What field instructors of social work students need from hospital field work programs.

Hospital field instructors of graduate social work students can experience considerable stress in managing their dual roles as practitioners and teachers. This paper looks at the kinds of supports that field instructors need from hospital social work departments to help them experience field instruction positively. Annual program evaluations completed by field instructors at one hospital over a five year period were analyzed. Findings suggest that ongoing departmental seminars for field instructors can be critical in supporting them in this role well beyond the first year. Implications for retaining field instructors and directions for further research are highlighted.     

Clinical and immunohistochemical assessment of the effect of cyclosporin in keratinocytes and dermal dendrocytes in psoriasis

BACKGROUND: Cyclosporine is a potent immunosupressor, which induces cytokeratin expression pattern changes and dermal dendrocytes number increase. OBJECTIVES: To evaluate its clinical effect in psoriasis, on keratinocytic proliferation and differentiation, and on dermal dendrocytes proliferation. METHODS: Thirty patients with psoriasis were treated and evaluated for 8 weeks. Clinical improvement was evaluated by Psoriasis Area and Severity Index (PASI). Biopsies were performed initially and after 8 weeks. Immunohistochemistry [CK markers 10, 14, and 16, and factor XIIIa+ (FXIIIa+)] was performed. RESULTS: Mean PASI before treatment was 26.32 and 3.71 after. Mean initial and final PASI difference was 22.61 (p < 0.001). Two patients had serum creatinine and six uric acid increase. Before and after treatment, mean numbers per field of dermal dendrocytes were 7.07 and 3.68, respectively. Mean difference was 3.39, with p < 0.001. CK10 immunohistochemical pattern demonstrated recovery of normal expression pattern in 26 patients, while CK14 pattern demonstrated improvement in 21 patients. CONCLUSIONS: Cyclosporine was effective and safe for psoriasis in low doses, with significant decrease of PASI and dermal dendrocytes number after 8 weeks of therapy. CK10 and 14 pattern changed and, less prominently, CK16 expression. These modifications occur later than the PASI and dermal dendrocytes variation.     

A homozygous CEP57 c.915_925dupCAATGTTCAGC mutation in a patient with mosaic variegated aneuploidy syndrome with rhizomelic shortening in the upper and lower limbs and a narrow thorax

Mosaic variegated aneuploidy syndrome (MVA) is a rare autosomal recessive disorder characterized by random chromosome gains and losses. Mutations in BUB1B and CEP57 genes have been involved in MVA. Here we report on a male child with MVA due to c.915_925dupCAATGTTCAGC mutation in the CEP57 gene. Our patient was homozygous for this mutation and he is the first case with rhizomelic shortening of both the upper and lower limbs and mild respiratory insufficiency due to a narrow thorax. It is also the second MVA Mexican family reported with this mutation that lives in the northwestern region of Mexico, suggesting a “local founding effect”. Additional cases are needed to better understand the MVA genotype-phenotype relationship.     

Eosinophilic fasciitis (Shulman syndrome)

We present a case of eosinophilic fasciitis, or Shulman syndrome, in a 35-year-old man and discuss its clinical and histopathologic aspects, as well as its relationship to scleroderma. Although controversial, the tendency is to set Shulman syndrome apart from all other sclerodermiform states.     

Translation and adaptation of the life stressor checklist-revised with Colombian women

We undertook the translation and adaptation of an instrument developed to measure women's lifetime trauma exposure, the Life Stressor Checklist-Revised (LSC-R), in order to determine its utility and cultural appropriateness with Colombian Spanish-speaking women. The LSC-R was forward and backward translated and administered to a sample (N = 217) of community-based women volunteers in Medellín, Colombia. Open-ended questions were included to assess the construct validity and cultural appropriateness of the LSC-R. The LSC-R was found to be valid and easily understood. Trauma exposure was common, but its assessment was not overly distressing to Colombian women.     

Proposal of a histopathological predictive rule for the differential diagnosis between American tegumentary leishmaniasis and sporotrichosis skin lesions

Background American tegumentary leishmaniasis (ATL) and sporotrichosis exhibit similar histopathology and low frequencies of microorganism detection. Objectives This study seeks to identify microscopic alterations that can distinguish between these diseases. Methods Haematoxylin and eosin stained slides of 171 ATL and 97 sporotrichosis samples from active cutaneous lesions were examined for histopathological alterations. The lesions were diagnosed by isolating the agent (which was not visible) in culture. An intuitive diagnosis was assigned to each slide. The strength of the association between the histopathological findings and the diagnosis was estimated by an odds ratio, and each finding was graded according to a regression model. A score was assigned to each sample based on the histopathological findings. A study of the interobserver reliability was performed by calculating kappa coefficients of the histopathological findings and intuitive diagnoses. Results The markers ‘macrophage concentration’, ‘tuberculoid granuloma’ and ‘extracellular matrix degeneration’ were associated with ATL. ‘Suppurative granuloma’, ‘stellate granuloma’, ‘different types of giant cells’, ‘granulomas in granulation tissue’ and ‘abscess outside the granuloma’ were associated with a diagnosis of sporotrichosis. ‘Macrophage concentration’ and ‘suppurative granuloma’ had the highest (substantial and almost perfect, respectively) reliability. The regression model score indicated 92·0% accuracy. The intuitive diagnosis had 82·5% diagnostic accuracy and substantial reliability. Conclusions Taking into account the clinical and epidemiological context, some histopathological alterations might be useful for the differential diagnosis between ATL and sporotrichosis cutaneous lesions in cases in which the aetiological agent is not visible.     

Lack of Response to HBHA in HIV‐Infected Patients with Latent Tuberculosis Infection

Heparin‐binding haemagglutinin (HBHA) has been proposed as an immunological biomarker for discriminating active tuberculosis (TB) from latent TB infection (LTBI) and to identify those at higher risk of progressing to active disease. Few data are available in immune‐compromised patients, which are those with increased risk of TB reactivation. The aim of this stusy was to evaluate the immune response to HBHA in HIV‐infected subjects with LTBI (HIV‐LTBI) or active TB (HIV‐TB) in comparison with the immune response to additional Mycobacterium tuberculosis (Mtb) or HIV and CMV antigens. The responses are evaluated in relation to TB status and in the LTBI subjects with the progression to active TB within 2 years. Forty‐one HIV‐infected antiretroviral‐naïve subjects were prospectively enrolled: 18 were HIV‐TB and 23 HIV‐LTBI. Whole blood was in vitro stimulated overnight with several antigens and mitogen. Interferon‐γ response in the harvested plasma was evaluated by ELISA. Despite that CD4 cell count was significantly different between HIV‐LTBI and HIV‐TB, no differences were observed in response to Mtb‐ or HIV‐specific antigens. Differently, low responses to HBHA were observed in both HIV‐LTBI and HIV‐TB subjects. Importantly, none of the six HIV‐LTBI responding to HBHA developed TB, while two of 17 non‐HBHA responders developed active disease. HIV‐TB‐coinfected subjects, regardless of their TB status, showed low responses to HBHA despite maintaining detectable responses to other antigens; moreover, among the HIV‐LTBI, the lack of HBHA responses indicated an increased risk to develop active TB. These results, although preliminary, suggest that a positive response to HBHA in HIV‐LTBI correlates with Mtb containment.