An atlas of cells in the human tonsil

Palatine tonsils are secondary lymphoid organs (SLOs) representing the first line of immunological defense against inhaled or ingested pathogens. We generated an atlas of the human tonsil composed of >556,000 cells profiled across five different data modalities, including single-cell transcriptome, epigenome, proteome, and immune repertoire sequencing, as well as spatial transcriptomics. This census identified 121 cell types and states, defined developmental trajectories, and enabled an understanding of the functional units of the tonsil. Exemplarily, we stratified myeloid slan-like subtypes, established a BCL6 enhancer as locally active in follicle-associated T and B cells, and identified SIX5 as putative transcriptional regulator of plasma cell maturation. Analyses of a validation cohort confirmed the presence, annotation, and markers of tonsillar cell types and provided evidence of age-related compositional shifts. We demonstrate the value of this resource by annotating cells from B cell-derived mantle cell lymphomas, linking transcriptional heterogeneity to normal B cell differentiation states of the human tonsil.

Integrated screening and testing for TB and COVID-19 in Peru

We describe the experience of integrating COVID-19 screening and testing into a mobile TB screening unit in Lima, Peru. All attendees received chest radiographs, which were analysed using CAD4TB and CAD4COVID; Xpert MTB/RIF Ultra was used to test for TB, and antibody and polymerase chain reaction (PCR) for SARS-CoV-2. One Xpert-positive TB case was diagnosed per 168 people screened, one person with SARS-CoV-2 antibodies per 3 people screened, and one PCR-confirmed SARS-CoV-2 infection per 8 people screened. Integrated screening can help to avoid delays in the diagnosis of both TB and COVID-19.

The effectiveness of computer system tools on potentially inappropriate medications ordered at discharge for adults older than 65 years of age: a systematic review

BACKGROUND

Prescribing potentially inappropriate medications to the elderly leads to adverse health outcomes. The use of computer systems decision making tools has been shown to decrease the incidence of prescribing potentially inappropriate medications for the elderly; however, these results are often dependent upon other variables, such as provider compliance.

OBJECTIVE

To examine and synthesize the best available evidence related to the effect of computer systems clinical decision making tools on frequency of ordering potentially inappropriate medications at discharge and related unplanned emergency room visits or hospital readmissions in community dwelling patients older than 65 years of age.

INCLUSION CRITERIA

Adults older than 65 years of age prescribed potentially inappropriate medications.Types of interventions Electronic or computer based clinical decision making supplement or support related to prescribing of potentially inappropriate medications.The outcome measures were frequency of ordering potentially inappropriate medications (PIMs) for patients at discharge, unexpected hospital readmission rate and unexpected emergency room visits of patients who were discharged on PIMs.Randomised control trials and quasi-experimental studies.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies in the English language from January 2003 through July 2011. A search of PubMED, CINAHL, Health Source Nursing/Academic Edition, MasterFILE Premier, Scopus, DARE, Academic Search Premier, Scirus, Embase was conducted.

METHODOLOGICAL QUALITY

Studies were critically evaluated by two independent reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute.

DATA COLLECTION

Data were extracted using the standardised data extraction instruments from the Joanna Briggs Institute.

DATA SYNTHESIS

Results from quantitative papers were pooled in statistical meta-analysis as appropriate using JBI-MAStARI. Where statistical pooling was not possible, the findings are presented in narrative form.

RESULTS

A total of five articles, four randomised control studies and one quasi-experimental study were included. One study demonstrated that a computerised alert tool along with collaboration of the health care providers resulted in a statistically significant (p=0.002) decrease in ordering of PIMs as well as improved medication safety in patients older than 65 years of age. Similarly, a randomised controlled study demonstrated that computerised physician order entry with decision support significantly (p=0.02) reduced prescribing of PIMs for seniors (odds ratio=0.55, 95% CI=0.34 - 0.89). Another study demonstrated that computer-based access to complete drug profiles and alerts reduced the rate of initiation of potentially inappropriate prescriptions by 18% (RR=0.82, 95% CI=0.69-0.98). Yet another study demonstrated that implementation of age specific alerts decreases prescription writing of PIMs from 21.9 prescriptions to 16.8 per 10,000 patients; p value < 0.01. One study demonstrated that age specific alerts reduced prescribing of PIMs from 150.2 to 137.2 prescriptions per 10,000 patients; the p value = 0.75 was not statistically significant. Results from two trials were pooled for meta-analysis, with summary RR = 0.82, and 95%CI (0.76 - 0.88). No studies were found that specifically addressed unexpected hospital readmission or unexpected visits to the emergency room of patients who were discharged on PIMs.

CONCLUSIONS

Reduction in prescribing of potentially inappropriate medications occurs when clinical decision making computer support tools, such as drug specific alerts, are available to providers.Computer systems clinical decision making tools have potential for reducing numbers of potentially inappropriate medications prescribed for the community based population older than 65 years of age.Future research should continue to explore the effects of computerized clinical decision making tools on prescription writing habits of practitioners for the elderly population. In addition, documentation of unplanned ER visits and unplanned readmission rates needs to be correlated with the use of potentially inappropriate medications.

Detection of Mycoplasma pneumoniae and Chlamydia pneumoniae in ruptured atherosclerotic plaques

This paper reports what is apparently the first observation of Mycoplasma pneumoniae in association with Chlamydia pneumoniae in thrombosed ruptured atheromas. We performed electron microscopy and in situ hybridization in specimens from three patients who died of acute myocardial infarction. These patients had typical symptoms of acute ischemic syndrome. Mycoplasmas were present mainly in the lipid core of the ruptured thrombosed plaque. Vulnerable atheromas are rich in cholesterol and may favor the growth of mycoplasmas, the only microorganisms that require cholesterol for survival. We suggest that the association of Mycoplasma pneumoniae and Chlamydia pneumoniae may increase the virulence of these microorganisms, favoring proliferation, plaque inflammation and possibly plaque rupture.

Great amount of C.pneumoniae in ruptured plaque vessel segments at autopsy. A comparative study with stable plaques

A possible relationship between C.pneumoniae (CP) infection, atherosclerosis and acute myocardial infarction is a debated matter. Now we performed the search of CP in histological segments of fatal ruptured plaques and of stable plaques by histochemistry (Macchiavello stain), immunohistochemistry and in situ hybridization techniques. Electron microscopy and confocal laser microscopy techniques were used in two additional cases. The semi-quantification of CP + cells (0-4+) and quantification of lymphocytes demonstrated greater amount of CP + cells and more inflammation in the adventitia of vulnerable plaque vessel segments than of stable ones, larger amount of CP + cells in adventitia than in the plaque and high frequency of CP + cells in all groups studied. This preliminary study strongly suggests a direct pathogenetic involvement of adventitial CP in the rupture of the atheromatous plaque, development of acute myocardial infarction and also in the development of atherosclerosis.

[LIVER ORTHOTOPIC TRANSPLANTATION IN EXPERIMENTAL ANIMALS WITH VENO-VENOUS BYPASS PUMP HOSPITAL NACIONAL EDGARDO REBAGLIATI MARTINS-HNERM- 09/1996 TO 07/1998]

This study was carried at at the Hospital Nacional Edgardo Rebagliati Martins, from September 1996 to July 1998. 61 surgical procedures were performed in experimental animals, 39 in dogs and 22 in pigs. During the anhepatic phase, we used veno-venous bypass with centrifugal pumps and without systemic anticoagulation drugs in 6 animals, and passive venovenous bypass with systemic anticoagulation drugs in 8 animals. Experimental animals were sacrified two hours after the procedures were concluded in order to assess the status of vascular anastomosis and thrombus formation.

Immunohistochemical characterization of infiltrating cells in human chronic chagasic myocarditis: comparison with myocardial rejection process

Cellular subpopulations that infiltrate the heart in human chronic chagasic myocarditis were defined immunohistochemically in endomyocardial biopsy (EMB) specimens. T cells formed 96.3% of the inflammatory infiltrate, predominantly CD8+ (cytotoxic/suppressor) T cells. The mean numbers of CD8+ and CD4+ (helper) T cells in the myocarditis were compared to those present in the myocardial rejection process. Mean numbers of CD8+ T cells were similar in both groups of EMB specimens while CD4+ T cell counts, CD4+/CD8+ ratios and CD4+ antigen expression were significantly lower in the chagasic group compared to the myocardial rejection group (P < 0.002). The persistent lower number and diminished expression of CD4+ T cells suggest an immunological imbalance in patients with chronic chagasic myocarditis. A possible participation of Trypanosoma cruzi parasites in the development of such immunological abnormalities is also discussed.