TLR4 (Toll-Like Receptor 4)-Dependent Signaling Drives Extracellular Catabolism of LDL (Low-Density Lipoprotein) Aggregates.

Objective: Aggregation and modification of LDLs (low-density lipoproteins) promote their retention and accumulation in the arteries. This is a critical initiating factor during atherosclerosis. Macrophage catabolism of agLDL (aggregated LDL) occurs using a specialized extracellular, hydrolytic compartment, the lysosomal synapse.

Magnitude and determinants of coronary artery disease in juvenile-onset, insulin-dependent diabetes mellitus.

The risk of premature coronary artery disease (CAD) and its determinants were investigated in a cohort of 292 patients with juvenile-onset, insulin-dependent diabetes mellitus (IDDM) who were followed for 20 to 40 years. Although patients with juvenile-onset IDDM had an extremely high risk of premature CAD, the earliest deaths due to CAD did not occur until late in the third decade of life. After age 30 years, the mortality rate due to CAD increased rapidly, equally in men and women, and particularly among persons with renal complications.

Islet cell antibodies and other autoantibodies in South African blacks and indians with insulin dependent diabetes mellitus (IDDM).

The presence or absence of islet cell antibodies and other autoantibodies was determined in 47 African and 34 Indian patients with IDDM and 37 controls. Islet cell antibodies (ICA-IgG) were found in over a third of the patients and in only 2 controls. Complement fixing antibodies (ICA-Cf) were found in 10% of patients, but in none of the controls.

HLA antigens and non-insulin-dependent diabetes mellitus in young South African Indians.

HLA, A, B and C antigens were determined in 84 South African Indian patients with non-insulin-dependent diabetes mellitus (NIDDM) in whom age of onset was under 35 years and in 760 healthy Indian controls. Increased frequencies of Aw24, B15 and Bw61 were seen in the patients, but the corrected P value was not significant. Among Indians of North Indian origin, however, there was a significant association between B15 and NIDDM (corrected P less than 0,012; relative risk 4,8).

HLA A, B, C and DR antigens in young South African Indians with insulin-dependent diabetes mellitus.

The HLA status of South African Indian insulin-dependent diabetic patients in whom the age of onset of diabetes was under 35 years was compared with that of a group of healthy Indian controls. HLA A, B and C antigens were determined in 68 patients and 760 controls, while DR specificities were determined in 35 patients and 235 controls. The diabetic patients showed a significant increase in the frequencies of HLA B8 (19,1% v.

Fournier's gangrene.

Over a 5-year period 43 men with severe classic Fournier's gangrene of the scrotum and perineum and in some cases of the abdominal wall were treated at King Edward VIII Hospital, Durban. There were 8 deaths, an overall mortality rate of 18,6%. The mortality rate was high (33%) when associated with diabetes mellitus and lower (14,7%) among non-diabetic patients.

Nephropathy in Indian patients with non-insulin-dependent diabetes in the young.

In 85 patients diagnosed as having non-insulin-dependent diabetes in the young (NIDDY), 6 were found to have nephropathy. The duration of diabetes ranged from 2 to 17 yr; 5 of the 6 patients had retinopathy as evidenced by fluoroscein angiography (3 with proliferative changes). All 6 patients had a 24-h urinary protein excretion greater than 0.

Oral hypoglycaemic agents. An update.

Despite the availability of oral hypoglycaemic agents for nearly 30 years, their precise mode of action and role in the management of diabetes mellitus remains poorly defined and controversial. They are regarded by many, though not all, clinicians as helpful adjuncts in the treatment of patients with non-insulin-dependent diabetes who have failed to respond satisfactorily to an adequate programme of dietary treatment. Their initial effectiveness is greatest in those patients who have had diabetes for less than 5 years, are overweight at the time of initiation of therapy, and whose fasting blood glucose levels are not unduly raised (less than 200 mg/dl).

Patterns of diabetes mellitus in young Africans and Indians in Natal.

Young African and Indian patients (age of onset under 35) were studied in order to determine the pattern of diabetes mellitus seen in these groups. Of the 110 African patients 86 had IDDM and 18 NIDDM, whereas of the 101 Indian patients the distribution was 40 and 60 respectively. Tropical diabetes (J-type and Z-type) was rare in both groups.

C-peptide response to a glucose load in young blacks and Indians with insulin-dependent diabetes mellitus.

Residual beta cell function based on C-peptide assays was estimated in 39 patients (27 Blacks, 12 Indians) with insulin-dependent diabetes mellitus and 18 controls (9 Blacks, 9 Indians) using glucose as a stimulus. The diabetic patients showed significantly lower maximal C-peptide values (mean 0,53 +/- 0,08 nmol/l) and delayed peak levels (mean 137 minutes after ingestion of glucose) compared with the controls (mean 2,15 +/- 0,31 nmol/l and 54 minutes respectively). Just over 20% of the patients had no residual beta cell function, this conclusion being made on the basis of undetectable basal C-peptide levels which failed to rise after glucose stimulation.

Complications of early-onset insulin-dependent diabetes mellitus in Blacks and Indians.

Blacks and Indians with early-onset insulin-dependent diabetes mellitus (IDDM) were studied in order to assess the prevalence of acute and chronic complications. Of the 92 Blacks almost 70% developed ketoacidotic coma on one or more occasions, whereas 50% of the 41 Indians manifested this complication. Most of the chronic complications were related to duration of IDDM.

HLA-A, B, C and DR antigens in young South African blacks with Type 1 (insulin-dependent) diabetes mellitus.

The HLA status of South African black Type 1 (insulin-dependent) diabetic patients with age of onset under 35 years was compared with that of healthy black control subjects. HLA-A, B and C antigens were determined in 94 patients and 995 control subjects, while DR typing was carried out on 56 patients and 195 control subjects. There was a significant increase in the frequency of DR4 in patients as compared with control subjects (p less than 0.

Thyrotoxicosis and asthma. A case report.

A 55-year-old woman with intrinsic asthma that was aggravated by the onset of thyrotoxicosis is described. The possible mechanism for such a relationship is discussed.

The effect of strict control with the artificial beta-cell on plasma lipid levels in insulin-dependent diabetes.

The artificial beta-cell can establish normoglycemia within 2 h in an indifferently controlled diabetic patient. In the present study, the temporal relationship between the achievement of normoglycemia and its effect on plasma lipid concentrations has been examined in 12 insulin-dependent diabetic patients regulated by the artificial beta-cell for 7 days. The fasting values (mean +/- SEM) of blood glucose (BG), triglycerides (TG), total cholesterol (T-chol), HDL-cholesterol (HDL), and the calculated LDL/HDL ratio (obtained while participants were on single or split insulin regimens) were 385 +/- 42 mg/dl, 148 +/- 24 mg/dl, 219 +/- 22 mg/dl, 39 +/- 3.

The phytohaemagglutinin response and lymphocyte subpopulations in young Blacks and Indians with insulin-dependent diabetes mellitus.

The lymphocyte transformation response to phytohaemagglutinin (PHA) and the relative numbers of T, B and null lymphocytes were studied in 32 insulin-dependent diabetics and 32 healthy matched controls. The mean stimulation index (Sl) of the 18 patients with poorly controlled diabetes mellitus was significantly lower than that of controls. No difference was seen in the mean Sl values of well-controlled diabetics compared with controls.

Insulin response to oral glucose in young African and Indian noninsulin-dependent diabetic patients in Natal.

The insulin response to an oral glucose load was studied in 24 Indian and 14 African patients with NIDDM and 20 controls. The maximal insulin levels attained during the glucose tolerance test were significantly lower, and the peak insulin response occurred later in the diabetic patients compared to controls. The insulinogenic indices were also much lower in the patients.

The clinical presentation and biochemical diagnosis of acromegaly and gigantism.

Over a 5-year period 14 patients with acromegaly and gigantism were seen at the endocrine clinic of King Edward VIII Hospital: 9 were Blacks and 5 Indians; 8 of the patients were women. The mean age of the patients was 46 years. Surprisingly, only 2 patients complained of acral overgrowth.

Cholesterol, triglyceride and high-density lipoprotein cholesterol levels in non-insulin-dependent diabetes in the young.

Cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol levels were measured in Indian patients with non-insulin-dependent diabetes in the young (NIDDY). Both cholesterol and triglycerides were increased as compared with reference values. The HDL cholesterol levels were lower in cases of NIDDY.

C-peptide response to glucagon in black and Indian insulin-dependent diabetics.

Residual beta cell function was estimated in 35 young diabetic patients (25 Blacks and 10 Indians) and 22 controls by means of C-peptide assays using glucagon as a provocative agent. The basal C-peptide levels (mean 0,32 +/- 0,23 nmol/l) and the 6-minute post-glucagon levels (mean 0,56 +/- 0,47 nmol/l) were significantly lower in the diabetic patients than in the controls (mean values 0,49 +/- 0,20 nmol/l and 1.24 +/- 0,48 nmol/l respectively).

The insulin and glucose response to an oral glucose load in non-insulin-dependent diabetes in the young.

Non-insulin-dependent diabetes with age of onset under 35 years was studied in 85 Indian patients eighty-one per cent of the group were females, the mean age of onset of diabetes was 27 years while the mean duration was 6.3 years. the mean percentage desirable mass of the patients was 112%, obesity being present in 55% of the group.

Haemoglobin A1C levels in Black and Indian insulin-dependent diabetic patients of poor socio-economic status.

Haemoglobin A1C (HbA1C) levels were measured in 71 Black and Indian insulin-dependent diabetic outpatients. The mean HbA1C level was 13,7 +/- 1,8%, and levels showed a significant positive correlation with random plasma glucose values measured at the same time (r = 0,47; P less than 0,001). Unsatisfactory socio-economic circumstances may be responsible for the poor quality of control in these patients.

Insulin-dependent diabetes mellitus with early onset in blacks and Indians.

Insulin-dependent diabetes mellitus (IDDM) with onset below 35 years of age was studied in 52 Black and 38 Indian patients. IDDM accounted for approximately 10.4% and 1.