Improving the management of diabetes in the community [Seychelles

A complete first cycle of audit of the care of diabetic patient in a stratified sample of community clinics is reported from the republic of Seychelles. One in seven of the known diabetic patients was selected from a community clinic in each health district for note review [n=97]. 77[81%] of these attended for clinical examination. A vailability of equipment and organization of clinics had been accompanied by increases in the numbers of all examinations recorded. Mean fasting blood sugar levels were reduced by 0.6mmol /I. There was no increase in the total number of visits to the doctor. A flow charts which had been introduces at an earlier point in the audit was considered to have contributed to this. Nurses were better able to comply with the new recording system than were doctors. It is possible to adapt system of practice management which have been found effective in Britain to apply to chronic diseases in different cultures although it may take many years before the full impact of this changes upon morbidity and mortality is known

effect of caffeine and corticosterone on maternal plasma and fetal corticosterone level in pregnant mice and rats

The effect of caffeine and corticosterone administration alone and in combination on total and free maternal plasma and fetal corticosterone levels was studied in pregnant mice and rats. Animals were divided into four groups: the first was the control, the second was given caffeine 200 mg/kg [mice] or 100 mg/kg [rats] orally, the third was given cor-ticosterone 5 mg [mice] or 100 mg/kg [rats] s.c., and the fourth was given caffeine and corticosterone. Blood samples and whole litter homogenate were taken 3 h [mice] or 2 h [rats] after dosing on day 14 of gestation and were assayed for corticosterone fluorimetrically. Caffeine administration increased plasma corticosterone levels in pregnant mice and rats, but most of it was protein bound and did not pass to the fetus. Injection of exogenous corticosterone alone or in combination with caffeine raised total and free corticosterone levels in the plasma of the mother and in their fetuses. The high corticosterone fetal levels in corticosterone injected animals, compared to caffeine treated ones, may account for the high incidence of cleft palate in the former group despite of similar high plasma total corticosterone levels in both groups

Mechanism of caffeine-induced corticosterone release in pregnant mice

The pituitary-adrenal axis of day 14 pregnancy was suppressed by parenteral administration of dexamethasone [0.4 mg/mouse, -20 h], pentobarbital [80 mg/kg, -0.75 h], pentobarbital [20 mg/kg, -0.75 h], intraperitoneally [100 mg/kg, 0 h] and plasma corticosterone and caffeine levels were determined 1.5 hours later. Plasma corticosterone of suppressed control animals was significantly decreased than that of unsuppressed controls at day 14 of gestation. Caffeine administration produced no change in plasma corticosterone level of 3 out of 7 animals and slightly increased the steroid level of the other 4 suppressed mice. In unsuppressed animals, however, a marked increase in plasma corticosterone level was observed. The low plasma corticosterone level in caffeine treated suppressed mice, compared with that of unsuppressed ones, indicated the high corticosterone level, and may indicate that the high corticosterone level induced by caffeine administration during pregnancy in mice could be mediated through release of adrenocorticotrophic hormone from the anterior pituitary gl and and not due to direct stimulation of the adrenal cortex