Additional Diagnostic Yield of Adding Serology to PCR in Diagnosing Viral Acute Respiratory Infections in Kenyan Patients 5 Years of Age and Older

The role of serology in the setting of PCR-based diagnosis of acute respiratory infections (ARIs) is unclear. We found that acute- and convalescent-phase paired-sample serologic testing increased the diagnostic yield of naso/oropharyngeal swabs for influenza virus, respiratory syncytial virus (RSV), human metapneumovirus, adenovirus, and parainfluenza viruses beyond PCR by 0.4% to 10.7%. Although still limited for clinical use, serology, along with PCR, can maximize etiologic diagnosis in epidemiologic studies.     

Acute noise stress impairs feedback processing

We examined the impact of acute noise stress on the feedback-related negativity (FRN) and whether this effect depended on stressor predictability. Participants performed a gambling task in a silence and a noise condition with either predictable or unpredictable noise. FRN amplitude was measured in three ways, either neglecting (mean amplitude) or correcting for overlap with other components (base-to-peak; mean amplitude minus average mean amplitude of surrounding peaks). Notably, results differed between measures. Valence and magnitude both affected the FRN. These effects were additive on the mean amplitude and base-to-peak measures, but interactive on the mean amplitude corrected for both peaks measure. Acute noise stress specifically modulated valence and magnitude effects on the FRN, although evidence differed between measures as to whether valence and/or magnitude were processed differently. These findings indicate that acute stress impairs cognitive control by the anterior cingulate cortex. Stressor predictability added little to the explanation of effects.     

Spectrophotometric dental colour measurement to assess age in living adults

The aim of this study was to evaluate the usefulness of spectrometrically measured colour parameters of teeth for age estimation in living adults. A total of 329 teeth were selected (162 upper central incisors and 167 upper canines) from 52 men and 50 women aged between 20 and 86 years. Colour measurements were performed in vivo on the vestibular surface of the teeth using a portable contact Spectro-color device. Colorimetric variables (L*, a*, b*), chromaticity coordinates (x, y, z), and indexes of whiteness (WIC, Z%, WI) and yellowness (YI) were calculated. The accuracy of colour values to estimate the age was determined by Receiver Operating Characteristic analysis. A more powerful age discrimination was obtained with upper incisors than with upper canines. Areas under the ROC curve ranged from 0.7 to 0.8 for all dental colour parameters measured in upper central incisors except for the variables L* and Z%, with sensitivity values ranging from 56% to 93% and specificity values from 38% to 92%. We conclude that spectrophotometric dental colour measurement may be an objective and useful tool to estimate age and meets medical ethical standards for application in living adults. However, further research is needed to study the effect of ethnicity and other factors on tooth colour.     

Hypoxia and its therapeutic possibilities in paediatric cancers

In tumours, hypoxia—a condition in which the demand for oxygen is higher than its availability—is well known to be associated with reduced sensitivity to radiotherapy and chemotherapy, and with immunosuppression. The consequences of hypoxia on tumour biology and patient outcomes have therefore led to the investigation of strategies that can alleviate hypoxia in cancer cells, with the aim of sensitising cells to treatments. An alternative therapeutic approach involves the design of prodrugs that are activated by hypoxic cells. Increasing evidence indicates that hypoxia is not just clinically significant in adult cancers but also in paediatric cancers. We evaluate relevant methods to assess the levels and extent of hypoxia in childhood cancers, including novel imaging strategies such as oxygen-enhanced magnetic resonance imaging (MRI). Preclinical and clinical evidence largely supports the use of hypoxia-targeting drugs in children, and we describe the critical need to identify robust predictive biomarkers for the use of such drugs in future paediatric clinical trials. Ultimately, a more personalised approach to treatment that includes targeting hypoxic tumour cells might improve outcomes in subgroups of paediatric cancer patients.Subject terms: Tumour biomarkers, Paediatric cancer, Cancer microenvironment, Cancer therapy     

Befriending death: A mindfulness-based approach to cultivating self-awareness in counselling students

The importance of self-awareness in counselling education is widely recognized; however, strengthening this vital aspect is often left to educators’ discretion. The author addresses this deficiency by first exploring four theoretical constructs: mindfulness, emotional regulation, death anxiety, and relationship dynamics. Then, she outlines a practical learning activity on the topic of death. The main exercise involves a guided meditation in which students imagine both a worst-case and best-case scenario of their own death, while practicing mindfulness, followed by a debriefing period and a written self-reflection. This activity can be used by educators to promote greater self-awareness in master’s level counselling students.     

Association of rs1568885, rs1813443 and rs4411591 polymorphisms with anti-TNF medication response in Greek patients with Crohn’s disease

AIM:To investigate the correlation between rs1568885,rs1813443 and rs4411591 polymorphisms and response to infliximab in a cohort of Greek patients with Crohn’s disease(CD).METHODS:One hundred and twenty-six patients diagnosed with CD based on standard clinical,endoscopic,radiological,and pathological criteria were enrolled in this study at the Gastroenterology Unit of the 2nd Department of Surgery and at the Colorectal Unit of the1st Department of Propaedeutic Surgery.Infliximab at a dose of 5 mg/kg was administered intravenously at weeks 0,2,6 and then every 8 wk.Clinical and serological responses were assessed using the HarveyBradshaw Index and serum C-reactive protein(CRP)levels,respectively,and the endoscopic response was evaluated by ileocolonoscopy performed at baseline and after 12-20 wk of therapy.The changes in endoscopic appearance compared to baseline were classified into four categories,and patients were classified as responders and non-responders.Genomic DNA from whole peripheral blood was extracted and genotyping was performed by allele-specific polymerase chain reactions.χ2test with Yate’s correction based on the S-Plus was used to compare the genotype frequencies.RESULTS:Eighty patients(63.49%)were classified as complete and 32(25.39%)as partial responders to infliximab,while 14(11.11%)were primary non-responders.No correlation was found between response to infliximab and patients’characteristics such as age,gender and disease duration.There was consistency between Harvey-Bradshaw index scores and serum CRP levels.The TT genotype of the rs1568885 polymorphism was significantly related to partial response(P=0.024)and resistance to infliximab(P=0.007)while the AT genotype was more frequent in partial responders(P=0.035)and in primary non-responders(P=0.032).Regarding rs1813443,the CC genotype was found to be associated with partial response(P=0.005)and primary resistance(P=0.002)to infliximab while no association was found between the rs4411591 polymorphism and the clinical response to infliximab.CONCLUSION:Based on our results,the rs1568885and rs1813443 polymorphisms are associated with clinical and biochemical response to infliximab in Greek patients with Crohn’s disease.     

Rabeprazole,clarithromycin, and amoxicillin Helicobacter pylori eradication therapy: Report of an efficacy study

AIM:To investigate the efficacy of a standard triple therapy(comprising rabeprazole,clarithromycin,and amoxicillin)for Helicobacter pylori(H.pylori)eradication,noting factors that influence the outcome and documenting any adverse events.METHODS:Following institutional ethical approval,fifty consecutive and consenting symptomatic patients with evidence of H.pylori infection by either a positive urea breath test(UBT)and/or a campylobacter-like organism test who presented to the Gastroenterology clinic of Lagos State University Teaching Hospital between 2012 and 2013 were recruited into the study.Patients were openly randomized to either a 7-d or a 10-d regimen of amoxicillin 1 g,clarithromycin 500mg and rabeprazole 20 mg twice daily.The extent of symptom resolution was noted following the treatment,and at the end of one month after the completion oftreatment,a repeat UBT was performed in each patient to document the eradication of the infection.All data(demographics,symptoms,and eradication rates)were collated and analyzed with SPSS version 18.RESULTS:Forty-seven patients completed the study(three were excluded from the analysis for breaching the study protocol).The patients included 18 males and 29 females within the age range of 13-80 years(mean 43.7,SD 16.8).The clinical features of the study subjects were dyspepsia,reflux symptoms and features of gastrointestinal bleeding.The average eradication rate was 87.2%.Eighteen subjects were enrolled in the 7-d arm,while 29 were in the 10-d arm.There was no statistically significant difference in the age or sex distributions of the two arms.There was no significant advantage of the 10-d treatment duration over the 7-d duration(P=0.78),and the eradication outcomes were not influenced by the gender or age of the subjects.No adverse effects were reported in either arm.CONCLUSION:The triple therapy regime,employing a combination of amoxicillin,clarithromycin and rabeprazole,showed great efficacy and safety in the eradication of H.pylori,and this outcome was not influenced by gender or age.No difference was observed between the 7-d and 10-d regimens.     

Multicenter Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Study for Identification of Clinically Relevant Nocardia spp.

This multicenter study analyzed Nocardia spp., including extraction, spectral acquisition, Bruker matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) identification, and score interpretation, using three Nocardia libraries, the Bruker, National Institutes of Health (NIH), and The Ohio State University (OSU) libraries, and compared the results obtained by each center. A standardized study protocol, 150 Nocardia isolates, and NIH and OSU Nocardia MALDI-TOF MS libraries were distributed to three centers. Following standardized culture, extraction, and MALDI-TOF MS analysis, isolates were identified using score cutoffs of ≥2.0 for species/species complex-level identification and ≥1.8 for genus-level identification. Isolates yielding a score of <2.0 underwent a single repeat extraction and analysis. The overall score range for all centers was 1.3 to 2.7 (average, 2.2 ± 0.3), with common species generally producing higher average scores than less common ones. Score categorization and isolate identification demonstrated 86% agreement between centers; 118 of 150 isolates were correctly identified to the species/species complex level by all centers. Nine strains (6.0%) were not identified by any center, and six (4.0%) of these were uncommon species with limited library representation. A categorical score discrepancy among centers occurred for 21 isolates (14.0%). There was an overall benefit of 21.2% from repeat extraction of low-scoring isolates and a center-dependent benefit for duplicate spotting (range, 2 to 8.7%). Finally, supplementation of the Bruker Nocardia MALDI-TOF MS library with both the OSU and NIH libraries increased the genus-level and species-level identification by 18.2% and 36.9%, respectively. Overall, this study demonstrates the ability of diverse clinical microbiology laboratories to utilize MALDI-TOF MS for the rapid identification of clinically relevant Nocardia spp. and to implement MALDI-TOF MS libraries developed by single laboratories across institutions.