Pitfalls in TCR gene clonality testing: teaching cases

Clonality testing in T-lymphoproliferations has technically become relatively easy to perform in routine laboratories using standardized multiplex polymerase chain reaction protocols for T-cell receptor (TCR) gene analysis as developed by the BIOMED-2 Concerted Action BMH4-CT98-3936. Expertise with clonality diagnostics and knowledge about the biology of TCR gene recombination are essential for correct interpretation of TCR clonality data. Several immunobiological and technical pitfalls that should be taken into account to avoid misinterpretation of data are addressed in this report. Furthermore, we discuss the need to integrate the molecular data with those from immunohistology, and preferably also flow cytometric immunophenotyping, for appropriate interpretation. Such an interactive, multidisciplinary diagnostic model guarantees integration of available data to reach the most reliable diagnosis

The meaning of a poor childbirth experience – A qualitative phenomenological study with women in Rwanda

Being pregnant and giving birth is a pivotal life event and one that a woman ordinarily remembers for most of her life. A negative childbirth experience can affect a woman's health well beyond the episode of the labour and birth itself. This study explored the meaning of a poor childbirth experience, as expressed by women who had given birth in Rwanda.In a cross-sectional household study conducted in Northern Province and in Kigali City, the capital of Rwanda, a structured questionnaire was answered by women who had given birth one to 13 months earlier. One question, answered by 898 women, asked them to rate their overall experience of childbirth from 0 (very bad) to 10 (very good). Of these, 28 women (3.1%) who had rated their childbirth experience as bad (≤ 4) were contacted for individual interviews. Seventeen of these women agreed to participate in individual in-depth interviews. The texts were analysed with a reflective lifeworld approach.The essential meaning of a "poor" childbirth experience was that the women had been exposed to disrespectful care, constituted by neglect, verbal or physical abuse, insufficient information, and denial of their husband as a companion. The actions of carers included abandonment, humiliation, shaming and insult, creating feelings of insecurity, fear and distrust in the women. Two of the women did not report any experience of poor care; their low rating was related to having suffered from medical complications.It is challenging that the main finding is that women are exposed to disrespectful care. In an effort to provide an equitable and high quality maternal health care system in Rwanda, there is a need to focus on activities to implement respectful, evidence-based care for all. One such activity is to develop and provide education programmes for midwives and nurses about professional behaviour when caring for and working with women during labour and birth

A practical approach to diagnostic Ig/TCR clonality evaluation in clinical pathology

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Treatment of Anxiety in Children and Adolescents

Purpose of Review: The purpose of this review is to provide an up-to-date summary of the treatment of anxiety disorders in children and adolescents. We review the evidence in relation to treatments deemed to be efficacious followed by novel interventions that hold promise as potentially efficacious treatments. Recent Findings: The latest research suggests that cognitive-behavioural therapy is an efficacious treatment, whether delivered individually, in groups, via the computer or internet, within the classroom, or in brief, intensive formats or over longer durations. Pharmacological treatments such as SSRIs and SNRIs are also efficacious but negative side events may dampen enthusiasm for their use. Augmentation of exposure therapy with D-Cycloserine, cognitive bias modification interventions, interpersonal therapy and ACT/mindfulness are promising but require more research to establish their efficacy. Summary: The main conclusion is that personalised approaches are needed to identify the most effective intervention, or combination thereof, for each anxious youth within a stepped model of care that provides access to evidence-based services for different levels of need.No Full Tex