Psychosocial problems in families of a child with cancer

Eighty-one children with malignancies and their families were investigated for the psychosocial changes that take place during the course of the disease. Seventeen patients were in the initial phase of treatment, 24 were in first remission, 14 were long-term survivors already off therapy, 11 were in relapse, and 15 children died 1-5 years before this study. Detailed personal interviews with the parents showed profound changes in the families' life and severe problems in adapting to the new situation. Marital problems, neglecting the healthy siblings, and a loss of interest in work occurred in the majority of parents, especially in mothers. Younger siblings suffered more from the strains imposed on the family than did elder ones. Psychosocial care is felt to be helpful for all families in adjusting to the altered circumstances and emotional upheavals.     

Late effects of therapy in children previously treated for leukaemia or malignant tumour

The late sequelae of leukaemia and tumour therapy are discussed. The most important and/or the most frequent are neuro-psychologic disturbances, deformities of the bones, the decreased reproduction capacity and the second tumours. Because of the rapidly growing number of cured patients a better knowledge of the occurrence, aetiology, prophylaxis and rehabilitation of these changes is needed.     

Preventing perioperative adverse drug reactions

The purpose of this article is to help nurses prevent adverse drug reactions (ADRs) in the perioperative, endoscopic, and special procedure areas. Up to 30% of hospitalized patients experience an ADR. Taking comprehensive medication histories, maintaining constant vigilance, and recognizing inherently dangerous patient/medication combinations are essential in preventing ADRs. The mechanisms of medication toxicity and identifying potentially preventable adverse reactions are discussed. Practical nursing guidelines and tips that patients can use to prevent ADRs from occurring are delineated. Not every ADR can be prevented, but informed nurses can implement measures to reduce their occurrence. AORN J 77 (Jan 2003) 106-117.     

A method for measuring the cross sectional area of the anterior portion of the optic nerve in vivo using a fast 3D MRI sequence

Purpose:

To investigate the three‐dimensional (3D) fast‐recovery fast spin‐echo accelerated (FRFSE‐XL) sequence as a new application for measuring the intraorbital optic nerve (ION) mean cross‐sectional area in vivo and to determine its value within a commonly used high resolution imaging protocol.

Materials and Methods:

The entire ION was scanned in nine healthy volunteers (mean age 32 ± 4 years) using the 3D FRFSE‐XL sequence and a commonly used high resolution short‐echo fast fluid‐attenuated inversion‐recovery (sTE fFLAIR) sequence with identical slice locations at 1.5T. The mean cross‐sectional area from both sequences was measured on a slice‐by‐slice basis from 3 mm behind the globe to the orbital apex. The reproducibility of both techniques was assessed from repeated scans (scan‐rescan) and repeated image analysis (intraobserver).

Results:

Measurement of the mean cross‐sectional area of the anterior 9 mm segment of the ION was only possible using the 3D FRFSE‐XL sequence with a mean area of 11.6 ± 2.2 mm² (scan rescan COV = 3.3 ± 1.5, intraobserver COV = 2.4 ± 0.02) whereas the remainder segment of the ION (i.e., 9 mm behind the globe to the orbital apex) could only be measured with the use of the sTE fFLAIR with a mean area of 8.5 ± 1.7 mm² (scan rescan COV = 4.9 ± 2.5 and intraobserver COV = 3.70 ± 0.03).

Conclusion:

The 3D FRFSE‐XL allows fast and reproducible measurement of the cross‐sectional area of the anterior 9mm segment of the ION, which is not possible using commonly used imaging sequences due to image degradation from motion, and is of complementary value to the existing imaging protocol for ION atrophy quantification. J. Magn. Reson. Imaging 2010;31:1486–1491. © 2010 Wiley‐Liss, Inc.     

Stratification-score matching improves correction for confounding by population stratification in case-control association studies

Proper control of confounding due to population stratification is crucial for valid analysis of case-control association studies. Fine matching of cases and controls based on genetic ancestry is an increasingly popular strategy to correct for such confounding, both in genome-wide association studies (GWASs) as well as studies that employ next-generation sequencing, where matching can be used when selecting a subset of participants from a GWAS for rare-variant analysis. Existing matching methods match on measures of genetic ancestry that combine multiple components of ancestry into a scalar quantity. However, we show that including nonconfounding ancestry components in a matching criterion can lead to inaccurate matches, and hence to an improper control of confounding. To resolve this issue, we propose a novel method that assigns cases and controls to matched strata based on the stratification score (Epstein et al. [2007] Am J Hum Genet 80:921-930), which is the probability of disease given genomic variables. Matching on the stratification score leads to more accurate matches because case participants are matched to control participants who have a similar risk of disease given ancestry information. We illustrate our matching method using the African-American arm of the GAIN GWAS of schizophrenia. In this study, we observe that confounding due to stratification can be resolved by our matching approach but not by other existing matching procedures. We also use simulated data to show our novel matching approach can provide a more appropriate correction for population stratification than existing matching approaches.     

Multiple myeloma: the relationship between CALLA (CD10) positive lymphocytes in the peripheral blood and light chain isotype suppression

This study describes the presence of small numbers of common acute lymphocytic leukaemia antigen (CALLA, CD10)-positive lymphocytes in the peripheral blood of patients with multiple myeloma. A significant correlation (0.001 less than P less than 0.01) was found between the lack of light chain isotype suppression (LCIS), which is characteristic of progressive myeloma, and the presence of CALLA-positive lymphocytes. Sixty patients with multiple myeloma, four with benign monoclonal gammopathy (BMG) and seven with solitary plasmacytoma (SP) were monitored in this study. Nineteen of the patients with multiple myeloma demonstrated LCIS, of which only three were found to have CALLA-positive lymphocytes. Of the 41 patients with multiple myeloma who did not have LCIS, 20 (49%) had CALLA-bearing lymphocytes. None of the patients with BMG or SP demonstrated LCIS or were found to have CALLA-bearing lymphocytes in their blood. Forty-four of the patients with multiple myeloma were also monitored for serum beta-2-microglobulin (SB2M levels. There was no correlation between the SB2M and either LCIS or CALLA-positivity. Detection of CALLA-positive lymphocytes in the blood of patients with multiple myeloma may be an early marker of the onset of progressive disease. The correlation of CALLA expression on lymphocytes with lack of LCIS provides further evidence for the operation of immunoregulatory systems in these patients.     

TB Diagnostic Capacity in Sub-Saharan African HIV Care Settings

ABSTRACT:: As HIV care services continue to scale-up in sub-Saharan Africa, adequate tuberculosis diagnostic capacity is vital to reduce mortality among HIV-infected persons. A structured survey was administered at 663 health facilities providing HIV care to 908,043 patients in across 9 sub-Saharan African countries to estimate the proportion of facilities and HIV patients at these facilities with access TB-related diagnostic tests. Sputum smear microscopy was available at 87% of facilities (representing 97% of patients), chest x-ray at 26% of facilities (representing 56% of patients), tuberculin skin tests were available at 12% of facilities (representing 33% of patients). Acid-fast bacillus culture was available on-/off-site at 53% of facilities (representing 77% of patients). Primary health facilities had lower availability of tuberculosis diagnostic tests compared with secondary and tertiary health facilities. As HIV care continues to decentralize to primary health facilities, a corresponding expansion of diagnostic capacity to lower levels of the health system will be essential.     

Erosive pustular dermatosis of the scalp – an Australian perspective: Insights to aid clinical practice

Erosive pustular dermatosis of the scalp has particular relevance in Australia, due to its association with actinic damage. Despite its rarity, the recalcitrant nature of erosive pustular dermatosis of the scalp dictates a protracted recovery fraught with relapse and recurrence, posing inherent challenges to successful treatment and complete recovery. In Australia, erosive pustular dermatosis of the scalp is prevalent in the elderly, who are negatively affected due to the condition. We propose a management outline to aid clinical practice, to improve the quality of life in the elderly, whilst providing insight into the current understanding and treatment of erosive pustular dermatosis of the scalp.     

Ultrastructural study of mitochondria and their cristae in embryonic rats and primate (N. nemistrina)

Information on the morphology of mitochondria during embryogenesis is scattered in the literature but there appears to be a developmental pattern characterized by vesiculation of the mitochondrial cristae. During early organogenesis, the embryo is in a relative state of hypoxia and this is associated with decrease of terminal electron transport system activity and a marked increase in glycolysis. Ultrastructural studies of a 14 somite monkey embryo, and day 10 and 12 rat embryos, along with a review of the literature led us to determine that this hypoxic stage is characterized by vesiculation of the mitochondrial cristae. Starting in the late morula stage and continuing during early postimplantation embryogenesis the cristae increase and appear tubular or vesicular. After the end of neurulation, and with onset of vascular perfusion, the cristae gradually become lamellated and by the limb bud stage appear more mature. We suggest that new cristae form from blebs of the inner mitochondrial membrane and that subsequently with maturation these blebs collapse giving them a lamelliform appearance. The delamellated state of the cristae may protect the embryo from toxic respiratory end-products of oxidative respiration which could accumulate in an embryo lacking vascular perfusion. In the heart of monkey and rat embryos, the mitochondria had diameters which were approximately twice those found in skin and neural tube. Anat. Rec. 252:383–392, 1998. © 1998 Wiley-Liss, Inc.