Women Breast Cancer: Knowledge, Attitudes, Practices and Factors Associated with Early Screening in the Municipality of Abomey-Calavi in Benin in 2018

Background: Breast cancer is the dominant cancer in women in both developed and developing countries. The objective of this study was to assess the knowledge, attitudes, practices and factors associated with early breast cancer screening among women in the Municipality of Abomey-Calavi in Benin. Methods: This was a cross-sectional, descriptive, analytical study with prospective data collection from October 1 to 8, 2018, involving 1740 women in the Municipality of Abomey-Calavi, aged 18 years or older and selected by WHO four-stage random cluster sampling. Consenting women who were mentally competent, 18 years of age or older at the time of the survey, and residing continuously in the Municipality of Abomey-Calavi for the last six months prior to the survey were included. On the other hand, women who belonged to a breast cancer prevention service, women in whom secondary screening was noted, or non-consenting women were not included. The initial minimum size was estimated by the Schwartz formula with a cluster effect of k = 2. Information was collected by questionnaire survey, entered with Epidata 3.1. Fr and analyzed with R Studio 3.5.1. software. Results: The mean age of the women surveyed was 32.0 ± 11.5 years with a range of 18 and 71 years. Regarding knowledge, the clinical manifestation known by the majority of women was the presence of a nodule (68.50%). In the series, 1308 (75.17%) declared having heard about breast cancer once before, either on the radio, television or from friends and 726 (55.50%) had heard about breast cancer screening. Five hundred and twelve (70.52%) of the 726 who had heard of breast cancer said they knew that breast cancer could be screened earlier. Breast self-examination was the most cited screening method (67.58%). The disease is of natural origin according to 37.84% of them. Regarding attitudes and practices, the prevalence of early breast cancer screening was 12.93%, of which 11.67% declared that they had checked themselves to know whether they were carriers of the disease or not. The main means of the early screening used was breast self-examination (85.78%). Factors associated with early breast cancer screening found in multivariate analysis were age (≤50 years), education level (increasingly higher), marital status (married/coupled), place of residence (downtown), and socioeconomic level (average/high). Conclusion: The frequency of early breast cancer screening among women is still low in the municipality of Abomey-Calavi, although they have a good knowledge of the disease. This raises the need to strengthen awareness of early breast cancer screening.

Epidemiology, Clinical Features and Antifungal Resistance Profile of Candida auris in Africa: Systematic Review

Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.

SARS-CoV-2 Antibody Seroprevalence in Children and Workers from Belgian French-Speaking Primary Schools

Purpose: During the COVID-19 pandemic, closing schools was discussed to limit the virus transmission, despite a lack of evidence on the role of young children in the virus spread. We undertook a study among Belgian primary schools to assess the SARS-CoV-2 antibody seroprevalence and its relationship with local incidence, school size, and socioeconomic status (SES). Methods: Schools were purposively selected using three criteria: an area with either a low or a high COVID-19 incidence, either a small or a large size, and either a low or a high SES. 932 (/2488, 38%) children and 242 (/444, 55%) staff signed informed consent. COVID-19 antibodies were tested using rapid finger prick tests. Results: Children participation was positively correlated with staff (r = +0.33;95% CI [−0.34;0.78]), and strongly with SES (r = +0.81;95% CI [0.40;0.95]). Seroprevalence was 21% in children (191/922) and 25% in staff (61/240). Seroprevalence did not correlate with local cumulative incidence (children: r = +0.06;95% CI [−0.59;0.67];staff: r = +0.26;95% CI [−0.40;0.74]). In staff, seroprevalence was higher in schools with higher SES (r = +0.37;95% CI [−0.29;0.79]), but not in children (r = −0.10;95% CI [−0.66;0.53]). Conclusion:The lower seroprevalence in children suggests they are lower transmitters than adults, but poor socioeconomic levels were less representative.

Children and Workers Well-Being in Belgian French-Speaking Primary Schools during the COVID-19 Pandemic

Purpose: During the COVID-19 pandemic, a significant number of measures were taken worldwide to limit the transmission of SARS-CoV-2, and in many ways, changed human life. All these measures had harmful consequences and impacted the well-being of many people. Children were one of the most vulnerable groups. We conducted the present study to assess children’s and staff’s well-being in French-speaking primary schools in Belgium during the COVID-19 pandemic. Methods: A 37-question questionnaire for each child based on the Revised Children’s Manifest Anxiety Scale (RCMAS), and a 14-question questionnaire for each staff based on the Hospital Anxiety and Depression (HAD) scale was undertaken in order to assess the well-being. Multiple logistic regressions were performed to assess the relationship between RCMAS or HAD and other explanatory variables. Staff reported their perception of their current life and their future life in 5 years on a Visual Analogue Scale (VAS). Results: A total of 231 children and 221 staff in 11 primary schools answered the well-being questionnaire between January and May 2021. 53% (122/231) of children had symptoms of anxiety. Girls reported more anxiety symptoms than boys (≥10: 59%;Adj OR = 2.25;95% CI [1.28;4.03]). 52% (120/231) of children had a definite state of social desirability. According to age, the youngest (6 - 7 years) children were more likely to have social desirability (≥5: 71%;Adj OR = 3.44;95% CI [1.53;8.09]) compared to the oldest (10 - 12 years). Children who did not practice outdoor/street activities were more likely to have social desirability (≥5: 60%;Adj OR = 2.59;95% CI [1.38;4.99]). In schools with a higher local incidence of SARS-CoV-2, children were more likely to have social desirability (≥5: 64%;Adj OR = 2.15;95% CI [1.13;4.17]). In schools with a lower socioeconomic status, children were more likely to have social desirability (≥5: 72%;Adj OR = 2.74;95% CI [1.23;6.37]). Higher RCMAS anxiety (r = −0.18;p −0.23;p −0.20;p Conclusion: Our results showed that the well-being of children was impacted during the COVID-19 pandemic. Special attention must be focused on the most vulnerable groups, as the consequences can be catastrophic in the long term.

Increased Risk of Arterial Stiffness in Rhumatoid Arthritis Patients in a Sub-Saharan African Setting

Background: Analysis of arterial stiffness (AS) is a good marker of early arterial disease and an important determinant of cardiovascular risk, independent of other traditional cardiovascular risk factors. Carotid-femoral pulse wave velocity (CfPWV) is the gold standard to evaluate arterial stiffness. There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have higher cardiovascular (CV) risk. However, data on arterial stiffness in African rheumatoid arthritis patients is scarce. Objectives: To determine the patterns of arterial stiffness in rheumatoid arthritis patients in a sub-Saharan African setting, using CfPWV and Augmentation index (AIx). Method: We conducted a case-control study, at the Douala general hospital over four months (February to May 2018) on 63 subjects among which 31 RA patients matched for age and sex with 32 healthy subjects. AIx and CfPWV were determined non-invasively by radial pulse wave analysis and carotid femoral wave analysis respectively, using a sphygmocor Atcor device (SphygmoCor, PWV Medical, Sydney, Australia). Results: The mean age of RA patients was 47 ± 14 years with most of them being females (n = 26, 83.9%). CfPWV was significantly higher in RA patients compared to the control group (mean: 8.85 ± 2.1 vs 7.45 ± 1.38;p ≤ 0.01) as well as was AIx (Median: 33 [26 - 43] vs 26 [20 - 31];p = 0.01). RA (OR: 6.105;95% CI: 1.52 - 24.54;p 1.34;95% CI: 1.14 - 5.17;p = 0.05), elevated CRP levels (OR: 4.01;95% CI: 1.16 - 13.68;p = 0.03) and Hypertension (OR: 5.75;95% CI: 1.24 -11.60;p Conclusion: Arterial stiffness, a well-recognized marker of cardiovascular risk is increased among patients suffering from rheumatoid arthritis when compared to a healthy control group.

Effects of Sarcocephalus latifolius Fruits Extract on Paracetamol-Induced Liver Damage in Wistar Rats

Background and Aim: Sarcocephalus latifolius is a medicinal plant commonly used in traditional medicine to treat various diseases. The aim of the present study is to evaluate the hepatoprotective activity of Sarcocephalus latifolius fruits aqueous extract against paracetamol-induced liver damage in rats. Material and Methods: Aqueous extract of Sarcocephalus latifolius fruits at doses of 100, 250 and 500 mg/kg were administered orally to rats with paracetamol-induced hepatotoxicity (1 g/kg). The treatment with the extract and paracetamol lasted 7 days. Silymarin (50 mg/kg) was given as reference control. All tested drugs were administered orally. Results: Our results show that the Sarcocephalus latifolius fruits extract induced a significant reduction (p < 0.05) of serum enzymes alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase (PAL) and total bilirubin (TB). Then, the extract at the dose of 500 mg/kg showed a better protection (p < 0.001) of hepatocytes with a percentage of protection of 43.59% ± 2.03%;59.43% ± 4.12%;73.29% ± 5.72% and 62.55% ± 7.48% for ALAT, ASAT, PAL and TB, respectively. The histology of livers exposed to paracetamol shows an inflammation of the hepatocytes. In addition, there was a significant alteration of the liver parenchyma. The 500 mg/kg extract showed a resorption of the inflammation. Histopathological examination showed that the extract regenerated paracetamol-induced liver damage. Conclusion: Aqueous extract of Sarcocephalus latifolius fruits has hepatoprotective activity against paracetamol-induced hepatotoxicity in rats. But it would be important to evaluate the activity of aqueous extract of Sarcocephalus latifolius fruits on oxidative stress parameters in vivo in rats. .

Gradual Bedside Reduction of Gastroschisis in a Resource Constrained Setting: Preliminary Results from 32 Cases

Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised everywhere, constituting an alternative approach to surgery in poor areas. Patients and Methods: This observational and descriptive study included newborn babies with gastroschisis who underwent gradual bedside reduction at the Paediatric Surgery Department of the Yaounde Central Hospital. Results: Our cohort was constituted by 32 newborn babies with a mean age of 18.12 hours on admission. The Lefort type 2 was the most frequent in 81.25% of cases. The mean time for oral feeding after complete reduction was 17.4 days and the duration of hospital stay was 24.91 days. Survival rates were at 40.63%, with a residual hernia after healing in 38.46% of cases. Conclusion: Despite the high rate of mortality, gradual reduction of gastroschisis at the bedside seems to be an opportunity for resource constrained areas and can be an alternative solution to surgery.

Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences

Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Here, we review the management of women with breast cancer during pregnancy(BCP), focusing on biology, diagnosis and staging, local and systemic treatments, obstetric care and long-term follow-up of children with prenatal exposure to anticancer treatments.

Carbon dioxide for gut distension during digestive endoscopy:Technique and practice survey

AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digestive endoscopy.RESULTS:The response rate was 24.5%.Fewer than half the respondents(66/142,46.5%)were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy,and 4.2%of respondents were actually using CO2 as the insufflation agent.Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice(84%and 49%of answers,respectively;two answers were permitted for this item).CONCLUSION:Based on this survey,adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional.A majority of endoscopists were not aware of this possibility,while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.

A geometric Model for the Spatial Correlation of an Acoustic Vector Field in Surface-generated Noise

健全压力和在水平地成层的媒介的表面噪音的粒子速度的空间关联被表明，与一致地在海洋表面上散布的方向性的噪音来源一起。在粒子速度的评估，飞机波浪近似被用于每条事件光线。由于健全来源关联性质和它的择向性的等价，这域的空间关联的解决方案被转变成单身的方向性的来源产生的协调函数的集成。作为一典型水平地成层的媒介，在完美的波导的表面噪音被调查。正常模式和几何模型给的关联系数显示出令人满意的同意。另外，在健全压力之间的规范的协变性和粒子速度的垂直部件与声学的吸收系数成正比，当在半无穷地同类的空间的表面噪音的是零时。

Radioembolisation and portal vein embolization before resection of large hepatocellular carcinoma

Resectability of hepatocellular carcinoma in patients with chronic liver disease is dramatically limited by the need to preserve sufficient remnant liver in order to avoid postoperative liver insufficiency. Preoperative treatments aimed at downsizing the tumor and promoting hypertrophy of the future remnant liver may improve resectability and reduce operative morbidity. Here we report the case of a patient with a large hepatocellular carcinoma arising from chronic liver disease. Preoperative treatment, including tumor downsizing with transarterial radioembolization and induction of future remnant liver hypertrophy with right portal vein embolization, resulted in a 53% reduction in tumor volume and compensatory hypertrophy in the contralateral liver. The patient subsequently underwent extended right hepatectomy with no postoperativesigns of liver decompensation. Pathological examination demonstrated a margin-free resection and major tumor response. This new therapeutic sequence, combining efficient tumor targeting and subsequent portal vein embolization, could improve the feasibility and safety of major liver resection for hepatocellular carcinoma in patients with liver injury.

Galectin-1-mediated biochemical controls of melanoma and glioma aggressive behavior

Gliomas and melanomas are associated with dismal prognosis because of their marked intrinsic resistance to proapoptotic stimuli,such as conventional chemotherapy and radiotherapy,as well as their ability to escape immune cell attacks.In addition,gliomas and melanomas display pronounced neoangiogenesis.Galectin-1 is a hypoxia-sensitive protein,which is abundantly secreted by glioma and melanoma cells,which displays marked proangiogenic effects.It also provides immune tolerogenic environments to melanoma and glioma cells through the killing of activated T cells that attack these tumor cells.Galectin-1 protects glioma and melanoma cells against cytotoxic insults(including chemotherapy and radiotherapy) through a direct role in the unfolded protein response.Altogether,these facts clearly point to galectin-1 as an important target to be combated in gliomas and melanomas in order to:(1) weaken the defenses of these two types of cancers against radiotherapy,chemotherapy and immunotherapy/vaccine therapy;and(2) reinforce antiangiogenic therapies.In the present article,we review the biochemical and molecular biology-related pathways controlled by galectin-1,which are actually beneficial for melanoma and glioma cells,and therefore detrimental for melanoma and glioma patients.

TTF-1 positive small cell cancers:Don't think they're always primary pulmonary!

Thyroid transcription factor 1 (TTF-1) plays a key role in morphogenesis of the lungs and is expressed in up to 90% of pulmonary small cell carcinomas.This explains why this marker is frequently used in the search for the primary origin of metastatic endocrine tumours.Here we report on a TTF-1 expressing mixed endocrine-exocrine carcinoma of the common bile duct in a patient with pulmonary nodules that did not appear to be neoplastic.TTF-1 positivity in pulmonary and extrapulmonary neuroendocrine tumours is reviewed,and we conclude that TTF-1 expression in neuroendocrine tumours of the small-cell type are not uncommon at extrapulmonary locations.Therefore,immunohistochem-istry for TTF-1 in such tumours should be interpreted with caution.

Missing metastases as a model to challenge current therapeutic algorithms in colorectal liver metastases

In oncosurgical approach to colorectal liver metastases, surgery remains considered as the only potentially curative option, while chemotherapy alone represents a strictly palliative treatment. However, missing metastases, defined as metastases disappearing after chemotherapy, represent a unique model to evaluate the curative potential of chemotherapy and to challenge current therapeutic algorithms. We reviewed recent series on missing colorectal liver metastases to evaluate incidence of this phenomenon, predictive factors and rates of cure defined by complete pathologic response in resected missing metastases and sustained clinical response when they were left unresected. According to the progresses in the efficacy of chemotherapeutic regimen, the incidence of missing liver metastases regularly increases these last years. Main predictive factors are small tumor size, low marker level, duration of chemotherapy, and use of intra-arterial chemotherapy. Initial series showed low rates of complete pathologic response in resected missing metastases and high recurrence rates when unresected. However, recent reports describe complete pathologic responses and sustained clinical responses reaching 50%, suggesting that chemotherapy could be curative in some cases. Accordingly, in case of missing colorectal liver metastases, the classical recommendation to resect initial tumor sites might have become partially obsolete. Furthermore, the curative effect of chemotherapy in selected cases could lead to a change of paradigm in patients with unresectable liver-only metastases, using intensive first-line chemotherapy to intentionally induce missing metastases, followed by adjuvant surgery on remnant chemoresistant tumors and close surveillance of initial sites that have been left unresected.

Autoimmune Thyroid, Celiac and Addison’s Diseases Related to HLA-DQ Types in Young Patients with Type 1 Diabetes in Belgium

Objective: To define the prevalence of auto antibodies (Ab) to different organs in young patients with type 1 diabetes (type 1DM). Methods: Ab to thyroid, celiac and adrenal disease was analyzed in 831 type 1 DM patients. Results: Hundred twenty-three (14.8%) had positive thyroid Ab. The risk of developing thyroid Ab was increased in girls (HR 2.3;95% CI 1.6 - 3.2, p < 0.0001). Thirty-three (3.9%) patients had positive endomysium Ab (3.1% in girls and 3.5% in boys, p = NS). Adrenal Ab was detected in 5 patients. The DQA1*0301-DQB1*0301 haplotype was more prevalent in patients with thyroid Ab (p = 0.0281);DQA1*301-DQB1*302 and DQA1*501-DQB1*201 in patients with endo- mysium Ab (p = 0.0251 and p < 0.0001). All patients with adrenal Ab were DQA1*301-DQB1*302 positive. Conclusions: Type 1D patients should be screened annually for thyroid autoimmunity and celiac disease. The DQA1*0301-DQB1*0301 haplotype seems to confer susceptibility to thyroid autoimmunity, DQA1*301-DQB1*302 and DQA1*501-DQB1*201 to celiac disease and DQA1*301-DQB1*302 to adrenal autoimmunity.

Injury-Related Profiles among School-Aged Children in Cameroon: Analysis Based on the “First Survey—Health Young People”

Aims: Establish profiles of young “at risk” of injuries, first, on an overall point of view and, secondly, for some types of injuries (sport, home, road traffic, school and work injuries). Methods: We have taken nearly 50 variables into consideration: 17 variables for construction of the socioeconomic status, 9 variables for the investigation of symptoms, 11 concerning drugs, 5 for healthy habits, 3 for investigating the violence behavior, 4 concerning the school, 3 for subjective health and finally 3 for social network. We have used the principal component analysis, the multiple correspondence analysis and the weighted-frequency score for reducing the number of them. After these reductions, 15 variables were available for analyses. The relationship between injuries and investigated factors was assessed using the Pearson’s chi-square test. We also calculated odds ratio (OR) with their 95% confidence intervals (95%CI) to estimate the strengths of the associations. To further assess these relationships but also for taking into account the potentials confounding effects of some variables, logistic regression model and multinomial logistic regression model were applied. Results: The whole injury prevalence was equal to 45.6% and among the injured, the proportion of the several types was equal to 33.8% for sport injuries, 32.2% for home injuries, 16.6% for traffic injuries, 11.6% for school injuries and 5.7% for work injuries. We can say that, in light of the variables studied, the “at risk” profile for having reported an injury is being a boy, being younger, having drug experiences, with the violent profile, and declaring several symptoms. There are no consistent and marked deviations in this study from the findings obtained in previous studies. Conclusion: Analyzing injuries in general is interesting but for preventing them it is important to know in which activities children and students are engaged when they are injured.

Effects of air pollution on the risk of acute myocardial infarction in Charleroi, Belgium

Atmospheric pollution would increase morbidity and mortality rates for various respiratory illnesses in urban areas, and could also be an explanatory factor of higher rates of myocardial infarction in Charleroi compared with the other Belgian cities. The present study investigates the health effects of acute exposure to air pollution on cardiovascular morbidity/mortality in Charleroi. The study is based on comparing hospital data taken from the registry of ischaemic cardiopathies in Charleroi (1999 to 2008) to data on the air quality in this region. To measure the association between atmospheric pollution and the number of cases of myocardial infarction, Poisson regression was carried out. The excess risk of myocardial infarction was analysed according to the month of admission. For men, a decrease in the attack rate of myocardial infarction is visible during the first three years of the study, later to remain stable. For women, attack rates are stable throughout the study. Most of the pollutants vary according to season. Except for ozone, concentrations are generally higher in winter. We observe an association between the concentrations of PM10 and NO2 and morbidity/mortality by acute myocardial infarction. The increased risk for an increase of 10 μg/m3 of pollutant is 1.8% for PM10 and 4.0% for NO2. Multivariate models must still be developed and applied to our data.

Two diglucosylated anthocyanins from <i>Combretum paniculatum</i>flowers

From Combretum paniculatum flowers, two diglucosylated derivatives from cyanidin and pelargonidin were identified using chromatographic (TLC), chemical (degradation by hydrolysis, tests of revelations) and spectral [UV-visible, 1H-NMR (1H and 13C, TOCSY-1D, DQF-COSY, NOESY-2D)] methods. These pigments were found to consist of cyanidin 3,5-O-β-D-diglu-copyranoside and pelargonidin 3。

Flexofytol^(■) (A Belgian Curcumin Extract)for the Treatment of Aged Patients with Osteoarthritis and Comorbidity

Introduction: Currently, the therapeutic arsenal of osteoarthritis includes several extracts of Curcuma including Flexofytol&reg;, a bio-optimized extract of Curcuma longa. However, in older patients, indications for treatment might be limited by comorbidity and polymedication. Therefore, we aimed to assess the benefits and risks of Flexofytol&reg;, in an older population with comorbidities. Patients and Methods: This retrospective observational study included 31 patients over age 70 years (medianage: 77 years, range 71 - 81) that were treated with Flexofytol for painful osteoarthritis of the knee or lumbar spine. These patients were initially weakened by diabetes (48%) and/or renal insufficiency (71%), or they were taking anticoagulants (35%). The effects of Flexofytol&reg;, were evaluated at 0, 6 and 12 weeks with visual analog scales for pain and disability and the SF-12 Quality of Life questionnaire. Adverse effects and drug interactions of Flexofytol&reg;, were evaluated. In particular, we evaluated renal function, diabetes parameters and coagulation tests. The data were analyzed with Kruskal-Wallis and Wilcoxon-Mann-Withney non-parametric tests. Results: Patients with Flexofytol&reg;, showed significant improvement: pain improved by 50% (p = 0.0002) and functional disability improved by 33% (p = 0.0075). A series of quality of life parameters improved within the first 6 weeks of treatment and up to 3 months of treatment without impacting renal function, metabolic parameters or coagulation tests. We observed no significant adverse effects. Conclusion: In conclusion, our results suggested that Flexofytol&reg;, may be useful in the management of painful osteoarthritis, particularly in older patients that are fragile due to comorbidity and polymedication. These initial results must be confirmed in future studies.

One center in Brussels has consistently had the lowest HbA1c values in the 4 studies(1994-2009) by the Hvidoere International Study Group on Childhood Diabetes: What are the "recipes" ?

The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications(retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels(Hb A1c) provide a good criterionof overall glycemic control. The Hvidoere Study Group(HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control(1995, 1998, 2005,2009) have been performed. The one center that has consistently had the lowest Hb A1 c values(approximate7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called "Dorchy's recipes" are summarized.The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment(i.e., goals). When there are no mutually agreed upon goals for BG and/or Hb A1 c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes,as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of Hb A1 c are very different, diabetes treatment teams should individually explore the reasons for failure,without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.