Clinical dysautonomia in diabetes mellitus--a study with seven autonomic reflex function tests.

Thirty-eight patients of NIDDM, 12 of IDDM and 10 healthy age matched controls were subjected to seven standardised autonomic reflex function tests. A scoring criteria was utilised for diagnosing and grading the severity of dysautonomia. Eight patients of IDDM and 24 of NIDDM had dysautonomia. One-third of the patients in each group had grade IV autonomic dysfunction. Severity of autonomic dysfunction was directly related to the duration of disease in NIDDM whereas in IDDM this relation was not seen. Peripheral neuropathy was almost always associated with dysautonomia in NIDDM. On the contrary, in IDDM dysautonomia was independent of peripheral neuropathy. Charcot's arthopathy, dysphagia, constipation and nocturnal diarrhea were always associated with evidence of dysautonomia. Other symptoms viz. gustatory sweating, postural dizziness and impotence did not necessarily indicate dysautonomia.

Comparison of biochemical parameters in pleural effusion.

A comparison of various biochemical parameters used in differentiation of nature of pleural effusion in transudate and exudate was done in 84 patient of pleural effusion. Pleural fluid (P) cholesterol and bilirubin which have gained an importance in recent years were compared with pleural fluid protein, LDH, P/S protein, P/S LDH and Light's criteria. It was seen that Light's criteria is still the best in differentiation. Sensitivity of individual test was nearly same for Pl. protein (94.11%), P/S Protein (94.11%), Pl. LDH (95.5%), P/S LDH (92.75%). Pl cholesterol (88.3%) and P/S cholesterol (91.42%) had slightly lower sensitivity. Pl. Protein and P/S LDH had 100% specificity. Lights criteria had 100% specificity and sensitivity % of cases misclassified by various criteria were Pl Protein 5.95%, P/S protein 5.95%, PLDH 4.76%, P/S LDH 4.76% P. Cholesterol 13% and P/S Cholesterol 9.52% Measurement of Bilirubin did not provide any correlation in classifying the effusion and thus did not hold any value.

Clinical assessment of autonomic functions in anemics.

Sixty five anemics and 20 healthy control subjects carefully age and sex matched were subjected to seven standardised tests to evaluate autonomic status. Due care was taken to remove factors which could interfare with the results. Tests concerned with the basal parasympalhetec tone viz heart rate response to standing (p < 0.001) and intravenous atropine test (p < 0.05) showed significant difference which persisted with severity and type of anemia. Test requiring stimulation of the parasympathatic system i.e. deep breathing test, valsalva maneuver and carotid sinus massage did show not significant difference. No difference of significance was found with postural fall of blood pressure and sustained hand grip test, chiefly concerned with the sympathatic system. These results suggest that anemics have low basal parasympathatic outflow to increase the heart rate as compensatory mechanism. Stimulation of parasympathatic and sympathetic system arouse normal response.

Microbiological evaluation of women with bad obstetrics history.

In the present study a total of 300 pregnant women were evaluated, 200 women with bad obstetrics history (BOH) and 100 clinically normal women. Cervical culture studies, as well as serological evaluation was carried out in each woman. It was noted that among the various microbial agents detected, the presence of genital mycoplasmas, chlamydia, Toxoplasma gondii and cytomegalovirus was significant. Foetal outcome could be noted in some of the BOH patients. Toxoplasmosis was associated with complete abortion (38%), stillbirths (6%), premature delivery (16%) and congenital anomalies (6%). Cytomegalovirus infection was associated with complete abortion (41.66%), preterm delivery (33.33%) and congenital anomalies (8.33%). Ureaplasma infection in BOH patients resulted in preterm delivery with premature rupture of membranes in 45 per cent of women and complete abortion in 35 per cent.

Detection of Chlamydia trachomatis antigen & Toxoplasma gondii (IgM) & Mycoplasma hominis (IgG) antibodies by ELISA in women with bad obstetric history.

A total of 365 non pregnant women with bad obstetrics history (BOH) were studied with a control group of 100 women who had delivered full term clinically normal infants. The presence of C. trachomatis antigen and T. gondii (IgM) and M. hominis (IgG) antibodies was assessed by ELISA test. C. trachomatis antigen was detected in 28.2 per cent of women with BOH whereas T. gondii and M. hominis specific antibodies were found in 43.83 and 27.1 per cent respectively, these were highly significant (P < 0.001) in comparison with the control group. In case, facilities for culture are not available then detection of antigen and IgM class of antibodies by ELISA can pinpoint current infection.

Modification in sucrose tolerance test with acarbose, guargum and their combination in patients with non-insulin dependent diabetes.

The study was undertaken to assess the efficacy guargum, Acarbose and their combination in modifying the sucrose absorption in patients of non Insulin dependent diabetes mellitus (NIDDM). Fifty patients of NIDDM were randomly distributed in three groups. Group A had 20 patients who received 20 grams of guargum, Group B had 10 patients who received 100 mg of Acrabose, Group C had 20 patients who received 10 grams of guargum and 50 grams of Acrabose. All the patients underwent 50 grams sucrose tolerance test with and without the trial drugs. Blood glucose levels were determined at 0, 30, 60, 90 and 120 minutes after sucrose loading. With the drugs, there was a significant decrease in the blood glucose levels at all time intervals (p < 001) in all the three groups. In all the three groups the blood glucose levels with the trial drugs was significantly lower (p < 001) than without the drug. It was seen that acarbose alone and guargum alone did not differ significantly in reducing the blood sugar level whereas combination of two produced significantly greater reduction in blood glucose levels than either of the drug used alone. Thus both guargum and acarbose are equally effective in modifying the absorption of sucrose. When combined in half the dosage they have synergistic effect and the reduction in blood glucose level is greater than either of the drug used alone.

Effect of beta-blockers on ventilatory function in smokers and non smokers.

Twenty healthy nonsmokers, 20 asymptomatic mild smokers and 20 asymptomatic moderate smokers were assessed for ventilatory functions, before and after equipotent dosages of atenolol, propranolol and oxprenolol in a single blind longitudinal study. The basal spirometric values were significantly lower in smokers than non smokers. After propranolol significant reduction was seen from basal values in FEV1, FEF 75%, MMFR, FEF 200-1200 in all the three groups. After oxprenolol significant difference was seen only with MMFR in the moderate smokers. With atenolol the variation was not significant in any group. Intercomparison of values after the drugs in each group was done. The values after propranolol was significantly lower than values after atenolol or oxprenolol for FEF 75%, MMFR and FEF 200-1200 in both the smoker groups whereas values after oxprenolol and Atenolol did not differ significantly from each other. Thus, in smokers atenolol offers a safe choice. If propranolol is to be used, the possibility of significant bronchospasm should be considered.

Functional hypothalamic amenorrhoea-isolated gonadotropin deficiency.

A 21 year old female patient with primary amenorrhoea was diagnosed to have isolated gonadotropin deficiency with probable functional hypothalamic amenorrhoea. The evaluation included buccal smear for sex chromatin, trial of medroxy-progesterone acetate, trial of oestrogen-progesterone preparation and estimation of serum prolactin, gonadotrophin and oestrogen levels. When diagnosed as isolated gonadotropin deficiency, treatment with gonadotropin is rewarding.

Acute scleredema with fatal outcome.

Death due to scleredema is rare. We report a patient with scleredema, which had an acute onset and rapid progression, leading to death within a month. Such an acute course terminating in fatality has not been described earlier.

Cardiovascular response to dynamic treadmill exercise in patients with essential hypertension before and after therapy with atenolol or captopril.

Thirty eight patients with essential hypertension and 20 healthy volunteers were subjected to treadmill exercise test. The hypertensives were then controlled with atenolol or captopril by randomly forming two groups of 19 patients each, and treadmill evaluation was repeated. The resting rate-pressure product (RPP) and myocardial oxygen consumption (MVO2), as well as peak RPP and MVO2 and recovery time, were increased and exercise duration decreased significantly in uncontrolled hypertensives (p less than 0.001). Control of hypertension resulted in significant improvement of exercise performance in both the groups. Atenolol, when compared to captopril, resulted in better exercise conditioning with considerable lowering of resting and peak RPP and MVO2 (p less than 0.001), though the difference in exercise duration, maximum work load and recovery time were not significant (p greater than 0.05). Thus, where myocardial oxygen consumption is an important consideration while treating hypertension, atenolol offers a better choice.

Cardiovascular dysautonomia in patients with lepromatous leprosy.

Autonomic functions were studied by six standard tests in 65 patients with lepromatous leprosy and 25 healthy controls. Dysautonomia was observed in 22 patients, all having the disease for more than five years. Associated peripheral neuropathy, judged clinically, was present in all, except one patient. Of the 22 dysautonomic patients, 9 each had mild or moderate dysantonomia and 4 had severe dysautonomia as per the scoring schedule devised by us. Syncope, gustatory sweating and impotence were the symptoms suggestive of dysautonomia. But not all affected patients reported these symptoms. Involvement of the sympathetic system was more frequent than that of the parasympathetic system. Statistically significant abnormality was seen with Atropine ratio, standing 30:15 beat ratio, postural hypotension and sustained hand grip test. Sustained hand grip test was the one which consistently gave abnormal results in all the 22 dysautonomic patients.