Prevalence of Mycoplasma gallisepticum and Mycoplasma synoviae in commercial poultry,racing pigeons and wild birds in Belgium

Mycoplasma gallisepticum is the most important pathogenic avian Mycoplasma species and causes chronic respiratory disease in poultry. In addition, the prevalence of Mycoplasma synoviae is of increasing concern in several EU member states. We investigated the prevalence of M. gallisepticum in commercial poultry (5220 layers, 1224 broilers and 1020 meat turkeys), 56 racing pigeons and 890 wild birds (Order Anseriformes, Galliformes, Pelecaniformes, Accipitriformes, Gruiformes, Charadriiformes, Columbiformes, Strigiformes, Falconiformes and Passeriformes). Broilers and wild birds were also evaluated for Mycoplasma synoviae. Dependent on the bird lifespan and the nature of the sample, different diagnostic tests were used including the rapid plate agglutination test, enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction and real-time polymerase chain reaction. A low prevalence of M. gallisepticum was found in both layers (0.9%; 95% CI: 0.7–1.2%) and broilers (2.7%; 95% CI: 1.9–3.8%) possibly due to reduced vertical transmission by breeder farms, which are under official surveillance. None of the samples from turkeys or racing pigeons tested positive. In wild birds, we found five birds were positive (1.7%; 95% CI: 0.7–3.9%): one wood pigeon, two grey herons, one mallard and one Eurasian magpie. For M. synoviae a high prevalence was found in broilers (12.9%: 95% CI: 11.1–14.9%). Four samples collected by hunters gave a positive result for M. synoviae (4%: 95% CI: 1.6–9.8%): one carrion crow and three wood pigeons. In addition, 12 house sparrows were found to be positive (3%; 95% CI: 1.7–5.2%). Wild birds probably play a limited role as a reservoir but we cannot exclude a possible impact on transmission of Mycoplasmas.     

Lymphocytosis and chronic lymphocytic leukaemia: investigation and management

Lymphocytosis is a common blood-test finding. Establishing whether the cause of lymphocytosis is benign or malignant is key to managing patients appropriately. A lymphocytosis should always prompt clinical review including a thorough history, examination and appropriate preliminary investigations (blood tests, blood film). The majority of patients with chronic lymphocytic leukaemia (CLL) present incidentally due to a lymphocytosis found on routine blood tests. Patient outcomes vary considerably based on genetic pre-disposition and various prognostic markers (age, Binet or Rai staging, and B2-microglobulin). Although not curative, chemo-immunotherapy is an effective treatment strategy for the majority of CLL patients with progressive disease. More recently, novel oral therapies have been developed that target key signalling and apoptosis pathways and that are being used in relapse settings and as first-line treatments for certain patients.KEYWORDS: chronic lymphocytic leukaemia, haematology, lymphocytosis, investigation, management     

You never walk alone: An exploratory study of the needs and burden of an informal care group

Little is known about the dynamics of a group of people giving informal care together. The aim of this study was to investigate the characteristics of an informal care group, the obstacles the informal care group experiences, the needs and desires they have and how the informal care group can be supported by general practitioners (GPs) and other professionals. Nine informal care groups were interviewed based on a questionnaire that was preapproved by the six Flemish official informal caregiver organisations. The results were analysed using open coding. A survey was conducted among 137 caregivers who were part of a group. Univariate analysis was performed. Informal care group usually consist of close relatives of the patient, with often the partner of the patient as the main caregiver. The size of the informal care group depends on the size of the family. If there are more caregivers in a group, the perceived burden of the individual caregiver decreases. The support of the other caregivers in the group increases capacity. The cooperation and agreements are often spontaneously organised and few problems are reported. There is a large variation in the expectations of support from the general practitioner, ranging from availability in emergencies to information about the possibilities of formal home care. This study depicts a positive image of the informal care group. Being part of a caregiver group both decreases burden and increases capacity. Informal care groups usually function well without a need for formal agreements within the group, and they rarely need a third party to coordinate with them or intervene.     

平积汤加味联合三苯氧胺治疗子宫肌瘤并发乳腺增生临床研究

目的:探讨平积汤加味联合三苯氧胺对子宫肌瘤并发乳腺增生患者临床疗效、瘤体缩小程度及性激素水平的影响。方法:选取200例子宫肌瘤并发乳腺增生患者,按随机数字表法分为观察组与对照组,各100例。对照组给予三苯氧胺治疗,观察组则在对照组的基础上增加平积汤加味治疗。观察并比较2组治疗前后子宫、瘤体缩小程度,性激素水平[卵泡生成激素(FSH)、黄体生成素(LH)、雌二醇(E_2)]变化情况。结果:观察组总有效率为96.00%,对照组为83.00%,2组比较,差异有统计学意义(P0.05)。治疗前,2组子宫及肌瘤体积、FSH、LH、E_2水平比较,差异无统计学意义(P0.05)。与治疗前比较,治疗后2组子宫及肌瘤体积均明显缩小,FSH、LH水平均明显上升,E_2水平均明显下降,差异均有统计学意义(P0.05);观察组子宫及肌瘤体积显著小于对照组,FSH、LH水平显著高于对照组,E_2水平显著低于对照组,差异均有统计学意义(P0.05)。结论:平积汤加味联合三苯氧胺治疗子宫肌瘤并发乳腺增生疗效确切,可有效缩小子宫及肌瘤体积,改善性激素水平,具有较高的推广价值。     

Thrombocytopenia: the good,the bad and the ugly

New thrombocytopenia may be associated with a variety of conditions and diagnosis can be challenging. Presentation can vary from life-threatening bleeding or thrombosis to an incidental finding in an asymptomatic patient. New thrombocytopenia requires urgent investigation. Investigations are mainly guided by findings from the clinical history, physical examination, full blood count and blood film analysis. Aside from the actively bleeding patient, rare but life-threatening causes of thrombocytopenia must be identified early as they require urgent treatment. These include thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, suspicion of new acute promyelocytic leukaemia, and vaccine-induced prothrombotic immune thrombocytopenia. Here, we discuss how to approach a patient with new thrombocytopenia, along with key differentials not to be missed.KEYWORDS: thrombocytopenia, thrombosis, bleeding, platelets, haematology