bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of intravesical prostatic protrusion with bladder outlet obstruction
Authors: Chia S.J. , Heng C.T. , Chan S.P. , Foo K.T. 
Published: March 2003

OBJECTIVESTo determine the effect of intravesical protrusion of the prostate (IPP, graded I to III) on lower urinary tract function, by correlating it with the results of a pressure‐flow study.PATIENTS AND METHODSIn a prospective study men (aged> 50 years) with lower urinary tract symptoms were initially evaluated as recommended by the International Consultation on Benign Prostatic Hyperplasia, together with the IPP and prostate volume, as measured by transabdominal ultrasonography. These variables were then correlated with the results from a pressure‐flow study.RESULTSThe IPP was a statistically significant predictor (P < 0.001) of bladder outlet obstruction (BOO) compared with other variables in the initial evaluation. In all, 125 patients had significant BOO, defined as a BOO index of> 40. Of these men, 94 had grade III and 30 had grade I–II IPP. Seventy‐five patients had a BOO index of < 40; 69 had grade I–II and six grade III IPP. In patients with BOO confirmed on the pressure‐flow study, grade III IPP was associated with a higher BOO index than was grade I–II (P < 0.001).CONCLUSIONThe IPP assessed by transabdominal ultrasonography is a better and more reliable predictor of BOO than the other variables assessed.
NF‐κB nuclear localization and its prognostic significance in prostate cancer
Authors: Lessard L. , Mes‐Masson A.‐M. , Lamarre L. , Wall L. , Lattouf J.‐B. , Saad F. 
Published: March 2003

OBJECTIVETo detect the subcellular localization of NF‐κB (p65) in human prostate cancer tissues of different histological grades, and to test whether NF‐κB localization alone, or combined with the histological grade, can be used to predict patient outcome.PATIENTS AND METHODSProstate cancer tissues were obtained from radical prostatectomy specimens; the histological grade was determined using the Gleason grading system. Clinical outcomes were defined as good (5‐year disease‐free survival with undetectable levels of prostate specific antigen) or poor (progression to bone metastases). The subcellular localization of NF‐κB was visualized by immunohistochemistry using an anti‐p65 antibody.RESULTSThe NF‐κB subcellular localization was initially assessed in 45 specimens; in these samples a nuclear localization of NF‐κB was specific to cancer tissues, but did not correlate with the Gleason score (P = 0.089). NF‐κB was then assessed as a prognostic marker to complement Gleason score in predicting cancer progression. Tumour tissues from 30 men with a known clinical outcome were included; 10 of 17 patients who had a poor outcome were positive for NF‐κB nuclear staining, whereas only two of 13 with a good outcome were positive (P = 0.026). When NF‐κB subcellular localization and Gleason score were combined, two risk categories of progression were defined. Eleven of 13 specimens from those with a good outcome were in the low‐risk category (Gleason 2–4 or Gleason 5–7 with negative nuclear NF‐κB) and 12 of 17 in the poor outcome group were in the high‐risk category (Gleason 8–10 or Gleason 5–7 with positive nuclear NF‐κB; P = 0.004).CONCLUSIONNF‐κB is detectable in the nucleus in prostate cancer tissues and positivity can be used to help predict patient outcome. Multivariate analyses using other clinical and molecular variables are underway, and will validate the usefulness of NF‐κB as a prognostic factor.
Diabetes in the elderly: problems of care and service provision
Authors: Croxson S. 
Published: March 2003

AbstractDiabetes is common in the elderly and old UK citizens, affecting between 10% and 25%. There is considerable associated morbidity and mortality, with dementia being a common problem. The diabetic elder is also at risk of drug side‐effects. Most of the evidence base for treatment is based on trials performed in younger diabetic subjects or older nondiabetic subjects; however, we can practice evidence‐biased medicine whilst awaiting the results of ongoing trials. The older persons national service framework (NSF) may share some similarities with the diabetes NSF; it was 1 year late, and had no clear funding, amongst several other worries. Residential care, which is more likely to be required by diabetic elders, is also under‐funded with major concerns about the quality of care for the diabetic resident. The little evidence that we have regarding care of the older diabetic person also suggests inadequacies. Given the likelihood that we will have to manage with present resources, managed clinical networks may be one way to cope.
Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 4. Dietetic services and nutritional issues
Authors: Winocour P. H. , Mearing C. , Ainsworth A. , Williams D. R. R. ,   the Association of British Clinical Diabetologists
Published: March 2003

AbstractAims To examine the provision of, and variations in, dietetic services for diabetes in secondary care in the UK.Method A postal survey of all secondary care providers of diabetes services.Results There was a 77% response rate. A dedicated dietician supported diabetes services in 73% of responses, but only 45% were able to see newly diagnosed patients within 1 month. Only 3% of responses documented that dietetic services provided the recommended minimum 22 h weekly input to diabetes care, and an annual dietetic review was said to be available in 15%. An opportunity for more frequent visits was most likely if there was poor glycaemic control (78% of responses), particularly when services were provided by a dedicated diabetes dietician. Although dieticians frequently provided input to patient education (88%), specific training for this purpose and provision for continuing education of these individuals was less common (14% and 63%, respectively). Nutritional guidelines were available in 74%, but only 31% of responses documented current guidelines on obesity management. Of bids for additional dietetic resources, only 21% had been successful. There was evidence of regional variation in service provision, and no greater provision of dietetic services in areas with a large South Asian population and an expected high prevalence of diabetes. In broad terms, dietetic services for diabetes care had not altered in comparison with a similar survey in 1997.Conclusions The level of dietetic support of secondary care diabetes services remains dramatically lower than recommended in advisory documents, and appears to have changed little over the last 3 years. This is compounded by marked regional differences, and was no better in areas with a higher than average prevalence of diabetes. The survey also highlights the need for more co‐ordinated and structured education and training of dieticians as well as more consistency in nutritional guidelines.
Patterns of contraception in UK women with Type 1 diabetes mellitus: a GP database study
Authors: Lawrenson R. A. , Leydon G. M. , Williams T. J. , Newson R. B. , Feher M. D. 
Published: March 2003

Summary Aim To establish the patterns of contraceptive prescribing for women aged 15–49 with Type 1 diabetes mellitus (DM) and compare them with the patterns in women without diabetes. Methods This was a cross‐sectional study using a UK primary care database. Results Nine hundred and thirty‐eight women with a diagnosis of Type 1 DM were identified. A comparison group of women aged 15–49 without diabetes (n = 10 000) were randomly selected from the database. Twenty‐five per cent of the women with diabetes and 32% without diabetes were prescribed a hormonal contraceptive in 1994. Women with Type 1 DM were more likely to be prescribed a combined oral contraceptive than a progestogen only pill (POP) but were 2.12 (95% CI 1.65–2.72) times more likely to be prescribed a POP than women without diabetes and were less likely to be prescribed a combined pill – odds ratio 0.53 (95% CI 0.44–0.64). The pregnancy rate in women with Type 1 DM over the age of 25 years was lower than for women without diabetes. Women under 25 years with Type 1 DM seemed more likely to record a pregnancy. Conclusions Differences between women with Type 1 DM and those without diabetes highlight the variation in the way that GPs and patients evaluate the risks and benefits when deciding on contraception.Diabet. Med. 16, 395–399 (1999)
A high uptake eye and foot screening service for an urban population
Authors: Bryant V. M. , Wilson A. , Jones T. H. , Hague R. V. 
Published: March 2003

Summary Aims A community diabetes eye screening service using slit‐lamp biomicroscopy and colour fundus photography was set up in 1993 at the Barnsley District General Hospital Diabetes Centre with a foot screening service being added in 1994. The service is available for all diabetic patients in the Barnsley health district (encompassing 220 000 people). After 4½ years, a survey was carried out to establish the uptake of this service. Methods All diabetic patients on the local diabetes register were checked for attendance at the eye screening service or the Barnsley District General Hospital Eye Department. Questionnaires were sent to general practitioners to establish what screening was received by those attending neither of these services. Results More than 10% of patients were found to be incorrectly registered. Of the 4000 correctly registered diabetic patients, 62% were screened annually by this service and 25% were under the care of the Department of Ophthalmology. Half of the remaining 13% were screened at other hospitals or by opticians or general practitioners and the other half were either too old or ill to be screened or were non‐compliant. Conclusions This service has a high uptake, and is recommended for a circumscribed urban population.
Is undetected autonomic dysfunction responsible for sudden death in Type 1 diabetes mellitus? The ‘dead in bed’ syndrome revisited
Authors: Weston P. J. , Gill G. V. 
Published: March 2003

SummaryAims Sudden nocturnal death in young persons with Type 1 diabetes mellitus has been recently described, and is known as the ‘dead in bed’ syndrome. Its aetiology is unknown, and we have therefore explored the details of all papers recording the syndrome, to formulate a hypothesis of causation.Methods Literature review of ‘dead in bed’ reports as well as of nocturnal hypoglycaemia, and autonomic dysfunction in relation to baroreceptor–cardiac reflex sensitivity.Results Clinical reports of ‘dead in bed’ cases strongly suggest that nocturnal hypoglycaemia is a likely precipitant, but that the death is sudden and probably arrhythmic. Ventricular dysrhythmias may occur in the context of early autonomic neuropathy, with relative sympathetic overactivity, in young Type 1 diabetic persons.Conclusion We conclude that the ‘dead in bed’ syndrome probably occurs in Type 1 diabetic persons with early autonomic neuropathy, resulting in relative sympathetic overactivity. In such persons, risks of ventricular dysrhythmias will be compounded by nocturnal hypoglycaemia, which may be associated with an increase in the electrocardiographic Q–T interval, and Q–T dispersion. This could lead to the observed sudden death in undisturbed beds. Further research in this area is urgently needed, in particular into the possible protective use of drugs that modulate the autonomic nervous system.
Gastrointestinal symptoms in Chinese patients with Type 2 diabetes mellitus
Authors: Ko G. T. C. , Chan W. ‐B. , Chan J. C. N. , Tsang L. W. W. , Cockram C. S. 
Published: March 2003

Summary Aims To examine and compare gastrointestinal (GI) symptoms in Hong Kong Chinese Type 2 diabetic outpatients and non‐diabetic control subjects. Methods A total of 149 Chinese Type 2 diabetic patients (66 men and 83 women, age (mean ± sd) 46.8  ± 11.1 years) newly referred to the diabetes clinic of the Prince of Wales Hospital, Hong Kong were examined. Sixty‐five age and sex‐matched non‐diabetic subjects were recruited from the community as controls (22 men and 43 women, age (mean ± sd) 46.5 ± 6.6 years, P = 0.820). All patients were interviewed regarding GI symptoms over the past year, using a questionnaire that covered 14 items. A scoring system from 0 to 4 was used to grade severity. Results Diabetic patients had higher blood pressure, fasting plasma glucose and glycated haemoglobin and were more often smokers than control subjects. Of the 149 diabetic subjects, 105 (70.5 ± 45.8%) had GI symptoms while only 20 (30.8%) of the 65 control subjects had GI symptoms (P < 0.001). The respective percentages of upper and lower GI symptoms in diabetic and normal subjects were 44.3% vs. 24.6% (P = 0.006) and 54.4% vs. 13.9% (P < 0.001). The three commonest GI symptoms in diabetic patients were diarrhoea (34.9%), constipation (27.5%) and epigastric fullness (16.8%). After adjustment for age, sex, duration of diagnosed diabetes and smoking, patients with or without metformin had similar percentages or scores for GI symptoms. On multivariate analysis using age, body mass index, fasting plasma glucose, glycated haemoglobin, duration of diagnosed diabetes and presence of peripheral neuropathy as independent variables, duration of diabetes was the only independent parameter associated with total score for GI symptoms (β = 0.116, P = 0.003), for upper GI symptoms (β = 0.073, P = 0.005) and for lower GI symptom (β = 0.043, P = 0.020). Conclusions Up to 70% of the Chinese Type 2 diabetic outpatients have GI symptoms, which is a much higher rate than in non‐diabetic control subjects. Duration of diabetes is the most important factor associated with the presence of such GI symptoms.
The prevalence of multiple diabetes‐related complications
Authors: Morgan C. LL. , Currie C. J. , Stott N. C. H. , Smithers M. , Butler C. C. , Peters J. R. 
Published: March 2003

Summary Aims To determine the prevalence of the complications of diabetes and the interrelationship between them within a United Kingdom district health authority population. Methods Data extracted from a general practice diabetes audit were combined with data for patients with diabetes derived from a patient index constructed using record linkage techniques. Results A total of 10 709 patients were identified as having diabetes (prevalence 2.47%). Coronary heart disease was present in 25.2%, cerebrovascular disease in 9.6%, complications of the ‘diabetic foot’ in 18.1%, retinopathy in 16.5% and nephropathy in 2.0%. Over a half of the patients (52.1%) had none of the studied complications, 30.2% had one, 12.7% had two, 4.1% had three, 0.8% had four and 0.1% had all five. All complications were related to both age and duration of diabetes but duration was particularly apparent for the microvascular complications (retinopathy and nephropathy). Macrovascular complications in the Type 2 diabetic population appear advanced in onset compared with Type 1. Conclusions Multiple complications are apparent in almost one fifth of patients with diabetes. Macrovascular morbidity in Type 2 diabetes of early onset indicates that a targeted approach to treatment may prove most beneficial in both patient and health service terms.
Aldose reductase gene polymorphisms and susceptibility to diabetic nephropathy in Type 1 diabetes mellitus
Authors: Moczulski D. K. , Scott L. , Antonellis A. , Rogus J. J. , Rich S. S. , Warram J. H. , Krolewski A. S. 
Published: March 2003

Summary Aims To investigate association and linkage between DNA sequence variants in the aldose reductase (AR) gene on chromosome 7q35 and diabetic nephropathy (DN) in Type 1 diabetes mellitus. Methods By sequencing the promoter region and 10 exons in eight DN cases and eight controls, a frequent bi‐allelic polymorphism (C‐106T) was discovered. This polymorphism and the known 5′ALR2 dinucleotide repeat polymorphism were genotyped in unrelated cases with advanced nephropathy (n = 221) and unrelated controls with normoalbuminuria (n = 193). For a family based study, 166 case‐trios (case and both parents) and 83 control‐trios (control and both parents) were also genotyped. Results In the case–control study, carriers of the Z‐2 allele of the 5′ALR2 polymorphism had a significantly higher risk of DN than non‐carriers (odds ratios: 1.6 for heterozygotes and 2.1 for homozygotes, P < 0.05 for each). The same was true for carriers of the T allele of the C‐106T polymorphism (odds ratios: 1.6 for heterozygotes and 1.9 for homozygotes, P < 0.05 for each). Moreover, the haplotype carrying both risk alleles was in excess in DN cases. In the family study, transmission of risk alleles from heterozygous parents was consistent with the case–control study, excess transmission in case‐trios and deficient in control‐trios. Conclusions Association between DN and two DNA sequence variants in the promoter region of the AR gene implicates the polyol pathway in the development of kidney complications in Type 1 diabetes mellitus. Further examination of the molecular mechanisms underlying these findings may provide insight into the pathogenesis of DN.
Is mild gestational hyperglycaemia associated with maternal and neonatal complications? The Diagest Study
Authors: Vambergue A. , Nuttens M. C. , Verier‐Mine O. , Dognin C. , Cappoen J. P. , Fontaine P. 
Published: March 2003

Summary Aims To evaluate the maternal and neonatal complications rates of mild gestational hyperglycaemia (MGH) compared to a control group in France. Methods A systematic screening by a 50‐g glucose challenge test was offered to all women between 24 and 28 weeks of gestation in 15 maternity units. If the 50‐g glucose challenge test was ≥ 7.2 mmol/l, a 100‐g 3‐h oral glucose tolerance test (OGTT) was performed. MGH (n = 131) was defined by one abnormal value on the 3‐h OGTT (Carpenter and Coustan criteria). The control group (n = 108) was defined by a 50‐g glucose challenge test below 7.2 mmol/l. Women with MGH received no treatment or specific advice during the pregnancy. Large for gestational age (LGA) was defined by a birth weight of at least the 90th percentile on French standard growth curves. Results Women with MGH were older than the controls (28.8 (5.8) vs. 27.0 (5.2); P < 0.05) and had a higher body mass index (24.8 (4.8) vs. 23.0 (3.9); P < 0.01). The rate of pregnancy‐induced hypertension and Caesarean section were not different between the MGH and control group. The rate of LGA was significantly higher in the MGH group than the control group (22.1% vs. 11.4%; P < 0.05). After adjustment for confounding factors of macrosomia (pre‐pregnancy body mass index > 27, maternal age > 35, multiparity and educational level), there was a persistent relationship between LGA and MGH (odds ratio 2.50; 95% confidence interval (1.16–5.40); P < 0.05). MGH was more frequently associated with adverse maternal and fetal outcome than in the controls (53.4% vs. 28.7%; P < 0.01). Conclusions This study suggested that the increased rate of adverse maternal and fetal outcome, especially LGA, was associated with untreated mild gestational hyperglycaemia women compared to a control group. This link to lower degrees of hyperglycaemia during pregnancy is independent of confounding factors.
Impaired glucose tolerance and fasting hyperglycaemia have different characteristics
Authors: Davies M. J. , Raymond N. T. , Day J. L. , Hales C. N. , Burden A. C. 
Published: March 2003

Summary Aims Use of the oral glucose tolerance test (OGTT) to define glucose intolerance in the general population may bias towards selection of those with insulin resistance. Beta cell function and insulin resistance markers were analysed in four groups: controls (n = 101); fasting hyperglycaemia (FH, n 45); impaired glucose tolerance; (IGT, n = 16) and those with features of both FH and IGT (‘Both’, n = 30). Methods Subjects underwent an OGTT. Plasma glucose, fasting lipid profiles, fasting, 30 and 120 min insulin were measured and beta cell function (% B) and insulin sensitivity (% S) assessed by homeostatic model assessment (HOMA)Results The FH group compared to controls had a significantly lower % B. The IGT group compared to controls had features of insulin resistance (higher body mass index (BMI), systolic blood pressure and 2 h insulin concentration). Subjects with ‘both’ IGT and FH had features of insulin resistance (higher BMI, systolic and diastolic blood pressure and triglyceride concentration) as well as beta cell dysfunction with a lower % B and 30 min insulin–glucose ratio compared to controls. There was a preponderance of males in this group. In all, 192 subjects' 30‐min insulin concentration and incremental insulin response showed only a significantly negative correlation with fasting glucose concentration. In a linear regression analysis, a low 30‐min insulin–glucose ratio was only a significant factor in the fasting glucose model. Thus, higher fasting glucose concentrations appear to be associated with beta cell dysfunction. However, HbA1 only showed a significant correlation with 120‐min glucose, not fasting glucose concentration.Conclusions In those with milder degrees of glucose intolerance, FH is associated with beta cell dysfunction and those with IGT and a relatively ‘normal’ fasting glucose have features of the insulin resistance syndrome.
Blindness following a diabetic foot infection: a variant to the ‘eye–foot syndrome’?
Authors: Yuen K. C. J. , Baker N. R. , Reddy A. , Edelsten C. , Rayman G. 
Published: March 2003

SUMMARY Aims  The ‘eye–foot syndrome’ was initially described by Walsh et al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58‐year‐old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer.Results  Our case describes the link between the eye and the foot but is somewhat different to the association as described by Walsh et al. Endogenous endophthalmitis is rare with diabetic patients being especially at risk, and we report the first case of endogenous staphylococcal endophthalmitis related to a diabetic foot lesion.Conclusions  Our case illustrates several important issues in the management of diabetic patients admitted to hospital with infection; the need to thoroughly examine the feet to ascertain any foot lesions and any underlying peripheral vascular disease or peripheral neuropathy, to treat aggressively any infected foot lesions to prevent serious complications of septicaemia and to consider rare conditions like endogenous endophthalmitis in any diabetic patient presenting with acute visual impairment and septicaemia.