Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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FOXP3+ CD4 T-cell maturity and responses to microbial stimulation alter with age and associate with early life gut colonization

Publication date: Available online 30 May 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Sophia Björkander, Maria A. Johansson, Lena Hell, Gintare Lasaviciute, Caroline Nilsson, Ulrika Holmlund, Eva Sverremark-Ekström

Teaser

Peripheral CD4⁺FOXP3⁺ T-cells from children are immature and less responsive to S. aureus. Early gut colonization with S. aureus and lactobacilli associates with the functional phenotype of FOXP3⁺ cells, implying involvement of microbes in immune-maturation.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Dendritic Cells as Vaccines: Key Regulators of Tolerance and Immunity

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Correcting for H2O interference using a RAD7 electrostatic collection-based silicon detector

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): G. De Simone, C. Lucchetti, G. Galli, P. Tuccimei
The effect of water molecules on the electrostatic collection of ²¹⁸Po ions onto the surface of silicon detectors (neutralization) is evaluated through the comparison with a scintillation cell (ZnS), not affected by air humidity. A radon monitor (RAD7, Durridge Company) was connected to a stainless steel radon chamber, equipped with the scintillation cell. Radon gas, extracted from an acidified RaCl2 source, was injected into the chamber and the amount of water molecules in the system was alternatively lowered or increased (from 0.00075 to 0.014 g of water in RAD7) by connecting the chamber to a desiccant or to a bubbling water bottle. The relative efficiency of the silicon detector with respect to the scintillation cell decreases with the growth of water molecules inside RAD7. This dependence, with a fixed i) electrostatic chamber geometry and ii) nominal high voltage, diverges during the humidification or the drying phase because it is in turn influenced by the length of interaction of polonium atoms with water molecules, which impacts on the size of ²¹⁸Po clusters and thus on the neutralization process. For water contents higher that 0.01 g in RAD7, this effect is greatly enhanced. Temperature in the investigated range (18.5–35.6 °C) does not affect the efficiency of electrostatic collection-based silicon detectors.Based on these experiments, admitting a certain error on the efficiency (from 1.8 to 7.5%, depending on the water content), proper corrections were developed to adjust soil radon readings, when a desiccant is removed. This operation is necessary if recent Non-Aqueous Phase Liquids (NAPLs) leakage has occurred in the subsoil to avoid the sorption and possible later release of radon by Drierite, with related partition between the solid and liquid phases (water and NAPL).



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Manual of Dietetic Practice 5e & Case Studies Set

This is a set comprising of the Manual of Dietetic Practice, 5th Edition and Dietetic and Nutrition Case Studies Read More...

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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Dendritic Cells as Vaccines: Key Regulators of Tolerance and Immunity

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FOXP3+ CD4 T-cell maturity and responses to microbial stimulation alter with age and associate with early life gut colonization

Publication date: Available online 30 May 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Sophia Björkander, Maria A. Johansson, Lena Hell, Gintare Lasaviciute, Caroline Nilsson, Ulrika Holmlund, Eva Sverremark-Ekström

Teaser

Peripheral CD4⁺FOXP3⁺ T-cells from children are immature and less responsive to S. aureus. Early gut colonization with S. aureus and lactobacilli associates with the functional phenotype of FOXP3⁺ cells, implying involvement of microbes in immune-maturation.


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Correcting for H2O interference using a RAD7 electrostatic collection-based silicon detector

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): G. De Simone, C. Lucchetti, G. Galli, P. Tuccimei
The effect of water molecules on the electrostatic collection of ²¹⁸Po ions onto the surface of silicon detectors (neutralization) is evaluated through the comparison with a scintillation cell (ZnS), not affected by air humidity. A radon monitor (RAD7, Durridge Company) was connected to a stainless steel radon chamber, equipped with the scintillation cell. Radon gas, extracted from an acidified RaCl2 source, was injected into the chamber and the amount of water molecules in the system was alternatively lowered or increased (from 0.00075 to 0.014 g of water in RAD7) by connecting the chamber to a desiccant or to a bubbling water bottle. The relative efficiency of the silicon detector with respect to the scintillation cell decreases with the growth of water molecules inside RAD7. This dependence, with a fixed i) electrostatic chamber geometry and ii) nominal high voltage, diverges during the humidification or the drying phase because it is in turn influenced by the length of interaction of polonium atoms with water molecules, which impacts on the size of ²¹⁸Po clusters and thus on the neutralization process. For water contents higher that 0.01 g in RAD7, this effect is greatly enhanced. Temperature in the investigated range (18.5–35.6 °C) does not affect the efficiency of electrostatic collection-based silicon detectors.Based on these experiments, admitting a certain error on the efficiency (from 1.8 to 7.5%, depending on the water content), proper corrections were developed to adjust soil radon readings, when a desiccant is removed. This operation is necessary if recent Non-Aqueous Phase Liquids (NAPLs) leakage has occurred in the subsoil to avoid the sorption and possible later release of radon by Drierite, with related partition between the solid and liquid phases (water and NAPL).



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Manual of Dietetic Practice 5e & Case Studies Set

This is a set comprising of the Manual of Dietetic Practice, 5th Edition and Dietetic and Nutrition Case Studies Read More...

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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Correcting for H2O interference using a RAD7 electrostatic collection-based silicon detector

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): G. De Simone, C. Lucchetti, G. Galli, P. Tuccimei
The effect of water molecules on the electrostatic collection of ²¹⁸Po ions onto the surface of silicon detectors (neutralization) is evaluated through the comparison with a scintillation cell (ZnS), not affected by air humidity. A radon monitor (RAD7, Durridge Company) was connected to a stainless steel radon chamber, equipped with the scintillation cell. Radon gas, extracted from an acidified RaCl2 source, was injected into the chamber and the amount of water molecules in the system was alternatively lowered or increased (from 0.00075 to 0.014 g of water in RAD7) by connecting the chamber to a desiccant or to a bubbling water bottle. The relative efficiency of the silicon detector with respect to the scintillation cell decreases with the growth of water molecules inside RAD7. This dependence, with a fixed i) electrostatic chamber geometry and ii) nominal high voltage, diverges during the humidification or the drying phase because it is in turn influenced by the length of interaction of polonium atoms with water molecules, which impacts on the size of ²¹⁸Po clusters and thus on the neutralization process. For water contents higher that 0.01 g in RAD7, this effect is greatly enhanced. Temperature in the investigated range (18.5–35.6 °C) does not affect the efficiency of electrostatic collection-based silicon detectors.Based on these experiments, admitting a certain error on the efficiency (from 1.8 to 7.5%, depending on the water content), proper corrections were developed to adjust soil radon readings, when a desiccant is removed. This operation is necessary if recent Non-Aqueous Phase Liquids (NAPLs) leakage has occurred in the subsoil to avoid the sorption and possible later release of radon by Drierite, with related partition between the solid and liquid phases (water and NAPL).



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Manual of Dietetic Practice 5e & Case Studies Set

This is a set comprising of the Manual of Dietetic Practice, 5th Edition and Dietetic and Nutrition Case Studies Read More...

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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Correcting for H2O interference using a RAD7 electrostatic collection-based silicon detector

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): G. De Simone, C. Lucchetti, G. Galli, P. Tuccimei
The effect of water molecules on the electrostatic collection of ²¹⁸Po ions onto the surface of silicon detectors (neutralization) is evaluated through the comparison with a scintillation cell (ZnS), not affected by air humidity. A radon monitor (RAD7, Durridge Company) was connected to a stainless steel radon chamber, equipped with the scintillation cell. Radon gas, extracted from an acidified RaCl2 source, was injected into the chamber and the amount of water molecules in the system was alternatively lowered or increased (from 0.00075 to 0.014 g of water in RAD7) by connecting the chamber to a desiccant or to a bubbling water bottle. The relative efficiency of the silicon detector with respect to the scintillation cell decreases with the growth of water molecules inside RAD7. This dependence, with a fixed i) electrostatic chamber geometry and ii) nominal high voltage, diverges during the humidification or the drying phase because it is in turn influenced by the length of interaction of polonium atoms with water molecules, which impacts on the size of ²¹⁸Po clusters and thus on the neutralization process. For water contents higher that 0.01 g in RAD7, this effect is greatly enhanced. Temperature in the investigated range (18.5–35.6 °C) does not affect the efficiency of electrostatic collection-based silicon detectors.Based on these experiments, admitting a certain error on the efficiency (from 1.8 to 7.5%, depending on the water content), proper corrections were developed to adjust soil radon readings, when a desiccant is removed. This operation is necessary if recent Non-Aqueous Phase Liquids (NAPLs) leakage has occurred in the subsoil to avoid the sorption and possible later release of radon by Drierite, with related partition between the solid and liquid phases (water and NAPL).



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Manual of Dietetic Practice 5e & Case Studies Set

This is a set comprising of the Manual of Dietetic Practice, 5th Edition and Dietetic and Nutrition Case Studies Read More...

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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Methotrexate induced chronic hepatotoxicity

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy.
55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/cu.mm; ascitic tap done and fresh frozen plasma was infused.


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Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Ravi Shankar Manchukonda, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah.
Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4.


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Proteinase 3-antineutrophil cytoplasmic antibody positive necrotizing vasculitis induced by ciprofloxacin

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Khalid Ahmed, Syeda Atia Qudsia, Syed Hani Abidi, Rabia Malik, Muhammad Awais, Abdul Rehman.
Granulomatosis with polyangiitis (Wegeners), microscopic polyangitis, and eosinophilic granulomatosis with polyangiitis are commonly grouped together as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides. Many drugs and infections can induce serologic positivity for ANCA, while a few can precipitate overt ANCA-positive vasculitis. Although fluoroquinolones have been reported to cause ANCA-negative leukocytoclastic vasculitis (LCV), fluoroquinolones are not known to induce proteinase 3-ANCA (PR3-ANCA)-positive vasculitis. Here, we present the case of a middle-aged man who developed severe headache, purpura on legs and numbness in hands and feet after taking ofloxacin for 5 days. Subsequently, he was diagnosed with ANCA-negative LCV and treated with steroids and immunosuppressants. Thirteen years later, he inadvertently received intravenous ciprofloxacin and developed severe headache and epistaxis. Serologic testing at that time revealed elevated titers of PR3-ANCA. Biopsy of nasal septum revealed a mixed mononuclear and polymorphonuclear infiltrate without evidence of granuloma formation. He was treated with steroids and immunosuppressive therapy. Over the next several years, he remained stable with residual hearing loss and nasal septal deformity. This case provides the first evidence for a PR3-ANCA-positive necrotizing vasculitis induced by ciprofloxacin.


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Phenytoin induced drug rash with eosinophilia and systemic symptoms syndrome: a case report

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Yogesh Devaraj, Sathyanarayana Dasegowda Belagola, Ranga Swaroop Mukunda, Ravi Shankar Manchukonda, Puneetha Basavanaik, Aneesa K. Hasanabba, Priyanka Kumari.
DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe adverse drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. Although the death rate can reach 10%, rapid diagnosis and prompt withdrawal of the offending drug is the key to limit morbidity and mortality. The potential role of corticosteroids remains controversial. We report a case of a 45-year-old male patient who suffered a head injury, for which he was prescribed phenytoin. Five weeks later he developed features of DRESS syndrome including facial and peri-orbital oedema, generalized erythematous, maculo-papular rash, conjunctivitis, inguinal lymphadenopathy, leucocytosis, eosinophilia and elevated liver enzymes. Skin biopsy revealed acanthosis and spongiosis of epidermis and dense inflammatory cell infiltrate comprising eosinophils and lymphocytes. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that phenytoin was a probable cause for the adverse drug reaction (score-7). Phenytoin was immediately stopped and patient was treated with systemic corticosteroids. The patient improved dramatically within the next few days. Early recognition of symptoms of DRESS and immediate withdrawal of the offending drug followed by prompt treatment with corticosteroids and other supportive measures will ensure quick recovery and will avoid fatal outcomes.


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Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

2016-05-31T00-28-17Z
Source: International Journal of Basic & Clinical Pharmacology
Rakesh Tilak Raj, Rajnish Raj, Anuradha Raj.
Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in


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Universe, Vol. 2, Pages 9: Virial Theorem in Nonlocal Newtonian Gravity

Nonlocal gravity is the recent classical nonlocal generalization of Einstein's theory of gravitation in which the past history of the gravitational field is taken into account. In this theory, nonlocality appears to simulate dark matter. The virial theorem for the Newtonian regime of nonlocal gravity theory is derived and its consequences for "isolated" astronomical systems in virial equilibrium at the present epoch are investigated. In particular, for a sufficiently isolated nearby galaxy in virial equilibrium, the galaxy's baryonic diameter D 0 —namely, the diameter of the smallest sphere that completely surrounds the baryonic system at the present time—is predicted to be larger than the effective dark matter fraction f D M times a universal length that is the basic nonlocality length scale λ 0 ≈ 3 ± 2 kpc.

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Energies, Vol. 9, Pages 421: The Influence of Slight Protuberances in a Micro-Tube Reactor on Methane/Moist Air Catalytic Combustion

The combustion characteristics of methane/moist air in micro-tube reactors with different numbers and shapes of inner wall protuberances are investigated in this paper. The micro-reactor with one rectangular protuberance (six different sizes) was studied firstly, and it is shown that reactions near the protuberance are mainly controlled by diffusion, which has little effect on the outlet temperature and methane conversion rate. The formation of cavities and recirculation zones in the vicinity of protuberances leads to a significant increase of the Arrhenius reaction rate of CH4 and gas velocity. Next, among the six different simulated conditions (0–5 rectangular protuberances), the micro-tube reactor with five rectangular protuberances shows the highest methane conversion rate. Finally, the effect of protuberance shape on methane/moist air catalytic combustion is confirmed, and it is found that the protuberance shape has a greater influence on methane conversion rate than the number of protuberances. The methane conversion rate in the micro-tube decreases progressively in the following order: five triangular slight protuberances > five rectangular protuberances > five trapezoidal protuberances > smooth tube. In all tests of methane/moist air combustion conditions, the micro-tube with five triangular protuberances has the peak efficiency and is therefore recommended for high efficiency reactors.

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Energies, Vol. 9, Pages 418: Three-Dimensional Finite-Element Analysis of the Short-Time and Peak Withstand Current Tests in Substation Connectors

Power devices intended for high-voltage systems must be tested according to international standards, which includes the short-time withstand current test and peak withstand current test. However, these tests require very special facilities which consume huge amounts of electrical power. Therefore, mathematical tools to simulate such tests are highly appealing since they allow reproducing the electromagnetic and thermal behavior of the test object in a fast and economical manner. In this paper, a three-dimensional finite element method (3D-FEM) approach to simulate the transient thermal behavior of substation connectors is presented and validated against experimental data. To this end, a multiphysics 3D-FEM method is proposed, which considers both the connector and the reference power conductors. The transient and steady-state temperature profiles of both the conductors and connector provided by the 3D-FEM method prove its suitability and accuracy as compared to experimental data provided by short-circuit tests conducted in two high-current laboratories. The proposed simulation tool, which was proven to be accurate and realistic, may be particularly useful during the design and optimization phases of substation connectors since it allows anticipating the results of mandatory laboratory tests.

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Examination of endothelial cell induced epidermal regeneration in a mice based chimney wound model

ABSTRACT

As wound contraction in the cutaneous layer occurs rapidly in mice, mechanical means are typically used to deliberately expose the wound in order to properly investigate healing by secondary intention. Previously, silicon rings and splinting models were attempted to analyze histological recovery but prevention of surrounding epidermal cell migration and subsequent closure was minimal. Here, we developed an ideal chimney wound model to evaluate epidermal regeneration in murine under hESC-EC transplantation through histological analysis encompassing the three phases of regeneration; migration, proliferation, and remodeling. Human embryonic stem cell derived endothelial cells (hESC-EC) were transplanted due to possessing a well-known therapeutic effect in angiogenesis which also enhances epidermal repair in order to depict the process of regeneration. Following a standard 1mm biopsy punch, a chimney manufactured by modifying a 1.7ml micro tube was simply inserted into the excisional wound to complete the modeling process. Under this model, the excisional wound remained fully exposed for 14 days and even after 4 weeks, only a thin transparent layer of epidermal tissue covered the wound site. This approach is able to more accurately depict epidermal repair in relation to histology while also being a user-friendly and cost-effective way to mimic human recovery in rodents and evaluate epithelial repair induced by a form of therapy. This article is protected by copyright. All rights reserved.

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Ciprofloxacin-loaded keratin hydrogels reduce infection and support healing in a porcine partial-thickness thermal burn

Abstract

Infection is a leading cause of morbidity and mortality in burn patients. Current therapies include silver-based creams and dressings, which display limited antimicrobial effectiveness and impair healing. The need exists for a topical, point-of-injury antibiotic treatment that provides sustained antimicrobial activity without impeding wound repair. Fitting this description are keratin-based hydrogels, which are fully biocompatible and support the slow-release of antibiotics. Here we develop a porcine model of an infected partial-thickness burn to test the effects of ciprofloxacin-loaded keratin hydrogels on infection and wound healing. Partial-thickness burns were inoculated with either Pseudomonas aeruginosa or Methicillin-resistant Staphylococcus aureus, resulting in infections that persisted for greater than 2 weeks that exceeded 10⁵ and 10⁶ cfu per gram of tissue, respectively. Compared to silver sulfadiazine, ciprofloxacin-loaded keratin hydrogel treatment significantly reduced the amount of Pseudomonas aeruginosa and Staphylococcus aureus in the burn by greater than 99% on days 4, 7, 11 and 15 post-injury. Further, burns treated with ciprofloxacin-loaded keratin hydrogels exhibited similar healing patterns as uninfected burns with regards to reepithelialization, macrophage recruitment, and collagen deposition and remodeling. The ability of keratin hydrogels to deliver antibiotics to fight infection and support healing of partial-thickness burns make them a strong candidate as a first-line burn therapy. This article is protected by copyright. All rights reserved.

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Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis

Abstract

Differentiation between psoriatic arthritis (PsA) sine psoriasis and rheumatoid arthritis (RA) may be a challenge, especially in the early stages, hence the need for new instrumental markers to assist their diagnosis. In this study, we investigated possible dermoscopic differences in vascular appearance of nail fold and elbow (a classic site of repeated trauma) in these two conditions. Fifteen patients with PsA sine psoriasis, 12 patients with RA and 12 controls were included in the study. Regarding the nail fold vascular appearance in PsA sine psoriasis and RA cohorts, the presence of diffuse reddish background with or without sparse dotted vessels was significant in the former, whereas the evidence of parallel dotted/short linear vessels ("fish school-like" pattern) or irregular/ramified, blurry, purple vessels were significant in the latter; none of these patterns were detected in the control group. Regarding the elbow, the pattern significantly associated with PsA sine psoriasis consisted of diffusely distributed, red, dotted vessels. On the other hand, RA patients and controls displayed similar dermoscopic findings, with three possible vascular patterns being observed: (i) irregular, blurry, purple vessels; (ii) avascular appearance; and (iii) sparse, dotted, purple vessels. In conclusion, dermoscopy may be a useful supportive tool for differentiating early PsA sine psoriasis from RA.

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Up-dosing non-sedating antihistamines in patients with chronic spontaneous urticaria: A systematic review and meta-analysis

Abstract

Background

There is a lack of large, randomized, double-blind studies that address antihistamine up-dosing for chronic spontaneous urticaria (CSU).

Objectives

To explore and analyze available data to provide clinical evidence for antihistamine up-dosing.

Methods

We searched literature using the keywords "chronic, urticaria, antihistamines" in the Medline, Scopus, Google Scholar, Embase, Web of Science and Cochrane databases between January 1990 and November 2014. We assessed quality with the Jadad score that evaluates quality of randomization, double blinding, and losses to follow-up. We identified 1,042 articles, including 15 in the final evaluation. We performed two meta-analyses, one including studies that analyzed treatment response among groups receiving different antihistamine doses versus placebo, and another that analyzed antihistamine up-dosing in those patients who did not respond to standard doses.

Results

Only five articles reached a high quality level. We did not find significant differences in rate's response or number of wheals between those patients who received a standard dose vs. a high dose. We found a significant improvement only in the pruritus variable of the urticaria activity score (UAS) scale. The estimated relative risk for improvement by increasing the antihistamine dose was 2.27 (95% CI 1.68-3.06); however, there was significant heterogeneity. The proportion of non-respondent CSU patients who responded to antihistamine up-dosing was 63.2% (95% CI 57-69.6%).

Conclusions

We found that up-dosing antihistamines significantly improved control of pruritus but not of wheal number. However, the relative weakness of the studies and the significant heterogeneity among them made it difficult to reach a final conclusion.

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