Plaque psoriasis following Kawasaki disease and varicella

We describe the case of a 15-month-old boy with Kawasaki disease who developed varicella 7 days after the beginning of the disease and diffuse plaque psoriasis after 43 days. Associations between Kawasaki disease and psoriasis, between Kawasaki disease and varicella and between varicella and psoriasis have all been reported in the literature. The triple association of Kawasaki disease, varicella and psoriasis is very rare. Neither the double nor the triple associations are well known among a diverse group of practitioners.

https://ift.tt/2MkKRGn

A differential diagnosis for annular lesions: contact dermatitis to transdermal rivastigmine patches

Description

During an appointment for an unrelated condition at a dermatology clinic, a 75-year-old man was noted to have a number of annular lesions on his trunk. The patient mentioned that he had been prescribed transdermal rivastigmine patches (Alzest 4.6mg/24h) for memory impairment 4 months previously. These were applied and left on for 24 hours before being replaced. He noticed that each patch left a red, pruritic area.

The patient was otherwise well, his only medication being an antihypertensive. He did not have any drug allergies or sensitivity to plasters.

On examination, there were multiple annular lesions scattered over his trunk with a predilection for the flanks (figure 1). These demonstrated an evolution of clinical features; more recent lesions were erythematous, inflamed plaques (figure 1A) which progressed into brown, postinflammatory patches (figure 1B) which gradually faded. All the lesions were well demarcated, circular and approximately 40 mm in diameter.

...

https://ift.tt/2LZN1i2

Haptic, Physical, and Web-Based Simulators: Are They Underused in Maxillofacial Surgery Training?

Publication date: Available online 4 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Samantha G. Maliha, J. Rodrigo Diaz-Siso, Natalie M. Plana, Andrea Torroni, Roberto L. Flores

Purpose

Surgical residencies have increasingly incorporated both digital and mannequin simulation into their training programs. The aim of our review was to identify all digital and mannequin maxillofacial simulators available for education and training, highlight their benefit, and critically assess the evidence in support of these educational resources.

Materials and Methods

We performed a comprehensive literature review of all peer-reviewed publications of digital and mannequin simulators that met the inclusion criteria, defined as any simulator used in education or training. All simulators used in surgical planning were excluded. Before the query, it was hypothesized that most studies would be descriptive in nature and supported by low levels of evidence. Literature search strategies included the use of multiple combinations of key search terms, review of titles and abstracts, and precise identification of the use of the simulator described. All statistics were descriptive.

Results

The primary search yielded 259 results, from which 22 total simulators published on from 2001 to 2016 were identified using the inclusion and exclusion criteria: 10 virtual reality haptic-based simulators, 6 physical model simulators, and 6 Web-based simulators used for a variety of procedures such as dental skills, instrument handling, orthognathic surgery (Le Fort I osteotomy, vertical ramus osteotomy, bilateral sagittal split ramus osteotomy), genioplasty, bone grafting, sinus surgery, cleft lip repair, orbital floor repair, and oral biopsy. Only 9 formalized studies were completed; these were classified as low-level evidence-based cohort studies (Levels IV and V). All other simulator reports were descriptive in nature. There were no studies with high levels of evidence completed (Level I to III).

Conclusions

The results of this review suggest that, although seemingly beneficial to the trainee in maxillofacial surgery, simulation in education in this field is an underused commodity because of the significant lack of scientific and validated study designs reported on in the literature thus far. The maxillofacial and simulation communities would benefit from studies on utility and efficacy with higher levels of evidence.

https://ift.tt/2OdyiNV

Sepsis caused by acute phlegmonous gastritis based on a group A Streptococcus

Abstract

We present a case of 45-year-old male with acute phlegmonous gastritis (APG) based on a hemolytic group A Streptococcus. APG is a rare and often a potentially fatal disease, which is characterized by a severe bacterial infection of the gastric wall. Because APG is a rapidly progressive disease, it comes with high mortality rates. Patients with an early diagnosis may undergo successful treatment and have a survival benefit. As soon as the diagnosis of APG is suspected, aggressive and adequate antibiotic treatment in combination with surgical intervention should be considered.

https://ift.tt/2MiBOpJ

Cutaneous resurfacing around a permanent tracheostoma with an internal mammary artery perforator flap

Abstract

When soft tissue reconstruction near a permanent tracheostoma is needed, transfer of a thin and pliable flap is preferable in order to avoid occlusion of the newly created tracheostomal opening. Although microsurgical fasciocutaneous flap transfer may be desirable for such reconstruction, it is not always an option due to lack of recipient vessels for vascular anastomosis or a patient's poor medical condition that would prohibit a lengthy procedure. An alternative option is the internal mammary artery perforator flap, which is easy to elevate, has a long arc of rotation, and has a reliable blood supply. Here, we report three cases of cutaneous resurfacing around a permanent tracheostoma with an internal mammary artery perforator flap.

https://ift.tt/2vhbjKC

An unusual presentation of Merkel cell carcinoma: a case report

Abstract

Merkel cell carcinoma (MCC) is a rare, aggressive carcinoma that usually arises in sun-exposed regions. MCC is a primary neuroendocrine tumor that arises in the skin. This report describes an unusual case of MCC on the buttocks that was treated with excision, radiation and chemotherapy. Physicians should consider MCC as a differential diagnosis when encountering a rapidly growing, painless lesion. Early diagnosis and treatment may improve patient survival rates.

https://ift.tt/2OaZHQi

Intraductal papillary mucinous neoplasm originating from a heterotopic pancreas within the jejunum: a case report

Abstract

We report a case of intraductal papillary mucinous neoplasm arising within the heterotopic pancreatic tissue which was found incidentally in the jejunum during surgery for bowel obstruction. A 54-year-old female patient was admitted to our hospital due to sudden abdominal pain. In preoperative findings, we diagnosed bowel obstruction and performed surgery. Intra-operative findings showed adhesive intestinal obstruction, we performed synechiotomy for adhesion release. During surgery, when searching the small intestine, we coincidentally found a tumor in the jejunum and partial resected the jejunum. Pathological examination revealed a 1.2 cm × 1.0 cm × 1.0 cm white yellow nodule with cystic spaces. Histological examination demonstrated heterotopic pancreatic tissue consisting of well-formed lobules of pancreatic acini and cystically dilated ducts containing intraductal papillary neoplasm. Moreover, in immunohistochemical staining, MUC5AC was diffusely expressed, but not MUC1, MUC2 and MUC6.

https://ift.tt/2LXbuEu

Thyroid paraganglioma: a case series of a rare head and neck tumor

Abstract

Thyroid paragangliomas are rare neuroendocrine tumors. We present two cases analyzing their clinical presentation and pathology findings. A 44-year-old woman presented with a 33 mm left thyroid lobe mass. A 27-year-old male presented with a 27-mm right thyroid lobe mass and a FNA biopsy suggesting a follicular thyroid tumor. Both patients underwent total thyroidectomy. Vigorous bleeding was noted on the first case. Histologic sections revealed encapsulated tumors, whereas immunochemical stains were positive for chromogranin A, synaptophysin and NSE and negative for thyroglobulin, calcitonin, CEA and S-100. After an 18- and 12-month follow-up, respectively, both patients have no signs of local recurrence or distant metastasis. Preoperative diagnosis of thyroid paragangliomas was never attained in this series. Immunohistochemistry is mandatory for proper differential diagnosis. For the surgeon, the operation is technically demanding mainly due to the increased vascularity and friability of the tumor.

https://ift.tt/2MfwX8p

Medication-related osteonecrosis of the jaw – Personal comments

Publication date: Available online 4 August 2018

Source: American Journal of Otolaryngology

Author(s): Poramate Pitak-Arnnop

https://ift.tt/2OEX0YB

Plasma rich in growth factors (PRGF) for the promotion of bone cell proliferation and tissue regeneration

Abstract

Objectives

Over the past few years, studies about growth factors have been increasingly developed and the knowledge of their role in stimulating cell proliferation and differentiation used for therapeutic purposes. This study aims to compare a platelets concentrate, the plasma rich in growth factors (PRGF) to a control, consisting of cellulose membranes, to evaluate in vitro the cellular adhesion and migration of human osteoblasts (hOb) and understand if the use of platelets concentrates could be an advantage in view of bone tissue regeneration.

Study design

Twenty-seven human donors provided 27 blood samples used to make 54 samples: 27 for PRGF and 27 for the control group. PRGFs and controls were incubated for 48 h in sterility in 1 ml of culture with 10⁵ hOb and hOb in the scaffolds were then quantified.

Results

In PRGF samples, hObs were more numerous than in controls. (T = 6.6964, p < 0.0001).

Conclusions

Human osteoblasts are driven to colonize PRGFs with a greater efficacy than negative controls, probably due to the presence of chemokines and growth factors in PRGFs.

https://ift.tt/2vfbC8Q

Diplopia—an unheralded consequence of neck dissection: case report

Abstract

Introduction

Neck dissection is a part of the standard surgical procedure in the management of head and neck malignancy. Diplopia following neck dissection is a rare entity; hence, its diagnosis and management strategies needed to be discussed for prevention of its grave consequences.

Case report

A 30-year-old male patient presented with binocular horizontal diplopia following total thyroidectomy and neck dissection. On evaluation, there was internal jugular vein (IJV) thrombosis followed by cerebral venous sinus thrombosis (CVST). After meticulous medical management with diuretics and antiplatelet drugs, diplopia resolved completely and normal vision was restored.

Conclusion

Therapeutic ligation of internal jugular vein during neck dissection may result in IJV thrombosis followed by CVST leading to raised intracranial tension (ICT). It has to be anticipated and addressed as early as possible to prevent its grave consequences like blindness and death.

https://ift.tt/2MkD4ID

Sweat in the pathogenesis of atopic dermatitis

Publication date: Available online 3 August 2018

Source: Allergology International

Author(s): Hiroyuki Murota, Kosuke Yamaga, Emi Ono, Ichiro Katayama

Abstract

Sweat is a transparent hypotonic body fluid made from eccrine sweat glands. Various ingredients contained in sweat are involved in a broad sense in skin homeostasis including temperature regulation, skin moisture, and immune functions. Thus, sweat plays a major role in maintaining skin homeostasis. Therefore, abnormal sweating easily compromises human health. For example, in atopic dermatitis (AD), perspiration stagnation accompanying sweat tube or sweat pore blockage, leakage of perspiration from the sweat gland to the outside tissue, and impaired secretion of sweat from the sweat gland are confirmed. In recent years, the hypothesis that atopic dermatitis is a sweat stasis syndrome has been clarified by the establishment of a sweat and sweat gland dynamic analysis technique. Secretion of sweat and leakage into tissues is caused by dermatitis and is thought to promote itching. Furthermore, from the metabolomic analysis of sweat of patients with atopic dermatitis, it was confirmed that the glucose concentration in AD sweat increased according to severity and skin phenotype, suggesting that elevated glucose affected the homeostasis of the skin. Multifaceted analyses of sweat from subjects with AD have revealed new aspects of the pathology, and appropriate measures to treat sweat can be expected to contribute to long-term control of AD.

https://ift.tt/2visqvv

A Large-Scale Genetic Analysis Reveals An Autoimmune Origin Of Idiopathic Retroperitoneal Fibrosis

Publication date: Available online 4 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Davide Martorana, Ana Márquez, F. David Carmona, Francesco Bonatti, Alessia Adorni, Maria L. Urban, Federica Maritati, Eugenia Accorsi Buttini, Chiara Marvisi, Alessandra Palmisano, Giovanni M. Rossi, Giorgio Trivioli, Paride Fenaroli, Lucio Manenti, Maria Nicastro, Monia Incerti, Davide Gianfreda, Stefano Bani, Stefania Ferretti, Domenico Corradi

https://ift.tt/2KrpL7t

Insulin resistance is associated with Sfrp5 in obstructive sleep apnea

Publication date: Available online 4 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Shibo Sun, Huifen Zhai, Mei Zhu, Peili Wen, Xin He, Haoyan Wang

Abstract

Introduction

Obstructive sleep apnea, a common disease, is usually complicated by insulin resistance and type 2 diabetes mellitus. Adipokine is considered to play an important role in the development of insulin resistance and type 2 diabetes mellitus in obstructive sleep apnea.

Objective

To assess whether secreted frizzled-related protein 5, a new adipokine, is involved in untreated obstructive sleep apnea patients.

Methods

Seventy-six subjects with obstructive sleep apnea and 33 control subjects without obstructive sleep apnea were recruited and matched in terms of body mass index and age. The fasting secreted frizzled-related protein 5 plasma concentration was tested using ELISA. In addition, the correlation between secreted frizzled-related protein 5 and the homeostasis model assessment of insulin resistance was obtained. Multiple linear regression analysis models with stepwise selection were performed to determine the independent associations between various factors and secreted frizzled-related protein 5.

Results

Plasma secreted frizzled-related protein 5 levels were significantly lower in the obstructive sleep apnea group than in the control group (obstructive sleep apnea group: 28.44 ± 13.25 ng/L; control group: 34.16 ± 13.51 ng/L; p = 0.023). In addition, secreted frizzled-related protein 5 was negatively correlated with homeostasis model assessment of insulin resistance but positively correlated with the mean and lowest oxygen saturation with or without adjusting for age, gender, body mass index, neck circumference, waist circumference and waist-to-hip ratio. The multiple linear regression analysis showed there was an independent negative association between secreted frizzled-related protein 5 and homeostasis model assessment of insulin resistance.

Conclusion

Secreted frizzled-related protein 5 was involved in obstructive sleep apnea and the decrease in secreted frizzled-related protein 5 was directly proportional to the severity of obstructive sleep apnea. There was an independent negative correlation between homeostasis model assessment of insulin resistance and secreted frizzled-related protein 5 in the obstructive sleep apnea group. Secreted frizzled-related protein 5 might be a therapeutic target for insulin resistance in obstructive sleep apnea.

Resumo

Introdução

A apneia obstrutiva do sono, sendo uma doença comum, é geralmente complicada com resistência à insulina e diabetes melito tipo 2. Considera-se que a adipocina desempenhe um papel importante no desenvolvimento de resistência à insulina e diabetes melito tipo 2 na apneia obstrutiva do sono.

Objetivo

Avaliar se a proteína secretada relacionada ao receptor frizzled-5, uma nova adipocina, está envolvida em pacientes com apneia obstrutiva do sono não tratada.

Método

Setenta e seis indivíduos com apneia obstrutiva do sono e 33 indivíduos controle sem apneia obstrutiva do sono foram recrutados e pareados em relação a índice de massa corporal e idade. A concentração plasmática de proteína secretada relacionada ao receptor frizzled-5, foi testada em jejum utilizando o teste ELISA. Além disso, obteve-se correlação entre a proteína secretada relacionada ao receptor frizzled-5 e o modelo de avaliação da homeostase de resistência à insulina. Modelos de análise de regressão linear múltipla com seleção stepwise foram realizados para determinar as associações independentes entre vários fatores e a proteína secretada relacionada ao receptor frizzled-5.

Resultados

Os níveis plasmáticos de proteína secretada relacionada ao receptor frizzled-5 foram significativamente menores no grupo com apneia obstrutiva do sono do que no grupo controle (grupo com apneia obstrutiva do sono: 28,44 ± 13,25 ng/L; grupo controle: 34,16 ± 13,51 ng/L; p = 0,023). Além disso, a proteína secretada relacionada ao receptor frizzled-5 foi correlacionada negativamente com o modelo de avaliação da homeostase de resistência à insulina, mas correlacionou-se positivamente com a média e a saturação mínima de oxigênio com ou sem ajuste para idade, gênero, índice de massa corporal, circunferência do pescoço, circunferência da cintura e relação cintura-quadril. A análise de regressão linear múltipla mostrou que houve uma associação negativa independente entre a proteína secretada relacionada ao receptor frizzled-5 e o modelo de avaliação da homeostase de resistência à insulina.

Conclusões

A proteína secretada relacionada ao receptor frizzled-5 esteve envolvida na apneia obstrutiva do sono e sua diminuição foi diretamente proporcional à gravidade da apneia obstrutiva do sono. Houve uma correlação negativa independente entre o modelo de avaliação da homeostase de resistência à insulina e a proteína secretada relacionada ao receptor frizzled-5 no grupo da apneia obstrutiva do sono. A proteína secretada relacionada ao receptor frizzled-5 pode ser um alvo terapêutico para a resistência à insulina na apneia obstrutiva do sono.

https://ift.tt/2vgrvfc

Long-term follow-up of an Activated PI3K-δ Syndrome 2 patient presenting with an agammaglobulinemia phenotype

Publication date: Available online 4 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Nguyen Yann, Rosain Jérémie, Aguilar Claire, Picard Capucine, Malphettes Marion

https://ift.tt/2Mik1yL

The possibilities of a portable low-budget three-dimensional stereophotogrammetry system in neonates: a prospective growth analysis and analysis of accuracy

With the technical development, portable three-dimensional (3D) photogrammetry systems are becoming more en vogue because of cost-effectiveness and comparable accuracy to common stationary 3D systems. The purp...

https://ift.tt/2AD3kN0

Short Runs for a Long Slide: Principalization in Complex Facial Restoration after Acid Attack Burn Injury

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1668511

Burn injuries are responsible for a significant portion of surgically treatable morbidity throughout the world and particularly in underdeveloped and developing countries. Intentional flame, chemical, and contact burns are unfortunately a common mechanism of injury. It is estimated that intentional chemical burns are responsible for between 2 and 20% of burn injuries seen at burn centers in lower income countries. Women are commonly targeted and the perpetrators are often known to the victims. The combination of a high disease prevalence, limited surgical and anesthetic resources, a vulnerable patient population, and largely disfiguring, nonlethal injuries present unique challenges for the reconstructive surgeon who may not encounter such cases regularly. In this article, we present a case of a 16-year-old female who sustained severe, full-thickness burns to the face including eyelids, neck, abdomen, and upper extremities after an intentional acid attack. She began her treatment course with us approximately 1 year after the injury. The deformities of her oral and periorbital regions presented particularly difficult reconstructive problems, including impending visual loss. Using plastic surgical principalization, we provided our patient adequate restoration of facial form and function through numbers of interventions using fundamental and state-of-the-art techniques.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2KquPsM

Long-term follow-up of an Activated PI3K-δ Syndrome 2 patient presenting with an agammaglobulinemia phenotype

Activated phosphoinositide 3-kinase δ syndrome type 2 (APDS2) is a primary immunodeficiency caused by heterozygous loss-of-function mutations in PIK3R11,2. This mutation leads to hyperactivation of PI3K, a kinase involved in the signaling pathway of multiple receptors of the immune system3. APDS2 is characterized by the early occurrence of recurrent respiratory tract infections followed by the development of chronic benign lymphoproliferation, gastrointestinal manifestations and autoimmune cytopenias4,5.

https://ift.tt/2AEF7WV

Food allergy is an independent risk factor for decreased lung function in children with asthma

Individuals with asthma and food allergy have increased asthma-related morbidity – daily cough/wheeze, lifetime hospitalizations, unplanned healthcare utilization – and mortality compared to individuals without food allergies.1-4 In patients with both diseases, this higher morbidity and mortality may be related to direct and/or indirect effects of food allergy on a child or young adult's bronchial hyperreactivity and lung function.3,5-12 Indeed, the influence of food allergy on asthma appears to present early in life.

https://ift.tt/2vdvRUa

Chronic rhinosinusitis with severe nasal polyposis in Hyper-IgE syndrome

Autosomal-dominant Hyper-IgE syndrome (AD-HIES) is a rare multisystem disorder that is characterized by eczema, infections with staphylococcal and fungal organisms, elevated total serum IgE level and skeletal and connective tissue involvement. The transcription factor signal transducer and activator of transcription 3 (STAT3) plays a crucial role in the development and differentiation of Th17 cells and mutations in STAT3 cause AD-HIES.1 Patients with AD-HIES are reported to have markedly decreased or absent circulating Th17 cells.

https://ift.tt/2AEF39D

Surgical correction of hypertrophic upper lip in vascular malformations

Publication date: Available online 3 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Margherita Dessy, Giacomo Colletti, Ambra Dionisio, Carlotta Liberale, Federico Biglioli

Abstract

Capillary malformations (CMs) and Lymphatic malformations (LMs) are vascular malformations that share a common tendency to cause soft and hard tissue hypertrophy, expressed in the three dimensions of the space. The middle third of the face is the most commonly involved area, with a predominance of the upper lip.

To our knowledge, no paper has previously focused on the surgical technique to correct such deformities. We propose and illustrate a surgical protocol, consisting in merging an asymmetric bikini upper lip reduction and a unilateral bull horn resection technique, that allowed to reduce the overall volume of the hypertrophied lip thus restoring lip symmetry. We adopted this technique in 2 patients affected by CMs and 4 patients with LMs, with satisfactory results.

https://ift.tt/2vyuBuw

Validity of sentinel node biopsy in early oral and oropharyngeal carcinoma

Publication date: Available online 3 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): C.G.U. Riese, J.-A. Karstadt, A. Schramm, S. Güleryüz, G. Dressel, K.J. Lorenz, B. Klemenz, A. Sailer, S. Seitz, F. Wilde

Summary

Purpose

This study investigates the possibility and sensibility of using sentinel node biopsy (SNB) during surgery for oropharyngeal carcinomas with clinically and radiographically unremarkable cervical lymph nodes.

Materials and Methods

A total of 36 patients who were treated for early oral and oropharyngeal carcinoma and unremarkable cervical lymph nodes were included in this study. After lymphoscintigraphy for detecting sentinel lymph nodes (SLN), the SLN were excised first. Thereafter elective neck dissection was performed. Histopathological and immunochemical examinations were used to examine the SLN and all other lymph nodes.

Results

The preoperative SLN detection rate was 97.2% (35 of 36). SLN in level V were detected in four patients (11.1%). Metastases were found in 33.3% of the patients (12 of 36). All metastases were in the marked SLN. No skip metastases could be detected. A specificity of 100% and a sensitivity of 94.4% were identified for the SNB.

Conclusion

The study confirms that SNB is a precise diagnostic procedure for assessing the nodal status of cervical lymph nodes. Further studies are needed to determine whether SNB without elective neck dissection for clinically and radiologically unremarkable cervical lymph nodes can become a reliable course of treatment for carcinomas of the head and neck region.

https://ift.tt/2LTD4U3

Multiple granular cell tumors associated with joint hypermobility, facial dysmorphism, and asymptomatic neurologic findings: A rare syndrome

Background: The granular cell tumor (GCT), also known as Abrikossoff tumor, is a rare, benign tumor. Its supposed origin is related to Schwann cells. It generally presents with a solitary nodule, but multiple tumors may be found in up to 25% of patients, less frequently in children. Bakos and Muscardin have reported multiple GCT associated with malformations in cardiovascular, neurologic and musculoskeletal systems in addition to a dysmorphic face, which could be features of a rare syndrome.

https://ift.tt/2M6DJ3S

Multiple eruptive myxoid dermatofibroma in a man with chronic hepatitis B infection

We report the first known case of multiple eruptive myxoid dermatofibromas (MEMDF) in a male with chronic hepatitis B infection presenting with eruptive lesions showing marked deposits of dermal mucin. Tumor cells were positive for CD68 and vimentin and negative for S-100 and SMA. CD34 stained regular endothelial cells. Work-up showed asymptomatic chronic hepatitis B infection without cirrhosis. This case highlights an extremely rare histologic variant and the importance of screening for altered immunity in patients with eruptive dermatofibromas.

https://ift.tt/2O6R4Gw

Psychologic health status and health-related quality of life in adults with atopic dermatitis

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder which is characterized by recurrent pruritic eczematous skin lesions. Patients with AD often suffer from a lot of psychologic distress and poor health-related quality of life (HRQoL) because of the irritating and disfiguring nature of the disease. However, psychologic burden of the AD patients has been underestimated and often considered to be of little importance even in clinics.

https://ift.tt/2vhkmv5

Classic Sweet sydrome: A case report

Sweet syndrome, or acute febrile neutrophilic dermatosis, is the most common of the neutrophilic dermatoses. We present a 54-year-old man who began 11 days before consultation with an upper respiratory tract infection, fever, and painful blisters on the face and arms, receiving treatment with antivirals and antibiotics unsuccessfully. Clinically he had bilateral conjunctivitis, vesicles, blisters, some with purulent exudate, flattened and necrotic center, plaques with erythematous and raised edges affecting face, neck, ears, chest, and upper limbs.

https://ift.tt/2O6Drr2

Clear cell variant of eccrine porocarcinoma of the hand: A case report

Introduction: Eccrine porocarcinoma (EP) is a rare malignant neoplasm of the acrosyringium with metastatic potential that most commonly presents on the acral skin in older adults. The primary lesions present as verrucous or polypoid nodules or plaques, often with spontaneous bleeding and ulceration, and arise either from a preexisting eccrine poroma or de novo. Only 8% of porocarcinomas occur in the upper extremity and only 3% are on the hand. The histologic characteristics of EP vary a lot so more than one consultation is often needed to establish the diagnosis.

https://ift.tt/2vfSs2C

Clinical analysis of linear focal elastosis

Background: Linear focal elastosis (LFE) is an uncommon disease of elastic tissue. There have been 31 cases of LFE in the English-language literature.

https://ift.tt/2Mi08Ij

Clinical and dermoscopic features of 135 cases of small-diameter melanomas

Introduction: Early diagnosis of melanoma reduces morbidity, mortality, and costs. As a result of the increasingly early diagnosis, the percentage of melanomas removed when their diameter does not exceed 6 mm is rising and about 50% of the cases are already invasive. These lesions represent a diagnostic challenge both clinically and dermatoscopically.

https://ift.tt/2LUD8lJ

Clinical and economic implications of a noninvasive molecular pathology assay for early detection of melanoma

Background: More than 90% of ∼2.5 million surgical biopsies performed to rule out melanoma in the U.S. alone are benign and classified as neither invasive melanomas nor melanomas in situ by histopathology. A recently described adhesive patch skin biopsy based noninvasive gene expression test (pigmented lesion assay; PLA) demonstrated utility and differentiated benign from malignant pigmented skin lesions with a test performance that exceeded visual inspection (VI) and a sensitivity that matching the criterion standard of dermatopathology.

https://ift.tt/2O5TCoi

Clinical and erythema-directed instrumental evaluation of papulopustular rosacea treated with topical ivermectin

Background: Ivermectin 1% cream is a new therapeutic topical option able to control mild/moderate papulopustular rosacea (PPR). Nontransient erythema from inflammatory lesions represents an important component of PPR often leading to patient emotional suffering, and digital photography equipped with RBX system enabling separation of red/brown skin color signatures is a useful tool for evaluation of erythema in patients affected by inflammatory dermatoses including rosacea. Colorimetry is also a sensitive technique for skin color analysis.

https://ift.tt/2LZfvIK

Clinical and instrumental characterization of hair and scalp aging in nonbalding Caucasian women

Introduction: Aging affecting the body doesn't spare scalp and hair, leading to changes in the physiology of scalp and the physical properties of the hair, with potential psychologic repercussions. Most of the time, it is difficult to isolate the aging effects alone because they can be superimposed to a preexisting alopecic phenomenon.

https://ift.tt/2O9DqCt

Secukinumab demonstrates significantly lower immunogenicity potential compared with ixekizumab and adalimumab

Background: Secukinumab (SEC), a fully human monoclonal antibody (mAb) that selectively neutralizes IL-17A, has significant efficacy in the treatment of moderate to severe plaque psoriasis (Pso) and psoriatic arthritis (PsA), demonstrating a rapid onset of action and sustained responses up to 5 years with a favorable safety profile and 0.4% immunogenicity in the Pso phase 3 program. SEC has previously demonstrated lower potential for immunogenicity compared with other mAbs used to treat Pso and PsA in in vitro assays.

https://ift.tt/2vf0Xe8

The menace of persistent dermatophytosis: What is the cause?

'Background: Many patients with tinea corporis and or cruris are showing incomplete response to treatment or relapse soon after stopping treatment. The present study was carried out to determine the minimum inhibitory concentration (MIC) of the commonly used antifungal drugs in such cases and to identify predisposing factors.

https://ift.tt/2Me4pfE

Unilateral mucocutaneous lymphangioma circumscriptum: A rare case successfully treated with simple sclerotherapy and laser ablation

A 15-year-old boy presented with growth in the right buccal mucosa extending to chin skin since childhood. These were complaints for pain, bleeding, cosmetic looks. He has a linear multivesicular swellings with hemorrhagic, crusted hard swellings extending up to angle of mouth. These tumors were nontender, nonpulsatile with an irregular warty surface, and firm in consistency. Right side of the chin skin showed grouped vesicles with flash colored to dark red and black colored. A clinical suspesion of lymphangioma was made due to frog spawn picture and then biopsy from mucosa was taken.

https://ift.tt/2LZrjL2

Successful treatment of severe plaque psoriasis with secukinumab in a patient with myasthenia gravis: Case report

The treatment of severe psoriasis is often tailored around patients needs, weighting the potential benefits and side-effects. Patients' comorbidities can often make the effective treatment challenging. In the herein report, we present our experience of a patient in whom the treatment of severe psoriasis didn't aggravate myasthenia gravis (MG) symptomatology. A 60-year-old Caucasian man was first admitted to our institution suffering from severe plaque psoriasis in 2014. His medical history included MG for which was treated with neostigmine for the past 30 years.

https://ift.tt/2O9z6mH

Rate of regional nodal metastases of cutaneous squamous cell carcinoma in the immunosuppressed patient: An update

Background: The immunosuppressed patient has both an increased incidence of cutaneous squamous cell carcinoma (SCC) and a worse prognosis due to the propensity for metastatic spread. The single most important prognostic indicator for mortality in patients with SCC is the presence or development of regional lymph node metastasis. Previous studies have sought to determine the rate of regional lymph node metastases in solid organ transplant recipients (SOTRs). However, reported rates appear surprisingly low and are limited to only SOTRs.

https://ift.tt/2M6Dkyo

Topical glycerol improved psoriasiform lesions and inhibited epidermal hyperplasia in an in vivo mouse model of psoriasis

Psoriasis is a chronic incurable skin disease that has been extensively studied. Although multiple treatments have been introduced, emollients are still used as a topical treatment to control several aspects of the disease. Glycerol, an emollient, has been shown to restore barrier function and accelerate wound healing. Glycerol is transported into epidermal keratinocytes via aquaporin-3 (AQP3), which is associated with the lipid-metabolizing enzyme phospholipase D2 (PLD2). PLD2 can convert glycerol to phosphatidylglycerol, which has been shown to inhibit proliferation and promote differentiation in keratinocytes in vitro.

https://ift.tt/2Me4foy

TH17 pathway assessment in the inflammatory infiltrate of psoriasis and geographic tongue

Psoriasis is an immune-mediated disease with a genetic basis, associated with an inappropriate immune activation, mediated by T cells. There is predominance of the TH1 response and, more recently, was confirmed the participation of TH17 cells. Some studies have shown a direct relationship between psoriasis (Ps) and geographic tongue (GT), both with etiologic, histopathologic and genetic similarities. The aim of this study was to demonstrate that the histologic pattern and immunoreactivity to anti–IL-6, –IL-17, and –IL-23 antibodies, in the inflammatory response of geographic tongue are similar to psoriasis.

https://ift.tt/2LYH98v

Sociodemographics, comorbidities, and management in a pediatric cohort of chronic spontaneous urticaria

Rationale: Chronic urticaria (CU) is defined when itchy hives and/or angioedema develop for at least 6 weeks. Although not life threatening, CU is reported to be associated with recurrent visits to the emergency room, stress and missing days of school and work due to severe itchiness. In 80% of CU cases, hives occur spontaneously and are not attributable to a physical stimulus or an identifiable cause (CSU). The objective of our study is to assess sociodemographics, comorbidities, and management of CSU in a pediatric cohort.

https://ift.tt/2Ml5CC8

Risk of rhegmatogenous retinal detachment in atopic dermatitis: A 12-year nationwide cohort study

Background: Atopic dermatitis (AD) causes various ophthalmic complications, of which rhegmatogenous retinal detachment (RRD) is the most serious.

https://ift.tt/2M6D8iE

Validation of scratching severity as an objective assessment for itch

Background: Itch is a very bothersome symptom that is associated with many medical and dermatologic conditions. Itch is typically assessed subjectively, e.g., numeric rating scale (NRS). Yet, there are currently no simple, standardized, objective assessments of itch for clinical trials and practice.

https://ift.tt/2Oc2jxE

Three-dimensional planning accuracy and follow-up protocol in orthognathic surgery: a validation study

The purpose of the study was to propose and validate a three-dimensional (3D) tool for the assessment of orthognathic surgery planning accuracy and postoperative follow-up. A total of 15 patients (four male, 11 female; mean age 29.6 years) with skeletal class II and III, who underwent bimaxillary surgery were recruited for the study. All patients had preoperative computed tomography (CT), and cone-beam computerized tomography (CBCT) scans 1–6 weeks and 6 months postoperatively. The data was exported to a customized stepwise module developed in Amira software resulting in the accuracy being presented as translational and rotational differences between the planning and the actual outcome.

https://ift.tt/2LR32HF

Chronic rhinosinusitis with severe nasal polyposis in Hyper-IgE syndrome

Publication date: Available online 3 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Evie Huang, Joseph A. Church

https://ift.tt/2naByy1

Validity of sentinel node biopsy in early oral and oropharyngeal carcinoma

This study investigates the possibility and sensibility of using sentinel node biopsy (SNB) during surgery for oropharyngeal carcinomas with clinically and radiographically unremarkable cervical lymph nodes.

https://ift.tt/2LSZfcI

Surgical correction of hypertrophic upper lip in vascular malformations

Capillary malformations (CMs) and Lymphatic malformations (LMs) are vascular malformations that share a common tendency to cause soft and hard tissue hypertrophy, expressed in the three dimensions of the space. The middle third of the face is the most commonly involved area, with a predominance of the upper lip.To our knowledge, no paper has previously focused on the surgical technique to correct such deformities. We propose and illustrate a surgical protocol, consisting in merging an asymmetric bikini upper lip reduction and a unilateral bull horn resection technique, that allowed to reduce the overall volume of the hypertrophied lip thus restoring lip symmetry.

https://ift.tt/2KqYoe5

Mucosal melanoma of the cranio-facial region: Surgical challenges and therapeutic options

The treatment of cutaneous melanoma (CM) and many other tumors has been revolutionized by new therapeutic options that are constantly improving the overall survival. However, the mucosal melanoma remains (MM) a rare tumor disease with a poor clinical outcome. MM is a neuroectodermal tumor arising from melanocytes. Precursors of melanocytes arise from the neural crest, from where they migrate to their final destination through embryonic mesenchyme, along specific pathways [1].

https://ift.tt/2LR6Hp0

Three-dimensional planning accuracy and follow-up protocol in orthognathic surgery: a validation study

Publication date: Available online 3 August 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): E. Shaheen, S. Shujaat, T. Saeed, R. Jacobs, C. Politis

Abstract

The purpose of the study was to propose and validate a three-dimensional (3D) tool for the assessment of orthognathic surgery planning accuracy and postoperative follow-up. A total of 15 patients (four male, 11 female; mean age 29.6 years) with skeletal class II and III, who underwent bimaxillary surgery were recruited for the study. All patients had preoperative computed tomography (CT), and cone-beam computerized tomography (CBCT) scans 1–6 weeks and 6 months postoperatively. The data was exported to a customized stepwise module developed in Amira software resulting in the accuracy being presented as translational and rotational differences between the planning and the actual outcome. To evaluate the reliability of the proposed method, intra-class correlation coefficient (ICC) was applied at a 95% confidence interval on the translational and rotational output of two observers. The inter- and intra-observer reliability were found to be high (ICC range: 0.94–0.98) with mean variability of less than 0.4mm and 0.7° for translational and rotational movements for both planning accuracy and follow-up protocols. The study provides a reliable, quantitative and time-efficient method for evaluating the accuracy of virtual surgical planning and postoperative follow-up.

https://ift.tt/2KoQUrZ

Mucosal melanoma of the cranio-facial region: Surgical challenges and therapeutic options

Publication date: Available online 3 August 2018

Source: Auris Nasus Larynx

Author(s): Julia Thierauf, Anna-Maria Glück, Peter Plinkert, Johannes A. Veit, Thomas K. Hoffmann, Andreas Körber, Christoph Bergmann

https://ift.tt/2MekAcN

The possibilities of a portable low-budget three-dimensional stereophotogrammetry system in neonates: a prospective growth analysis and analysis of accuracy

Abstract

Background

With the technical development, portable three-dimensional (3D) photogrammetry systems are becoming more en vogue because of cost-effectiveness and comparable accuracy to common stationary 3D systems. The purpose of the study was to evaluate the feasibility and accuracy of a low-budget portable system for 3D image acquisition with special regard to the gracile nasal region in neonates. Furthermore, the study aimed to establish a 3D data set of the first 180 days post partum.

Methods

Thirty-three healthy, full-term newborn were enrolled and 3D photographs were prospectively taken monthly with a portable low-budget 3D stereophotogrammetry system (FUEL3D® SCANIFY®) for six months. In the third month, age-matched and corresponding 3D models were acquired by taking an impression of the perinasal area. The resulting plaster models were scanned (3Shape D700, 3Shape® A/S, Denmark). Three examiners analyzed independently 21 defined landmarks of the generated Standard Tessellation Language files with regard to accuracy by using 3dMDvultus™ software. A semi-automatic 3D best-fit analysis of 3D photo and plaster models were performed by using Geomagic® and the Root Mean Squared (RMS) errors were calculated.

Results

Statistically significant changes of midfacial distances and angles with a focus on nasal growth during the first 180 days postpartum could be specified in absolute and relative dimensions. Best-fit analysis in the third month revealed a RMS error of 0.72 ± 0.22 mm with a mean standard deviation of 0.71 ± 0.21 mm.

Conclusions

The analyzed portable 3D stereophotogrammetry system is a feasible methodology with good accuracy, even in newborn. A description of the growth as well as the establishment of a 3D data set was performed. Its implementation for basic documentation for example in cleft patients is possible and might reduce the need for impressions and facilitate the communications with parents and the interdisciplinary team.

https://ift.tt/2vuGSQk

Brain Health and the Batterer

Violence and Gender, Ahead of Print.


https://ift.tt/2vGlTuj

Characterization of Adult Vestibular Organs in 11 CreER Mouse Lines

Abstract

Utricles are vestibular sense organs that encode linear head movements. They are composed of a sensory epithelium with type I and type II hair cells and supporting cells, sitting atop connective tissue, through which vestibular nerves project. We characterized utricular Cre expression in 11 murine CreER lines using the ROSA26^tdTomato reporter line and tamoxifen induction at 6 weeks of age. This characterization included Calbindin2^CreERT2, Fgfr3-iCreER^T2, GFAP-A-CreER™, GFAP-B-CreER™, GLAST-CreER^T2, Id2^CreERT2, Otoferlin^CreERT2, Parvalbumin^CreERT2, Prox1^CreERT2, Sox2^CreERT2, and Sox9-CreER^T2. Otoferlin^CreERT2 mice had inducible Cre activity specific to hair cells. GLAST-CreER^T2, Id2^CreERT2, and Sox9-CreER^T2 had inducible Cre activity specific to supporting cells. Sox2^CreERT2 had inducible Cre activity in supporting cells and most type II hair cells. Parvalbumin^CreERT2 mice had small numbers of labeled vestibular nerve afferents. Calbindin2^CreERT2 mice had labeling of most type II hair cells and some type I hair cells and supporting cells. Only rare (or no) tdTomato-positive cells were detected in utricles of Fgfr3-iCreER^T2, GFAP-A-CreER™, GFAP-B-CreER™, and Prox1^CreERT2 mice. No Cre leakiness (tdTomato expression in the absence of tamoxifen) was observed in Otoferlin^CreERT2 mice. A small degree of leakiness was seen in GLAST-CreER^T2, Id2^CreERT2, Sox2^CreERT2, and Sox9-CreER^T2 lines. Calbindin2^CreERT2 mice had similar tdTomato expression with or without tamoxifen, indicating lack of inducible control under the conditions tested. In conclusion, 5 lines—GLAST-CreER^T2, Id2^CreERT2, Otoferlin^CreERT2, Sox2^CreERT2, and Sox9-CreER^T2—showed cell-selective, inducible Cre activity with little leakiness, providing new genetic tools for researchers studying the vestibular periphery.

https://ift.tt/2kOrgCg

Platelet-Derived Growth Factor Subunit B Signaling Promotes Pericyte Migration in Response to Loud Sound in the Cochlear Stria Vascularis

Abstract

Normal blood supply to the cochlea is critical for hearing. Noise damages auditory sensory cells and has a marked effect on the microvasculature in the cochlear lateral wall. Pericytes in the stria vascularis (strial pericytes) are particularly vulnerable and sensitive to acoustic trauma. Exposure of NG2DsRedBAC transgenic mice (6–8 weeks old) to wide-band noise at a level of 120 dB for 3 h per day for 2 consecutive days produced a significant hearing threshold shift and caused pericytes to protrude and migrate from their normal endothelial attachment sites. The pericyte migration was associated with increased expression of platelet-derived growth factor beta (PDGF-BB). Blockade of PDGF-BB signaling with either imatinib, a potent PDGF-BB receptor (PDGFR) inhibitor, or APB5, a specific PDGFRβ blocker, significantly attenuated the pericyte migration from strial vessel walls. The PDGF-BB-mediated strial pericyte migration was further confirmed in an in vitro cell migration assay, as well as in an in vivo live animal model used in conjunction with confocal fluorescence microscopy. Pericyte migration took one of two different forms, here denoted protrusion and detachment. The protrusion is characterized by pericytes with a prominent triangular shape, or pericytes extending fine strands to neighboring capillaries. The detachment is characterized by pericyte detachment and movement away from vessels. We also found the sites of pericyte migration highly associated with regions of vascular leakage. In particular, under transmission electron microscopy (TEM), multiple vesicles at the sites of endothelial cells with loosely attached pericytes were observed. These data show that cochlear pericytes are markedly affected by acoustic trauma, causing them to display abnormal morphology. The effect of loud sound on pericytes is mediated by upregulation of PDGF-BB. Normal functioning pericytes are required for vascular stability.

https://ift.tt/2J9DvYL

miR-29b directly targets activation-induced cytidine deaminase in human B cells and can limit its inappropriate expression in naïve B cells

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Timothy Recaldin, Philip S. Hobson, Elizabeth H. Mann, Faruk Ramadani, David J. Cousins, Paul Lavender, David J. Fear

Abstract

Class-switch recombination (CSR) is an essential B cell process that alters the isotype of antibody produced by the B cell, tailoring the immune response to the nature of the invading pathogen. CSR requires the activity of the mutagenic enzyme AID (encoded by AICDA) to generate chromosomal lesions within the immunoglobulin genes that initiate the class switching recombination event. These AID-mediated mutations also participate in somatic-hypermutation of the immunoglobulin variable region, driving affinity maturation. As such, AID poses a significant oncogenic threat if it functions outside of the immunoglobulin locus. We found that expression of the microRNA, miR-29b, was repressed in B cells isolated from tonsil tissue, relative to circulating naïve B cells. Further investigation revealed that miR-29b was able to directly initiate the degradation of AID mRNA. Enforced overexpression of miR-29b in human B cells precipitated a reduction in overall AID protein and a corresponding diminution in CSR to IgE. Given miR-29b's ability to potently target AID, a mutagenic molecule that can initiate chromosomal translocations and "off-target" mutations, we propose that miR-29b acts to silence premature AID expression in naïve B cells, thus reducing the likelihood of inappropriate and potentially dangerous deamination activity.

https://ift.tt/2M1HI1i

Continuing Medical Education Calendar

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2MgI3du

Information for Readers

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2M0k857

Editorial Board

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2KonCta

Table of Contents

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2OBSBW6

Brief Overview of This Month's JACI

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2KrflF4

Cover 1

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2OFqc1v

Correction

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s):

https://ift.tt/2KoXAWR

Reply

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Njira L. Lugogo, Cynthia Green, Monica Kraft

https://ift.tt/2M1kXdZ

Viral induced overproduction of epithelial TSLP: Role in exacerbations of asthma and COPD?

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Lena Uller, Carl Persson

https://ift.tt/2KpmtBY

Wireless optical monitoring system identifies limb induration characteristics in patients with Kawasaki disease

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Ho-Chang Kuo, Chi-Chun Lo, Pin-Xing Lin, Chien-Chun Kao, Ying-Hsien Huang, Bor-Shyh Lin

https://ift.tt/2LZxcrq

Does reduced zona pellucida binding protein 2 (ZPBP2) expression on chromosome 17q21 protect against asthma?

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Marina Miller, Christine Vuong, Meghan Farrell Garcia, Peter Rosenthal, Sudipta Das, Ning Weng, Alexa Pham, Yu Jin Kim, David H. Broide

https://ift.tt/2MfvY8x

Epithelial barrier dysfunction in desmoglein-1 deficiency

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Laura Polivka, Smail Hadj-Rabia, Elodie Bal, Stéphanie Leclerc-Mercier, Marine Madrange, Yamina Hamel, Damien Bonnet, Stéphanie Mallet, Hubert Lepidi, Caroline Ovaert, Patrick Barbet, Christophe Dupont, Bénédicte Neven, Arnold Munnich, Lisa M. Godsel, Florence Campeotto, Robert Weil, Emmanuel Laplantine, Sylvie Marchetto, Jean-Paul Borg

https://ift.tt/2M0jULj

A kindred with mutant IKAROS and autoimmunity

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Erika Van Nieuwenhove, Josselyn E. Garcia-Perez, Christine Helsen, Princess D. Rodriguez, Pauline A. van Schouwenburg, James Dooley, Susan Schlenner, Mirjam van der Burg, Els Verhoeyen, Rik Gijsbers, Seth Frietze, Hilde Schjerven, Isabelle Meyts, Frank Claessens, Stephanie Humblet-Baron, Carine Wouters, Adrian Liston

Abstract

IKAROS (encoded by IKZF1) is an important hematopoietic transcription factor critical for early B cell differentiation, with major defects known to lead to low B cell numbers and hypogammaglobulinemia. More perplexing is the link between IKZF1 variants and autoimmunity, including polymorphisms associated with susceptibility to SLE, and recently, rare variants driving monogenic autoimmunity. We identified a novel p.L188V mutation in IKZF1 in the index patient and her father and found this mutation to lead to loss of DNA binding. Peripheral B cells lacking a full complement of IKAROS function show upregulation of molecules accentuating B cell activation, while CD22, a key negative feedback circuit, is suppressed. The resulting hyperresponsiveness of peripheral B cells, in combination with elevated follicular helper T cell (Tfh) numbers, provides a putative mechanistic explanation for the association of IKZF1 variants with the emergence of autoimmune manifestations in this kindred.

https://ift.tt/2MgWXAr

Matrix protein tenascin-C expands and reversibly blocks maturation of murine eosinophil progenitors

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Ton C. Doan, Brian M. Jeong, Mackenzie E. Coden, Lucas F. Loffredo, Swati Bhattacharyya, Sergio E. Chiarella, John Varga, Hiam Abdala-Valencia, Sergejs Berdnikovs

https://ift.tt/2OBSj1s

Dexamethasone induces ω3-derived immunoresolvents driving resolution of allergic airway inflammation

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Katerina Pyrillou, Aikaterini-Dimitra Chairakaki, Constantin Tamvakopoulos, Evangelos Andreakos

https://ift.tt/2MdQ1Ed

A novel human mast cell activation test for peanut allergy

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Alexandra F. Santos, Natália Couto-Francisco, Natalia Bécares, Matthew Kwok, Henry T. Bahnson, Gideon Lack

https://ift.tt/2M0jNiR

Severity of allergic rhinitis assessed by using urine metabolomic profiling: Proof of concept

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Darryl J. Adamko, Mona M. Khamis, Lisa M. Steacy, Shana Regush, Rhonda Bryce, Anne K. Ellis

Summary/ Clinical Implications

Patients with chronic airway diseases tend to become "accustomed" to their impairments and fail to recognize the significance of their symptoms. We suggest that a metabolomic approach could become a diagnostic/monitoring solution in clinical trials or in a typical doctor's office.

https://ift.tt/2KtPFaK

Glucagon-like peptide 1 receptor signaling attenuates respiratory syncytial virus–induced type 2 responses and immunopathology

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Melissa H. Bloodworth, Mark Rusznak, Connor C. Pfister, Jian Zhang, Lisa Bastarache, Sandra Alvarez Calvillo, James D. Chappell, Kelli L. Boyd, Shinji Toki, Dawn C. Newcomb, Matthew T. Stier, Weisong Zhou, Kasia Goleniewska, Martin L. Moore, Tina V. Hartert, Kevin D. Niswender, R. Stokes Peebles

https://ift.tt/2OIzg5w

Thromboxane A2 facilitates IL-17A production from Vγ4+ γδ T cells and promotes psoriatic dermatitis in mice

Publication date: August 2018

Source: Journal of Allergy and Clinical Immunology, Volume 142, Issue 2

Author(s): Yuri Ueharaguchi, Tetsuya Honda, Nobuhiro Kusuba, Sho Hanakawa, Akimasa Adachi, Yu Sawada, Atsushi Otsuka, Akihiko Kitoh, Teruki Dainichi, Gyohei Egawa, Chisa Nakashima, Saeko Nakajima, Teruasa Murata, Sachiko Ono, Makoto Arita, Shuh Narumiya, Yoshiki Miyachi, Kenji Kabashima

https://ift.tt/2Mk8f7e

Food allergy is an independent risk factor for decreased lung function in children with asthma

Publication date: Available online 3 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Michael G Sherenian, Anne M Singh, Lester Arguelles, Lauren Balmert, Deanna Caruso, Xiaobin Wang, Jacqueline Pongracic, Rajesh Kumar

https://ift.tt/2AFLfhA

Association analyses of eQTLs of the TYRO3 gene and allergic diseases in Japanese populations

Publication date: Available online 3 August 2018

Source: Allergology International

Author(s): Jun Kanazawa, Hironori Masuko, Yohei Yatagai, Tohru Sakamoto, Hideyasu Yamada, Haruna Kitazawa, Hiroaki Iijima, Takashi Naito, Takefumi Saito, Emiko Noguchi, Tomomitsu Hirota, Mayumi Tamari, Nobuyuki Hizawa

Abstract

Background

TYRO3 is a member of the TAM (TYRO3, AXL, MERTK) receptor tyrosine kinase family and functions to limit type 2 immune responses implicated in allergic sensitization. Recent studies have shown that multiple intronic variants of TYRO3 were associated with asthma, implying that genetic variation could contribute to errant immune activation. We therefore hypothesized that expression quantitative trait loci (eQTLs) of the TYRO3 gene influence the development of allergic diseases (including asthma and allergic rhinitis) in Japanese populations.

Methods

We performed a candidate gene case–control association study of 8 eQTLs of TYRO3 on atopy, asthma, and allergic rhinitis using 1168 unrelated Japanese adults who had GWAS genotyping. We then examined the genetic impact of rs2297377 (TYRO3) on atopy and allergic rhinitis in 2 other independent Japanese populations.

Results

A meta-analysis of 3 Japanese populations (a total of 2403 Japanese adults) revealed that rs2297377 was associated with atopy and allergic rhinitis (OR = 1.29 and 1.31; P = 0.00041 and 0.0010, respectively). The risk allele at rs2297377 correlated with decreased expression of TYRO3 mRNA. The gene–gene interaction between HLA-DPB1 and TYRO3 was not significant with regard to sensitization. The estimated proportion of atopy and allergic rhinitis cases attributable to the risk genotype was 14% and 16%, respectively.

Conclusions

Our study identified TYRO3 as an important susceptibility gene to atopy and allergic rhinitis in Japanese.

https://ift.tt/2OG0kT2

Pembrolizumab/Placebo Plus Trastuzumab Plus Chemotherapy in Human Epidermal Growth Factor Receptor 2 Positive (HER2+) Advanced Gastric or Gastroesophageal Junction (GEJ) Adenocarcinoma (MK-3475-811/KEYNOTE-811)

Conditions:   Gastric Neoplasms;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Biological: Pembrolizumab;   Biological: Placebo;   Drug: Cisplatin;   Drug: 5-FU;   Drug: Oxaliplatin;   Drug: Capecitabine;   Drug: S-1;   Biological: Trastuzumab
Sponsor:   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2Mfy5Jq

Comparison of Lindioil (Indigo Naturalis Oil Extract) Ointment to Protopic® Ointment 0.1% in Treating Atopic Dermatitis

Condition:   Atopic Dermatitis
Interventions:   Drug: Lindioil ointment;   Drug: Protopic ointment 0.1%
Sponsors:   Chang Gung Memorial Hospital;   Ministry of Science and Technology, Taiwan
Not yet recruiting

https://ift.tt/2OBHRqK

Study of a Simplified Geriatric Evaluation Performed by Oncologists Prior to Cancer Treatment by Radiotherapy or Chemotherapy in Subjects Aged 70 Years or Older With Inoperable Squamous Cell Cancer of the Head and Neck

Condition:   Inoperable Squamous Cell Cancer of the Head and Neck
Interventions:   Other: Geriatric Screening Test G8;   Other: Geriatric fragility test GERICO
Sponsor:   Gustave Roussy, Cancer Campus, Grand Paris
Recruiting

https://ift.tt/2KpUrGx

Neue Erkenntnisse zur Psychodermatologie bei Psoriasis

https://ift.tt/2OACtnX

Aneurysmal Bone Cyst of the Maxillary Sinus with USP6 Rearrangement: Case Report of a Rare Entity and Review of the Literature

Abstract

Aneurysmal bone cysts (ABCs) are benign lesions which most frequently occur in the long bones of pediatric patients. Long thought to be reactive, recent molecular advances have demonstrated that the majority of primary ABCs harbor rearrangements of the USP6 gene, confirming their neoplastic nature. Secondary ABCs arising from other lesions do not demonstrate this recurrent genetic anomaly. ABCs rarely occur in the craniofacial bones, and sinonasal ABCs are exceedingly rare. We report a case of a primary ABC arising the maxillary sinus of a 14-year-old female, which was found to harbor USP6 rearrangement. We describe the clinical, radiologic, and pathologic features of this case, and review the current literature on craniofacial ABCs. Careful histologic evaluation and genetic studies are warranted in order to confirm the rare occurrence of a primary sinonasal ABC.

https://ift.tt/2OGNLqI

Aneurysmal Bone Cyst of the Maxillary Sinus with USP6 Rearrangement: Case Report of a Rare Entity and Review of the Literature

Abstract

Aneurysmal bone cysts (ABCs) are benign lesions which most frequently occur in the long bones of pediatric patients. Long thought to be reactive, recent molecular advances have demonstrated that the majority of primary ABCs harbor rearrangements of the USP6 gene, confirming their neoplastic nature. Secondary ABCs arising from other lesions do not demonstrate this recurrent genetic anomaly. ABCs rarely occur in the craniofacial bones, and sinonasal ABCs are exceedingly rare. We report a case of a primary ABC arising the maxillary sinus of a 14-year-old female, which was found to harbor USP6 rearrangement. We describe the clinical, radiologic, and pathologic features of this case, and review the current literature on craniofacial ABCs. Careful histologic evaluation and genetic studies are warranted in order to confirm the rare occurrence of a primary sinonasal ABC.

https://ift.tt/2OGNLqI

Ultrabiomicroscopy Anterior Segment Evaluation of Ocular Contusive Trauma Caused by Pressurized Bottled Drink Caps: A Case Report

We report the case of a patient presented to the emergency department because of a contusive trauma from a pressurized bottled drink cap. During the visit, the patient indicated that he had been hit in his left eye by a cork while he was opening a sparkling wine bottle. He underwent a total ophthalmology examination. He had an important reduction of visual acuity, corneal swelling, Descemet's folds, and hyphema. Therefore, we decided to perform ultrabiomicroscopy (UBM) of the anterior segment to study the endothelial damage and Descemet's membrane. UBM images confirmed the direct biomicroscopy, highlighting the damaged location.
Case Rep Ophthalmol 2018;9:365–368

https://ift.tt/2ve0oBz

Aneurysmal Bone Cyst of the Maxillary Sinus with USP6 Rearrangement: Case Report of a Rare Entity and Review of the Literature

Abstract

Aneurysmal bone cysts (ABCs) are benign lesions which most frequently occur in the long bones of pediatric patients. Long thought to be reactive, recent molecular advances have demonstrated that the majority of primary ABCs harbor rearrangements of the USP6 gene, confirming their neoplastic nature. Secondary ABCs arising from other lesions do not demonstrate this recurrent genetic anomaly. ABCs rarely occur in the craniofacial bones, and sinonasal ABCs are exceedingly rare. We report a case of a primary ABC arising the maxillary sinus of a 14-year-old female, which was found to harbor USP6 rearrangement. We describe the clinical, radiologic, and pathologic features of this case, and review the current literature on craniofacial ABCs. Careful histologic evaluation and genetic studies are warranted in order to confirm the rare occurrence of a primary sinonasal ABC.

https://ift.tt/2OGNLqI

Making a difference – providing healthcare to undocumented immigrants

Washington and Oberdorfer published a case report entitled, "A 5-year old boy with miliary and osteoarticular tuberculosis," in BMJ Case Reports. The case was can important reminder of a clinical lesson, and a good outcome. "Seven months after discharge, the patient had persistent limited ROM, but was otherwise asymptomatic…. [F]amily agreement to surgery was still pending." However, on presentation, "[The patient] was febrile, tachycardic, tachypnoeic… and [had] a weight of 12 kg (<5%)…. [The patient] was in moderate distress, with bilateral lung ronchi, mild subcostal retractions, severe low back lordosis, right hip tenderness and limited and painful active and passive ROM of the right hip…. He was unable to stand without assistance." The patient was from Myanmar and "had moved to Thailand without documentation to live with his father approximately 2 months prior to presentation." This is mentioned by the authors only because, "[T]he patient revealed having received unknown evaluation and treatment in Myanmar and… The healthcare system in Myanmar… is among the world's poorest performing."

This is important to mention because Thailand is, "the only country in the world where migrants there illegally have the same healthcare rights as nationals."^[1] Migrants make up about 6% of the Thai population, and the only barrier to healthcare access is whether they can buy into a plan, costing about $58 USD. While a few European countries with universal health care (UHC) allow undocumented migrants to access health care in the same way as citizens, they have additional requirements including residence for at least three months.

In the United States, "Undocumented immigrants with routine health needs who are not covered through family members' insurance currently obtain care from a patchwork of Federally Qualified Health Centers, private charities, and hospital emergency departments, or go without." ^[2] This issue is further complicated by the fact that, even when undocumented immigrants are eligible for government-sponsored health care, many delay seeking healthcare for fear of immigration repercussions…. Policies that discourage undocumented immigrants from obtaining healthcare… can both increase costs and have serious public health effects."

In the EU there is, "no clear EU provision for undocumented migrants' right to healthcare or to other basic social needs and that Member States… are increasingly using it as a tool to discourage the entry of new migrants." These barriers can include the requirement of health care providers to report undocumented immigrants to the immigration authority, language problems, difficulties in continuity of care, lack of knowledge about the health care system and other barriers.^[3]

In this case, it is obvious that the patient was better served by being an undocumented immigrant in Thailand than he would have been in the United States or European Union. The need to provide care for undocumented immigrants is obvious from a standpoint of human rights and public health. As described by the authors in their "learning points," "International borders do not stop infectious diseases." Health care professionals have an obligation to care for the health of the patients that present to them, not merely those who possess adequate documentation.

 

BMJ Case Reports invites authors to submit global health case reports that describe the complexities of caring for immigrants in diverse situations. These cases could focus on:

-How healthcare policies affect individual patients
-Successful interventions for providing access to undocumented immigrants
-Challenges to providing healthcare for undocumented immigrants

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at casereports.bmj.com. For more information, review our guidance on how to write a global health case report and look through our online collection.

 

To read more about undocumented immigrants and migrant health at BMJ Case Reports, please review:

–Illegal immigration: the puzzling role of several risk factors for rhabdomyolysis
–A Rohingya refugee's journey in Australia and the barriers to accessing healthcare
–Atopic dermatitis complicated by severe impetigo in a Syrian refugee infant

 

To read more about undocumented immigrant healthcare from other sources, please review:

^[1] Yan W. Only one country offers universal health care to all migrants. NPR. 2016 Mar 31.
^[2] Fernandez A, Rodriguez RA, 2017. Undocumented immigrants and access to health care. Jama Internal Medicine. 2017 Apr 1;177(4):536-7
^[3] Brady H, Humphris R, Newall D, Phillmore J. Public health aspects of migrant health: a review of the evidence on health status for refugees and asylum seekers in the European Region. 2015.

The post Making a difference – providing healthcare to undocumented immigrants appeared first on BMJ Case Reports blog.

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Local and systemic effects of low-level light therapy with light-emitting diodes to improve erythema after fractional ablative skin resurfacing: a controlled study

Abstract

Therapy with light-emitting diodes (LED) has been associated with the reduction of erythema and accelerated wound healing. LED phototherapy has been used in various clinical practices including post-laser wound healing enhancement. Fractional laser resurfacing is one of the popular dermatological procedures; however, the duration and degree of downtime may limit daily life activity and studies on the effect of LED low-level light therapy (LED-LLLT) on post-ablative laser wound care are still limited. To evaluate local and systemic effects of LED-LLLT on post-ablative laser erythema and wound healing acceleration after fractional ablative laser resurfacing. The study was divided into two arms. First, a prospective split-face randomized controlled and single-blinded study involved 17 patients (split-face group) to determine the local and systemic effect of LED-LLLT. Patients with acne scars or rhytides were treated with a single session of fractional CO₂ laser followed by 830/590 nm LED-LLLT on one side of their faces. The duration of post-laser erythema, the erythema index, and transepidermal water loss were collected at baseline, and compared with 7-daily follow-up visits posttreatment for the non LED- and LED-treated sides. The second controlled arm of the study was performed on an additional 19 subjects (CO₂ group). The patients received a single fractional CO₂ laser treatment without any LED-LLLT with the same follow-up protocol. All measurements were compared with the results from the patients from the split-face group. In the split-face group, the duration of erythema post laser was equal (7.4 ± 2.8 days). No significant reduction in the erythema index and transepidermal water loss was seen in the LED-treated vs the non-treated side (p values = 0.99 and 0.78 respectively). For the second part of the study that compared the results between the split-face group and the control CO₂ only group, the duration of the post-laser erythema was comparable (p value = 0.32). However, the percentage difference of the erythema index from baseline in the split-face group was significantly lower than the CO₂ group on days 1, 4, 5, and 7 post-laser treatment (p value = 0.03 on days 1, 4, 5, and 0.04 on day 7) and the LED-treated side provided the lowest percentage difference of the erythema index followed by the non LED-treated side compared with the control CO₂ only group. 830/590 nm LED-LLLT may provide both local and systemic effects on the degree of post-ablative laser erythema in human skin, however, appropriate protocol settings should be considered to achieve a significant clinical outcome.

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Photobiomodulation of the microbiome: implications for metabolic and inflammatory diseases

Abstract

The human microbiome is intimately associated with human health, with a role in obesity, metabolic diseases such as type 2 diabetes, and divergent diseases such as cardiovascular and neurodegenerative diseases. The microbiome can be changed by diet, probiotics, and faecal transplants, which has flow-on effects to health outcomes. Photobiomodulation has a therapeutic effect on inflammation and neurological disorders (amongst others) and has been reported to influence metabolic disorders and obesity. The aim of this study was to examine the possibility that PBM could influence the microbiome of mice. Mice had their abdomen irradiated with red (660 nm) or infrared (808 nm) low-level laser, either as single or multiple doses, over a 2-week period. Genomic DNA extracted from faecal pellets was pyrosequenced for the 16S rRNA gene. There was a significant (p < 0.05) difference in microbial diversity between PBM- and sham-treated mice. One genus of bacterium (Allobaculum) significantly increased (p < 0.001) after infrared (but not red light) PBM by day 14. Despite being a preliminary trial with small experimental numbers, we have demonstrated for the first time that PBM can alter microbiome diversity in healthy mice and increase numbers of Allobaculum, a bacterium associated with a healthy microbiome. This change is most probably a result of PBMt affecting the host, which in turn influenced the microbiome. If this is confirmed in humans, the possibility exists for PBMt to be used as an adjunct therapy in treatment of obesity and other lifestyle-related disorders, as well as cardiovascular and neurodegenerative diseases. The clinical implications of altering the microbiome using PBM warrants further investigation.

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Pediatric free flap reconstruction for head and neck defects

Purpose of review The aim of this study was to review recent literature on the use of pediatric free flap reconstruction for head and neck defects with focus on skull base, congenital deformities, mandibular reconstruction and operative considerations. Recent findings Reconstruction of the skull base depends on the defect size, location, bony involvement, and pedicle length with a variety of flaps to choose from. Free flaps may be used to correct congenital anomalies due to facial clefts and syndromic causes requiring bony and tissue bulk. Preservation of the condyle together with free flap mandibular reconstruction has better growth potential. Delayed repair of mandibular defects may be an option especially for patients with malignancy. Chemotherapy and radiation therapy may inhibit the growth potential of the mandible. The use of running or coupled arterial anastomosis is associated with an increased immediate complication. Summary Pediatric free flap reconstruction is a reasonable option for various head and neck defects such as skull base, congenital, and mandibular defects. Correspondence to Daniel Jose C. Mendoza, MD, Department of Otorhinolaryngology-Head and Neck Surgery, Jose R. Reyes Memorial Medical Center, San Lazaro Compound, Rizal Avenue Sta. Cruz, Manila 1003 Philippines. Tel: +632 743 6921; e-mail: danieljosemendoza@yahoo.com.ph Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Extended release bupivacaine formulations for postoperative analgesia: an update

Purpose of review New formulations of local anesthetics with sustained release and longer duration of action are being developed to improve patient outcomes following surgery. This review summarizes the efficacy and safety of the three most recently developed extended-release formulations of the local anesthetic, bupivacaine. Recent findings Bupivacaine liposome injectable suspension (EXPAREL) encapsulates bupivacaine in biodegradable liposomes. It is currently the only extended-release formulation of bupivacaine approved by the FDA for infiltration of the tissues during surgery and for interscalene nerve block analgesia following shoulder surgery. SABER-Bupivacaine and HTX-011, are extended-release bupivacaine products in active development. Available data suggest relative safety and efficacy of all three formulations, although more data are needed to define their indications and dosing. Summary Extended-release bupivacaine formulations are promising alternatives to prolong duration of analgesia. To date, only EXPAREL has been approved by the FDA for tissue infiltration during surgery and for interscalene nerve block. Correspondence to Admir Hadzic, MD, PhD, Professor, Department of Anesthesiology, Ziekenhuis Oost-Limburg (ZOL), Schiepse bos 6, 3600 Genk, Belgium. E-mail: admir@nysora.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Pediatric free flap reconstruction for head and neck defects

Purpose of review The aim of this study was to review recent literature on the use of pediatric free flap reconstruction for head and neck defects with focus on skull base, congenital deformities, mandibular reconstruction and operative considerations. Recent findings Reconstruction of the skull base depends on the defect size, location, bony involvement, and pedicle length with a variety of flaps to choose from. Free flaps may be used to correct congenital anomalies due to facial clefts and syndromic causes requiring bony and tissue bulk. Preservation of the condyle together with free flap mandibular reconstruction has better growth potential. Delayed repair of mandibular defects may be an option especially for patients with malignancy. Chemotherapy and radiation therapy may inhibit the growth potential of the mandible. The use of running or coupled arterial anastomosis is associated with an increased immediate complication. Summary Pediatric free flap reconstruction is a reasonable option for various head and neck defects such as skull base, congenital, and mandibular defects. Correspondence to Daniel Jose C. Mendoza, MD, Department of Otorhinolaryngology-Head and Neck Surgery, Jose R. Reyes Memorial Medical Center, San Lazaro Compound, Rizal Avenue Sta. Cruz, Manila 1003 Philippines. Tel: +632 743 6921; e-mail: danieljosemendoza@yahoo.com.ph Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Ring artefacts in cranial CT

Description 

A ring or arc artefact in a CT is a hardware related artefact that occurs due to a defective or miscalibrated detector. It is more common with third-generation CT scanners with solid-state detectors. It appears as complete circles (sequential scans), annular rings (multiple circles) or partial rings (helical/multislice CT) at the same spot near the isocentre in multiple sections.1 2 Recognising this artefact is important as it may be subtle and misinterpreted as a pathological entity by the novice clinician.3 This artefact is usually more clearly visualised in the soft-tissue window of CT scans (video 1) than in the bone window (video 2).

Video 1

Serial sections of the scan (soft-tissue window) showing ring artefact.

Video 2

Serial sections of the scan (bone window) showing ring artefact.

Presented here is a case where an...

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Rare cause of manic period trigger in bipolar mood disorder: testosterone replacement

Hypogonadotropic hypogonadism is a rare congenital disorder characterised by the deficiency and the absence of puberty and infertility. It is caused by the deficient production, secretion or action of gonadotropin-releasing hormone, which is the master hormone regulating the reproductive axis. Gonadotropin-releasing hormone or gonadotropin injections and testosterone replacement therapy are required in the treatment of this disorder. Psychiatric symptoms and disorders may be seen with the use of anabolic androgenic steroids. In this case report, we present a case report in which a patient had behavioural symptoms in childhood and develops bipolar disorder after testosterone replacement therapy. This patient was reached to the remission by increasing the doses of psychiatric drugs without interfering with hormonal therapy. It should be considered that patients receiving testosterone replacement therapy may develop bipolar disorder or trigger mood changes in bipolar mood disease, so behavioural and mood state changes should be closely followed in patients who have bipolar mood disease.

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Acquired generalised lipodystrophy and type 1 diabetes mellitus in a child: a rare and implacable association

Lipodystrophy syndromes are frequently associated with marked degree of insulin resistance and lipoatrophic diabetes. Although acquired generalised lipodystrophy (AGL) has been known to be associated with various autoimmune disorders, type 1 diabetes mellitus (T1DM) is very rarely reported to occur with AGL. Combination of AGL and T1DM can lead to a totally different phenotype with very difficult-to-treat diabetes and progressive complications of both the conditions. We report a case of AGL with T1DM with poor diabetes control despite high doses of insulin, metformin and pioglitazone. Our case further progressed to develop complication of retroperitoneal fibrosis, not hitherto reported with AGL.

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Patient with native valve infective endocarditis and concomitant bacterial myopericarditis

A 39-year-old man with known mitral regurgitation (MR) presented with chest pain, nausea and dizziness. Troponin of 5801 ng/L and scooped ST segments indicated myopericarditis. Cardiac MRI demonstrated an epicardial late gadolinium enhancement pattern consistent with a significantly myocarditic syndrome. Initially afebrile, the patient reported fevers a week earlier when abroad where he received amoxicillin.

The patient then began spiking temperatures and infective endocarditis (IE) was confirmed following blood cultures positive for Streptococcus sanguinis and Transoesophageal echocardiography (TOE) showing a vegetation on the anterior mitral valve leaflet. Patient underwent 6 weeks of intravenous benzylpenicillin and on resolution he was discharged to await valve surgery.

A model is proposed where septic embolism from IE caused bacterial myopericarditis, triggering the initial presenting complaint. It is suggested that prior antibiotic therapy and paracetamol suppressed the systemic symptoms of IE.

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Neuroleptic malignant syndrome following reintroduction of an antipsychotic after overdose

Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse drug reaction. We report a case of NMS potentially induced by dehydration in a female patient suffering from schizoaffective disorder. We discuss possible aetiologies and triggering factors alongside the existing literature.

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