Primary Epstein-Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study.

BACKGROUND: Epstein-Barr virus (EBV)-seronegative renal transplant recipients are at risk of post-transplant lymphoproliferative disorder (PTLD). We compared primary EBV infection, seroconversion, and PTLD in EBV-seronegative patients who received renal allograft from seropositive or seronegative donors (D+/R- and D-/R-, respectively). METHODS: We prospectively followed 25 D+/R- and 8 D-/R- recipients. We followed patients from January 1999 to June 2009 with clinical visits, monthly EBV polymerase chain reaction tests, and serologic tests for a period of 1 year after kidney transplantation and on an individual basis thereafter. RESULTS: Three patients (9%) developed PTLD including 2 early-onset (<12 months) and 1 late-onset (>12 months) disease. In D+/R- and D-/R- patients, the frequencies of PTLD (8% vs. 12.5%, P = 0.7), EBV seroconversion (64% vs. 50%, P = 0.4), and EBV viremia (40% vs. 25%, P = 0.6) were not significantly different. Clinical, serologic, and virologic surveillance as well as reduction in immunosuppression after evidence of primary EBV infection resulted in a PTLD rate of 9%, despite a seroconversion rate of 60.6%. Rate of graft loss after reduction in immunosuppression was 10% (2 of 20), which was not significantly different from 13 patients without EBV seroconversion (no graft loss, P = 0.5). Rates of viremia, seroconversion, and PTLD in D+/R- and D-/R- patients appear to be similar. CONCLUSIONS: The incidence of PTLD in renal transplants ranges from 0.5% to 2.9%. Our data show a significantly higher rate in EBV-seronegative renal allograft recipients, suggesting the need for close surveillance. Our data also suggest that donors for EBV-seronegative recipients may be accepted irrespective of positive or negative serostatus, with ongoing surveillance important in either circumstance.

A twelve month study of sports injuries in one Irish school.

A literature review suggested that both acute and overuse injuries were common in body contact sports. This hypothesis was tested on a group of 266 Irish adolescents in an investigation that examined the incidence of injury amongst these individuals over a twelve months period. The mean age of the subjects was:- males 14.3 +/- 0.85 years and females 14.1 +/- 0.90 years. The responses of the subjects to a questionnaire on their sporting involvement, training and sports injuries were analysed. A total of 230 injuries were incurred by the subjects during the twelve month period: 181 of these were to males. However, the number of injuries per hour of participation was similar in the two sexes. Subjects involved in body contact sports incurred the highest number of overuse injuries. The injury rate per 10,000 hours of participation was highest in badminton (70.85 injuries per 10,000 hours), gymnastics (68.18), rugby (59.77) and basketball (56.22). The rate of overuse injuries was high in swimming, badminton and athletics. The most common injuries was found to be common. The results of the study suggests that injury prevention programmes should be targeted to a wider range of sports, to females as well as to males, and that rehabilitation programmes need to be improved.

Predicting the unpredictable: issues for output-based funding in psychiatric services.

In this study a number of important issues relating to diagnosis related groups and psychiatry are highlighted. Retrospective analysis of admissions to a rural psychiatric admission unit was undertaken utilising two differing approaches to statistical analysis. Results revealed that diagnosis alone is not highly predictive of cost. However, when linked to other variables, greater explanation in variation of length of stay was achieved. Data from social variables yielded sufficiently interesting results to warrant further investigation. The authors conclude by reporting the resultant groups from the classification analysis and offer some suggestions for further research.