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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the predominant paradigm of epidemiological investigation continues to focus narrowly on the individual and on individual risk factors, there is a growing body of work that calls for a rethinking of the current epidemiological models. In this paper we illustrate the need for a more comprehensive epidemiological approach towards understanding the risks for diabetes, by exploring the lived experiences of diabetes and lay meanings of risk among Aborigines living in Melbourne, Australia. Ethnographic fieldwork was conducted within the Melbourne Aboriginal community in the state of Victoria over a 22-month period (1994-1996). Melbourne Aborigines see non-insulin dependent diabetes mellitus (NIDDM) as the result of living a life out of balance, a life of lost or severed connections with land and kin and a life with little control over past, present or future. The lay model regarding diabetes that is derived from the narratives of Melbourne Aborigines, consists of three levels of connectedness important in determining an individual's susceptibility not only to diabetes but to all disease--(1) family, (2) community and (3) society. This structure of interactive systems at successive levels from the individual to the population fits within the framework of an ecological paradigm. The strength of ethnography as applied to epidemiology is that it has the capacity to discover previously unknown components of a system at several different levels, and to build models to explain how these components interact. This framework, developed using an ethno-epidemiological approach, has application in other indigenous populations who have been dispossessed of their land, their pasts and their future. There is great potential to apply this approach to the major public health challenges presented by rapid global socio-cultural and environmental change that are impacting negatively on population health.
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PMID:Trying to keep a balance: the meaning of health and diabetes in an urban aboriginal community. 1107 50

An autopsy case of chronic mucocutaneous candidiasis (CMCC) is reported here, in which cerebral vasculitis developed in the final stage. A 32-year-old man who had suffered from superficial candidial infection since his childhood was diagnosed as having CMCC. During the past 7 years the patient had developed various associated disorders including insulin-dependent diabetes mellitus (IDDM), common variable immunodeficiency (CVID), candidial esophagitis, multiple digestive tract ulcers and pyothorax. In 1998, at the age of 32, he developed convulsions that were accompanied by impairment of consciousness, and which were temporarily treated with steroid pulsed-medication. Epileptic status associated with widespread cerebral infarctions occurred subsequently, however, and the patient died of sepsis 2 months later. At autopsy, multiple cerebral infarctions and arterial thrombosis were evident. These were histologically proven to be primary vasculitis which was confined solely to the brain, and this was verified by general pathological examination. Thus, some as yet unknown cerebrovascular factors might be involved in the onset of an autoimmune-related vasculitis in patients with a longstanding immunodeficiency state such as CMCC.
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PMID:Cerebral vasculitis in chronic mucocutaneous candidiasis: autopsy case report. 1121 Oct 56

FK 506 (Tacrolimus) was used with steroids to treat 61 pediatric patients who received living related partial liver transplantation. Fifty-two recipients survived and 9 died between 6 months and 3 years after transplantation. In the surviving patients, oral doses of Tacrolimus were tapered from 0.298 +/- 0.277 mg/kg daily at 1 month after transplantation to 0.078 +/- 0.054 at 24 months after transplantation. The 12 h trough levels of Tacrolimus were 12.6 +/- 7.1 ng/ml and 4.1 +/- 2.4 at 1 and 24 months after transplantation, respectively. The percentage of recipients free from steroids was 77%, 97%, and 94% at 6, 12, and 24 months after transplantation, respectively. Liver allograft rejection was encountered in seven recipients, five of whom were treated by steroid pulse therapy and a dose increase of Tacrolimus; the remaining two required OKT3. However, there was no episode of rejection that required retransplantation. Infectious complications encountered in 34 patients included 12 bacterial, 3 fungal, and 19 viral infections. Two recipients died one of fungal pneumonia and one of Epstein-Barr virus-associated lymphoproliferative disorder. Regarding adverse reactions of Tacrolimus, hypertension was observed in 28 patients, diabetes mellitus in 3, pancreatitis in 3, convulsion in 1, tremor in 12, itching in 5, and pigmentation in the oral mucosa in 2. Slightly increased values of creatinine were observed in most of the patients; however, an abnormal increase of serum of serum creatinine (> 1.0 mg/dl) was confined to the complicated cases. Improvement of somatic growth was observed in 21 patients (62%) and 13 (75%) at 12 and 24 months after transplantation, respectively. The long-term use of Tacrolimus is highly effective in terms of its immunosuppressive potential and reduced adverse reaction. Steady growth development can be expected in pediatric recipients free from steroids.
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PMID:Long-term use of FK 506 in living related liver transplantation. 1127 41

Hypoglycaemia is a common side effect of insulin therapy in type 1 diabetes. In patients with type 2 diabetes treated with blood-glucose lowering agents of the sulphonylurea group, hypoglycaemia is less frequent than in insulin-treated patients. In most patients strict metabolic control increases the risk of hypoglycaemia, but this risk may be reduced if patients are offered individualised insulin treatment in combination with active support and education. Previously experienced hypoglycaemic episodes and lack of endogenous insulin production are risk factors for repeated episodes. Patients with longstanding diabetes and loss of warning symptoms have increased risk of severe hypoglycaemic episodes, which may lead to loss of consciousness or convulsions. Driving performance is significantly disrupted at relatively mild hypoglycaemia, and persons with diabetes should not start driving when their blood glucose is in the 4-5 mmol/l range without prophylactic treatment. They ought to have carbohydrate-rich snacks easily available in the car and should stop driving if they feel hypoglycaemic. Repeated episodes of severe hypoglycaemia seem to be associated with cognitive dysfunction. When deciding the targets of blood-glucose lowering therapy, the risk of severe hypoglycaemia must be weighed against the beneficial effects of good metabolic control.
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PMID:[Hypoglycemia--a dreaded complication of diabetes]. 1147 34

In treating diabetes over the long term, controlling the daily life is very important and cannot be neglected. In particular, the patient's awareness and practice of their treatment had a great influence on their treatment. However, there has been very little scientific research done with regard to how much the patient understands the instructions about taking their medicine and whether they actually follow those instructions. Due to these facts, in this research we studied what guidance should be given when taking medicines made from insulin after analyzing the results of an investigation taken from the patients' point of view. In carrying out a study on the education and the degree of understanding of insulin self-injections, it became clear that older patients' ability to understand diminished, and the patients forgot to shake the NPH insulin immediately before injection. And, in more than a few cases, even when the NPH insulin was shaken, injections took place after some time had passed. After studying the amount of time that elapses once sedimentation begins, it was found that the insulin is effective if it is injected within 2.5 minutes of being shaken. Next, a study was carried out on the problems of maintaining the quality of life (QOL) of patient while continuing the treatment for diabetes. As a result, it became clear that the patient's lifestyle, including psychological factors, exerts a large influence on continuing the correct treatment. In particular, in cases of insulin injections when the patient eats out, younger patients tend to be more susceptible to psychological influence. This suggests that there is a need to work on guidance for the patient in taking their medicine. And, such guidance should strictly adhere to information regarding the patient's lifestyle, which comes through good communication with the patient. On the other side, the coring of the insulin vial of insulin was examined in terms of medicine production technology. As a result, the occurrence of coring is seen irrespective of the type of needle and the temperature of the rubber vial stopper, and the fact that rubber fragments were found in the injection solution, suggesting the possibility of subcutaneous rubber fragments through injection. Further examination of the problems of continued long-term treatment of injected medicines may be necessary in the future. Due to the necessity of self-control of patients and the long time span of treatment that is involved, maintaining the QOL of the patient is important in diabetes treatment. We feel that it is important to give guidance about treatment, which fits the patients' lifestyles.
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PMID:[Research regarding proper use of insulin in diabetes patients]. 1155 49

In this report, we present evidence that the HLA class II DPB1 locus (or a locus with alleles in linkage disequilibrium with DPB1) contributes to Type I diabetes (IDDM) susceptibility in addition to the contribution of the HLA DR and DQ loci. The marker association segregation chi-square (MASC) method, which fits both genotype frequency and affected sib-pair identity-by-descent (IBD) distributions, was applied to 257 sib pairs affected with IDDM. Fitting DR-DQ as the sole HLA susceptibility loci was strongly rejected. Next, we considered the DPB1 contribution to disease susceptibility. Published reports indicate a predisposing role for alleles DPB1*0301 and DPB1*0202, including our previous stratification analyses of association data on this sample. IDDM probands were stratified into those not carrying the alleles DPB1*0301 and DPB1*0202 (group DPB1-A), and those carrying at least one copy of either allele (group DPB1-B). Both groups of probands have almost identical frequencies of DR and DQ haplotypes but significantly different IBD distributions in the subset of families with probands who do not carry the highly predisposing DR3/DR4 genotype. In these data, DPB1 (or a locus in linkage disequilibrium), in addition to DR-DQ, is involved in IDDM susceptibility and affects IBD in the HLA region. Addition of DPB1 in a genetic model of IDDM gives a better fit to the data than consideration of DR-DQ alone. Our results are consistent with previous reports implicating DPB1 in IDDM susceptibility.
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PMID:Modeling of HLA class II susceptibility to Type I diabetes reveals an effect associated with DPB1. 1166 78

The amiloride-sensitive Na+/H+ exchanger (NHE) mediates uphill H+ extrusion and thus causes intracellular alkalinization. The NHE plays a major role in pH homeostasis, Na+ absorption, cell volume regulation, and cell proliferation; it is activated by growth factors, mitogens, neurotransmitters, tumor promoters, and others. At intracellular pH (pHi)>7.2-7.4, the system is quiescent; when pHi falls, the rate of H+ - efflux increases in an allosteric manner to reach a maximum around pHi=6.0. The kinetics for external Na+ follows the Michaelis-Menten model with a single, binding site. The effect of intracellular H+ best fits an allosteric model with at least two binding sites. According to the postulate that erythrocyte sodium-lithium countertransport (NLCT) might be one mode of operation of the ubiquitous NHE, and following the trail of previous investigations of NLCT association with hypertension and diabetic nephropathy, several studies have confirmed elevated NHE activity in different cell types in patients with essential hypertension. However, the relation between NHE and either NLCT or hypertension remains unclear and the usefulness of NLCT activity as a risk marker for the development of essential hypertension has been now excluded. On the contrary, few publications have dealt with the physiologic NHE in diabetic nephropathy, and contrasting results have been reported. We have observed an accelerated NHE in essential hypertension and in Type 1 diabetes, however without any relationship with urinary albumin excretion rate. Furthermore, NHE activity increased in non-diabetic first-degree relatives of Type 1 diabetic patients, yet no difference could be observed between relatives of probands with diabetic nephropathy and relatives of probands with normoalbuminuria. Unlike erythrocyte NHE activity, abnormal albumin excretion was a distinctive feature of non-diabetic first-degree relatives of Type 1 diabetic patients with nephropathy. The lack of agreement among Authors, even using both the same cell and the same method, testifies to the difficulty in performing a correct patient selection and uniformly reproducible NHE measurement. We compare individual clinical characteristics among different study populations confirming previous conclusions regarding NLCT in essential hypertension: main determinant for the flux values of NHE seems to be patient selection rather than methodology. A common effort is advisable to collaborate, standardise, compare methodologies, and unify criteria of subject recruitment.
Diabetes Nutr Metab 2001 Aug
PMID:Sodium/hydrogen exchange activity in type 1 diabetes mellitus: the never-ending story. 1171 94

Home telemedicine presents special challenges for data security and privacy. Experience in the Informatics for Diabetes Education And Telemedicine (IDEATel) project has demonstrated that data security is not a one-size-fits-all problem. The IDEATel users include elderly patients in their homes, nurse case managers, physicians, and researchers. The project supports multiple computer systems that require a variety of user interactions, including: data entry, data review, patient education, videoconferencing, and electronic monitoring. To meet these various needs, a number of different of security solutions were utilized, including: UserID/Password, PKI certificates, time-based tokens, IP filtering, VPNs, symmetric and asymmetric encryption schemes, firewalls and dedicated connections. These were combined in different ways to meet the needs of each user groups.
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PMID:Making grandma's data secure: a security architecture for home telemedicine. 1182 67

In this study, a second case of hyperinsulinemic hypoglycemia due to activation of glucokinase is reported. The 14-year-old proband had a history of neonatal hypoglycemia, treated with diazoxide. He was admitted with coma and convulsions due to nonketotic hypoglycemia. His BMI was 34 kg/m(2), and his fasting blood glucose ranged from 2.1 to 2.7 mmol/l, associated with inappropriately high serum levels of insulin, C-peptide, and proinsulin. An oral glucose tolerance test (OGTT) showed exaggerated responses of these peptides followed by profound hypoglycemia. Treatment with diazoxide and chlorothiazide was effective. His mother never had clinical hypoglycemic symptoms, even though her fasting blood glucose ranged from 2.9 to 3.5 mmol/l. Increases in serum insulin, C-peptide, and proinsulin in response to an OGTT suggested a lower threshold for glucose-stimulated insulin release (GSIR). Screening for mutations in candidate genes revealed a heterozygous glucokinase mutation in exon 10, substituting valine for alanine at codon 456 (A456V) in the proband and his mother. The purified recombinant glutathionyl S-transferase fusion protein of the A456V glucokinase revealed a decreased glucose S(0.5) (the concentration of glucose needed to achieve the half-maximal rate of phosphorylation) from 8.04 (wild-type) to 2.53 mmol/l. The mutant's Hill coefficient was decreased, and its maximal specific activity k(cat) was increased. Mathematical modeling predicted a markedly lowered GSIR threshold of 1.5 mmol/l. The theoretical and practical implications are manifold and significant.
Diabetes 2002 Apr
PMID:The second activating glucokinase mutation (A456V): implications for glucose homeostasis and diabetes therapy. 1191 51

We report a case of 58-year-old man who had repeated cardiac arrests on the first post-operative day. The patient underwent splenectomy due to ITP (idiopathic thrombocytopenic purpura). He also had diabetes mellitus and nephrotic syndrome. There was no abnormal finding at the preoperative examination, except bleeding time of 6 minutes. The operation was finished without complications under general anesthesia. Midnight on the day of surgery, the first cardiac arrest occurred, and lasted for about 10 seconds. He recovered soon from the incident, but at 6 o'clock next morning, he developed severe bradycardia and cardiac arrest. He recovered again, but around 10 o'clock, he developed bradycardia and arrest again, and fell into a fit of convulsions and lost his consciousness. Again he recovered soon and no bradycardia and cardiac arrest occurred after this episode. Two years later, he was scheduled for vitrectomy due to diabetic retinosis. There were a few PACs and PVCs in his Holter-ECG, but no typical bradycardia and ST changes. During the operation, we injected atropine sulfate, dopamine hydrochloride and bucladesine sodium to increase his heart rate above 60 per minute. The operation was finished smoothly and there was no trouble perioperatively. A year later, he also underwent bilateral cataract extraction under local anesthesia without any troubles.
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PMID:[Recurrent cardiac arrest after splenectomy in a patient with ITP and diabetes mellitus]. 1192 91


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