Blood sugar control and the heart

Diabetes mellitus is one of the leading health problems in the industrialized world and in emerging countries. This presentation will focus on: 1) The effect of diabetes mellitus on the cardiovascular system; 2) Epidemiological data on the magnitude of the problem; 3) Discussion of the role of exercise in evaluation of asymptomatic coronary disease as well as in therapy for improved glycaemic control; 4) Interventions which reduce cardiovascular mortality in diabetes mellitus. Diabetes mellitus causes accelerated microvascular and macrovascular complications leading to excess morbidity and mortality. Cardiovascular complications are related to coronary artery disease, ventricular myopathy, myocardial infarcation, autonomic dysfunction, congestive cardiac failure and associated hypertension. Data from the U.S. show a twofold increase in risk of cardiovascular disease and a fourfold greater increase in risk of death due to coronary disease in diabetics. Exercise plays an important role in the management of diabetic patients. Before an exercise prescription is determined, cardiovascular examination is carried out to ascertain whether heart disease is present. Algorithms for the detection of coronary disease in the asymptomatic diabetic are currently being debated by the American Diabetes Association and the American College of Cardiology and guidelines are anticipated in the near future. Individual prescriptions for exercise will have varying thresholds for frequency, intensity and exercise duration and these will be discussed. Interventions which have been shown to reduce cardiovascular mortality in diabetics include glycaemic control, lipid lowering, aspirin, beta-blockade, angiotensin converting enzyme inhibition, coronary revascularisation, smoking cessation and control of blood pressure (AU)

The POEMS syndrome

The POEMS syndrome is an unusual disorder manifesting primary as peripheral sensorimotor neuropathy in association with a monoclonal gammopathy. The importance of its recognition is that significant clinical improvement may result from localization and treatment of the underlying plasma cell tumour. AU)

Acquired immune deficiency syndrome (AIDS) in a Jamaican

The acquired immune deficiency syndrome (AIDS) is a new disease of epidemic proportions, especially in the U.S.A. Although Haitians living in the U.S.A. are reported to be at special risk, other Caribbean populations do not seem to be so predisposed. The case presented here is the first seen at the University Hospital in Jamaica and serves to focus attention on some of the common manifestations of AIDS in order to increase physician awareness of this unusual disorder (AU)