Enhanced basophil reactivities during severe malaria and their relationship with the Plasmodium falciparum histamine-releasing factor translationally controlled tumor protein

Recent studies suggest shared pathogenic pathways during malaria and allergy. Indeed, IgE, histamine, and the parasite-derived Plasmodium falciparum histamine-releasing factor translationally controlled tumor protein (PfTCTP) can be found at high levels in serum from patients experiencing malaria, but their relationship with basophil activation remains unknown. We recruited P. falciparum-infected patients in Senegal with mild malaria (MM; n = 19) or severe malaria (SM; n = 9) symptoms and healthy controls (HC; n = 38). Levels of serum IgE, PfTCTP, and IgG antibodies against PfTCTP were determined by enzyme-linked immunosorbent assays (ELISA). Basophil reactivities to IgE-dependent and -independent stimulations were measured ex vivo using fresh blood by looking at the expression level of the basophil activation marker CD203c with flow cytometry. Unstimulated basophils from MM had significantly lower levels of CD203c expression compared to those from HC and SM. After normalization on this baseline level, basophils from SM showed an enhanced reactivity to calcimycin (A23187) and hemozoin. Although SM reached higher median levels of activation after anti-IgE stimulation, great interindividual differences did not allow the results to reach statistical significance. When primed with recombinant TCTP before anti-IgE, qualitative differences in terms of a better ability to control excessive activation could be described for SM. IgE levels were very high in malaria patients, but concentrations in MM and SM were similar and were not associated with basophil responses, which demonstrates that the presence of IgE alone cannot explain the various basophil reactivities. Indeed, PfTCTP could be detected in 32% of patients, with higher concentrations for SM. These PfTCTP-positive patients displayed significantly higher basophil reactivities to any stimulus. Moreover, the absence of anti-PfTCTP IgG was associated with higher responses in SM but not MM. Our results show an association between basophil reactivity and malaria severity and suggest a pathogenic role for plasmodial PfTCTP in the induction of this allergy-like mechanism.     

Chronic confusion and memory impairment in Hmong elders: Honoring differing cultural beliefs in America

The Hmong began arriving to the United States as refugees in the mid 1970s and constitute a growing number of the population. Little is known about the prevalence and care of dementia in Hmong elderly individuals. The purpose of this article is to discuss the traditional beliefs and treatment of tem toob (memory impairment) within the Hmong culture. This includes a discussion of the authors' encounters with Hmong herbalists in open-air markets during a journey in Laos and Thailand. A story cloth is then featured to discuss a shamanic healing ceremony for an elderly woman with tem toob. Nursing implications are discussed.     

La diverticulose colique à Dakar: aspects épidémiologiques, cliniques et endoscopiques chez 34 patients

Introduction

Colonic diverticulosis is a rare disorder among Africans and few studies have been carried out in Africa. Our objective was to report its epidemiological, clinical and endoscopic features in a centre for digestive endoscopy in Dakar.

Patients and method

This was a retrospective study of patients who had had a total colonoscopy in the Aristide-Le-Dantec Hospital in Dakar between January 2006 and December 2008. All patients who had at least one diverticula were included. Age, sex, indications and colonoscopy results were analysed.

Results

Of the 358 patients, 34 had diverticulosis (9.49%). The mean age was 67 years (extremes: 45 and 85 years) and the male to female ratio was 1:1. The colonoscopic examinations were indicated chiefly by rectal bleeding, constipation and abdominal pain. Most of the diverticula were on the left colon (76.47%). Diffuse colonic diverticulosis was present in 13 patients (38.23%). Associated lesions were found in 9 cases (26.47%).

Conclusion

Colonic diverticulosis has an endoscopical prevalence of 9.49% in the hospital Aristide-Le-Dantec in Dakar. It affects elderly subjects without distinction of sex and it is often revealed by rectal bleeding, constipation and abdominal pain. Localisation on the left colon is predominant.     

从美国外科住院医师培训制度看如何改进我国临床研究生教育

临床研究生是我国继续医学教育的重要组成部分。借助美国住院医师培训制度的经验,对改进我国临床研究生教育,提高其临床工作能力提出一些建议。改变或摒弃目前临床硕士研究生的培养模式,适当降低临床博士研究生的科研要求,加强和完善博士生的临床考试和考核制度,对增加临床博士生毕业后的临床工作能力是有益的。将目前的临床研究生教育与专科医师培养制度衔接起来亦可以作为提高临床研究生工作能力的一种方法或作为全面推行专科医师培养制度的一个过渡阶段。     

Vector competence of Aedes aegypti populations from Senegal for sylvatic and epidemic dengue 2 virus isolated in West Africa

Vector competence of Aedes aegypti populations from six locations in different bioclimatic zones and habitats of Senegal was assessed for sylvatic (ArD 140875) and epidemic (ArA 6894) dengue 2 virus (DENV-2) isolates. F1 generation mosquitoes were fed with a blood meal containing 10(6.5) and 1.6 x 10(7) tissue culture infectious dose (TCID50) of the sylvatic DENV-2 isolate or 10(6.5) TCID50 of the epidemic isolate and incubated for 14 days. After this period, legs and wings of each individual were pooled and the corresponding body was collected separately. An immunofluorescence assay was used to test bodies and wings/legs for DENV-2 infection separately. The results showed that: (i) Senegalese Ae. aegypti populations have lower vector competence (infection rate 0-26%, dissemination rate 10-100%) for sylvatic and epidemic dengue viruses than populations from Asia and America; (ii) there was no obvious geographic variation in susceptibility among mosquito populations; (iii) the only apparent factor affecting the susceptibility was the virus titre; and (iv) except for that of Kédougou, all populations were able to disseminate the virus. Overall our findings, while extended to four other populations, confirm previous studies showing low susceptibility of Senegalese Ae. aegypti populations.     

Double-valve Libman-Sacks endocarditis causing ventricular fibrillation cardiac arrest

Libman-Sacks endocarditis is a well-known and rather common cardiac manifestation of systemic lupus erythematosus. Transesophageal and transthoracic echocardiography are the definitive imaging methods used to evaluate cardiac valvular involvement in this disease. Valvular masses (vegetations) and valvular thickening are 2 common morphologic echocardiographic patterns. Libman-Sacks lesions are typically characterized by single-valve involvement and their small size of 1 to 4 mm.Herein, we present the unusual case of a 22-year-old woman with newly diagnosed systemic lupus erythematosus who had large, sterile vegetations of Libman-Sacks endocarditis that involved the mitral and aortic valves. This compromised coronary blood flow and resulted in ventricular fibrillation cardiac arrest. The vegetations were surgically excised, and the patient's cardiac function recovered. We discuss the treatment of the patient and that of Libman-Sacks endocarditis.