Challenges in the management of HIV-infected malnourished children in Sub-Saharan Africa

Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.Publisher PDFPeer reviewe

Minimally Invasive Right Anterior Mini-Thoracotomy Aortic Valve Replacement

Since the emergence of small skin incision aortic valve surgery in the late 1990s, minimally invasive aortic valve replacement has now become a viable alternative to standard full sternotomy. The spectrum includes (a) upper hemi sternotomy (T or J shaped), (b) lower partial sternotomy, and (c) right anterior mini-thoracotomy. Potential advantages include a cosmetically appealing scar, decreased post-operative pain and bleeding, shorter ventilation time and hospital stay, and early return to active life. The operative challenges include restricted view and access to the operative field, longer aortic cross-clamp time, and cardiopulmonary bypass time. This necessitates detailed pre-operative imaging, correct selection and assessment of patients, and good communication with perfusionists and anesthetists regarding the plan of each surgery, with a solid back-up plan in case conversion to full sternotomy is required intra-operatively. In recent times, the use of suture less valves and rapid deployment bio prosthesis has dramatically reduced operative time. Here, we describe the work-up, selection criteria, key steps, and potential pitfalls of the right anterior mini-thoracotomy approach for aortic valve replacement

Scrub typhus: A case report

Fever with rash is a common cause for dermatological referral. The causes can range from viral to protozoal, bacterial or spirochaetal. A case of rickettsial fever is reported

Re-Focusing - Building a Future for Entrepreneurial Education & Learning

The field of entrepreneurship has struggled with fundamental questions concerning the subject’s nature and purpose. To whom and to what means are educational and training agendas ultimately directed? Such questions have become of central importance to policy makers, practitioners and academics alike. There are suggestions that university business schools should engage more critically with the lived experiences of practising entrepreneurs through alternative pedagogical approaches and methods, seeking to account for and highlighting the social, political and moral aspects of entrepreneurial practice. In the UK, where funding in higher education has become increasingly dependent on student fees, there are renewed pressures to educate students for entrepreneurial practice as opposed to educating them about the nature and effects of entrepreneurship. Government and EU policies are calling on business schools to develop and enhance entrepreneurial growth and skill sets, to make their education and training programmes more proactive in providing innovative educational practices which help and facilitate life experiences and experiential learning. This paper makes the case for critical frameworks to be applied so that complex social processes become a source of learning for educators and entrepreneurs and so that innovative pedagogical approaches can be developed in terms both of context (curriculum design) and process (delivery methods)

Gene expression signatures of peripheral CD4+ T cells clearly discriminate between patients with acute and chronic hepatitis B infection

CD4+ T and regulatory T cells (Tregs) seem to play a key role in persistence of hepatitis B virus (HBV) infection. However, the molecular events by which Tregs exert their modulatory activity are largely unknown. The transcriptional profiles of CD4+ T cells of healthy controls (HCs) and patients affected by acute hepatitis B (AVH-B) or chronic hepatitis B (CHB) infection were established using a custom expression array consisting of 350 genes relevant for CD4+ T cell and Treg function. These studies were complemented by real-time reverse-transcription polymerase chain reaction. Peripheral blood mononuclear cells (PBMCs) were also analyzed for the presence of Tregs, which were more abundant in the acute stage of the disease (7%) than in HCs and CHB infection (HCs versus AVH-B, P = 0.003; AVH-B versus CHB, P = 0.04). One hundred eighteen genes (34%) intrinsically differentiate HBV-infected patients from HCs. Using gene ontology, we identified T cell receptor signaling and clusterization, mitogen-activated protein kinase kinase signaling, cell adhesion, cytokines and inflammatory responses, cell cycle/cell proliferation, and apoptosis as the most prominent affected modules. A higher expression of CCR1, CCR3, CCR4, CCR5, and CCR8 was seen in AVH-B than in CHB-infected patients and HCs. Annotation of the interconnected functional network of genes provided a unique representation of global immune activation during acute infection. Almost all genes were down-regulated in patients with CHB infection. Conclusion: The fingerprints enable clear discrimination between patients suffering from AVH-B or CHB infection. The observed profiles suggest accumulation of effector T cells with a potential role in necro-inflammation during the acute stage. Subsequent down-regulated effector functions support the hypothesis of suppressed CD4+ effector T cells favoring viral persistence in the chronic infection stage

CANDLES Assay for monitoring GPCR induced cAMP generation in cell cultures

Background: G protein-coupled receptors (GPCRs) represent a physiologically and pharmacologically important family of receptors that upon coupling to GαS stimulate cAMP production catalyzed by adenylyl cyclase. Thus, developing assays to monitor cAMP production is crucial to screen for ligands in studies of GPCR signaling. Primary cell cultures represent a more robust model than cell lines to study GPCR signaling since they physiologically resemble the parent tissue. Current cAMP assays have two fundamental limitations: 1) absence of cAMP kinetics as competition-based assays require cell lysis and measure only a single time-point, and 2) high variation with separate samples needed to measure consecutive time points. The utility of real-time cAMP biosensors is also limited in primary cell cultures due to their poor transfection efficiency, variable expression levels and inability to select stable clones. We therefore, decided to develop an assay that can measure cAMP not only at a single time-point but the entire cAMP kinetics after GPCR activation in untransfected primary cells.Results: CANDLES (C yclic A MP iN direct D etection by L ight E mission from S ensor cells) assay for monitoring cAMP kinetics in cell cultures, particularly in primary cultures was developed. The assay requires co-culturing of primary cells with sensor cells that stably express a luminescent cAMP sensor. Upon GPCR activation in primary cells, cAMP is transferred to sensor cells via gap junction channels, thereby evoking a luminescent read-out. GPCR activation using primary cultures of rat cortical neurons and mouse granulosa cells was measured. Kinetic responses of different agonists to adrenergic receptors were also compared using rat cortical neurons. The assay optimization was done by varying sensor-test cell ratio, using phosphodiesterase inhibitors and testing cell-cell contact requirement.Conclusions: Here we present CANDLES assay based on co-culturing test cells with cAMP-detecting sensor cells. This co-culture setup allows kinetic measurements, eliminates primary cell transfections and reduces variability. A variety of cell types (rat cortical neurons, mouse granulosa cells and established cell lines) and receptors (adrenergic, follicle stimulating hormone and luteinizing hormone/chorionic gonadotropin receptors) were tested for use with CANDLES. The assay is best applied while comparing cAMP generation curves upon different drug treatments to untransfected primary cells.</p

Child stunting is associated with low circulating essential amino acids

AbstractBackgroundStunting affects about one-quarter of children under five worldwide. The pathogenesis of stunting is poorly understood. Nutritional interventions have had only modest effects in reducing stunting. We hypothesized that insufficiency in essential amino acids may be limiting the linear growth of children.MethodsWe used a targeted metabolomics approach to measure serum amino acids, glycerophospholipids, sphingolipids, and other metabolites using liquid chromatography-tandem mass spectrometry in 313 children, aged 12–59months, from rural Malawi. Children underwent anthropometry.FindingsSixty-two percent of the children were stunted. Children with stunting had lower serum concentrations of all nine essential amino acids (tryptophan, isoleucine, leucine, valine, methionine, threonine, histidine, phenylalanine, lysine) compared with nonstunted children (p<0.01). In addition, stunted children had significantly lower serum concentrations of conditionally essential amino acids (arginine, glycine, glutamine), non-essential amino acids (asparagine, glutamate, serine), and six different sphingolipids compared with nonstunted children. Stunting was also associated with alterations in serum glycerophospholipid concentrations.InterpretationOur findings support the idea that children with a high risk of stunting may not be receiving an adequate dietary intake of essential amino acids and choline, an essential nutrient for the synthesis of sphingolipids and glycerophospholipids

Successful removal of a telephone cable, a foreign body through the urethra into the bladder: a case report

The variety of foreign bodies inserted into or externally attached to the genitourinary tract defies imagination and includes all types of objects. The frequency of such cases renders these an important addition to the diseases of the genitourinary organs. The most common motive associated with the insertion of foreign bodies into the genitourinary tract is sexual or erotic in nature. In adults this is commonly caused by the insertion of objects used for masturbation and is frequently associated with mental health disorders. We report a case of insertion of telephone cable wire into the urethra. Our case highlights the importance of good history, clinical examination, relevant radiological investigation and simple measures to solve the problem

Perceiving ‘capability’ within dynamic capabilities: the role of owner-manager self-efficacy

This article combines two popular, yet separate concepts, dynamic capabilities and self-efficacy. Both are concerned with ability / capability and offer potentially valuable synergies. As such, our in-depth qualitative study based in three micro-enterprises in the United Kingdom (UK), investigated, ‘what role(s) may owner-manager perceived self-efficacy play as a micro-foundation of dynamic capabilities in micro-enterprises?’ Our findings show that perceived self-efficacy can influence dynamic capability enactment in multifaceted ways and even suggest that in some cases, perceived self-efficacy is a crucial component of dynamic capabilities, without which there may be no such capability. These insights help open up the black box of dynamic capabilities by contributing important knowledge to the growing body of research into the micro-foundations of such capabilities. Furthermore, our study illuminates the importance of idiosyncratic micro-foundations of dynamic capabilities in micro-enterprises and expands extant knowledge of the potential effects of self-efficacy in the small business and entrepreneurship domain