Neuropsychiatric symptoms in systemic lupus erythematosus: impact on quality of life.

Objective Assess quality of life in patients with systemic lupus erythematosus (SLE) presenting with neuropsychiatric symptoms (neuropsychiatric SLE, NPSLE). Methods Quality of life was assessed using the Short-Form 36 item Health Survey (SF-36) in patients visiting the Leiden NPSLE clinic at baseline and at follow-up. SF-36 subscales and summary scores were calculated and compared with quality of life of the general Dutch population and patients with other chronic diseases. Results At baseline, quality of life was assessed in 248 SLE patients, of whom 98 had NPSLE (39.7%). Follow-up data were available for 104 patients (42%), of whom 64 had NPSLE (61.5%). SLE patients presenting neuropsychiatric symptoms showed a significantly reduced quality of life in all subscales of the SF-36. Quality of life at follow-up showed a significant improvement in physical functioning role ( p = 0.001), social functioning ( p = 0.007), vitality ( p = 0.023), mental health ( p = 0.014) and mental component score ( p = 0.042) in patients with neuropsychiatric symptoms not attributed to SLE, but no significant improvement was seen in patients with NPSLE. Conclusion Quality of life is significantly reduced in patients with SLE presenting neuropsychiatric symptoms compared with the general population and patients with other chronic diseases. Quality of life remains considerably impaired at follow-up. Our results illustrate the need for biopsychosocial care in patients with SLE and neuropsychiatric symptoms.

Cloned mouse cells with natural killer function and cloned suppressor T cells express ultrastructural and biochemical features not shared by cloned inducer T cells.

We have examined the morphology, cytochemistry, and biochemistry of mouse leukocyte subsets by analyzing cloned leukocyte populations specialized to perform different immunologic functions. Cloned cells expressing high-affinity plasma membrane receptors for IgE and mediating natural killer (NK) lysis and cloned antigen-specific suppressor T cells contained prominent osmiophilic cytoplasmic granules similar by ultrastructure to those of mouse basophils. Both clones also incorporated 35SO4 into granule-associated sulfated glycosaminoglycans, expressed a characteristic ultrastructural pattern of nonspecific esterase activity, incorporated exogenous [3H]5-hydroxytryptamine, and contained cytoplasmic deposits of particulate glycogen. By contrast, cloned inducer T cells lacked cytoplasmic granules and glycogen, incorporated neither 35SO4 nor [3H]5-hydroxytryptamine, and differed from the other clones in pattern of nonspecific esterase activity. These findings establish that certain cloned cells with NK activity and cloned suppressor T cells express morphologic and biochemical characteristics heretofore associated with basophilic granulocytes. However, these clones differ in surface glycoprotein expression and immunologic function, and the full extent of the similarities and differences among these populations and basophils remains to be determined.

Mumps epidemiology in the mid-west of Ireland 2004-2008: increasing disease burden in the university/college setting.

Mumps is a contagious vaccine-preventable viral disease that is experiencing a revival in students attending second and third level colleges. Large mumps outbreaks have been reported in several countries despite the presence of childhood immunisation programmes over many years, including measles, mumps, and rubella (MMR) vaccination. In 2008, 1,377 cases of mumps were notified in Ireland and 1,734 in the first three months of 2009 (provisional data). This paper reviews the recent epidemiology of mumps in the Mid-West region of Ireland and highlights preventive measures. A substantial proportion of cases were not laboratory-confirmed and it is important that doctors continue to notify suspected cases. In the Irish Mid-West, data from enhanced surveillance shows a high proportion of mumps in the age group 15-24 years. Complications were uncommon and rarely severe. Where data were available, over half of the cases did not recall having received two doses of MMR, but most recalled one dose. Parents should continue to ensure children receive both MMR vaccinations so that uptake is optimal for protection. Steps were taken to increase awareness of the disease in the school, college and university settings. Preventive measures implemented to limit mumps transmission in the school/college setting over recent years included vaccination of close contacts, isolation for five days and hand hygiene.

Trends in genital chlamydia infection in the Mid-West of Ireland, 2001-2006.

Genital Chlamydia trachomatis (GCT) infection is the most common bacterial sexually transmitted infection (STI) in Ireland. A retrospective analysis of 2,087 laboratory-confirmed GCT patient episodes from 2001 to 2006 in the Mid-West of Ireland was undertaken in conjunction with statutorily notifiable data that were reported by the Sexually Transmitted Disease/Genito-Urinary Medicine (STD/GUM) services in the region and used in national surveillance. Data were analysed by year, source, sex and age. The annual incidence of GCT in the Mid-West is increasing. A substantial proportion of GCT infections were diagnosed in the non-STD/GUM setting. The issue of sexually active young people seeking STI screening is a sensitive one, and delays increase the potential for transmission and the possibility of long-term complications when the disease is not treated. Based on this sample, national surveillance would significantly underestimate the burden of disease in Ireland, due to under-reporting. This would have implications for any national chlamydia screening programme. Among those who sought testing, women aged 15 to 19 years are five times more likely to be found positive than men in the same age group. Of those diagnosed in the non-STD/GUM setting, 83% were women. General practitioners and clinicians might consider targeting those aged 15 to 29 years for opportunistic screening and sexual health advice. Contact tracing and follow-up in the non-STD/GUM setting, as well as access for general practitioners to ongoing education on STIs are challenges to be addressed.

A case of rivaroxaban-associated acute tubulointerstitial nephritis.

Rivaroxaban is a direct oral anticoagulant that is prescribed for the prevention and treatment of thromboembolisms. Rivaroxaban is cleared renally and a common side effect (1-10%) is renal impairment of unknown pathophysiology. We are the first to describe a case of biopsy-proven acute tubulointerstitial nephritis, most likely caused by rivaroxaban.

An Irish outbreak of New Delhi metallo-ß-lactamase (NDM)-1 carbapenemase-producing Enterobacteriaceae: increasing but unrecognized prevalence.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-ß-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases. AIM: To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures. METHODS: This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates. FINDINGS: This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 µg/mL. All were tigecycline susceptible (MICs ≤1 µg/mL). One isolate was colistin resistant (MIC 4.0 µg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected. CONCLUSION: The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk.

The incidence of S. aureus bacteraemia in acute hospitals of the Mid-Western Area, Ireland, 2002-2004.

Concerns about healthcare-associated infections and the global crisis in antimicrobial resistance has combined to accentuate the fears around so-called "superbugs". In Ireland there is no single agreed indicator regarded as a true measure of the level of methicillin resistant Staphylococcus aureus (MRSA) in hospitals. The objective of this study was to compare two crude measures of MRSA - the percentage of bacteraemia caused by MRSA and the incidence rate (per 1000 bed days used) of MRSA bacteraemia in six acute hospitals. We examined all blood cultures positive for S. aureus (methicillin sensitive and resistant) from 2002 to 2004 in the Health Service Executive (HSE) Mid-Western Area of Ireland. Hospital In-Patient Enquiry (HIPE) data was used to determine monthly in-patient bed days used. Of 245 patient episodes of bacteraemia, 119 were MRSA. The trends in the percentage of isolates that were MRSA and the incidence rate calculated were compared. The incidence rate appears to be a more reliable and robust indicator of MRSA in hospitals than the percentage. Despite many difficulties in interpreting indicators of MRSA they should not preclude the regular publication of data at least at regional level in Ireland.

The incidence of S. aureus bacteraemia in acute hospitals of the Mid-Western Area, Ireland, 2002-2004.

Concerns about healthcare-associated infections and the global crisis in antimicrobial resistance has combined to accentuate the fears around so-called "superbugs". In Ireland there is no single agreed indicator regarded as a true measure of the level of methicillin resistant Staphylococcus aureus (MRSA) in hospitals. The objective of this study was to compare two crude measures of MRSA--the percentage of bacteraemia caused by MRSA and the incidence rate (per 1000 bed days used) of MRSA bacteraemia in six acute hospitals. We examined all blood cultures positive for S. aureus (methicillin sensitive and resistant) from 2002 to 2004 in the Health Service Executive (HSE) Mid-Western Area of Ireland. Hospital In-Patient Enquiry (HIPE) data was used to determine monthly in-patient bed days used. Of 245 patient episodes of bacteraemia, 119 were MRSA. The trends in the percentage of isolates that were MRSA and the incidence rate calculated were compared. The incidence rate appears to be a more reliable and robust indicator of MRSA in hospitals than the percentage. Despite many difficulties in interpreting indicators of MRSA they should not preclude the regular publication of data at least at regional level in Ireland.

Crohn's disease: transmission electron microscopic studies. III. Target tissues. Proliferation of and injury to smooth muscle and the autonomic nervous system.

Transmission electron microscopy was done on surgical specimens from 12 patients with Crohn's disease and three control subjects. Nonulcerated involved areas of ileum as well as proximal, grossly uninvolved resection margins were chosen for study. Specimens for transmission electron microscopy were prepared by a variety of techniques and 112 blocks were examined by electron microscopy. The study was concentrated on two target tissues of the gut: the autonomic nervous system and the smooth muscle. Proliferative and injurious changes were found in each. Proliferation, myofibroblastic transformation, hypercontraction, and necrosis characterized the smooth muscle changes seen in Crohn's disease of the ileum. Autonomic nervous system changes included proliferation of axons containing dense core granules (catecholamines) and axonal necrosis. The possible pathogenetic significance of these changes is discussed here and in the accompanying article beginning on page 606 of this issue.

Crohn's disease: transmission electron microscopic studies. II. Immunologic inflammatory response. Alterations of mast cells, basophils, eosinophils, and the microvasculature.

Transmission electron microscopy was done using surgically resected specimens from 12 patients with Crohn's disease and three control subjects. Nonulcerated involved areas of ileum as well as proximal, grossly uninvolved resection margins were chosen for study. Specimens for transmission electron microscopy were prepared for viewing by a variety of techniques. Six hundred five Epon embedded blocks were studied by light microscopy, and 112 of these were viewed in the transmission electron microscope. Study of the immunologic inflammatory response revealed a number of changes of interest. The number of mast cells was markedly increased, and they were found predominantly in edematous submucosa and between smooth muscle cells in the muscular coats of the involved gut. Evidence of focal and complete degranulation of mast cells was frequently seen. Basophilic leukocytes, some of which had degranulated, were also identified. Another frequently encountered cell, the eosinophil, showed changes in the granules, which might reflect the release of eosinophil granule materials. Eosinophils also contained an increased number of small dense granules of the arylsulfatase containing type. Eosinophils, basophils, and mast cells formed close associations. Evidence of acute and chronic damage to vascular endothelia was present. Small lymphocytes, plasma cells, macrophages, and epithelioid cells were present. Multinucleated giant cells were infrequently encountered. Lymphoblasts, however, were rarely seen.

Crohn's disease. Ultrastructural studies showing basophil leukocyte granule changes and lymphocyte parallel tubular arrays in peripheral blood.

Buffy coat preparations from the peripheral blood of a 40-year-old woman with a six-year history of Crohn's disease were studied by electron microscopy. This patient did not receive treatment with prednisone, sulfasalazine, or azathioprine, and the blood samples for this study were taken prior to ileocolectomy. Four patients without Crohn's disease were studied as controls. In the circulating blood from the patient with Crohn's disease, there were several significant findings: lymphocytes that contained parallel tubular arrays were prominent, and degranulation was observed in the circulating basophilic leukocytes. These observations may be related to defective immunologic inflammatory processes in this disease, which is of unknown origin, and may lead to an understanding of some of the extraintestinal symptoms experienced by patients with Crohn's disease.

Metastatic adenocarcinoma of unknown primary site: diagnostic electron microscopy to determine the site of tumor origin.

Poorly differentiated malignant tumors and metastatic adenocarcinomas have been studied by electron microscopy. Rapid ultrastructural analysis allows the accurate diagnosis of the cell of tumor origin to be reported in conjunction with the routine surgical signout of paraffin sections. The identification of specialized intracellular structures is useful for determining the site of origin of metastatic tumors. Particularly useful in this material was the presence of lamellar (surfactant) bodies, typical of alveolar cell carcinoma of the lung, as well as the presence of apical terminal webs, diagnostic of gut epithelial cells.

Unusual inclusions in plasmacytoid cells. Their occurrence in a patient with Waldenström's macroglobulinemia.

The bone marrow from a patient with Waldenström's macroglobulinemia was studied, and histologic, immunopathologic, and ultrastructural features correlated. The infiltrating plasmacytoid lymphocytes contained PAS-negative cytoplasmic inclusions, which were shown to contain a specific immunoglobulin that matched the patients's circulating paraprotein. Electron microscopic studies revealed abundant dense fibrillar and globular material within dilated cisternae of rough endoplasmic reticulum. This material was morphologically similar to, but quantitatively different from, an endoplasmic reticulum-associated structure previously described in several patients with chronic lymphocytic leukemia. The differences between these fibrillar inclusions and Russell bodies are stressed.

Magnetic resonance imaging: practical theory and clinical relevance.

Magnetic resonance imaging can be a valuable diagnostic tool. Some fundamental concepts behind MRI are discussed, using clinical cases to illustrate the potential of this imaging system.

Hemifacial microsomia. Etiology, diagnosis and treatment.

BACKGROUND: Three percent of all newborns have significant structural anomalies. Hemifacial microsomia, or HFM, is the second most common facial anomaly, second only to cleft lip and palate. New therapeutic and clinical management techniques offer promising interventions that can allow many patients to have more normal childhoods at earlier ages. DESCRIPTION: Due to a unilateral deficiency of the mandible and lower face, patients who have HFM have specific dental needs that require restorative, orthodontic and surgical correction. CLINICAL IMPLICATIONS: Oral and maxillofacial malformations present diagnostic and treatment challenges unique to the dental profession. The etiology, diagnosis and treatment modalities discussed in this article can be used to help effectively rehabilitate patients who have HFM.

Automated extraction of lysergic acid diethylamide (LSD) and N-demethyl-LSD from blood, serum, plasma, and urine samples using the Zymark RapidTrace with LC/MS/MS confirmation.

A forensic procedure for the quantitative confirmation of lysergic acid diethylamide (LSD) and the qualitative confirmation of its metabolite, N-demethyl-LSD, in blood, serum, plasma, and urine samples is presented. The Zymark RapidTrace was used to perform fully automated solid-phase extractions of all specimen types. After extract evaporation, confirmations were performed using liquid chromatography (LC) followed by positive electrospray ionization (ESI+) mass spectrometry/mass spectrometry (MS/MS) without derivatization. Quantitation of LSD was accomplished using LSD-d3 as an internal standard. The limit of quantitation (LOQ) for LSD was 0.05 ng/mL. The limit of detection (LOD) for both LSD and N-demethyl-LSD was 0.025 ng/mL. The recovery of LSD was greater than 95% at levels of 0.1 ng/mL and 2.0 ng/mL. For LSD at 1.0 ng/mL, the within-run and between-run (different day) relative standard deviation (RSD) was 2.2% and 4.4%, respectively.

Periapical and localized radiopacities.

Anatomic conditions and pathologic entities that commonly present as periapical and solitary radiopacities are categorized according to radiographic appearance. Clinical criteria for establishing a differential diagnosis are presented, and the rationale behind treatment objectives is discussed.

Potential outcomes of clinical experience.

This exploratory study examined potential outcomes of clinical experience. Sixteen baccalaureate nursing students completed data collection instruments. The eight students in the control group completed the clinical course as prescribed in the curriculum; the eight students in the experimental group received no assigned clinical experience. The first hypothesis, that there would be an increase in the identification of accurate clinical nursing judgments as a result of clinical experience, was not supported. The second hypothesis, that there would be progress in the development of professional identity as a result of clinical experience, was not supported. Analysis of demographic and secondary data supports a conclusion that the learning outcomes of clinical experience have yet to be identified.

Nursing home employment: the nurse's aide's perspective.

1. Nurse's aides are an essential component of quality nursing home care. This study explores some of their opinions about their employment. 2. Despite the many individual demographic differences, the findings of this study indicate that nurse's aides as a group hold many similar opinions about what they like and dislike about their jobs. 3. Multiple factors affect the attitudes of nurse's aides toward their employment. 4. The findings of this study indicate that attachment to others (residents, co-workers) and a sense of personal gratification in the work itself are major themes associated with both retention and morale of nurse's aides.