Presence of the metabolic syndrome distinguishes patients with ketosis-prone diabetes who have a Type 2 diabetic phenotype

OBJECTIVE: This study was designed to determine if patients with ketosis-prone diabetes could be distinguished clinically on the basis of features of the metabolic syndrome (MetS). METHODS: Participants with ketosis-prone diabetes admitted to our institution during a 3-year period were studied. One hundred seventy-two patients from four ethnic backgrounds were divided into two groups: with or without MetS, as defined by the World Health Organization. Pearson's chi-square test or one-way ANOVA was used as appropriate to evaluate group differences. RESULTS: Of the 172 patients, 74 (43%) had at least three characteristics of MetS (+MetS group), while 98 (57%) had less than three characteristics of MetS (-MetS group). The +MetS group had significantly higher beta-cell functional reserve as measured by the glucagon stimulation test [area under the curve (AUC) for C-peptide levels 19.50+/-2.26 compared with 8.66+/-1.66 ng/ml over 10 min; P=.0001]. A significantly higher proportion of patients in the +MetS group had preserved beta-cell functional reserve than in the -MetS group (70% compared with 30%; P<.00001). After 12 months of follow-up, +MetS patients had significantly lower HbA1c levels (8.3+/-0.4% compared with 9.8+/-0.4%; P=.01) and higher C-peptide/glucose ratios (2.01+/-0.28 compared with 1.14+/-0.21; P=.02) than the -MetS patients did. CONCLUSIONS: Patients with ketosis-prone diabetes with the MetS are more likely to have features associated with Type 2 diabetes, despite having developed diabetic ketoacidosis (DKA), with better beta-cell functional reserve and glycemic control after the index DKA episode.     

Heterotopic bone formation in rectal carcinoma

A case of heterotopic bone formation in a primary rectal adenocarcinoma was recently observed in a 54-year-old woman. This unusual finding was present both in the diagnostic biopsy and in the subsequently resected bowel. Pertinent gross and microscopic features are presented. This report represents the twelfth case in the literature of heterotopic bone formation in a primary rectal adenocarcinoma and the first such finding in a colonic biopsy from one of these malignancies. The average age of these patients was 56 years (range 32-72) and the male-to-female ratio was 5:7. The rectum is the most common site of ossification in the gastrointestinal tract. The exact mechanism of heterotopic ossification is unknown, but it is probably the result of metaplasia of fibroblasts. Adenocarcinoma has been associated with 12 of the 16 reported cases of rectal glandular tumors with heterotopic bone.     

Expanded range of Burkholderia species in Australia

We recently reported the production of the recombinant kinesin-related protein of Leishmania donovani with a molecular weight of 42 kd (rKRP42) and the value of the antigen in serum-based ELISA for the diagnosis of visceral leishmaniasis (VL). In this study, the rKRP42 antigen was validated with ELISA using urine samples (rKRP42 urine ELISA). The urine-based ELISA showed 94% sensitivity (108 positives among 115 VL samples) and 99.6% specificity (239 negatives among 240 non-VL samples). The sensitivity and specificity are almost similar to our previous results by ELISA with acetone-treated L. donovani promastigote antigen and direct agglutination test, both methods being done by use of urine samples. A comparison of the rKRP42 urine ELISA with the commercially available urinary antigen detection kit (KAtex) using 108 VL samples showed much higher sensitivity of the ELISA (96.3%) than KAtex (55.6%). The use of the rKRP42 antigen with urine samples will facilitate epidemiologic studies.     

Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality

BACKGROUND: HIV-1 transmission through breastfeeding is a global problem and has been associated with poor maternal micronutrient status. METHODS: A total of 1078 HIV-infected pregnant women from Tanzania were randomly assigned to vitamin A or multivitamins excluding A from approximately 20 weeks' gestation and throughout lactation. RESULTS: Multivitamins excluding A had no effect on the total risk of HIV-1 transmission (RR 1.04, 95% CI 0.82-1.32, P= 0.76). Vitamin A increased the risk of transmission (RR 1.38, 95% CI 1.09-1.76, P = 0.009). Multivitamins were associated with non-statistically significant reductions in transmission through breastfeeding, and mortality by 24 months among those alive and not infected at 6 weeks. Multivitamins significantly reduced breastfeeding transmission in infants of mothers with low baseline lymphocyte counts (RR 0.37; 95% CI 0.16-0.85, P = 0.02) compared with infants of mothers with higher counts (RR 0.99, 95% CI 0.68-1.45, P = 0.97; -for-interaction 0.03). Multivitamins also protected against transmission among mothers with a high erythrocyte sedimentation rate (P-for-interaction 0.06), low hemoglobin (P-for-interaction 0.06), and low birthweight babies (P-for-interaction 0.04). Multivitamins reduced death and prolonged HIV-free survival significantly among children born to women with low maternal immunological or nutritional status. Vitamin A alone increased breastfeeding transmission but had no effect on mortality by 24 months. CONCLUSION: Vitamin A increased the risk of HIV-1 transmission. Multivitamin (B, C, and E) supplementation of breastfeeding mothers reduced child mortality and HIV-1 transmission through breastfeeding among immunologically and nutritionally compromised women. The provision of these supplements to HIV-infected lactating women should be considered.     

Conceptual and measurement issues in assessing disability cross-nationally: Analysis of a WHO-sponsored survey of the disablement process in Indonesia

The World Health Organization, in collaboration with the Indonesian Institute of Health Research and Development, conducted a survey of disability in 14 of 24 Indonesian provinces. This survey was designed to assess the validity of the disablement process as described in WHO's (1980) classification of impairments, disabilities, and handicaps. We analyzed these data with a multivariate procedure which simultaneously identifies subgroups in the surveyed population and the typical attributes of those subgroups. The purpose of the analysis was to (a) determine the association of basic patterns of physical and psychological impairments with disabilities (limitations of the ability to perform certain functions) and handicaps (limitations in the ability to fulfill social roles); (b) assess how those disabilities and handicaps were expressed in urban and rural contexts in a developing country, and (c) determine how the relation of impairments with disabilities and handicaps varied with age.Drs. Manton's and Woodbury's efforts in this research were supported by HCFA grant no. 18-C-98641, NIA grant AG01159 and NSF grant no. SES 8219315.     

Treatment of breast cancer with gonadotropin-releasing hormone

Analogs of GnRH, given chronically in a continuous fashion, produce a paradoxic inhibition of pituitary gonadotropin secretion and, consequently, gonadal steroidogenesis. Thus, GnRH analogs are an attractive class of compounds for achieving a medical castration in the treatment of hormone-dependent neoplasms. In a group of 25 premenopausal patients with progressive advanced breast cancer, daily sc administration of 1-10 mg Leuprolide [D-Leu6-Pro9GnRH ethylamide (NEt)] induced objective tumor regression in 44% with a median duration of 9 months. All women treated for at least 10 weeks developed amenorrhea. Profound suppression of gonadotropins, estradiol, and progesterone secretion occurred in all patients on chronic therapy and persisted for the whole treatment period. These effects on tumor growth and ovarian hormone levels are similar to those observed after surgical ovariectomy. Other GnRH analogs such as Buserelin and Zoladex have been found to have similar antitumor and hormonal effects which are also comparable to those produced by surgical ovariectomy. The mode of drug administration is important. Consistent suppression of ovarian function has only been observed with sc injections of the analogs. Chronic intranasal therapy has been found to induce an incomplete suppression of ovarian function in most patients, probably as a result of the poor absorption of these compounds through this route (approximately 2%). Treatment of metastatic breast cancer with GnRH analogs has been associated with remarkable absence of significant toxicity. Despite some evidence in favor of a direct antitumor effect independent of suppression of ovarian function, the use of GnRH analogs in the therapy of advanced breast cancer should be restricted to premenopausal women.