RESUMO
Over 18% of pregnant women are affected by diabetes mellitus (DM) and Insulin has been the commonest drug used in its treatment. There are reports of noncompliance to insulin due to trypanophobia, with suggestions for the use of oral hypoglycaemic agents (OHAs). However, the opposing views about the benefits and risk of oral hypoglycaemic agents (OHAs) warrant a continuous search for an alternative regimen. Therefore, this study is aimed at comparing the antidiabetic effects of d-ribose-l-cysteine (riboceine) with vildagliptin, glibenclamide, metformin, glipizide and insulin in diabetes in pregnancy. Forty (40) female Sprague-Dawley (SD) rats were mated with twenty (20) male SD rats. Diabetes was induced by streptozotocin and the female SD rats were divided into 8 groups of five (5) rats each. The animals were administered either of the OHAs vildagliptin, glibenclamide, metformin, glipizide and riboceine for a period of 19 gestational days. The results showed that streptozotocin (STZ) significantly (p < 0.05) decreased the weights of the animals, increased malondialdehyde, blood glucose levels and altered reproductive hormones. These effects of STZ were better ameliorated in animals that received insulin and riboceine compared to the other OHAs. While progesterone levels were significantly (p < 0.05) higher in animals that received riboceine compared to insulin. Glibenclamide increased (p < 0.05) foetal weights compared to non-diabetic animals. In conclusion, glibenclamide may be a threat to mother`s life in the management of diabetes in pregnancy however, riboceine as well as vildagliptin, metformin and glipizide are effective oral hypoglycaemic agents which could serve as a potent adjuvant comparable to insulin in the management of diabetes during gestation.
RESUMO
BACKGROUND: Management of surgical emergencies in Nigeria is characterised by mismatch between supply of facilities and demand for care. This study aimed to evaluate the waiting time between presentation at hospital with acute abdominal disease and operative intervention. PATIENTS AND METHOD: We prospectively studied adult patients with abdominal diseases requiring emergency operation. The interval between presentation and first contact with emergency room doctors was defined as T1; time from contact to decision to operate as T2; time taken to resuscitate patient T3 and to commencement of operation T4. Causes of delay and its impact on outcome of treatment were noted. RESULTS: There were 488 patients, mean age 32 +/-1.7 SD years. TT ranged between 0.8 and 79.0 hours, mean 22.3 +/- 10.0 hours. In 81.6% operative intervention was delayed beyond 6 hours of which financial constraints accounted for 53.8%. T3 accounted for the longest delay (0.5 -53.0 hours). Patients of lower socio-economic class had longer T3 (p<0.005). Waiting for complementary investigations caused delay in 22.1%. Post-operative complications (p=0.0001) and their severity were higher in patients with longer TT. Prolonged TT (p<0.001), ASA grade (0.005) and time from onset of symptoms to admission (p=0.009) were associated with mortality. Patients whose operations were delayed beyond 24 hours had a longer hospital stay. CONCLUSION: Emergency abdominal operations were delayed in our patients mainly because of scarce financial resources. Delayed interventions were associated with higher morbidity and mortality.