Care for People with Diabetes during Haj

Haj is one of the five cardinal components of Islam commonly known as the five pillars of Islam. Approximately two million Muslims perform it each year. Haj involves travel to the holy sites in and around Mecca and Medina during a specified short period of time in a limited space; not usually inhabited by such a large number of people. This article deals with the effects of this event on diabetes and its management. The importance of this arises from the fact during Haj; the person's life routine changes as he travels to a different place of his own for a period of 4-6 weeks where geography; weather; diet; and habits are different. During Haj most people live what is effectively a very basic life in very crowded places. Therefore; medical conditions; such as diabetes; whose management depends on a stable routine; would predictably be affected significantly. People with diabetes should have enough time to consider a management plan for their diabetes. The objectives are to achieve a good control and avoid any complications that may be particularly associated with the conditions faced during Haj

Autoantibodies to IGF-1 binding sites in thyroid associated ophthalmopathy.

Graves' disease is an autoimmune disorder but the nature of the association between hyperthyroidism and ophthalmopathy is not yet understood. Serum autoantibodies to orbital tissues have previously been identified and the cross-reactivity with orbital and thyroid antigens has been implicated in the development of thyroid-associated ophthalmopathy (TAO). The ophthalmopathy of Graves' disease is remarkable for the hypertrophy of extraocular muscles and proliferation of fibroblasts within the orbit; features which suggest a possible involvement of growth factors. The present study was therefore undertaken to investigate the interaction of IgGs extracted from the sera of patients with Graves' disease, with or without overt ophthalmopathy, with respect to IGF-1 receptor binding sites on fibroblasts from human orbital tissue. IGF-1 binding sites were demonstrated on human orbital fibroblast monolayers grown from eye muscle explants. These cells exhibited a population of high affinity IGF-1 binding sites (Kd, 0.5nM SEM +/- 0.05). IgG prepared from sera taken from patients with Graves' disease (n = 23) significantly inhibited [125I]IGF-1 binding to orbital fibroblasts when compared to IgGs prepared from normal volunteers (n = 13, p < 0.002). It was found that 12 of 23 (52%) patients' IgG samples gave rise to significant levels of inhibition of [125I]IGF-1 binding to orbital fibroblasts. The IgG preparations did not bind directly to IGF-1. This study demonstrates that IgG prepared from patients with Graves' disease with or without overt ophthalmopathy interact with IGF-1 binding sites on orbital fibroblasts whereas IgG from normal subjects had no significant effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of hyperthyroidism in pregnancy.

One hundred and five consecutive pregnancies in 79 women affected by hyperthyroidism were observed during an 8-year period. All had received treatment either with carbimazole alone (Group I) or with the combination of carbimazole and propranolol (Group II). There were 72 pregnancies in Group I, 33 in Group II. Seventy-five pregnancies occurred whilst the mother was receiving antithyroid therapy and in the other 30 the diagnosis of hyperthyroidism was made following conception. The total fetal loss was 17.1%, with a spontaneous abortion rate of 5.5% in Group I and 24.2% in Group II. No congenital malformation or maternal deaths occurred. Carbimazole is safe and effective during pregnancy. Adding propranolol offers no further advantage and may indeed be detrimental.

Sella size and contents in Sheehan's syndrome.

High-resolution computerized tomography was used to assess the size and contents of the pituitary fossa in 57 patients with Sheehan's syndrome and 17 female control subjects. No correlation was found either in the patients or the control group, between sella volume and age, weight, height, parity or time interval from postpartum haemorrhage to scan. The sella volume showed wide variation. The mean sella volume for all patients was 565 mm3 (SD 292) in contrast to a mean volume for the controls of 922 mm3 (SD 155). The difference was statistically significant (P less than 0.001) using the Mann-Whitney test. The stalk was visualized in 46 patients (81%) (20 of these showed other pituitary tissue in addition). The remaining 11 patients showed no pituitary tissue, and only pure CSF density was observed.

Management of diabetes during open heart surgery.

The management of 5 insulin-dependent diabetics following open heart surgery was studied and compared with a group of 5 similar diabetics who had undergone urological or orthopaedic operations. The patients were all treated with a glucose/insulin/potassium infusions regimen, but the cardiac group needed much greater amounts of insulin (1.0 unit/g of glucose) than the non-cardiac group (0.3 units/g) to achieve a similar level of control. The high requirements of the cardiac patients are probably related to trauma, hypothermia and glucose loading when cardiopulmonary bypass begins. Diabetics undergoing such surgery need suitably modified insulin regimens from the outset.