A randomized placebo controlled trial of Inolter (herbal product) in the treatment of type 2 diabetes.

OBJECTIVE: To evaluate the safety and effectiveness of Inolter in achieving glycemic control and changes in lipid profile of newly diagnosed type 2 diabetics. MATERIAL AND METHODS: Study design: A randomized, placebo-controlled double blind. Sixty newly diagnosed patients of type-2 diabetes were randomized. Of these, 30 were put on Inolter monotherapy and 30 patients on placebo. Efficacy of Inolter was determined by observing glycemic control by estimating glycosylated haemoglobin (HbA1c) and fasting blood sugar (FBS), alteration of lipid profile by serum cholesterol, LDL, VLDL, HDL and triglycerides. STATISTICAL METHODS: Student's unpaired 't' test. RESULTS: Patients compliance was satisfactory and no adverse effects were observed. Better hypoglycemic effect was observed with Inolter both respect to fasting blood sugar (mean 65.4 +/- 63.72 mg/dl) compared to placebo (mean 26.45 +/- 38.3 mg/dl) (p < 0.001). The mean change, with Inolter, in serum cholesterol (21.33 +/- 26.05 mg/dl), serum triglyceride (30.36 +/- 32.62 mg/dl), VLDL (8.85 +/- 3.25 mg/dl), LDL (10.00 +/- 4.48 mg/dl) and HDL (-2.33 +/- 5.66 mg/dl) was also significantly different (p < 0.001) from those given placebo, where it was 15.7 +/- 20.14 mg/dl, 8.70 +/- 13.24, 0.10 +/- 4.10 mg/dl, -0.70 +/- 4.58 mg/dl and 0.65 +/- 0.00 mg/dl, respectively. CONCLUSION: Inolter appears to be an useful adjunctive therapy to exercise and diet control in newly diagnosed type 2 diabetes mellitus.

Polygraphic recordings of respiration in neonates: a pointer to SIDS?

Polygraphic respiratory recordings of 60 neonates were obtained from the infants in paediatric intensive care unit of a large public hospital. Thirty infants were pre-term and thirty infants were in the term (control) group. The recordings were analysed for periodic breathing and apnoeic episodes. Results were also determined for apnoeic density in pre-term and term Infants. Apnoeic episodes were found to be statistically significant in the pre-term infants over term Infants.

Sperm motility and morphology as changing parameters linked to sperm count variations.

Variations in semen analyses of 177 males over a 1 year period were assessed. The average means of total counts, motility, morphology, total motile count and non-motile % were determined for 5 classes of patients ranging from azoospermic to normospermic. Positive relationships between a falling sperm count, a decrease in motility and total motile counts were seen. Also, increasingly, abnormal forms were found with lower sperm counts.

Management of isoniazid poisoning--case report.

A young girl was admitted with generalized tonic clonic seizures and unconsciousness, four hours after ingestion of 12 gm of isoniazid (INH). In the absence of injectable preparation of pyridoxine, she was treated with oral pyridoxine and made a complete recovery.

Tissue magnesium content and histopathological changes in non-survivors of aluminium phosphide poisoning.

The study was conducted in 30 non-survivors of Aluminium Phosphide poisoning and similar number of age and sex matched controls (fatalities as a result of road side accidents, head injury, etc). Magnesium content was estimated in brain, heart, stomach, kidney, liver and lung using atomic absorption spectrophotometer. It was found that tissue magnesium levels were not significantly different (p = NS) when comparison was carried out between controls (Group II) and Patients who were not given magnesium as part of treatment (group IB). However magnesium levels in different organs of patients who received magnesium as part of treatment were found to be significantly higher (group IA)(P < 0.01) in comparison to controls as well as patient group not treated with magnesium sulphate. Significant histopathological changes were observed in almost all the organs. The changes seem to be the result of direct tissue damage by phosphine rather than shock and anoxia which occurred in all these cases.

Changes in structure and function of photosynthetic apparatus of Brassica pods during seed maturation.

Rate of photosynthesis; primary photochemical reactions, viz. whole chain electron transport, PSI and PSII activities; polypeptide profiles and lipid composition of thylakoid membranes were determined at different stages of Brassica pod development. Net CO2 exchange rate increased till 20 days after anthesis (DAA), remained constant till 30 DAA and decreased thereafter. While stomatal conductance followed a similar pattern, transpiration rate and internal CO2 concentration were least affected by age. Chlorophyll content decreased from 10 DAA till maturity, However, Chl a:b ratio increased during the period of active photosynthesis and was maximum at 30 DAA. Among the photochemical activities, PSII activity was reduced to 30% in mature pods. Qualitatively, the polypeptide composition of PSI, PSII and their light harvesting complexes were not affected adversely by aging. Total lipids, phospholipids, glycolipids and total free fatty acids decreased with maturity. However, the decrease in glycolipid content was more severe particularly during maturity phase. It seems that decrease in glycolipid content of thylakoids and chlorophyll content of chloroplasts are responsible for the decrease in photochemical activity and hence a reduction in CO2 assimilation at later stages of pod development.

Serum & tissue magnesium content in patients of aluminium phosphide poisoning and critical evaluation of high dose magnesium sulphate therapy in reducing mortality.

Role of high dose magnesium sulphate therapy was evaluated in 50 patients of Aluminium Phosphide (AIP) poisoning. Simultaneously serum and RBC magnesium levels were studied in these patients at six different points within first 24 hours. In non-survivors magnesium content of various tissues (brain, stomach, kidneys, liver, lungs and heart) was also estimated. Magnesium estimation (tissue as well as serum) was done using atomic absorption spectrophotometer. No significant difference was found in dose related mortality rates in patients treated with and without magnesium sulphate. The immediate causes of death in these patients included intractable shock, shock coupled with arrhythmias and adult respiratory distress syndrome (ARDS). Serum as well as RBC magnesium content was within normal range at all the six points (0, 1, 3, 6, 12 and 24 hours after arrival in hospital). Tissue magnesium content of various organs (in non-survivors) was more (p < 0.01) compared to that of corresponding organs in controls (accidental deaths). No significant alterations were seen in other serum electrolytes (Na, K, Ca, PO4). The data confirmed that neither there was any evidence of hypomagnesemia in these patients nor magnesium sulphate therapy improved survival. Survival can be improved (to some extent) with continuous cardiac monitoring and use of appropriate anti-arrhythmic agents. However, imposition of stringent restrictions on the free supply of AIP and caging of tablets in plastic packs with holes and spikes may yield better results in preventing AIP poisoning rather than treating these patients.

Comparative evaluation of dopamine infusion & treadmill exercise tests in the diagnosis of coronary artery disease.

Dopamine infusion test (DIT) was compared with treadmill exercise test (TMT) in 20 patients of chronic stable angina (TMT +ve) for inducing reversible myocardial ischaemia so as to assess its efficacy as an alternative to TMT in patients who cannot perform exercise test due to certain non-cardiac diseases. DIT was positive in 15 of the 20 patients studied; five patients in whom DIT was negative had late onset, early offset changes in TMT. Haemodynamically the increase in heart rate (HR) was less but rise in systolic blood pressure (SBP) was more with dopamine infusion in comparison to the corresponding stage of TMT. However, evidence of myocardial ischaemia (ST segment depression) appeared at a lower rate pressure product (RPP) with dopamine infusion compared to exercise test. The test was tolerated well, in higher doses (stages III & IV) side effects like ventricular ectopic beats, palpitation and angina not warranting stoppage of test, were seen in some patients. Dopamine infusion is a good chemical stress test, and can be used as an alternative to TMT especially in situations where the latter cannot be performed. The test is simple, cost effective, non-invasive and well tolerated.

Saddle embolism of aorta.

Aortic saddle embolus is a rare but serious form of arterial embolisation in patients with myocardial infarction. Four patients with aortic saddle embolism with peripheral propagation of the clott are reported. Two patients had suffered an attack of acute anterior myocardial infarction (one and four weeks respectively) prior to the embolic episode. One patient had a transmural myocardial infarct five years ago, and the 4th patient had dilated cardiomyopathy. The onset was sudden, marked by pain, parasthesias, pallor, pulselessness in three patients, and gradual in one. Two of the three patients (both females) in whom clott migration occured in only one limb developed below-knee gangrene of the affected side. In one patient (a young male) clott migration occurred in both popliteal arteries and the limbs were spared from developing gangrene although he continues to have leg angina. One patient presented with intermittent calf claudication only. All our patients reported late due to which none could be subjected to embolectomy.