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Biomedical subjects

G V Gill

Publications and source records attributed to G V Gill.

At least 55 records · Page 3Linked to original sources
PubMed1998

Serious hand sepsis and diabetes mellitus: specific tropical syndrome with western counterparts.

Infection in the extremities of diabetic patients most commonly involves the feet and, at least in western societies, is often associated with chronic complications of diabetes. Severe hand infection, often culminating in amputation and even death, is, however, well-described in tropical countries, where it may not be associated with any evidence of neuropathy or arterial insufficiency. Similar cases are described in the western literature but are more often associated with more severe antecedent trauma. The literature describing hand sepsis in diabetic patients both in tropical and in western practice is reviewed and we draw some conclusions about pathogenesis and treatment from the literature and from original data documenting the varying experience of hand sepsis in diabetic practice throughout Africa.

Adult↗
PubMed1998

Anabolic steroid induced hypogonadism treated with human chorionic gonadotropin.

A case is presented of a young competitive body-builder who abused anabolic steroid drugs and developed profound symptomatic hypogonadotrophic hypogonadism. With the help of prescribed testosterone (Sustanon) he stopped taking anabolic drugs, and later stopped Sustanon also. Hypogonadism returned, but was successfully treated with weekly injections of human chorionic gonadotropin for three months. Testicular function remained normal thereafter on no treatment. The use of human chorionic gonadotropin should be considered in prolonged hypogonadotrophic hypogonadism due to anabolic steroid abuse.

Adolescent↗
PubMed1997

Fatal hand sepsis in Tanzanian diabetic patients.

Hand infections are common presentations among diabetic patients admitted to hospital in Tanzania. The morbidity and mortality are high and patients' hospital inpatient stay tend to be prolonged because of suboptimal therapy. We describe four diabetic patients with hand infections and fatal outcomes. In contrast to patients with foot infections, none of our patients had clinical evidence of peripheral neuropathy or vascular disease. All four patients eventually died in hospital after acquiring hand sepsis and diabetic ketoacidosis which did not respond to prolonged courses of intravenous insulin and antimicrobials. Literature review suggests such infections are at least as likely to include Gram-negative organisms as Staphylococcus aureus. Primary management should have included aggressive surgery with limb amputation if necessary with adjunctive antimicrobial therapy.

Adult↗
PubMed1997

Diazoxide treatment for insulinoma: a national UK survey.

A survey of UK patients receiving the drug diazoxide, revealed 40 patients with insulinoma on this treatment. Mean age (+/- SD) was 67 +/- 18 years, and 74% were female. Duration of treatment was 7 +/- 6 years (range 1-22). Most (55%) patients were treated with diazoxide because of tumour non-localisation (including failed previous surgery). Metastatic disease (20%) and poor surgical risk (10%) were other indications. Side-effects (notably fluid retention and hirsutism) were common (47%) but not troublesome. Treatment was highly effective--59% were symptom free and 38% had only occasional symptoms. Only one patient had frequent hypoglycaemia despite treatment. We conclude that diazoxide is effective in the management of insulinoma. Side-effects are common but not problematic. Treatment should be considered for all patients not cured by surgery, or unsuitable for surgical treatment.

Adult↗
PubMed1996

Smoking habits of black South African patients with diabetes mellitus.

Cigarette smoking is a major arteriosclerotic risk factor, and this is enhanced by the presence of diabetes mellitus. Although smoking rates are increasing in many African countries, they have been little studied. We have critically assessed smoking among black diabetic and general medical patients at Baragwanath Hospital in Soweto, South Africa. As well as direct questioning of patients, we also used urinary cotinine:creatinine ratio as an objective marker. The admitted smoking rate was 16% in 118 diabetic patients, compared with 22% in 105 medical patients. Using a validated biochemical index of smoking (urinary cotinine:creatinine > 1.0 microgram mg-1) the rates were 37% and 33%, respectively. Most of the excess however was due to women who took snuff, and when excluded, the estimated real rates were 20% (diabetic) and 24% (medical). Amongst diabetic smokers mean cotinine:creatinine ratio was higher than in medical smokers (4.7 +/- 6.0 v 1.8 +/- 2.0 micrograms mg-1) despite admitted similar smoking consumption. A separate control group of British smokers had a mean level of 3.6 +/- 1.3 though their consumption was twice that of the South African groups. We conclude that smoking is common among South African black diabetic patients (20%), though it is less than reported figures for the black general population (28%), and British diabetic patients (35%). Questionnaire studies may seriously underestimate smoking rates, though this effect is considerably less in African compared with British smokers. Urinary cotinine also allows quantification of the 'smoking load', which is rarely reflected by admitted cigarette consumption.

Adult↗
PubMed1996

Prevalence and characteristics of brittle diabetes in Britain.

We investigated the prevalence and characteristics of 'brittle diabetes', defined as insulin-dependent diabetes mellitus associated with glycaemic instability of any type, leading to life disruption with recurrent and/or prolonged hospitalizations. A questionnaire was sent to all physicians and paediatricians running diabetic clinics in the UK, from lists held at the British Diabetic Association. A total of 414 brittle patients were reported (72% questionnaire return). Most were young (mean age +/- SD was 26 +/- 15 years), though there was a small peak at ages 60-70 years. There was an excess of females (66%) and overall clinic prevalence was 1.2 per 1000 diabetic patients and 2.9 per 1000 insulin-treated diabetic patients. On average, there was 1.0 brittle patient per diabetic clinic. The most common form of brittleness was recurrent ketoacidosis (59%), with 17% having predominant hypoglycaemia, and 24% mixed instability. Female excess was highest and mean age lowest in the recurrent ketoacidosis group, whilst the reverse was true for those with recurrent hypoglycaemia. Causes of brittleness were offered by 58% of consultants, and most (93%) considered various psychosocial problems as likely underlying factors. We conclude that brittle diabetes is a small but significant problem, currently affecting about 1 per 1000 diabetic patients. Most, but by no means all, are young females--often with recurrent ketoacidosis. Older age groups are more likely to have recurrent hypoglycaemic or mixed types of brittleness. Perceived causes of brittleness are usually psychosocial.

Adolescent↗
PubMed1996

Targeted screening for diabetes in community chiropody clinics.

Population screening for diabetes mellitus is of uncertain value. We therefore assessed the value of screening amongst community chiropody clinic attenders in Liverpool. All attenders aged between 40 and 75 years during a 3-month period were offered screening by urine glucose self-testing, 2 hours post-prandially, backed up with glucose tolerance tests (GTT) for positive respondents. Of 1058 patients screened, 11 (1.0%) reported positive results, of whom four (0.4% of total) had diabetes, and two had impaired glucose tolerance (IGT). Screening costs were 11p per person, 2.06 pounds per 'positive' person, and 34.46 pounds for each newly diagnosed patient. The screening procedure was simple and highly cost-effective, but the diagnostic returns were only moderate. This may have been because of a high rate of known diabetes amongst the chiropody clinic attenders (17.3%). In view of this, routine widespread diabetes screening in chiropody clinics cannot at present be recommended.

Adult↗
PubMed1996

A malignant pleural effusion infected with Salmonella enteritidis.

A patient is described with a unilateral pleural effusion persistently infected with Salmonella enteritidis. The infection was eventually eradicated with ciprofloxacin. A computed tomographic scan and mediastinal lymph node biopsy demonstrated an underlying small cell bronchogenic carcinoma.

Aged↗
PubMed1995

Mortality and outcome of insulin-dependent diabetes in Soweto, South Africa.

Sixty-four insulin-dependent (Type 1) diabetic patients (IDDM) in Soweto, South Africa were followed over a 10-year period. Patients were assessed in 1982 and again in 1992. There were 10 deaths (16%), half of which were due to renal failure. Ketoacidosis, hypoglycaemia, and sepsis accounted for the rest. At the 10-year follow-up mean age (+/- SD) was 32.4 +/- 5.0 years and diabetes duration 13.6 +/- 2.6 years. Retinopathy affected 52%, peripheral neuropathy 42%, and nephropathy 28% (all significantly increased from the 1982 assessment). Microalbuminuria and autonomic neuropathy were also common. Serum cholesterol was over 6.5 mmol l-1 in 19%, hypertension affected 22%, and 28% were cigarette smokers; though no patient had evidence of macroangiopathy. We conclude that IDDM in South Africa is associated with excess mortality, a significant proportion of which is related to nephropathy. Diabetes of long duration is now not uncommon in South Africa, and although diabetic complications frequently occur, most patients have good life quality and freedom from large vessel disease.

Adolescent↗
PubMed1994

Mortality and outcome of patients with brittle diabetes and recurrent ketoacidosis.

The long-term outlook of patients with brittle insulin-dependent diabetes is uncertain. We assessed the outcome of a group of young female patients with diabetes and recurrent ketoacidosis originally investigated in 1979-85 and reassessed after a mean of 10.5 (SD 1.4) years. 7 of the 33 patients could not be traced. 5 (19%) of the remaining 26 had died. Causes of death were not certain, but were probably ketoacidosis (2), hypoglycaemia (2), and renal failure (1). Of the 21 survivors, only 2 (10%) were still considered to have brittle diabetes. Diabetic complications were common (67%), and were more frequent than in a matched control group of stable patients with diabetes (25%). Brittle diabetic patients also had lower quality-of-life scores, more frequent psychosocial disruptions, and were on higher insulin doses (77 [39] vs 47 [15] U per day, p = 0.007) than controls. Pregnancy complications had occurred in 13 of 28 (46%) pregnancies in severely unstable patients compared with 2 of 27 (7%) in stable controls. Patients with brittle diabetes have a tendency to become more stable with time, but have a higher risk of death, more microvascular and pregnancy complications, and a poorer quality of life.

Adolescent↗
PubMed1994

Diabetes and alternative medicine: cause for concern.

'Alternative' medicines are becoming increasingly popular, and in this paper we describe our experience with alternative approaches to orthodox diabetes management. Four patients with insulin-dependent diabetes reduced or stopped their insulin in favour of therapeutic approaches including prayer, faith healing, unusual diets, and supplements of vitamins and trace elements. This resulted in ketoacidosis in three, in one case life-threatening; and weight loss and hyperglycaemia in the other. One patient developed serious retinopathy. Additionally, eight other types of alternative diabetic treatment are described, not as far as we know associated with such serious complications. These include homeopathy, reflexology, meditation, herbal treatment, 'cellular nutrition', 'subconscious healing', 'pearl therapy' (drinking milk in which pearls have been boiled) and 'astrotherapy' (typing pieces of coral around the arm). Diabetes is a chronic incurable disease, for which modern treatments remain somewhat unsatisfactory. It is therefore perhaps not surprising that some patients seek alternative treatments with more attractive claims. Diabetes health professionals need to be aware of the potential dangers associated with some of these treatments.

Adult↗
PubMed1994

Autonomic neuropathy in African diabetic patients.

To determine the prevalence and extent of autonomic neuropathy amongst Africans with insulin-dependent diabetes mellitus (IDDM), we investigated 50 such patients at our clinic. Mean age (+/- 1 s.d.) was 26 +/- 6 years, male:female ratio was equal (25M:25F) and duration of diabetes was 4.0 +/- 3.0 years. A battery of six validated tests of autonomic function was performed, testing both sympathetic and parasympathetic systems. Overall 16 (32%) had evidence of autonomic damage, affecting parasympathetic only in 14, and both sympathetic and parasympathetic in two. Those with autonomic neuropathy had a significantly longer diabetes duration than those without (6.0 +/- 2.8 years versus 3.1 +/- 2.7 years, P < 0.005), but there was no difference in glycosylated haemoglobin (HbA1) between the two groups. Autonomic neuropathy was also not significantly associated with peripheral neuropathy or other diabetic complications. Autonomic neuropathy carries a poor prognosis in IDDM and this high prevalence in a group of patients with relatively short diabetes duration gives cause for concern.

Adolescent↗