Cytokine responses in a severe case of glandular fever treated successfully with foscarnet combined with prednisolone and intravenous immunoglobulin

Viral loads and cytokine responses Epstein–Barr virus (EBV) were measured in an 18‐year‐old boy with severe glandular fever complicated by a mild anaemia, severe thrombocytopaenia and neutropaenia. Hepatosplenomegaly was detected by abdominal ultrasound in the presence of significant hepatitis. Cytokine testing demonstrated elevated cell‐mediated Th1 (IFN‐γ, IL‐12, sTNFR1, CXCL10, CXCL9 and CCL3) and humoral Th2 (IL‐4) immune responses. Serum antibodies to EBV virus capsid antigen (VCA) IgM and IgG antibodies were detected, together with a raised EBV DNA level (up to about 70,000 DNA copies/mL) in the acute phase of the illness. This EBV DNA load decreased rapidly in response to treatment with a combination of foscarnet, intravenous immunoglobulin and prednisolone, and the boy's symptoms settled eventually after approximately 50 days of illness, following this combined antiviral and immune‐modulating therapy. Detailed immunological, virological, haematological and biochemical laboratory parameters are presented to document this patient's severe EBV disease and eventual recovery. J. Med. Virol. 81:99–105, 2009. © 2008 Wiley‐Liss, Inc.     

A clinical advancement program for registered nurses with an outpatient focus.

Clinical advancement programs have been in use for almost 30 years. Although clinical advancement programs have been designed for many areas, it appears that one has never been developed specific to the outpatient-focused registered nurse. This article describes the development of a clinical advancement program for non-hospital-based registered nurses employed at the Guthrie Clinic in Sayre, Pennsylvania and highlights recommendations for instituting this program in any outpatient setting.     

Impulsivity and cigarette craving: differences across subtypes

Rationale  

Cigarette smoking has been linked to a number of personality characteristics, including impulsivity. Smokers tend to endorse high levels of impulsivity, and more impulsive smokers have greater difficulty quitting, but little is known about potential explanatory mechanisms. Although indirect evidence suggests craving as a candidate mechanism, direct evidence has been mixed.     

What should chris say? The ability of children with specific language impairment to recognize the need to dissemble emotions in social situations.

PURPOSE: In this study, the authors examined the ability of children with specific language impairment (SLI) and their typical peers to judge when an experienced emotion should be dissembled (hidden) in accord with social display rules. METHOD: Participants included 19 children with SLI and19 children with typical language skills, both groups ranging in age from 7;9 (years;months) to 10;10, with a mean age of 9;1. Children were presented with 10 hypothetical social situations in which a character, Chris, experienced an emotion that should be dissembled for social purposes. The participants' responses were categorized as to whether or not they dissembled or displayed the emotion. RESULTS: Although the task was difficult for many participants, children with SLI indicated that the experienced emotion should be dissembled significantly less often than did their typical peers. Children in the 2 groups did not significantly differ in their judgments of the social display rules governing these situations. CONCLUSION: These results suggested that the children with SLI did not understand the impact of displaying emotion on relationships in the same way as did their typical peers. In this respect, they seemed to lag behind the typical children in their developing emotion knowledge.