Typhoid Fever Complicated by Rhabdomyolysis with Acute Hepatitis, Splenic Infarct, Pancreatitis, and Acute Kidney Injury

Typhoid fever is a potentially life-threatening infectious disease that presents itself with a wide array of symptoms ranging from uncomplicated fever to sepsis with multiorgan dysfunction syndrome. An 18-year-old male college student presented with progressively increasing fever with abdominal discomfort, anorexia, and persistent vomiting. Typhoid fever was suspected in view of clinical findings along with leukopenia, grossly elevated transaminases, and acute kidney injury. He was managed with intravenous (IV) antibiotics, which resulted in the resolution of fever and other symptoms. Rhabdomyolysis is an extremely rare complication in typhoid fever, which is a very common cause of fever in tropical countries, leading to acute renal failure, causing very high morbidity and mortality.

Under-mask beard cover (Singh Thattha technique) for donning respirator masks in COVID-19 patient care

Tight-fitting filtering facepiece (FFP3) face masks are essential respiratory protective equipment during aerosol-generating procedures in the coronavirus disease 2019 (COVID-19) environment, and require a fit test to assess mask–face seal competency. Facial hair is considered to be an impediment for achieving a competent seal. We describe an under-mask beard cover called the Singh Thattha technique, which obtained a pass rate of 25/27 (92.6%) by qualitative and 5/5 (100%) by quantitative fit test in full-bearded individuals. Sturdier versions of FFP3 were more effective. For individuals for whom shaving is not possible, the Singh Thattha technique could offer an effective solution to safely don respirator masks.

Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study

Background

There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries’ cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women.

Methods

A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders.

Results

Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya’s healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity.

Conclusions

Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya.

Knowledge, Attitudes, and Behavior of Nigerian Students Toward Organ Donation

BACKGROUND

The Nigerian transplantation program is evolving but is currently over-reliant on living donors. If deceased donation is to be viable in Nigeria, it is important to ascertain the views of the public. The objective of the study was to explore the knowledge, attitudes, and behavior of Nigerian international students toward organ donation.

METHODS

A cross-sectional study was conducted among Nigerian international students of the University of Bedfordshire through the use of a modified self-administered questionnaire. The participants were recruited by means of purposive sampling.

RESULTS

Of the 110 questionnaires distributed, 103 were returned fully completed (response rate = 93.6%). A significant majority (93.2%) of the participants are aware of organ donation, and 76.7% have a good knowledge on the subject. Furthermore, more than half (52.8%) of the participants have a positive attitude toward organ donation, and less than half (42.8%) have favorable behavior toward it. Higher knowledge does not correlate to either positive attitude or behavior, but a positive attitude is correlated with favorable behavior toward donation.

CONCLUSIONS

The attitudes and behavior of the respondents toward organ donation is not commensurate with the level of knowledge they possess. This highlights the urgent need for well-structured educational programs on deceased organ donation.

The Potential Role of Social Capital in the Willingness to be a Deceased Organ Donor: A Case Study of UK Polish Migrants

BACKGROUND

In the United Kingdom, the demand for transplantable organs exceeds supply, leaving many patients on the active transplant waiting list with the majority on dialysis as the kidney is the most commonly transplanted organ. This is a marked issue across black, Asian, and minority ethnic communities. This article uses the Polish migrant community as a case study for making new theoretical insights into the willingness to become an organ donor in a host country using social capital theory.

METHODS

There were 31 participants who took part in interviews and small group discussions. Grounded theory methodology was used as the study explored the relationships between deceased organ donation, religion, and Mauss's gift-exchange theory and the notion of social capital arose as an emergent theme from the study.

RESULTS

Elements of social capital were explored with participants such as social networks, civil engagement, trust, and reciprocity. Polish social networks were found to be small and the formation of networks to be influenced by English language skills. Participants were willing to donate organs to others inside and outside of their social networks in the United Kingdom and wanted to help a patient in need and influenced by the overall migrant experience in the United Kingdom and whether they felt a sense of belonging. Overall, participants had mixed experiences and views about trust in the National Health Service.

CONCLUSIONS

Through a discussion of the results using a communitarian social capital, cognitive and structural social capital lens, and collective-action theory, it is concluded that an interplay of these social capital theories can reframe debates within organ donation such as reciprocity policies, the relevancy of altruism, and the role of migration experiences and networks in the willingness to donate organs posthumously in a host country.

Role of Religion in Organ Donation-Development of the United Kingdom Faith and Organ Donation Action Plan

At a national policy level, the United Kingdom is at the forefront of recognizing the role of faith and its impact on organ donation. This is demonstrated by the recommendations of the Organ Donation Taskforce, National Institute for Clinical Excellence guidelines on organ donation, All-Party Parliamentary Kidney Group, and National Black, Asian and Minority Ethnic Taskforce Alliance. Evidence to date shows that further thought is required to ensure the active engagement of faith communities with organ donation in the UK. The "Taking Organ Transplantation to 2020" strategy was launched in July 2013 by National Health Service Blood and Transplant (NHSBT) in collaboration with the Department of Health and Welsh, Scottish, and Northern Irish governments and seeks to increase the number of people, from all sections of the UK's multiethnic and multifaith population, who consent to and authorize organ donation in their life. NHSBT seeks to work in partnership with faith leaders and this culminated in a Faith and Organ Donation Summit. Faith leaders highlight that there is a need for engagement at both national and local levels concerning organ donation as well as diagnosis and definition of death.

A study of urgent and emergency referrals from NHS Direct within England

OBJECTIVES

The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-based healthcare can manage urgent and emergency care.

SETTING

NHS Direct, England, UK PARTICIPANTS: NHS Direct anonymised call data (N=1,415,472) were extracted over a representative 1-year period, during the combined month periods of July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269,558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ(2) test of independence with cross-tabulations used to test within-group differences.

PRIMARY AND SECONDARY OUTCOME MEASURES

Urgent and emergency referrals to 999; accident and emergency or to see a general practitioner urgently, which are expressed as call rate per 100 persons per annum. Outcomes related to symptom variations by patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day).

RESULTS

Urgent and emergency referrals varied by a range of factors relating to call, patient and symptom characteristics. For young children (0-4), symptoms related to 'crying' and 'colds and flu' and 'body temperature change' represented the significantly highest referrals to 'urgent and emergency' health services symptoms relating to 'mental health' alongside 'pain' and 'sensation disorders' represented the highest referrals to urgent and emergency health services for adults aged 40+ years.

CONCLUSIONS

This study has highlighted characteristics of 'higher likelihood' referrals to urgent and emergency care through the delivery of a national nurse-led telephone healthcare service. This research can help facilitate an understanding of how patients engage with both in and out of hours care and the role of telephone-based healthcare within the care pathway.

Altruism, gift giving and reciprocity in organ donation: a review of cultural perspectives and challenges of the concepts

Living and deceased organ donation are couched in altruism and gift discourse and this article reviews explores cultural views towards these concepts. Altruism and egoism theories and gift and reciprocity theories are outlined from a social exchange theory perspective to highlight the key differences between altruism and the gift and the wider implications of reciprocation. The notion of altruism as a selfless act without expectation or want for repayment juxtaposed with the Maussian gift where there are the obligations to give, receive and reciprocate. Lay perspectives of altruism and the gift in organ donation are outlined and illustrate that there are differences in motivations to donate in different programmes of living donation and for families who decide to donate their relative's organs. These motivations reflect cultural views of altruism and the gift and perceptions of the body and death.

Young people's use of NHS Direct: a national study of symptoms and outcome of calls for children aged 0-15

OBJECTIVES

National Health Service (NHS) Direct provides 24/7 expert telephone-based healthcare information and advice to the public in England. However, limited research has explored the reasons to why calls are made on behalf of young people, as such this study aimed to examine call rate (CR) patterns in younger people to enable a better understanding of the needs of this population in England.

SETTING

NHS Direct, England, UK.

PARTICIPANTS AND METHODS

CRs (expressed as calls/100 persons/annum) were calculated for all calls (N=358 503) made to NHS Direct by, or on behalf of, children aged 0-15 during the combined four '1-month' periods within a year (July 2010, October 2010, January 2011 and April 2011). χ² Analysis was used to determine the differences between symptom, outcome and date/time of call.

RESULTS

For infants aged <1, highest CRs were found for 'crying' for male (n=14, 440, CR=13.61) and female (n=13 654, CR=13.46) babies, which is used as a universal assessment applied to all babies. High CRs were also found for symptoms relating to 'skin/hair/nails' and 'colds/flu/sickness' for all age groups, whereby NHS Direct was able to support patients to self-manage and provide health information for these symptoms for 59.7% and 51.4% of all cases, respectively. Variations in CRs were found for time and age, with highest peaks found for children aged 4-15 in the 15:00-23:00 period and in children aged <1 in the 7:00-15:00 period.

CONCLUSIONS

This is the first study to examine the symptoms and outcome of calls made to NHS Direct for and on behalf of young children. The findings revealed how NHS Direct has supported a range of symptoms through the provision of health information and self-care support which provides important information about service planning and support for similar telephone-based services.

The changing face of donation in the UK: kidney donation after circulatory death

Affiliated to the Association of Surgeons in Training and the British Transplantation Society, the Carrel Club is the transplant trainee surgical society. The Carrel Club held a joint meeting with the Chapter of Transplant Surgeons, a subsidiary organisation of the British Transplantation Society, at the Manchester Hilton Hotel on 31 January and 1 February 2013. As part of the meeting, ten abstracts were presented. A selection is printed below. The winner of the Best Presentation award was Mr Mownah.

An examination of concordance and cultural competency in the diabetes care pathway: South Asians living in the United Kingdom

The Care Pathway project used a multilevel and multimethod approach to explore access to the care pathway for diabetic renal disease. Taking what was known about the outcomes of ethnic minority patients with diabetic renal disease; the study sought to explore and further understand how and why South Asian patients’ experiences may be different from the majority of population in relation to access. Through improved understanding of any observed inequalities, the study aimed to inform the development of culturally competent diabetes services. The design incorporated audits of patient indicators for diabetes and renal health at key points in the pathway: Diagnosis of diabetes and referral to specialist renal services in two years- 2004 and 2007, and qualitative individual interviews with patients and providers identified through the 2007 samples. This article describes the care provider perspective of access to diabetes care from a thematic analysis of 14 semistructured interviews conducted with professionals, at three study sites, with different roles in the diabetes pathway. National policy level initiatives to improve quality have been mirrored by quality improvements at the local practice level. These achievements, however, have been unable to address all aspects of care that service providers identified as important in facilitating access to all patient groups. Concordance emerged as a key process in improving access to care within the pathway system, and barriers to this exist at different levels and are greater for South Asian patients compared to White patients. A conceptual model of concordance as a process through which access to quality diabetes care is achieved and its relation to cultural competency is put forward. The effort required to achieve access and concordance among South Asian patients is inversely related to cultural competency at policy and practice levels. These processes are underpinned by communication.

Concordance facilitates access in diabetes care--service provider perspectives of service improvement and cultural competency

AIMS

Inequalities between different ethnic groups in diabetes care and outcomes are well documented in the UK. This research sought to explore and understand how national and local policy interventions impacted upon access and the development of culturally competent diabetes services from the care provider perspective.

METHODS

This paper describes the care provider perspective of access to diabetes care in ethnically mixed populations from a thematic analysis of 14 semi-structured interviews conducted with professionals, at three study sites, with different roles in the diabetes care pathway.

RESULTS

National policy level initiatives to improve quality have led to quality improvements at a practical level. These achievements, however, have been unable to address all aspects of care that service providers identified as important in facilitating access for all patient groups. Concordance emerged as a key process in improving access to care within local systems and barriers to this exist at different levels and are greater for some groups of patients compared with others.

CONCLUSIONS

Concordance is a key concept that underpins access and cultural competency in diabetes service improvement. A focus on concordance at different levels within local systems may improve access to quality diabetes care for ethnic minority groups.

THE CHALLENGE OF KIDNEY TRANSPLANTATION AMONG MINORITY ETHNIC GROUPS IN THE UK

The increased rate of renal failure secondary to diabetes among minority ethnic groups compared to Caucasians in the UK has been well documented. However, the impact of this phenomenon on kidney transplant services has been relatively unexplored. The Government has recently published its 'Tackling Health Inequalities: A Programme for Action' report which emphasises the importance of reducing health inequalities at all levels of the health service. This article provides a timely review of the UK's national transplant database examining the provision of kidney transplant services to minority ethnic groups in the United Kingdom. It seeks to explore the demographics of the database by focusing upon waiting list data, donor data, and recipient data. Inequalities do currently exist in transplant services and the solutions to rectifying this situation are complex. However, the financial and human burden of not addressing these inequalities encourages some immediate action.

Caring for older adults with diabetes mellitus: characteristics of carers and their prime roles and responsibilities

AIMS

Expanding prevalence of diabetes has a major health impact on older people and the burden experienced by their informal carers. We report research which aimed to examine the burden on carers and highlight their input into diabetes care.

METHODS

Of 98 diabetes patients aged over 59 years, 89 regularly received help with day-to-day activities or looking after from someone else and, of these, 83 carers consented to interview. Patients and carers were administered questionnaires related to the management of diabetes and personal strain (including Diabetes Knowledge Questionnaire, EuroQol, Caregiver Strain Scale and General Health Questionnaire).

RESULTS

A substantial unmet need of older people with diabetes mellitus, in relation to domestic activities and diabetes care, was highlighted. Patient and carer diabetes knowledge was low. Primary carers were generally female relatives from the same household, not in paid employment. Twenty-seven carers (33%) provided > or = 35 h of care work each week. Most carers experienced a moderate level of stress, but 11 (14%) regularly felt overwhelmed. Thirty-three carers (40%) said they had never received any information on diabetes from professionals. Help most frequently wanted was advice and support in relation to accessing community services and about finances, benefits and/or allowances.

CONCLUSIONS

Both patient and carer diabetes education strategies are required. Instruction for carers in the basic care of patients with diabetes is also needed and should be targeted. As many as one in seven carers felt regularly overwhelmed and lacked adequate support. Finally, 26 carers (31%) were entitled to benefits which they did not claim.

Commentary on de Cock Buning: a United kingdom perspective

de Cock Buning (1998) highlighted the existence of alternative and more favorable options available to xenotransplantation. Clearly, there is a need to emphasize a review of existing organ procurement programs worldwide. A tree interest in the welfare of animals encourages increased liaison between transplant communities throughout the world to discuss the experiences of various procurement programs.

The meanings of cancer and perceptions of cancer services among South Asians in Luton, UK

Recent research has suggested that there is limited awareness of and information about cancer and cancer services among South Asian communities. This study explores the meanings of cancer and perceptions of cancer services among South Asians living in Luton. Six single-sex focus groups were conducted among the three main South Asian groups in Luton: (1) Punjabi-speaking Muslims originating from Pakistan (Pakistani Punjabi); (2) Sylheti-speaking Muslims originating from Bangladesh (Bangladeshi Sylheti); and (3) Punjabi-speaking Sikhs originating from the Indian Punjab (Indian Punjabi). Overall, it was found that the information relating to cancer for South Asian communities was limited. Participants in the study expressed a keen desire for this information to be made available via their community social networks. This lack of information resulted in low levels of awareness about cancer and related issues. Cancer was often perceived as an incurable disease, a reflection of the fact that access to appropriate services had been experienced at a relatively late stage of the illness. Informed education, therefore, is clearly essential to influence how people manage cancer and access cancer services. This paper describes the challenges that service providers and users face in ensuring effective and informed awareness.

Conducting focus groups for health research among Asian communities: insights and experiences

An exploratory qualitative study was undertaken in Luton to examine the issues that may underlie the severe shortage of organ donors from the United Kingdom's (UK) Asian population. To date, this subject area had not been researched within this sub-population of the UK. Thus, focus groups were employed as the initial stage of research to pre-test the applicability and validity of questions used in empirical studies undertaken within other cultural groups, and to allow the opportunity for new and unexpected issues to emerge. These focus groups also allowed us to gauge the response of conducting research on a sensitive topic among the Asian communities in Luton. The processes involved in conducting focus group discussions among Asian communities, and in using the subsequent findings to inform a semi-structured questionnaire, are discussed.

The UK's Asian population: solving the transplant crisis

The United Kingdom Transplant Authority has recently re-introduced a policy to identify the ethnicity of patients. This is in response to the realisation byTransplant Co-ordinators and other health professionals in the field that a number of disparities existed between Asian residents and the indigenous population. The limited data that exists highlights that the Asian population are in a disproportionately greater need of kidney transplants. The situation is clear, there needs to be a greater number of donors coming forward from the Asian communities to increase the pool of suitable organs. However, this may only be achieved if we understand the reasons for the current lack of supply. Very little empirical research has been devoted to this subject and those studies, which have been carried out, highlight the need for greater attention to this life-threatening problem.

The changing nature of organ procurement policies and the implications for the UK

The shift away from socialized forms of welfare over the past twenty years has changed the symbolic basis on which bodily parts are exchanged. Titmuss viewed the newly-formed National Health Service in the United Kingdom as a vehicle for institutionalizing altruistic practices, notably the voluntary "gift" of blood to strangers represented by the transfusion service. More recent advances in medical technology have made new forms of bodily tissue donation possible, including the transplantation of whole organs. Yet the excess of demand over supply is forcing a change from the principle of voluntarism on which "opting-in" procurement arrangements have hitherto rested to one of presumed consent and the system of "opting-out" adopted in other countries. The implications of this transition within the context of late twentieth century multi-cultural Britain are examined.

Awareness and attitudes towards organ donation and transplantation among the asian population. A preliminary survey in Luton, UK

Currently the demand for transplant organs, particularly kidneys, far outstrips the supply in the UK. This problem is particularly severe for the Asian population, which has been shown to have a disproportionately large representation on kidney-transplant waiting lists in some regions of the UK. The situation is clear: there is an urgent need to address the number of Asians requiring a kidney transplant, otherwise the human and economic costs will be very high. An exploratory qualitative study was therefore undertaken with the aim of assessing current awareness of organ donation and transplantation and to explore attitudes towards these issues in a cross section of the Asian population in Luton. It was found that nearly half of the respondents in this survey did not know what a donor card was used for, and approximately half of these had never seen one; only 6 of the 64 people interviewed had heard of the National Donor Register. Of the three people who carried a donor card, two had an immediate family member who had received a transplant. This suggests that media campaigns aimed at attracting donors from the Asian population have had limited success thus far. It appears that the vast majority of the Asian population is at the initial stage of the process of making a decision about donating their organs, that of simply knowing that transplantation takes place. Very little debate of pertinent issues seems to have taken place, which is essential for reaching a decision on whether or not to donate an organ. The study should be seen as exploratory but is nonetheless an important initial step towards the establishment of a greater knowledge and understanding of the issues affecting the low donation rate in the Asian population.

The presence of the Rb c-box peptide in the cytoplasm inhibits p210bcr-abl transforming function

In order to test if the carboxyl terminal polypeptide of the Retinoblastoma (Rb) tumor suppressor protein, could be used to suppress the growth factor-independent growth phenotype of p210bcr-abl positive myeloid cells, we introduced a truncated form of the 3' end of the Rb cDNA encoding its last 173 amino acid residues (Rb C-box) which localize into the cytoplasm where the p210bcr-abl transforming protein is found, into myeloid cells (32D) which depends on the p210bcr-abl protein for IL3 growth factor-independent growth (32D-p210). The expression of the plasmid vectors carrying the Rb C-box cDNAs was shown to inhibit the abl tyrosine specific protein kinase activity of the p210(bcr-abl) oncoprotein and to suppress the IL3-independent growth phenotype of the 32D-p210 cells. The Rb C-box polypeptides did not suppress the growth of the untransfected 32D parental cell line in methylcellulose in the presence of IL3-conditioned medium. These results suggest that the cytoplasmic localization of the p210(bcr-abl) allows it to escape the effect of intranuclear proteins such as Rb which negatively regulate the p145(c-abl) kinase.

Informing the UK's South Asian communities on organ donation and transplantation

There is a growing demand for human organs for transplantation, particularly of the kidney among the UK's South Asian population which, due to problems with histocompatibility can only be met with a significant increase in the number of Asian donors. Specific attempts have only recently been made to attract donors from South Asian communities using 'ethnically-targeted mass media'. A recent pilot study sought to evaluate the effectiveness of these initiatives in providing information with regards to organ donation for the South Asian population. The findings show that detailed information related to transplantation activity had been learned only through the experience of people undergoing transplants within the community and has been transmitted through various informal networks rather than through the resources provided by the Department of Health. This paper provides an overview of who the South Asians are and how these community networks were established.

An exploratory study examining the influence of religion on attitudes towards organ donation among the Asian population in Luton, UK

Currently the demand for transplant organs far outstrips the supply in the UK. This problem is even more severe for the Asian population, who have been shown to be disproportionately over-represented on transplant waiting lists in some regions of the UK. Several commentators have suggested that religious and cultural traditions may be the major determinant preventing Asians from donating organs. An exploratory qualitative study was undertaken with the aim of examining the influence of religious beliefs, amongst other things, on the extent and direction of public attitudes towards organ donation in a cross-section of the Asian population in Luton. This study indicates that, in the population studied, culture and religion play a much less prohibitive part in determining the level of organ donation than previously suggested. However, there is a desire to be aware of the religious stances so that people can make a more informed decision. The emphasis should clearly been a reconsideration of the presently inadequate approaches to organ procurement and on devising and supplementing these with more appropriate ones. An example of the failure to inform effectively the relevant populations about important developments is that only two of the 32 Muslims in the survey had heard of the 'fatwa' by the Muslim Legislative Council permitting organ donation.

Specialist nurse training programme: dealing with asking for organ donation

The issue of cadaveric organ transplantation is by its very nature emotional as it is associated with the very traumatic time of a loved one's death. Making a request for organs needs to be handled very sensitively by health professionals when discussing the issue with a family. Those nurses working in critical care areas are most likely to confront this issue and need to be equipped for dealing with ensuing events. The major challenge for the nurse is to address the concerns with brain death and organ donation in an environment of grief and sadness. Asking for organ consent is the most important element of all and needs to be done in the most sensitive manner, providing appropriate support to the donor family. To facilitate this process specialist training programmes in the nursing curriculum are imperative. Education programmes should incorporate presentations, role play situations and discussions based upon past experiences of organ requests. This would hopefully result in increased rates of donor consent and thereby a reduction in transplant waiting lists.

The impending kidney transplant crisis for the Asian population in the UK

Kidney transplantation offers the opportunity of an improved quality of life for those patients suffering from renal failure. Unfortunately, this treatment is not available to all people as this is influenced by the increasing demand for a limited supply of suitable organs. This situation is particularly alarming for the UK's Asian population with their higher susceptibility to end-stage renal failure which has resulted in a greater demand for transplants. Consequently, the proportion of Asians on transplant waiting lists is growing rapidly. Coupled with this are problems of cross-racial tissue type matching which has led to longer waiting times for a transplant. The situation is clear, there is an urgent need to address the number of Asians requiring a kidney transplant otherwise the human and economic costs will be very severe. In the short term there needs to be a greater number of donors coming forward from the Asian communities to increase the pool of suitable organs. In the long term, there needs to be greater attention on preventive strategies to reduce the number of Asians requiring renal replacement therapy.

Low frequency of p57KIP2 mutation in Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) is an autosomal dominant disorder of increased prenatal growth and predisposition to embryonal cancers such as Wilms tumor. BWS is thought to involve one or more imprinted genes, since some patients show paternal uniparental disomy, and others show balanced germ-line chromosomal rearrangements involving the maternal chromosome. We previously mapped BWS, by genetic linkage analysis, to 11p15.5, which we and others also found to contain several imprinted genes; these include the gene for insulin-like growth factor II (IGF2) and H19, which show abnormal imprint-specific expression and/or methylation in 20% of BWS patients, and p57KIP2, a cyclin-dependent kinase inhibitor, which we found showed biallelic expression in one of nine BWS patients studied. In addition, p57KIP2 was recently reported to show mutations in two of nine BWS patients. We have now analyzed the entire coding sequence and intron-exon boundaries of p57KIP2 in 40 unrelated BWS patients. Of these patients, only two (5%) showed mutations, both involving frameshifts in the second exon. In one case, the mutation was transmitted to the proband's mother, who was also affected, from the maternal grandfather, suggesting that p57KIP2 is not imprinted in at least some affected tissues at a critical stage of development and that haploinsufficiency due to mutation of either parental allele may cause at least some features of BWS. The low frequency of p57KIP2 mutations, as well as our recent discovery of disruption of the K(v)LQT1 gene in patients with chromosomal rearrangements, suggest that BWS can involve disruption of multiple independent 11p15.5 genes.

Enhancing the health professional's role in requesting transplant organs

The shortfall in organs for transplant continues in the UK. To address this problem, methods of organ procurement are continuously widening with the recent development of protocols in elective ventilation and non-heart beating donors. Until recently, the nurse's role in the success of organ procurement was largely limited to those working in intensive care units involved in cadaveric transplant and community-based nurses working with patients on kidney dialysis who may become involved with live related transplant. Involvement in organ procurement has now extended to nurses working in general wards and accident and emergency centres. It is imperative that health professionals are aware of the large numbers of patients for whom donors have not been found. They need to be aware of the possible reasons which deter relatives from giving consent for potential donors and prevent relatives themselves from becoming potential live donors. Those who are involved in the organ request process need to be alerted to the factors that affect the decision to give consent. It is hoped that these efforts will help to reduce the drastic shortage of available organs for transplant in the UK.

The first intron of human h-ras is regulated by p53 - mediation of specific activation by a p53-binding element

We conducted transient reporter gene expression assays to show that the wild-type but not the mutant-type p53 protein positively regulates the expression of the human H-ras gene. This activation of expression is mediated through a specific p53-binding DNA element located in the first intron of the H-ras gene. This element is similar to a previously identified p53-binding element. Without this element, wild-type p53 represses the H-ras promoter, as do several p53 mutants. The repression function is lost when the N-terminal 81 amino acids of the p53 protein are deleted, suggesting that the N-terminus is required for repression. Therefore, p53 seems to regulate the H-ras through both positive and negative mechanisms.

Organ donation: social and cultural issues

This article explores the social and cultural issues surrounding the donation of organs for transplantation. With the increasing shortage of suitable organs, the author suggests that healthcare professionals should be more aware of such issues when discussing transplantation with potential donors or their families and highlights the need for a national information campaign.

Posthysterectomy carcinoma of the fallopian tube presenting as vaginal adenocarcinoma: a case report

The clinical and pathological features of a case of adenocarcinoma of the fallopian tube with a unique presentation are described. The 68-year-old patient presented with vaginal bleeding 25 years after a vaginal hysterectomy. Pelvic examination revealed a 0.5-cm nodule of tumor involving the mucosa of the vaginal apex. At laparoscopy, the left fallopian tube was dilated and adherent to the vaginal vault. Pathological examination of the upper vaginectomy and bilateral salpingo-oophorectomy specimen revealed a primary papillary adenocarcinoma of the left fallopian tube that had invaded directly into the mucosa of the vaginal apex. Vaginal involvement, either at the time of presentation or subsequently in the course of the disease, is very rare in patients with carcinoma of the fallopian tube.

A method of performing descending venography

With the recent development of successful methods to correct valve incompetence in the lower extremity, there is a need for a standardized approach to descending venography. This is the single test that accurately defines the site of the venous valve and demonstrates its competence or degree of incompetence. This report describes a technique of descending venography, including the details of catheter placement, injection procedure, and monitoring techniques. Interpretation of the study requires a method that analyzes both the individual valve function and the overall valvular competence of the entire extremity. Descending venography can separate patients with primary valve incompetence from those with postthrombotic valve destruction, as well as the occasional case of valve aplasia. Points on interpretation of valve function and the use of the Valsalva maneuver for "stressing" the valve are discussed. The descending venographic results are compared with the clinical state and with venous pressure findings in 78 extremities.

Cervical thymoma

A 45-year-old woman presented with a five-year history of neck swelling and occasional difficulty in swallowing. The clinical impression was of a thyroid nodule, and fine-needle aspiration biopsy cytology revealed a monotonous lymphoid population, raising the suspicion of Hashimoto's thyroiditis. At surgery, the mass was identified at the level of the cricoid cartilage, displacing the right lobe of the thyroid gland superiorly and extending posteriorly to the prevertebral fascia. Although a frozen-section diagnosis of malignant lymphoma had been suggested at the time of surgery, permanent sections favored a diagnosis of thymoma. Surface marker studies showed the majority of cells to be of thymic T-cell phenotype, and ultrastructural examination demonstrated a dual population of lymphoid and epithelial cells, thus confirming the presence of thymoma. Cervical thymomas are extremely rare and this case report illustrates the difficulties in diagnosis; we speculate that cervical thymoma may be an underdiagnosed entity.