The Role of Exercise on Fatigue Among Patients With Multiple Sclerosis in the King Fahad Hospital, Madinah, Saudi Arabia: An Analytical Cross-Sectional Study.

Background Multiple sclerosis (MS) is a chronic autoimmune disease caused by multiple factors. It can lead to many physical and mental symptoms. Fatigue is one of the most commonly mentioned complaints among MS patients that can affect their quality of life. Physical activity has many benefits for the physical and mental health of patients with MS. Aim To assess the role of exercise on fatigue among patients with multiple sclerosis and identify the relationship between depression, sleep quality, sociodemographic variables, and fatigue. Methods This is an analytical cross-sectional study based on a sample size of 235 patients recruited from the MS clinic at King Fahad Hospital (KFH) in Madinah. The outcome of the study was fatigue among MS patients. Data were collected through telephone calls from February to May 2022 using a structured questionnaire and scales, such as the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Modified Fatigue Impact Scale (MFIS), Patient Health Questionnaire (PHQ2), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed through SPSS version 20 (IBM Corp., Armonk, NY, USA). The correlation coefficient (r), Chi-square tests, and simple and multiple logistic regression were used as found appropriate. Results Out of the total samples, 37.4% were male and 62.6% were female. The median age of patients was 36 years. The prevalence of fatigue was 37% among patients, with a reported median fatigue score of 26. It was found that 63% of the patients were physically inactive; 32.2% were overweight, 14.2% were obese; 63.8% of patients had poor sleep quality. The fatigue score was negatively correlated with the GLTEQ score, but the results were not significant (r=-0.066; P-value (level of significance)=0.335). Nonetheless, a moderately significant correlation was observed between the MFIS and PSQI and MFIS and PHQ2 (r=0.505, P=<0.001 and r=0.520, P=<0.001, respectively). The Chi-square test showed a significant association between fatigue and progressive types of MS, the primary progressive MS (PPMS), secondary progressive MS (SPMS), and relapsing-remitting MS (RRMS) (odds ratio (OR)=4.4; 95% confidence interval (CI): 2.1-8.9), P=<0.001). Depressed patients were 9.7 times more likely to develop fatigue compared to non-depressed patients (P=<0.001). Those with poor sleep quality were 4.6 times more likely to develop fatigue compared to those with good sleep quality (P=<0.001). Fifty-six percent of fatigue among MS patients were predicted by low income, progressive types, unemployment, obesity, depression, and poor sleep quality. Conclusion Fatigue is a major complaint among MS patients. Most of the patients were found to be physically inactive, depressed, and have poor sleep quality. This study found an association between physical inactivity and fatigue, but the results were not significant. There was a significant association between sociodemographic factors like low income and unemployment, poor sleep quality, obesity, progressive types of MS, depression, and fatigue. Encouraging exercise practice and implementing a regular exercise program are needed, along with weight management plans. Further studies and psychological support meetings are required, with the importance of a holistic approach to patient care.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (<4 Years): Findings from the Feeding Infants and Toddlers Study (FITS) 2021.

Background: The transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development. Objectives: The study aims to examine the nutritional status and food-consumption patterns of children under 4 y of age in the United Arab Emirates (UAE) and their adherence to nutrient and dietary recommendations. Methods: A population-based cross-sectional survey of 525 children aged 0-47.9 mo was conducted in 3 major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometric measurements were obtained, and dietary assessment was conducted using the 24-h dietary recall approach. Usual intakes of energy, macronutrient, and micronutrients, including from supplements, were assessed using PC-SIDE software. Adherence to food-group recommendations was evaluated based on the American Heart Association/American Academy of Pediatrics dietary guidelines. Results: Among 0-4-y-old children, 10% were stunted, 6% were wasted, 17% were at risk of overweight, 5% were overweight, and 3% were obese. The contribution of sweets and sugar sweetened beverages to energy intake increased from 5% in 6-11.9-mo-old children to 17% in 36-47.9-mo-old children. Compared with dietary guidelines, the lowest adherence was for fruit (13-18%) and vegetables (7-12%), while protein was within the recommendations, and 92% and 89% of children (aged 24 to 35.9 mo and 36 to 47.9 mo, respectively) had high intakes of saturated fat. Almost all toddlers failed to meet the Adequate Intake for fiber. The proportions of children exceeding the free-sugar upper limit increased from 10.6% in infants (0-5.9 mo) to 56.7% in toddlers (12- 23.9 mo). Micronutrient inadequacies were observed, particularly for calcium, zinc, folate, and vitamins A and D. Conclusions: This study suggests a triple burden of malnutrition among infants and young children in the UAE. Results call for national nutrition intervention strategies aimed at improving dietary quality in the pediatric population.

Cutaneous Photoaging: A Notable Pattern of Distribution of Lentigines on the Face.

Importance: Facial lentigines are a common patient complaint encountered in general and cosmetic dermatology practices. Lentigines are a marker of photoaging and understanding their distribution will provide insight into the aging process in order to better counsel patients. Objectives: To compare the relative distribution of lentigines in facial cosmetic subunits. Methods: We reviewed clinical photographs of patients receiving Alexandrite laser treatment for facial lentigines during the time period 11/1/2017-12/1/2018. Individual lentigines were plotted for each patient into one of 21 aesthetic units. A "heat map" was created to compare the relative density of these lesions. Results: Grouped peripheral cosmetic subunits contained more lentigines compared to grouped central cosmetic units. The mean number of lentigines in the central units was 0.60 and in the peripheral units was 0.85. This finding was statistically significant with a p value of 0.0001. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5193.

Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center.

OBJECTIVE: The aim of this study was to evaluate the use of neoadjuvant chemotherapy (NACT) and primary debulking surgery (PDS) before and after results from a randomized trial were published and showed non-inferiority between NACT and PDS in the management of advanced-stage ovarian carcinoma. METHODS: We evaluated consecutive patients with advanced-stage ovarian cancer treated at our institution from 1/1/08-5/1/13, which encompassed 32 months before and 32 months after the randomized trial results were published. We included all newly diagnosed patients with high-grade histology and stage III/IV disease. Associations between the use of NACT and clinical variables over time were evaluated. RESULTS: Our study included 586 patients. Median age was 62 years (range, 30-90); 406 patients (69%) had stage III disease, and 570 (97%) had disease of serous histology. Twenty-six percent (154/586) were treated with NACT and 74% (432/586) with PDS. NACT use increased significantly from 22% (56/256) before 2010 (at which point the results of the randomized trial were published) to 30% (98/330) after 2010 (p=0.037). Although patients who underwent PDS were more likely to experience grade 3/4 surgical complications than those who underwent NACT, those selected for PDS had a median OS of 71.7 months (CI, 59.8-not reached) compared with 42.9 months (CI 37.1-56.3) for those selected for NACT. CONCLUSIONS: In this single-institution analysis, the best survival outcomes were observed in patients who were deemed eligible for PDS followed by platinum-based chemotherapy. Selection criteria for NACT require further definition and should take institutional surgical strategy into account.

A Yoga Intervention Program for Patients Suffering from Symptoms of Posttraumatic Stress Disorder: A Qualitative Descriptive Study.

OBJECTIVE: To understand how individuals with symptoms of posttraumatic stress disorder (PTSD) perceive a trauma-sensitive Kundalini yoga (KY) program. METHODS: Digitally recorded telephone interviews 30-60 minutes in duration were conducted with 40 individuals with PTSD participating in an 8-week KY treatment program. Interviews were transcribed verbatim and analyzed using qualitative thematic analysis techniques. RESULTS: Qualitative analysis identifies three major themes: self-observed changes, new awareness, and the yoga program itself. Findings suggest that participants noted changes in areas of health and well-being, lifestyle, psychosocial integration, and perceptions of self in relation to the world. Presented are practical suggestions for trauma-related programming. CONCLUSION: There is a need to consider alternative and potentially empowering approaches to trauma treatment. Yoga-related self-care or self-management strategies are widely accessible, are empowering, and may address the mind-body elements of PTSD.

Knowledge of periconceptional folic acid use among pregnant women at Ain Shams University Hospital, Cairo, Egypt.

Egypt has a high incidence of neural tube defects. Folic acid supplementation in the periconceptional period is known to lower the risk of such defects. This cross-sectional study aimed to measure the level of knowledge about periconceptional folic acid use among pregnant women attending for antenatal care at Ain Shams University Hospital, Cairo, Egypt in 2012. Questionnaires were filled through personal interviews with 660 pregnant women. Of the respondents, 62.4% had heard of folic acid and 39.2% knew about the role of folic acid supplementation in prevention of congenital anomalies. Knowledge about using folic acid before and in the first trimester of pregnancy was highest among university-educated women and those working in professional occupations. Only 18.8% of women reported taking folic acid, and 8.8% had used it before conception. Awareness campaigns are suggested to improve knowledge about folic acid among women in the childbearing period in Egypt.

Knowledge of periconceptional folic acid use among pregnant women at Ain Shams University Hospital, Cairo, Egypt

Egypt has a high incidence of neural tube defects. Folic acid supplementation in the periconceptional period is known to lower the risk of such defects. This cross-sectional study aimed to measure the level of knowledge about periconceptional folic acid use among pregnant women attending for antenatal care at Ain Shams University Hospital, Cairo, Egypt in 2012. Questionnaires were filled through personal interviews with 660 pregnant women. Of the respondents, 62.4% had heard of folic acid and 39.2% knew about the role of folic acid supplementation in prevention of congenital anomalies. Knowledge about using folic acid before and in the first trimester of pregnancy was highest among university-educated women and those working in professional occupations. Only 18.8% of women reported taking folic acid, and 8.8% had used it before conception. Awareness campaigns are suggested to improve knowledge about folic acid among women in the childbearing period in Egypt

En Egypte, l'incidence des malformations du tube neural est élevée. La supplémentation en acide folique durant la période périconceptionnelle est connue pour réduire le risque de telles malformations. La présente étude transversale visait à mesurer le niveau de connaissances sur l'utilisation périconceptionnelle de l'acide folique chez des femmes enceintes consultant à l'hôpital universitaire Ain Shams au Caire [Egypte] pour des soins prénatals en 2012. Des questionnaires ont été remplis pendant des entretiens individuels avec 660 femmes enceintes. Parmi les répondantes, 62,4% avaient entendu parler de l'acide folique et 39,2% connaissaient le rôle de la supplémentation en acide folique dans la prévention des anomalies congénitales. Les femmes ayant fait des études universitaires et celles exerçant une activité professionnelle possédaient les connaissances les plus élevées sur l'utilisation de l'acide folique avant et pendant le premier trimestre de grossesse. Seules 18,8% des femmes ont déclaré prendre de l'acide folique, et 8,8% y avaient eu recours avant la conception. Des campagnes de sensibilisation sont suggérées pour améliorer les connaissances sur l'acide folique chez les femmes en âge de procréer en Egypte

لوحظ في مر وقوع مرتفع لعيوب الأنبوب العصبي. ومن المعروف أن المعالجة التكميلية بحمض الفوليك في الفرة المحيطةبالحمل تقلل من مخاطر مثل هذه العيوب. وقد هدفت هذه الدراسة المستعرضة إلى قياس مستوى المعرفة حول استخدام حمضالفوليك في الفرة المحيطة بالحمل لدى النساء الحوامل اللائي يرددن عى الرعاية السابقة للولادة في مستشفى جامعة عن شمسبالقاهرة في مر في عام 2012 . فتم ملء استبيانات من خال مقابات شخصية مع 660 امرأة حامل. فتبنَّ أن 62.4 % من المستطلَعاتقد سمعنَ بحمض الفوليك، و 39.2 % منهن عى علم بدور المعالجة التكميلية بحمض الفوليك في الوقاية من الشذوذات الخلقية.وكانت المعرفة عن استخدام حمض الفوليك قبل الحمل وفي الأشهر الثلاثة الأولى منه أعى بن النساء اللواتي تلقن تعلياً جامعياًوالنساء اللواتي يعملن في مهن حِرَفيّة. وقد أفادت 18.8 % فقط من النساء بتناول حمض الفوليك، و 8.8 % منهن كنَّ قد استخدمنهقبل الحمل. وتم اقراح القيام بحمات توعية لتحسن المعرفة عن حمض الفوليك لدى النساء اللواتي هنّ في فرة الإنجاب في مر

Antibacterial effect of coffee: calcium concentration in a culture containing teeth/biofilm exposed to Coffea Canephora aqueous extract.

UNLABELLED: This study determined the changes of calcium concentration in a medium containing teeth/biofilm exposed to Coffea canephora extract (CCE). Enamel fragments were randomly fixed into two 24-well polystyrene plates containing BHI. Pooled human saliva was added to form biofilm on fragments. Specimens were divided into treatment groups (G, n = 8 per group) and treated with 50 µl daily for 1 min per week, as follows: G1, 20% CCE; G2, Milli-Q water (negative control); G3, antibiotic (positive control). Six fragments represented the blank control (G4). The calcium content was observed at baseline, 4 and 7 days of treatment by atomic-absorption spectrophotometry. Cross-sectional hardness of enamel was a demineralization indicator. Calcium increased in the medium after 4 and 7 days of treatment in G1 (3·80 ± 1·3 mg l(-1) and 4·93 ± 2·1 mg l(-1) , respectively) and G3 (4th day = 5·7 ± 1·8 mg l(-1) ; 7th day = 6·7 ± 3·5 mg l(-1) ) (P > 0·05). Calcium from G2 decreased after 7 days, which was different from G3 (P < 0·05). The lower calcium content, at the end of the experiment, was represented by G4, 2·16 ± 0·2 mg l(-1) . The increase in calcium after treatment with CCE is probably due to its antibacterial effect, which caused the bacterial lysis and consequent release of calcium in the medium. SIGNIFICANCE AND IMPACT OF THE STUDY: This study revealed an inhibitory action of Coffea canephora against dental biofilm. This coffee species caused bacterial lysis and consequent release of calcium into the medium. Furthermore, the advantage of coffee as an antibacterial beverage is that it is consumed in a concentrated form (6-10%) as opposed to various medicinal infusions that have shown such effect in vitro and are usually consumed at 1-2%. Therefore, a light roasted C. canephora aqueous extract can be considered as a potential anticariogenic substance.

Inhibitory properties of Coffea canephora extract against oral bacteria and its effect on demineralisation of deciduous teeth.

OBJECTIVES: The antibacterial activity of Coffea canephora extract was evaluated in vitro against Streptococcus mutans and Streptococcus sobrinus. The viability of planktonic cells was analysed by susceptibility tests (MIC and MBC) and time-kill assays. The effect of the extract on dental demineralisation was also investigated. METHODS: Primary 1st molar fragments (n=24) were inoculated with a saliva pool and sustained in a multiple plaque growth system for 10 days to form biofilm. The biofilm was treated with light roasted C. canephora extract at 20%, Milli-Q water (negative control) and chlorhexidine (positive control) once a day, during a week. Blank controls comprised fragments without treatment. Biofilm pH was monitored in the last day of treatment. Changes in tooth mineralisation were assessed by cross-sectional microhardness (CSMH) test. RESULTS: MIC and MBC for S. mutans were 7±2 mg/mL and 160±0 mg/mL, respectively, showing no activity for S. sobrinus. The extract produced a 4-log reduction in the number of colonies of S. mutans after 3-h treatment (p<0.05) with undiluted extract (20%) and MBC concentration (16%). There was no difference among negative/blank controls and coffee plaque pH. Differences between CSMH values of dental fragments subjected to the coffee extract and to chlorhexidine were not significant. At depths up to 30 µm from the enamel surface, coffee extract and chlorhexidine promoted higher CSMH values when compared to blank/negative controls (p<0.05). CONCLUSION: Our data suggest that light roasted C. canephora extract is beneficial as an anticariogenic substance.

Use of traditional and complementary medicine in Malaysia: a baseline study.

BACKGROUND: The increasing popularity and use of traditional and complementary medicine (TCAM) in both developed and developing countries, including Malaysia, have raised significant public health policy issues. However, currently, there is a paucity of baseline data on such usage by the Malaysian community. OBJECTIVE: This study was conducted to identify and describe the prevalence and frequency of various TCAM modalities that are being used by the Malaysian population by age, gender, marital and working status, educational level and ethnic group for health issues and maintenance. DESIGN: A nationwide interviewer-administered questionnaire survey was conducted in August 2004. An open-ended questionnaire pertaining to TCAM modalities was used to increase the probability of capturing maximum data. This survey implemented a multistage design, stratified by state and urban/rural random sampling, proportionate to the size of the state population and was representative of the Malaysian population. Post-survey classification of modalities was done accordingly. Complex data analysis was carried out using SPSS 13.0. RESULTS: Various TCAM modalities that were used by the Malaysian population were identified and categorised. Biological-based therapies, which included herbal therapy, were most commonly used for health problems (88.9%) and for health maintenance (87.3%). Under this category, herb-based application/herb-based beauty product/herb-based hygiene product group was most commonly used for health issues (23.6%) while pure herbs were the ones most commonly used for health maintenance (29.6%). There was no significant difference across all groups in the usage of biological-based therapies for health issues. CONCLUSION: The study showed that there is a high prevalence of TCAM use by the Malaysian population, particularly in the use of herb-based therapies for both health issues and health maintenance. Thus, a strict guideline for herbal commercialisation as well as public education is important.

Effects of chronic coffee consumption on glucose kinetics in the conscious rat.

Epidemiological studies indicate that regular coffee consumption reduces the risk of developing type 2 diabetes. Despite these findings, the biological mechanisms by which coffee consumption exerts these effects are unknown. The aim of this study was twofold: to develop a rat model that would further delineate the effects of regular coffee consumption on glucose kinetics, and to determine whether coffee, with or without caffeine, alters the actions of insulin on glucose kinetics in vivo. Male Sprague-Dawley rats were fed a high-fat diet for 4 weeks in combination with one of the following: (i) drinking water as placebo (PL), (ii) decaffeinated coffee (2 g/100 mL) (DC), or (iii) alkaloid caffeine (20 mg/100 mL) added to decaffeinated coffee (2 g/100 mL) (CAF). Catheters were chronically implanted in a carotid artery and jugular vein for sampling and infusions, respectively. Recovered animals (5 days postoperative) were fasted for 5 h before hyperinsulinemic-euglycemic clamps (2 mU x kg(-1) x min(-1)). Glucose was clamped at 6 mmol/L and isotopes (2-deoxy-[(14)C]glucose and [3-(3)H]glucose) were administered to obtain indices of whole-body and tissue-specific glucose kinetics. Glucose infusion rates and measures of whole-body metabolic clearance were greater in DC than in PL or CAF, indicating increased whole-body insulin sensitivity. As the only difference between DC and CAF was the addition of alkaloid caffeine, it can be concluded that caffeine antagonizes the beneficial effects of DC. Given these findings, decaffeinated coffee may represent a nutritional means of combating insulin resistance.

Too many births, too many deaths.

In Yemen, where both population increase and maternal mortality are exceptionally high, a strategy for safe motherhood has been adopted. The authors outline the obstacles to progress and suggest ways in which the aims of the strategy might be realized, with particular reference to complete reorganization of the services of family planning and maternal and child health care.

PIP: Yemen's population is growing at an annual rate of 3.1%. Women on average have more than 8 children. Few pregnant women are well nourished. Women marry early. Many women are illiterate and know little about maternal health services. Harmful traditional practices and poor socioeconomic and environmental conditions threaten women's health (e.g., annual maternal mortality rate = 1000/100,000 live births). The Government of Yemen's Population Action Plan has a strategy for safe motherhood. It aims to reduce mortality by 50%, raise contraceptive use from 3% to 35% and the minimum marriage age to 18 years, provide accessible post- and prenatal care, and empower women through participation in development programs by the year 2000. The government needs to overcome various obstacles to achieve these goals. The key obstacle is lack of qualified health personnel, especially females. This weakness is worsened by the fact that well-trained personnel prefer to work in urban areas and to provide clinic-based modes of service. Few physicians work in rural areas where 75-80% of the population lives. Most health centers do not provide family planning and maternity services. The shift to vertical management of immunization and diarrheal disease programs has resulted in even fewer women having access to these services. Primary care units should provide them. The community should participate in the units. A well- trained female primary health care worker and a medical assistant should staff each unit. Each district health center should have a physician, a midwife, nurses, a lab technician, a radiographer, an assistant pharmacist, local primary care workers, and traditional birth attendants. Each hospital should have a family planning and maternity clinic. Integration of family planning into pre- or in-service training is needed. The Ministry of Public Health must assume leadership to motivate the nongovernmental sector to effectively participate in the safe motherhood strategy.

Mobilization for an Expanded Programme on Immunization in Somalia.

Political commitment, adequate planning, careful logistics and media preparation, and adequate supervision, coupled with house-to-house registration of vaccines, including follow-up of nonattendees, were important ingredients in accelerating and improving immunization coverage in Somalia. Satellite immunization sites with outreach teams, along with utilization of traditional birth attendants to channel mothers, are planned to ensure sustainability of achievements.

Community and individual acceptance: family planning services in the Sudan.

PIP: The Sudan Community-Based Health Project, initiated by the University of Khartoum in cooperation with the Ministry of Health in 1980, sought to test the proposition that government-trained village midwives could provide maternal-child health and birth spacing services in addition to their ongoing obstetrical duties. The project area encompassed 92,000 people in 93 villages. The 120 midwives serving the project area received training in 4 interventions -- oral rehydration therapy, maternal and child nutrition, immunization, and birth spacing -- and introduced these services by means of 3 rounds of household visits over a 5-month period. Comparison of pre- and post-intervention survey data indicates that village midwives can indeed be used successfully to promote not only contraceptive use, but also health attitudes and practices that are positively associated with fertility regulation. Between the 2 surveys, the percentage of women who ever used contraception increased from 22% to 28%, while the percentage of current users rose from 10% to 13%. Parity was significantly related to current use; each child born multiplied the likelihood of contraceptive acceptance (by a factor of 0.76 in the post-intervention sample). Maternal education was the socioeconomic variable that most enhanced receptivity to contraceptive acceptance after the project's interventions. In terms of community-level variables, village location along the Nile and proximity to a paved road were significant correlates of contraceptive use. When variables related to the project itself were analyzed, women with vaccinated children were found to be twice as likely to contracept as those with nonvaccinated children and women who believed breast feeding should be continued during diarrhea episodes were 1.5 times more likely to use birth spacing than those who did not. Although midwives did not specifically emphasize contraceptive use, it appears women who were encouraged by midwives to take positive steps in the area of child health were also likely to become more innovative in terms of fertility regulation.^ieng

Historical perspectives on inotropic agents.

Although early experiments in animals and humans suggested that digitalis glycosides increased cardiac output only in the failing heart, later studies showed that these cardiotonic agents increase intraventricular systolic pressure and decrease relaxation time in the normal animal. The controversy concerning the peripheral vascular or direct cardiac effects of digitalis was finally resolved when new methods were applied to the study of the effects of this drug on intraventricular pressures and cardiac contractile force. Other positive inotropic agents, such as the adrenergic agonists, have also been tested for the treatment of heart failure. However, during long-term oral or intravenous therapy, the effectiveness of these drugs appears to diminish. Clinical studies of glucagon, a polypeptide with positive inotropic and chronotropic effects, have revealed its potential for causing side effects and its reduced activity in patients with chronic heart failure. With the discovery of several new types of inotropic agents, i.e., the bipyridines and the imidazole and benzimidazole derivatives, interest in revising our therapeutic approach to congestive heart failure has increased. This review discusses recent developments in this area.

Glucagon and the circulation.

Glucagon is a vasodilator substance that reduces blood pressure via a decreased vascular resistance in the splanchnic and hepatic vasculature. Species differences in the response of various vascular beds to glucagon have been documented. In the kidney, glucagon in relatively large doses increased renal plasma flow, glomerular filtration, and electrolyte excretion. It has been shown that intraarterial injection of glucagon into the renal artery can produce an increase in electrolyte excretion on the side that received an injection with minimal or no changes in glomerular filtration. This indicated a direct tubular effect of this polypeptide. This effect may be related to the increased glomerular filtration observed in poorly controlled diabetics where insulin concentrations are low and glucagon concentrations are high. The tubular effects of glucagon are probably mediated via cAMP and prostaglandin formation in renal tubular cells, especially the ascending limbs of Henle and collecting ducts. Glucagon increases the RNA concentration in glomerular tissue, and this effect is probably independent of cAMP. The latter effect of glucagon has been related to the glomerular enlargement and membrane thickening observed in poorly controlled insulin-dependent diabetics. Starvation natriuresis has been related to increased concentrations of glucagon in blood. The likely mechanism is that glucagon increased the renal excretion of organic acids, possibly by inhibiting the renal tubular reabsorption of these acids. Little is known concerning the effects of glucagon on the cAMP content of vascular smooth muscle. Indirect evidence suggests that such effects may be mediated via the production of cAMP. If this can be established, it would be likely that the glucagon-induced vasodilation is due to a cAMP-dependent phosphorylation of the myosin light chain kinase. This kinase shows reduced sensitivity to the Ca++ calmodulin complex when it is phosphorylated by the cAMP-dependent kinase and thus may produce relaxation of smooth muscle. In cardiac muscle, glucagon produced positive inotropic and chronotropic effects. These effects show species differences and in some species activate only the auricle with minimal effects of ventricular muscle. The effects of glucagon in general resemble those of a beta-adrenergic agent; however, glucagon seems to be nonarrhythmogenic in a variety of cardiac preparations and its effects are not blocked by propranolol. In some of these experimental conditions the chronotropic effects of glucagon play an important role in the antiarrhythmogenic effects, although direct cardiac membrane effects have been postulated. Several factors can modify the