Regulation of blood services in Africa

Blood and blood products save lives and are a part of the WHO Essential Medicines List. Access to safe and quality-assured blood and blood products are essential for health systems strengthening and it is a global concern. Their use is associated with infectious and immunologic risks. At global level, many resolutions have been adopted by the World Health Assembly that urged Member States to ensure regulatory control of access to quality-assured blood and blood products along the entire transfusion chain. The WHO has also developed an action framework to advance universal access to blood. As part of the implementation of these resolutions and guidelines, the WHO Regional Office for Africa and some partners provided support to countries in the region to strengthen their capacity to establish an effective blood regulatory system through organization of regional training workshops on blood regulation, benchmarking of blood regulatory systems, internship at Paul Ehrlich Institut and establishment of the African Blood Regulators Forum. The current status of blood regulation reveals that there are weak transfusion legislation and blood regulatory systems in most African countries, since many national blood transfusion services still rely on self-regulation. However, the national regulatory authorities have reached the maturity level 3 in two countries (Ghana and Tanzania), but only the experience from Ghana has been described in this paper. Like in other low- and middle-income countries, the regulatory systems for associated substances and medical devices including IVDs are not well established in the African region. Misunderstanding by different stakeholders, lack of legislation that provides legal basis, weak capacity and insufficiency of resources are main challenges facing countries to establish an effective national blood regulatory system. To address these challenges, strong advocacy with governments and collaboration with partners are needed to strengthen national blood regulatory systems.     

Difference in the distribution of tumor-infiltrating CD8+ T cells and FOXP3+ T cells between micronodular thymoma with lymphoid stroma and micronodular thymic carcinoma with lymphoid stroma

Micronodular thymoma with lymphoid stroma (MNT) is a rare thymic epithelial neoplasm subtype characterized by a micronodular tumor cell growth pattern and abundant lymphoid stroma. Micronodular thymic carcinoma with lymphoid stroma (MNCA) is considered as a malignant counterpart of MNT and exhibits a growth pattern similar to that of MNT but has histologic features reminiscent of thymic squamous cell carcinoma, such as cytologic atypia and CD5 and CD117 immunoexpression. Although both MNT and MNCA are characterized by abundant lymphoid stroma, it remains unknown whether there are differences in infiltrating lymphocytes between MNT and MNCA. We analyzed the immune microenvironment profile in eight MNT and three MNCA cases. The cell density of CD8-positive T cells was significantly higher in MNT than in MNCA, whereas that of FOXP3-positive T cells was significantly higher in MNCA than in MNT. There was no significant difference in the cell density of programmed death protein 1-positive T cells and programmed death ligand 1 expression between the MNT and MNCA cases. Our findings indicated that the immune microenvironment of MNCA differed from that of MNT and, compared with the T-cell profile of MNT, that of MNCA was more suppressive to patients′ antitumor immune response.     

Pseudomalignancies of the head and neck

Pseudomalignancies are benign or reactive lesions that mimic malignant neoplasms either clinically or histologically. In the head and neck region there are a number of pseudomalignancies that may present to a histopathologist, including soft tissue lesions, benign odontogenic tumours and salivary gland pathology. In this review we discuss common pseudomalignant lesions that may present in the head and neck, including their clinical presentation, histopathological features and differential diagnosis.     

Seroepidemiology of the human herpesvirus 8 infection among people living with HIV in Taiwan, 2014–2018

BackgroundHuman herpesvirus type 8 (HHV-8) can be transmitted through unprotected sex as HIV. We aimed to investigate the seroincidence of HHV-8 and associated factors among people living with HIV (PLWH).MethodsFrom 2014 to 2018, blood samples of PLWH on the first date of HIV care were determined for antibodies against HHV-8. Individuals testing HHV-8-seronegative at baseline were followed for at least four months to estimate the annual seroconversion rate. To identify the factors associated with HHV-8 seroconversion, we compared the clinical characteristics between seroconverters and non-seroconverters who were matched for observation duration.ResultsThe HHV-8 seroprevalence increased from 8.1% in 2014 to 20.0% in 2018. HHV-8 seroconversion occurred in 154 (14.7%) PLWH after a total of 2652.16 person-years of follow-up (PYFU), resulting in an overall incidence rate of 5.62 per 100 PYFU, which increased from 3.20 to 6.84 per 100 PYFU during the study period. HHV-8 seroconverters were less likely to have chronic hepatitis B virus (HBV) infection (1.9% vs 10.6%) and more likely to be antiretroviral-naïve on entry into care (87.7% vs 75.4%) (both p < 0.05). In multivariate logistic analysis, men who have sex with men (MSM) (adjusted odds ratio [aOR], 2.22; 95% CI, 1.01–4.86), being antiretroviral-naïve (aOR, 2.91; 95% CI, 1.27–6.67), and chronic HBV infection (aOR, 0.13; 95% CI, 0.03–0.61) at baseline were associated with HHV-8 seroconversion.ConclusionsAn increasing trend of HHV-8 infection was observed among PLWH in Taiwan between 2014 and 2018. MSM and being antiretroviral-naïve were associated with higher risk for HHV-8 seroconversion.     

Activity of Ligustrum robustum (Roxb.) Blume extract against the biofilm formation and exopolysaccharide synthesis of Streptococcus mutans

Ligustrum robustum (Roxb.) Blume is utilized as a traditional Chinese herbal tea with various health benefits and protective effects. Streptococcus mutans is an important cariogenic oral bacteria species. The present study aimed to assess the influence of Ligustrum robustum extract (LRE) on the biofilm formation of S. mutans and the mechanism of its action, as well as to identify its chemical components. For chemical identification, HPLC‐MS and nuclear magnetic resonance were applied and four identified phytochemicals were reported (Ligurobustoside B, Ligurobustoside N, Ligurobustoside J, and Ligurobustoside C). The dose‐dependent (0.5 to 2.0 μg/μL) antimicrobial toxicity of LRE against S. mutans biofilm formation and exopolysaccharide (EPS) synthesis was evaluated by confocal laser scanning microscopy (CLSM), Crystal violet stain, and CFU counting. The microstructure of S. mutans biofilm treated with LRE was investigated both on glass coverslips and ex vivo bovine dental enamel by scanning electron microscopy (SEM). Moreover, LRE downregulated the expression of S. mutans glucosyltransferase‐encoding genes gtfB, gtfC, and gtfD, and the quorum sensing (QS) factors comD and comE, suggesting its toxic mechanism. In addition, the result of CCK‐8 test on human oral cells revealed an acceptable biocompatibility of LRE. These findings indicated the possible application of this daily consumed herbal tea for caries prevention.     

Maternal attachment influences mother–infant styles of regulation and play with objects at nine months

We examined the association between the quality of maternal representations of attachment evaluated by the Adult Attachment Interview (AAI) and mother styles of regulating attention and emotion during free play with objects in 41 mother dyads when infants were nine months old. The secure mother dyads showed a greater duration of engagement matches, with more positive matches, and a greater capacity to move from non-matched to matched states. Secure mother dyads demonstrated greater involvement in play with objects than insecure mother dyads. Insecure mother dyads showed a greater duration of mismatches and spent more time in negative matches. Correlations between maternal AAI scores and the variables studied also showed that the maternal Passivity and Unresolved scales were associated with less adequate dyadic attention and emotion regulation, while the maternal Coherence scale was associated with more adequate dyadic attention and emotion regulation.     

自我效能增强干预联合多维宣教对哮喘患儿自我护理能力及生活质量的影响

目的:探讨自我效能增强干预联合多维宣教对哮喘患儿自我护理能力及生活质量的影响。方法:选取2017年8月—2019年8月某院收治的哮喘患儿248例为研究对象,按照入院先后顺序将其分为观察组和对照组各124例。观察组实施常规护理干预措施,对照组实施自我效能增强干预联合多维宣教模式,观察并比较两组患儿干预前后的自我护理能力、自我效能感及生活质量的变化。结果:干预后观察组患儿的自我护理能力量表(ESCA)评分明显高于对照组患儿(P<0.05);观察组患儿的一般自我效能感量表(GSES)评分明显高于对照组患儿(P<0.05);观察组患儿的哮喘生活质量评分量表(AQLQ)评分明显高于对照组患儿(P<0.05)。结论:自我效能增强干预联合多维宣教在哮喘患儿的疾病管理中具有重要作用,能够增强患儿对疾病的认知和掌握能力,提高患儿的自我护理能力及自我效能感,提高其疾病管理的主观能动性,明显改善生活质量。