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Speciality
Spotlight

 




 


Family Practice


 

 




Metabolism and Endocrinology

 

  • Lipids


    Hu FB, Stampfer MJ, Manson JE, et al [Havard Med School, Boston]


    Dietaey Fat Intake and the Risk of Coronary Heart Disease in Women


    N Engl J Med 337:1491-1499, 1997

       


    Most previous studies have been in males. This study comprised 80,082 female nurses in the age group of 34 to 59 years. At the outset in 1980, they were free of coronary artery disease, stroke, malignancy hypercholesterolemia and diabetes.

       


    Coronary heart disease incidence increases as the consumption of saturated fat is increased. This applies to trans unsaturated fats but to a lesser extent and is progressively lower for mono and poly unsaturated fat. Conclusions were derived over a 14 year period. 

       
  • Lamarche B, Tchernof A, Mauriege P, et al [Laval Univ, Ste-Foy, Quebec; Univ of Montreal]


    Fasting Insulin and Apolipoprotein B levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease


    JAMA 279: 1955-1961, 1998

       


    Many patients with myocardial ischemia present with normal total cholesterol levels. Finding high fasting levels of insulin, apolipoprotein B levels and low density as well as very low density levels of cholesterol add to the finesse in preventing and treating ischemic heart disease.

       
  • Ridker PM, Glynn RJ, Hennekens CH [Brigham and Women’s Hosp, Boston: Havard Med School, Boston]


    C-Reactive Protein Adds to the Predictive Value of Total and HDL Cholesterol in Determining Risk of First Myocardial Infraction


    Circulation: 97:2007-2011, 1998

        


    14,916 men free from heart disease, chronic infections, and malignancy were studied. Baseline levels of Total cholesterol, HDL-C and C-reactive protein were established. 246 of these developed a first MI in the next 9 years whereas 543 that comprised the control were normal for this paramater.

       


    Elevated CRP had a predictive value even in those with normal cholesterol studies. This is expected as C.R.P. is an indicator of inflammation.

       
  • Willett WC [Harvard Med. School, Boston]


    Is Dietary Fat a Major Determinant of Body Fat ?


    Am J Clin Nutr 67: 556S-562S, 1998

       


    Over short periods of time fat restriction leads to weight loss. In a study over a period of 1 year fat restriction to 18 and 40 percent of energy intake had no such effect. Despite fat restriction in diet over the last 20 years obesity continue to be a major concern. Other adjustment by metabolic needs is possible. 

        
  • Coakley EH, Rimm EB, Colditz G, et al [Harvard Med School, Boston]

    Predictors of Weight Change in Men : Results from
    the Health Professionals Follow-up Study

    Int J Obes 22: 89-96, 1998

       


    In 1986, 51,529 men between the ages of 40 and 75, were selected for study. Information was asked for in 1988 and 1992. Details were available for 19,478 men. Weight gain was observed in those who ate between meals. Watched TV or had given up smoking or had lost weight on their own before entering the study. Group not eating between meals, reduction in time spent on TV watching and exercise led to loss of weight, or maintaining a constant level.

       
  • Kiberd BA, Jindal KK
    [Dalhousie Univ. Halifax, Nova Scotia, Canada]


    Routine Treatment of Insulin-Dependent Diabetic patients With ACE Inhibitors to prevent Renal Failure: An Economic Evaluation


    Am J Kidney Dis 31: 49-54, 1998

       

    If a patient of diabetes is being controlled with insulin and is candidate for diabetic nephropathy, the latter can be prevented by introducing ACE inhibitors. If he or she already has microalbuminuria its progression can be stopped.

       


    It is not known whether this would occur in Non-Insulin Dependent Diabetes.

      
  • Riley MD, Dwyer T [Univ of Tasmania, Hobart, Australia]


    Microalbuminuria is Positively Associated with Usual Dietary Saturated Fat Intake and Negatively Associated with Usual Dietary Protein Intake in People with Insulin-Dependent Diabetes Mellitus


    Am J Clin Nutr 67: 50-57, 1998

       


    Development of nephropathy in IDDM is a significant cause of morbidity and mortality. Linking this to protein intake has been taken for granted. It is the increasing saturated fat intake that is associated with renal involvement. High protein intake is not thus associated, and rather prevents its occurrence. Mono and poly-unsaturated fat intake does not correlate with nephropathy. 

        
  • Purnell JQ, Hokanson JE, Marcovina SM [Univ of Washington, Seattle; George Washington Univ, Rockville, Md: Univ of Minnesota, Minneapolis]


    Effect of Excessive Weight Gain with Intensive Therapy of Type 1 Diabetes on Lipid Levels and Blood Pressure: Results from the DCCT


    JAMA 280: 140-146, 1998

       


    18 Years and over constituted the study group of 1168 individuals. A tight control of diabetes with insulin led to weight gain and change in lipid levels. The latter included a rise in low-density lipo-protein component of cholesterol. Weight gain in the truncal region was more than elsewhere.

       


    Thus the chances of cardiovascular complications are raised at the cost of reducing renal and ocular involvement.

       
  • Balkau B, Shipley M, Jarrett RJ, et al [INSERM, Villejuif, France; Univ of Kuopio, Finland; Univ College Med School, London; et al ]


    High Blood Glucose Concentration is a Risk Factor for Mortality in Middle-aged 

    Nondiabetic Men : 20-Year Follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study


    Diabetes Care 21: 360-367, 1998

       


    High blood glucose levels not tantamount to a diagnosis of diabetes were evaluated as risk factors involved in causation of death due to all causes. Men between 44-55 years were given a standard 2 hour glucose tolerance test and followed up for 20 years. The total was made up of 10,025 in the Whitehall Study, 6629 in the Paris group and 631 in the Helsinki police men. Deaths from cardiovascular disease, coronary heart disease [CHD] and neoplasms were evaluated.

       


    Policemen had the maximum incidence in the all cause group except neoplasms. Deaths from cardiovascular and CHD were more than would be expected. Information of this type may suggest early control of glucose levels.

        
  • Landau Z [Kaplan Hosp, Rehovot Israel]


    Topical Hyperbaric Oxygen and Low Energy Laser for the Treatment of Diabetic Foot Ulcers


    Arch Orthop Trauma Surg 117: 156-158, 1998 

       


    50 diabetic subjects had nonhealing foot ulcers of 9 months mean duration. 15 received topical hyperbaric oxygen alone and 35 in addition were given low energy laser. 25 treatments over a period of 3 months resulted in curing 43 ulcerated feet.

        
  • Endocrine-Miscellaneous


    Bartalena L, Marcocci C, Bogazzi F, et al [Istituto di Endocrinologia, Pisa, Italy; Clinica Oculistica, Pisa, Italy; Univ of Pisa, Italy; et al]


    Relation Between therapy for Hyperthyroidism and the Course of Graves’ Ophthalmopathy


    N Engl J Med 338: 73-78, 1998

       


    443 patients of ‘Graves’ disease were treated with methimazole for 3 to 4 months. Radiotherapy [120 to 150 (G ] for 18 months radioiodine and prednisone [ 0.4 to 0.5 mg/kg] for 3 months were given to some and methimazole was continued for others.

        


    Opthalmopathy began or became worse in 6 months of treatment with radioiodine alone. This was observed in 23 of the 150 subjects. Those who smoked outnumbered the non-smokers. 140 subjects treated with radioiodine and prednisone revealed either regression of ocular changes or non development of such changes if they had none at the onset. In the group of 148 on methimazole 3/74 with ocular changes improved, four developed them or became worse. 141 maintained their status quo.

        


    This study is important as it emphasizes the role of autoimmunity in the pathogenisis of opthalmopathy in hyperthyroidism thus bringing out the role of a corticosteriod in both prevention and therapy of the evolved state.

        
  • Gravholt CH, Juul S, Naeraa RW, et al [ Aarhus Univ, Denmark]


    Morbidity in Turner Syndrome


    J Clin Epidermiol 51: 147-158, 1998

    Absence of an X-chromosome or a part of it in a female gives a myriad of abnormalities described as Turner’s syndrome.

        


    This article emphasizes the occurrence of fractures in children. Colonic cancers and cirrhosis of the liver are other, features described in women with Turner’s syndrome. Ischaemic heart disease, diabetes mellitus and strokes are more frequent.

      
  • Diabetes

     

    Hoffman
    J, Spengler M [Clinical Research Collaborative Study
    Group, Essen, Germany: Bayer AG, Leverkusen, Germany


     


    Efficacy of 24-Week Monotherapy With Acarbose, Metformin,
    or Placebo in Dietary-treated NIDDM  patients –
    The Essen -II Study


     

    Am
    J Med 103: 483-490, 1997



    This
    is the first article to compare the efficacy of acarbose
    and metformin in the treatment of NIDDM, with placebo
    control. All the subjects of study were on a diet
    control regime only between the ages of 37 and 70
    years. 

    Dose
    of acarbose was 100 mgm tablet thrice a day orally with
    food; metformin was given as 850 mgm tablet twice a day.

    Acarbose
    in addition to reducing blood glucose levels also
    reduced cholesterol levels, whereas metformin acts only
    on the former. Lactic acidosis reported with metformin
    seems not to occur with acarbose.

       
       

  • Levetan CS, Passaro M, Jablonski K, et al
    [Medlantic Research Inst, Washington, DC; Washington Hosp Ctr, Washington, DC]

    Unrecognized Diabetes among Hospitalized Patients 

    Diabetes Care 21: 246-249, 1998.

       


    Missing diabetes in patients admitted for other disorders is not uncommon. Glucose levels in the range around 200
    mg/dL is often ascribed to infections or stress. Early detection of disease may lead to prevention of subsequent complications, hence all such hyperglycemias need to be investigated.

        

  • Mayer-Davis
    EJ, for the IRAS Investigators [Univ of South Carolina, Columbia: Wake Forest Univ. Winston-Salem, NC; Permanente Med Group Inc, Oakland,
    calif; et al]

    Intensity and Amount of Physical Activity in Relation to Insulin Sensitivity: The Insulin Resistance Atherosclerosis Study

    JAMA 279: 669-674, 1998

        


    After an intravenous glucose tolerance test insulin sensitivity was used to compare the exercising and non-exercising groups.

        


    Whereas vigorous exercise is known to reduce the incidence of NIDDM it is interesting to note that moderate exercise is also useful.

       



 

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Speciality Spotlight

 

 

Metabolism and Endocrinology
 

  • Lipids
    Hu FB, Stampfer MJ, Manson JE, et al [Havard Med School, Boston]
    Dietaey Fat Intake and the Risk of Coronary Heart Disease in Women
    N Engl J Med 337:1491-1499, 1997
       
    Most previous studies have been in males. This study comprised 80,082 female nurses in the age group of 34 to 59 years. At the outset in 1980, they were free of coronary artery disease, stroke, malignancy hypercholesterolemia and diabetes.
       
    Coronary heart disease incidence increases as the consumption of saturated fat is increased. This applies to trans unsaturated fats but to a lesser extent and is progressively lower for mono and poly unsaturated fat. Conclusions were derived over a 14 year period. 
       
  • Lamarche B, Tchernof A, Mauriege P, et al [Laval Univ, Ste-Foy, Quebec; Univ of Montreal]
    Fasting Insulin and Apolipoprotein B levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease
    JAMA 279: 1955-1961, 1998
       
    Many patients with myocardial ischemia present with normal total cholesterol levels. Finding high fasting levels of insulin, apolipoprotein B levels and low density as well as very low density levels of cholesterol add to the finesse in preventing and treating ischemic heart disease.
       
  • Ridker PM, Glynn RJ, Hennekens CH [Brigham and Women’s Hosp, Boston: Havard Med School, Boston]
    C-Reactive Protein Adds to the Predictive Value of Total and HDL Cholesterol in Determining Risk of First Myocardial Infraction
    Circulation: 97:2007-2011, 1998
        
    14,916 men free from heart disease, chronic infections, and malignancy were studied. Baseline levels of Total cholesterol, HDL-C and C-reactive protein were established. 246 of these developed a first MI in the next 9 years whereas 543 that comprised the control were normal for this paramater.
       
    Elevated CRP had a predictive value even in those with normal cholesterol studies. This is expected as C.R.P. is an indicator of inflammation.
       
  • Willett WC [Harvard Med. School, Boston]
    Is Dietary Fat a Major Determinant of Body Fat ?
    Am J Clin Nutr 67: 556S-562S, 1998
       
    Over short periods of time fat restriction leads to weight loss. In a study over a period of 1 year fat restriction to 18 and 40 percent of energy intake had no such effect. Despite fat restriction in diet over the last 20 years obesity continue to be a major concern. Other adjustment by metabolic needs is possible. 
        
  • Coakley EH, Rimm EB, Colditz G, et al [Harvard Med School, Boston]
    Predictors of Weight Change in Men : Results from the Health Professionals Follow-up Study
    Int J Obes 22: 89-96, 1998
       
    In 1986, 51,529 men between the ages of 40 and 75, were selected for study. Information was asked for in 1988 and 1992. Details were available for 19,478 men. Weight gain was observed in those who ate between meals. Watched TV or had given up smoking or had lost weight on their own before entering the study. Group not eating between meals, reduction in time spent on TV watching and exercise led to loss of weight, or maintaining a constant level.
       
  • Kiberd BA, Jindal KK [Dalhousie Univ. Halifax, Nova Scotia, Canada]
    Routine Treatment of Insulin-Dependent Diabetic patients With ACE Inhibitors to prevent Renal Failure: An Economic Evaluation
    Am J Kidney Dis 31: 49-54, 1998
       
    If a patient of diabetes is being controlled with insulin and is candidate for diabetic nephropathy, the latter can be prevented by introducing ACE inhibitors. If he or she already has microalbuminuria its progression can be stopped.
       
    It is not known whether this would occur in Non-Insulin Dependent Diabetes.
      
  • Riley MD, Dwyer T [Univ of Tasmania, Hobart, Australia]
    Microalbuminuria is Positively Associated with Usual Dietary Saturated Fat Intake and Negatively Associated with Usual Dietary Protein Intake in People with Insulin-Dependent Diabetes Mellitus
    Am J Clin Nutr 67: 50-57, 1998
       
    Development of nephropathy in IDDM is a significant cause of morbidity and mortality. Linking this to protein intake has been taken for granted. It is the increasing saturated fat intake that is associated with renal involvement. High protein intake is not thus associated, and rather prevents its occurrence. Mono and poly-unsaturated fat intake does not correlate with nephropathy. 
        
  • Purnell JQ, Hokanson JE, Marcovina SM [Univ of Washington, Seattle; George Washington Univ, Rockville, Md: Univ of Minnesota, Minneapolis]
    Effect of Excessive Weight Gain with Intensive Therapy of Type 1 Diabetes on Lipid Levels and Blood Pressure: Results from the DCCT
    JAMA 280: 140-146, 1998
       
    18 Years and over constituted the study group of 1168 individuals. A tight control of diabetes with insulin led to weight gain and change in lipid levels. The latter included a rise in low-density lipo-protein component of cholesterol. Weight gain in the truncal region was more than elsewhere.
       
    Thus the chances of cardiovascular complications are raised at the cost of reducing renal and ocular involvement.
       
  • Balkau B, Shipley M, Jarrett RJ, et al [INSERM, Villejuif, France; Univ of Kuopio, Finland; Univ College Med School, London; et al ]
    High Blood Glucose Concentration is a Risk Factor for Mortality in Middle-aged 
    Nondiabetic Men : 20-Year Follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study

    Diabetes Care 21: 360-367, 1998
       
    High blood glucose levels not tantamount to a diagnosis of diabetes were evaluated as risk factors involved in causation of death due to all causes. Men between 44-55 years were given a standard 2 hour glucose tolerance test and followed up for 20 years. The total was made up of 10,025 in the Whitehall Study, 6629 in the Paris group and 631 in the Helsinki police men. Deaths from cardiovascular disease, coronary heart disease [CHD] and neoplasms were evaluated.
       
    Policemen had the maximum incidence in the all cause group except neoplasms. Deaths from cardiovascular and CHD were more than would be expected. Information of this type may suggest early control of glucose levels.
        
  • Landau Z [Kaplan Hosp, Rehovot Israel]
    Topical Hyperbaric Oxygen and Low Energy Laser for the Treatment of Diabetic Foot Ulcers
    Arch Orthop Trauma Surg 117: 156-158, 1998 
       
    50 diabetic subjects had nonhealing foot ulcers of 9 months mean duration. 15 received topical hyperbaric oxygen alone and 35 in addition were given low energy laser. 25 treatments over a period of 3 months resulted in curing 43 ulcerated feet.
        
  • Endocrine-Miscellaneous
    Bartalena L, Marcocci C, Bogazzi F, et al [Istituto di Endocrinologia, Pisa, Italy; Clinica Oculistica, Pisa, Italy; Univ of Pisa, Italy; et al]
    Relation Between therapy for Hyperthyroidism and the Course of Graves’ Ophthalmopathy
    N Engl J Med 338: 73-78, 1998
       
    443 patients of ‘Graves’ disease were treated with methimazole for 3 to 4 months. Radiotherapy [120 to 150 (G ] for 18 months radioiodine and prednisone [ 0.4 to 0.5 mg/kg] for 3 months were given to some and methimazole was continued for others.
        
    Opthalmopathy began or became worse in 6 months of treatment with radioiodine alone. This was observed in 23 of the 150 subjects. Those who smoked outnumbered the non-smokers. 140 subjects treated with radioiodine and prednisone revealed either regression of ocular changes or non development of such changes if they had none at the onset. In the group of 148 on methimazole 3/74 with ocular changes improved, four developed them or became worse. 141 maintained their status quo.
        
    This study is important as it emphasizes the role of autoimmunity in the pathogenisis of opthalmopathy in hyperthyroidism thus bringing out the role of a corticosteriod in both prevention and therapy of the evolved state.
        
  • Gravholt CH, Juul S, Naeraa RW, et al [ Aarhus Univ, Denmark]
    Morbidity in Turner Syndrome
    J Clin Epidermiol 51: 147-158, 1998
    Absence of an X-chromosome or a part of it in a female gives a myriad of abnormalities described as Turner’s syndrome.
        
    This article emphasizes the occurrence of fractures in children. Colonic cancers and cirrhosis of the liver are other, features described in women with Turner’s syndrome. Ischaemic heart disease, diabetes mellitus and strokes are more frequent.
      
  • Diabetes

     

    Hoffman J, Spengler M [Clinical Research Collaborative Study Group, Essen, Germany: Bayer AG, Leverkusen, Germany

     

    Efficacy of 24-Week Monotherapy With Acarbose, Metformin, or Placebo in Dietary-treated NIDDM  patients – The Essen -II Study

     

    Am J Med 103: 483-490, 1997

    This is the first article to compare the efficacy of acarbose and metformin in the treatment of NIDDM, with placebo control. All the subjects of study were on a diet control regime only between the ages of 37 and 70 years. 
    Dose of acarbose was 100 mgm tablet thrice a day orally with food; metformin was given as 850 mgm tablet twice a day.
    Acarbose in addition to reducing blood glucose levels also reduced cholesterol levels, whereas metformin acts only on the former. Lactic acidosis reported with metformin seems not to occur with acarbose.
           

  • Levetan CS, Passaro M, Jablonski K, et al [Medlantic Research Inst, Washington, DC; Washington Hosp Ctr, Washington, DC]
    Unrecognized Diabetes among Hospitalized Patients 
    Diabetes Care 21: 246-249, 1998.
       
    Missing diabetes in patients admitted for other disorders is not uncommon. Glucose levels in the range around 200 mg/dL is often ascribed to infections or stress. Early detection of disease may lead to prevention of subsequent complications, hence all such hyperglycemias need to be investigated.
        

  • Mayer-Davis EJ, for the IRAS Investigators [Univ of South Carolina, Columbia: Wake Forest Univ. Winston-Salem, NC; Permanente Med Group Inc, Oakland, calif; et al]
    Intensity and Amount of Physical Activity in Relation to Insulin Sensitivity: The Insulin Resistance Atherosclerosis Study
    JAMA 279: 669-674, 1998
        
    After an intravenous glucose tolerance test insulin sensitivity was used to compare the exercising and non-exercising groups.
        
    Whereas vigorous exercise is known to reduce the incidence of NIDDM it is interesting to note that moderate exercise is also useful.