Mental health problems of homeless children and families: longitudinal study

Objective: To establish the mental health needs of homeless children and families before and after rehousing.

Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey

Objective To assess whether equity is achieved in use of general practitioner, outpatient, and inpatient services by children and young people according to their ethnic group and socioeconomic background.

Spontaneous rupture of malarial spleen: two case reports and review of literature

Malaria has long been among the most common diseases in the southeast Anatolia region of Turkey. In 1992, 18676 cases were diagnosed in Turkey, and Diyarbakir city had the highest incidence (4168 cases), followed by SanliUrfa city (3578 cases). Malaria was especially common during 1994 and 1995, with 84 345 and 82 094 cases being diagnosed in these years, respectively. Spontaneous rupture of malarial spleen is rare. We saw two cases during 1998, which are reported herein. Both patients were male, and were receiving chloroquine treatment for an acute attack of malaria. One of the patients had developed abdominal pain and palpitations, followed by fainting. The other patient had abdominal pain and fever. Explorative laparotomy revealed an enlarged spleen in both patients. Splenectomy was performed in both patients. We have identified 15 episodes of spontaneous rupture of the spleen in the English language literature published since 1961. Because of increased travel to endemic areas and resistance to antimalarial drugs, malaria is a major medical problem that is becoming increasingly important to surgeons worldwide. Malaria is a particularly important problem in the southeast Anatolia region of Turkey. Prophylactic precautions should be taken by tourists who travel to this region, especially during the summer.

Evolution by the birth-and-death process in multigene families of the vertebrate immune system

Concerted evolution is often invoked to explain the diversity and evolution of the multigene families of major histocompatibility complex (MHC) genes and immunoglobulin (Ig) genes. However, this hypothesis has been controversial because the member genes of these families from the same species are not necessarily more closely related to one another than to the genes from different species. To resolve this controversy, we conducted phylogenetic analyses of several multigene families of the MHC and Ig systems. The results show that the evolutionary pattern of these families is quite different from that of concerted evolution but is in agreement with the birth-and-death model of evolution in which new genes are created by repeated gene duplication and some duplicate genes are maintained in the genome for a long time but others are deleted or become nonfunctional by deleterious mutations. We found little evidence that interlocus gene conversion plays an important role in the evolution of MHC and Ig multigene families.

Fas (CD95) expression and death-mediating function are induced by CD4 cross-linking on CD4+ T cells.

The CD4 receptor contributes to T-cell activation by coligating major histocompatibility complex class II on antigen presenting cells with the T-cell receptor (TCR)/CD3 complex, and triggering a cascade of signaling events including tyrosine phosphorylation of intracellular proteins. Paradoxically, CD3 cross-linking prior to TCR stimulation results in apoptotic cell death, as does injection of anti-CD4 antibodies in vivo of CD4 ligation by HIV glycoprotein (gp) 120. In this report we investigate the mechanism by which CD4 cross-linking induces cell death. We have found that CD4 cross-linking results in a small but rapid increase in levels of cell surface Fas, a member of the tumor necrosis factor receptor family implicated in apoptotic death and maintenance of immune homeostasis. Importantly, CD4 cross-linking triggered the ability of Fas to function as a death molecule. Subsequent to CD4 cross-linking, CD4+ splenocytes cultured overnight became sensitive to Fas-mediated death. Death was Fas-dependent, as demonstrated by cell survival in the absence of plate-bound anti-Fas antibody, and by the lack of CD4-induced death in cells from Fas-defective lymphoproliferative (lpr) mice. We demonstrate here that CD4 regulates the ability of Fas to induce cell death in Cd4+ T cells.

In vivo estimates of division and death rates of human T lymphocytes.

We present data on the decay, after radiotherapy, of naive and memory human T lymphocytes with stable chromosome damage. These data are analyzed in conjunction with existing data on the decay of naive and memory T lymphocytes with unstable chromosome damage and older data on unsorted lymphocytes. The analyses yield in vivo estimates for some life-history parameters of human T lymphocytes. Best estimates of proliferation rates have naive lymphocytes dividing once every 3.5 years and memory lymphocytes dividing once every 22 weeks. It appears that memory lymphocytes can revert to the naive phenotype, but only, on average, after 3.5 years in the memory class. The lymphocytes with stable chromosome damage decay very slowly, yielding surprisingly low estimates of their death rate. The estimated parameters are used in a simple mathematical model of the population dynamics of undamaged naive and memory lymphocytes. We use this model to illustrate that it is possible for the unprimed subset of a constantly stimulated clone to stay small, even when there is a large population of specific primed cells reverting to the unprimed state.

Risk for engagement in nonsuicidal self-injury in children and adolescents

Although NSSI engagement is a growing public health concern, little research has documented the developmental precursors to NSSI in longitudinal studies using youth samples. This study aimed to expand upon previous research on groups of NSSI engagement in a population-based sample of youth using multi-wave data. Moreover, this study examined whether chronic peer and romantic stress, the serotonin transporter gene (5-HTTLPR), parenting behaviors, and negative attributional style predicted the NSSI group membership as well as the role of sex and grade. Participants were 549 youth in beginning in the 3rd, 6th, and 9th grades at the baseline assessment. NSSI was assessed across 7 waves of data. Chronic peer and romantic stress, 5-HTTLPR, parenting behaviors, and negative attributional style were assessed at baseline. Growth mixture models, conducted to test the latent trajectory of NSSI groups did not converge. Three NSSI groups were manually created according to classifications that were determined a priori. NSSI groups included: no NSSI (85.1%), episodic NSSI (8.5%), and repeated NSSI (6.4%). Chronic peer and romantic stress, sex, and grade differentiated the no NSSI vs. repeated NSSI groups and the episodic NSSI vs. repeated NSSI groups. Specifically, higher levels of stress, being female, and being in higher grades related to repeated NSSI. 5-HTTLPR differentiated the no NSSI vs. repeated NSSI groups, such that carrying the short allele of 5-HTTLPR related to repeated NSSI. Exploratory analyses revealed that the relationship between attributional style and NSSI group was moderated by grade. This study suggests chronic interpersonal peer and romantic stress is an important factor placing youth at greater risk for repeatedly engaging in NSSI.

Distortion of self-image: risk factor for obesity in children and teenagers

Introduction: Self-image is important in the behaviour and lifestyle of children and adolescents. Analysing the self-image they have and the factors that might influence their distortion, can be used to prevent problems of obesity and anorexia. The main objective of present publication was to analyse the risk factors that may contribute to self-image distortion. Material and Methods: A descriptive survey study was conducted among 659 children and adolescents in two social classes (low and medium-high), measuring height and weight, calculating BMI percentile for age and gender. Body image and self-perception were registered. Results: The percentage of overweight-obesity is higher in scholars (41.8% boys, 28.7% girls) than in adolescents (30.1% and 22.2% respectively), with no difference between socioeconomic classes. The multinomial logistic regression analysis gives a risk of believing thinner higher (p=0.000) among boys OR=2.9(95%CI:1.43-3.37), school (p=0.000) OR=2.42(95%CI:1.56-3.76) and much lower (p=0.000) between normally nourished OR=0.08(95%CI:0.05-0.13), with no differences according to socioeconomic status. The risk of believing fatter is lower (p=0.000) between boys OR=0.28(95%CI:0.14-0.57), school(p=0.072) OR=0.54(95%CI:0.27-1.6), and much higher among underweight (p=0.000) OR=9x108(95% CI:4x108-19x108). Conclusions: Are risk factors of believing thinner: males, being in a group of schoolchildren and overweight-obesity. Conversely, are risk factors of believing fatter: females, teen and above all, be thin.

Revisiting a series of epithelial salivary gland tumors in children and adolescents in southern Portugal

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Treatment approach in patients with hyperbilirubinemia secondary to liver metastases in gastrointestinal malignancies: a case series and review of literature

BACKGROUND: Treatment of patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastases of gastrointestinal (GI) cancer is challenging. Regimen of oxaliplatin and fluoropyrimidine (FP)/folinic acid (FA) ± a monoclonal antibody (moAb), represents a feasible option considering the pharmacokinetics. Clinical data on the respective dosage and tolerability are limited and no recommendations are available. METHODS: Consecutive patients with severe hyperbilirubinemia [>2 × upper limit of the normal range (ULN) and >2.4 mg/dl] due to liver metastases of GI cancer without options for drainage receiving oxaliplatin, FP/FA ± moAb were analyzed. To collect further data a review of the literature was performed. RESULTS: A total of 12 patients were identified between 2011 and 2015. At treatment start, median bilirubin level was 6.1 mg/dl (>5 × ULN, range 2.7-13.6). The majority of patients (n = 11) received dose-reduced regimen with oxaliplatin (60-76%) and FP/FA (0-77%), rapidly escalating to full dose regimen. During treatment, bilirubin levels dropped more than 50% within 8 weeks or normalized within 12 weeks in 6 patients (responders). Median overall survival was 5.75 months (range 1.0-16.0 months) but was significantly prolonged in responders compared to nonresponders [9.7 and 3.0 months, p = 0.026 (two-sided test); 95% confidence interval (CI): 1.10-10.22]. In addition, case reports or series comprising a further 26 patients could be identified. Based on the obtained data a treatment algorithm was developed. CONCLUSION: Treatment with oxaliplatin, FP/FA ± moAb is feasible and may derive relevant benefits in patients with severe liver dysfunction caused by GI cancer liver metastases without further options of drainage.