Isolation of Bacterial Contaminants from Operating Theatres in EnNahud City, West Kordofan State – Sudan

Background: The prevalence of nosocomial infections has continued to rise due to microbial contamination of the hospital environment. Operating room contamination, on the other hand, is one of the most common and life-threatening sources of nosocomial infections. Objective: The goal of this research is to isolate and identify bacterial contaminants in operating rooms and equipment in EnNahud, West Kordofan. Methods: A total of 45 samples (from three hospitals) were collected from various operating theatre sites between September and December 2020. Using the accepted bacteriological methods (ISO/TC 147/SC 4 Microbiological techniques), all isolated bacteria were identified. S. Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 25923 were employed as control bacterial strains to track the entire bacteriological process. Results: Five kinds of bacteria were recovered from the 45 (100%) positive specimens in three hospitals in this study. The number of polluted hospitals is on the rise (100%). The most prevalent bacterial pollutants identified from operation theaters were Staphylococcus aureus 24 (53.3%), Pseudomonas aeruginosa 13 (28.8%), Bacillus spp 6 (13.3%), Proteus spp 1 (2.2%), and Salmonella spp 1 (2.2%), according to the findings (2.2%). All of the places where samples were taken were found to be completely contaminated. Conclusion: The relatively high degree of bacterial contamination in hospital operating rooms highlights the need for ongoing microbiological surveillance aimed at detecting bacterial contamination levels and their impact on nosocomial infection early.

Renal histological alterations induced by acute exposure of titanium dioxide nanoparticles / Alteraciones histológicas renales inducidas por la exposición aguda de nanopartículas de dióxido de titanio

SUMMARY: Titanium dioxide nanoparticles (TiO2 NPs) are widely used in many commercial products, nanomedicine, agriculture, personal care products, different industries and pharmaceutical preparations with potential risk in human health and the environment. The current work was conducted to investigate the renal damage that might be induced by the acute toxicity TiO2 NPs. A total of 40 healthy male adult Wistar albino rats (Rattus norvegicus) were exposed to TiO2 NPs (126, 252, 378 mg/kg bw) for 24 and 48 h. Fresh portions of the kidneys from each rat were processed for histological and histochemical alterations. In comparison with respective control rats, exposure to TiO2 NPs has marked the following glomerular, tubular and interstitial alterations including the followings: glomerular congestion, Bowman's capsule swelling and dilatation, inflamed glomeruli, renal tubules cloudy swelling, karyorrhexis, karyolysis, infiltration of inflammatory cells, congestion, necrosis, hydropic degeneration, dilatation and congestion of blood vessels, hyaline droplets and hyaline casts precipitation, interstitial edema and fibrosis. From the findings of the current work one may conclude that TiO2 NPs are capable of inducing kidney damage with more insulation in the cortex and the proximal convoluted tubules than the medulla and the distal ones respectively. In addition, it might be concluded that renal damage induced by these nanomaterials is dose and duration of exposure dependent. Further hematological, biochemical, immunohistochemical, and ultra-structural studies are recommended.

RESUMEN: Las nanopartículas de dióxido de titanio (TiO2 NP) se usan ampliamente en muchos productos comerciales, nanomedicina, agricultura, productos para el cuidado personal, diferentes industrias y preparaciones farmacéuticas con riesgo potencial para la salud humana y el medio ambiente. El trabajo actual se realizó para investigar el daño renal que podría ser inducido por la toxicidad aguda NP de TiO2. Un total de 40 ratas Wistar albinas adultas sanas (Rattus norvegicus) fueron expuestas a TiO2 NP (126, 252, 378 mg / kg de peso corporal) durante 24 y 48 h. Las muestras de los riñones de las ratas se procesaron para estudios histológicos e histoquímicos. En comparación con las ratas control, la exposición de las ratas a TiO2 NP presentaron las siguientes alteraciones glomerulares, tubulares e intersticiales: congestión glomerular, dilatación de la cápsula de Bowman, inflamación glomerular, túbulos renales aumentados, cariorrexis, cariólisis, infiltración de células inflamatorias, congestión, necrosis, degeneración hidrópica, dilatación y congestión de vasos sanguíneos, gotas y precipitaciones hialina, edema intersticial y fibrosis. A partir de los hallazgos del trabajo actual, se puede concluir que las NP de TiO 2 son capaces de inducir daño renal con más aislamiento en la corteza y en los túbulos contorneados proximales que en la médula y los túbulos contorneados distales, respectivamente. Además, se podría concluir que el daño renal inducido por estos nanomateriales depende de la dosis y la duración de la exposición. Se recomiendan estudios adicionales hematológicos, bioquímicos, inmunohistoquímicos y ultraestructurales.

Ameliorative effect of propolis against hepatorenal alterations induced by methotrexate: morphohistopathological study / Efecto protector del propóleo en las alteraciones hepatorrenales inducidas por el metotrexato: estudio morfohistopatológico

Methotrexate (MTX) is widely used in the treatment of some forms of cancer but having severe side effects. The present work aimed to investigate the protective role of propolis treatment against alterations induced by MTX on the hepatic and renal tissues. Rabbits were exposed to MTX (0.25 mg/kg), with or without propolis (50 mg/kg) while hepatic and renal biopsies were examined for histological and histochemical abnormalities. Methotrexate induced hydropic degeneration, pyknosis, sinusoidal dilatation and bile duct hyperplasia in the liver together with renal tubular degeneration, glomerular shrinkage and hyaline droplet precipitation. While propolis partially ameliorated some of the morphometric and biochemical alterations, none of the hepatic alterations induced by MTX was protected by propolis treatment. Nevertheless glomerular shrinkage and renal tubule degeneration were partially protected in animals received both MTX plus propolis. It is concluded that propolis treatment has little or no ameliorative effect in protecting the hepatic and renal tissues from MTX toxicity.

El metotrexato (MTX) es ampliamente utilizado en el tratamiento de algunas formas de cáncer, pero tiene efectos secundarios graves. El presente trabajo tuvo como objetivo investigar el papel protector del tratamiento con própoleo frente a las alteraciones inducidas por el MTX en los tejidos hepático y renal. Se expusieron conejos a MTX (0,25 mg / kg), en grupos con y sin propóleo (50 mg / kg), y se realizaron biopsias hepáticas y renales, que fueron examinadas buscando anomalías histológicas e histoquímicas. El metotrexato indujo la degeneración hidrópica, picnosis, dilatación sinusoidal e hiperplasia del conducto biliar en el hígado, junto con la degeneración tubular renal, la contracción glomerular y la precipitación hialina. Mientras que el propóleo parcialmente mejoró algunas de las alteraciones morfométricas y bioquímicas, ninguna de las alteraciones hepáticas inducidas por MTX fue protegido por el tratamiento con propóleo. Sin embargo, la contracción glomerular y la degeneración de los túbulos renales fueron parcialmente protegidos en animales que recibieron MTX más propóleo. Se concluye que el tratamiento con propóleo tiene poco o ningún efecto mejorador en la protección de los tejidos hepáticos y renales sometidos a la toxicidad de MTX.

Histological Alterations in the Rabbit Epididymis Induced by Sildenafil Overdosing.

Background: Sildenafil is used for the treatment of erectile dysfunction and is helping millions of men around the world to achieve and maintain a long lasting erection. The histological alterations in the genital system epithelial lining due to sildenafil overdoses intoxication has not yet been well documented. Aim: The present study was carried out to investigate the histological alterations induced by sildenafil overdoses in the epididymal epithelial lining. Methodology: Fifty adult male rabbits (Oryctolagus cuniculus) were subjected to sildenafil (0, 1, 3, 6, 9 mg/kg/day) for 5 days per week for 7 weeks. Samples from left and right proximal epididymis were applied to conventional histological techniques and subjected to histological examination. Results: Exposure to overdoses of sildenafil had provoked histological alterations in the epididymal tissue in the form of epididymal hyperplasia and dilated lumina. Mature spermatozoa were less frequent in the lumen of the epididymis than the control ones while spermatogenic cells, cellular debris and spermatid giant cell were seen in the lumen of the epididymis. Conclusion: The results of the present study confirms that sildenafil provoked alterations in the epididymal epithelial lining together with partial arresting spermatogenesis and impairing the spermatic cells differentiation towards maturation. The findings together might indicate an affect on male fertility induced by sildenafil overdoses.

Prescription pattern of antimicrobial agents in a teaching hospital of South India.

Background: Use of irrational and unnecessary antimicrobials remains common in the developing countries. The present study was conducted to evaluate the use of antimicrobial agents in the tribal district hospital of Andhra Pradesh India. Methods: In this retrospective study, 200 hospitalized cases from medicine, surgery, obstetrics and gynaecology and paediatrics departments were randomly selected. Results: Most common diagnosis was febrile illness (15%) followed by gastroenteritis (10%) and malaria (8%). Antimicrobials were used in 57% cases. All the cases were managed by empirical treatment. Cefixime (40%) was the most common antimicrobial followed by ampicillin (32.50%), metronidazole (30%) and ciprofloxacin (26.50%). Use of antimicrobial monotherapy (41.67%) and 2 drug therapy (36.46%) was common. Conclusion: Empirical use of higher antimicrobial agents is routine and cheap antimicrobials like ampicillin are still most useful drugs in the region. There is a need of specific essential drug list for the region.

Substance Dependence in a Tribal District.

Introduction: Retrospective study was carried out with an aim to understand the status of substance dependence in Adilabad which is a tribal district of Telangana region and to know the possible reasons behind it. Material and Methods: Records from September 2009 to August 2010 was collected and analysed from patients of RIMS Adilabad. Cases of single substance dependence or polysubstance dependence and associated disorders were included in the study. Parameters were incidence, socio-demographics, age, sex, polysubstance dependence, alcohol dependence, comorbidity, management of substance dependence and hospital stay. Results: A total of 157 patients included in the study. Significant (p<0.05) seasonal variations were observed. Villagers 57.32%, Hindus 92.36%, Muslims 6.37% with mean age of 37 years was observed. Female to male ratio was 0.05:1. 86% females were from tribal villages, chronic beedi smokers and all had family history. Polysubstance dependence (3.18%) included alcohol 100% and cannabis 2.55%. Chronic alcoholics 44.59%, moderate quantity in 76%, consciousness in 53%, handmade liquor in 18% and alcohol without food in 7.64% observed. Associated comorbidity seen in 70.70% cases. Death occurred in 3.18% cases. Ranitidine and ampicillin were mainly given. Mean hospital stay was 2.26 days. Conclusion: Productive age group and handmade liquor is common but polysubstance dependence is negligible. Comprehensive strategy involving education, counselling, treatment and rehabilitation programs are needed to fight against substance dependence in the region.

Inhibition of Naja nigricolis (Reinhardt) venom protease activity by Luffa egyptiaca (Mill) and Nicotiana rustica (Linn) extracts.

Luffa egyptiaca and Nicotiana rustica are used in traditional medicine to treat snakebites and were evaluated for inhibitory activities on Naja nigricolis venom protease. The aqueous and ethanolic extracts of L. egyptiaca significantly reduced the maximum velocity (Vmax) and the computed index of physiological efficiency (Kcat) of the enzyme in a dose dependent fashion. The protease activity was non-competitively inhibited by the aqueous extract of N. rustica with the Vmax significantly decreased and the KM remained unchanged. However, the N. rustica ethanol extract completely inhibited the protease activity. Ethyl acetate fractions partitioned from ethanol extracts of both plants were also found to completely inhibit the N. nigricolis venom protease activity at 0.1 and 0.05%. The use of these plants could be important in the treatment of snakebites.

Chemical Composition of Gallstones from Al-Jouf Province of Saudi Arabia

Background: It is essential to understand the aetiopathogenesis of gallstone disease. This study was undertaken to determine the chemical composition of gallstones from patients living in Al-Jouf Province of Saudi Arabia. Methods: This was a descriptive study where 46 gallstones from Al-Jouf Province of Saudi Arabia were analysed by semiquantitative titrimetric and colourimetric methods. The proportion of different types of gallstones was described using 95% confidence interval based on exact method. Results: Gallstones were found more frequently in female patients (60.9%) than males (39.1%), and these stones were composed of pure cholesterol (54.3%), pure bilirubin (2.2%), or mixed stones (43.5%). The most common chemical constituent was cholesterol (82.6%), while bilirubin was seen in 26.1% of the stones. Calcium was present in 32.6% of the stones in the form of calcium salts of bilirubin and carbonate. Bilirubin-containing stones were slightly more frequent in males than in females, while cholesterol-containing stones were less frequent in males. Conclusion: The findings indicate that gallstones in the Al-Jouf Province develop more frequently in the age group of the third decade of life, with more risk among females than males, and are predominated by cholesterol together with calcium bilirubinate and calcium carbonate.

Morphology: histology and histochemistry of the venom apparatus of the centipede, Scolopendra valida (Chilopoda, Scolopendridae) / Morfología, histología e histoquímica del aparato venenoso del ciempiés: Scolopendra valida (Chilopoda, Scolopendridae)

Morphological, histological and histochemical characterizations of the venom apparatus of the centapede, S. valida have been investigated. The venom apparatus of Scolopendra valida consists of a pair of maxillipedes and venom glands situated anteriorly in the prosoma on either side of the first segment of the body. Each venom gland is continuous with a hollow tubular claw possessing a sharp tip and subterminal pore located on the outer curvature. The glandular epithelium is folded and consists of a mass of secretory epithelium, covered by a sheath of striated muscles. The secretory epithelium consists of high columnar venom-producing cells having dense cytoplasmic venom granules. The glandular canal lacks musculature and is lined with chitinous internal layer and simple cuboidal epithelium. The histochemical results indicate that the venom-producing cells of both glands elaborate glycosaminoglycan, acid mucosubstances, certain amino acids and proteins, but are devoid of glycogen. The structure and secretions of centipede venom glands are discussed within the context of the present results.

Fueron investigadas las características morfológicas, histológicas e histoquímicas del aparato venenoso del ciempiés, S. valida. El aparato venenoso de Scolopendra valida consta de un par de maxilopodos y glándulas de veneno situadas anteriormente en el prosoma, a cada lado del primer segmento del cuerpo. Cada glándula de veneno se continúa en una garra con una cavidad tubular que posee una punta afilada y un poro subterminal situado sobre la curvatura externa. El epitelio glandular es plegado y se compone de una masa de epitelio secretor, cubierto por una vaina de los músculos estriados. El epitelio secretor consiste en células columnares altas productoras de veneno con gránulos citoplasmáticos de veneno densos. El conducto glandular carece de musculatura y está revestido por capa interna quitinosa y epitelio cuboidal simple. Los resultados histoquímicos indican que las células productoras de veneno de ambas glándulas elaboran glucosaminoglucanos mucosustancias ácidas, ciertos aminoácidos y proteínas, pero carecen de glucógeno. La estructura y las secreciones de las glándulas de veneno del ciempiés son examinadas en el contexto de los presentes resultados.

Deferral patterns of voluntary blood donors at the National Blood Transfusion Service, North East zonal centre, Maiduguri

Appropriate donor selection in an important step in ensuring safe supply of blood and blood products. In this study deferral patterns of voluntary non-renumerated blood donors were determined at the North-Eastern Zonal Centre of the National Blood Transfusion service. The study was conducted between April 2007 and April 2009; and it involved the administration of a structured questionnaire. A total of 4032 voluntary blood donors were recruited; seven hundred and thirteen (17.7) were temporarily deferred. The commonest reasons for deferral were low haemoglobin; self-deferral; high blood pressure; low weight and high risk behaviour. Other reasons are use of certain medications; low blood pressure and failed venopuncture. Gender analysis showed that more females were deferred for low haemoglobin and more males were self-deferred. Following donor recall; 146 of the 173 donors temporarily deferred came back to donate. These consisted of 113 deferral due to low haemoglobin; 30 self-deferred and 3 induced in risky behaviour. Effective education or counseling; the old tradition of giving haematinics and good dietary advice to those with low haemaglobin values; improved the safety and availability of blood and blood products. Donors who are self-deferred and those involved in high risk bahviour should never be persuaded to donate blood. There is also the need for a review of operational guidelines with regards the uniform acceptable cut-off point of 12.5g/dl haemoglobin value for males and females

Epidemiological aspects of scorpion stings in Al-Jouf Province, Saudi Arabia

Information on scorpion stings is available for many parts of Saudi Arabia, but not for Al-Jouf Province. We reviewed and analyzed 1449 cases of scorpion stings that presented to the emergency department of the hospitals and medical centers in Al-Jouf Province during a 2-year period [2005-2006]. The majority of patients [92.7%] manifested class I envenomation with local pain at the sting site as the primary complaint. Systemic toxicity was noticed in 7.3% of cases but no deaths were reported. Scorpion stings were recorded throughout the year with the highest seasonal incidence in the summer [64.3%] and the lowest during the winter [10.6%]. The highest monthly incidence was in June [21.5%] and the lowest in December [1.5%]. Most of the patients were male [77.3%] and the age of 44.2% of victims ranged between 15 to 30 years. Diurnal stings exceeded the nocturnal ones with a ratio of 3:2, and most of the stings were located mainly on the exposed limbs [88.6%], especially the lower limbs [51.7%]. Leiurus quinquestriatus and Androctonus crassicc cauda were incriminated in most recorded cases. Our findings indicate that scorpion stings are common in Al-Jouf Province, especially during the summer. The overall threat to human health was found to be low

Clinical and etiological profile of hyperprolactinemia--data from a tertiary care centre.

OBJECTIVE: To study the clinical presentation and etiology of hyperprolactinemia, a common disorder encountered in endocrine practice. METHODS: We analyzed the clinical data, hormone profile and imaging reports of 187 females with documented hyperprolactinemia, over a period of 6 years (5 years retrospective analysis and one year prospective study). RESULTS: Majority of the 187 subjects studied presented in 3rd or 4th decade. Galactorrhoea was the commonest presenting symptom occurring in 159 subjects (85%), followed by amenorrhea in 68.9%; both amenorrhea and galactorrhea were seen in 45.4%. A microprolactinoma was demonstrated in 67 patients (35.8%), a nonfunctioning pituitary macroadenoma with stalk hyperprolactinemia occurred in 30 patients (16%) and polycystic ovarian disease was documented in 24 (12.8%). In 52 patients (27.8%) no apparent cause could be ascertained. CONCLUSIONS: Syndrome of amenorrhea and/or galactorrhea is the commonest presentation in hyperprolactinemia. Microprolactinoma was the most frequent identifiable etiology followed by idiopathic and stalk hyperprolactinemia in our series.

Prevalence and pattern of sick euthyroid syndrome in acute and chronic non-thyroidal illness--its relationship with severity and outcome of the disorder.

BACKGROUND: Non-thyroidal illness is a common cause of alterations in thyroid hormone economy in absence of underlying intrinsic thyroid disorder. OBJECTIVE: To study the prevalence and pattern of alterations in thyroid hormone economy in various non-thyroidal illnesses in our region and also to correlate these alterations with the severity and outcome of the non-thyroidal illness. MATERIAL AND METHODS: We analyzed circulating T3, T4, TSH in 382 patients with non-thyroidal illness (285 acute and 97 acute on chronic) and correlated the alterations with severity and outcome of the non-thyroidal disorder. The patients had one or more organ failure at the time of enrollment to the study. The hormones were estimated at the onset of sickness, and at 3rd and 24th week. T3, T4 and TSH in 75 age and sex matched euthyroid subjects were taken as controls. RESULTS: T3 (mean +/- SEM) was significantly reduced at the onset of illness, in both acute and chronic patient groups (1.61 +/- 0.05 nmol/l) compared to that in the controls (3.17 +/- 0.06 nmol/l). In spite of clinical improvement in most instances, T3 continued to remain low in the 3rd week (1.49 +/- 0.11 nmol/ l) but increased (2.14 +/- 0.09 nmol/l) in 24th week. Low T3 was found in 93 (32.6%) cases with acute illness in 20 (20.6%) cases with chronic illness. A combination of low T3 and T4 was found in 35 (12.3%) of cases with acute and 15 (15.5%) with chronic illness. Although serum TSH showed noticeable fall and rise in some individuals, no significant difference in mean TSH was observed during any period of illness compared to that in the controls. Severity of illness correlated with decrease in T3 (r=0.58) and T4 (r=0.38). A low T3 and T4 with low or undetectable TSH were associated with increased mortality. At the onset of acute illness low T3 was seen in 113 (29.6%, low T3 -low T4 in 50 (13.1%), high T4 in 28 (7.3%) lowT3-lowT4- low TSH in 10 (2.6%) and low T4 alone in 4 (1%) patients. Fifty one 1 (13.4%) of our patients demonstrated alterations in TSH in presence of normal T3 and T4-26 patients had decreased TSH while as 25 had increased TSH. Of 118 patients who followed at 24 weeks, 11 (9.3%) had low T3, 7(5.9%) had low T3- low T4 and 13 (11%) had elevated TSH. CONCLUSION: Pattern and prevalence of sick euthyroid syndrome in this part of the world, a recognized iodine deficient region, appears to be similar to that reported elsewhere. Important finding in our study was higher percentage of TSH elevation, which we believe to reflect the underlying iodine deficiency state of our community. Besides a significant number of subjects persisted with alterations in thyroid functions even after 6 months of therapy. Though the severity of thyroid hormone derangement correlated with severity of sickness, the derangement was similar in acute vs. acute on chronic nonthyroidal illnesses.

Ultrastructural alterations in renal tissues of rabbits induced by dicofenac sodium [Voltaren]

Although diclofenac sodium [Voltaren] is one of the most frequently prescribed non-steroidal anti-inflammatory drugs [NSAIDs] worldwide for the treatment of inflammation and pain; data on the ultrastructural alterations in renal tissues due to its chronic exposure are limited. Therefore, the present study was designed to identify the ultrastructural renal alterations induced by diclofenac sodium. The experiment was conducted at the animal house of the Department of Zoology, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period from April 2003 to June 2003. A total of 30 male rabbits were exposed to intraperitoneal injection with a daily dose of diclofenac sodium [1.5 mg/kg body weight] for 70 days to investigate the resultant ultrastructural alterations in renal tissues. In comparison with the respective control rabbits, chronic exposure to therapeutic doses of diclofenac sodium produced significant ultrastructural renal alterations, which involved swelling and cristolysis of the mitochondria, marked dilatation of the endoplasmic reticulum, detachment of ribosomes, increased lysosomal structures, nuclear chromatin condensation in the tubular cells, thickening of the glomerular basement membranes, distention of glomerular capillaries, which showed lodgment of neutrophils, mesangial and endothelial cell proliferation in the glomeruli, swelling and fusion of the glomerular podocytes foot processes with focal obliteration of the filtration slits. The obtained results indicate that chronic exposure to diclofenac sodium produces significant ultrastructural alterations in renal tissues

Diffuse abdominal lipomatosis.

We report a 22-year male who developed progressive distension of abdomen, clinically diagnosed as ascites. A diagnosis of abdominal lipomatosis was made on the basis of CT evidence of excessive fatty tissue in abdominal cavity which was confirmed on laparotomy.

Response of regimens of insulin therapy in type 2 diabetes mellitus subjects with secondary failure.

OBJECTIVE: To find the response of various regimen of combination therapy (Insulin and Glibenclamide) in type 2 diabetes mellitus subjects who failed to respond to maximum doses of glibenclamide (GBC) plus phenformin. METHODS: A total of 188 subjects with secondary sulfonylurea failure who failed to respond to maximum doses of GBC and phenformin were randomised to receive one of the four regimens. Group A (50 patients) received two doses of insulin; Group B (49 patients) received two doses of insulin and GBC 20 mg/day; Group C (43 patients) received morning dose of insulin with GBC 20 mg/day; and Group D (46 patients) received evening dose of insulin with GBC 20 mg/day. Insulin dose was adjusted to achieve an acceptable blood glucose control. Control of diabetes was revaluated at three months post-treatment period. RESULTS: Age, duration of diabetes, weight, body mass index (BMI) and biochemical parameters were comparable in all four groups at admission. Dose of insulin was 0.83 +/- 0.07, 0.86 +/- 0.06, 0.46 +/- 0.04 and 0.39 +/- 0.03 units/Kg/day in groups A, B, C and D, respectively. Comparing groups A and B, we found that the dose of insulin (IU/kg/day) required to achieve acceptable fasting blood glucose (FBG) did not differ significantly. Similarly, comparison between Groups C and D did not reveal any significant difference in insulin dose. Mean hospital stay required to achieve an acceptable FBG was 8.42 +/- 0.34, 11.95 +/- 1.11, 8.59 +/- 0.61 and 7.10 +/- 0.48 days in groups A, B, C and D, respectively (p = 0.013). On comparing the four treatment regimens, at three months follow-up, there was a significant increase in bodyweight in Group C; also there was an increase in fasting blood glucose in all the groups except in Group D. CONCLUSIONS: Continuation of GBC in type 2 diabetes mellitus subjects who fail to respond to maximum doses of GBC plus phenformin and who need two doses of insulin for control has no added advantage over giving insulin alone. In subjects controlled on a single dose of insulin with glibenclamide it is preferable to give an evening dose rather than a morning dose.

A critical evaluation of signs and symptoms in the diagnosis of Addison's diseases.

OBJECTIVES: To determine the usefulness of clinical symptoms and signs in the diagnosis of Addison's disease. METHODOLOGY: A retrospective, hospital based study from analysis of case records of over 12 years period (1988-1999). Individual or groups of signs and symptoms in 66 patients of confirmed Addison's diseases were compared with 76 subjects with normal ACTH stimulation test, when clinical presentations were similar. RESULTS: Age spectrum of the two groups was similar. Signs and symptoms like weakness, weight loss, gastro-intestinal disturbances, skin/mucosal pigmentation and blood pressure were not statistically different between the two groups. Similarly blood glucose, sodium and potassium were not different between the two groups. Combination of three or more symptoms/signs had a high predictive value of diagnosing the disease than any individual or a combination of < 3 signs/symptoms (P=0.033). CONCLUSIONS: Combination of skin and mucosal pigmentation with gut disturbances and weight loss carried high predictive value in diagnosis of Addison's disease, while individual sign and symptom has poor differentiating value.

Prevalence of obesity in adults--an epidemiological study from Kashmir Valley of Indian Subcontinent.

OBJECTIVE: Obesity is a health problem in the majority of the developed countries and is emerging as a serious problem in the developing countries. In this study we examined 5083 Kashmiri adults to determine the prevalence of obesity. METHODS: In this epidemiological study, after multistage sampling procedure from all the six districts of Kashmir Valley, 5083 Kashmiri adults (males and non-pregnant females of > or = 40 years age) were examined for body mass index (BMI) and waist to hip ratio (WHR). RESULTS: Out of 5083 study subjects, 2496 were males and 2587 were females. BMI ranged between 14.6 to 38.5 kg/m2 in males and between 13.6 to 42.6 kg/m2 in females. BMI in females was comparatively more than that in males (23.88 +/- 3.94 Vs 22.30 +/- 3.11, p < 0.001). WHR ranged between 0.68 to 1.16 in males and between 0.65 to 1.16 in females. Again females had comparatively more WHR than their male counterparts (0.935 +/- 0.055 vs 0.926 +/- 0.055, P < 0.001). According to BMI, the overall prevalence of obesity in the study population was 15.01%; the prevalence of obesity in males was 7.01% and in females 23.69%. CONCLUSIONS: We conclude that obesity is a growing problem even in developing regions like ours. It is more common in females and in urban population.