Impact of insulin reduction on glycemic control in children attending a residential diabetes camp

BACKGROUND/OBJECTIVES

Children attending diabetes camp are more active, increasing the risk of hypoglycemia. Decreasing initial insulin doses may reduce this risk. The objectives of our study were to compare glycemic control between campers receiving multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and analyze the impact of decreasing basal insulin by 10%.

METHODS

We analyzed 849 camp sessions (599 children, 5-19 years old) from Camp Sweeney's 2016/2017 summers. Campers were separated into groups by year and insulin route (MDI_2016, MDI_2017, CSII_2016, and CSII_2017). The MDI_2016 group had initial basal insulin decreased 10%, while CSII_2016, MDI_2017, and CSII_2017 did not. Time spent in blood glucose ranges and area under the curve (AUC) were compared by year and insulin route using ANOVA. We also performed repeated measures ANOVA using campers who attended both years.

RESULTS

No significant differences in time spent in any glucose range could be attributed to the initial 10% basal decrease, including on paired analysis. MDI_2017 had more decreases to basal insulin than the other groups. CSII campers had higher AUC and more hyperglycemia than MDI campers.

CONCLUSIONS

Campers on MDI may benefit from decreasing basal insulin, either at the beginning of camp or during the first week. Future research is needed to optimize glycemic control in the camp setting.

Skin-sparing mastectomy

Skin-sparing mastectomy is still in its infancy in Malaysia. The option of skin-sparing mastectomy is rarely given to patients as many general surgeons perform the conventional mastectomy. This could also be compounded by the lack of awareness amongst the local surgeons on the safety, surgical technique and treatment outcome of this relatively new procedure. This case report demonstrates the feasibility of this procedure performed on a Malaysian patient with a comparable outcome of those reported in the Western countries.

Thoracoplasty with acrylic plate-marlex mesh combination following near total resection of sternum: a case of chondrosarcoma of sternum

Removal of the whole sternum for malignant tumours results in a large defect, causing severe deformity and possible paradoxical movements of the chest wall. The reconstruction of the resultant large defect of the chest wall is often complex and difficult. Commonly used materials include rib autograft, steel strus acrylic plate and various synthetic meshes such as Goretex or Marlex mesh, with a myocutaneous flap for coverage. A case of a 48-year-old man with sternal chondrosarcoma successfully treated with thoracoplasty using acrylic plate-marlex mesh combination following near total resection of sternum is reported.

Serotyping of Clostridium difficile

A total of 246 live Clostridium difficile cultures were serotyped by a slide agglutination technique. Fifteen grouping antisera were produced which serotyped 98% of the cultures (241 of 246). Our results indicated that certain serogroups may have specific pathogenicity. Strains of serogroups A, G, H, K, S1, and S4 were cytotoxigenic and were isolated mainly from adult patients with pseudomembranous colitis or antibiotic-associated diarrhea. Nontoxigenic strains of serogroups D and Cd-5 were isolated mainly from asymptomatic neonates and small children. Some cross-reactions occurred among some strains of serogroups A, Cd-5, G, and K. These strains were further examined by analysis of protein profiles and restriction endonuclease patterns to elucidate their serology. Typing of C. difficile by using slide agglutination is a simple technique suitable for routine examination. Serogrouping may be a useful epidemiological marker and could help in elucidating the medical relevance of some C. difficile isolates.