CD64 as a potential biomarker in septic arthritis

Background Traditional inflammatory markers are generally unhelpful in discerning septic arthritis from inflammatory joint disease due to their lack of specificity. We wished to explore the discriminatory power of the novel inflammatory marker, Fc-gamma-receptor type 1, CD64, in patients presenting with acute arthritis. Methods Patients were recruited prospectively in the time period June 2009 to December 2011. Thirty-six patients presenting with an acute flare of chronic rheumatic arthritis, 31 with crystal-induced arthritis and 23 with septic arthritis were included. Traditional inflammatory markers, CD64 and procalcitonin (PCT) were measured and their diagnostic abilities were compared. Results CD64 and PCT both demonstrated a specificity of 98%, but poor sensitivities of 59% and 52%, respectively. White blood cell count (WBC), and erythrocyte sedimentation rate (ESR) did not have significant discriminatory power, while C-reactive protein (CRP) proved to have the best diagnostic accuracy as measured by area under the ROC curve (AUC 0.92, 95% confidence-interval 0.87-0.98). Subgroup analysis excluding patients with septic arthritis without concurrent bacteremia, and likewise exclusion of the patients with septic arthritis caused by coagulase negative staphylococci, both improved the diagnostic accuracy of CD64 and PCT, but not of WBC and CRP.</p< Conclusions CD64 and PCT are highly specific for infectious disease, but they predominantly measure bacteremia. Their use in hospital practice has yet to be defined, and especially so in localized infections

Thoughts and emotions during traumatic birth: a qualitative study.

Background: Previous research shows that 1-9% of women will develop posttraumatic stress disorder following birth (1, 2). Aims: This study therefore examined thoughts and emotions during birth, cognitive processing after birth, and memories of birth that might be important in the development of postnatal posttraumatic stress symptoms. Method: Women with posttraumatic stress symptoms (n=25) and without (n=25) were matched for obstetric events in order to examine nonmedical aspects of birth that make it traumatic. Women were interviewed 3 months after birth. Results: Themes that emerged for all women were as follows: thoughts during birth included mental coping strategies, wanting labor to end, poor understanding of what was going on, and mental defeat. More negative emotions were described during birth than positive emotions; primarily feeling scared, frightened and upset. Postnatal cognitive processing included retrospective appraisal of birth, e.g. taking a fatalistic view, as well as focusing on the present, e.g. concentrating on the baby. Memories of birth included not remembering parts of the birth and forgetting how bad it was. Women with posttraumatic stress symptoms reported more panic, anger, thoughts of death, mental defeat, and dissociation during birth. After birth, women with symptoms reported fewer strategies that focused on the present, more painful memories, intrusive memories, and rumination. Conclusion: The results provide a useful first step towards identifying aspects of birth and postnatal processing that might determine whether women develop postnatal posttraumatic stress symptoms. However, further research is needed to address limitations of the current study and to broaden knowledge in this area

Powerful owls : possum assassins move into town

Once thought to live only in large forested areas, the powerful owl (Ninox strenua), Australia’s largest and most iconic of owls (figure 11.1), surprisingly is now turning up frequently in the cities of eastern Australia. Powerful owls require ample prey and large tree cavities for nest sites how this top-order predator is able to survive in human-dominated landscapes is an important question for conservation and the focus of ongoing research. The powerful owl is endemic to Australia, resident in the three eastern mainland states and the Australian Capital Territory, and classified nationally as “rare.”2,3 First described by Gould in 1838, powerful owls are an unusual raptor in that they do not exhibit reversed sexual size dimorphism, the prevalent trait among raptors in which females are larger than males. For reasons still not understood, male powerful owls grow to a height of 65 cm and weigh up to 1,700 g, compared to females, which grow to a height of 54 cm and weigh up to 1,308 g.