The Challenges in the Development of Diabetes Prevention and Care Models in Low-Income Settings.

In low- and middle-income countries (LMICs), the burden of non-communicable diseases such as diabetes is rapidly rising, overpassing the existing burden of communicable diseases. Patients with diabetes living in low-income communities face unique challenges related to lack of awareness, difficulty in accessing health care systems and medications, and consequently failure in achieving optimal diabetes management and preventing complications. Effective diabetes prevention and care models could help reduce the rising burden by standardizing guidelines for prevention and management, improving access to care, engaging community and peers, improving the training of professionals and patients and using the newest technology in the management of the disease. In this article, we review the latest research and evidence on effective models of diabetes prevention and diabetes care delivery in low- income settings. We also provide existing evidence relating to the effectiveness of these models in low-resource contexts, with the aim to highlight characteristics and strengths that make their implementation successful and long-lasting.

Historical retrospective of the SRC oncogene and new perspectives (Review).

Since its first discovery as part of the Rous sarcoma virus (RSV) genome, the c-SRC (SRC) proto-oncogene has been proved a key regulator of cancer development and progression, and thus it has been highlighted as an attractive target for anti-cancer therapeutic strategies. Though the exact mechanisms of its action are still not fully understood, SRC protein mediates crucial normal cell functions, such as cell development, proliferation and survival, and its dysregulation is considered as an oncogenic signature and a driving force for cancer initiation. In the present review, we present a flashback to the history of the Src research, while focusing on the most important milestones in the field. Moreover, we investigate the proposed regulatory mechanisms and molecules that mediate its action in order to designate putative therapeutic targets and useful prognostic and/or diagnostic tools. Furthermore, we present and discuss existing therapeutic approaches that are explored in clinical settings.

A cohort of children with type 1 diabetes in Greece: predictors of direct costs of care.

AIM: To examine the predictors of direct costs of pediatric type 1 diabetes (T1D) in a hospital-based outpatient clinic in Greece. METHODS: The outpatient records of 89 children and adolescents (mean age: 12.05 ± 5.15 y) with T1D followed in the Second Department of Pediatrics, University of Athens Medical School, were analyzed. RESULTS: The mean ± SD diabetes duration was 4.9 ± 3.88 y (range: 0.25-17) and glycated hemoglobin (HbA1c) was 8.2 ± 1.09% (66 ± 11.9 mmol/mol). A total of 80% of patients were on multiple daily injections regimen, 10% on pump therapy, and 10% on conventional regimen. Total direct costs per patient-year (ppy) were estimated at €2.712 [95% confidence interval (CI): 2.468-2.956]. Supply costs accounted for 73.7% of total costs and were the highest for pump therapy (P < .001). Multivariate linear regression analysis showed that costs were significantly higher for children (1) on multiple daily injections or pump therapy (r = 0.364, P < .001), (2) of older age (r = 0.25, P < .001) and (3) higher daily insulin dose (r = 0.46, P < .001). Patients on pump therapy had significantly higher costs €5.538 (95%CI 4480-6597) compared with patients on multiple daily injections €2.447 (95% CI 2320-2574) and conventional regimen €1.978.5 (95%CI 1682-2275) (P = .0001). Patients on pump therapy had better glycemic control compared with all other patients [HbA1c (mean ± SD): 7.2% ± 1.0 vs 8.3% ±1.5, P = .039]. CONCLUSION: The total T1D cost in this cohort of Greek children was €2712 ppy. The main factor that predicted direct cost was the use of pump. However, pump therapy was associated with better glycaemic control, which may decrease the risk of total long-term diabetes care cost.

Stromal tumors of the stomach: a clinicopathological study of 15 cases and review of the literature.

AIMS AND BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the digestive tract, although their incidence is low. These tumors make up a unique entity based on their molecular pathogenesis, immunohistochemical staining and responsiveness to targeted therapy. Gastrointestinal stromal tumors vary in malignant potential ranging from small incidentally detected tumors with an excellent outcome to aggressive sarcomas. Their optimal diagnostic approach and treatment remain a matter of debate. We present our experience in this rapidly moving field. METHODS: We present our experience on 15 patients presented during a 5-year period (June 2000-September 2005) with gastrointestinal stromal tumors located in the stomach. RESULTS: Upper gastrointestinal endoscopy and CT scan revealed the tumors in all cases. All patients underwent curative surgery. A definitive diagnosis was established after surgery. CONCLUSIONS: Although an inverse correlation between level of risk and survival of patients with gastrointestinal stromal tumors has been observed, 6 of our patients with an intermediate risk of recurrence had a favorable outcome.

Malignant insulinoma in childhood.

Pancreatic tumors constitute a rare surgical problem in infancy and childhood. Insulinomas are rare in all age groups with an estimated incidence of one per 250,000 person-years and even rarer in childhood. We report a 10 year-old girl with malignant insulinoma. The presenting symptom was hypoglycemic attacks. Laboratory investigation demonstrated that the hypoglycemia was due to hyperinsulinism. MRI of the abdomen revealed a mass at the tail of the pancreas. Distal pancreatectomy with splenectomy was performed. Histological examination showed malignant insulinoma with peripancreatic lymph node metastases. One month later abdominal MRI revealed the existence of multiple small metastatic foci in the liver, which were confirmed by In111 octreoscan. Treatment with octreotide was started and the disease is stable after 12 months of therapy.

Abdominal metastases from lung cancer resulting in small bowel perforation: report of three cases.

Metastatic lung cancer to the small bowel is a rare occurrence. Acute complications such as perforation, hemorrhage and obstruction are even rarer. We present 3 cases of small bowel perforation from metastatic lung cancer. All 3 patients underwent emergency laparotomy. In 2 of them there was no obvious macroscopic appearance of metastatic disease either at the site of perforation or in any other area of the abdomen, whereas in the third patient there were hepatic metastases. The postoperative period was uneventful in all three cases. The longest survival was four months. Our cases bring the number of cases reported in the international literature to a total of 43.