Add-on treatment with intermediate-acting insulin versus sliding-scale insulin for patients with type 2 diabetes or insulin resistance during cyclic glucocorticoid-containing antineoplastic chemotherapy: a randomized crossover study.

The aim of this study was to compare the effectiveness and safety of intermediate-acting insulin (IMI) titrated on body weight and glucocorticoid dose with that of short-acting sliding-scale insulin (SSI) in patients on recurrent high-dose glucocorticoid-containing chemotherapy. We enrolled 26 patients with type 2 diabetes mellitus or random blood glucose level >12 mmol/l in a previous cycle of chemotherapy in a randomized crossover study. In two consecutive cycles of glucocorticoid-containing chemotherapy, participants were treated with either IMI or SSI, as add-on to routine diabetes medication. We compared time spent in target range (3.9-10 mmol/l), measured by continuous glucose monitoring (CGM), and the occurrence of hypoglycaemia. IMI resulted in a higher proportion of glucose values within target range than SSI (34.4 vs 20.9%; p < 0.001). There were no severe or symptomatic hypoglycaemic events. Two participants in each group had a subclinical hypoglycaemia detected only by CGM. Once-daily IMI resulted in better glycaemic control than SSI in patients with glucocorticoid-induced hyperglycaemia during chemotherapy. Safety was not compromised as the incidence of hypoglycaemia was low and not different between both regimens.

A supervision approach for teaching structural/strategic therapy in a limited setting.

Many counselors are currently undergoing a Kuhnian paradigm shift from linear models of behavioral problem conceptualization to systemic conceptual models. As a result, it has become incumbent on counselor-educators to introduce the systems concept of family therapy to their students within a framework that renders it meaningful not only intellectually but also practically. This paper presents one way of doing this successfully with master's level counselors-in-training who have no live families on which to practice. An overview of systems approaches to family therapy is presented along with a seven-stage supervision approach for teaching structural/strategic therapy in limited situations where the supervision of live families is not practical or possible.

Long term follow up of serostatus after maternofetal parvovirus B19 infection.

BACKGROUND: Maternofetal parvovirus B19 infection may result in fetal hydrops or abortion. Chronic infection has been associated with long term complications (polyarthritis, persistent aplastic anaemia, hepatitis). In pregnancy maternal immunosuppression caused by a TH2 dominant response to viral antigens has been observed. There is little information on long term reactivity to intrauterine infection. AIMS: To assess the serological status in children and their mothers after maternofetal parvovirus B19 infection and development of fetal hydrops. METHODS: A total of 18 children and their mothers, and 54 age matched control infants were studied. Main outcome measures were parvovirus B19 DNA, specific IgM and IgG against the virus proteins VP1/VP2, and NS-1 in venous blood. RESULTS: Parvovirus B19 DNA and antiparvovirus B19 (IgM) were undetectable in all sera. A significant larger proportion of maternal sera compared to study children's sera contained IgG against the non-structural protein NS-1. Mean levels of VP1/VP2 IgG antibodies were significantly lower in the children than in their mothers (48 (36) v 197 (95) IU/ml). There was no history of chronic arthritis in mothers and children. Five women had subsequent acute but transient arthritis postpartum, which was not correlated with antibodies against NS-1. CONCLUSIONS: Serological evidence of persistent infection after maternofetal parvovirus B19 disease could not be detected. Increased maternal prevalence of anti NS-1 (IgG) and increased levels of antiparvovirus B19 (IgG) may reflect prolonged viraemia compared to fetal disease.

[Toxic shock syndrome due to osteomyelitis]. / Toxic-Schock-Syndrom (TSS) infolge Osteomyelitis.

An 11 3/4 year old girl contracted Toxic-Shock-Syndrome following osteomyelitis. The symptoms comprised a severe fall in blood-pressure with centralisation, petechiae and haematoma particularly in the lower extremities, hyperaemia of the oral mucosa and of the throat with profuse and unstaunchable bleeding in this area within in a short period of time. In order to stabilise the blood-pressure the patient had be given approx. 15 l colloidal solution (350 ml/kg) intravenously, mainly frozen-plasma. The risk of aggravation of a pulmonary failure along the lines of ARDS particularly due to the backward flow of the interstitial deposited fluid was avoided by the use of continuous veno-venous haemofiltration (CVVH).