One small step for stool, one giant leap for IBD surveillance

Inflammatory bowel diseases (IBDs) are chronic conditions in which the digestive tract undergoes cycles of relapsing and remitting inflammatory episodes that cause patients to experience severe abdominal pain, bleeding, and diarrhea. Developing noninvasive and cost-effective surveillance methods that can detect an ensuing disease bout proffers an avenue to improve the quality of life for patients with IBD. Now, a recent report describes an ingenious, economical approach using a rationally designed Escherichia coli strain that can dynamically monitor inflammation inside the mammalian gastrointestinal tract. The ability of the engineered probiotic to specifically discern between dormant and activated inflammatory states of the digestive system demonstrates that living biosensors can be used to monitor health status, thus providing a powerful proof of concept that heralds the arrival of a new age of clinical diagnostics for people living with inflammatory diseases of the gut.

Caught red feathered: infection from cockatoo to human and mice reveals genetic plasticity of Cryptococcus neoformans during mammalian passage

The fungus Cryptococcus neoformans is pervasive in our environment and causes the infectious disease cryptococcosis in humans, most commonly in immunocompromised patients. In addition to corroborating the avian origins of a case of cryptococcosis in an immunocompromised patient in 2000, a fascinating recent report has now characterized the genetic and phenotypic changes that occur in this C. neoformans during passage in mammalian hosts. Interestingly, mouse-passaged isolates showed differences in virulence factors ranging from capsule size, melanization, nonlytic macrophage exocytosis, and amoeba predation resistance as compared to the patient strain. Taken together, these results provide new insights about the relationship between mutations acquired during an infection and changes in virulence.

Forever young by Alpha(diversity)ville: restricting intestinal microbiome maturation stunts immune system development and increases susceptibility to infection

The microbiome is a keystone of adult gastrointestinal (GI) tract health, where it facilitates digestion, wards off pathogen colonization, and exerts a powerful influence on the physiological health of organs ranging from the brain to the kidneys. From its establishment at birth and through the initial years of childhood, the human microbiome is particularly dynamic, shifting in its composition and alpha (species) diversity to an adult profile as dietary sustenance transitions from milk-based sources to others such as solid food. An innovative study has now demonstrated how microbiome maturation is requisite both for the progression of immune system development and for long-term gut barrier function. These insights have significant ramifications for designing pediatric approaches to cultivate immune cell ontogeny in the formative stages of human infancy.

You shall not pass: how complement C5 mediated antifungal immunity blocks systemic candidiasis and preserves renal tissue barriers

The rising prevalence of fungal infections is a significant and growing public health threat, and this risk is further underscored by our incomplete understanding of why organs like the kidney are so susceptible to systemic candidiasis. To combat the high mortality of such infections, we urgently need to advance our understanding of fungal pathogenesis and how it articulates with human immune response. Now, a recent landmark study has illuminated a crucial role of the complement system in the response to candidiasis and determined the stepwise local response of phagocytes within the kidney during infection. These fundamental discoveries provide crucial insights that can be leveraged to improve the care and outcome for patients with fungal infections.

Central nervous system tumors in children

OBJECTIVES

To examine how pediatric and adult central nervous system (CNS) tumors differ and to discuss the unique aspects of diagnosis, treatment, and long-term effects of brain tumors in children.

DATA SOURCES

Research, review articles, book chapters, and abstracts.

CONCLUSIONS

A child's growing and developing body and brain place him or her at great risk for permanent damage as a result of traditional treatment methods. A family-centered nursing approach assists the child and family in coping with the impact of a brain tumor.

IMPLICATIONS FOR NURSING PRACTICE

Children have unique needs during and following treatment for CNS tumors. All oncology nurses need to be fully informed about and help monitor for intellectual, endocrinologic, and oncogenic late effects from the disease and treatment.

An argument for orogastric tubes during caesarean section

Routine orogastric aspiration of stomach contents during general anaesthesia for caesarean section was recommended in the latest triennial report on maternal deaths. We conducted a postal survey which revealed that the majority of obstetric units do not follow this guideline. Following the report, we aspirated the stomach contents of all our patients undergoing general anaesthesia for caesarean section and analysed the aspirate volume and pH. Despite routine antacid prophylaxis, a large proportion of our emergency patients remain at risk for aspiration pneumonia. We thus concur with the recommendation that the stomach should be aspirated during general anaesthesia for emergency caesarean section.

Nursing management of the infant with a congenital malignancy

Care of the newborn diagnosed with a congenital malignancy is a challenge for the neonatal intensive-care unit nurse. Malignancies found in infants differ from those found in older children. Nursing care of the neonate suspected or diagnosed with congenital malignancy includes standard practices and problem identification as well as interventions unique to the patient with cancer. This article reviews the incidence, diagnosis, treatment, and nursing management of neoplasms diagnosed in neonates.

Retinoblastoma: a hereditary tumor in children

Retinoblastoma, a malignant intraocular tumor of infancy and childhood, originates from primitive embryonal retinal cells. The cause of retinoblastoma is the loss or deletion of genetic information from the long arm of chromosome 13. Retinoblastoma has a hereditary form characterized by bilateral and multifocal tumors, and a nonheritable form that presents with a single tumor.

Similarities between the nursing care needs of children with cancer and children with human immunodeficiency virus infection

The incidence of human immunodeficiency virus (HIV)-related diseases among children is steadily increasing. The most common clinical manifestations of pediatric HIV infection are similar to those seen in childhood cancer. There are striking similarities between the care needs of these children and children with other chronic, potentially fatal diseases. Pediatric oncology nurses are among those who possess the knowledge and skills necessary to care for these children and their families. The interdisciplinary, holistic approach to caring for children with cancer is an excellent model for care of pediatric patients with acquired immunodeficiency syndrome.

Use of i.m. ranitidine for the prophylaxis of aspiration pneumonitis in obstetrics

Twenty patients who underwent elective Caesarean section received ranitidine 150 mg by mouth 8-14 h, and 50 mg i.m. 90 min, before surgery. Intraoperative gastric aspiration resulted in contents with a pH greater than 2.5 and volume less than 25 ml in all patients (mean pH 6.5 (SD 0.8); mean volume 9.0 (SD 7.2) ml). Sixty patients in labour, who received ranitidine 50 mg i.m. 6-hourly, underwent emergency surgery. Half of this group received, in addition, a single preinduction dose of either 15 or 30 ml of sodium citrate 0.3 mol litre-1. A further 30 patients who remained unmedicated during labour and required emergency surgery received a preinduction dose of 15 or 30 ml of sodium citrate 0.3 mol litre-1 alone. Ranitidine medication resulted in a mean aspirated gastric volume of 31.4 (26.6) ml and pH of 5.3 (2.1); five of 30 patients had a pH less than 2.5. The addition of sodium citrate 0.3 mol litre-1 resulted in gastric pH greater than 2.5 in all patients and a mean gastric volume of 43.2 (38.3) ml. The group who received only sodium citrate 0.3 mol litre-1 had a mean pH of 5.3 (1.1) and a mean volume 122.7 (98.2) ml.

One hundred cases of anaesthesia for extracorporeal shock wave lithotripsy

One hundred cases of anaesthesia for Extracorporeal Shock Wave Lithotripsy (ESWL) are described. Epidural or general anaesthesia was used. Anaesthetic complications were mainly cardiovascular, namely hypotension and bradycardia. With increased experience, it was noted that the use of minimal concentrations of general anaesthetic agents, or epidural anaesthesia supplemented with ephedrine, decreased the incidence of these problems. There was a low incidence of nausea or vomiting or analgesic requirements postoperatively, and the average length of stay in hospital postoperatively was 3 days.

Psychological assessment of the adolescent with cancer

Pediatric oncology nurses are often faced with the difficult task of assessing the psychological symptoms of adolescents with cancer and determining when referral to a mental health specialist is needed. Such professionals are called upon to determine whether a teenager's difficulties reflect transient turmoil associated with adaptation to the illness which would respond to support and reassurance, or whether psychological disturbance is present which demands more intensive intervention. In making this decision, the health provider must carry out an evaluation which takes into account the adolescent's special psychological concerns as well as the nature of the presenting symptoms. This paper presents a conceptual framework to be used by the nurse clinician in evaluating the psychological functioning of adolescents with cancer.