Good glycaemic control is important in preventing the acute and long-term complications of diabetes mellitus. We assessed long-term glycaemic control using glycosylated haemoglobins in 83 diabetic patients, of mean age 47 years and of mean known duration 4.5 years, attending Port Moresby General Hospital over a one-year period. Significant improvement in glycaemic control was observed in only 11 (13%) of the patients. Glycaemic control worsened in 13 (16%) and no change was observed in the remainder (71%). Mean glycosylated haemoglobin and fasting plasma glucose levels were similar at the beginning and end of the study period. Over a one-year period 53 patients (64%) exhibited poor control with mean glycosylated haemoglobin levels exceeding 10%. Among the 19 newly diagnosed diabetic patients (23% of the total) glycaemic control improved in only 2 (11%). Glycaemic control was not influenced by sex, treatment, obesity or duration of diabetes. The demonstration of poor metabolic control in the majority of patients suggests that urgent measures are needed to reevaluate the management of diabetic patients, particularly with respect to education and diet. This may improve the poor survival rates reported in diabetic patients from Papua New Guinea.
Diabetes Mellitus, Type 1 - blood ; Diabetes Mellitus, Type 1 - drug therapy ; Glycated Hemoglobin - analysis ; Human

Although isolated cranial nerve palsies are common in diabetic patients, multiple, simultaneous cranial neuropathies are rare. We describe the second case of a complete superior orbital fissure syndrome including the optic nerve in a middle-aged Papuan man with newly diagnosed diabetes mellitus. The differential diagnosis included septic cavernous sinus thrombosis and Tolosa Hunt syndrome, and management was initially directed at excluding these serious, treatable conditions.
Cavernous Sinus Thrombosis - diagnosis ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; New Guinea ; Oculomotor Nerve Diseases - diagnosis ; Oculomotor Nerve Diseases - etiology ; Tolosa-Hunt Syndrome - diagnosis

Carotid intima media thickness (CIMT) is used commonly as a non-invasive test for assessment of degree of atherosclerosis. The present study, in a tertiary care centre of Eastern India was aimed to determine the relation between CIMT and the known and novel risk factors of ischemic stroke. Of the 62 patients studied, 82% were hypertensive and 61% were smokers, 95% were above 50 years of age. Seventy one percent of our patients had high CIMT. CIMT was signifi cantly related to high sensitivity C-reactive protein (hsCRP), fi brinogen, LDL levels and age of the patient. By logistic regression analysis, hsCRP, fi brinogen and age were signifi cantly associated with high CIMT. When the patients have elevation of both hsCRP and fi brinogen, the risk of high CIMT were even higher. Our study highlights the needs for better screening in high risk patients.

Intestinal infarction is a rare complication of systemic lupus erythematosus (SLE). A 26-year-old Papua New Guinean female who developed such a complication and underwent emergency laparotomy is described. The pathological changes in the mesenteric vessels and possible pathogenetic mechanisms are discussed. The relevant literature is briefly reviewed.

Although the Contingent Negative Variation (CNV) paradigm has been useful in schizophrenia, limited research involving such paradigm in subjects with Bipolar Disorder (BD) has produced contradictory findings. To the best of our knowledge, no study has investigated CNV in Paediatric Bipolar Disorder (PBD) subjects. Thirty remitted PBD patients and thirty matched healthy control group subjects participated in the study. No significant between group main effect could be found for either CNV latency or amplitude. We propose that CNV is unlikely to be a true endophenotype of BD. However, absence of CNV finding during euthymic phase in BD may help us in advancing our understanding of BD and such finding may, in fact, have some specificity with regard to differentiating BD from schizophrenia.
Bipolar Disorder ; Contingent Negative Variation ; Endophenotypes ; Humans ; Schizophrenia ; Sensitivity and Specificity

PURPOSE: Estrogen, through its binding to nuclear estrogen receptor (ER), has been implicated in the development of human breast cancer. The presence or absence of ER in breast lesions has been used to classify breast cancer into ER+ or ER- type. Maspin, an anti-breast cancer protein produced in normal mammary cells, has also been reported to control the condition. Studies have been conducted to determine the role of ER+ and ER- status in neutrophils in the synthesis of maspin in human breast cancer. METHODS: Maspin presence was determined by enzyme linked immunosorbent assay, while nitric oxide (NO) level was determined using the methemoglobin method. RESULTS: Scatchard plots of the equilibrium binding of estrogen demonstrated the presence of 4.18x10(7) receptors per normal neutrophil and 2.46x10(7) receptors per ER+ neutrophil with a similar dissociation constant (0.926 nM). The ER- type showed nonspecific estrogen binding only. At 0.6 nM estrogen, NO synthesis was maximally increased to 1.829 and 0.887 microM NO/10(9) cells at 4 hours in normal and ER+ neutrophils respectively, with synthesis of 2.383 and 1.422 nM maspin in normal and ER+ neutrophils respectively. Estrogen failed to produce these effects in ER- neutrophils. CONCLUSION: ER status in neutrophils determined maspin synthesis in breast cancer through the stimulation of NO synthesis. Neutrophils with ER- status which do not produce any maspin when treated with estrogen, might imply a worse prognostic outcome in ER- breast cancer due to the lack of anti-breast cancer protein synthesis.
Breast ; Breast Neoplasms ; Dissociative Disorders ; Enzyme-Linked Immunosorbent Assay ; Estrogens ; Humans ; Methemoglobin ; Neutrophils ; Nitric Oxide ; Receptors, Estrogen ; Serpins

BACKGROUND: Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. METHODS: Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. RESULTS: The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, p<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, p<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, p<0.01). CONCLUSIONS: In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted.
Adolescent ; Adult ; Anemia, Iron-Deficiency/*blood/drug therapy ; Child ; Female ; Ferritins/blood ; Hemoglobin A, Glycosylated/*analysis ; Hemoglobins/analysis ; Humans ; Iron/therapeutic use ; Male ; Time Factors

Conidiobolomycosis/Nasofacial zygomycosis is a relatively rare disease entity. It is almost always caused by Conidiobolus coronatus and is also known as conidiobolomycosis. It has been more commonly reported in tropical countries than in other regions. Diagnosis is made mainly on a clinical and pathological basis as fungal cultures may be difficult to grow. Different antimycotic drugs have been tried for its treatment. This report probably is the first case in English literature that has shown a very good response to treatment with itraconazole.
Conidiobolus ; Diagnosis ; Itraconazole* ; Rare Diseases ; Zygomycosis*

BACKGROUND AND OBJECTIVES: The bilateral choanal atresia is a medical emergency for which surgery is the only and definite treatment. We performed an atretic bone perforation using Hagers dilators. The purpose of this study, then, is to evaluate the efficacy of this simple technique of perforation, dilation and stenting. MATERIAL AND METHODS: We studied five patients who underwent surgery for a complete bilateral bony atresia from 1994 to 2004. All the patients were newborn: two males and three females babies. The male female ratio was 1 : 1.5. Their age varied from 1 day to 4 days. The surgery was performed with Hagers dilators using the puncture and dilation technique. Stenting was carried out in all cases using a non cuffed endotracheal tube. RESULTS: The reestablishment of the nasal passage through a perforating atretic plate was considered a successful criteria of surgery. All the neonates had good nasal air passage after the perforation, dilation and stenting. Two of the patients who were with the CHARGE association died within 7 days due to causes unrelated to surgery. The other three patients had successful removal of stent after six weeks. There was no follow-up afterwards. CONCLUSION: The puncture, dilation and stenting technique by Hagers dilator is safe, quick and simple. It involves minimum blood loss and is without any complications. Stenting, therefore, is essential for preventing restenosis.
CHARGE Syndrome ; Choanal Atresia* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; Male ; Punctures* ; Stents*

PIP: By mid-1995, a total of 308 HIV cases had been reported in Papua New Guinea. The majority (74%) of these cases were diagnosed in Port Moresby. This article describes the clinical characteristics of HIV infection in 67 adults who presented to Port Moresby General Hospital in 1990-95. The median age at presentation was 27 years in men and 28 years in women, with an equal distribution of cases by sex. The major presenting symptoms were wasting and weight loss exceeding 10% of body weight (94%), chronic diarrhea (47%), prolonged fever (77%), and oropharyngeal candidiasis (66%). Pulmonary tuberculosis was diagnosed on the basis of chest X-ray and history in 37 patients (56%), but only 3 had sputum positive for acid-fast bacilli. Anemia was present in 75%. 65 patients (97%) fulfilled the World Health Organization criteria for AIDS. The inpatient mortality rate in this series was 43%, and 13 of these 29 patients died within a month of their first presentation.
Acquired Immunodeficiency Syndrome - diagnosis ; Acquired Immunodeficiency Syndrome - epidemiology ; HIV Infections - diagnosis ; HIV Infections - epidemiology ; Humans ; Papua New Guinea - epidemiology ; Risk Factors