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Biomedical subjects

I Jialal

Publications and source records attributed to I Jialal.

At least 127 records · Page 7Linked to original sources
PubMed1987

An assessment of posterior pituitary function in patients with Sheehan's syndrome.

Antidiuretic hormone (ADH) function was assessed in a group of 16 patients with Sheehan's syndrome and 17 controls. All patients were on adequate cortisone and thyroxine replacement therapy before testing. During the dehydration test the patients revealed an impairment of ADH function. The maximum urine osmolalities and the urine-plasma osmolality ratios were significantly lower in the patients with Sheehan's syndrome compared to controls (maximum urine osmolalities 633 +/- 38 (SEM) and 873 +/- 29 (SEM) mOsm/kg, respectively, P less than 0.001; urine-plasma osmolality ratios 2.15 +/- 0.14 (SEM) and 3.01 +/- 0.10 (SEM), respectively, P less than 0.001). Plasma osmolalities were significantly higher in the patients (296.1 +/- 1.2 (SEM) and 290 +/- 0.9 (SEM), respectively, P less than 0.001). The patients took a longer period to achieve these maximum urine osmolalities. Three of the patients with Sheehan's syndrome were diagnosed as having diabetes insipidus since their maximum urine osmolalities were below 600 mOsm/kg and following desmopressin all three had an increment in urine osmolality which exceeded 9%. In addition these three patients had a maximum urine-plasma osmolality ratio below 1.9. Thus, it appears the patients with Sheehan's syndrome have an impairment of ADH function which manifests in some as diabetes insipidus.

Adult↗
PubMed1987

Evidence for insulin resistance in nonobese patients with polycystic ovarian disease.

In this study seven normal weight Indian patients with polycystic ovarian disease (PCOD) with no evidence of acanthosis nigricans and 7 age- and weight-matched normal Indian women were studied to determine whether PCOD patients were insulin-resistant. While all 14 women had normal glucose tolerance, the PCOD women had significantly higher mean plasma glucose levels at 30 and 60 min and higher mean incremental glucose areas [incremental areas: PCOD, 9.0 +/- 2.2 (+/- SEM); normal women, 4.0 +/- 0.8 mmol/L; P less than 0.05]. Insulin responses were significantly higher in the PCOD compared to normal women (incremental areas: PCOD, 623.8 +/- 78.3; normal women, 226.2 +/- 30.3 microU/mL; P less than 0.001). Both serum testosterone and androstenedione levels correlated with the insulin areas (r = 0.82; P less than 0.001 and r = 0.86; P less than 0.001, respectively). [125I] Insulin binding to erythrocytes revealed decreased maximum specific binding in the PCOD women (6.9 +/- 0.6%) compared to that in normal women (9.2 +/- 0.7%; P less than 0.02). While Scatchard analysis revealed similar receptor numbers, ID50 values demonstrated decreased receptor affinity in the women with PCOD. In conclusion, in the absence of acanthosis nigricans, nonobese patients with PCOD are insulin resistant, and this insulin resistance correlates with the hyperandrogenism.

Adult↗
PubMed1987

Renal function in urinary schistosomiasis in the Natal Province of South Africa.

Renal function was assessed in 101 schoolchildren with active urinary schistosomiasis by measuring serum creatinine, urate, urea, and B2-microglobulin, urinary B2 microglobulin, and the glomerular filtration rate. Glomerular function in all subjects was normal as were serum creatinine, urate, and urea levels. Serum B2-microglobulin was elevated in only 8% of subjects while urinary B2-microglobulin only was raised in 7% of subjects, indicating proximal tubular dysfunction, a previously unreported feature in urinary schistosomiasis. Urinary tract abnormalities were found in 43% of subjects consenting to an excretory urogram but no correlation with biochemical parameters of renal function was noted. Serum angiotensin converting enzyme level measured in 70 subjects was elevated in 11% of subjects and was regarded as a possible measure of increased granulomatous activity.

Adolescent↗
PubMed1987

Thyroid function in hospitalized patients: effect of illness and serum albumin concentrations.

We assessed the clinical utility of measuring thyrotropin (TSH) in serum by immunoradiometry and of measuring total thyroxin (TT4), total triiodothyronine (TT3), free thyroxin (FT4), and free triiodothyronine (FT3). We used a group of 110 healthy volunteers, 45 ill hypoalbuminemic patients, and 42 ill normoalbuminemic patients. In addition, the free thyroxin index (FTI) and TT4:thyroxin-binding globulin (TBG) ratio were also calculated. The hypoalbuminemic group had significantly lower FT4, FT3, TT4, TT3, and FTI concentrations, but only FT3 and TT3 were significantly lower in the ill normoalbuminemic group as compared with controls. We found significant correlation between FT4 and albumin (r = 0.372, P less than 0.001) and FT3 and albumin (r = 0.465, P less than 0.001). TSH concentrations were undetectable in two of 45 hypoalbuminemic patients, significantly higher in the rest. The TT4/TBG ratio was the only parameter of thyroid function that remained unchanged in the ill patients.

Hospitalization↗
PubMed1987

Insulin binding to circulating monocytes and erythrocytes in patients with non-insulin-dependent diabetes in the young.

125I-insulin binding to circulating monocytes and erythrocytes was carried out in 9 patients with non-insulin-dependent diabetes in the young (NIDDY), who belonged to families in which non-insulin-dependent diabetes was transmitted through 3 generations. The diabetics had a decreased mean maximum specific binding to monocytes 2.1 (1.1-4.1%) compared to 4.0 (2.6-6.2%) in their age, sex and weight matched reference subjects. This decreased binding was primarily due to a decrease in receptor number as all diabetics had normal affinity values (2-10 ng/ml). We have attributed the decreased binding in NIDDY to the down regulatory effect of the basal hyperinsulinemia (23.6 +/- 3.2 vs 11.7 +/- 0.5 microU/ml). By contrast the maximum specific binding to erythrocyte was similar in both groups (9.7 +/- 0.5; 8.9 +/- 0.5%; p greater than 0.5).

Adolescent↗
PubMed1987

125 I-insulin binding to cultured fibroblasts in non-insulin-dependent diabetes in the young.

125 I-insulin binding to circulating monocytes was found to be decreased in Indian patients with non-insulin-dependent diabetes in the young, when compared to controls. To determine whether this was due to an inherent defect in the insulin receptor, fibroblasts from diabetics and controls were grown in an environment free from the diabetic milieu. Under these conditions 125 I-insulin binding to fibroblasts in patients with non-insulin-dependent diabetes in the young was similar to that obtained in controls. (1.5 +/- 0.4% and 1.3 +/- 0.3% per 10(6) cells, p greater than 0.5). It thus appears that the receptor defect manifest on circulating monocytes is unlikely to be a primary defect.

Adult↗
PubMed1987

A study of erythrocyte insulin receptors in normal Indian and African volunteers.

125I-insulin binding to erythrocytes were compared between 19 Indian and African healthy volunteers matched for age, sex and body mass index. There were no significant differences in 125I-insulin binding between Indians and Africans (maximum specific binding 9.13 +/- 0.52% and 8.74 +/- 0.51% respectively, p = 0.29). However, when 125I-insulin binding was compared between 16 males and females matched for age and body mass index, the males had significantly higher specific binding than the females (maximum specific binding 9.8 +/- 0.6% and 7.9 +/- 0.4% respectively, p less than 0.01). This difference in binding was due to a lower receptor number in females as evidence by Scatchard analysis; ID50 values revealed similar receptor affinities. In conclusion, while there is no difference in receptor binding between Indians and Africans, males have significantly higher specific binding than females.

Adult↗
PubMed1987

Stress hyperglycaemia is a predictor of abnormal glucose tolerance in Indian patients with acute myocardial infarction.

66 non-diabetic Indian patients with acute myocardial infarction were assessed prospectively for the presence of hyperglycaemia and the value of this admission hyperglycaemia and glycosylated haemoglobin (HbA1) levels in reflecting the glucose tolerance status of the patients was studied. Hyperglycaemia, defined as admission plasma glucose greater than or equal to 8 mmol/l was detected in 49% of the patients, whilst raised HbA1 values were seen in 11%. The admission plasma glucose (APG) correlated significantly with both the HbA1 levels and with the 2 hour glucose value in the oral glucose tolerance test (p less than 0.001). An oral glucose tolerance test performed 3 months after the acute episode revealed that 35 patients (53%) had abnormal glucose tolerance according to WHO criteria. Of the patients with initial hyperglycaemia, 75% had abnormal glucose tolerance tests, whilst 32% of patients with normal APG had abnormal glucose tolerance. Abnormal glucose tolerance was also detected in all patients with raised HbA1 values (greater than 8.9%) and in 48% of patients with normal levels. The sensitivity and specificity of APG greater than or equal to 8 mmol/l for abnormal glucose tolerance was 68.6% and 74.2% respectively and that of raised HbA1 values were 20% and 100%. Hence an APG greater than or equal to 8 mmol/l in patients with myocardial infarction is more likely to indicate the presence of unrecognized abnormal glucose tolerance rather than stress. HbA1 measurements do not appear to offer any further advantage in the assessment of hyperglycaemia following myocardial infarction.

Adult↗
PubMed1986

Insulin secretion in Indian patients with impaired glucose tolerance.

The insulin response to a 75 g oral glucose load was studied in 26 indian patients with impaired glucose tolerance (IGT) and 26 controls matched for age, sex and weight. There were no significant differences between the mean insulin responses and incremental insulin areas between the patients with IGT and controls. However, when the patients were divided into obese and non-obese subgroups and their mean insulin levels compared, the obese patients with IGT had significantly higher insulin levels at 120 minutes than the obese controls.

Adult↗
PubMed1986

The insulin and glucose response to an oral glucose load in non-insulin-dependent diabetes in the young. A study of 4 families.

Four Indian families with three-generation transmission of non-insulin-dependent diabetes were studied. Only 30% of the siblings were diabetic. The mean age of onset of diabetes was 20,1 years; 25% of the diabetics were obese, while all non-diabetic family members were of normal weight. All consenting living family members (12 diabetics and 16 non-diabetics) were subjected to an oral glucose tolerance test. After glucose administration, the 12 diabetics displayed a delayed and attenuated insulinaemic response. The area under the insulin curve and the insulin-glucose ratio were lower in the diabetics.

Adolescent↗
PubMed1986

Antibodies to the thyroid gland and to the thyrotrophin receptor in African and Indian thyrotoxic patients.

Sixty two thyrotoxic patients, 34 African and 28 Indian, were studied in order to assess the prevalence of thyroid antibodies and TSH binding inhibitory activity (TBI): 45 had Graves' disease and 17 had toxic nodular goitres. Microsomal and thyroglobulin antibodies were positive more often in Indian than in African patients with Graves' disease (microsomal 52% vs 37.4%, P less than 0.05; thyroglobulin 38.1% vs 4.2%, P less than 0.001). Patients with toxic nodular goitres had a lower prevalence of positive microsomal antibodies (P less than 0.01), but not of thyroglobulin antibodies (P = 0.1) when compared with patients with Graves' disease. TBI activity measured by a radioreceptor assay was positive in 43 of the 45 (95%) patients with Graves' disease and only 1 of the 17 patients (5.9%) with toxic nodular goitre. It thus appears that TBI activity is a sensitive marker in the diagnosis of Graves' disease and that there is a lower prevalence of thyroglobulin and microsomal antibodies in African patients compared with Indian patients.

Africa↗
PubMed1986

Prolactin secretion in Sheehan's syndrome. Responses to thyrotropin-releasing hormone and metoclopramide.

The prolactin response to thyrotropin-releasing hormone (TRH) and metoclopramide was studied in 16 patients with Sheehan's syndrome and 16 matched controls in the follicular phase. Metoclopramide resulted in a greater prolactin response than TRH did in the controls. However, both stimuli failed to evoke any appreciable prolactin response in the patients with Sheehan's syndrome. Since metoclopramide is generally free of side effects and far cheaper than TRH, we recommend the prolactin response to metoclopramide as the preferred screening test in the diagnosis of Sheehan's syndrome.

Adult↗
PubMed1986

Insulin secretion during intravenous glucose tolerance tests in non-insulin-dependent diabetes in the young.

The phasic response of insulin to intravenous glucose was studied in 9 patients with non-insulin-dependent diabetes in the young (NIDDY), with 3-generation transmission of the disease; and 9 age-, weight- and sex-matched reference subjects. Furthermore, 10 non-diabetic siblings of these diabetic patients were submitted to the same test procedure in an attempt to identify a prodrome of impaired glucose tolerance. In comparison to the controls and non-diabetic family members, the diabetics had no first phase insulin release. In addition, the non-diabetic siblings had insulin and glucose responses similar to those of the reference subjects. Therefore, it would appear that there is no prodromal phase in this discrete syndrome of NIDDY.

Adult↗
PubMed1986

Arginine-stimulated acute phase of insulin secretion in non-insulin-dependent diabetes in the young.

The acute insulin response to a 5 g pulse of arginine monohydrochloride was studied in 10 patients with non-insulin-dependent diabetes in the young (NIDDY) and 10 age-, weight- and sex-matched control subjects. All diabetics belonged to families in which non-insulin-dependent diabetes was transmitted through 3 generations. Mean peak insulin responses were similar in both groups (84.1 +/- 10.6; 68.2 +/- 8 microU/ml, p greater than 0.5). However, it is well known that hyperglycaemia accentuates the insulin response to non-glucose stimuli. To test this hypothesis, 5 of the diabetics were subjected to an intravenous insulin tolerance test, prior to the administration of the arginine pulse. At this lowered glucose level, the beta-cell secretory response was significantly decreased in the diabetics (C-peptide peak responses 2.5 +/- 0.3 vs 4.4 +/- 0.7 ng/ml, p less than 0.02). Thus it can be concluded that hyperglycaemia enhances the insulin secretory response to non-glucose stimuli and that following correction of the hyperglycaemia patients with NIDDY have an attenuated insulinaemic response.

Adult↗
PubMed1986

Pituitary tumours in African and Indian patients.

Over a five year period 55 patients with pituitary tumours (35 African and 20 Indian patients) were seen at the Endocrine Unit, King Edward VIII Hospital. Of the 33 patients with secretory tumours 20 had GH-secreting tumours (acromegaly), 8 prolactinomas and 5 ACTH-producing tumours (Cushing's disease); in addition 4 of the patients with acromegaly probably had combined GH and prolactin secreting tumours. The group with non-secretory tumours comprised 13 patients with craniopharyngioma, 7 with chromophobe adenomas and 2 patients with parasellar tumours. The majority of patients with non-secretory tumours were of African descent. Hormonal deficiencies present in the patients tested, were as follows: GH deficiency 73.3%; hypocorticolism 66.7%; hypogonadism 35.9% and hypothyroidism 14%. It thus appears that the patients in the present study differ from populations studied elsewhere with respect to the relative frequency of the various secretory tumours and the prevalence of certain hormonal deficiencies.

Acromegaly↗