ABSTRACT
Vaccination has been recently attracted as one of the most successful medical treatments of the prevalence of many infectious diseases. Mucosal vaccination has been interested in many researchers because mucosal immune responses play part in the first line of defense against pathogens. However, mucosal vaccination should find out an efficient antigen delivery system because the antigen should be protected from degradation and clearance, it should be targeted to mucosal sites, and it should stimulate mucosal and systemic immunity. Accordingly, mucoadhesive polymeric particles among the polymeric particles have gained much attention because they can protect the antigen from degradation, prolong the residence time of the antigen at the target site, and control the release of the loaded vaccine, and results in induction of mucosal and systemic immune responses. In this review, we discuss advances in the development of several kinds of mucoadhesive polymeric particles for mucosal vaccine delivery.
ABSTRACT
Vaccination has been recently attracted as one of the most successful medical treatments of the prevalence of many infectious diseases. Mucosal vaccination has been interested in many researchers because mucosal immune responses play part in the first line of defense against pathogens. However, mucosal vaccination should find out an efficient antigen delivery system because the antigen should be protected from degradation and clearance, it should be targeted to mucosal sites, and it should stimulate mucosal and systemic immunity. Accordingly, mucoadhesive polymeric particles among the polymeric particles have gained much attention because they can protect the antigen from degradation, prolong the residence time of the antigen at the target site, and control the release of the loaded vaccine, and results in induction of mucosal and systemic immune responses. In this review, we discuss advances in the development of several kinds of mucoadhesive polymeric particles for mucosal vaccine delivery.
ABSTRACT
The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.
ABSTRACT
Scrub typhus develops after the individual is bitten by a trombiculid mite infected with Orientia tsutsugamushi. Since it has been reported that pneumonia is frequently observed in patients with scrub typhus, we investigated whether intranasal (i.n.) vaccination with the outer membrane protein of O. tsutsugamushi (OMPOT) would induce a protective immunity against O. tsutsugamushi infection. It was particular interest that when mice were infected with O. tsutsugamushi, the bacteria disseminated into the lungs, causing pneumonia. The i.n. vaccination with OMPOT induced IgG responses in serum and bronchoalveolar lavage (BAL) fluid. The anti-O. tsutsugamushi IgA Abs in BAL fluid after the vaccination showed a high correlation of the protection against O. tsutsugamushi. The vaccination induced strong Ag-specific Th1 and Th17 responses in the both spleen and lungs. In conclusion, the current study demonstrated that i.n. vaccination with OMPOT elicited protective immunity against scrub typhus in mouse with O. tsutsugamushi infection causing subsequent pneumonia.
ABSTRACT
Purpose@#Despite the prevalent use of insulin pump therapy worldwide, few studies have been conducted among young patients with type 1 diabetes (T1D) in Korea. We investigated the durability and effectiveness of insulin pump therapy among Korean pediatric and young adult patients with T1D. @*Methods@#This study included 54 patients with T1D diagnosed at pediatric ages (range, 1.1–14.1 years) who initiated insulin pump therapy during 2016–2019 at Seoul National University Children's Hospital and Seoul National University Bundang Hospital. Clinical and biochemical data, including anthropometric measurements, insulin dose, and glycated hemoglobin (HbA1c) levels were obtained from T1D diagnosis to last follow-up. @*Results@#Forty-four patients (81.5%) continued insulin pump therapy with a median pump use duration of 2.9 years (range, 0.2–3.5 years); 10 discontinued the therapy within 12 months (<1 month, n=6; 1–6 months, n=1; and 6–12 months, n=3) due to physical interferences or financial problems. Older age (≥10 years of age) and longer diabetes duration (≥2 years) at the initiation of pump therapy were associated with discontinuation (P<0.05 for both). For patients continuing pump therapy, HbA1c levels significantly decreased after 1 year of therapy (from 8.9% to 8.1%, P<0.001) without changes in the body mass index z-scores or insulin dose. Although 4 patients experienced diabetic ketoacidosis, all recovered without complications. @*Conclusion@#Insulin pump therapy was effective in improving glycemic control in T1D patients during 12 months of treatment. Early initiation of insulin pump therapy after T1D diagnosis was helpful for continuing therapy.
ABSTRACT
Purpose@#Despite the prevalent use of insulin pump therapy worldwide, few studies have been conducted among young patients with type 1 diabetes (T1D) in Korea. We investigated the durability and effectiveness of insulin pump therapy among Korean pediatric and young adult patients with T1D. @*Methods@#This study included 54 patients with T1D diagnosed at pediatric ages (range, 1.1–14.1 years) who initiated insulin pump therapy during 2016–2019 at Seoul National University Children's Hospital and Seoul National University Bundang Hospital. Clinical and biochemical data, including anthropometric measurements, insulin dose, and glycated hemoglobin (HbA1c) levels were obtained from T1D diagnosis to last follow-up. @*Results@#Forty-four patients (81.5%) continued insulin pump therapy with a median pump use duration of 2.9 years (range, 0.2–3.5 years); 10 discontinued the therapy within 12 months (<1 month, n=6; 1–6 months, n=1; and 6–12 months, n=3) due to physical interferences or financial problems. Older age (≥10 years of age) and longer diabetes duration (≥2 years) at the initiation of pump therapy were associated with discontinuation (P<0.05 for both). For patients continuing pump therapy, HbA1c levels significantly decreased after 1 year of therapy (from 8.9% to 8.1%, P<0.001) without changes in the body mass index z-scores or insulin dose. Although 4 patients experienced diabetic ketoacidosis, all recovered without complications. @*Conclusion@#Insulin pump therapy was effective in improving glycemic control in T1D patients during 12 months of treatment. Early initiation of insulin pump therapy after T1D diagnosis was helpful for continuing therapy.
ABSTRACT
Based on the 4th Injection Technique Questionnaire results, new insulin injection technique recommendations were announced at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, on October 23 and 24, 2015, in which 183 physicians, nurses, educators, and allied healthcare professionals from 54 countries attended. Through these new recommendations, we hope to identify and localize the new insulin injection technique recommendations that could be applicable in local clinical settings. It is recommended to use a pen needle with a wider inner diameter when its gauge remains the same. Also, recommended injection sites such as the abdomen, upper arms, thighs, and buttocks are well described based on anatomical landmarks. The insulin absorption rate is the fastest at the abdomen, upper arms, thighs and buttocks in the case of human insulin; however, there is no difference in absorption rate in the case of insulin analog, regardless of site selection. Also, air-shooting is not necessary if drops are observed as soon as the needle is attached to the pen. Diabetes educators should be familiar with new insulin injection technique recommendations, not only to keep themselves updated with new knowledge, but also so they can educate patients to assure patient safety and achieve better outcomes.
Subject(s)
Humans , Abdomen , Absorption , Arm , Buttocks , Delivery of Health Care , Education , Hope , Insulin , Italy , Needles , Patient Safety , ThighABSTRACT
PURPOSE: Diabetes mellitus is a chronic disorder and strict glycemic control, which cannot be successfully obtained without behavior modification, is the most important factor in prevention and management of complications. The purpose of this study was to investigate the short-term effects and associated factors of the diabetes education program and to assess the necessity of regular and structured education and support in diabetic children and adolescents. METHODS: Thirty patients (10.0-18.9 years) with type 1 diabetes mellitus (T1DM), attending the diabetes clinic in Seoul National University Children's Hospital, were included in the diabetes education program with intensified treatment. A six-day-course program was provided by a diabetes care team with doctors, a specialist diabetes nurse, a clinical dietitian, and a social worker. Patient data of disease duration and complication studies at the time of enrollment were reviewed and changes in HbA1c levels before and after the education program were analyzed. RESULTS: In 28 of 30 patients, significant decrease of average HbA1c levels (average 0.9%, median 0.8%, P < 0.001) was observed after education. The changes in average HbA1c levels were prominent in patients who were educated for the first time. On follow-up, HbA1c level at 3 months was significantly decreased (P = 0.009) but after 9 months, it tended to increase again. The decrease of average HbA1c levels after education was negatively correlated with disease duration (r = -0.60, P = 0.001). CONCLUSION: The short-term effect of the diabetes education program with intensified treatment in diabetic children and adolescents was optimistic but regular education and support in these patients should be sustained.