IL-12RB1 deficiency and disseminated Mycobacterium tilburgii disease.

Mycobacterium tilburgii rarely causes disseminated disease. We describe a case of M. tilburgii infection in an otherwise healthy 33-year-old woman, who was found to carry bi-allelic mutations of the gene encoding the β1 chain of the IL-12 receptor.

Reducing the incidence of coronary heart disease

The incidence of coronary heart disease (CHD) has been significantly reduced by the introduction of the National Service Framework in 2000 but has not yet reached set targets. This article analyses the adverse effects of specific CHD risk factors to the cardiovascular system and proposes local and national strategies for further reduction in the incidence, morbidity and mortality of CHD. It provides an example of how nurses can use a health promotion programme to support patients in giving up smoking, a major contributing factor in CHD. The programme uses cognitive behaviour therapy to improve patients' uptake and adherence.

Barriers to effective pain management in sickle cell disease

Sickle cell disease (SCD) is a long-term condition that would benefit from a long-term conditions approach to its care and management. SCD is growing in prevalence, affecting 10,000-12,000 people in the UK, with SCD sufferers having an increased life expectancy from in the past. The most problematic aspect of managing SCD is management of the pain from vaso-occlusive crises. Vaso-occlusive pain is the most common reason for hospital admissions in people with SCD and accounts for large numbers of accident and emergency (A&E) attendances. A literature review was carried out to examine the management of vaso-occlusive pain in SCD. The review identified three main barriers to effective pain management in SCD: the manifestation of vaso-occlusive pain, the sociocultural factors affecting pain assessment, and the concerns regarding addiction and pseudo-addiction. Addressing these barriers will allow people with SCD to have their pain managed more effectively, improve their quality of life and potentially reduce A&E attendances and admissions to hospital.

The vague, the viral, the parasitic: Piranesi's metropolis

In mid-18th century Giovanni Battista Piranesi’s etchings systematically document the old and new monuments, decrepit buildings and broken down infrastructures of a Rome that continues to inhabit and reinvent its past. His views of Rome offer a devastating account of the blurring of distinctions and articulations that time, use and neglect have imposed on the old differentiations of the urban and the rural, the public and the private, the monumental and the domestic in the 18th century city. Rome becomes for Piranesi the laboratory for a questioning of architecture that places his work well beyond the debate on style and on the origin that dominated the architectural discourse of his time. This paper suggests that Piranesi’s images anticipate the dispersion and sprawl of the city of today, in which the ‘vague’, the ‘viral’ and the ‘parasitic’ become modes of inhabitation and of transient negotiated definition. In the Antichità di Roma, ancient buildings are represented not only in their large scale and magnificence, but also in their decay and reversal to a state of naturalness. These works, together with the acute observations of the Vedute di Roma, provide the materials that are then dislocated, manipulated, cloned and endlessly mutated by Piranesi in the synthesis of the Campo Marzio dell’Antica Roma, in which the historical city is almost entirely dissolved and replaced by an extraordinary congestion of fragments. When they are re-examined on the grounds of contemporary architectural and urban theory, the sites of Piranesi's views reveal anticipations of phenomena that affect the metropolis of today. Political, social and economic conditions have changed dramatically, but the questions asked of architecture in and by these sites challenge the definition of an architecture of style, forms and boundaries - in the 18th century as well as in the 21st -in favour of an architecture of change.

Epidemiological and nutrition transition in developing countries: impact on human health and development

Whereas common infectious and parasitic diseases such as malaria and the HIV/AIDS pandemic remain major unresolved health problems in many developing countries, emerging non-communicable diseases relating to diet and lifestyle have been increasing over the last two decades, thus creating a double burden of disease and impacting negatively on already over-stretched health services in these countries. Prevalence rates for type 2 diabetes mellitus and CVD in sub-Saharan Africa have seen a 10-fold increase in the last 20 years. In the Arab Gulf current prevalence rates are between 25 and 35% for the adult population, whilst evidence of the metabolic syndrome is emerging in children and adolescents. The present review focuses on the concept of the epidemiological and nutritional transition. It looks at historical trends in socio-economic status and lifestyle and trends in nutrition-related non-communicable diseases over the last two decades, particularly in developing countries with rising income levels, as well as the other extreme of poverty, chronic hunger and coping strategies and metabolic adaptations in fetal life that predispose to non-communicable disease risk in later life. The role of preventable environmental risk factors for obesity and the metabolic syndrome in developing countries is emphasized and also these challenges are related to meeting the millennium development goals. The possible implications of these changing trends for human and economic development in poorly-resourced healthcare settings and the implications for nutrition training are also discussed.

Morphological and molecular characteristics of a new species of Pasteuria parasitic on Meloidogyne ardenensis

A species of the hyper-parasitic bacterium Pasteuria was isolated from the root-knot nematode Meloidogyne ardenensis infecting the roots of ash (Fraxinus excelsior). It is morphologically different from some other Pasteuria pathogens of nematodes in that the spores lack a basal ring on the ventral side of the spore and have a unique clumping nature. Transmission electron microscopy (TEM) showed that the clumps of spores are not random aggregates but result from the disintegration of the suicide cells of the thalli. Sporulation within each vegetative mycelium was shown to be asynchronous. In addition to the novel morphological features 16S rRNA sequence analysis showed this to be a new species of Pasteuria which we have called P. hartismeri. Spores of P. hartismeri attach to juveniles of root-knot nematodes infecting a wide range of plants such as mint (Meloidogyne hapla), rye grass (unidentified Meloidogyne sp.) and potato (Meloidogyne fallax).