Biomedical subjects
Publications and source records attributed to I Mincu.
The classification, the mechanisms of action and the main side effects of sulfonylureic derivatives and biguanides are discussed. Emphasis is laid on the present controversy concerning the assumed adverse effect of these drugs on the cardiovascular system. The authors' opinion in this problem and their practical conclusions are based on their experience at the Center of Nutrition and Metabolic Diseases, Bucharest.
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For a preliminary estimation of the prevalence and significance of HLA antigens, tests were carried out on the A and B loci in an unselected group of 107 patients with type 1 diabetes in Bucharest. Monospecific antisera furnished by NIH, Bethesda were used. For HLA-A the following data were obtained: A2 (20.3% of the total specificities); A1 (18.4%); A3 (14.0%); A28 (10.1%). Provisional estimations in the healthy population also indicated HLA-A2 as being more frequent than followed by A30/31, A1, A9, A3. For HLA-B: B7 (38.2%); B5, B12 and B14 (14.0% each); B8 (11.1%). In the healthy subjects, the order was B12, B35, B5, B8 the same as B18, then B7 (which did not exceed 11%). The most frequently encountered haplotypes in the diabetic patients were: A2/B7 (8.4% of the total haplotypes); A3/B7 (6.9%); A1/B7 (6.6%); A10/B7 (3.8%); A9/B7 and A11/B7 (3.6% each). An unexpectedly high frequency of the HLA-B7 antigen was found in group of diabetic patients investigated, contrasting with its assumed "protector" role in the Caucasian population. The frequency of antigen HLA-A3 and haplotype HLA-A3/B7 infringes their listing in the "resistance axis" to diabetes.
Clinical heterogeneity of diabetic peripheral neuropathy could express a neurophysiological and electrophysiological heterogeneity possibly related with the dissociated metabolic susceptibility of the difference types of nerve fibres and endings. To evaluate the functional status of the skin autonomous nervous system and of the deep pain sensitivity system in diabetics we studied two electrophysiological parameters skin electrical potential (using Digital Multimeter 3466 Hewlet Packard, USA) and the perception threshold (microA) at an electrical stimulus (spike wave, 0.5 m sec duration) 1 cm deeply applied through 2 acupuncture needles placed 30 cm distance each other, in 3 groups: Ia-18 diabetic patients with clinical signs of neuropathy (12 M, 6 F, aged 55 +/- 17 yrs); Ib - 17 diabetic patients without clinical signs of diabetic neuropathy (12 M, 5 F, aged 57 +/- 16 yrs); I1 - 10 age and sex matched non-diabetic controls. Our data show: a higher mean value of the potential in the acupuncture points as against neighbour areas, both in non-diabetic control (- 111 +/- 25 mV v.s. -81 +/- 29 mV, p less than 0.05) and in diabetics (-85 +/- 43 mV v.s. -58 +/- 25 mV, p less than 0.01); a lower mean value of the electrical potentials in diabetic with clinical signs of neuropathy as against in those without clinical signs of neuropathy (-66 +/- 29 mV v.s. -108 +/- 43 mV, p less than 0.01): a higher mean value of the perception threshold in diabetics with clinical signs of neuropathy as against in diabetics without clinical signs of neuropathy (213 +/- 82 microA. v.s. 102 +/- 40 microA, p less than 0.01); a significant correlation (r = -0.81) between the perception threshold and the electrical potentials of the studied points.
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Cytochemical study of peripheral lymphocytes in 78 diabetic patients and 22 controls included the determination of glycogen (with calculation of the "glycogen score"), lipids and nucleolar RNA (with calculation of the so-called "lymphocyte nucleologram"). All three metabolic components showed marked differences between the diabetes and the controls. Further analysis in terms of sex, patient's age, duration of disease, basic treatment and main complications of diabetes, also showed certain variations of the above parameters but of lesser amplitude. Metabolic alterations of lymphocytes in diabetes mellitus reflect the pathogenic particularities of the disease, and might probably be used as a basis for further practical purposes.
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The present report discusses the immunogenic properties of insulin: the factors upon which immunogenicity depends, the characteristics of insulin antibodies, clinical aspects (insulin allergy, immunologic insulin resistance, lipodystrophy, etc.), as well as the significance of highly purified insulin products. The authors then review the role of autoimmunity in the etiopathogenesis of the diabetic disease as results from the association of diabetes with other autoimmune diseases, lymphocytic islet cell infiltration, phenomena of cell mediated and humoral mediated autoimmunity (islet cell antibodies). The present pathogenetic model of insulin-dependent diabetes (type 1) is marked by the predominance of these aspects. The last part of the report concerns immunologic functions in diabetics and the question of immune complexes.
In a group of 51 women who had given birth to giant children, the glucose tolerance test (GTT) was performed at entry in the study and after intervals of 6 to 12 years. The results of the first determination, estimated according to the WHO's criteria (1980), have revealed an impaired glucose tolerance (IGT) in 7 cases (14%); the second determination showed IGT in 10 cases (20%) and diabetes mellitus in 2 (4%). Insulinemia assays, concomitant with the second performance of GTT, showed the highest values in the diabetic subjects, moderate values in those with IGT, and low values in those with normal glucose tolerance. The presence of obesity in some cases could not be considered as fully responsible for the glucose tolerance impairment in the women with fetal gigantism. The dynamics of glucose tolerance disorders showed variations in time, i.e. the initial pathologic changes were no more recorded on the second testing in the same subjects, while women with normal initial GTT showed high insulinemia or IGT on the second determination.
Between 1978 and 1982, 459 cases of severe diabetic ketoacidosis (pH less than or equal to 7.20, total -CO2 less than or equal to 10 mMol/l) were admitted to our Intensive Care Unit. 416 (241 males, 175 females) were under 60 years (41 +/- 7) and 43 (22 males, 21 females) exceeded 60 years of age (67 +/- 7). The precipitating causes were fairly similar, in both groups, with infections foremost (68%). Presenting biochemical parameters, before and after 60 years showed differences in: blood glucose: 32.7 +/- 12 versus 34.8 +/- 8.1 mMol/l; plasma sodium 137 +/- 14 versus 143 +/- 16 mMol/l; plasma potassium 4.2 +/- 0.9 versus 4.9 +/- 0.7 mMol/l; hydrogen ion concentration 95 +/- 17 versus 73 +/- 12 mMol/l, (p less than 0.01); plasma osmolarity 327 +/- 98 versus 379 +/- 96 mOsm/l. The difference was significant (p less than 0.01) in frequency of hypernatremic hyperosmolarity (initial sodium greater than 147 mMol/l): 7.4% of 202 cases before age 60 years versus 24.1% of 29 case after age 60 years. The fluid amounts administered i.v. within the first 24 h was greater before (7516 +/- 2121 ml; p less than 0.01) than after 60 years (5276 +/- 1132 ml); insulin requirements were greater after 60 years (236 +/- 78 U/24 h; p less than 0.01) than before the age of 60 years (182 + 59 U/24 h). The mortality rate in the course of severe diabetic ketoacidoses was significantly lower before 60 years (1.3%, p less than 0.01) as against 6.9% after age 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)