No abstract

Concentrations of p,p'-DDT, p,p'-DDE, and p,p'-DDD have been determined in breast milk of mothers residing in two different areas of KwaZulu. Annual intradomiciliary application of DDT was used for the interruption of malaria transmission in one area, while the other served as the control. Milk from mothers living in DDT-treated dwellings had significantly higher mean levels of DDT and metabolites (mean sigma DDT 15.83 mg kg-1 in milk fat) than those from the control area (0.69 mg kg-1). The highest recorded sigma DDT value was 59.3 mg kg-1 (milk fat). Primiparous mothers from the malarious area had significantly more sigma DDT and metabolites (sigma DDT 24.82 mg kg-1) than multiparous mothers from the same area (mean 12.21 mg kg-1). Parity was the best predictor of DDT in breast milk of the exposed group. The percentage DDT and the sigma DDT increased significantly with an increase in parity. The same, but not significant, trend was also found for the control group. It was hypothesized that the increase in percentage DDT that occurred with higher parities was due to the uptake of DDT and elimination via milk. This process was faster than the uptake and endogenous formation of DDE. Designing predictive models using multiple regression was not very successful. The recorded levels do not represent an appreciable health risk to the mothers. From the literature it was deduced that at the recorded levels, a well-founded risk to the infants, particularly the firstborns, exists in sprayed areas.

In Brief The prevalence of type 2 diabetes has been increasing rapidly and with it has been resultant morbidity and mortality. Strict glycemic control reduces the progression of diabetic microvascular disease; however, most patients treated with sulfonylureas require additional insulin therapy. This article addresses common clinician concerns about prescribing insulin early in type 2 diabetes. It presents strategies for incorporating basal insulin therapy with glargine (Lantus) into a regimen that promotes compliance.

Concentrations of p,p'-DDT, p,p'-DDE, and p,p'-DDD were determined in serum of members of households of two different areas of KwaZulu. Annual intradomiciliary application of DDT is used for the interruption of malaria transmission in one area (the exposed group) while the other served as the control. Demographic differences between the two groups resulted in significantly more females in the control group. The two groups were comparable with respect to age. Serum from household members living in DDT-treated dwellings had significantly higher (p less than .005) levels of sigma DDT and metabolites (mean sigma DDT 140.9 micrograms/l) than those from the control area (mean sigma DDT 6.04 micrograms/l). Percentage DDT was also significantly higher (p less than .05) in the exposed group (28.9%) than the control group (8.3%). sigma DDT for the 3-10 yr age interval (168.6 micrograms/l) was significantly higher (p less than .05) than the 20-29 (60.5 micrograms/l) and 30-39 (84.2 micrograms/l) yr age intervals. There seemed to be two groups with regard to accumulation and elimination. The age group 3-29 appeared to be eliminating DDT, most likely accumulated from contaminated breast milk, faster than they accumulated it. From around 29 yr of age accumulation predominated as the levels increased with age. Regression analysis suggested pharmacokinetic differences for DDE and DDT between the two groups. Liver function parameters between the two groups only differed significantly for gamma-glutamyl transferase (gamma GT) (p less than .005), but the influence of difference in alcohol consumption, which was significantly higher in the exposed group (p less than .0001), offered a better explanation. Those of the exposed group that consumed alcohol had a significantly higher (p less than .05) mean gamma GT level (41.5 IU/l) than those that did not (20.2 IU/l), but were not significantly different for sigma DDT (p greater than .05). The safety of DDT used in malaria control for subjects aged 3 and older was confirmed by the levels of DDT in serum when compared with other studies, which showed lack of any negative effects associated with these levels in adults, and an apparently normal liver function in the exposed and control groups.

No abstract

No abstract

Type 2 diabetes is by far the predominant type of diabetes in the United States. Lifestyle changes can be effective in controlling blood glucose levels in many patients with early type 2 diabetes. However, as the disease evolves and slowly progresses, its successful treatment can move beyond diet and exercise to oral antidiabetic agents and later to the addition of insulin to oral therapy. Both physicians and patients may be hesitant to start insulin treatment, which can be complex and need ongoing adjustment. Here, Dr Cooppan describes the indications for insulin use in type 2 diabetes, outlines the insulin analogue therapies available, and explains the latest in best management strategies for using insulin and getting to goal.

No abstract