ABSTRACT
Multicentric reticulohistiocytosis (MRH) is a rare systemic inflammatory granulomatous disease marked by severe and often rapidly progressive polyarticular arthritis and cutaneous papulonodules. Initial clinical diagnosis may be difficult. We describe a 2-year-old girl presenting with pink dermal papules on the forehead, thighs, elbows, knees, and palms of the hands. Based on clinical findings and skin biopsy results, she was initially diagnosed with granuloma annulare. At 5 years of age, she developed arthritis, fatigue, and more widespread skin papules leading to the diagnosis of MRH. To our knowledge, this is the youngest individual with MRH yet described. We outline the timeline and unique features of her case and review the literature pertaining to MRH in children. Although rare, MRH can be permanently debilitating, making prompt diagnosis critical. A standardized approach to investigation and management needs to be developed.
Subject(s)
Histiocytosis, Non-Langerhans-Cell/diagnosis , Biopsy , Dermatologic Agents/therapeutic use , Diagnosis, Differential , Female , Histiocytosis, Non-Langerhans-Cell/drug therapy , Humans , Infant , Infliximab/therapeutic useABSTRACT
The attitudes of medical students toward the current United States healthcare system are not well described in the literature. A graded survey was developed to assess awareness and motivation toward the care of the uninsured and underinsured as well as the impact of a video intervention on these attitudes. The survey, which showed good internal consistency (Cronbach's alpha = 0.85), was administered before and after viewing a collection of videotaped patient stories. Although a spectrum of beliefs emerged from the analysis of survey responses, some common attitudes were identified. Eighty-five percent of respondents either agreed or strongly agreed that medical care should be provided to everyone, regardless of their ability to pay. In addition, 66% indicated they would be willing to forgo a portion of their income to provide care to those who do not have access to healthcare services. These values were strongly correlated with increasing respondent age and primary care specialty choice (p<0.01). The video intervention did not heavily influence student responses, perhaps due to a ceiling effect created by the large number of students who were already sympathetic toward the underserved. Overall, this data reflects that United States medical students recognize a need to provide care to the underserved and are willing to make personal sacrifices to meet that need.
Subject(s)
Attitude of Health Personnel , Insurance, Health , Medically Uninsured/psychology , Primary Health Care , Students, Medical/psychology , Adult , Data Collection , Delivery of Health Care , Humans , United States , Videotape Recording , Young AdultABSTRACT
To study the effects of cytokinin O-glucosylation in monocots, maize (Zea mays L.) transformants harbouring the ZOG1 gene (encoding a zeatin O-glucosyltransferase from Phaseolus lunatus L.) under the control of the constitutive ubiquitin (Ubi) promoter were generated. The roots and leaves of the transformants had greatly increased levels of zeatin-O-glucoside. The vegetative characteristics of hemizygous and homozygous Ubi:ZOG1 plants resembled those of cytokinin-deficient plants, including shorter stature, thinner stems, narrower leaves, smaller meristems, and increased root mass and branching. Transformant leaves had a higher chlorophyll content and increased levels of active cytokinins compared with those of non-transformed sibs. The Ubi:ZOG1 plants exhibited delayed senescence when grown in the spring/summer. While hemizygous transformants had reduced tassels with fewer spikelets and normal viable pollen, homozygotes had very small tassels and feminized tassel florets, resembling tasselseed phenotypes. Such modifications of the reproductive phase were unexpected and demonstrate a link between cytokinins and sex-specific floral development in monocots.
