Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V).

SARS-CoV-2 vaccine roll-out has been successful in the UK and other parts of the world; however, there are increasing concerns about adverse events. A 44-year-old woman presented to a UK hospital with left upper arm pain at the vaccine site a couple of days after receiving the Pfizer-BioNTech mRNA vaccine, which progressed to fever, diarrhoea and abdominal pain over the next few days. She had an erythematous rash on the chest with subcutaneous oedema. Her C reactive protein was 539 mg/L, white cell count of 17×109/L (1.8-7.5), troponin-T of 1013 ng/L and creatine kinase of 572 u/L. She developed an unprovoked pulmonary embolism with acute kidney injury. After administration of intravenous methylprednisolone, the muscle oedema, skin rashes and acute kidney injury resolved. Although multisystem inflammatory syndrome (MIS) is described in children (MIS-C) and adults (MIS-A) following SARS-CoV-2 infection, we highlight the first reported MIS-V case after the SARS-CoV-2 vaccine.

The adoption of children from out-of-home care: The understandings of key decision makers in Victoria, Australia.

Adoption is one of a range of options that can provide children in out-of-home care with permanency when they are unable to be reunified with their birth parents. This paper reports on how the adoption of children from out-of-home care is understood by professionals involved in making decisions about the permanent placement of children in out-of-home care in Victoria, Australia, where adoption is rarely used. Data were collected through a single, face-to-face semi-structured interview with 21 professionals; eight child welfare specialists, eight adoption and permanent care specialists and five judicial officers. The adoption of children from out-of-home care was primarily understood as a child-centered practice that can afford children stability and a sense of belonging. Adoption was largely viewed as a voluntary process dependent upon the consent of a child's birth parents. Adoption and permanent care specialists were the only group to refer to the dispensation of parental consent as a means of obtaining an adoption order. Most decision makers understood that contact between children and their birth parents is possible following adoption, but this was not understood by all judicial officers or all child welfare specialists. Children's connection to their cultural heritage was viewed as important to the consideration of adoption for children in out-of-home care. This research provides insight into the foundations upon which decision makers may appraise adoption, within a hierarchy of options, as a potential outcome for children in need of permanency.

Screening of Patients with Snoring and Obstructive Sleep Apnoea using Heart Rate Variability Indices.

OBJECTIVE: Snoring and obstructive sleep apnea (OSA) are common disorders. Snoring associated with excessive daytime sleepiness is the most prevalent symptoms of OSA. Heart rate variability (HRV) is altered in patients with OSA and the degree of alteration may be linked to the severity of OSA. Alterations in HRV in 24 hour tachograms have recently been used in screening OSA patients. Autonomic components causing HRV can be reliably studied using spectral analysis techniques involving fast Fourier transformation (FFT). METHODS: Twenty-three subjects, 13 with severe OSA and 10 controls matched for age and body mass index, were selected from patients who had undergone polysomnography (PSG) for snoring at Sultan Qaboos University Hospital, Oman. A 24- hour electrocardiogram (ECG) Holter recording was done at home, starting at 10am. Spectral analysis of ECG from sleep Holter and PSG recordings was analysed using fast Fourier transformation (FFT). RESULTS: The ECG RR intervals of snorers with OSA were significantly shorter than in snorers without OSA (p<0.01). The low frequency (LF) spectral densities of HRV from polysomnography and Holter were significantly higher in OSA patients than in snorers, (p< 0.0001). The power spectral density of the high frequency bands was similar in the two groups. The overnight ECG Holter accurately identified all 13 snorers with severe OSA. CONCLUSION: The spectral power of the LF band obtained using FFT of sleep HRV from Holter tachograms may be a useful and cost effective test in identifying snorers with severe OSA.

Immunohistochemical labeling of normal melanocytes.

Comparison of seven antibodies for the demonstration of normal melanocytes in formalin-fixed, paraffin-embedded surgical discard skin showed that the monoclonal antibody Mel-5 (clone TA99) directed against pigment associated antigen was the most sensitive. Quantitative data were obtained for the sensitivity of the antibodies NKI/beteb, S100, T311, Melan A (clone A103), c-kit, and Mel-5 in parallel sections of human skin. An anticytokeratin antibody (CK34betaE12) was also used to stain basal keratinocytes and provide a negative image of the melanocytes present. Optimal conditions for the use of Mel-5 in paraffin sections of skin are described.