Malaria and acute kidney injury.

Malaria is a parasitic infection transmitted by mosquitos, resulting in significant morbidity and mortality. It affects 212 million worldwide, causing death in up to 303,000 children annually. In the USA, up to 1700 people are affected yearly. Although the prevalence in developed countries is less than in developing countries, travelers from low transmission areas, and those from endemic areas who later return, are very susceptible to malaria and its complications. Severe malaria can cause significant multiorgan dysfunction including acute kidney injury (AKI). The pathogenesis is not clearly understood but proposed mechanisms include acute tubular necrosis (ATN) due to impediments in renal microcirculation, infection-triggered proinflammatory reactions within the kidney, and metabolic disturbances. Providers must consider malarial infection in cases of AKI in someone with a travel history, as early recognition and treatment are crucial to improving outcomes. This article will review malaria-induced AKI in order to provide a better understanding of this infection's effect on the kidneys.

Familial chronic lymphocytic leukemia in Israel: A disproportionate distribution among Ashkenazi Jews.

BACKGROUND: Relatives of patients with chronic lymphocytic leukemia (CLL) are at increased risk of developing CLL. Familial CLL is defined as more than one case of CLL among blood relatives, a phenomenon reported in approximately 5%-10% of all CLL patients. OBJECTIVE: Given the known predisposition of CLL among Ashkenazi Jews, we studied the features of familial CLL in an Israeli population. METHODS: This is a retrospective study, in which we reviewed the demographics, clinical characteristics, and outcomes of a total of 332 patients with CLL/small lymphocytic lymphoma. RESULTS: Familial CLL was recorded in 41 cases (12.3%) of the patients. The age at diagnosis was younger in patients with familial CLL (by almost 3.5 years). Familial CLL was strongly associated with Ashkenazi Jewish origin. Patients with familial CLL more commonly presented with higher hemoglobin and lower serum ß-2-microglobulin levels. No significant differences were detected between sporadic and familial CLL in disease stage, time to treatment, second cancers, or overall survival. CONCLUSION: Familial cases of CLL in an Israeli population show a disproportionate ethnic distribution toward Jews of Ashkenazi origin. The clinical characteristics and the overall outcome are not substantially different from sporadic cases.

Integration of capillary microscopy and dermoscopy into the rheumatology fellow curriculum.

OBJECTIVES: This study evaluates a novel, three-part nailfold capillaroscopy training curriculum for adult and paediatric rheumatology fellows. METHODS: All rheumatology fellows training at an academic medical centre took part in the three-part nailfold capillaroscopy curriculum. Tests of fellows' usage, interest, confidence, and ability in nailfold capillaroscopy were taken at multiple time-points throughout the curriculum. RESULTS: Fellows self-reported high levels of interest, increased confidence in delineating normal and abnormal nailfold capillaries (p=0.03) and increased usage of nailfold capillaroscopy (p=0.09). The ability of fellows to identify normal nailfold capillaries (p=0.03) and systemic sclerosis-specific nailfold capillary changes, such as neoangiogenesis (p<0.001), also increased. CONCLUSIONS: The curriculum was feasible and led to improved ability of learners to distinguish normal from abnormal and to recognise and describe systemic sclerosis-specific nailfold capillary changes. This curriculum also led to improved confidence in examining nailfold capillaries and increased usage of this skill in rheumatologic consultation.