罗格列酮和二甲双胍对初诊2型糖尿病胰岛素抵抗的影响

目的:观察罗格列酮和二甲双胍对初诊2型糖尿病患者胰岛素抵抗(IR)的影响. 方法:初诊2型糖尿病48例,在饮食和运动治疗基础上随机给予罗格列酮片4 mg 1次/d,即罗格列酮组;给予二甲双胍片500 mg 2次/d,即二甲双胍组,疗程12 wk. 结果:在两组患者取得相当降糖疗效基础上,二甲双胍组和罗格列酮在治疗后空腹和馒头餐后C肽水平均较用药前有明显降低、IR亦有降低、β细胞功能明显改善. 罗格列酮在降低餐后胰岛素、改善IR方面优于二甲双胍,两药物治疗前后血游离脂肪酸水平未见显著差异. 结论:二甲双胍和罗格列酮都可降低IR和改善β细胞功能,在降低IR方面,罗格列酮优于二甲双胍.     

A study of Hepatitis A and E virus seropositivity profile amongst young healthy adults in India

Background

Various Serosurveys and studies provide ample evidence of differing perspectives regarding epidemiology of HAV and HEV in India. This study was conducted to assess the seroprevalence of HAV and HEV and its associated factors with an aim to provide inputs to planners regarding requirement of HAV vaccine.

Methods

A multi-centric cross sectional survey amongst 4175 healthy trainees (young adults) was carried out in training centres, selected by multistage random sampling, giving equal representation to all regions of India. Sample size was calculated by taking prevalence of HAV seropositivity amongst adults as 60% and alpha 0.05.

Results

Seroprevalence for HAV and HEV was 92.68% (95% CI 91.82, 93.47) and 17.05% (15.90, 18.26), respectively. Logistic regression showed that hand washing without soap, regular close contact with domestic animals, consumption of unpasteurized milk and regular consumption of food outside home were risk factors for HAV (p < 0.05). For HEV, irregular hand washing, consumption of unpasteurized milk and irregular consumption of freshly prepared food were risk factors (p < 0.05).

Conclusion

High level of immunity against HAV among the healthy young adults clearly demonstrates that vaccination against HAV is not required at present in our country. The large proportion being susceptible to HEV points towards the requirement of preventive strategies in the form of safe drinking water supply, hygiene, sanitation, increasing awareness and behaviour change with respect to personal hygiene especially hand and food hygiene.     

心脏移植围手术期肺动脉高压的诊断和治疗进展

0 引言 自1967年人类首例同种心脏移植成功,随着移植技术的提高及相关学科的发展,心脏移植的成功率及疗效都有了很大的改善.目前同种异体原位心脏移植术(orthotopic heart transplantation,OHT)已成为治疗终末期心脏病最有效的手段,为这类患者的生存带来了新的希望.肺动脉高压(pulmonary hypertension,PHT)作为终末期心衰的严重并发症,被视为心脏移植的高危因素,增加围手术期的死亡率[1],是当前心脏移植的一大难题.近年来,随着PHT认识的不断深入和有效药物的应用,PHT患者成功接受心脏移植的报道也越来越多.本文就肺动脉高压对心脏移植的影响、心脏移植手术指征以及围手术期相关处理综述如下.     

Childhood tuberculosis in Malawi: caseload,diagnostic practices and treatment outcomes

There were 22,982 cases of TB registered in Malawi in 1998, of which 2739 (11.9%) were children. Children accounted for 11.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extrapulmonary TB (EPTB). A significantly higher proportion of TB cases were diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. In 2001, all 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB) were surveyed to determine actual diagnostic practice. This cross sectional study identified 150 children aged 14 years or below in hospital receiving anti-TB treatment, 98 with pulmonary TB (PTB) and 52 with extrapulmonary TB (EPTB). Median duration of illness was 8 weeks. Most patients had fever, no response to anti-malarial treatment and antibiotics, and 40% had a positive family history of TB. Nearly 45% had weight for age < 60%. Diagnosis was mainly based on clinical features and radiography, with less than 10% having tuberculin skin tests or HIV serology, and very few having other sophisticated investigations. Diagnostic difficulties make it difficult to accurately define the actual burden of childhood TB in Malawi. Diagnostic practices are poor and treatment outcomes unsatisfactory.     

脑立体定向多靶点毁损治疗精神分裂症1例

1 临床资料患者,女性,35岁,主因"失眠、焦虑8 a余,加重伴思维障碍、行为异常6 a,被害妄想2 mo"入院.病史特点为心理应激后出现神经衰弱症状.发展期渐出现思维逻辑错乱、脱离现实,认为与父母无血缘关系;情感、思维、意志行为与周围环境不协调;生育后有孩子被害妄想.其母患抑郁症.无神经系统查体及CT阳性发现.     

Neuroprotective effect of a triterpenoid saponin isolated from Momordica cymbalaria Fenzl in diabetic peripheral neuropathy

Objectives:

To investigate the neuroprotective potential of a saponin isolated from the roots of Momordica cymbalaria against peripheral neuropathy in streptozotocin-induced diabetic rats.

Materials and Methods:

A steroidal saponin (SMC) was isolated from M. cymbalaria Fenzl and purified by preparative high-performance liquid chromatography. Diabetes was induced in male Wister rats by injecting streptozotocin 45 mg/kg. Diabetic rats were divided into six groups for neuroprotective effect—three each for preventive and curative groups. Neuropathic analgesia was assessed by tail-flick and hot-plate methods. Dorsal root ganglion (DRG) neurons and sciatic nerves were isolated, and histopathological analysis was performed. Antioxidant activity (superoxide dismutase, catalase, and inhibition of lipid peroxidation) of the saponin was also carried out on the isolated DRG neurons and sciatic nerves to assess total oxidative stress.

Results:

In both preventive and curative protocols, rats administered with SMC showed significant decrease in tail immersion latency time and increase in pain sensitivity when compared to diabetic control group. There was improvement in the myelination and degenerative changes of the nerve fiber in both the groups, and an obvious delay in the progression of neuropathy was evident. SMC treatment showed significant decrease in superoxide dismutase, catalase activity, and lipid peroxidation in the nerves.

Conclusions:

The steroidal saponin of M. cymbalaria (SMC) possesses potential neuroprotective effect in diabetic peripheral neuropathy with respect to neuropathic analgesia, improvement in neuronal degenerative changes, and significant antioxidant activity.KEY WORDS: Antioxidant, diabetic peripheral neuropathy, neuroprotection, saponin of Momordica cymbalaria     

Perceived control over condom use among sex workers in Madagascar: a cohort study

Background  

Women's perceived control over condom use has been found to be an important determinant of actual condom use in some studies. However, many existing analyses used cross-sectional data and little quantitative information exists to characterize the relationships between perceived control and actual condom use among sex worker populations.     

Norms of the Rorschach Test for Indian Subjects

Background

The clinical utility of the Rorschach test in Indians is hampered by the absence of reliable normative data. Method : The Rorschach by Dlopfer''s method was administrated to 1256 subjects consisting of 300 normal army personnel, 300 normal civilians, 250 schizophrenics, 300 neurotics and 106 patients with organic disorders.

Results

The Rorschach protocols of normal Indian army personnel and normal civilians showed significant differences from one another and also from the western norms. These differences are culturally determined and are not indicative of low intelligence or psychopathology. Patients with schizophrenia, neurosis, head injury and epilepsy show significant differences from the records of normal subjects. The protocols of army schizophrenics show significant deviations from those of normal army personnel and these changes revert to normal with clinical recovery.

Conclusion

The Rorschach test is not a culture fee test as claimed earlier. In view of the differences from Western norms, Rorschach protocols of Indians should be interpreted using the norms for Indians. In the case of army personnel the norms for army personnel should be used. While the use of the Rorschach to study the personality patterns of normal individuals and as an aid to clinical diagnosis was strongly supported, the findings of the study indicate that the test can also be employed to assess therapeutic response of patients with schizophrenia.Key Words: Rorschach test, norms, schizophrenia, neurosis