Gene/Protein Disease Symptom Drug Enzyme Compound
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When symptoms of peripheral neuropathy appear, the possibility that they have been induced by drugs should be considered. A large number of drugs of all kinds, several of which are considered indispensable, have been implicated in peripheral neuropathy. A list of some of these drugs is provided. Neuropathy is a universal and dose-limiting factor during treatment with vinca alkaloids, but is otherwise a rare complication of drug therapy. Drug-induced peripheral neuropathy is almost always due to a dose-dependent primary axonal degeneration caused either by toxic reactions or by metabolic changes in neurons or their surroundings. The use of drugs should be restricted, especially in patients with a risk for development of neuropathy or with already existing neuropathy, e.g. patients with hepatic or renal failure, diabetes mellitus, or malnutrition. Patients should be given vitamins, prophylactically or therapeutically, which will sometimes allow a treatment to be continued. In other cases of drug-induced neuropathy the drug should be stopped. Reversal depends on the severity of the neuropathy, intensity and duration of the treatment and existence of causative cofactors, but generally the prognosis is good. While waiting for recovery physiotherapy is of importance, and when paraesthesia and pain are troublesome the patient should be treated with carbamazepine, imipramine or lidocaine (lignocaine).
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PMID:Prevention and management of drug-induced peripheral neuropathy. 165 73

1. The effects of streptozotocin-diabetes, bulk-diet, low protein diet (8%) and protein-calorie malnutrition on parotid gland response to sympathetic nerve stimulation were studied in male Wistar rats. 2. Mean body weights were considerably less in diabetic and protein-calorie malnourished rats than in the other groups, but parotid gland weight was reduced only in animals placed on a low-protein diet. 3. Salivary flow rate (microliter/min/g tissue) and total protein output (mg secreted/g tissue) were reduced in diabetic rats. 4. Salivary composition was altered in diabetes and protein-calorie restriction, and the specific changes were unique to each condition. 5. Thus, with the possible exception of gland weight the effects of diabetes on parotid gland structure and function are not related to either hyperphagia or nutritional status.
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PMID:Effects of diabetes and dietary manipulation on rat parotid gland secretory response to sympathetic nerve stimulation. 167 1

Nearly 50% of individuals with type II diabetes mellitus are over the age of 65 years. There are numerous reasons to maintain blood glucose levels below 11.1 nmol/L (200 mg/dl) in older persons, and there are a number of changes often seen with advancing age that persons, and there are a number of changes often seen with advancing age that may interfere with the management of diabetes mellitus, e.g. hypodipsia, anorexia, visual disturbance, altered renal and hepatic function, depression, impaired basoreceptor response and multiple medications. Hyperglycaemia appears to produce cognitive impairment which may lead to poor compliance. It is often difficult to manipulate diet in older people, and in fact dietary changes can lead to severe protein energy malnutrition. High maximum voluntary oxygen intake has been correlated with increased glucose disposal, but there is little evidence that physical exercise can improve diabetic control in the elderly. Oral sulphonylurea hypoglycaemic agents are extremely useful in the treatment of diabetes in these patients, but it should be remembered that they are more liable to develop hypoglycaemia than are younger diabetics. The role of metformin in the management of older diabetic patients is poorly studied. Many older persons can cope well with insulin therapy, but those with visual disturbances often make errors when drawing up insulin and require special attention. Combination therapy of insulin with oral hypoglycaemic agents is not recommended in this group of patients, and serum fructosamine is preferred to glycated haemoglobin to monitor control. Successful management of elderly diabetic patients thus requires an interdisciplinary team approach.
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PMID:The management of diabetes mellitus in older individuals. 171 59

Two unrelated male infants presented with brittle insulin-dependent diabetes mellitus in the first days of life. Subsequently they each developed severe secretory diarrhea, with stool volumes of more than 100 ml/kg/day. Extensive biochemical and serological investigation failed to reveal the etiology of the diarrhea. The infants, cared for at different institutions, underwent therapeutic trials of various agents including loperamide, cholestyramine, prednisone, indomethacin, and somatostatin analogue, without response. Both infants succumbed to septicemia and malnutrition related to diarrhea and poor control of glycemia. At autopsy, both were found to have absence of islets of Langerhans in the pancreas, and diffuse dysplastic changes in small and large intestinal mucosae. In particular, the entire alimentary tract in each case was lined by epithelia most typical of foregut mucosa: secretory-type glands, absent crypts of Lieberkuhn, and absent villi. These cases are contrasted with previously-reported infants with congenital diabetes mellitus, and the possible interrelation of these two highly unusual findings, congenital diabetes mellitus and diffuse intestinal dysplasia, is examined.
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PMID:Congenital diabetes mellitus and fatal secretory diarrhea in two infants. 177 17

In developing countries diabetics frequently suffer from varying grades of malnutrition. The combined effect of malnutrition and non-insulin dependent diabetes (NIDDM) on the drug metabolising enzyme system has been evaluated using antipyrine as a protodrug. All the patients were under treatment and their plasma glucose values were within normal limits. The AUC of antipyrine was similar in all the groups. Although none of the kinetic parameters was altered in normal diabetics, the clearance of antipyrine was decreased and its half life was prolonged, with an increase in volume of distribution, in undernourished diabetics compared to undernourished controls. The results indicate that diabetes per se may not influence antipyrine kinetics when the blood glucose is well under control, but in the presence of undernutrition, it significantly alters the disposition of the drug.
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PMID:Antipyrine kinetics in undernourished diabetics. 180 53

The nutritional status of 93 noninstitutionalized elderly of the city of Perugia, mostly of them examined longitudinally, was assessed at the eleventh year follow-up. Diet is still rather rich and unbalanced. Alcohol intake in men is very high. Biological dietary errors have an impact on the nutritional status, particularly for folates, of the individual. But in this regard it is interesting to note that in some cases vitamin and mineral nutriture has improved at this follow-up. In addition the distribution of malnutrition is rather different from that of the previous follow-up. As on previous occasions, no correlation was observed between vitamin intake and corresponding nutritional status (with the exception of riboflavin). Obesity is rather common among women; men present a higher muscular area and hand muscular strength. The clinical evaluation of nutritional status evidences principally changes which are mostly ascribable to old age. Among the pathologies, chronic ischemic heart disease, hypertension, chronic respiratory diseases, osteoarthrosis and diabetes occur most frequently.
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PMID:Nutritional status of the elderly V). Dietary and biochemical data and anthropometry of noninstitutionalized elderly in Perugia at the eleventh year follow-up. 180 40

The effect of chronic undernutrition on coexisting diabetes mellitus was studied in pair-fed littermate rats with mild streptozocin-induced diabetes. They were either fed ad libitum or 50% food restricted for 9 wk. Undernourished diabetic rats, in which weight gain was reduced by 40%, had significantly higher glucose intolerance (mean +/- SE, fractional rate of glucose disappearance during glucose tolerance test [Kgtt] 1.77 +/- 0.16) than diabetic littermates fed ad libitum (2.33 +/- 0.21, P less than 0.05) or nondiabetic controls (3.8 +/- 0.7, P less than 0.01). The total area under the insulin response curve was significantly reduced in both groups of diabetic rats, but the undernourished group showed a 45% greater reduction in overall secretion than normally nourished diabetic littermates (21.3 +/- 2.7 vs. 39.4 +/- 6.3 nM.min in the diabetic group, P less than 0.01, and 65.7 +/- 6.1 nM.min in controls). There was also a marked reduction in first-phase insulin secretion in the undernourished rats (4.75 +/- 0.24 vs. 9.84 +/- 1.36 nM, P less than 0.05, and 14.3 +/- 1.8 nM, P less than 0.01, respectively, in normally nourished diabetic littermates and controls). After refeeding, a significant improvement occurred in Kgtt (to 2.67 +/- 0.24, P less than 0.01) and first-phase insulin secretion (to 9.69 +/- 1.65 nM, P less than 0.05). The postrefeeding values were not different from those in the normally nourished diabetic littermates, indicating that the effect was fully reversible and solely attributable to undernutrition rather than to enhanced beta-cell cytotoxicity from streptozocin.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes 1991 Nov
PMID:Chronic undernutrition accentuates insulin deficiency in rats with mild streptozocin-induced diabetes. 183 98

This essay describes the rich tradition of research in the English-speaking Caribbean and the possibilities for meaningful collaboration between Caribbean researchers and scientists from developed countries. Significant contributions include work related to the human T-lymphotropic virus type I (HTLV-I), Jamaican vomiting sickness, veno-occlusive disease of the liver, J-type diabetes, and the role of skin sepsis and streptococcal infection in the etiology of glomerulonephritis. In the fields of malnutrition, human metabolism, child development, and sickle cell anemia, the Caribbean has been at the forefront of medical research internationally. Many characteristics of the Caribbean population, including the disease profile, offer advantages and unique opportunities for significant research, despite difficulties related to the "brain drain" and weaknesses of the infrastructure.
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PMID:Is serious research possible in the Caribbean? 184 51

Fetal malnutrition, a worldwide problem, is accompanied by varying degrees of lifelong morbidity for the child. Only 25% of fetal malnutrition is accomplished by maternal risk factors known to cause intrauterine growth retardation (ie, chronic hypertension, advanced diabetes mellitus, or severe preeclampsia). If the malnourished fetus could be detected early in pregnancy, nutritional intervention might be successful in improving fetal growth rate and in avoiding the morbidity due to malnutrition. This communication reviews the almost 40 years of studies by Jack Metcoff, MD, and coworkers to unravel the causes of fetal malnutrition and their efforts to prevent it.
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PMID:Studies in fetal malnutrition. 185 23

Anthropometric studies were carried out in three groups of diabetics seen in southern India, namely fibrocalculous pancreatic diabetes (FCPD) (n = 49) (a subtype of malnutrition related diabetes), insulin dependent diabetes mellitus (IDDM) (n = 55) and non-insulin dependent diabetes mellitus (NIDDM) (n = 104). Both FCPD and IDDM had significantly lower body mass index, skinfold thickness (triceps, biceps, subscapular and suprailiac), mid-arm circumference and fat mass compared to controls and NIDDM patients, (p less than 0.001 for all parameters). FCPD and IDDM males did not show any significant differences in any of the anthropometric parameters studied. Among the females, FCPD had lower triceps skinfold measurements (p = 0.007) and mid-arm circumferences (p less than 0.05) compared to IDDM patients. Patients with NIDDM did not show any significant difference compared to the control group. This study shows that both FCPD and IDDM patients have lower body mass and fat mass compared to NIDDM patients and control subjects.
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PMID:Anthropometric studies in diabetes in the Tropics. 186 92


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