Assessment of insulin action on carbohydrate metabolism: physiological and non-physiological methods.

Carbohydrate metabolism in humans is regulated by insulin secretion from pancreatic ß-cells and glucose disposal by insulin-sensitive tissues. Insulin facilitates glucose utilization in peripheral tissues and suppresses hepatic glucose production. Any defects in insulin action predispose an individual to glucose intolerance and Type 2 diabetes mellitus. Early detection of defects in insulin action could provide opportunities to prevent or delay progression of the disease state. There are different approaches to assess insulin action. Initial methods, such as peripheral insulin concentration and simple indices, have several limitations. Subsequently, researchers developed methodologies using intravenous glucose infusion to determine glucose fluxes. However, these methodologies are limited by being non-physiological. Newer, innovative techniques that have been developed are more sophisticated and physiological. By modelling glucose kinetics using isotope dilution techniques, several robust parameters can be obtained that are physiologically relevant and sound. This brief review summarizes most of the non-physiological and physiological methodologies used to measure the variables of insulin action.

Lessons from smallpox eradication campaign in Bihar State and in India.

Following several key breakthroughs during the mid-1960s under the global smallpox eradication programme namely, development of a thermo-stable vaccine, efficient and acceptable technique of it's delivery by bifurcated needle and evolution of a strategy (in lieu of mass vaccination) of active case search and containment, an intensified campaign of smallpox eradication from India was successfully implemented during 1973-1975. A formidable battle was fought, particularly in Bihar state leading to the occurrence of last indigenous case on 17 May 1975. The rapid achievement of eradication of the scourge from India in a record time was hailed as unprecedented in public health history. The single key factor in the achievement was the sustained efforts of a band of national and international epidemiologists, supported by young medical interns heading mobile containment teams, working under trying field conditions. Through the campaign several important lessons were learnt and innovations made. Important among these were: (i) need for refinement of tools, techniques, and strategies for attaining the objective; (ii) implementation of a time and target oriented campaign; (iii) support of adequate and dedicated short term personnel to supplement supervision and field activities; (iv) providing of flexible funding and a convenient disbursement procedure; (v) building private-public partnership; (vi) devising of simple innovations, based on feedback from field, to support activities; (vii) development of political commitment; (viii) improved communication from field to higher levels to enable action on recent information; (ix) regular periodic staff meetings at each administrative level to facilitate early recognition and correction of deficiencies; (x) mobilization of support from international community, whenever required.

Minimal model assessment of hepatic insulin extraction during an oral test from standard insulin kinetic parameters.

In this article, a first aim was to develop a minimal modeling approach to noninvasively assess hepatic insulin extraction in 204 healthy subjects studied with a standard meal by coupling the already available meal C-peptide minimal model with a new insulin model. The ingredients of this model are posthepatic IDR, which in turn is described in terms of pancreatic ISR and hepatic insulin extraction HE, and a linear monocompartmental model of insulin kinetics. Even if ISR is provided by the C-peptide minimal model, the simultaneous assessment of HE and insulin kinetics is critical, since compensations may arise between parameters describing these two processes. Therefore, as a second aim of this study, a method was developed to predict standard values of insulin kinetic parameters in an individual on the basis of the individual's anthropometric characteristics. The statistical analysis, based on linear regression of insulin kinetic parameters estimated from IM-IVGTT data performed on the same subjects, demonstrated that insulin kinetic parameters can be accurately predicted from age and body surface area. Once kinetic parameters of the new insulin model were fixed to these values, HE profile and indexes during a meal were reliably estimated in each individual, indicating a significant suppression during the meal since the overall index of HE, equal to 60 +/- 1% in the basal state, is reduced to 40 +/- 1% during a meal. However, standard parameters provide an approximation of the individual one; thus, the third aim was to define the impact on estimated indexes of using standard instead of individually estimated values. Our results showed that the 25% uncertainty affecting as an average insulin kinetic parameters of an individual, when they are predicted from age and body surface area, translates into a similar relative uncertainty in the individual's hepatic insulin extraction indexes.

Patients' reference for evening pay clinic at a tertiary care hospital.

To lessen overcrowding in the regular morning OPD and obtain better patient satisfaction, Evening Pay Clinic in a tertiary care hospital with daily OPD attendance between 1000 and 1200 patients was conceptualised. To elicit patients' response to the proposed system a survey with a structured questionnaire among 202 randomised sample of patients was conducted. Patient preference depended on distance of their home from the hospital as well as availability of suitable transport to reach the pay clinic and the likelihood of their being able to go back by the same evening after their encounter with the hospital was over. The majority of the patients preferred the proposed system as it promised quick and personalised service and the attendance by the doctors of their choice.

A baseline study on neonatal tetanus in India.

PIP: In 1980 sample surveys were collected to provide reliable baseline data on neonatal tetanus and poliomyelitis in India. Surveys were prepared by the Directorate General of Health Services, along with the Indian Council of Medical Research and WHO. Each state consisting of populations with more than 20,000,000 were surveyed separately; union territories were surveyed along with neighboring states. States with less than 20,000,000 were grouped together, forming one unit. Rural and urban areas were surveyed separately, 16 urban, 15 rural. A sample of 2,000 live births were collected with 67 live births recorded at each of the 30 birth sites throughout wards and villages. House to house visits by health workers recorded the survey's findings. Estimates based on the mortality rates of neonatal tetanus in 12 states in the survey suggest 90,657 to 115,935 neonatal deaths occur annually. Annually 159,818 to 204,380 children die within the 1st months of life due to tetanus. Total number of cases of tetanus deaths reported is, however 48,651 on an annual average. Neonatal tetanus can be prevented by safe delivery services and successfully immunizing pregnant women. Neonatal tetanus mortality rates were lower in urban areas than rural, in some states where deliveries were performed in hospitals with trained personnel, and mothers were protected by tetanus toxoid immunization. Tetanus toxoid vaccination is included in the expanded program on immunization (EPI), and during the year covered 8,000,000 pregnant women, 35% of the eligible populations with 2 doses of TT vaccine. By 1990, 100% of the pregnant women will be provided with vaccination services. Children have been given TT vaccinations since 1980, these in the last classes of secondary schools. Girls were given only a booster shot during subsequent pregnancies. Overall, both maternal and child health services are being significantly improved and upgraded to include antenatal, natal, and postnatal care with an inclusion of dias training.^ieng