HIV-Associated CD8 Encephalitis: A UK Case Series and Review of Histopathologically Confirmed Cases

HIV-associated CD8-encephalitis (HIV-CD8E) is a severe inflammatory disorder dominated by infiltration of the brain by CD8 T-lymphocytes. It occurs in people with HIV, typically when the virus is apparently well-controlled by antiretroviral treatment (ART). HIV-CD8E presents with symptoms and signs related to marked cerebral inflammation and swelling, and can lead to coma and death unless treated promptly with corticosteroids. Risk events such as intercurrent infection, antiretroviral therapy interruption, immune reconstitution inflammatory syndrome (IRIS) after starting ART, and concomitant associations such as cerebrospinal fluid (CSF) HIV viral escape have been identified, but the pathogenesis of the disorder is not known. We present the largest case series of HIV-CD8E to date (n = 23), representing histopathologically confirmed cases in the UK. We also summarize the global literature representing all previously published cases with histopathological confirmation (n = 30). A new variant of HIV-CD8E is described, occurring on a background of HIV encephalitis (HIVE).Together these series, totalling 53 patients, provide new insights. CSF HIV viral escape was a frequent finding in HIV-CD8E occurring in 68% of those with CSF available and tested; ART interruption and IRIS were important, both occurring in 27%. Black ethnicity appeared to be a key risk factor; all but two UK cases were African, as were the majority of the previously published cases in which ethnicity was stated. We discuss potential pathogenic mechanisms, but there is no unifying explanation over all the HIV-CD8E scenarios.

Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report.

BACKGROUND: Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. CASE PRESENTATION: A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. CONCLUSIONS: The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria will aid the interpretation of, often conflicting, information on malaria pathophysiology in humans

Reflective writing analytics for actionable feedback

© 2017 ACM. Reflective writing can provide a powerful way for students to integrate professional experience and academic learning. However, writing reflectively requires high quality actionable feedback, which is time-consuming to provide at scale. This paper reports progress on the design, implementation, and validation of a Reflective Writing Analytics platform to provide actionable feedback within a tertiary authentic assessment context. The contributions are: (1) a new conceptual framework for reflective writing; (2) a computational approach to modelling reflective writing, deriving analytics, and providing feedback; (3) the pedagogical and user experience rationale for platform design decisions; and (4) a pilot in a student learning context, with preliminary data on educator and student acceptance, and the extent to which we can evidence that the software provided actionable feedback for reflective writing

Implementing AcaWriter as a Novel Strategy to Support Pharmacy Students’ Reflective Practice in Scientific Research

Objective. To explore pharmacy students’ perceptions of a novel web application tool (AcaWriter) implemented in a Master of Pharmacy curriculum to support reflective thinking in scientific research. Methods. A qualitative research design involving a 50-minute focus group (n=12) was used. The focus group session was audio-taped, transcribed verbatim, and analyzed thematically using the Braun and Clarke framework. Results. Analysis generated four themes related to AcaWriter’s utility in enhancing students’ research thinking and capacity. The themes identified included: ease of use to prompt reflection, tangible tool with non-judgmental capacity; benefits for enhancing self and peer reflection on research techniques and group dynamics; benefits of the reflective writing process to enhance research capacity compared with engaging in reflective dialogue; and benefits beyond the writing process: cultivating self-improvement and self-confidence. Conclusion. The findings of this study show that a novel web application implemented within a pharmacy curriculum can assist students’ self and peer reflection on a research task. Further research is needed to explore the impact of using this tool and its relationship with academic performance and outcomes

Comparison of new and primary production models using SeaWiFS data in contrasting hydrographic zones of the northern North Atlantic.

The accuracy of two satellite models of marine primary (PP) and new production (NP) were assessed against 14C and 15N uptake measurements taken during six research cruises in the northern North Atlantic. The wavelength resolving model (WRM) was more accurate than the Vertical General Production Model (VGPM) for computation of both PP and NP. Mean monthly satellite maps of PP and NP for both models were generated from 1997 to 2010 using SeaWiFS data for the Irminger basin and North Atlantic. Intra- and inter-annual variability of the two models was compared in six hydrographic zones. Both models exhibited similar spatio-temporal patterns: PP and NP increased from April to June and decreased by August. Higher values were associated with the East Greenland Current (EGC), Iceland Basin (ICB) and the Reykjanes Ridge (RKR) and lower values occurred in the Central Irminger Current (CIC), North Irminger Current (NIC) and Southern Irminger Current (SIC). The annual PP and NP over the SeaWiFS record was 258 and 82 gC m-2 yr-1 respectively for the VGPM and 190 and 41 gC m-2 yr-1 for the WRM. Average annual cumulative sum in the anomalies of NP for the VGPM were positively correlated with the North Atlantic Oscillation (NAO) in the EGC, CIC and SIC and negatively correlated with the multivariate ENSO index (MEI) in the ICB. By contrast, cumulative sum of the anomalies of NP for the WRM were significantly correlated with NAO only in the EGC and CIC. NP from both VGPM and WRM exhibited significant negative correlations with Arctic Oscillation (AO) in all hydrographic zones. The differences in estimates of PP and NP in these hydrographic zones arise principally from the parameterisation of the euphotic depth and the SST dependence of photo-physiological term in the VGPM, which has a greater sensitivity to variations in temperature than the WRM. In waters of 0 to 5C PP using the VGPM was 43% higher than WRM, from 5 to 10C the VGPM was 29% higher and from 10 to 15C the VGPM was 27% higher

Leishmania isoenzyme polymorphisms in Ecuador: Relationships with geographic distribution and clinical presentation

Background: Determinants of the clinical presentation of the leishmaniases are poorly understood but Leishmania species and strain differences are important. To examine the relationship between clinical presentation, species and isoenzyme polymorphisms, 56 Leishmania isolates from distinct presentations of American tegumentary leishmaniasis (ATL) from Ecuador were analyzed. Methods: Isolates were characterized by multilocus enzyme electrophoresis for polymorphisms of 11 isoenzymes. Patients were infected in four different ecologic regions: highland and lowland jungle of the Pacific coast, Amazonian lowlands and Andean highlands. Results: Six Leishmania species constituting 21 zymodemes were identified: L. (Viannia) panamensis (21 isolates, 7 zymodemes), L. (V.) guyanensis (7 isolates, 4 zymodemes), L. (V.) braziliensis (5 isolates, 3 zymodemes), L. (Leishmania) mexicana (11 isolates, 4 zymodemes), L. (L.) amazonensis (10 isolates, 2 zymodemes) and L. (L.) major (2 isolates, 1 zymodeme). L. panamensis was the species most frequently identified in the Pacific region and was associated with several clinical variants of cutaneous disease (CL); eight cases of leishmaniasis recidiva cutis (LRC) found in the Pacific highlands were associated with 3 zymodemes of this species. Mucocutaneous leishmaniasis found only in the Amazonian focus was associated with 3 zymodemes of L. braziliensis. The papular variant of CL, Uta, found in the Andean highlands was related predominantly with a single zymodeme of L. mexicana. Conclusion: Our data show a high degree of phenotypic variation within species, and some evidence for associations between specific variants of ATL (i.e. Uta and LRC) and specific Leishmania zymodemes. This study further defines the geographic distribution of Leishmania species and clinical variants of ATL in Ecuador

Caffeine-induced synaptic potentiation in hippocampal CA2 neurons

Caffeine enhances cognition, but even high non-physiological doses have modest effects on synapses. A 1 adenosine receptors (A 1 Rs) are antagonized by caffeine and are most highly enriched in hippocampal CA2, which has not been studied in this context. We found that physiological doses of caffeine in vivo or A 1 R antagonists in vitro induced robust, long-lasting potentiation of synaptic transmission in rat CA2 without affecting other regions of the hippocampus

Effects of spoilage on nitrogen and carbon stable isotopes signatures of the clam Ruditapes decussatus

Fish and seafood products are highly susceptible to post-mortem spoilage due to autolytic reactions at start, then microbiological activity and eventually oxidative reactions. Chemical and microbiological parameters are usually used to assess quality and make decisions for protecting public health, but they lack precision in defining which spoilage pathway is occurring at each moment. The objective of this work was to assess the effects of spoilage reactions on nitrogen and carbon stable isotopes in the grooved carpet shell clam, Ruditapes decussatus, and compare them to biochemical indicators of seafood deterioration, in order to better understand the relations between the different spoilage pathways during commercial storage conditions. Clams were kept in a refrigerator at 5 ºC, to simulate normal commercial storage conditions, and sampled in the beginning of the experiment, and after eight, ten and twelve days. Moisture, condition index, percentage edibility, total volatile basic nitrogen (TVB-N), pH, nitrogen and carbon percentages and stable isotopes were determined for each sampling moment. Stable isotope analyses were performed using a Costech Elemental Analyzer (ECS 4010) coupled to a ThermoFinnigan Delta V Advantage. Stable isotopes analysis, especially for nitrogen, proved to be a good tool for the study of clam deterioration. Nitrogen stable isotopes results showed a relation with other spoilage indicators, such as pH and TVB-N, and allowed identifying spoilage specific pathways, such as amino acids decarboxylation and production of volatile nitrogen compounds.info:eu-repo/semantics/publishedVersio