Analysis of expressed V(H) genes in persistent polyclonal B cell lymphocytosis reveals absence of selection in CD27+IgM+IgD+ memory B cells

Persistent polyclonal B cell lymphocytosis (PPBL) is a hematological disorder diagnosed predominantly in women, characterized by a polyclonal increase in the number of peripheral blood B lymphocytes. Abnormality of the B cell population was evidenced by the finding of multiple bcl-2/Ig gene rearrangements and an additional long-arm chromosome within a significant proportion of B cells. To gain further insight about the developmental status of B lymphocytes in PPBL, analysis of cell surface Ig receptors was undertaken. An important expansion of the CD27+IgM+IgD+ B cell population was noted in PPBL patients (n=4). When investigated by PCR, pattern of heavy chain variable region (VH) genes usage in patients (n=6) was shown tobe similar to that observed in healthy individuals (n=3). In-depth investigation was then conducted through cloning and sequencing of individual VH genes in three of those patients. They were mostly found to be mutated (21/29), correlating with the observed increase in CD27 expression, a marker of memory B cells. Altogether, these data clearly point out to the exact nature of the expanding B cell subset in patients. Finally, analysis of the repartition of recombinant versus silent mutations in framework regions (FR) of Ig genes showed no evidence of positive antigenic selection following somatic hypermutation. Thus, we suggest that a lack of response to physiological signals responsible for the elimination of low affinity memory IgM+IgD+ B cells in germinal centers could play an important role in the development of PPBL.     

Chemokine Expression Patterns in the Systemic and Genital Tract Compartments are Associated with HIV-1 Infection in Women from Benin

Introduction  

Understanding the genital mucosal immunity and the factors involved in linking innate to adaptive immunity is crucial for the design of efficient preventive strategies against human immunodeficiency virus (HIV)-1.     

Providing better opportunities for older children in the child welfare system

A growing number of children over age 10 reside in and emancipate from foster care every year. Older children face many of the same challenges as younger children, but they also have unique developmental needs. This article discusses older children in the child welfare system and finds: Approximately 47% of children in foster care are over age 11, and in 2001, 20% of children leaving foster care were over age 16. Older children need permanency, stability, and a "forever family." Maintaining connections with siblings and other kin can be a crucial resource for older children as they transition to independence. Former foster children are at higher risk for a number of negative outcomes, such as substance abuse, homelessness, and low educational attainment, but the research on older youth is limited and often does not consider the strengths these youth exhibit. Much can be done to better serve older children while they are in care and to provide them with better opportunities as they transition out of the system. Programs that draw on community resources, promote a system of care, link children to mentors, and teach them life skills hold promise for improving the lives of these children.     

Trauma Surveillance and Registry Development in Mozambique: Results of a 1-Year Study and the First Phase of National Implementation

World Journal of Surgery - Mozambique has had no policy-driven trauma system and no hospital-based trauma registries, and injury was not a public health priority. In other low-income countries,...     

Measuring outcomes in the changing environment of child welfare services

Child welfare service organizations are undergoing profound changes with the advent of managed care. Expensive development of new infrastructures is required, including information systems to track services and outcomes. The authors examine key considerations in designing an outcomes measurement program for child welfare agencies and challenges for implementation. In addition, they review national initiatives to determine best practices for outcomes measurement of children's services, and how these initiatives can help guide others' efforts.     

Epidemiology and clinical presentation of community-acquired Staphylococcus aureus bacteraemia in children under 5 years of age admitted to the Manhiça District Hospital,Mozambique, 2001–2019

Staphylococcus aureus bacteraemia (SAB) is one of the most common bloodstream infections globally. Data on the burden and epidemiology of community-acquired SAB in low-income countries are scarce but needed to define preventive and management strategies. Blood samples were collected from children < 5 years of age with fever or severe disease admitted to the Manhiça District Hospital for bacterial isolation, including S. aureus. Between 2001 and 2019, 7.6% (3,197/41,891) of children had bacteraemia, of which 12.3% corresponded to SAB. The overall incidence of SAB was 56.1 episodes/100,000 children-years at risk (CYAR), being highest among neonates (589.8 episodes/100,000 CYAR). SAB declined significantly between 2001 and 2019 (322.1 to 12.5 episodes/100,000 CYAR). In-hospital mortality by SAB was 9.3% (31/332), and significantly associated with infections by multidrug-resistant (MDR) strains (14.7%, 11/75 vs. 6.9%, 14/204 among non-MDR, p = 0.043) and methicillin-resistant S. aureus (33.3%, 5/15 vs. 7.6%, 20/264 among methicillin-susceptible S. aureus, p = 0.006). Despite the declining rates of SAB, this disease remains an important cause of death among children admitted to MDH, possibly in relation to the resistance to the first line of empirical treatment in use in our setting, suggesting an urgent need to review current policy recommendations.