Increased recognition of IgA nephropathy in African-American children

Based upon the percentage of cases of IgA nephropathy (IgAN) in biopsy series, a lower prevalence has been assumed for African-Americans compared with Americans of European descent. This may be due to a racial difference in the basic underlying pathology of IgAN or to racial differences in patterns of referral and biopsy selection practices. Over the past decade (1985 – 1994), we have found similar incidences of IgAN in Caucasian and African-American children from Shelby County, Tennessee. The incidence was 3.0 cases per million per year for Caucasian and 5.7 cases per million per year for African-American children. IgAN may be more common in African-American children than previously appreciated. Population-based incidence studies will be necessary to determine whether or not our experience has become a more widespread phenomenon. Received August 21, 1996; received in revised form and accepted December 18, 1996     

Outcomes of simultaneous kidney-pancreas transplantation in African-American recipients: a case-control study

INTRODUCTION: Previous studies have suggested that African-American (AA) ethnicity is a risk factor for rejection and graft loss after kidney transplantation. However, little data is available regarding outcomes after simultaneous kidney pancreas transplantation (SKPT) in AA recipients. The objective of this study was to compare the outcomes of SKPT in AA patients to matched Caucasian patients as controls. METHODS: From January 1996 to September 1999, we performed 79 SKPTs, including 10 in AA recipients. Ten Caucasian controls were selected and matched for age, gender, weight, timing and technique of transplantation, and immunosuppressive regimen. Clinical outcomes were collected and compared between the two groups. RESULTS: The two groups were well matched for donor and recipient demographic, immunologic and transplant characteristics, including 2 patients in each group with type 2 diabetes. All patients received tacrolimus (TAC), mycophenolate mofetil (MMF) and steroids, and about half in each group received antibody induction therapy. Patient survival was 100% in both groups with a mean follow-up of 18 months (range 6 47). Kidney and pancreas graft survival rates were both 80% in the AA and 100% in the Caucasian groups, respectively (p = 0.14). All but one kidney (in the AA group) and all pancreas grafts experienced immediate function. There were two immunologic kidney and two immunologic pancreas graft losses in the AA group. No grafts were lost due to technical problems. The mean length of initial hospital stay was 16 d in the AA group compared to 10 d in the Caucasian group (p = 0.07). The AA group had a slight increase in the number of readmissions (mean 2.2 AA vs. 1.6 Caucasian, p = 0.08). The incidence of biopsy-proven pancreas acute rejection was significantly higher in the AA group (50%) compared to the Caucasian group (10%) (p = 0.05). The incidence of either kidney or pancreas acute rejection was also higher in the AA group (60% AA vs. 20% Caucasian, p = 0.06). TAC levels were comparable at specific times after transplantation, al-though there was a trend toward higher doses of TAC in the AA group to achieve therapeutic levels. The incidences of relaparotomy (30% AA vs. 20% Caucasian) and major infection (40% AA vs. 60% Caucasian) were similar between groups. Renal and pancreas allograft functions were comparable between groups at specific times after transplantation. CONCLUSIONS: These results suggest that SKPT in AA recipients may be associated with a higher incidence of rejection and immunologic graft loss compared to matched Caucasian controls.     

Validation of the language component of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for aphasia in stroke patients

Aim: Several tests are available for aphasia screening following stroke. However, some of them have shortcomings such as need of specialist knowledge, low sensitivity and/or specificity and lengthy administration time. Our study aims to evaluate the language component of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for aphasia in stroke patients. Methods: The language component of ACE‐R was administered to consecutive patients admitted to a post‐acute stroke unit. Patients who were medically unstable or had a significant history of sensory impairment or mental health issues were excluded. The test was administered by two junior doctors with basic training in ACE‐R administration. Patients recruited were also assessed by an experienced speech and language therapist (SLT). The results of the two assessments were documented by a different member of the team and the SLT results were used as the benchmark to calculate the ACE‐R language component sensitivity and specificity. Results: Fifty‐nine participants were recruited and 27 of them were women. The mean age was 72 (SD 11.9). Thirty‐four participants had left and 11 right hemisphere stroke. Fourteen had bilateral affection. Six participants were left handed. A cut‐off value of 22/26 of ACE‐R language component showed 100% specificity and 83.1% sensitivity, while a cut‐off value of 16/26 had 88.2% specificity and 100% sensitivity. Conclusion: Our results suggest that the language component of ACE‐R has a satisfactory sensitivity and specificity compared with other screening tests used in strokes. It is easy to administer and free to use.     

The Role of Serotonin (5-HT) in Behavioral Control: Findings from Animal Research and Clinical Implications

The neurotransmitters serotonin and dopamine both have a critical role in the underlying neurobiology of different behaviors. With focus on the interplay between dopamine and serotonin, it has been proposed that dopamine biases behavior towards habitual responding, and with serotonin offsetting this phenomenon and directing the balance toward more flexible, goal-directed responding. The present focus paper stands in close relationship to the publication by Worbe et al. (2015), which deals with the effects of acute tryptophan depletion, a neurodietary physiological method to decrease central nervous serotonin synthesis in humans for a short period of time, on the balance between hypothetical goal-directed and habitual systems. In that research, acute tryptophan depletion challenge administration and a following short-term reduction in central nervous serotonin synthesis were associated with a shift of behavioral performance towards habitual responding, providing further evidence that central nervous serotonin function modulates the balance between goal-directed and stimulus-response habitual systems of behavioral control. In the present focus paper, we discuss the findings by Worbe and colleagues in light of animal experiments as well as clinical implications and discuss potential future avenues for related research.     

Hemolytic anemia in COVID-19

Annals of Hematology - COVID-19 is a global pandemic triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 entry point involves the interaction with...     

An outbreak of tuberculosis in the South West of England related to a public house.

There had been a continuous decline in Mycobacterium tuberculosis infection (TB) during the last century until the trend plateaued in the mid-1980's and started to increase in the early 1990's in the United Kingdom (UK). In England and Wales the incidence of TB has increased by 11% between 1993 and 1998 with an overall incidence equal to 10.9/100,000 population. In the South West (SW) of England the incidence of TB is less than the UK average (4.6/100,000). We report an outbreak of TB in the SW of England which was based around a local public house. Sixteen patients received treatment and thirteen received chemo-prophylaxis. Using a rapid IS6 110- based PCR and Restricted Fragment Length Polymorphism Method, all mycobacteria isolated were shown to be identical, and all cultures were sensitive to the usual anti-mycobacterial drugs. All patients were white Caucasians and none were from high risk groups. Despite the absence of conventional close household contacts a significant number of secondary cases were detected. Possible links between TB cases should be considered even in areas of low prevalence.     

Detecting EGFR alterations in clinical specimens—pitfalls and necessities

We investigated the epidermal growth factor receptor (EGFR) status in early stage lung cancer in Southern Sweden, a population for which there are no previous reports on the EGFR mutation frequency. Three hundred fifty small cell lung cancers, adenocarcinomas (AC), squamous cell carcinomas (SqCC), and large cell carcinomas were analyzed using a combination of techniques for the analysis of protein expression, gene copy numbers, and mutations. Immunohistochemical (IHC) staining with antibodies for the EGFR mutations L858R and del E746-A750 revealed intratumoral heterogeneity and several discrepant cases when compared to mutation-specific polymerase chain reaction (PCR)-based analysis. The frequencies of these two mutations, when considering IHC staining with mutation-specific antibodies in a cohort of 298 cases and subsequent confirmation by PCR, were 10 % in AC and <2 % in SqCC. Furthermore, screening by sequencing of EGFR in a cohort of 52 lung AC and squamous carcinomas demonstrated a more diverse mutation spectrum, not covered by the mutation-specific antibodies. High expression of total EGFR protein was correlated to high gene copy numbers but did not reflect the mutational status of the tumors. We believe that the mutation spectra in a Southern Swedish population is too diverse to be covered by the mutation-specific antibodies, and we also raise some other issues regarding the use of the mutation-specific antibodies, for example concerning heterogeneous expression of the mutated protein, optimal antibody dilution, and discrepancies between staining results and PCR.