Insulin for diabetes: 100 years of therapy

This month is the 100th anniversary of insulin use in humans. Peter Jennings and Martha Stewart provide an overview of how this advancement improved care for people living with diabetes January 2022 marks 100 years since insulin was first successfully used to treat diabetes in humans. Everyone with type 1 diabetes – except those who have received pancreas or islet-cell transplants – and more than half of people with type 2 diabetes use insulin to manage their diabetes. Instead of being seen as a death sentence, type 1 diabetes is now seen as a long-term condition that can be self-managed for people with access to insulin and glucose monitoring technology. However, many people living with diabetes around the world are still unable to access affordable insulin, technologies and the support needed to self-manage their diabetes.

History of insulin treatment of pediatric patients with diabetes in Korea

The year 2021 is the centennial of insulin discovery. The discovery of insulin changes diabetes mellitus from a death sentence to a manageable disease. It became a historical turning point in the lives of people with diabetes. Since the first use of insulin in a patient in 1922, insulin and its analogs have been remarkable in saving the lives of people with diabetes. As insulin began to be used as a drug, it was introduced to, and used in Korea until now. This review briefly summarizes the history of insulin treatment in Korean children and adolescents with diabetes.

The Global Dialogics of the New Age

The London-based weekly the New Age, edited by A. R. Orage from 1907 to 1922, was known for promoting spirited debates on politics, literature, and the arts. Scholars have been attentive to what Ann Ardis terms the magazine’s ‘unusual commitment to […] Bakhtinian dialogics in the public sphere’, but less so to the role that the letters column played in facilitating these often contentious, often transnational debates. This essay argues that the letters column functioned as a forum for linking not only individual readers and contributors from around the world, but also wider discursive and periodical communities. A case study of global dialogics, the essay focuses on an eleven-month debate that unfolded in New Age correspondence concerning the so-called black peril — the purported epidemic of black men attempting to rape white women in South Africa, which historians today regard as a moral panic fuelled by a desire to reinforce white supremacy. The flames of the panic were stoked by the Umtali case of 1910, in which Lord Gladstone commuted the death sentence of an Umtali native convicted of attempted rape to life imprisonment. This decision sparked mass protests and petitions among the white community in South Africa and a heated discussion about race and racism that reverberated throughout the empire, including in the columns of the New Age. The letters column served as an international forum, drawing in white settlers from Johannesburg, Crisis editor and NAACP founder W. E. B. Du Bois, Sudanese-Egyptian writer Dusé Mohamed Ali, and British suffragette Emily Wilding Davison, among others. This essay examines the gendered and racial politics of this debate and how it was shaped by its specific periodical context and by the national and ideological contexts of its interlocutors.

Iatrogenic depression: the case of Frederic Chopin

Psychological disorders caused by the doctor’s rash words are as common as the side effects of drug. Iatrogenic depression caused by ethical and psychological mistakes of doctors will never go away. Their frequency can be reduced only by improving the physicians’ skills in the fields of medical ethics and psychology. A clinical case analysis based on a famous person’s history of the disease is an effective pedagogical tool. The study aims to present the case of the famous Polish composer Frederic Chopin. The A comparative analysis of doctors’ objective actions and patients’ subjective evaluations of their actions were made based on a study of Chopin’s and Sand’s letters as well as the works of composer’s biographers. This approach provides a valuable opportunity to see doctors through the patient’s eyes. In the fall of 1838, during his rest in Majorca, the local doctors diagnosed pulmonary tuberculosis in Chopin. The Majorcan doctors made a serious ethical mistake. They ignored the patient’s anamnesis vitae indicating his phthisiophobia and informed Chopin about the diagnosis of pulmonary tuberculosis and a poor prognosis in a very cynical manner. Chopin wrote: ‘One (doctor) said I had died the second that I am dying, the 3rd that I shall die’. Chopin perceived the diagnosis of tuberculosis as a ‘death sentence’, as a result of which he developed iatrogenic depression. All previous and subsequent Chopin’s doctors used other tactics: they prescribed the correct treatment, but the diagnosis was not voiced. The analysis shows the effectiveness of this tactic: Chopin lived another 10 years after the Majorcan episode. Chopin’s case shows typical doctors’ ethical and psychological issues in informing the patient about the dangerous diagnosis and poor prognosis as well as tactics for building a good physician‑patient relationship.

“Standing behind your phrase”: Arendt and Jaspers on the (post-)metaphysics of evil

This article turns to Hannah Arendt's Eichmann in Jerusalem in order to illustrate the difficulties involved in approaching the (formerly) metaphysical concept of evil as a secular phenomenon. It asks how the advocate of plurality, natality and forgiveness could also vouch for the death sentence of Eichmann based on a rhetoric of retribution and revenge. It then shows that Arendt's surprisingly consistent view of evil is based on a quasi-ontological understanding of the human condition that allowed her to negate Eichmann's humanity. Rather than simply unmasking a metaphysical account in disguise, however, the article develops an alternative perspective that emerges from the conversation between Arendt and Jaspers. It argues that Jaspers's interpretation of Kant offers a way to defend the idea of secular evil and judge Eichmann on the basis of his thoughtlessness.

The Warsaw Ghetto Workshops: Perspectives of Space and Time in Emanuel Ringelblum and Reuven Ben Shem's Diaries

"In this paper, I analyze the notion of time and space in the small factories of the Warsaw Ghetto, commonly known as shops, through a close reading of the diaries written in the Ghetto by Emanuel Ringelblum and Reuven Feldschu Ben Shem. In the Warsaw Ghetto of July 22, 1942, there were but two options for Jews: being deported to Treblinka or ""postponing"" the death sentence by becoming a shop worker. As long as one worked in a shop, one's life ー and only one's life, not his family's ー was spared for a while. The authors of the diaries who will be presented, both worked in the shops, and in their writings, they exposed how space and time became significant oppressing factors. As I will show, every familiar perception was challenged in this space of an imposed slave-like existence. Keywords: Jews, 2nd World War, Warsaw Ghetto, Treblinka. "

Factors that Predict Survival From Mesenteric Ischemia in the Geriatric Patient: Not a Death Sentence

Background The mortality rate from mesenteric ischemia is reported to be as high as 80%. The goal of our study was to identify demographic and clinical predictors of post-operative mortality and discharge disposition among elderly patients with mesenteric ischemia. Methods All patients 65 years and older who underwent emergency surgery (ES) for the management of mesenteric ischemia in the American College of Surgeons–National Surgical Quality Improvement Program database from 2007 to 2017 were included. Univariate analyses and logistic regressions were used to identify independent predictors of mortality and discharge disposition. Results A total of 2438 patients met inclusion criteria, with a median age of 77 years and 60.8% being female. The 30-day mortality of the overall cohort was 31.5% and the 30-day morbidity was 65.3%. The following were the major predictors of 30-day mortality: pre-operative diagnosis of septic shock [OR: 2.46, (95% CI: 1.94-3.13)], dialysis dependence [OR: 2.05, (95% CI: 1.45-2.90)], recent weight loss [OR: 1.80, (95% CI: 1.16-2.79)], age ≥80 years [OR: 1.67, (95% CI: 1.25-2.23)], and ventilator dependence [OR: 1.65, (95% CI: 1.23-2.23)]. In the absence of these predictors, survival rate was 84%. The major predictors of discharge to post-acute care (PAC) included age ≥80 years [OR: 3.70, (95% CI: 2.50-5.47)] and pre-operative septic shock [OR: 2.20, (95% CI: 1.42-3.41)]. Conclusion In the geriatric patient, a diagnosis of mesenteric ischemia does not equate to an automatic death sentence. The presence of certain pre-operative risk factors confers a high risk of mortality, whereas their absence is associated with a high chance of survival.

EXTH-43. IL-13RΑ2 IMMUNOCONJUGATE TARGETED THERAPY FOR H3K27M-MUTANT MIDLINE GLIOMAS

High grade gliomas are devastating diseases. In the pediatric population, diffuse midline gliomas with the H3K27M mutation (H3K27M DMG) are the most aggressive primary malignant brain tumors. With no effective therapies available, children typically succumb to disease within one year of diagnosis. In adults, glioblastoma (GBM) remains a death sentence despite standard clinical care. Therefore, effective therapies for these tumors remain one of the most urgent and unmet needs in modern medicine. Interleukin 13 receptor subunit alpha 2 (IL-13Rα2) is a cell-surface transmembrane protein upregulated in H3K27M DMG and GBM versus normal brain tissue, posing a potentially promising therapeutic target for both tumors. In this study, we investigated the pharmacological effects of a novel peptide-toxin conjugate, IL13.E13K-PE4E (also known as GB-13), that contains a targeting moiety designed to bind IL-13Rα2 with high specificity and a point-mutant cytotoxic domain derived from Pseudomonas exotoxin A. We demonstrated that IL13.E13K-PE4E was a potent killer of cultured H3K27M DMG and GBM cells in vitro. Intratumoral administration of IL13.E13K-PE4E via convection-enhanced delivery (CED) decreased tumor burden and prolonged survival in both H3K27M DMG and GBM murine xenograft models. Furthermore, we observed enhanced drug tissue retention and volume of distribution after CED, suggesting IL13.E13K-PE4E is capable of covering the target area and remaining at the site of infusion long enough to impart therapeutic effects. In summary, administration of IL13.E13K-PE4E demonstrated a potent pharmacological response in H3K27M DMG and GBM models both in vitro and in vivo in a manner strongly associated with IL13Rα2 expression, underscoring the potential of IL13Rα2 targeted therapy in a subset of these tumors.

Is COVID-19 Infection a Death Sentence in Patients Living with Haematological Malignancies? A Case Series

The year 2020 saw the rise of an influenza-like illness from SARS-nCoV2 (Severe Acute Respiratory Illness by novel Coronavirus 2), which causes myriad of symptoms in patients, ranging from mild upper respiratory symptoms to severe ARDS (Acute Respiratory Distress Syndrome). It is, however, known to cause high morbidity and mortality in patients with underlying comorbidities like diabetes, hypertension, kidney disease, obesity and malignancies. Amongst these, the subset with haematological malignancies has an especially poor prognosis possibly as a result of immune suppression, due to underlying bone marrow depression as well as effects of chemotherapeutic agents. These patients need frequent visits and admissions to the hospital for treatment, thus exposing them to the risk of acquiring the infection. Also, a high index of suspicion, with low threshold for testing is needed in view of possible atypical presentation and symptoms. These patients may also warrant an early ICU admission, as they tend to develop severe disease with ARDS more frequently, with an overall poor prognosis and high mortality rate. We hereby present a series of six patients with underlying haematological malignancies who were admitted in our ICU with a serious COVID-19 illness and a grave outcome.