted with normal glucose tolerance (N-N); of the 40 subjects in the pIGT group, 16 (40%) had progressed to NIDDM (IGT-D), 17 (42.5%) had persisted with IGT (IGT-IGT), and 7 (17.5%) had reverted to normal glucose tolerance (IGT-N). Significant predictive factors for reversion to normal glucose tolerance included absence of obesity (P = 0.0131, odds ratio [OR] 4.2, 95% CI 1.4-13.1) and 2-h plasma glucose level (P = 0.027, OR 2.4, 95% CI 1.11-5.13) at baseline (year 0). Intergroup (cross-sectional) analysis showed that the serum insulin response was higher in the pIGT than in the trIGT subgroup (fasting serum insulin: IGT-N vs. N-IGT and N-N, 16.9 +/- 1.9 vs. 6.8 +/- 2.1 and 6.1 +/- 2.4 microU/ml, respectively, P < 0.001; 2-h postload serum insulin: IGT-IGT vs. N-IGT, 116.8 +/- 2.2 vs. 60.3 +/- 1.7 microU/ml, P < 0.05). By contrast, the insulinogenic index was higher in the trIGT subgroups both at year 1 (90-min: N-N vs. IGT-D, 48.9 +/- 3.9 vs. 14.1 +/- 2.5; P < 0.05) and at year 4 (N-N vs. remaining four subgroups, P < 0.01 at 60 min and 90 min). Intragroup (prospective) comparisons showed that in the N-IGT subgroup, the mean 2-h insulinogenic index was lower at year 4 than at year 1 (19.9 +/- 1.7 vs. 66.0 +/- 2.7; P < 0.05).

CONCLUSIONS

In this 4-year prospective study in South African Indians, transient IGT carries no risk of progression to NIDDM. The significant predictive factors for reversion to normal glucose tolerance include lower baseline obesity prevalence and 2-h postload plasma glucose level. Moreover, in this group, beta-cell secretory function appeared to deteriorate with worsening of glucose tolerance.

Shaping the health of the nation: development of human resources in Eritrea

Looks at human resources (HR) issues with regard to the health care system in Eritrea, the newest nation in Africa with a population of 3.5 million. Notes the problems of poor infrastructure, high mortality rates and poverty. Considers the present situation and future requirements in terms of HR. Features programmes being established aimed at bridging this gap and looks particularly at initiatives aimed at enabling ex-combatants who have wartime health care experience to train further as health workers.

The significance of a positive family history in South African Indians with non-insulin-dependent diabetes (NIDDM)

A group of South African Indians with NIDDM participated in a study to evaluate the frequency of positive family histories of the disease and to determine the relative contribution of maternal or paternal genetic determinants. Information was elicited by means of an interview and recorded. Of the 1098 diabetic subjects studied 70% gave a positive family history of a first degree relative suffering from NIDDM. Three-generation transmission was recorded in 5.3% of the subjects. A significantly greater proportion of probands (40%) had a mother with NIDDM than those with a father (26%). A positive family history in an offspring was more common in female probands (10.6%) than males (5.5%). Twice as many probands with 3 generation transmission had a maternal grandmother suffering from NIDDM (2.5%) compared with those who had a paternal grandmother afflicted (1.2%) (P < 0.05), whereas the frequencies in the maternal (0.9%) and paternal (0.8%) grandfathers were similar. This study has highlighted, not only the high prevalence of a positive family history in South African Indians with NIDDM, but also a stronger maternal contribution to the putative gene responsible for the disease.

Pregnant women's perceptions of prenatal care

PROBLEM

To describe pregnant women's perceptions in two specific areas: expectations about prenatal care and satisfaction with prenatal care.

METHOD

A focus group technique using a semi-structured interview format. Three focus groups (N = 22) were conducted in the third trimester of pregnancy. Data were transcribed from the taped sessions and studied using content analysis.

FINDINGS

Three major dimensions of satisfaction were identified: satisfaction with health care provider(s); satisfaction with support staff; and satisfaction with the prenatal care, including the desire for continuity of provider, clear explanations, and accessible quality care.

CONCLUSIONS & IMPLICATIONS FOR NURSING

The provider relationship was identified as having the greatest influence on the women's satisfaction with prenatal care. Satisfaction with prenatal care can be enhanced through positive provider-patient interactions.

Acute hypoglycaemic coma--a rare, potentially lethal form of early onset Sheehan syndrome

This case emphasizes the importance of intensive obstetric management that is required when confronted with prolonged postpartum haemorrhage. Anticipation of the possibility of acute hypoglycaemic coma as an initial manifestation of Sheehan syndrome and prompt recognition may prevent disastrous consequences, including maternal death.

Rapid surveys in support of district health information systems: an experience from Uganda

The role of rapid health assessment in generating data other than routine reporting for a multi-element primary health care information system is presented. Rapid surveys, based on the adaptation of the WHO/EPI cluster survey methodology, may generate reliable and valid results useful for the support of a managerial PHC information system. However, because of the limitations inherent to the method, so far, only few studies have investigated more than few PHC related issues. The experience of a household rapid survey conducted in Arua District, Uganda, using a modified EPI cluster survey methodology, is reported. Rapid appraisal methods were used to prioritize the information requirement and to identify the survey items. Fully supervised teams of primary school teachers were used as interviewers. Data processing, check and analysis were speeded up by a lap-top computer, in spite of problems of erratic power. Within a 10-day time span between the start of the survey and the publishing of results, data on health services' utilization, health seeking behaviour, coverage of PHC services, including immunization, and anthropometric data on the nutritional status of under-five children were obtained. Standard errors and 95% confidence intervals were calculated taking into account the variability of the parameters under investigation and true design effects were computed. The findings were utilized for the identification of health priorities and the monitoring of effectiveness of programmes, as well as to validate routine reporting. The methodological package was built up looking at the local context, so that it could become an operational tool for the district health management team.

Developing an information system to support the pursuit of decentralization. The perspective of Cearà State in Brazil

Discusses the national health information system in Brazil which, until very recently, consisted of two main structures of health services with a dichotomy between curative and preventive health care acting in a vertical manner. The autonomy of health authorities and specialized structures created numerous independent health information systems with different methods of data collection. Although the issues of decentralization and a unified health system had been agreed on in 1963, they had not been implemented until the new health policy reform was lunched in 1988. The reform was based on the strengthening of primary health care at national level and accelerating decentralization of health systems. However, in spite of strong political will the new health managers at local level are lacking essential information, data and instruments that only a decentralized health management information system can provide. Based on a study conducted in the Cearà State of the north east of Brazil, explores how the present health information system can support the process of decentralization.

Evidence for impaired pancreatic beta cell function in South African Indians with impaired glucose tolerance

In a prospective study of South African Indians with impaired glucose tolerance (IGT), the serum insulin response during a 75 g oral glucose tolerance test (OGTT) was examined in 128 subjects who were classified as IGT 1 year previously (year 0) and in 60 matched control subjects. Based on the results at year 1, study subjects were divided into three groups, using World Health Organization criteria for glucose tolerance: IGT (n = 47), diabetes (n = 41), and transient IGT (normal glucose tolerance) (n = 40). When compared with the control group, despite higher plasma glucose concentrations, the IGT group showed similar fasting insulin, but lower 30-min insulin response (57.4 +/- 1.9 mUl-1 vs 86.5 +/- 1.8, p < 0.001) and lower 30-min insulin/glucose ratio (7.4 +/- 5.2 vs 13.3 +/- 8.7, p < 0.001). The insulinogenic index was lower in the IGT group than in the control group at 30, 60, 90, and 120 min (p < 0.01, p < 0.001, p < 0.001, p < 0.001, respectively). The 2-h insulin response was higher in the IGT group (106.7 +/- 1.9 mUl-1 vs 59.2 +/- 1.9, p < 0.01). The IGT group displayed a delayed pattern of insulin response with maximum levels only at 2-h. Insulin area was similar in the two groups. In the transient IGT group, despite similar plasma glucose levels, the insulin responses at 0, 15, 30, and 60 min (p < 0.01, p < 0.001, p < 0.001, p < 0.001, respectively) were lower than in the control group; the 30-min insulin/glucose ratio (7.1 +/- 5.1 vs 13.3 +/- 8.7, p < 0.001) and 60-min insulinogenic index (46.9 +/- 86.3 vs 123.4 +/- 206.3, p < 0.001) were also lower in the transient IGT group.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of WHO and NDDG criteria for impaired glucose tolerance

A 4-year prospective study on the natural history of IGT in South African Indians has allowed for the evaluation of the WHO and NDDG criteria for IGT, using the five groups for non-diabetic glucose tolerance recently recommended and relating these to the risk of diabetes development. Using WHO criteria, 128 subjects were classed IGT in a baseline survey (Year 0). The five recommended categories were applied to the OGTTs done between Year 1 and Year 4 of the study, when mid-test plasma (MPG) samples were also obtained. These categories included N-N (Normal by WHO and NDDG); N-ND1 (Normal by WHO, non-diagnostic level 1 by NDDG); N-ND2 (Normal by WHO, non-diagnostic level 2 by NDDG); I-ND3 (IGT by WHO, non-diagnostic level 3 by NDDG) and I-I (IGT by WHO and NDDG). The risk of diabetes development and the significance of the non-diagnostic category were evaluated by comparing the glucose tolerance status at Year 4 with the status at Year 1. In the cross-sectional evaluation at Year 1, of the 87 non-diabetic OGTTs analysed, 31% (n = 27) were classified I-I, 34.5% (n = 30) were classed N-N and 34.5% (n = 30) were classified non-diagnostic [I-ND3 (23.1%); N-ND2 (8%); N-ND1 (3.4%)]. In the prospective analysis, of the 72 subjects who completed the study, 16 subjects developed NIDDM by Year 4; of these 13 subjects were classed I-I and 3 subjects I-ND3 at Year 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Low risk of sexual transmission of hepatitis C virus in Somalia

The prevalence in Somalia of antibody to hepatitis C virus (anti-HCV) was determined in a survey of 236 female prostitutes, 80 sexually transmitted disease (STD) clinic patients, 79 male soldiers, and 43 tuberculosis patients. Of 98 (22%) serum samples repeatedly anti-HCV reactive by first and second generation enzyme-linked immunosorbent assay kits, only 8 (1.8%) were anti-HCV positive by immunoblot assay (RIBA-2). Anti-HCV seropositivity by immunoblot assay was not associated with any risk group or with positive syphilis serology (found in 18% of subjects) or antibody to human immunodeficiency virus 1 (in 1.4% of subjects). These data indicate that sexual transmission of hepatitis C virus is not common in Somalia among sexually active populations, including female prostitutes and other groups at high risk of STDs and the acquired immune deficiency syndrome.

South African Indians show a high prevalence of NIDDM and bimodality in plasma glucose distribution patterns

OBJECTIVE

To determine the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and to test for bimodality in the plasma glucose distribution in South African Indians.

RESEARCH DESIGN AND METHODS

Subjects were selected by systematic cluster sampling in various areas of Durban. They underwent a modified glucose tolerance test whereby fasting and 2-h postglucose (75 g) plasma glucose levels were measured. The program MIX was used to test for bimodality in the plasma glucose distribution.

RESULTS

We tested 2,479 subjects (1,441 women and 1,038 men). Based on the revised World Health Organization criteria, the crude prevalence of diabetes mellitus was 9.8%, and the crude prevalence of IGT was 5.8%; the age- and sex-adjusted prevalence was 13.0 and 6.9%, respectively. IGT was significantly more common in men (7.6%) than in women (4.4%). Obesity was a feature of both diabetes mellitus and IGT, particularly in women. Both fasting and 2-h plasma glucose values did not conform to a single normal distribution pattern in any age-group, whereas unequivocal evidence of bimodality was seen in the 55- to 74-year age-group of both sexes for fasting and 2-h glucose and also in the 2-h levels of men in the 25- to 34-year age-group.

CONCLUSIONS

This study has highlighted a high prevalence of non-insulin-dependent diabetes mellitus in South African Indians and bimodality in the plasma glucose distribution.

The district health information system and its potential in the management of district and rural hospitals

A study to assess the role that the HIS plays in the management of district and rural hospitals in Zvimba district (Zimbabwe) was carried out by the authors between August and October 1993. It revealed that there is an elaborate and well-developed set of tools which mainly collect data on morbidity, mortality, births, coverage and health activities. Cost and financial data as well as community-based data are not entering the HIS at the peripheral level. Very little analysis and interpretation of data takes place at the rural and district hospitals, therefore limiting the indicators that could be derived. Staff use the raw data they collect mostly for patient care. In terms of processed data, there is little use made of it.

Selected risk factors for coronary heart disease in male scholars from the major South African population groups

A number of risk factors for coronary heart disease (CHD) in 7 groups of South African male scholars aged between 15 and 20 years were surveyed. Selection of the groups was based on socioeconomic status and comprised urban and rural blacks, Indians of higher and lower socio-economic status, coloureds of higher and lower socioeconomic status, and middle-class whites. Both Indian groups, both coloured groups and the whites had a much greater prevalence and severity of CHD risk factors than the two black groups. This held for total cholesterol, low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), the HDLC/LDLC ratio, apolipoprotein B, apolipoprotein A-I, insulin, fibrinogen and mass. One exception was lipoprotein a, levels of which were higher in both black groups. In general the CHD risk factor profile was worse in the higher socio-economic groups, and it also tended to be worse in urban than in rural blacks. These findings stress the need to reduce CHD risk factors in our developed populations and to prevent their emergence in our developing peoples.

Vaginal yeast infections in diabetic women

Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for the presence of yeasts and Trichomonas vaginalis. Yeasts were isolated from the vaginas of 35.5% of patients and were more common in the symptomatic group (48.0%) than the asymptomatic group (25.4%; P < 0.05). Candida albicans was isolated from 12.8% of all patients and showed a significant association with pruritus vulvae (P < 0.05). A significant association was also shown between the presence of yeasts in the rectum and in the vagina. C. glabrata (Torulopsis glabrata) was the commonest yeast species isolated (50.0%), with C. albicans the next most frequent (36.1%). T. vaginalis infection was present in 14.3% of all subjects.

The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was determined in 479 urbanised South African blacks (141 men and 338 women) of Zulu descent selected by cluster sampling in a suburb of Durban. All subjects underwent a modified glucose tolerance test whereby fasting and 2-hour post-glucose (75 g) plasma glucose levels were measured. On the basis of the revised World Health Organisation criteria, the overall prevalence of diabetes was 4.2% and of IGT 6.9%; the age- and sex-adjusted prevalences were 5.3% and 7.7% respectively. Diabetes mellitus was more common in women (5.2% v. 2.3%), while the reverse was true of IGT (5.5% v. 11.5%). The mean age-adjusted body mass indices (BMIs) of diabetic (31.3 +/- 1.9) and IGT (29.7 +/- 1.9) subjects were significantly higher than those of the group with normal glucose tolerance (28 +/- 0.5). Female subjects with all types of glucose tolerance had significantly higher mean BMIs than men. There was a significant correlation between BMI and both fasting glucose (r = 0.16; P = 0.0039) and 2-hour plasma levels (r = 0.15; P = 0.0065) in the women, while in men only the fasting levels showed such a relationship (r = 0.21; P = 0.01719).

Vaginal infections in diabetic women: is empiric antifungal therapy appropriate?

BACKGROUND

Diabetes mellitus is reported to predispose women to vaginal candidiasis and hence patients attending busy diabetic clinics are often treated empirically with antifungal agents for genital symptoms.

GOAL OF THIS STUDY

To investigate the etiology of vaginal infections in diabetic women and to determine appropriateness of empiric antifungal therapy for symptomatic women.

DESIGN

Prospective study performed on consecutive patients attending two diabetic clinics.

SETTING

Diabetic clinics serving developing communities belonging to two ethnic groups.

STUDY POPULATION

Two hundred and one women (101 African and 100 Indian) comprising 90 women with symptoms of pruritus vulvae and/or vaginal discharge and 111 asymptomatic women.

RESULTS

Candidiasis (50% vs. 24%; P = 0.012) and bacterial vaginosis (28% vs. 8%; P = 0.017) occurred significantly more frequently in symptomatic African women compared to asymptomatic African women. Among Indian women bacterial vaginosis (28% vs. 5%; P = 0.026) occurred more frequently in symptomatic women. The prevalence of trichomoniasis was similar in symptomatic and asymptomatic women of both ethnic groups. Mixed vaginal infections were detected significantly more often in African compared to Indian women (24% vs. 5%; P = 0.03).

CONCLUSION

In diabetic women with genital symptoms, an attempt at diagnosis should be made prior to commencement of therapy. However, in busy clinics with overstressed facilities where investigations cannot be performed, the use of empiric antifungal therapy alone is not appropriate and consideration should be given to the use of an antifungal plus a nitroimidazole agent which would be effective for both trichomoniasis and bacterial vaginosis.

High risk of progression to NIDDM in South-African Indians with impaired glucose tolerance

A four-yr prospective study was undertaken to examine the natural history of IGT in 128 South-African Indians classified as such at year 0 of the study, based on WHO criteria. Subjects were reexamined at year 1 and year 4. Of the 113 subjects who completed the study, 50.4% progressed to NIDDM (rate of progression 12.6%/yr), 24.8% persisted with IGT, and 24.8%, reverted to NGT. The majority (72%) who progressed to NIDDM did so in year 1. At year 1, 47 subjects were still classified as IGT; of the 40 subjects completing the study, 16 subjects (40%) progressed to NIDDM, 17 subjects (42.5%) persisted with IGT, and 7 subjects (17.5%) reverted to NGT. Examination of risk factors predictive of subsequent progression to NIDDM was undertaken by analysis of baseline variables in two ways: When year 0 was used as baseline (in 113 IGT0 subjects), significant predictive risk factors were the FPG and 2-h plasma glucose concentrations. All subjects who at year 0 had 2-h plasma glucose > or = 10.2 and < 11.1 mM or FPG > or = 7.3 but < 7.8 mM, subsequently progressed to NIDDM. When year 1 was used as baseline (40 IGT1 subjects), 90-min plasma glucose concentration (midtest level) was found to be a significant risk factor for development of NIDDM. In conclusion, this study has demonstrated that in South-African Indians with IGT, the majority (50.4%) progress to NIDDM within 4 yr; significant predictors of subsequent diabetes are the baseline fasting and 2-h plasma glucose concentration.(ABSTRACT TRUNCATED AT 250 WORDS)