The First Reported Case of Anti-Dob Causing an Acute Hemolytic Transfusion Reaction

The antibodies of the Dombrock blood group system have only rarely been encountered in transfusion practice, and anti-Do^b has not previously been implicated in an acute hemolytic transfusion reaction. We have encountered the first such case involving a chronically transfused black female with hemoglobin SS disease and multiple antibodies in her serum. During a previous admission for sickle cell crisis, the patient received 3 units of compatible blood with no untoward effects. Serum obtained 21 days later contained, in addition to the known antibodies, anti-S plus an unidentified antibody showing characteristics of HTLA. Blood lacking the E, K1, Fy(a), Jk(b) and S antigens was obtained, and 2 least incompatible units were transfused. While administering the second unit, the patient complained of fever and low back pain, and hemoglobinemia was detected. Anti-Do^b was identified in the post-reaction samples by absorption-elution tests, and the patient was confirmed to be Do(a+b–). The first unit transfused during this hemolytic episode tested Do (b+). This case, and a similar case involving anti-Do^a reported in 1986, strengthens the belief that Dombrock antibodies are clinically significant and illustrates the need for their differentiation, prior to transfusion from less clinically significant HTLA antibodies.     

Factors Influencing the Rate of Fibrosis Progression in Chronic Hepatitis C

Alcohol consumption, age at infection, and male gender have been identified as risk factors for faster fibrosis progression in patients with chronic hepatitis C (CHC). Yet the influence of liver steatosis, light to moderate alcohol consumption, or iron overload on this progression remains controversial. To analyze the effect of individual risk factors and their interaction on fibrosis progression in a group of patients with CHC and a definite date of infection, we studied 133 consecutive untreated patients. Covariates included were age, body mass index (BMI), gender, age at infection, alcohol intake, serum lipids, glycemia, serum ALT, AST, GGT, iron, and ferritin, grade and stage (METAVIR and Scheuer), and hepatic stainable iron (Perl's stain). The rate of fibrosis progression was inferred from the METAVIR score. By logistic regression analysis, hepatic steatosis (odds ratio [OR], 3.035; 95% confidence interval [CI], 1.16-7.93), serum ferritin levels higher than 290 ng/ml (OR, 5.5; 1.6-18.65), and light to moderate ethanol intake (1-50 g/day) (OR, 5.22; 1.5-17.67) were independently associated with faster fibrosis progression. There was no effect of interaction between these variables on the rate of fibrosis progression. Liver steatosis, serum ferritin levels, and light to moderate alcohol intake are associated with faster fibrosis progression in chronic hepatitis C. Combination of these factors did not further accelerate this progression. The impact of modification of these factors on progression should be tested in longitudinal studies.     

Enfermedad diverticular de colon no complicada sintomática: revisión sistemática del diagnóstico y tratamiento

Symptomatic uncomplicated diverticular colon disease (SUDCD) is a highly prevalent disease in our setting, which significantly affects the quality of life of patients. Recent changes in understanding the natural history of this disease and technological and pharmacological advances have increased the available options for both diagnosis and treatment. However, consensus regarding the use of these options is scarce and sometimes lacks scientific evidence. The objective of this systematic review is to clarify the existing scientific evidence and analyse the use of the different diagnostic and therapeutic options for SUDCD, comparing their advantages and disadvantages, to finally suggest a diagnostic-therapeutic algorithm for this pathology and, at the same time, propose new research questions.     

Perianal disease of tuberculous origin

PURPOSE: A case of anal tuberculosis in an otherwise asymptomatic patient with bleeding anal ulcers is presented. The clinical features of this entity and the problems in differential diagnosis between anal infectious vs. inflammatory diseases are discussed. METHODS: The management and outcome of the case of an adult patient who presented with perianal ulcers is described. RESULTS: On a three-drug antituberculous regimen, symptoms abated, radiographic infiltrates improved, and perianal ulcers healed. CONCLUSION: Anal tuberculosis is an extremely rare disease. A tuberculous origin must be considered when the cause of perianal ulcers is unclear to avoid undesirable delays in the diagnosis and treatment of this disease.     

Scaling up real networks by geometric branching growth

Real networks often grow through the sequential addition of new nodes that connect to older ones in the graph. However, many real systems evolve through the branching of fundamental units, whether those be scientific fields, countries, or species. Here, we provide empirical evidence for self-similar growth of network structure in the evolution of real systems—the journal-citation network and the world trade web—and present the geometric branching growth model, which predicts this evolution and explains the symmetries observed. The model produces multiscale unfolding of a network in a sequence of scaled-up replicas preserving network features, including clustering and community structure, at all scales. Practical applications in real instances include the tuning of network size for best response to external influence and finite-size scaling to assess critical behavior under random link failures.

In the context of network science, growth is most often modeled through the sequential addition of new nodes that connect to older ones in a graph by different attachment mechanisms (1, 2), including models of hidden variables, where nodes are characterized by intrinsic properties (3, 4). Other growth processes have also been considered, such as duplication to explain large-scale proteome evolution (5, 6). Here, we take an alternative approach and explore the relation between branching growth (7) and geometric renormalization (GR) (8) to explain self-similar network evolution. Renormalization in networks, based on the ideas of the renormalization group in statistical physics (9–11), acts as a sort of inverse branching process by coarse-graining nodes and rescaling interactions. Thus, branching growth can be seen as an inverse renormalization transformation: an idea that was introduced in ref. 12 using a purely topological approach to reproduce the structure of fractal networks, where fractality was interpreted as an evolutionary drive toward robustness. However, topological distances in networks are seriously constrained by the small-world property, while the characterization of fractality in real networks disregards fundamental features of their structure, including clustering and community organization.GR (8) is an alternative technique that can be performed by virtue of the discovery that the structure of real networks is underlain by a latent hyperbolic geometry (13, 14). Thus, the likelihood of interactions between nodes depends on their distances in the underlying space, via a universal connectivity law that operates at all scales and simultaneously encodes short- and long-range connections. This approach has been able to explain many features of the structure of real networks, including the small-world property, scale-free degree distributions, and clustering, as well as fundamental mechanisms such as preferential attachment in growing networks (4) and the emergence of communities (15, 16). Given a network map, GR produces a multiscale unfolding of the network in scaled-down replicas over progressively longer length scales. This transformation has revealed self-similarity to be a ubiquitous symmetry in real networks, whose structural properties remain scale-invariant as the observational resolution is decreased (8). This poses the question of whether this self-similarity could be related to the mechanisms driving the growth of real networks and, therefore, whether their evolution could be conceptualized within the framework of the GR group.In this work, we show that real networks—citations between scientific journals (17, 18) and international trade (19)—have evolved in a self-similar way over time spans of more than 100 y, meaning that their local, mesoscale, and global topological properties remain in a steady state as time goes by, with a moderate increase of the average degree. We demonstrate that the observations can be modeled by a geometric branching growth (GBG) process that produces a self-similar metric expansion. Beyond the capacity of the model to explain and predict the self-similar evolution of real networks effectively, the technique is flexible and allows us to generate scaled-up network replicas that, when combined with scaled-down network replicas (8), provide a full up-and-down self-similar multiscale unfolding of complex networks that covers both large and small scales. We illustrate the use of GBG multiscale unfolding in real network instances via the tuning of network size for optimal response to an external influence, referred to here as “the optimal mass,” and a finite-size scaling analysis of critical behavior under random link failures.     

Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis

Purpose

To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE).

Intraparental Inconsistency: The Influence of Parenting Behaviors on Aggression and Depression in Children

The authors examined several different predictive and mediation models of longitudinal parental inconsistency over a 3‐year time span. They hypothesized that parental behavior (communication/affection, kindness, and positive control) mediated the relationship between parental inconsistency (mother or father) and two emotional problems in children: (a) aggression and (b) depression. Data were obtained from a 3‐wave study (2007, 2008, and 2009) of 523 Spanish families with children ranging from 9–15 years of age at the beginning of Wave 1 (41.3% boys). Structural equation models revealed that multiple dimensions of parenting (mother or father) fully or partially mediated the relationship between longitudinal parental inconsistency and the child's adjustment. Communication/affection and kindness are the main processes through which parental inconsistency affects a child's aggression and depression. These results represent an important contribution to the improvement of parenting models of relationships between parental inconsistency and child adjustment.