Biomedical subjects
Publications and source records attributed to A Samanta.
A case of pyrexia of unknown origin (PUO) in a 54-year-old Asian lady is described. She subsequently developed ocular and aural inflammation suggestive of relapsing polychondritis (RP) with immediate clinical improvement following steroid therapy. PUO is an unusual presenting feature of RP. The literature is reviewed and the clinical features of RP are discussed.
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A 74 year old woman with rheumatoid arthritis, hepatosplenomegaly, neutropenia, and peripheral blood lymphocytosis is described. The lymphocytes had a large granular morphology and expressed a CD3+ CD8+ Leu7+ surface antigen phenotype. They did not have natural killer cell function. Southern analysis of the lymphocyte DNA using two restriction enzymes showed a rearranged pattern for the T cell receptor beta chain gene, indicating a monoclonal lymphoproliferation. Large granular lymphocytosis is a rare and heterogeneous phenomenon, which has become more clearly characterised through the application of molecular biology techniques. Most cases appear to be forms of T cell leukaemia with a chronic benign course. The association between rheumatoid arthritis and large granular lymphocytosis is emphasised.
Tiaprofenic acid is a potent non-steroidal anti-inflammatory drug which, in conventional tablet form, has been shown to be rapidly absorbed and eliminated from the plasma, while synovial fluid concentrations remain constant for at least 8 hours. Recently, a sustained action formulation of tiaprofenic acid has been developed to provide the patient with the convenience of a once daily dosage. The purpose of this study was to measure plasma and synovial fluid concentrations over a 24-hour period following repeated administration of the sustained action formulation, and thus determine the pharmacokinetic profile. Eight patients suffering from rheumatoid arthritis were included in this open study (of whom 3 were subsequently excluded from the analysis). All were hospital outpatients requiring aspiration of the knee joint. The patients received sustained action tiaprofenic acid in a dosage of 600 mg once daily for a period of 7 days. Plasma and synovial fluid samples were taken on the final treatment day at 0, 4, 8, 12, and 18 hours following administration of the last treatment dose. Areas under the concentration-time curves, maximum plasma and synovial fluid concentrations, times to maximum concentration, and apparent elimination half-lives are presented and the findings compared and discussed. The drug was found to be retained in both the plasma and synovial fluid over a 24-hour period. Synovial fluid concentrations exceeded plasma concentrations at 24 hours in 4 of the 5 patients who were analysed, while in the fifth patient the levels were very similar.
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The prevalence of diabetes mellitus in adults was determined within a specific area of Leicester City, containing 20,053 Asians and 18,068 White Caucasian over the age of 16 years in the 1981 census. Subjects who had ever had classical symptoms with a random venous plasma glucose greater than or equal to 11.1 mmol/l were taken as diabetic. Exact numbers were ascertained from an analysis of diabetic clinic records and specialist health visitor records. The latter have formed an important part of community care for diabetics in Leicester for the last 30 years, and patients are referred by hospital consultants and nursing staff, and by general practitioners. Diabetes was ascertained in 967 Asians and 1194 White Caucasians. Age-adjusted relative risk of diabetes (95% confidence interval) increased in Asians over 45 years of age and was 1.6 (1.3-1.8) and 2.7 (2.5-3.2) for those aged 45-64 years and over 65 years, respectively. Relative risk of NIDDM was significantly higher (approximately x 2) in Asians in all age-groups. Our study shows that in Asians the prevalence of diabetes rises above 45 years of age and that NIDDM occurs more frequently in adult Asians. The causes and long-term effects of this require further analysis.
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Glucose-stimulated insulin secretion was assessed in relation to the DNA polymorphism flanking the insulin gene in 16 women who had had gestational diabetes. When not pregnant they were studied by a Constant Glucose Infusion for 1 hr with Model Assessment (CIGMA). The patients with either heterozygous 1/3 alleles or homozygous 1/1 or 3/3 alleles in the 5' flanking region of the insulin gene had similar plasma insulin and C-peptide concentrations and similar estimates of beta-cell function. This suggests that the large DNA insert (Class 3 allele) near the insulin gene does not directly affect insulin secretion. The association of polymorphisms with Type 2 diabetes may be due to linkage disequilibrium with other disease-related alleles.
20 patients with non insulin dependent diabetes mellitus (NIDDM), and within 20% of their ideal body weight were studied. They had failed to achieve adequate diabetic control following 3 months of dietary therapy. They were randomly allocated to insulin or sulphonylurea therapy for 3 months and then "crossed over" for the same period of time. Patients were maintained at euglycaemia (plasma glucose 4-7 mmol/l) for 24 hr using an open-loop intravenous insulin infusion, and then underwent a standard 75 gm oral glucose tolerance test (OGTT) following each mode of therapy. Mean glycosylated haemoglobin and preprandial blood glucose were 8.7% and 7.7 mmol/l respectively after sulphonylurea, and 7.8% (p less than 0.05) and 6.6 mmol/l (p less than 0.05) after insulin therapy. There was no significant difference in change in body weight. Following a 75 gm OGTT mean plasma insulin at 1/2 hr and 1 hr was 14.0 mu/l and 16.5 mu/l after sulphonylurea, and 23.4 mu/l (p less than 0.05) and 22.1 mu/l (p less than 0.05) after insulin therapy. Plasma C-peptide responses were also improved at 1/2, 1 and 1 1/2 hr after a period of insulin therapy being 0.61 nmol/l, 0.65 nmol/l and 0.59 nmol/l respectively. After sulphonylurea therapy comparable plasma C-peptide responses were 0.31, 0.41 and 0.37 nmol/l respectively (p less than 0.05). There was no significant difference in the total amount of intravenous insulin required for 24 hr euglycaemia. Our study shows that short term insulin therapy in patients with NIDDM who had failed on diet alone has advantages over sulphonylurea therapy in that it achieves better diabetic control and an improved B-cell response to glucose stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)
Initial dietary advice for Asian diabetics attending a general practice diabetic clinic was given in Asian languages. Between 2 and 3 years later a questionnaire interview was conducted to assess the effectiveness of the advice given. Forty of the 59 Asian diabetic patients in the practice attended for interview. The majority continued to use sugar or 'gur' (jaggery), Asian sweets, and Asian snacks (which have a high fat content). Fat and oil consumption per person per month was also high. Failure to achieve dietary objectives seemed to result from lack of sufficient emphasis on the types of foods usually consumed and an inadequate understanding of eating and cooking habits of Asians. We conclude that for dietary advice to be successful, emphasis must be placed on specific types of food eaten together with an understanding of the sociocultural implications of eating practices in ethnic groups.
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Two standard 75 g oral glucose tolerance tests (OGTT) were performed on each of 16 patients, aged 65-84 years, presenting with a thrombotic stroke, and not previously known to have diabetes mellitus. The tests were performed within the first week and 12 weeks after the initial episode. There was no significant difference in the plasma glucose values between the tests. Six patients were diagnosed diabetic on the basis of both OGTTs being abnormal. Of the remaining ten, there was no worsening of glucose tolerance immediately following a stroke. It is concluded that an abnormal glucose tolerance soon after a stroke in the elderly represents true diabetes mellitus rather than 'functional diabetes'.
We report a patient with pulmonary and bony metastases due to follicular carcinoma of the thyroid, occurring 12 years after the initial diagnosis. This was brought to light by worsening diabetic control due to thyrotoxicosis from functioning malignant thyroid tissue. Following radio-active iodine therapy, she remains well with good control of her diabetes.
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To determine the effect of short term intensive insulin therapy in non-insulin-dependent diabetes mellitus (NIDDM) we studied 10 patients who had been on maximal doses of sulphonylurea therapy, with a glycosylated haemoglobin value persistently above the normal range. All patients were non-ketonuric, had negative islet cell antibodies, and had been on sulphonylureas for a mean duration of 5.6 yr. Patients were maintained at euglycaemia (plasma glucose 4-7 mmol/l) for 24 hr using an open-loop intravenous insulin regimen, and then underwent a standard 75 g oral glucose tolerance test (OGTT). This was repeated after 3 months of treatment with insulin. Mean fasting plasma glucose and glycosylated haemoglobin were 10.1 mmol/l and 12.2% respectively before, and 7.1 mmol/l (p less than 0.001) and 8.4% (p less than 0.001) after treatment. There was no significant change in body weight. Plasma insulin and C-peptide responses to 75 g OGTT did not change significantly, but the total amount of intravenously infused insulin required for 24-hr euglycaemia fell from a mean value of 138 u before treatment to 87 u (p less than 0.001) at the end of insulin therapy. Remission, with glycosylated haemoglobin in the normal range for more than 3 months after stopping insulin, was observed in 5 out of the 10 patients. All 5 who failed to achieve remission had markedly blunted maximal insulin responses of less than 10 mu/l on both OGTT's. Our study shows that insulin treatment in NIDDM appears to exercise a beneficial effect by lowering insulin resistance. We suggest that this may be of advantage early on in patients with NIDDM in preserving B-cell reserve.
We have studied the hyperglycaemic effect of the carbohydrate of glucose, sucrose, and honey equivalent to 20 g in twelve normal volunteers, eight patients with insulin-dependent diabetes mellitus (IDDM), and six patients with non-insulin-dependent diabetes mellitus (NIDDM). Honey produced an attenuated postprandial glycaemic response in normal volunteers (vs glucose p less than 0.005; vs sucrose p less than 0.05) and IDDMs (vs glucose p less than 0.005; vs sucrose p less than 0.05). The glycaemic index (GI) showed considerable variability within each subject group. Combined with a peak incremental index (PI), the two indices appear to be more valuable in predicting the glycaemic effects of carbohydrates rather than either one alone. We suggest that honey may prove to be a valuable sugar substitute in diabetics, and that both the GI and PI should be used in the analysis of food.