The prevalences of obesity and of non-insulin dependent diabetes mellitus (NIDDM) have increased in the United States population over the past two decades, and thus diabetes prevention has become a major concern of public health agencies such as the National Institutes of Health. Identification of individuals at risk for diabetes is an essential first step in designing and implementing intervention programs. Insulin resistance is the hallmark of the pathophysiology of NIDDM. Subjects with hyperinsulinemia, impaired glucose tolerance, or gestational diabetes are well accepted as being at high risk for diabetes. We propose that the easily identifiable skin lesion, acanthosis nigricans, is common in the major minority groups in the United States and that its presence is a surrogate for laboratory-determined hyperinsulinemia.
Our objective was to evaluate the effectiveness of the insulin-sensitizing agent rosiglitazone in obese women with polycystic ovary syndrome (PCOS) and severe insulin resistance. Twelve obese women with PCOS were recruited. All were hirsute and anovulatory with acanthosis nigricans indicating severe insulin resistance. All women were treated with 4 mg of rosiglitazone daily for 6 months. A standard 75-g oral glucose tolerance test with insulin levels was performed before and after the women were treated with rosiglitazone. Glucose and insulin areas under the curve (AUC) were calculated. Serum levels of total and free testosterone, dehydroepiandrosterone sulfate, LH, and 17-hydroxyprogesterone were also measured before and after treatment. The body mass index was determined before and after treatment. There was a highly significant (r = 0.881, P < 0.0001) positive correlation between insulin response during oral glucose tolerance test and basal total testosterone levels. After treatment with rosiglitazone, there were significant decreases in fasting insulin levels (46.0 +/- 6.5 vs. 16.9 +/- 2.0 microU/ml; P < 0.001), insulin AUC (749.3 +/- 136.3 vs. 225.0 +/- 15.7 microU/ml; P = 0.003), fasting glucose levels (90.8 +/- 3.0 vs. 81.8 +/- 1.9 mg/dl; P = 0.003), and glucose AUC (437.9 +/- 25.0 vs. 322.5 +/- 14.7 mg/dl; P < 0.001). Both total testosterone (96.3 +/- 17.3 vs. 56.1 +/- 5.8 ng/dl; P = 0.01) and free testosterone (5.8 +/- 0.6 vs. 3.4 +/- 0.5 pg/ml; P < 0.001) decreased significantly after treatment, although there was no significant change in LH levels. Levels of SHBG increased significantly (18.3 +/- 3.4 vs. 25.8 +/- 6.6 nmol/liter; P = 0.009) after treatment, and dehydroepiandrosterone sulfate levels decreased significantly (P = 0.04). There was no significant change in body mass index (40.4 +/- 2.4 vs. 41.1 +/- 2.7 kg/m(2)). Eleven of the women reverted to regular ovulatory cycles during the treatment period. We conclude that 1) rosiglitazone therapy improves insulin resistance and glucose tolerance in obese women with PCOS; 2) rosiglitazone decreases ovarian androgen production, which appears to be independent of any changes in LH levels; 3) hyperinsulinemia appears to play a key role in the overproduction of ovarian androgens in these women because attenuation of insulin levels is associated with decreased testosterone levels; and 4) short-term rosiglitazone therapy helps restore spontaneous ovulation.
Study on chemical characteristics of groundwater and impacts of groundwater quality on human health, plant growth, and industrial sector is essential to control and improve the water quality in every part of the country. The area of the Varaha River Basin is chosen for the present study, where the Precambrian Eastern Ghats underlain the Recent sediments. Groundwater quality is of mostly brackish and very hard, caused by the sources of geogenic, anthropogenic, and marine origin. The resulting groundwater is characterized by Na(+) > Mg(2+) > Ca(2+) : [Formula: see text] > Cl(-) > [Formula: see text], Na(+) > Mg(2+) > Ca(2+) : [Formula: see text] > Cl(-) > [Formula: see text] > [Formula: see text], Na(+) > Mg(2+) > Ca(2+) : [Formula: see text] > Cl(-), and Na(+) > Mg(2+) > Ca(2+) : Cl(-) > [Formula: see text] > [Formula: see text] facies, following the topographical and water flow-path conditions. The genetic geochemical evolution of groundwater ([Formula: see text] and Cl(-)-[Formula: see text] types under major group of [Formula: see text]) and the hydrogeochemical signatures (Na(+)/Cl(-), >1 and [Formula: see text]/Cl(-), <1) indicate that the groundwater is of originally fresh quality, but is subsequently modified to brackish by the influences of anthropogenic and marine sources, which also supported by the statistical analysis. The concentrations of total dissolved solids (TDS), TH, Mg(2+), Na(+), K(+), [Formula: see text], Cl(-), [Formula: see text], and F(-) are above the recommended limits prescribed for drinking water in many locations. The quality of groundwater is of mostly moderate in comparison with the salinity hazard versus sodium hazard, the total salt concentration versus percent sodium, the residual sodium carbonate, and the magnesium hazard, but is of mostly suitable with respect to the permeability index for irrigation. The higher concentrations of TDS, TH, [Formula: see text], Cl(-), and [Formula: see text] in the groundwater cause the undesirable effects of incrustation and corrosion in many locations. Appropriate management measures are, therefore, suggested to improve the groundwater quality.
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