Renal hypomagnesaemia in human diabetes mellitus: its relation to glucose homeostasis

Abstract. Interrelations between magnesium and glucose metabolism were studied in 215 insulin-treated diabetic out-patients aged 7–70 years. All had normal serum creatinine concentrations (below 115 μmol/l) and none had other diseases or received drugs known to interfere with mineral metabolism. A definite hypomagnesaemia (< normal mean —2 SD) and hypermagnesiuria (> normal mean + 2 SD) occurred in 38.6% and 55% of the patients. In the presence of hypermagnesiuria the serum magnesium concentration was inversely correlated to the urinary magnesium excretion rate ( R =–0.23, P <0.02). Serum magnesium correlated inversely with both fasting blood glucose ( R =—0.32, P <0.001) and the urinary glucose excretion rate ( R =–0.22, P <0.005). The urinary magnesium excretion rate correlated directly with the same variables ( R = 0.27, P <0.001 and R = 0.58, P <0.001, respectively). These data indicate that the net tubular reabsorption of magnesium is decreased in diabetic patients in presence of hyperglycaemia, leading to hypermagnesiuria and hypomagnesaemia.     

Polymyositis in Childhood A Case Report

A case of polymyositis in a 7-year-old girl, verified by electromyography and biopsy, is described. The difference between dermatomyositis and polymyositis is discussed. According to the literature, polymyositis appears to have a better prognosis. In the case reported, steroids were beneficial. This treatment is discussed     

Results from the Use of a Preshaped Lead for Single-Pass VDD/DDD Stimulation

Main criticisms about single-pass VDD stimulation in patients with AV block and normal sinus node function concern atrial undersensing in a lead with floating atrial electrodes, and loss of AV synchrony if sinus node dysfunction develops after implantation. We evaluated the concept of a preshaped single-pass lead designed to place the atrial ring electrodes in a constant position close to, or in contact with, the atrial wall. A preshaped lead (Model 2775, Medtronic Inc.) was implanted in 14 patients and followed for up to 2 years. Mean P wave amplitudes (PWAs) were 3.1 mV at implantation, 1.2 mV at predischarge, and 1.3 mV after 12 months. In all patients, minimal PWAs were well above maximal atrial sensitivity of the pacemaker in all body positions during the complete follow-up; atrial undersensing was not observed. Effective atrial stimulation was possible in all patients at implantation (mean stimulation threshold 2.5 V at 0.50 ms), in 11 patients on the first day after implant (mean stimulation threshold 0.22 ms at 5.0 V), in 10 patients after 1 month (mean stimulation threshold 0.57 ms at 5.0 V), and in 10 patients after 1 year (mean stimulation threshold 0.65 ms at 5.0 V). Intermittent phrenic nerve stimulation could be provoked in six patients. In conclusion, the concept of a preshaped single-pass lead facilitated implantation, improved atrial sensing performance, and allowed atrial stimulation in some patients. Still, further improvements are necessary to decrease the atrial stimulation thresholds to acceptable values in all patients.     

The HL-A7 Histocompatibility Antigen in Sarcoidosis Relation to Tuberculin Sensivity

Eighty cases of sarcoidosis have been investigated. In all except eight patients a histological verification of the diagnosis was obtained by mediastinoscopy or liver biopsy. The HL-A7 antigen was not increased in the entire group. However, in the group of patients with a negative sensitivity to tuberculin after the appearance of the disease there was a significant increase compared with controls. In the patients with a positive reaction, there was a complete absence of HL-A7. The HL-A system therefore does not seem to influence the liability to contract sarcoidosis, but once this condition has developed HL-A7 positives are more likely to lose cellular immunity to tuberculin and to reveal symptoms.     

HEALTH AWARENESS VERSUS ECONOMIC AFFLUENCE AS DETERMINANTS OF HEALTH STATUS : A COMMUNITY BASED EPIDEMIOLOGICAL ANALYSIS

A community-based cross-sectional analytic epidemiological study was undertaken to compare the health status of school children from two villages and to see the association of the school children''s health status with the level of health awareness among parents and teachers. The two villages had only one major difference, i.e., one had an agriculture-based economy and was more affluent than the other village. The study, however, revealed that the overall morbidity and nutritional deficiencies were significantly less (p < 0.01) and immunization status significantly better (p < 0.01) among school children of the less affluent village, possibly because level of health awareness was significantly higher among parents and teachers of this village as compared to the more affluent one (p < 0.01). The importance of health education has been reinforced by this study.KEY WORDS: Health status, Health planning, Health education     

A prospective study of oral lesions and their predictive value for progression of HIV disease

OBJECTIVE: This report evaluates and compares individual oral lesions and combinations of lesions in predicting progression-free survival in a seroprevalent cohort of men and women with HIV infection. DESIGN: This was a prospective study of HIV-infected patients, initially AIDS-free, followed for approximately 30 months. SETTING: Patients were volunteers examined at an academic medical center and at an inner-city hospital in New York. Participants identified themselves as homosexual men or as injection drug users (IDU).OUTCOME MEASURES: The primary outcome being assessed is time from a baseline oral examination until the development of an AIDS-defining condition or death from any cause within 12 months of the last study visit. Correlation is measured by relative risk (RR).RESULTS: While oral lesions were not predictive of progression among subjects with CD4s=200, they were highly predictive of progression among those with CD4<200.For subjects with CD4<200, the only individual lesion that was significantly associated with progression-free survival was oral candidiasis (RR=4.12, P= 0.009).Positivity for one or more lesions in a set demonstrated greater prognostic value among those with CD4<200, with RR's of 6.03 (P= 0.018) for the set consisting of oral candidiasis, hairy leukoplakia, and necrotizing ulcerative gingivitis (NUG), and 8.77 (P= 0.036) for the set consisting of the above lesions plus linear gingival erythema (LGE).Analysis by cohort suggested that the improvement in correlation was stronger in homosexual men than in IDU, but this question could not be resolved conclusively with these data. CONCLUSIONS: Lesion sets might be better prognosti-cators of progression-free survival than individual lesions among HIV-infected subjects with CD4<200.Prognostic value of the core lesion set (oral candidiasis and hairy leukoplakia) was enhanced by the addition of other lesions (NUG and LGE) not usually included in HIV staging systems. These results suggest that staging systems for HIV might be improved by the inclusion of other, survival-related oral lesions.