Lymphocytes activated by the Epstein-Barr virus to produce immunoglobulin do not express CD23 or become immortalized

Epstein-Barr virus causes polyclonal activation and immortalization of a small percentage of peripheral blood B lymphocytes after in vitro infection. However, the susceptible B lymphocytes have not been identified. We have used the B lymphocyte activation antigen, CD23, as a marker for separating immortalized and non-immortalized Epstein-Barr virus-infected B lymphocytes and have identified the polyclonally-activated cells, using double staining for cytoplasmic immunoglobulin and viral antigens. The vast majority of cells expressing cytoplasmic immunoglobulin are negative for CD23 and for Epstein-Barr virus nuclear antigen, and are non-immortalized. Conversely, the CD23-positive, immortalized population are positive for Epstein-Barr virus nuclear antigen and negative for cytoplasmic immunoglobulin. These results define a diversity in the response of B lymphocytes to Epstein-Barr virus infection and suggest separate pathways for terminal differentiation and immortalization. This diversity may be important in determining the outcome of Epstein-Barr virus infection in humans.     

Intestinal obstruction due to rectal endometriosis: a surgical enigma

Obstructed rectal endometriosis is an uncommon presentation. The clinical and intraoperative presentation may present as malignant obstruction. The difficulty in making the diagnosis may delay the definitive management of the patient. We report a unique case of rectal endometriosis mimicking malignant rectal mass causing intestinal obstruction and discuss the management of the case.     

A rare complication of forgotten ureteral stent

A 35 years old lady presented with history of something coming out of the genitalia for the last 5 days. She also had history of pain in the left lumbar region which was initially investigated but the patient did not follow-up. About 15 years ago she also underwent left ureteric reimplantation. On examination, a stick like tube was protruding out of the urethral meatus which was fixed to the underlying vesical calculus. The calculus was evident radiologically and on ultrasound. The projecting portion of the stick like tube was cut and the vesical calculus with the inner portion of the tube was removed by open procedure. On evaluation of the specimen, it was found that the vesical calculus was fixed to the plastic tube which had concretions around it. This plastic tube had been placed after the ureteric reimplantation done 15 years ago and the patient was not aware of it.     

Interval between clinical presentation of necrotizing enterocolitis and bowel perforation in neonates

Objective  

To define the interval between clinical presentation of necrotizing enterocolitis (NEC) and bowel perforation in neonates.     

Mortality predictions in the intensive care unit: comparing physicians with scoring systems

OBJECTIVE: Risk-prediction models offer potential advantages over physician predictions of outcomes in the intensive care unit (ICU). Our systematic review compared the accuracy of ICU physicians' and scoring system predictions of ICU or hospital mortality of critically ill adults. DATA SOURCE: MEDLINE (1966-2005), CINAHL (1982-2005), Ovid Healthstar (1975-2004), EMBASE (1980-2005), SciSearch (1980-2005), PsychLit (1985-2004), the Cochrane Library (Issue 1, 2005), PubMed "related articles," personal files, abstract proceedings, and reference lists. STUDY SELECTION: We considered all studies that compared physician predictions of ICU or hospital survival of critically ill adults to an objective scoring system, computer model, or prediction rule. We excluded studies if they focused exclusively on the development or economic evaluation of a scoring system, computer model, or prediction rule. DATA EXTRACTION AND ANALYSIS: We independently abstracted data and assessed study quality in duplicate. We determined summary receiver operating characteristic curves and areas under the summary receiver operating characteristic curves+/-se and summary diagnostic odds ratios. DATA SYNTHESIS: We included 12 observational studies of moderate methodological quality. The area under the summary receiver operating characteristic curves for seven studies was 0.85+/-0.03 for physician predictions compared with 0.63+/-0.06 for scoring system predictions (p=.002). Physicians' summary diagnostic odds ratios derived from the area under the summary receiver operating characteristic curves were significantly higher (12.43; 95% confidence interval 5.47, 27.11) than scoring systems' summary diagnostic odds ratios (2.25; 95% confidence interval 0.78, 6.52, p=.001). Combined results of all 12 studies indicated that physicians predict mortality more accurately than do scoring systems: ratio of diagnostic odds ratios (95% confidence interval) 1.92 (1.19, 3.08) (p=.007). CONCLUSIONS: Observational studies suggest that ICU physicians discriminate between survivors and nonsurvivors more accurately than do scoring systems in the first 24 hrs of ICU admission. The overall accuracy of both predictions of patient mortality was moderate, implying limited usefulness of outcome prediction in the first 24 hrs for clinical decision making.     

Origin of dengue type 3 viruses associated with the dengue outbreak in Dhaka, Bangladesh, in 2000 and 2001

Dengue and dengue hemorrhagic fever re-emerged in Bangladesh in 2000 and 2001 and nearly all viruses isolated were dengue type 3. Phylogenetic analyses of the envelope genes of examples of these viruses indicated that they were most closely related to recently emerged dengue type 3 viruses from neighboring Thailand and Myanmar but distinct from those from India and Sri Lanka. Since this strain of dengue virus type 3 had not been associated with unusual patterns of disease in Thailand or Myanmar, it suggested that the outbreak in Bangladesh was due to local factors after the introduction of viruses from countries to the east rather than to the evolution of an unusually virulent strain of virus in Bangladesh.