Acute effects of laboratory stress on blood glucose in noninsulin-dependent diabetes

The acute effects of two psychological stressors (personally stressful imagery and threat of shock) on blood glucose (BG), heart rate, blood pressure, skin conductance, and subjective stress were studied in 22 noninsulin-dependent diabetic adults and nine healthy, nondiabetic subjects similar in age, weight, education and sex. The diabetic group's BG rose significantly after threat of shock (M change from rest = 18.4 mg/dL, p < .05), although the nondiabetic group's BG remained stable throughout the assessment. Significant increases in subjective stress ratings (p < .05) and skin conductance level (p < .05) paralleled the noninsulin-dependent diabetes mellitis (NIDDM) subjects' BG response to threat of shock. The findings suggest that some stressors can have hyperglycemic effects on individuals with NIDDM, although generalization of these findings to the natural environment remains to be demonstrated. The methodology used is contrasted with other studies that have failed to demonstrate stress effects on BG.     

Assessing the clinical ethical competence of undergraduate medical students

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context.     

Do workshops make a difference in improving the capability of physicians?

Continuing medical education (CME) activities have been shown to improve the capability and capacity of physicians for appropriate management of their patients. However, doubts have been raised about the role of workshops and seminars. This study is an attempt to find out whether workshops can improve the knowledge (capability) of practicing physician. Participants of 10 randomly selected workshops conducted in whole of Sindh were included for this study. A pre-test followed by post-test methodology used for 214 participants demonstrated that physicians' knowledge increased for some of the basic facts after attending the workshop. However, when their knowledge was assessed with some problem-solving approach, no significant (P < 0.05) change could be noted. It is recommended that workshops should be designed and conducted more carefully. Besides, some innovative approaches for CME should be compared with 'workshops' approach to determine their effectiveness.     

Hippocratic fingers in Beh?et's disease

Digital clubbing has been a well recognised feature of several distinct clinical conditions, including respiratory, cardiac, and gastrointestinal diseases since the Hippocratic era. However, clubbing associated with Beh?et's disease has not been reported before. We describe a case of clubbing in a young man with Beh?et's disease, in the absence of any other apparent aetiology and propose that clubbing might be an accompanying feature of Beh?et's disease.     

Electroencephalographic changes in rats received antigens of different parasites

The prevalence of epilepsy in developing countries is much higher than in developed ones. Some of the highest prevalence rates in developing countries have been reported from tropical Africa where parasitic infections are endemic. This work was carried out to assess the effect of different parasitic antigens on the activity of cerebral cortex in rats. Nine crude antigens were used: Adult Fasciola, adult S. mansoni, hydatid cyst, T. spiralis, E. histolytica, Acanthamoeba spp. G. lamblia, Cryptosporidium spp. and crude antigen of T. gondii. All the parasitic antigens induced electroencephalographic changes compared with baseline tracings.     

Resuscitation after uncontrolled venous hemorrhage: Does increased resuscitation volume improve regional perfusion?

BACKGROUND: Recent studies have questioned the use of aggressive fluid resuscitation after uncontrolled arterial hemorrhage until the bleeding is controlled. However, it remains unknown whether resuscitation after hemorrhage from a venous origin (usually nonaccessible to surgical intervention) has any beneficial or deleterious effects on regional perfusion. The aim of this study, therefore, was to determine whether increased volume of fluid resuscitation after uncontrolled venous hemorrhage improves hemodynamic profile and regional perfusion in various tissues. MATERIALS AND METHODS: After methoxyflurane anesthesia and midline laparotomy, both lumbar veins in the rat were severed, which resulted in lowering the mean arterial blood pressure to approximately 40 mm Hg. This pressure was maintained for 45 minutes by allowing further bleeding from the lumbar veins. The abdominal incision was then closed in layers and the animals received either 0, 10, or 30 mL of lactated Ringer's solution intravenously over a period of 60 minutes. Cardiac output and regional blood flow were determined by radioactive microspheres immediately or at 1.5 hours after the completion of resuscitation. RESULTS: Fluid resuscitation with 10 or 30 mL lactated Ringer's solution increased mean arterial blood pressure and cardiac output immediately after resuscitation compared with the nonresuscitated animals. At both time points, regional perfusion in the heart, kidney and intestines remained significantly decreased compared with the sham values, irrespective of the volume of fluid resuscitation. Moreover, no further improvements in hemodynamics or regional perfusion occurred when volume resuscitation was increased from 10 mL to 30 mL. Total hepatic blood flow, however, increased with 10 mL lactated Ringer's solution compared with the other hemorrhage groups and the increase was evident even at 1.5 hours after resuscitation. CONCLUSIONS: Fluid resuscitation after uncontrolled venous bleeding transiently increased cardiac output and mean arterial blood pressure compared with nonresuscitated animals. Moderate fluid administration, i.e., 10 mL, however, did increase total hepatic blood flow. In contrast, increasing the resuscitation volume to 30 mL did not improve hemodynamic parameters or regional perfusion. Thus moderate instead of no resuscitation or larger volume of resuscitation is recommended in an uncontrolled model of venous hemorrhage.