Hypoglycaemic activity of Bixa orellana extract in the dog.

In West Indian folklore, a variety of plants are used for medicinal purposes. One such plant, Bixa orellana (annatto), is commonly used in the treatment of diabetes mellitus. Preliminary studies have shown that a crude annatto seed extract exhibited either glucose lowering or hyperglycaemia-inducing activity depending on how it was further manipulated. This present investigation sought to determine the effects of the glucose-lowering extract on C-peptide and streptozotocin-induced diabetic dogs. This annatto extract was found to decrease blood glucose levels in fasting normoglycaemic and streptozotocin-induced diabetic dogs. In addition, in normal dogs, it suppressed the postprandial rise in blood glucose after an oral glucose load. Interestingly, the extract also caused an increase in insulin-to-glucose ratio in normal dogs. Increased insulin levels were not due to increased insulin synthesis as after 1-h residence time and half-hour postprandial, decreased C-peptide levels was observed. It was concluded that Bixa orellana (annatto) lowered blood glucose by stimulating peripheral utilization of glucose, and it is possible that this glucose-lowering extract might be of pharmacological importance.

Some bio-medical mechanisms in athletic prowess.

Variations in somato-genetic patterns in muscle-fibre biology, biochemical metabolic pathways and pulmonary physiology are hypothesized to have been concentrated by natural selection over the centuries in the Afrocentric peoples displaced from West Africa to the New World. These phenotypic and genotypic characteristics are attributed to provide the athletic prowess so well documented in African-Americans. Not the least of coincidence seems to be the influence of the compensatory mechanisms on oxygen transport and its availability to the tissues, in response to the sickle cell gene. The reduced availability coupled with reduced myoglobin in the preponderant fast-twitch muscle fibres which are adapted for rapid energy (ATP) regeneration, all give a NET outcome of muscle anatomical and biochemical advantages which support outstanding performances in athleticism.

Isolation of a branched-chain alpha-keto acid decarboxylase from rat liver.

An enzyme which catalyses oxidative decarboxylation of branched-chain alpha-keto acids was extracted from rat liver mitochondria with the aid of NaClO4. Purification yielded a product which appeared homogenous upon electrophoresis. Some kinetic data are reported; however, the enzyme is inactive with alpha-ketoisovalerate. The tenacity of binding to mitochondria, specificity, and other features, suggest that the decarboxylase may be a component of an enzyme complex named alpha-ketoisocaproate: alpha-keto-beta-methylvalerate dehydrogenase.

Isolation of a branched chain alpha-keto acid dehydrogenase from rabbit liver.

An enzyme catalysing a series of reactions resulting in the oxidative decarboxylation of branched chain alpha-keto acids and production of NADH, was extracted from rabbit liver mitochondria with the aid of NaClO4. Purification yielded a product which appeared homogeneous on electrophoresis. The enzyme is active on three substrates alpha-ketoisocaproate, alpha-keto-beta-methyl valerate, and alpha-ketoisovalerate.

Changes in some liver enzymes in streptozotocin-induced diabetic rats fed sapogenin extract from bitter yam (Dioscorea polygonoides) or commercial diosgenin.

The effects of steroidal sapogenin extract from bitter yam or commercial diosgenin on liver enzyme changes were investigated Diabetic male Wistar rats were fed diets supplemented with 1% steroidal sapogenin extract or commercial diosgenin for three weeks. Plasma glucose levels and the activities of hepatic glucose-6-phosphatase, pyruvate kinase and glucose-6-phosphate dehydrogenase were assessed Liver total cholesterol, HDL-cholesterol and total phospholipid were also measured. Plasma glucose decreased significantly (p < 0.05) in diabetic rats fed the three test diets compared to the diabetic control. The three test diets significantly decreased glucose-6-phosphatase activity compared to the diabetic control The activities of ATP-citrate lyase, pyruvate kinase and glucose-6-phosphate dehydrogenase were significantly reduced in the liver of diabetic rats compared to normal control. Supplementation of the diet with bitter yam steroidal sapogenin extract or commercial diosgenin did not significantly alter ATP citrate lyase and pyruvate kinase activities but significantly increased glucose-6-phosphate dehydrogenase activity in the liver compared to diabetic rats. This study shows that the feeding of the two test diets to diabetic rats results in alterations in the metabolism of glucose with subsequent reduction in plasma glucose concentration.

The effect of phytic acid on the levels of blood glucose and some enzymes of carbohydrate and lipid metabolism.

In this study, six groups of rats were fed as follows: Groups 1 and 2 were fed formulated diets supplemented with zinc or without zinc respectively. Groups 3 and 4 were fed formulated diets supplemented with zinc plus phytic acid extracted from sweet potato (Ipomea batatas) or commercial phytic acid respectively. Groups 5 and 6 were fed formulated diets supplemented with phytic acid extract from sweet potato or commercial phytic acid respectively. The animals were fed for three weeks and then sacrificed The activities of key enzymes of carbohydrate and lipid metabolism as well as transaminases in the liver were determined. Blood glucose level was also assessed. Phytic acid extract consumption from sweet potato and commercial phytic acid plus zinc supplement lowered blood glucose levels. There was no significant change in the activity of 6-phosphogluconate dehydrogenase among the groups. Similarly, phytic acid supplementation showed no significant decrease in the activity of pyruvate kinase compared to the group fed formulated diets. There was a significant increase in the activity of glucose-6-phosphate dehydrogenase in the groups fed phytic extract from sweet potato compared to the other groups. The activities of malic enzyme and ATP-citrate lyase in this study were not significantly altered among the groups. There is a lowering of blood glucose levels which is desirable for diabetics who consume sweet potato diets. The changes in some of the hepatic metabolic enzymes are geared towards compensating for the decreased glycolytic responses.

The Jamaican Diabetes Survey. A protocol for the Caribbean.

OBJECTIVE: This study was designed to investigate the point prevalence of diabetes in Jamaica. RESEARCH DESIGN AND METHODS: A two-stage stratified random sampling design was used, and individuals aged 15 years and over were interviewed. Nonresponse was documented and factored into the final analysis of the survey data. The overall response rate obtained was 57.9%. All subjects with fasting blood glucose (FBG) greater than 6.1 mmol/1 (110 mg/dl) were brought back for an abbreviated glucose tolerance test. The data was analyzed using Epi 5, an advanced statistical program designed specifically for use with epidemiological data. RESULTS: The 2,109 subjects who participated were the basis for estimates of diabetes and IGT prevalence. Among those with previously diagnosed diabetes, diet therapy alone, oral hypoglycemic agents plus diet therapy, insulin therapy, and lack of treatment were reported. CONCLUSIONS: By the World Health Organization (WHO) criteria, Jamaica has a point prevalence of diabetes of 17.9% in the 15-and-over age-group.

Some social factors related to control of diabetes mellitus in adult Jamaican patients.

A population of 103 adult diabetic patients was interviewed at the Outpatient Clinic for diabetic patients of the University Hospital of the West Indies to examine the effects of severity of the illness and social variables, such as facilities at home, education attained, employment status, informal medication, and understanding of the illness in relation to its control. Patients were classified as severe if there were clinical evidence of vascular or neurologic complications of diabetes and as mild if there were no complications. Control of diabetes was regarded as good if the patients were free from or had less than 2+ glycosuria and as poor if they had had 2+ or more glycosuria during the six months before the study. We found that the quality of control was mainly determined by the severity of the disease. In the mild diabetic, proper diabetic control was not influenced by any social variable examined. In the severe diabetic the quality of control was associated with social amenities, educational status, employment status, and understanding of the disease.

J type diabetes revisited.

J type diabetes is grouped as a subtype of type III or malnutrition-related diabetes, known as protein-deficient pancreatic diabetes, (PDPD). J type diabetes has not been reported recently, but a clinical picture called phasic insulin-dependent diabetes mellitus (PIDDM) has been elaborated in Jamaica, the same home country of PDRD and appears to be a "formes frustes" syndrome. The following comparative studies were performed on a group of diabetic patients and normal controls: insulin receptor binding; renal, hepatic, and pancreatic function; and abdominal ultrasonography. The results show a considerably decreased white and red blood cell binding to insulin (P less than .05), extensive kidney damage (P less than .05), and increased pancreatic echogenicity in PIDDM, supporting a separate identity of this latter syndrome from types I and II diabetes mellitus. Also, the features of relative insulin resistance, absence of ketosis even in the presence of severe hyperglycemia, and intermittent insulin requirement suggests that PIDDM, J type diabetes, and PDPD are one and the same syndrome.

Radiological evaluation of the pancreas in malnutrition-related (phasic insulin dependent) diabetes mellitus.

This study was undertaken to investigate pancreatic changes associated with phasic insulin dependent diabetes mellitus (PIDDM). Twelve PIDDM patients were studied. They were compared with groups of patients, 10 insulin dependent (IDDM), 10 non-insulin dependent (NIDDM), and 10 normal controls. Each group was matched for age, sex, and body mass index. For the study, the mean age was 56.7 +/- 2.5 years, mean body mass index 24.0 +/- 0.8, and mean duration of diabetes 14.2 +/- 2.2 years. Flat abdominal radiograph and ultrasonography were performed on each participant. The results suggest an increased echogenicity of the pancreas in the phasic insulin dependent group of patients.

Change in serum cholinesterase activity in Jamaican diabetics.

This study investigates the alteration of serum cholinesterase levels in diabetics and its possible relationship to blood glucose, insulin, triglyceride, and cholesterol levels. Fourteen phasic insulin-dependent diabetes mellitus patients were compared with 10 insulin-dependent diabetes mellitus, 10 noninsulin-dependent diabetes mellitus, and 10 normal controls. Each group was matched for age, sex, body mass index, and duration of diabetes. Mean age was 56.7 +/- 2.5 years; mean body mass index, 24.0 +/- 0.8 kg/m2; and mean duration of diabetes, 14.2 +/- 2.2 years. Serum acetylcholinesterase, insulin, triglyceride, and cholesterol levels as well as fasting blood sugar were all assayed using standard techniques. Results suggest an associated increase of serum acetylcholinesterase with triglyceride levels in diabetics and may point to a possible association between increased serum acetylcholinesterase and vascular complications in Jamaican diabetics.

The Mauriac syndrome.

An insulin-dependent diabetic was diagnosed at the age of 7 years. After two years of satisfactory control she began to have several bouts of hospitalization with hyperglycaemic ketoacidosis, and developed tender hepatomegaly, which persisted to age 11 years. With restabilisation of her diabetes, the liver regressed and she continued to maintain good health for another 1 1/2 years when she died suddenly while asleep. Post-mortem examination by the coroner revealed ascites in the abdomen, hepatomegaly and fatty metamorphosis of the liver. Her diabetes control required up to 2.3 i.u. insulin per kg body weight per day plus a 1,900 calorie diet. Her growth was well below the tenth percentile, weight for height (Harvard charts). This clinical picture of high insulin dosage, hepatomegaly, unstable diabetes and growth failure approximates to the Mauriac syndrome.

Insulin receptor studies of erythrocytes and mononuclear leucocytes in phasic insulin diabetes mellitus.

This study was designed to investigate any differences in cellular binding of insulin between phasic insulin-dependent (malnutrition-related) diabetes mellitus (PIDDM) and insulin-dependent, non-insulin-dependent, and normal controls. Isolated, washed red and white blood cells obtained after 12-14 hr fast, were separately incubated with varying concentrations of non-radioactive insulin, and a fixed quantity of radioactively labelled insulin. After the 3-hr incubation, cells were washed with buffer, and radioactivity determined on an autogamma counter. Percentage binding, receptor sites number and affinity were all determined by linear regression of the Scatchard plot. Fasting plasma insulin and glucose levels were also assayed. The results obtained show decreased binding of insulin in red blood cells [11.3 +/- 1.3%) and white blood cells 2.9 +/- 0.5%) in PIDDM. This was due to decreased receptor sites (red blood cells 39 +/- 11; white blood cells 0.5 +/- 0.11 x 10(4] as well as decreased affinity (red blood cells 0.14 +/- 0.03 x 10(9) M-1; white blood cells 0.17 +/- 0.04 x 10(9) M-1) when compared to the normal and diabetic (both insulin and non-insulin-dependent) controls. Phasic insulin-dependent diabetes (malnutrition-related diabetes mellitus) is characterized by decreased red and white cellular binding to insulin, in addition to decreased production of insulin.

A retrospective study on hypothyroid patients.

A retrospective study of 58 hypothyroid patients attending the Endocrine Clinic, University Hospital of the West Indies, Jamaica, between July and August 1989, was undertaken. The age range at initial presentation varied from one month to eighty-four years. The majority of cases (51 or 87.9%) were between 21 and 70 years. There were 50 females (86.2%) and 8 males (13.8%). The underlying causes were idiopathic hypothyroidism (35 or 60.3%), posthyroidectomy (13 or 22.4%), post I131 therapy (6 or 10.4%), panhypopituitarism (3 or 5.2%), hypophysectomy (1 or 1.7%). Biochemical parameters used in diagnosis were serum thyroxine (T4) and thyroid-stimulating hormone (TSH). Forty-six patients (79.2%) had elevated TSH, indicative of a high correlation of elevated TSH with hypothyroidism. Duration of symptomatology prior to diagnosis was one year in 27 patients (46.5%), 2-10 years in 23 (39.6%) and 10 years in 4 cases (6.9%). The major presenting signs and symptoms were lethargy (20 or 34.5%), anaemia (mixed normochromic, microcytic (16 or 27.6%), slow relaxation of tendon reflexes (16 or 27.6%), coarsening of skin (15 or 25.9%), weight gain 10 or 17.2%), hoarseness (9 or 15.5%) and psychiatric symptoms (7 or 12%). The known association of primary hypothyroidism with other autoimmune disorders was not borne out in this study. The time-lapse in diagnosis from symptomatology emphasized the need for clinicians to be more alert to the subtle and varied presentation of hypothyroidism.

Kidney function in phasic insulin dependent diabetes mellitus in Jamaica.

In Jamaica, malnutrition related diabetes mellitus (MRDM) presents the clinical picture of phasic insulin dependence. This study was undertaken to investigate nephropathic changes associated with this group of patients. Fourteen phasic insulin dependent diabetes mellitus (PIDDM) patients were compared with 10 insulin dependent (IDDM) and 10 non-insulin dependent (NIDDM) diabetes mellitus patients, and 10 normal controls. Each group was matched for age, sex, body mass index (BMI) and, in the case of the diabetic patient controls, duration of diabetes. Urinary microalbumin concentration was significantly (p < 0.05) higher in the PIDDM group (mean +/- SD: 153 +/- 48.3 mg/dl) than in the groups of NIDDM (35.7 +/- 9.6 mg/dl) or IDDM (38.6 +/- 15.8 mg/dl) patients. Serum urea and creatinine concentrations (mean +/- SE 7.6 +/- 1.0 mmol/l and 130.0 +/- 20.3 mumol/l, respectively) were higher in the PIDDM patients than in the NIDDM and IDDM groups. Confounding factors such as hypertension and urinary tract infections were excluded as causes for these differences. We conclude that PIDDM patients have more severe renal dysfunction than NIDDM patients and, since glycosylated haemoglobin concentrations are comparable in these groups, we attribute this to a renal insult due to malnutrition predating the onset of the PIDDM.

Streptozotocin alters pancreatic beta-cell responsiveness to glucose within six hours of injection into rats.

A 24-hour glycaemic profile following streptozotocin (80 mg/kg. i.p.) injection was investigated in fasted rats. The most prominent changes in blood glucose were hyperglycaemia associated with low levels of plasma insulin after two hours followed by hypoglycaemia associated with high levels of plasma insulin after six hours; subsequently hyperglycaemia progressively developed and this was associated with decreasing levels of plasma insulin. Further probing revealed that at two hours after streptozotocin injection, the pancreatic beta-cells could not respond to an oral glucose load while, at six hours after, there was an apparent return of beta-cell responsiveness, but subsequently beta-cell responsiveness was progressively lost and histological examination revealed cellular damage. From these results, it is concluded that within six hours of injection, streptozotocin initiates pancreatic beta-cell damage which leads to the development of diabetes mellitus.

Lead pollution and amelioration measures in the community of Frazers Content, St Catherine, Jamaica.

Lead poisoning, especially in children, is a preventable disease. Many children are exposed to this hazard, especially in poor communities, because of a paucity of information on lead poisoning and increasing economic hardships. In 1994, the case of the poor suburban community of Frazers Content, St Catherine, Jamaica, came to the public attention because of the high frequency of hospital admissions, or outpatient treatment, of children for lead poisoning. This paper reviews a Blue Cross of Jamaica-led-initiative aimed at the clean up and education of the Frazers Content community. The following four-pronged approach was employed: environmental and biological sampling and sample analysis, health education, decontamination and community clean up and entrepreneurial activities. The project outputs included: training of 17 community wardens and 22 schoolteachers; the clean up of 64 residences which had lead levels in excess of 500 ppm; the establishment of an entombment site for the contaminated soil in accordance with the Jamaica Natural Resources Conservation Authority and training of residents in entrepreneurial skills, chicken and rabbit rearing and nursery establishment. The paper includes discussion of the lessons learnt and recommendations for future action.

The role of C-peptide in the classification of diabetes mellitus.

We investigated twenty-one insulin-using patients, who had all been labelled as having insulin dependent diabetes mellitus (IDDM) or type 1 diabetes. Physicians have been erroneously using the term IDDM loosely to include all diabetics on insulin. The clinical criteria of the National Diabetes Data Group/WHO were used to reclassify these patients. Only thirteen were found to have IDDM and eight non-insulin dependent diabetes mellitus (NIDDM). Using fasting C-peptide values, only five of the thirteen with clinical IDDM truly had IDDM, the others might have maturity onset diabetes of the young (MODY) or diabetes in the young. Of the eight with clinical NIDDM seven had normal to high C-peptide values; the lone patient with low C-peptide values had diabetes diagnosed at age 64 years. We conclude that the clinical classification of diabetes mellitus may be inaccurate and that C-peptide evaluation improves the accuracy of the classification.

Renal subcapsular islet cell transplantation in the dog. A preliminary report.

During the last two decades, islet cell transplantation has been pursed both experimentally and clinically in an effort to ameliorate diabetes mellitus. At present, however, islet cell transplantation still remains at the experimental stages as far as the treatment of diabetes is concerned. Also, culture of islet cells has proved to be rather frustrating and difficult. No consistent techniques have been developed, and simplified methods for islet cell preparation and adequate sites for islet cell placement would allow for further progress in this area. Ultimately, rejection remains the greatest obstacle to success. We report a simplified technique for enriching dog pancreatic islet cells. This preparation was injected into the renal subcapsular space in both homograft (3 experiments) and heterograft (3 experiments) situations. After six weeks, nephrectomy was performed, and histochemical techniques demonstrated many groups of live islets in between the tubules in the renal cortex. No acinar cells were observed. Blood samples from the renal artery and renal vein at the time of nephrectomy revealed an average 36.9% increase in insulin concentration in the renal veins, supporting an active secretory role of these transplanted islet cells. This technique points to (i) the possible role of "renal factor" in promoting growth of islet cells and (ii) the feasibility of successful transplantation of enriched islet cells as a potential approach to the curative treatment of diabetes mellitus.

Jamaican patients' understanding of diabetes mellitus.

Ambulant and hospitalized patients with diabetes mellitus were interviewed by two trained interviewers to obtain information about their knowledge of the illness and the communication they had received about it. Sixty to seventy per cent of patients claimed that no explanation about the illness was given to them at the time of diagnosis. This poor communication occurred in both public and private medical services. Fifty-seven per cent of the patients scored no more than the 50th percentile on the knowledge rating score, reflecting that patients' knowledge of the illness was in general poor. The hospitalized patients did learn about the illness while there, but still claimed that they learnt nothing. These data are examined in the context of the nature of the doctor-patient communication style and effect. Jamaican diabetic patients need to be better informed about their illness; despite short patient-physician contact time, an effort to explain the nature of the illness at the time of diagnosis would be worthwhile. This will need subsequent assessment and reinforcement by involving a team approach.