EFFECT OF CHRONIC TREATMENT WITH AMLODIPINE IN NON-INSULIN-DEPENDENT DIABETIC RATS

We have investigated the effects of amlodipine on streptozotocin- (STZ) induced neonatal non-insulin-dependent diabetes mellitus (NIDDM) rats. NIDDM was induced by intraperitoneal injection of STZ (70 mg kg⁻¹) to 5-day-old rat pups. The animals were weaned at 30 days and maintained with food and waterad libitumfor 3 months. Amlodipine (5 mg kg⁻¹p.o.) was administered for 6 weeks after the animals were confirmed diabetic (3 months after the STZ injection). A group of control animals were also maintained and this group received citrate buffer 5 days after birth. Fasting- and fed-glucose levels in NIDDM rats were significantly higher than control rats. Treatment with amlodipine reduced the elevated fasting- and fed-glucose levels significantly. Results of the oral glucose tolerance test (OGTT) revealed that glucose tolerance is impaired in the NIDDM rats. There was a marked increase in glucose levels after oral administration of glucose in the control NIDDM rats. Increased glucose levels were found to be associated with increased insulin levels. Treatment with amlodipine in the NIDDM rats caused a decrease in insulin release, however, glucose levels were found to be lowered significantly indicating that amlodipine causes an increase in insulin sensitivity. In conclusion, our data indicated that amlodipine increases insulin sensitivity in neonatal-STZ NIDDM rats.     

The attitudes of medical students to the objective structured practical examination

Summary. The objective structured practical examination (OSPE) together with the classical practical examination (CPE) form the basis for evaluation of laboratory teaching at the All India Institute of Medical Sciences, New Delhi. Students' attitudes to OSPE and CPE were assessed by preparing a questionnaire containing 32 item statements on Likert's 5-point scale (LS) and 11 bipolar adjectives on Osgood's 7-point Semantic Differential Scale (OSDS). The questionnaire was administered to 50 medical undergraduates before their final examination. Forty-two (84%) students responded to the questionnaire. The LS showed high internal consistency and validity. Attitude scoring on LS and OSDS revealed a high degree of correlation. The majority of students showed a positive attitude to OSPE, and high-rank students had a greater intensity of positive attitude. OSPE was rated as a reliable, effective, useful, interesting and challenging examination, although considered taxing, mentally and physically. The students preferred a combination of OSPE and CPE as in the present system to a complete change-over to the OSPE. The item analysis of the questionnaire is discussed.     

Epinephrine test dose in children: is it interpretable on ECG monitor?

Background:  Epidural and other regional blocks are performed in children under general anesthesia; the response to a 'test dose' may be altered during administration of general anesthetics. Limited data is available describing changes in electrocardiogram, blood pressure and heart rate (HR) following unintentional intravascular injection of a lidocaine–epinephrine-containing test dose, under sevoflurane anesthesia in children.
Methods:  Sixty-eight children undergoing elective surgeries under sevoflurane anesthesia were administered 0.1 ml·kg⁻¹ of 1% lidocaine with epinephrine 0.5 μg·kg⁻¹ or normal saline intravenously, to simulate an accidental intravascular test dose. T-wave changes in lead II on the anesthesia monitor and on a printed ECG were noted over the initial 1 min as well as changes in HR and systolic blood pressure (SBP) over an initial 3 min period.
Results:  Following injection of lidocaine–epinephrine, a significant increase in T-wave amplitude in lead II was noted in 91% of children on the ECG monitor and in 94% of children on the ECG printout of the same lead. In 64% of children, an increase in HR of ≥10 b·min⁻¹ and in 76% of children an increase in SBP of ≥15 mmHg was noted.
Conclusion:  An increase in T-wave amplitude can easily be detected by carefully observing the ECG monitor or an ECG printout within a minute following the accidental i.v. administration of 0.1 ml·kg⁻¹ of 1% lidocaine-epinephrine (0.5 μg·kg⁻¹) regional anesthetic test dose in children under sevoflurane anesthesia.     

Biliary ascariasis complicating endoscopic sphincterotomy for choledocholithiasis in India

Endoscopic sphincterotomy is the treatment of choice for patients with choledocholithiasis. Biliary ascariasis has been reported from many parts of the world but is common in Kashmir, India. We report five cases of biliary ascariasis of which four were the result of post-endoscopic sphincterotomy for choledocholithiasis. Therefore, biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy.