OBJECTIVE The evidence that some women wlth the polycystlc ovary syndrome (PCOS) are hyperinsuiinaemlc has brought into question their rlsk of developing early coronary artery disease. We have focused on three cardiac risk factors which have been associated with hyperlnsulinaemla by measuring glucose tolerance, fasting serum llpld concentrations and blood pressure In women with PCOS. DESIGN Comparison of cllnlcal and biochemical measurements in lean and obese women with PCOS and in women wlth normal ovaries. Determinants of the risk factors for coronary artery disease were assessed by multiple regresslon analysis. PATIENTS One hundred and two women with ultrasound diagnosed PCOS and 19 lean women wlth normal ovaries were studled. Patients were recruited from a reproductlve endocrine cilnlc. MEASUREMENTS Fasting total cholesterol, trlglycerides, high density lipoproteins (HDL), HDL2, glucose tolerance, fasting and stimulated insulin, gonadotrophins, testosterone and androstenedlone were measured during a 2hour oral glucose tolerance test. Recumbent blood pressure was measured automatlcaliy. RESULTS Lean women wlth PCOS were found to be hyperinsulinaemlc and have reduced serum HDL and HDLz concentrations compared to women with normal ovaries; serum insulin concentrations correlated positively with plasma glucose and blood pressure measurements in multiple regression analysis. Obese women with PCOS were in addition found to have higher systollc blood pressure, serum trlglyceride and plasma glucose concentration than lean women with PCOS and controls.CONCLUSiONS These results support the evidence that hyperinsullnaemlc women wlth PCOS have an Increased rlsk of developing cardiovascular dlsease and therefore form a population in whom metabolic screenlng is advisable.

Background/Objectives: Hypoglycemic effect of camel milk supplementation in experimental rat model and significant reduction in doses of insulin in type 1 diabetic patients have been observed in our previous studies. This long-term study was undertaken to assess the efficacy, safety and acceptability of camel milk as an adjunct to insulin therapy in type 1 diabetics. Subjects/Methods: In this 2-year randomized clinical, parallel design study, 24 type 1 diabetics were enrolled and divided into two groups. Group I (n ¼ 12) received usual care, that is, diet, exercise and insulin and Group II (n ¼ 12) received 500 ml camel milk in addition to the usual care. Insulin requirement was titrated weekly by blood glucose estimation. Results were analyzed by using the regression technique. Results: In camel milk group, there was decrease in mean blood glucose (118.58 ± 19-93.16 ± 17.06 mg/dl), hemoglobin A1c levels (7.81 ± 1.39-5.44 ± 0.81%) and insulin doses (32.50 ± 9.99-17.50 ± 12.09 U/day, Po0.05). Out of 12 subjects receiving camel milk, insulin requirement in 3 subjects reduced to zero. There was nonsignificant change in plasma insulin and anti-insulin antibodies in both the groups. Conclusion: It may be stated that camel milk is safe and efficacious in improving long-term glycemic control, with a significant reduction in the doses of insulin in type 1 diabetic patients.

Objectives:To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones. Methods: Between January 2013 and December 2013, 244 patients presenting with distal ureteric stones (size 5-10 mm) were randomized equally to tamsulosin (group A) or tamsulosin plus tadalafil (group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow up, endoscopic treatment and adverse effects of drugs were recorded. Statistical analyses were carried out using Student's t-test and the χ 2 -test. Results: There was a statistically significant higher expulsion rate in group B compared with group A (83.6% vs 65.5%; P-value = 0.031) and a shorter time to expulsion (14.9 ± 4.4 days vs 16.7 ± 4.8 days; P-value = 0.003). Statistically significant differences were noted in terms of the number of hospital visits and analgesic requirement in favor of group B. There was no serious adverse event. An improvement in erectile function was noted in patients of group B compared with those of group A. Conclusions: Medical expulsive therapy for distal ureteric stones using tamsulosin plus tadalafil is safe, effective and well tolerated. Furthermore, tadalafil provides the additional advantage of improving erectile dysfunction when this condition coexists with a lower ureteric stone.

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