Relapsing insulin-induced lipoatrophy, cured by prolonged low-dose oral prednisone: a case report

<p>Abstract</p> <p>Introduction</p> <p>Circumscript, progressing lipoatrophy at the insulin injection sites is an unexplained, however rare condition in diabetes mellitus.</p> <p>Case presentation</p> <p>We report a case of severe localised lipoatrophy developing during insulin pump-treatment (continuous subcutaneous insulin infusion) with the insulin analogue lispro (Humalog^®) in a woman with type-1 diabetes mellitus. After 11 months of progressing lipoatrophy at two spots on the abdomen, low-dose prednisone (5-10 mg) p.o. was given at breakfast for 8 months, whereby the atrophic lesions centripetally re-filled with subcutaneous fat tissue (confirmed by MRI) despite ongoing use of insulin lispro. However, 4 weeks after cessation of prednisone, lipoatrophy relapsed, but resolved after another 2 months of low-dose prednisone. No further relapse was noted during 12 months of follow-up on insulin-pump therapy with Humalog^®.</p> <p>Conclusion</p> <p>Consistent with an assumed inflammatory nature of the condition, low-dose oral prednisone appeared to have cured the lipoatrophic reaction in our patient. Our observation suggests a temporary intolerance of the subcutaneous fat tissue to insulin lispro (Humalog^®), triggered by an unknown endogenous mechanism.</p

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment

Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials

Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5–14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4–8·6]; rate ratio 1·37 [95% CI 1·17–1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92–1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95–1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94–1·15]; p=0·45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered—eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy

SMILE - Sustainable mariculture in Northern Irish Lough Ecosystem: assessment of carrying capacities for environmentally sustainable shellfish culture in Carlingford Lough Belfast Lough Larne Lough and Lough Foyle

The assessment of environmentally sustainable carrying capacity for aquaculture in coastal areas poses a major challenge, given the range of issues that must be taken into account, the interactions between natural and social components, and the coupling between watershed and coastal zone. In 2001, The Department of Agriculture and Rural Development published the Shellfish Aquaculture Management Plan for Northern Ireland. The Minister for Agriculture and Rural Development stated at the presentation: “There has been a significant growth in shellfish aquaculture in Northern Ireland over the past few years. It is important that this growth is structured and that the shellfish aquaculture industry develops in a sustainable manner and with minimal environmental impact.” Following this publication, Queen’s University Belfast and the Department for Agriculture and Rural Development (DARD) produced a Phase I study of Carrying Capacity in 2003. In 2004, a consortium made up of the Institute of Marine Research – IMAR (Portugal), Plymouth Marine Laboratory – PML (U.K.) and CSIR (South Africa) was awarded a two-year contract for the Sustainable Mariculture in northern Irish Lough Ecosystems (SMILE) project, with a duration of two years, with the aim of “developing dynamic ecosystem level carrying capacity models for the five northern Irish sea loughs. In order to provide medium-term guidelines, this work needed to be placed in the context of a set of European legislative instruments in the area of water policy, which include older generation directives such as Habitats, and new and emerging ones such as the Water Framework Directive and the proposed Marine Strategy Directive. The SMILE contract was conceived as an application of know-how collected in many R&D projects, but the excellent collaboration with the Agri-Food and Biosciences Institute (AFBI), Queen’s University of Belfast (QUB) and the Loughs Agency, together with the interest and feedback of the Environment and Heritage Service (EHS) and other agencies on the Oversight Committee, provided several avenues for research. In SMILE, carrying capacity assessment can be summed up as a clear practical application of integrated coastal zone management, using water quality criteria, cultivated shellfish production and sustainability of native wild species as environmental metrics. This book provides an overview of the approach taken in SMILE, and presents the key results for the five loughs. Data were drawn from many sources, and collected into databases that form the backbone of the modelling work. Our thanks go to all who provided data and information, and especially to the people on the ground, who watched this work develop and trusted us to get on with it. We are very grateful to Anne Dorbie for her support for this work, and her faith in the team, and to Jason Holt (POL) for Irish Sea boundary conditions. We additionally wish to thank all the producers and growers who helped with growth trials and provided the use of vessels, Tom Cowan, Greg Hood and Roy Griffin from Fisheries Division, Annika Mitchell from QUB and Nuala McQuaid from CMAR. We hope managers and shellfish farmers alike in Northern Ireland will find this and the other SMILE products both useful and profitable. Europe cannot hope to compete on quantity with the emerging shellfish export markets, the added value which is required to provide growth in jobs and profits at home must come from superior product quality, branding and environmental sustainability

Concepções de acadêmicos de enfermagem sobre usuários de drogas Concepciones de los estudiantes de enfermería sobre los usuarios de drogas Nursing students' conceptions about the user of drugs

OBJETO DO ESTUDO: Concepções dos graduandos de enfermagem sobre a abordagem ao paciente usuário de drogas. OBJETIVOS: Descrever a concepção dos estudantes de enfermagem sobre os usuários de drogas. MÉTODO: Estudo descritivo-exploratório desenvolvido com 321 estudantes de 15 Instituições privadas de Ensino Superior de Enfermagem, no estado do Rio de Janeiro. Utilizou-se a escala de atitudes e crenças NEADA, aplicada entre junho de 2006 e agosto de 2007. Os resultados evidenciam que as dificuldades em abordar um cliente que faz uso de drogas são reais, mas as limitações pessoais dos profissionais em atender essa clientela ainda permeiam a assistência, influenciando no cuidado.<br>OBJECTO DEL ESTUDIO: Concepciones de los estudiantes de enfermería sobre el acercamiento a un paciente usuario de drogas. OBJECTIVOS: describir la concepción de los estudiantes de enfermería en los usuarios de drogas. METODO: estudio descriptivo-exploratorio lo cual se desarrolló con 321 estudiantes de 15 escuelas privadas de grado en enfermería en el estado de Rio de Janeiro. La escala de actitudes y creencia NEADA hay sido utlizada y aplicada el junio del 2006 hasta el Agosto del 2007. Los resultados revelan que las dificultades en abordar a un cliente que usa drogas són verdaderos, pero en la asistencia a estos clientes todavía las limitaciones personales de los profesionales impregnan en la asistencia, influyendo en el cuidado.<br>STUDY'S OBJECT: Conceptions of nursing students on the approach to the drugs user. OBJECTIVES: To describe the conceptions of nursing students about the user of drugs. METHOD: Descriptive-exploratory study carried out with 321 students from 15 private nursing schools in the state of Rio de Janeiro. The scale of attitudes and beliefs NEADA was used to obtain the data between June 2006 and August 2007. The results demonstrate that the difficulties in dealing with the client who is a drug user are real, but the personal limitations of professionals in work with this kind of client still permeate the assistance, influencing care