High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Mauritius Noncommunicable Disease Study Group

Mauritius, a multiethnic island nation in the southwestern Indian Ocean, has one of the world's highest diabetes mortality rates. The prevalence of both impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) was investigated in 5080 Muslim and Hindu Indian, Creole (mixed African, European, and Indian origin), and Chinese Mauritian adults aged 25-74 yr who were selected by random cluster sampling. Based on a 75-g oral glucose tolerance test and World Health Organization criteria, the age-standardized prevalence of IGT was significantly greater in women (19.7%, 95% confidence interval [CI] 18.1-21.2) than in men (11.7%, CI 10.5-12.8). By contrast, the prevalence of NIDDM was similar in men (12.1%, CI 10.9-13.4) and women (11.7%, CI 10.5-12.8) for all ethnic groups combined. The sex difference in IGT prevalence was seen in all ethnic groups, but for NIDDM, the sex difference was not consistent across ethnic groups. However, age- and sex-standardized prevalence of IGT and NIDDM was remarkably similar across ethnic groups (16.2 and 12.4% in Hindu Indians, 15.3 and 13.3% in Muslim Indians, 17.5 and 10.4% in Creoles, and 16.6 and 11.9% in Chinese, respectively). Three new cases of diabetes were diagnosed for every two known cases. The high prevalence of abnormal glucose tolerance in Indian subjects is consistent with studies of other migrant Indian communities, but the findings in Creole and, in particular, Chinese subjects are unexpected. Potent environmental factors shared between ethnic groups in Mauritius may be responsible for the epidemic of glucose intolerance.     

The relation of physical activity to cardiovascular disease risk factors in Mauritians. Mauritius Noncommunicable Disease Study Group

The authors investigated the relation between physical activity and cardiovascular disease risk factors in a random sample of 4,658 Asian Indian, Creole, and Chinese adults aged 25-74 years from the island nation of Mauritius. Subjects known to have diabetes were excluded from analyses. Subjects were divided into "active" and "inactive" groups on the basis of a combined leisure and occupational physical activity score determined at interview (April 1987). Two-hour plasma glucose concentration and fasting and 2-hour serum insulin concentrations were significantly lower and high density lipoprotein (HDL) cholesterol was significantly higher in active subjects of both sexes. Plasma uric acid and fasting triglyceride levels were also lower among active subjects, but significantly so only in females. Systolic and diastolic blood pressure levels, body mass index (weight (kg)/height (m)2), and waist:hip ratio varied little between the two activity groups. In multiple linear regression analyses, physical activity made an independent negative contribution to the models for 2-hour glucose and insulin in both males and females, as well as for fasting insulin in males. When glucose and insulin were not included, physical activity also made an independent contribution to the models for plasma triglycerides (inversely) in females and HDL cholesterol and HDL cholesterol as a proportion of total cholesterol (positively) in males. The authors have demonstrated improved cardiovascular disease profiles associated with physical activity in Mauritians. The data suggest that much of the effect is modulated via an effect on insulin-glucose metabolism. Promotion of exercise should become an important strategy in the prevention of cardiovascular disease and glucose intolerance in this population.     

Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.     

Systemic effects of insulin-like growth factor-II produced and released from Wilms tumour tissue

The concentration of mRNA of insulin-like growth factor-II is (IGF-II) much elevated in some embryonic tumours such as Wilms tumour (nephroblastoma). In order to prove whether or not IGF-II is produced by the tumour tisue, IGF-II was extracted from freshly frozen tissue of Wilms tumour and hepatoblastoma. Normal adjacent tissue of kidney and liver was used as a control. The total IGF-II in Wilms tumour was 548.4±77.4 ng/g (n=7) compared to 112.8±38.2 ng/g (n=5) in kidney. In two hepatoblastomas, it was 96.1±22.8 ng/g compared to 30.1±14,2ng/g in normal liver. Small pieces of fresh primary tissue of several Wilms tumours were successfully transplanted into immunodeficient nude mice. In serum of tumour-bearing mice IGF-II was elevated compared to normal mice. Liver weight of tumour bearing mice was higher than that of control mice (2.29±0.4g and 2.02±0.06 g;P<0.005). This was also found for kidney weight (0.58±0.01 g vs. 0.51±0.01 g in controls,P<0.001). In contrast, serum glucose (9.73±0.29 mmol/l compared to 11.80±0.42 mmol/l in controls,P<0.0005) was decreased. However, there was no significant difference in nose-tail length of tumour-bearing compared to control mice. These results demonstrate that besides the highly increased IGF-II-mRNA, the synthesis of the peptide IGF-II and its release into circulation are also elevated in Wilms tumour transplanted into nude mice. Elevated circulating IGF-II is likely to stimulate growth of some inner organs and has a glucose lowering effect but does no stimulate skeletal growth. This is further evidence for the importance of IGF-II as a growth factor.     

Manifestations systémiques extracutanées du psoriasis pustuleux généralisé

Generalized pustular psoriasis of the von Zumbusch type is a severe form of psoriasis characterized by disseminated pustular skin lesions with high fever and hyperleukocytosis. We report a 32-year-old woman who presented a generalized pustular psoriasis with extra-cutaneous manifestations of the disease that included pulmonary involvement, aseptic arthritis, jaundice, and liver abnormalities. The extra-cutaneous manifestations of generalized pustular psoriasis should be known to physicians caring for patients with psoriasis in order to avoid diagnostic delay.     

Bullous lupus. About one case

Bullous lupus is a rare manifestation of systemic lupus characterized by subepidermal blistering. We report a case of a-27-year-old woman with vesiculobullous lesions and class IV lupus nephritis. Bullous lupus is often associated with autoimmunity to type VII collagen.