The 1 µg cosyntropin test in normal individuals: A reappraisal.

BACKGROUND: The 1µg cosyntropin test has some advantages over the 250µg test as a test of adrenal function. One of the concerns regarding the 1 µg test includes stability of the cosyntropin when reconstituted and stored. Classically the 5(th) percentile responses to cosyntropin in normal individuals have been used to define a normal response. Recent studies have shown that these normative values should be determined for individual assays. MATERIALS AND METHODS: We performed a 1µg cosyntropin test using reconstituted and refrigerated (4-8(°) C) cosyntropin in saline solution in 49 non pregnant adults who were apparently healthy and had no exposure to exogenous glucocorticoids. The cosyntropin solution was stored for up to 60 days following reconstitution. We analysed the data for any association between duration of cosyntropin solution storage and the cortisol responses to cosyntropin administration. RESULTS: The mean ± SD cortisol level at baseline, 30 and 60 min were-12.19 ± 3 µg/dl, 20.72 ± 2.63 µg/dl, 16.86 ± 3.33 µg/dl. The 5(th) percentile cortisol response at 30 min was 16.5 µg/dl (16.33 µg/dl rounded off). The correlation coefficients between number of days of cosyntropin solution storage and the cortisol responses at 30 and 60 min were (Spear mans rho = 0.06,-0.24 respectively) (P = 0.69 and 0.41). There were no differences in cortisol values whether the storage was for less than 30 days or more than 30 days (mean difference 0.25 µg/dl P = 0.44). CONCLUSION: The 5(th) percentile normative values determined for our assay is lower than what is currently being used clinically and in research publications. Prolonged refrigerated storage of cosyntropin solution does not affect the validity of the 1 µg cosyntropin test.

Baseline characteristics of the Indian cohort from the IMPROVE study: a multinational, observational study of biphasic insulin aspart 30 treatment for type 2 diabetes.

INTRODUCTION: The IMPROVE study is an openlabel, nonrandomized, observational study aimed at determining the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) treatment in subjects with type 2 diabetes from 11 countries. Here, we report the baseline data of the Indian cohort. METHODS: All subjects with type 2 diabetes requiring insulin and considered suitable for BIAsp 30 therapy based on their physician's clinical judgment were eligible to enter the study. The data recorded at baseline included demographic characteristics, detailed medical histories, physician-cited reasons for starting BIAsp 30 treatment, and the chosen dosage regimens. RESULTS: The Indian cohort included 17,995 subjects with diabetes. Poor glycemic control (glycated hemoglobin [HbA(1c)], 8.7%-9.6%) was observed at baseline in all four geographical zones (North, South, East, and West) and prestudy treatment groups (no therapy, only oral antidiabetic drug [OAD], OAD +/- insulin, and OAD +/- insulin +/- BIAsp 30). Prevalence of both micro- and macrovascular complications was high, also reflecting poor glycemic control. Improving HbA(1c) and fasting and postprandial blood glucose levels were the most common reasons for starting BIAsp 30 therapy. The subjects were prescribed a mean BIAsp 30 dose of approximately 24 IU, and a twice-daily regimen was employed in almost 80% of subjects. CONCLUSION: The baseline results of the IMPROVE study Indian cohort confirm the poor glycemic control and the delayed initiation and/or inadequacy of treatment in subjects with type 2 diabetes. These results also highlight the need for timely and appropriately intensive insulin-based therapy.

Percutaneous transluminal septal myocardial ablation in a child with hypertrophic obstructive cardiomyopathy and Noonan syndrome.

We report an 8-year-old child presenting with classical features of hypertrophic obstructive cardiomyopathy and Noonan syndrome with New York Heart Association (NYHA) class III symptoms. Due to progressively worsening symptoms, the child was taken up for percutaneous transluminal septal myocardial ablation, which was successfully performed. Postextrasystolic gradient fell down from 125 to 35 mm Hg. Other than postprocedure bifascicular block, no complications were encountered till 1 year of follow-up.

Hidradenitis suppurativa treated with finasteride.

BACKGROUND: Hidradenitis suppurativa (HS) is a distressing condition for which no satisfactory treatment is available. Studies on hormonal mechanisms responsible for HS point towards altered end-organ sensitivity, probably related to the enzyme 5a reductase that converts testosterone to dihydrotestosterone. Finasteride, an inhibitor of type II 5a reductase, has been reported to be effective in recalcitrant HS. AIM: To study the effectiveness and tolerability of finasteride in patients with HS in a preliminary trial. METHODS: Seven patients (five women and two men) with HS that was not responding well to antibiotics were treated with finasteride at a dose of 5 mg/day as monotherapy. Clinical response was assessed at regular intervals. Patients were followed up for periods varying from 8 months to 2 years. RESULTS: Six patients improved significantly and three of them had complete healing of lesions. Two patients who were followed up for more than 1 year experienced remissions lasting 8-18 months. The drug was generally well tolerated; however, two women complained of breast enlargement. CONCLUSION: The results of this preliminary study suggest that finasteride is an effective therapeutic option in HS.

Association of diabetes mellitus and clozapine : a case report.

A case of Paranoid Schizophrania who developed Type 2 diabetes mellitus while on treatment with clozapine, is described. A brief review of literature is provided. In this case, Clozapine therapy could have caused the diabetes, or accelerated a pre-existing process.This report aims to highlight the importance of monitoring for hyperglycemia, an adverse effect of clozapine, which is being increasingly recognized in recent times.

Indole alkaloid formation by Catharanthus roseus cells in a biofilm reactor.

Catharanthus roseus cells producing indole alkaloids were grown in the form of a biofilm. Production medium was circulated through the reactor parallel to the upper surface of the horizontal biofilm. Sugar consumption and indole alkaloid formation were followed to compare the performance of cultures with different biofilm thicknesses. Dissolved oxygen concentrations gradients within the biofilms were determined at the end of each run. RNA and protein content of the cells in the upper and lower layers of the the biofilms were compared. Results obtained in the biofilm experiments were compared to those obtained with suspension cultures. At optimized biofilm thicknesses, the biofilm reactor was more effective than suspension cultures in maximizing indole alkaloid titers. This is thought to be due to better cell-cell contact within the biofilm and nutrient concentration gradients, which resulted in low growth rates.

Littre's hernia in a child--an operative surprise (a case report).

The incidence of Littre's hernia in children is unknown. The diagnosis is usually made at operation or autopsy. One case in an eight month old infant is described. Heterotropic mucoglandular tissue causing nodularity and adhesions was noted in the diverticulum. Though histological findings in Littre's hernia are not mentioned in previous reports, we believe that Littre's hernia could often be associated heterotropic mucosa.