Travel related histoplasmosis – a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy

INTRODUCTION In a non-endemic setting, disseminated histoplasmosis is a rare travel-related health problem of immunosuppressed returnees from endemic regions. METHODS We describe the case of a 68-year-old man with rheumatoid arthritis and tumor necrosis factor alpha (TNF-α) inhibitor treatment-related immunodeficiency, who suffered from disseminated histoplasmosis after traveling to Brazil. Based on this case, we discuss challenges and pitfalls associated with the diagnosis of disseminated histoplasmosis in a non-endemic setting. RESULTS The disease mimicked a hemophagocytic lymphohistiocytosis (HLH) like syndrome. Histoplasma capsulatum was microscopically detected in bronchoalveolar fluid and bone marrow aspirate smears, but was initially misclassified as Leishmania spp., another class of pathogens, which may cause HLH like syndromes in immunocompromised individuals. DISCUSSION Since the clinical symptoms of histoplasmosis are nonspecific and physicians in non-endemic regions might not be familiar with this disease pattern, there is a risk of delayed diagnosis of travel related cases. Taking a thorough travel history is key in unclear cases of illness in immunocompromised patients

Travel related histoplasmosis - a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy.

INTRODUCTION In a non-endemic setting, disseminated histoplasmosis is a rare travel-related health problem of immunosuppressed returnees from endemic regions. METHODS We describe the case of a 68-year-old man with rheumatoid arthritis and tumor necrosis factor alpha (TNF-α) inhibitor treatment-related immunodeficiency, who suffered from disseminated histoplasmosis after traveling to Brazil. Based on this case, we discuss challenges and pitfalls associated with the diagnosis of disseminated histoplasmosis in a non-endemic setting. RESULTS The disease mimicked a hemophagocytic lymphohistiocytosis (HLH) like syndrome. Histoplasma capsulatum was microscopically detected in bronchoalveolar fluid and bone marrow aspirate smears, but was initially misclassified as Leishmania spp., another class of pathogens, which may cause HLH like syndromes in immunocompromised individuals. DISCUSSION Since the clinical symptoms of histoplasmosis are nonspecific and physicians in non-endemic regions might not be familiar with this disease pattern, there is a risk of delayed diagnosis of travel related cases. Taking a thorough travel history is key in unclear cases of illness in immunocompromised patients

Probing the momentum relaxation time of charge carriers in ultrathin semiconductor layers

We report on a terahertz time-domain technique for measuring the momentum relaxation time of charge carriers in ultrathin semiconductor layers. The phase sensitive modulation technique directly provides the relaxation time. Time-resolved THz experiments were performed on n-doped GaAs and show precise agreement with data obtained by electrical characterization. The technique is well suited for studying novel materials where parameters such as the charge carriers' effective mass or the carrier density are not known a priori

Magnetolocalization in disordered quantum wires

The magnetic field dependent localization in a disordered quantum wire is considered nonperturbatively. An increase of an averaged localization length with the magnetic field is found, saturating at twice its value without magnetic field. The crossover behavior is shown to be governed both in the weak and strong localization regime by the magnetic diffusion length L_B. This function is derived analytically in closed form as a function of the ratio of the mean free path l, the wire thickness W, and the magnetic length l_B for a two-dimensional wire with specular boundary conditions, as well as for a parabolic wire. The applicability of the analytical formulas to resistance measurements in the strong localization regime is discussed. A comparison with recent experimental results on magnetolocalization is included.Comment: 22 pages, RevTe

No association between the common calcium-sensing receptor polymorphism rs1801725 and irritable bowel syndrome

Background The calcium-sensing receptor (CaSR) is a calcium (Ca2+) sensitive G protein-coupled receptor implicated in various biological processes. In particular, it regulates Ca2+/Mg2+- homeostasis and senses interstitial Ca2+ levels and thereby controls downstream signalling cascades. Due to its expression in the gut epithelium, the enteric nervous system and smooth muscles and its key function in regulation and coordination of muscular contraction and secretion, it represents an excellent candidate gene to be investigated in the pathophysiology of irritable bowel syndrome (IBS). Disturbed CaSR structure and function may impact gastrointestinal regulation of muscular contraction, neuronal excitation and secretion and consequently contribute to symptoms seen in IBS, such as disordered defecation as well as disturbed gut motility and visceral sensitivity. Methods We have therefore genotyped the functional CASR SNP rs1801725 in three case control samples from the UK, Belgium and the USA. Results Genotype frequencies showed no association in the three genotyped case–control samples, neither with IBS nor with IBS subtypes. Conclusions Although we could not associate the SNP to any of the established bowel symptom based IBS subtypes we cannot rule out association to altered Ca2+ levels and disturbed secretion and gut motility which were unfortunately not assessed in the patients genotyped. This underlines the necessity of a more detailed phenotyping of IBS patients and control individuals in future studies

Demography and mating system shape the genome-wide impact of purifying selection in Arabis alpina

YesPlant mating systems have profound effects on levels and structuring of genetic variation and can affect the impact of natural selection. Although theory predicts that intermediate outcrossing rates may allow plants to prevent accumulation of deleterious alleles, few studies have empirically tested this prediction using genomic data. Here, we study the effect of mating system on purifying selection by conducting population-genomic analyses on whole-genome resequencing data from 38 European individuals of the arctic-alpine crucifer Arabis alpina. We find that outcrossing and mixed-mating populations maintain genetic diversity at similar levels, whereas highly self-fertilizing Scandinavian A. alpina show a strong reduction in genetic diversity, most likely as a result of a postglacial colonization bottleneck. We further find evidence for accumulation of genetic load in highly self-fertilizing populations, whereas the genome-wide impact of purifying selection does not differ greatly between mixed-mating and outcrossing populations. Our results demonstrate that intermediate levels of outcrossing may allow efficient selection against harmful alleles, whereas demographic effects can be important for relaxed purifying selection in highly selfing populations. Thus, mating system and demography shape the impact of purifying selection on genomic variation in A. alpina. These results are important for an improved understanding of the evolutionary consequences of mating system variation and the maintenance of mixed-mating strategies.This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1707492115/-/DCSupplemental

Emerging Knowledge: Students as Intermediate Agents in Construction and Transformation Processes

Even if it is not widespread enough, learning by doing is generally acknowledged as a didactic practice. This paper analyses the direct involvement of architecture students in construction and transformation processes. On the basis of examples from the last thirty years and the illustration of an experiment, a workshop method is theorized, which seems to be a viable approach not only for teaching, but for certain aspects of practice especially with respect to technological innovation.While design practice is often constrained by best practices or unquestioned conventions, a direct involvement of students and other non-experts can bring valid inputs to spatial transformation processes. This opens new opportunities for the spreading of architectural know-how in contexts that are generally difficult to attain with innovative approaches. If well managed, this can be a starting point for a greater performance of the built environment and hence for a more sustainable design.The building site itself becomes the central hub for the transfer of knowledge, from which new specifically tailored solutions can emerge

Icona animata - Riorganizzazione e nuova facciata di un blocco del complesso residenziale Bijlmermeer, Amsterdam

The article presents Greg Lynn’s awarded proposal for the spatial and functional reorganisation of part of the residential complex in Amsterdam’s Bijlmermeer. Beyond describing how the intervention is planned to improve the living conditions in one of the world’s most famous housing complexes, a special focus is given to the morphogenetic approach