Abnormal heart rate pattern in fetal anaemia secondary to transient abnormal myelopoeisis in a fetus without trisomy 21: A case report.

Decreased fetal movements (DFM) are a non-specific and common symptom in the third trimester of pregnancy that hold an association with fetal compromise. A 28-year-old woman at 31 weeks and 3 days of gestation presented with DFM and was found to have a pathological fetal heart rate trace. Following emergency Caesarean section the fetus was diagnosed with transient abnormal myelopoeisis (TAM). Timely treatment was initiated and the neonatal outcome was good. Transient myeloproliferative disorders are almost uniquely found in infants with trisomy 21 (T21). This is the first case report of TAM in the absence of T21 wherein the diagnostic process was commenced antenatally due to non-reassuring fetal status and highlights the importance of antenatal heart rate abnormalities.

New-Onset Abdominopelvic Pain After Initiation of Testosterone Therapy Among Trans-Masculine Persons: A Community-Based Exploratory Survey.

Purpose: The purpose of this study was to provide a preliminary characterization of new-onset abdominopelvic pain reported by trans-masculine persons after initiation of testosterone gender-affirming hormone therapy (GAHT). Methods: From December 2015 to February 2017, an anonymous survey was distributed through social media, listservs, and community centers to trans-masculine persons, 18 years or older, on testosterone GAHT, who experienced new-onset abdominopelvic pain after initiating GAHT. Results: Of the 183 persons who completed the survey, 127 (69.4%) endorsed new-onset abdominopelvic pain since the initiation of testosterone GAHT. Median interval from testosterone initiation to pain onset was 1 year (range: 1 month to 20 years). The majority of respondents reported pain that was intermittent (79.5%), cramping in nature (75.6%), and localized to the suprapubic region (78.7%). Those with a uterus and ovaries were 9.50 times (95% confidence interval 2.85-31.66) more likely to endorse suprapubic localization (as opposed to other abdominopelvic regions). All 28 respondents who reported pain resolution with treatment, identified this treatment as a hysterectomy. Conclusion: In this preliminary evaluation of new-onset abdominopelvic pain experienced by trans-masculine persons after the initiation of testosterone GAHT, the combination of suprapubic localization of pain with self-reported effectiveness of hysterectomy as treatment suggests a reproductive organ etiology. Based on our data, clinicians should be aware of the possibility that trans-masculine persons may present for this concern. This study offers a starting point for research. Further prospective studies are necessary to evaluate the incidence, cause(s), and the most appropriate interventions.

Synergistic induction of CXCL10 by interferon-gamma and lymphotoxin-alpha in astrocytes: Possible role in cerebral malaria.

Cerebral malaria (CM) has a high mortality rate and incidence of neurological sequelae in survivors. Hypoxia and cytokine expression in the brain are two mechanisms thought to contribute to the pathogenesis of CM. The cytokines interferon (IFN)-γ and lymphotoxin (LT)-α and the chemokine CXCL10 are essential for the development of CM in a mouse model. Furthermore, serum IFN-γ protein levels are higher in human CM than in controls, and CXCL10 is elevated in both serum and cerebrospinal fluid in Ghanaian paediatric CM cases. Astrocytes actively participate in CNS pathologies, becoming activated in response to various stimuli including cytokines. Astrocyte activation also occurs in murine and human CM. We here determined the responsiveness of mouse and human astrocytes to IFN-γ and LT-α, with the aim of further elucidating the role of astrocytes in CM pathogenesis. Initially we confirmed that Ifn-γ and Cxcl10 are expressed in the brain in murine CM, and that the increased Cxcl10 expression is IFN-γ-dependant. IFN-γ induced CXCL10 production in human and murine astrocytes in vitro. The degree of induction was increased synergistically in the presence of LT-α. IFN-γ induced the expression of receptors for LT-α, while LT-α increased the expression of the receptor for IFN-γ, in the astrocytes. This cross-induction may explain the synergistic effect of the two cytokines on CXCL10 production. Expression of these receptors also was upregulated in the brain in murine CM. The results suggest that astrocytes contribute to CM pathogenesis by producing CXCL10 in response to IFN-γ and LT-α.

Balancing dual roles in end-of-life research.

Ethical and practical issues are sure to arise from the majority of research studies done with palliative populations. Whether it is feeling opportunistic, being emotionally available, or struggling with witnessing a gap in service and needs of the participants receiving care, nurses involved in research find a way to balance both roles to meet the needs of the participants as well as the study (McIlfatrick, Sullivan, & McKenna, 2006). This paper highlights some of the practical and ethical issues that arise when frontline nurses also take on the role of research assistant for studies with palliative populations. Specifically, the authors highlight their personal experiences based on their research assistant work on a study examining family caregiver coping in end-of-life cancer care. The authors discuss the "balancing act" of taking on these dual roles and offer recommendations on how to be with and approach people when doing research at the end of life using a framework based on Swanson's Theory of Caring (1991).