Travel to Brazil

James Dunn asked:


Capoeira was formed by African slaves that were forced into immigration by Portugal into South America between the 16th and 19th centuries. The most popular destination for these African captives was Brazil, and with them, the slaves brought their music, traditions and religions. The oppression caused by slavery was a huge mechanism for Capoeira, and the martial art was mainly developed as a way to escape and resist the domination that governed their everyday lives. The music was one of the most important factors in Capoeira not only did it serve as a rhythm for the players to “fight” to, it helped lift the captives’ spirits and gave them joy when there was little other joy to be found.

Unfortunately, Capoeira took a turn for the worse in 1888 when slavery was eradicated. The now free Africans had no homes and nowhere to go, and sadly many of them created or joined unlawful gangs. Many of these gangs continued to uphold their traditions and practiced Capoeira within themselves, thus giving the art form a terrible reputation by associating it with illegal activities and crimes. It was for this reason that the British government outlawed Capoeira in 1890, and if any African was found practicing Capoeira, the government would slice the backs of their feet and completely severed the tendon, thus making it extremely difficult to continue practicing Capoeira.

Of course, the outlaw of Capoeira only served to fuel the Africans to play the game more often; however, they were quite careful when the game was played. The ring, or roda was only held in an area where escapes could be made quickly the bataria developed a type of rhythm that they would use to warn the players and bystanders that the police were on their way. Players of Capoeira even attributed themselves nicknames so that the police would not easily find out their true character. Fortunately, the ban on Capoeira was short-lived and the persecution of the martial art faded around 1918 and the Africans were free to practice their unique art once again.

Around the year 1937, a man by the name of Mastre Bimba opened the first school of Capoeira which led to its eventual legalization by the British government. However, not only did Mastre Bimba coerce Capoeira to be legalized, he performed the art in front of Getulio Vargas, the President of Brazil during that time, and the President became so enthralled by the art that he proclaimed Capoeira the National Sport of Brazil. Unfortunately, this upset many people that had practiced Capoeira during the years when it was banned and suffered greatly for it. To them, the sudden popularity and legalization was unfair to the people who had to endure the severity of the outlaw in earlier years.

The popularity of Capoeira spread and almost every continent on the globe has a school for Capoeira. Although this martial art may not be as well known as some of its counterparts, it is one of the few that is so steeped in culture.



Stanley

Kathy Steinemann asked:


Anyone who travels regularly is aware of luggage and carry-on restrictions post 9-11. However, if you travel abroad, there are other considerations to keep in mind. No foreign country wants undesirable insects, rodents, or diseases to infiltrate their population via border crossings.

Before reading further, remember that if you have outstanding police warrants or a criminal record, you should probably forget about foreign travel. Period.

What NOT to Take With You

Regulations vary by country. The snacks you pack for a domestic flight may not pass customs inspection for an overseas destination. Start with a good dose of ‘common sense’ and you will quickly realize why most of the items on the following list are not permitted:



Beer, wine, or other alcoholic beverages that have been opened

Pets without appropriate vaccination certificates

Native wildlife

Weapons or toys and other items that look like weapons

Big game bagged while on your safari or hunting trip

Prescription drugs without an accompanying doctor’s prescription

Drugs, vitamins, or nutritional supplements with unreadable labels

Illegal drugs or paraphernalia - DEATH PENALTY in some countries

Potted houseplants, seeds, soil, pebbles, or sand

Natural products like seashells, pieces of coral reef, whalebone

Uncooked pork, poultry, beef, and other meat or animal products

Unprocessed or uncooked vegetables, fruits, tubers, roots, etc.

Hay, straw, oats, and similar items

Any other natural products that may harbor diseases or pests

Fireworks and incendiary devices

Clothing and souvenirs manufactured with any of the above products



Some prohibited articles may be allowed with appropriate permits or certification. If you don’t know for sure - don’t pack them or bring them back home with you.

What you MUST Take With You

Imagine your chagrin should you go through customs on your return trip and discover that you must pay duty on your laptop computer, digital camera, and jewelry - even though you purchased them in your own country prior to your trip. Yes, it can - and does - happen. Protect yourself!

Pack copies of documents such as sales receipts, credit card statements, insurance policies, and appraisals for all valuable items to prove ownership and purchase date - especially for anything that looks like new.

No receipts or paperwork? Take a picture of each item next to a newspaper that plainly displays a readable date. Note the serial number(s) with each photo. Keep all photos and paperwork in a safe place along with your passport and other important documents. They will be invaluable when you fill in customs declarations - both leaving and returning.

Do Your Homework

Spend some time doing research on the internet before you travel. You should be able to find a government or embassy website that provides the regulations online. Do searches such as:



customs regulations France

customs regulations Spain

customs regulations Brazil

customs regulations USA



Advance investigation may save you considerable time, money, and effort as you pass through each border crossing.

Be aware! The resulting peace of mind will make your holiday much more enjoyable.

©Copyright Kathy Steinemann: This article is free to publish only if this copyright notice, the byline, and the author’s note below (with active links) are included.



Caleb

Douglas Scott asked:


Sao Paulo is the capital of the state of Sao Paulo in the South East of Brazil.

The biggest city in South America is a city of immigrants and ethnic neighbourhoods. An estimated 20 million people live in this plateau megalopolis, many of them descendants of Italian and Japanese migrants. Strong industrial development and cultural diversity have provided.

It has a humid subtropical climate. Temperatures seldom reach 30 during summer, while frost is rare during winter. Rainfall is abundant, especially in the warmer months, but rare between June and August.

Live music, a disco or just a bar to hang out in, you won have much of a problem in Sao Paulo. There are four main centres for nightlife Bixiga, with good bars and live music, Jardins, with some good neighbourhood bars, Itaim Bibi and Vila Olimpia, best known for its flashy nightclubs and Vila Madalena and adjoining Pinheiros, fast becoming known for its trendier, slightly alternative scene.

In such an enormous city where the hustle and bustle is constant the chance to step out of that and in to a more relaxed environment is precious.

Take some time at the Parque da Luz where the tree lined walkways, statues and open spaces offer a peaceful alternative. More tropical is the Parque Tenente Siqueira Campos, known also as Trainon Park, which is more of a rain forest experience.

Shopping is in different areas, each specialising in different aspects. Rua Santa Ifigenia for electrical goods, Rua Oscar Freire for designer fashions and Rua Teodoro Sampaio for furniture to name but a few. Part of this organisation stems from the cities history, and is a reminder of how things used to be in most places many years ago - with specialist districts for different needs.

The variety of eating options is one of the great joys, though the quality is often disappointing, not least at the more expensive end of the scale.

This huge exhibition of artists from around Brazil as well as around the world gathers on the edge of Ibirapuera Park for the biggest visual arts exhibition in Latin America.

This event takes place every September or October of the even numbered years. The artists are sponsored by their respective countries or by curators who select them for their outstanding works.

The main passion here though is football. Seen by some to offer a route out of poverty it is the biggest sport in Brazil and has a fanatical following.



Ana

Ron Peterson asked:


Some of the world’s most spectacular diamonds and other gems can be admired in the National Gem Collection in the Museum of Natural History, Smithsonian Collection in Washington, D.C. The collection is comprised of diamonds known to almost everyone, as well as other diamonds and precious gems possessing a priceless place in history.

While many are familiar with the Hope Diamond, they may be surprised to find out it is not a clear diamond, but instead of brilliant blue stone, surrounded by white diamonds and suspended from a diamond necklace. The Hope Diamond first appeared in history around the mid-1600s when it was purchased by a merchant named Jean Baptiste Tavernier who admired the stone’s original violet color. He later sold the stone Louis XIV of France, who gave it to Marie Antoinette.

The spectacular Blue Heart Diamond is a large, heart-shaped diamond mounted on a platinum ring surrounded by white diamonds. It was cut in Paris between 1909 and 1910 but the stone’s origin - Africa or India - is unclear. Famous jeweler Harry Winston mounted the diamond in its current setting in 1959 and sold the ring to Marjorie Merriweather Post. It’s possible that the popular “Heart of the Ocean” heart-shaped diamond necklace in the movie Titanic was based on the Blue Heart Diamond, which is actually set in a ring.

A wedding present from Napoleon, the Marie-Louise Diadem was presented to his wife on the occasion of their marriage in 1810. The diadem, originally part of a set that also included a necklace, comb, belt buckle and earrings, were all made of emeralds and diamonds set in silver and gold. They were made by French jeweler Etienne Nitot et Fils of Paris. After the fall of the empire, Marie-Louis fled to Vienna with her jewelry. She left the diadem to her aunt in Hapsburg. The emeralds were eventually sold individually as pieces “from the historic Napoleon Tiara.” The diadem, reset with turquoise cabochons, was purchased by Majorie Merriweather Post for the Smithsonian Institute.

One of the most spectacular all-diamond pieces of jewelry in the Smithsonian Institution is the Napoleon Necklace. Though to have originally been owned by Catherine the Great of Russia, it was presented by Emperor Napoleon of France to his second wife, Marie-Louise of Austria on the birth of their son in 1811. After a succession of owners, it eventually was sold to Harry Winston in 1960. Marjorie Merriweather Post obtained the necklace from Winston and donated it to the Smithsonian Institution in 1962. While difficult to place value on a piece such as this in today’s market, it is estimated to be worth millions.

While one does not typically associate diamonds with the Spanish Inquisition, a stunning necklace of diamonds and emeralds of the same name is part of the Smithsonian Collection. According to legend, a portion of the necklace belonged to Spanish royalty and was later worn by ladies of the French court. However, there’s little information about the provenance of the necklace. In the early 20th century, it was purchased by the Maharajah of Indore, whose son sold the necklace to Harry Winston. Winston sold the necklace to Mrs. Cora Hubbard Williams of Pittsburgh. She bequeathed it to the Smithsonian in 1972.

Having met an untimely end at the guillotine in 1793, Marie Antoinette loved jewelry and possessed many magnificent jewels. Two large, pear-shaped earrings, part of the Smithsonian collection, were supposedly set in earrings that belonged to Marie Antoinette. The diamonds were later acquired by the Grand Duchess Tatiana Yousupoff of Russia. They were never rested in the 100 years that they were in the family. Marjorie Merriweather Post acquired the earrings in 1928. They were eventually reset in platinum replicas of the original silver settings in the 1950s. The diamonds are originally from India or Brazil.

Women who discover Pandora Jewelry bracelets and complementing jewelry create their own collections with these exquisite pieces made of 14K gold and sterling silver. These Danish-designed pieces are also handcrafted with colorful precious stones and cultured pearls. With more than 600 beads and matching jewelry to choose from, Pandora bracelet wearers have an endless array of combinations from which to create their own masterpiece.



Barry

nicole asked:


I will be going to Brazil in December and I wanted to know if 500 USD would be enough for 2 weeks. I will be staying with friends and all of my expenses will be paid for.

Jasmine

Jay Siva asked:


Copyright (c) 2008 Medical-Tourism-Guide.com

Medical tourism is simply the practice of going to another country to obtain medical services. This practice allows the patient to receive top quality medical services in a country of choice.

Traveling abroad for medical services is a new concept to many of us, yet the elite have been traveling to foreign countries for years. Medical tourism is not just for the rich and famous anymore, and Switzerland is not the only destination. About ten years ago, countries in Asia realized that the opportunity exists to fill the unmet needs of millions worldwide. Top quality medical care is available, at a fraction of the price, in a plethora of countries across the world. India and Thailand are currently competing as the forerunners in the medical tourism industry; however they are not the only destination options. Countries like Mexico, Costa Rica, Brazil, Poland and others are offering world class services at third world prices!

There are still many skeptics that wonder if it is same to consider medical services in a foreign country. There is expressed concern of safety, the knowledge and skill of the staff, and the quality of services that are offered. If a person would travel thousands of miles to vacation, why not travel that far to have a medical procedure done? If a person is willing to risk having a foreign doctor perform the procedure in the developed country (E.G. a cardiologist from India, working in Chicago) why does that person not trust going to the same caliber cardiologist in the country of India itself? If a person is willing to fully research the hospitals and credentials in their homeland, why not check the ones abroad and save money by choosing a facility abroad?

Because of the decreased costs and ready access of air travel, medical tourism is a viable option for ALL people now! A person can obtain timely and quality medical services in a vacation paradise, for a fraction of the cost of the same medical procedure in the home country.

How does a person begin the task of choosing a country to consider traveling to as a medical tourist? It is advisable to begin by researching which countries offer medical tourism services and which are safe to travel to. There are medical tourism travel agents that can aid you with your research, as well as well researched books that will give you the guidance that you need.

Regardless of the country that you choose to receive services in, including your homeland, you will need to search out and choose a facility and doctors that you are confident in. It is true that all countries have good facilities and bad, all countries have highly skilled doctors as well as those who are poorly trained and running less than desirable operations. Again, the information is already researched for you, and you would be wise to access those resources.

All that is left for you to decide is which continent you want to go to, and which country in that continent you have always wanted to visit. Once you have decided that, you will need to think about particular parts of the country you desire to see while there. The process that you need to use in determining the country of choice is similar to if you were planning a vacation. As stated earlier, medical tourism is simply the practice of combining vacation and medical procedures. Where is it that you have always wanted to visit? There are several medical travel agencies available that offer a full menu of choices of destinations, and procedures offered in each!

India has a mission of becoming the leading medical tourism country in the world. There are multitudes of hospitals, located all over the country, that are top quality and accredited by the international organizations. Their doctors are often U.S., Canadian or U.K trained and they are fluent in English. Their intent is to cater to tourists from the U.S., Canada, the U.K and Australia; in particular. If a prospective medical tourist has always desired to see the Taj Mahal, then Arga would become the destination of choice. Kerala is another choice destination, with the Western Ghats towering 500-2700m to the east and is the meeting of forty four rivers. If it is the hustle and bustle of the Indian city that a person wants, then New Delhi or dozens of others might be a better choice.

Although India has been highlighted, the other choices are equally as beautiful. The destination is really a matter of deciding where it is that you have always longed to visit, and then combining that with your vacation, to create a “health holiday”. Thailand offers some of the most pristine beaches in the world. Brazil offers rainforests, Costa Rica offers jungles and beaches both, France offers beautiful countryside and the glitter of Paris, Italy offers romantic villas, and Switzerland (of course) offers the Swiss Alps! There are many more, unnamed that are options that a qualified medical travel agent can assist you with searching out.



Wanda

Douglas Scott asked:


A country in western South America, bordering Ecuador and Colombia to the north, Brazil to the east, Bolivia to the south east, Chile to the south, and the Pacific Ocean to the west.

It is the home of many indigenous ethnic groups.

The President of Peru is the head of state and head of government executive power is exercised by the government.

Like its rich national history, the popular culture of contemporary Peru is the result of a fusion of cultures, constituted primarily from the cultural legacy of the indigenous groups, and Spanish and African colonists. This cultural mixture has been further enriched by the contributions of other immigrant groups, particularly Asians and non Iberian Europeans.

Holiday in Peru is fascinating and thrilling country that promises to be all that is South America, from colourful markets, excellent music and smiling faces to historic civilisations, intriguing cultures and time honoured traditions. It encompasses the Andes Mountains, the Amazon Jungle, the desert plains and the towering snow capped volcanoes. Here too live the llama, the condor, the piranha and the jaguar.

Rising from Perus desert is the worlds highest sand dune, cutting through its mountains is the worlds deepest canyon, resting on its lofty plains is the worlds highest navigable lake and hiding in its rainforest is the worlds highest concentration of flora and fauna.

Inhabited by diverse cultures, a Peru holiday offers a wealth of archaeological treasures. In the desert are the extraordinary lines etched by the Nasca people, on the coast lies the vast adobe city of the Chimu kings and most famously, in the jungle, hides the ancient citadel of the Incas Machu Picchu. Trekking in Peru, most notably Machu Picchu, is stunning.

In addition, a Peru holiday offers charming colonial towns founded by the Spanish Conquistadors, the floating reed islands of the Aymara Indians and the traditional terraced farms of the Quechua communities.

A holiday in Peru holds the most extraordinary variety and colour for any visitor, with traditional Indian markets, colonial towns with their cobbled streets, imposing snow clad volcanoes, cascading streams and rivers racing down to the steamy Amazon Jungle.

Popular celebrations are the product of every town’s traditions and legends. These celebrations gather music, dances, meals and typical drinks.

Peruvian cuisine is becoming more popular on the world gastronomic scene. It is a blend of Amerindian and Spanish food with influence from other groups, including Africans, Italians, Chinese and Japanese, all of whom have added their own ingredients and traditions to the mix.



Malik

Graham Baylis asked:


owning a holiday home abroad is nothing more than a dream; a luxury which is the prerogative of the rich and famous or of bank robbers. It’s hardly for the likes of ordinary folk like you and me, is it?

Not so! If you investigate the possibilities of joining well over 250,000 other Britons and buying your own holiday home abroad, you could be very pleasantly surprised at how affordable it actually can be, and with property prices currently low but set to rise in many resorts overseas it could represent a real opportunity and provide you with a very high return on your investment.

With expert advice to help you secure exactly the right property, it’s really not difficult to buy a home overseas, be it for holidays, retirement or investment. There are some very attractive deals on offer. With some, you may only have to pay as little as 15% deposit, with nothing else to pay for three years and with 85% mortgages available, together with free packages for furniture of the highest quality! If you choose your advisers carefully, those people in the know will guide you every step of the way and ensure that the entire experience is stress-free and enjoyable.

Just imagine the sheer joy of having 300 days of sunshine a year virtually guaranteed; balmy temperatures, no grey skies and an umbrella as rare as hens’ teeth. Think how it would be to enjoy fabulous views of beautiful mountains and clear blue skies from the balcony of your luxury furnished apartment, ski chalet, villa or penthouse, and to be within just a few minutes walk of a pristine, white sandy beach or a superb golf course with all the amenities.

So what would be your fancy? A townhouse on the coast of Spain with its amazing beaches and intriguing culture? Or for a relaxed and informal lifestyle with great food, exciting nightlife, magnificent scenery and almost constant sunshine, you’d have to go a long way to beat a property in Crete. There again, have you considered Egypt, another very attractive option for investors? Definitely a country of the future, its wealth has traditionally come from oil, but this may well change as many predict that tourism will forge into the lead.

How about an apartment in South America’s largest country, Brazil? Home to more than 180 million people, this economically developing country with a very low cost of living is becoming increasingly popular with investors and would appeal to anyone with a sense of adventure and a love of excitement, be it a trek through the wild rainforests, a visit to the lively cities or partying at the famous Rio de Janeiro carnival.

Those with a fascination for history could not fail to be smitten by beautiful Bulgaria, with its immaculate beaches, sparkling clear lakes and rivers, magnificent mountains, gorges and natural hot water springs. It’s an enthralling country, rich in ancient monasteries, churches and mosques and with folklore traditions dating back more than thirteen centuries. Furthermore, as an investor, Bulgaria will offer you real value for money.

If your yen is for a superb climate, colourful culture and friendly people, you’d find Turkey hard to beat. With miles and miles of dramatic coastline, beautiful seas and pine-clad mountains, it’s little wonder that it’s become so incredibly popular with tourists, and with its current property boom, there’s never been a better time to invest in a Turkish holiday home.

A holiday home in the former British colony of Malaysia could well prove to be a lucrative investment for you. It’s a wealthy country with a very bright future and a property market looking increasing buoyant, due in part to the influx of investors from nearby Singapore and Hong Kong. Owing to its proximity to the equator, it enjoys a fabulous, year round tropical climate and boasts some of Asia’s best beaches.

If you’re not looking to retire abroad just yet, why not let your property work for you by renting it out during the holiday season? There are many emerging markets with a lower cost of living than in the UK, offering high rental and capital growth potential. Even the recent problems in the global economy, such as the credit crunch and increases in the cost of living don’t seem to have made a dent in people’s appetite for travelling abroad. The future’s looking much brighter for ‘buy-to-let’ investments and don’t forget, today’s cheaper and more frequent flights to many of the popular resorts are making the whole package much more attractive and affordable for everyone.

So you see, you don’t actually need to rob a bank. There are far easier and more legitimate ways of turning your dream into a reality…



Edwin

Geznak asked:


I’ve got blisters on my fingers! I am using the traditional nutcracker that everyone is probably familiar with and I try to be very careful, but I still end up with Brazil nut shreds. And blisters on my fingers. Help…..

Henry

lalaghulamrasool bhurgri asked:




To compare the role of glibenclamide and pioglitazone drugs in type 11 non- insulin dependent diabetes mellitus patients.

Authors:Raj kumar chohan,Mashori Ghulam Rasool,Bhurgri Ghulam Rasool,Shamim-u-Rehman,DahriGhulam mustafa,Anis-u-rehman.



Introduction:-



Diabetes comes from the greek word for ‘SIPHON” which one is the first term and implies for a lot of urine is made .The trm “mellitus” comes from a laton word, “met” which means “honey” and was used because the urine was sweet (Wheeler,2004)

Diabetic ketaocidosis is one of life threatening condition requiring some data hospitalization and treatment. Recognition of this condition is of almost importance, because even small delays can have an impact on survival (Nattrass, 2006). Hypoglycaemia are involved in insulin induced episodes in individuals with diabetes. Probably the major factor prescribing, insulin treated patient from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequancy of current mathods of insulin delievery which lead ot inappropriately high insulin concentration, particularly some persons after eating more foods at night onset of blindness and also a major risk factor heart disease and stroke

(Heller, 2003).



TYPES OF DIABETE MELLITUS

TYPE 1 DIABETES MELLITUS (IDDM):

Type I diabetes affect children of all ages, both sexes and all athenic groups. type 1 diabetes usually occurs by mechanisms. It is most common metabolic condition in children and adolescents (Bui, 2004). Type1diabetes is characterized by immune mediated destruction of pancreatic b -cells resulting in insulin deficiency. This results in a common biochemical end point of hyperglycaemia and risk of ketoacidosis, but the clinical presentaion varies, widely depending on the rate and degree of b -cells failure (Lambert & Bingley. 2005).

Type II diabetes mellitus (NIDDM):



Type II diabetes is a complex metabolic disorder associated with, b -cells dysfunction and with varying degree of insulin resistance primary pathogenic factors leading insulin resistance leading to type 2 diabetes and decreased insulin, secretion which arise from abnormalities with in liver, skeletal muscle and pancreatic b -cells (charles & clark, 1996).



GESTATIONAL DIABETUS MELLITUS

:

Women who develop glucose intolerance in late pregnancy and womens who with previously undiagnosed diabetes.





SECONDARY DIABETUS MELLITUS:



Secondary diabetes is due to disease of the pancreatic and endocrime system, genetic disorders, or exposure to chemical agents.

Type – I diabetes formerly known as insluin dependent diabetes mellitus (IDDM), is characterized by the destruction of the pancreatic beta cells that produces inslulin

Type – I diabetes formerly known as insulin dependent diabetes(IDDM),is characterized by the destruction of pancreatic beta cells that produces insulin.Type-1 diabetes occures most often in children and young adults but it can occures at any age.(Anderson et al 2007).

Type-11 diabetes is not straight uprward. A pancreas that does not produce enough insulin. Liver that release too much glucose,muscle cells that do not readily take in glucose.(Carren 2008)

Many genetic factors are involved in the development of diabetes.Because of new genetic methodology researchers are closers to identifying all of the cadidate gene for both non –insulin dependent and insulin dependent diabetes(Bernhard,1995).

Woman who had gestation diabetes are more likely to develop Type-11diabetes themselves.Pergnant women with diabetes are another disadvantaged group.They need much more intensive antenatal care and close monitoring of blood sugar,blood pressure and weight.(jawed2006)

Over weight children the progression of child obesity into adulthood is associated with early develop of complications, including IgpG2 diabetes and cardiovascular disease.Type diabetes is the most common clinical form of diabetes accountingforabout 90% of all cases,it is currently undergoing world wide epidemic. Type 11diabetes mellitus is caused by body’s infective use of insulin, it is often results from excess body weight and physical inactivity(WHO 2007).



PREVALACES& IINCIDENCE

:

Diabetes mellitus increases with aging, in 200 the prevalance of diabetes,it was estimated to be 0.19% people<20 years old and 8.6% in people>20 years old.There is considered geographic variation in the incidence of both type-1 and type-11 diabetes mellitus.Scavandinvian has the highest incidence of type-1 diabetes mellitus e.g in Finland, the incidence is 35/100,000 per year the pacific rim has a much lower rate in japan and china the incidence is 1 to 3/100,00 per year of type-1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100,000 per year).The prevalence of type 11 diabeties mellitus is highest in certain pacific island, intermediate in countries such as India and the United States, and relatively low in Russia and China.This variability is likely due to genetic, beharioral and enviromental factors(Power 2005).Diabettes mellitus prevalance also arises among different ethic population within a given countries it is common inall ethnic groups its prevalance increased with age and more than 5% of individuals of more than 65 years of age have diabetes mellitus (David Owerback 1988).The World wide prevalence of diabetes mellitus has risen dramatically over past two decades.The prevalence of type11 diabettes mellitus is expected, type 11 diabetes mellitus is more prevalent among Hispanies Native Americas,African,American,and Asians, pacific Islanders than in non- Hispanic whites,the incidence is essentially equal in woman and men in all populations. Type 11 diabetes is becoming increasingly common because people are living longer,and the prevalence of diabetes increases with age it is also seen more frequently now than before in young people, in association with the rising prevalenceof childhood obesity although type11 diabetes still countries with the estimated nubers of cases of diabetes in 2000and 2030.

Rank Country

2000 Individuals country with diabetes (milloins)

Country

2030 Individuals with diabtes (Million)

India

31.7

India

79.47

China

20.8

China

42.3

USA

17.7

USA

30.3

Indonesia

8.4

Indonesia

21.3

Japan

6.8

Pakistan

13.9

Pakistan

5.2

Brazil

11.3

Russian federation

4.6

Bangladesh

11.1

Brazil

4.6

Japan

8.9

Italy

4.3

Philippines

7.8

Bangladesh

3.2

Egypt

6.7

(Wareham& FOROUHI 2OO6)



DRUG TREATMENT OF DIABETIES MELLITUS

:

Biguanides lower blood glucose, they increase glucose uptake and utilize in skeletal muscle there by reducing insulin resistance, and reduce hepatic glucose production (gluconeogenesis).Lower blood glucose, addionally reduces low denisity and very low denisity lipoproteins (LDL and VLDL) respectively. Metformin has a half life of about 3 hours and is excreted unchanged in the urine.Clinically metformin used in type 2 diabetic who are obese and who fail treatment with diet alone.Adverse effects are produced dose related gastrointestinal disturbances e.g anorexia,diarrhoea,nausea,lactic acidosis rare but potentially fatal toxic effect.(Dale,2003).

Improving insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved.Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone,although they are usually taken in combination with sulfonylurease.

In some incouraging studies, thaiazolidiniones have produced very favorable effects on the heart, including reducing blood pressure and improving triglycerides and cholestrol levels including increasing HDL level,the good cholestrol. They may also block a molecule called 11 Best HSK that may play a significant role in metabolic syndrome,as well as diabetes type11. One study also sugessted that Rosiglitazone may even improve beta cells functions and so help prevent progression of diabetes.Anemia, weight gain, increased risk of fluid buildup, may worson heart failure.Troglitazone,was withdrawn after a few reports of heart failure.Liver failure abd death.Current Thiazoldinediones don not appear to pose the same effects on the liver although there have been a few reports of liver injury.

In patients with dietry failur the choice of a sulfonylurea agent or insulin therapy has been controversial and empric in favour of insulin therapy are the studies, who reported marked improvement post receptor diagnostic after intensive short term therapy in untreated type 2 diabetes mellitus (Scarlett et al,1984) Sulfonylureas further classified into two groups or generations based on their potency,duration,drug interaction,side effects profiles. Sulfonylureas enhance insulin action in cells in culture and stimulate the synthesis of glucose transporters (Jacobes et al 1998).A sulfonylurea drug should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) also recommends that a generic ,drug should be perscribed (Scsade et al1998).



RESEARCH DESIGN AND MATERIAL AND METHODS:



This study was conducted in the deprtment of Pharmacololgy and Therapeutics,Basic Medical Science Institute,Jinnah,Postgraduate Medical Centre,karachi under kind supervision od DRr:GhulamRsool Mashori,Associate Professoer and Head OF Department Of Pharmacology and Therapeutics in colloboration with Medical Outpatient Department Unit111 and Filter Clinic, Medical Department, JPMC,Karachi.

Seventy NIDDM (type-II)diabetic patients were initially enrolled in the study from the filter clinic/ out patient department Medical Unit III ,and diabetic clinic.Out of this 60 diabetic patients were associated in whole period of study, remaining 10 patients were dropped due to poor comlpiance or change in residential place.All the patients were divided in two main groups,groupI and in group II these patients were selected in this study according of inclusion and exclusion criteria.



INCLUSION CRITERIA

:



Newly diagnose patients of non Insulin Dependent Diabtes Mellitus.

Diagnsed patients of diabetes also including having no any history medication.

Having either sex of age between 30 to 60 years.

Diagnosed patients who were Non Insulin Depedent Diabetes Mellitus who were treated with Pioglitazone.

Diagnosed patients who were Non Imsulin Depedent Mellitus, who were treated with drug Glibenclamide.





EXCLUSION CRIRERIA

:



Patients suffering from blood pressure.

Patients suffering from liver disease.

Patients suffering from cardiac disease.

Pregnancies and lactating women.

Patient suffering from renal disorders.

Patients having serious complications.





MATERIAL:





Lacets.

Lancet Hlder(Abbots easy touch TM2 lot 03 Asee).

Glucometer(Medisense) optilim one touch(Abbotts).

Blood glucose nest trpis (IVD for Invitro diagnostic use (Abbott Labortries,Medisense UK Ltd,Abigngdon,Ox14ITR,Masde in UK). Stored between minimum 30?, (4°-30° C) and Maximum 40°C (39°-86°F).

Weight Machine Model No 1101 Lot No.312. TANTIATA.





DRUGS



Tab:Daonil 5 mg (Aventis Pharma)

Drug category:Sulphonylurea.

Generic Name: Glibenclamide.

MFGLIC:No.000007 RegistrationNO.000220

MFG Date:0-06

EXP Date:7-10

Lot NO:B230

Tab:piozer (Hilton Pharm) PvtLTd.

Tab:Poizer 15mg

Drug category:Thaiazolinedione.

Generic Name:Pioglitazone Hydrochloride.

MFG LIC: O.000136 Registration No.03270

MFG Date:3-06

EXP Date:3-o9

Lot No:6287

Tab: Poizer (Hilton Pharma)pvt ltd.

PARAMETERS:

Fasting Blood Sugar (FBS).

Random Blood Sugar (RBS).

Weight.

Key words:Diabetes mellitus,Non-insulin diabetes mellitus,Insulin depedent diabetes mellitus, Daonil,poizer,Insulin.



RESULTS:





Table 1



Weight and Blood Sugar level observed on baseline day 0

In group1 and group11

 

Group 1

Group 11

 

Pioglitazone n=27

Glibenclamide n=33

Weight

63.37

+ 2.25

¯

62.7

+ 15.56

¯

Fasting Blood Sugar

172.7

+ 13.32

¯

188.42

+ 12.o5

¯

Random Blood Sugar

285.11

+ 15 .532

¯

284.18

+ 17.07

¯

All Values are expressed in Means± SEM.

FIGURE-1 weight and blood sugar levels observed on baseline (day-o)



In table No shpwing the weight (KG’S) and blood sugar (msg/dl0 levels which is observed on baseline (day-0) in both groups 9group: 1 & group11)

Group: 1 Weight in (Kg’s) mean + SEM) IS 63.37±2.25 Fasting blood sugar 172.7±13.32,and Random

blood sugar 285.11±15.32



Group:11

Weight (KG’s0 (mean +SEM)62.7±1.56 Fasting blood sugar (mg/dl0 188.42±12.05, Random blood sugar is 284.18±17.03.

Figure 2: showing the weight and blood sugar levels observed in base line (day-0) in group: 1 and group 11 weight in 9kg’s) its mean values are 63.37,62.7, Fasting blood sugar in (mg/dl) is 172.71, 188.42 Random blood sugar (mg/dl) is 285.11 &284.18.

TABLE: 2

Peroidic Observation In All Parameters Group1

Goup1(Pioglitazon) n=27

 

P-value

 

Day-0

Day-45

Day-90

Day-0to45

Day-45-90

Weight

63.37

±2.25

63.63

±2.26

63.63

±2.23

>0.05

(NS)

>0.05

(NS)

Fasting blood sugar

172.7

±13.32

165.04

±8.98

153.37

±7.59

>0.05

(NS)

0.05

(NS)

Randomblood sugar

285.11

±15.32

279.78

±13.63

255.56

±12.65

>0.05

(NS)

>0.05

(NS)

All values are expressed in Mean±SEM .(NS) Non significant.









TABLE NO:2



Showing the periodic observations in all parameters in group 1 (piogiltazone) (n+27) weight P.value (day 0 to day 45)>0.05 (NS). Fasting blood sugar >0.05 (NS) Random blood sugar >0.05 (NS) P.values day 90 weight >0.05 (N.S), FBS>0.05 (N.S) 7RBS >0.05(N.S) NON SIGNIFICANT

FIGURE:2 Showing the periodic observation in all parameters in group 1 on day0 day 45& day-90.Mean values in weight (Kg) is 63.37,63.26,63.63, fbs (mg/dl) 172.7,165.04,153.37,RBS(mg/dl) 285.11,279.78,255.56.

TABLE NO3

Peroidic Observation in All Parameters Group11

 

Group 11 (Glibenclamide)

N=33

P-value

 

Day-0

Day-45

Day-90

Day-0 to 45

Day-45 to 90

Weight

62.7

±1.56

65.64

±2.10

64.55

±1.92

>0.05(NS)

0.05(NS0

Fasting blood sugar

188.42

±12.05

168.45

±10.99

140.06

±5.68

>0.05(NS)

>0.05(S)

Random blood sugar

284.18

±17.03

220.12

±13.39

170.94

±5.80

<0.005 (MS)

0.002(MS0

(s) significant, (MS) moderate significant

All values are expressed in Mean±SEM.



Table No3:



Showing the periodic observation in all parameter in goup:11, Group:11 containing drug (Glibenclamide),no of patients (n=33).It’s P-value on day 0 to day 45 on weight >0.05(NS),FBS>0.05(N.S) RBS<0.005 (MS) <0.01- AND DAY 45 TO DAY 90 WEIGHT >0.05 (NS) FBS (0.05) RBS <0.002(M.S0 moderately significant.



Figure 3:Shwing the periodic observations in all parameters in Group 11 weight 62.7,65.64,64.55,FBS (MG/DL) 188.42,168.45 140.06,RBS(mg/dl) 284.18 220.12, 170.94 (on day-0-day 45 to 90).



DISCUSSION:



In Denmark Beck-Nielsenet al,skillman TG (1981) published studies demonstation that glyburide increased he number of receptors on the monocytes of patients with type 11 diabetes mellitus. Some patients were treated with diet and in cobination of second generation sulfonyureas agents Wie. The numbers of insulin receptors all patients were measured before and after the treatment.Intrvenous glucose test shows the persistent impairent of insulin secretion afterthe starting of drug therapy.However those patient who were on drug Pioglitazone some results were obtained of insulin secretion in the impairment in early drug drug therapy.Clinical observations have suggested that the second generation sulfonylureas may exert their effects by potentiating insulin released by other primary stimulators Insulin secreting drug.

According to the study of WilliamC Dukworth et al(1972), aftr the chronic treatment with sulfonylureas it is well documented that plasma insulin levels were decreased in response to oral glucose load. This apparently occures even though glucose tolerance is improved over pre-treatment, levels,present study clearly support that study.

The result og group 11 correlates with the research conducted by Bonnie &Kimmel (2005) produces the same results as FBS reduces from baseline, and at the end of study,with an overall 23.44%,reduction,while with the results showed at the end of study peroid p-value were (p<0,001).

Similarly Michael Alvarsson et al (2003) conducted a similar type of study and the found and overall changes of change of 22.11% in Fbs and 40.88% in Rbs at the end of trial p-value were (p<0.001).

However a study conducted by (Stone &Brown in (2003) didnot match to our results in the parameter of FBS and observer a reduction of 26.22%.



CONCLUSION:



In the light of study discussion it is obiovus the glibenclamide was more effective,tolerable and safer than pioglitzone in a short duration.Diabetes Mellitus is chronic prolong disease for whole life.Poor community can afford it easily,on base of marketing of this drug in pakistan diabetes patients easily go and purchase economically,in fact ,mostly people buy it from pharmacy without dr’s perscription,because pharmacist and patient both of know about this disease.Just like dispirin as analgesic,it is famous anti-diabetic drug in our states as compared of other anti-diabetic drugs.



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