Lymphocyte interleukin 2 production and responsiveness are altered in patients with primary myelodysplastic syndrome

Immunoregulatory T and B cell functions in 15 patients with primary myelodysplastic syndrome (MDS) were studied by measuring the proliferative and the stimulatory capacity of T and B cells, respectively, in autologous (auto) and allogeneic (allo) mixed lymphocyte reaction (MLR). T cell proliferation in the auto MLR was 25% of the control (P less than .02), whereas proliferation in the allo MLR was normal. When control T cells were stimulated by MDS B cells, their proliferative response was only 57% of the control (P less than .01). The mechanism responsible for these abnormalities was studied by determining the capacity of MDS and normal T cells to produce interleukin 2 (IL 2) and to generate IL 2 receptors (IL 2R) following stimulation with control and MDS B cells. In the auto MLR of MDS patients, only 3% +/- 2% of T cells developed IL 2R positivity, whereas in control cultures 12% +/- 2% of T cells were positive, as determined by immunofluorescence, using a monoclonal antibody (MoAb) directed against the IL 2R, and FACS analysis. When MDS T cells were stimulated by control B cells, IL 2R generation and the production of IL 2 were within normal limits. In contrast, when control T cells were stimulated by MDS B cells or control B cells, the MDS B cells induced production of only 26% of IL 2 as compared with control B cells. In parallel experiments, IL 2R generation in control T cells stimulated by either MDS or control B cells was similar. We conclude that in the primary MDS, T and B cell interactions are impaired. Although MDS T cells develop normal quantities of IL 2R and produce normal amounts of IL 2 when stimulated by control B cells, they are markedly impaired when stimulated by self B cells. Similarly, MDS B cells can induce IL 2R generation in control T cells but not in MDS T cells. Myelodysplastic B cells are also defective in inducing IL 2 production by normal T cells in an allo MLR. These in vitro abnormalities strongly suggest that generation of lymphocytes with immunoregulatory functions is impaired in patients with MDS.     

Knowledge and Perspectives of Breast and Cervical Cancer Screening Among Female African Immigrants in the Washington D.C. Metropolitan Area

Black women in the USA have both a higher percentage of late-stage diagnoses as well as the highest rates of mortality from breast cancer when compared to women of other ethnic subgroups. Additionally, Black women have the second highest prevalence of cervical cancer. Many reports evaluating the cancer outcomes of Black women combine data on African-born immigrants and US-born Blacks. This categorization ignores subtle yet important cultural differences between the two groups, which may ultimately affect breast and cervical cancer screening practices. Therefore, this study investigated knowledge and awareness levels of breast and cervical cancer screening practices among female African-born immigrants to the USA residing in the Washington D.C. metropolitan area. Data were collected from 38 participants through key informant interviews, focus group sessions, and a sociodemographic questionnaire over a 3-month study period. Results suggest that fatalism, stigma, and privacy are among the major factors that affect the decision to seek preventative screening measures for breast and cervical cancer among this population. Additionally, the study implies that cervical cancer awareness is significantly lower among this population when compared to breast cancer. This study highlights differences between women of African descent residing in the USA and the need for continued research to increase understanding of the manner in which immigrant status affects health-seeking behavior. This information is critical for researchers, physicians, and public health educators aiming to design culturally appropriate interventions to effectively reduce the prevalence of breast and cervical cancer among female African immigrants living in the USA.     

Analysis of fasting antroduodenal manometry in children

Antroduodenal manometry has been used to determine the pathophysiology associated with signs and symptoms of gastrointestinal motility disorders. The diagnostic value of antroduodenal manomentry has been limited by the paucity of data from normal children. In this study, we compared antroduodenal manometry findings from 95 patients with symptoms suggesting a gastrointestinal motility disorder to 20 control children. Phase III of the migrating motor complex (MMC) was less frequent in patients (P<0.05), especially in those who required total parenteral nutrition (P<0.001), than in controls. Abnormal migration of phase III and short intervals between phase IIIs were more frequent in patients than in controls (P<0.01 andP<0.05, respectively). During phase II, persistent low-amplitude contractions and sustained tonic-phasic contraction were found only in parenteral-nutrition-dependent children. Short or prolonged duration of phase III, absence of phase I following phase III, tonic contractions during phase III, low amplitude of phase III contractions in a single recording site and clusters of contractions or prolonged propagating contractions during phase II were not more frequent in patients than in controls. We conclude that there are five manometric features having a clear association with pediatric gastrointestinal motility disorders: (1) absence of phase III of the MMC, (2) abnormal migration of phase III, (3) short intervals between phase III episodes, (4) persistent low-amplitude contractions, and (5) sustained tonic-phasic contractions.     

Ophthalmic manifestations in the COVID-19 clinical spectrum

Purpose:The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19.Methods:This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed.Results:A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis.Conclusion:Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity.     

Nursing education and professional role acquisition. A longitudinal study of expectations and attitudes towards nurse role acquisition

This article deals with professional role acquisition in nurses and discusses results from three studies concerning expectations and attitudes towards this acquisition. The studies have been carried out in Sweden. The discussion comprises expressed expectations and attitudes of nurse students and registered nurses in relation to our theoretical perspectives presented in a former article. The theoretical perspectives concentrate on three aspects of social action: change-drama, interchange-ritual, and maintenance-routine. The results indicate that the professional nurse role is acquired according to a traditional pattern, in spite of changes in curriculum and goals of nursing education and health care. Changes made to develop and improve the conditions under which role acquisitions take place.     

A study of orofacial bacterial infections in elderly Nigerians.

This retrospective study was designed to determine the pattern of occurrence, and principles of management of orofacial bacterial infections in elderly Nigerians. Ninety-two patients aged 55-90 years (mean +/- SD 62.4 +/- 7.5 years), were admitted into the study (male:female ratio 1.1:1). The origin of orofacial infection was predominantly odontogenic and the lower face was three times more commonly involved. The percentage of patients with underlying systemic disease was 16.2%. Patients with underlying disease had a 3.5 times greater risk of developing orofacial infections. Similarly, a significant correlation was demonstrated between both sexes of patients with orofacial infections and underlying illness (P < 0.05). There was a general delay before presenting for treatment (average 19.5 weeks) and the mortality rate was 3.3%. The study findings demonstrate that a significant relationship exists between elderly Nigerians with orofacial infections and systemic disease.     

Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization

OBJECTIVE: To examine psychosocial and obstetric outcomes at 1 year postpartum in first-time mothers who conceived after IVF. DESIGN: Prospective cohort study. SETTING: University medical center in the United Kingdom. PATIENT(S): One hundred twenty-nine mothers with a single naturally conceived birth, 95 mothers with a single IVF birth, and 36 mothers with a twin or triplet IVF birth. MAIN OUTCOME MEASURE(S): General Health Questionnaire and Parenting Stress Index. RESULT(S): Twenty-two percent of mothers of multiples had Parenting Stress Index scores indicating severe parenting stress, compared with 5% of mothers of IVF singletons (odds ratio, 5.14 [95% confidence interval (CI), 1.55-16.99]) and 9% of mothers of naturally conceived singletons (odds ratio, 2.76 [95% CI, 1.03-7.4]). Mothers of multiple children conceived by IVF did not have poorer mental health but were less likely to be in paid employment at follow-up than were mothers of singletons conceived by IVF (odds ratio, 0.3 [95% CI, 0.13-0.67]) or naturally (odds ratio, 0.27 [95% CI, 0.12-0.59]). Multiple births were more premature, had lower birth weights, and had more medical complications. They were more likely to have been admitted to special care than were singletons conceived by IVF (odds ratio, 14.6 [95% CI, 5.1-42.0)] or those conceived naturally (odds ratio, 10.59 [95% CI, 3.67-30.57]) CONCLUSION(S): Clinicians should ensure that couples making decisions about embryo transfer have considered the potential psychosocial burden of a multiple birth.     

Burkitt's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report

An unusual case of stage D Burkitt's lymphoma in a 24 year old Nigerian female undergraduate is reported. There was a four month history of left lower lip paraesthesia followed three months later by a slowly progressive 'pimple-sized' nodular mandibular swelling arising from the mental foramen region. A full-blown, rapidly developing abdominal mass manifested only three weeks after a biopsy of the mandibular swelling. Aspiration of the latter and a histologic report of the mandibular mass confirmed Burkitt's lymphoma. The patient responded very well to appropriate chemotherapy. Clinicians should not overlook insidious jaw swellings in any adult residing in the endemic zone of Burkitt's lymphoma, in view of the fact that successful therapy is dependent on early diagnosis. Mental nerve paraesthesia is very rarely seen in Burkitt's lymphoma.     

Unmet orthodontic treatment need in rural Nigerian adolescents

Abstract A survey of orthodontic treatment need was carried out among randomly selected rural Nigerian adolescents using the index of orthodontic treatment need. Altogether, 704 subjects (381 boys and 323 girls) aged 12–18 years (mean 14.8, SD 1.79) were recruited in the study. The results indicated that 12.6% of the population were in objective need of orthodontic treatment. Whilst there was a discrepancy in the proportions of Nigerian adolescents needing orthodontic treatment on aesthetic and dental health grounds, girls were found to have a more attractive dental appearance and less orthodontic treatment need than boys. However, the differences were not statistically significant (P > 0.05). The correlation between the orthodontist's and the subject's rating of dental appearance was found to be low (r=0.35). The study also provided reliable baseline data for planning orthodontic services in Nigeria especially in areas where there are no dental services.     

Orofacial injuries associated with prehospital management of febrile convulsion in Nigerian children

Abstract –  The aim of this prospective study was to determine in a population of pediatric patients with febrile convulsions the prevalence and pattern of orofacial and dental injuries caused by traditional remedies used in a suburban Nigerian community. Over the study period of 28 months, 75 cases of febrile convulsion presented to the Children's Emergency unit of our hospital. Of these, 27 children (36%) sustained orofacial injuries caused by forceful insertion of a spoon into the mouth (96.3%) or a bite (3.7%) during convulsive episodes. The ages of the patients ranged from 12 to 84 months with a mean 39.8 ± 18.3 months. There were 15 males and 11 females with a male to female ratio of 1.4:1. The orofacial and dental injuries sustained from prehospital treatment at home were lacerations and bruising of soft tissues including lips, tongue, mucosa and commissures and tooth subluxation, displacement or avulsion. Other injuries sustained outside the mouth include second-degree burns to the feet, a chin laceration and facial bruises resulting from a fall. Many oral injuries were overlooked by pediatricians. Prompt recognition and appropriate management of febrile convulsion would be of great benefit to the pediatric patients.