Treatment of immune thrombocytopenic purpura associated with cytomegalovirus infection in a child with pre-B cell acute lymphoblastic leukaemia after central nervous system relapse

A 13-year-old male patient with a history of pre-B cell acute lymphoblastic leukaemia (ALL) with isolated central nervous system relapse on maintenance chemotherapy presented with severe thrombocytopenia refractory to platelet transfusions. The patient showed only modest responses to two courses of intravenous immunoglobulin and steroids. He was found to be positive for cytomegalovirus (CMV) with modest viral load. His thrombocytopenia normalised with rituximab therapy and CMV treatment supporting the diagnosis of CMV-associated immune thrombocytopenic purpura (ITP). Following treatment, the patient continued to have a stable platelet count well above the threshold for transfusions. He continued to be intermittently treated for CMV when viral loads became detectable. This report discusses the unique management considerations of ITP in a patient undergoing therapy for ALL with a review of previously reported cases and discusses the possibility of CMV viraemia as a modulating factor.

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Unusual presentation of silently growing abdominal aortic aneurysm causing biliary obstruction

Biliary obstruction is a rare presentation of abdominal aortic aneurysm (AAA). The most common symptoms of AAA are abdominal or back pain and limb ischaemia from thromboembolism. We report a case of a 67-year-old male who was diagnosed with obstructive jaundice secondary to an AAA. CT angiogram revealed compression of the common bile duct by the large AAA, causing diffuse intrahepatic and extrahepatic ductal dilatation. Surgical repair of the aortic aneurysm was successful, and patient's symptoms improved.

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The eye as a complement dysregulation hotspot

Abstract

Complement turnover is tightly regulated throughout the human body in order to prevent over-activation and subsequent damage from inflammation. In the eye, low-level complement activation is maintained to provide immune tolerance in this immune privileged organ. Conversely, the complement system is suppressed in the cornea to protect it from continuous immunological insult. Over-activation of the complement cascade has been implicated in the disease progression of glaucoma and diabetic retinopathy and is now known to be a central driver in the pathogenesis of age-related macular degeneration (AMD). Indeed, it is with AMD where the most recent and exciting work has been carried out with complement-based therapies entering into clinical trials. However, the success of these trials will depend upon delivering the therapeutics to the correct anatomical sites within the eye, so a full understanding of how complement regulation is compartmentalized in the eye is required, a topic that will be highlighted in this review.

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Paclitaxel-related scleredema-like skin changes in a patient with breast cancer

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Paclitaxel-related scleredema-like skin changes in a patient with breast cancer

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A composite of exhaled LTB4, LXA4, FeNO and FEV1 as an “asthma classification ratio” characterizes childhood asthma

Abstract

Background

Aberrant generation of eicosanoids is associated with asthma, but the evidence remains incomplete and its potential utility as biomarkers is unclear. Major eicosanoids in exhaled breath condensates (EBCs) were assessed as candidate markers for childhood asthma.

Methods

Ten exhaled eicosanoid species was evaluated using ELISA in the discovery phase, followed by prediction model-building and validation phases.

Results

Exhaled LTB₄, LTE₄, PGE₂ and LXA₄ showed significant difference between asthmatics (N=60) and controls (N=20). For validation, an expanded study population consisting of 626 subjects with asthma and 161 healthy controls were partitioned into a training subset to establish a prediction model and a test sample subset for validation. Receiver Operating Characteristic (ROC) analyses of the training subset revealed the level of exhaled LTB₄ to be the most discriminative among all parameters, including FeNO, and a composite of exhaled LTB₄, LXA₄, together with FeNO and FEV₁, distinguishing asthma with high sensitivity and specificity. Further, the Youden index (J) indicated the cut point value of 0.598 for this composite of markers as having the strongest discriminatory ability (sensitivity = 85.2% and specificity = 83.6%). The predictive algorithm as "asthma classification ratio" was further validated in an independent test sample with sensitivity and specificity being 84.4% and 84.8%, respectively.

Conclusions

In a pediatric study population in Taiwan, the levels of exhaled LTB₄, LTE₄, LXA₄ and PGE₂ in asthmatic children were significantly different from those of healthy controls, and the combination of exhaled LTB₄ and LXA₄, together with FeNO and FEV₁, best characterized childhood asthma.

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A composite of exhaled LTB4, LXA4, FeNO and FEV1 as an “asthma classification ratio” characterizes childhood asthma

Abstract

Background

Aberrant generation of eicosanoids is associated with asthma, but the evidence remains incomplete and its potential utility as biomarkers is unclear. Major eicosanoids in exhaled breath condensates (EBCs) were assessed as candidate markers for childhood asthma.

Methods

Ten exhaled eicosanoid species was evaluated using ELISA in the discovery phase, followed by prediction model-building and validation phases.

Results

Exhaled LTB₄, LTE₄, PGE₂ and LXA₄ showed significant difference between asthmatics (N=60) and controls (N=20). For validation, an expanded study population consisting of 626 subjects with asthma and 161 healthy controls were partitioned into a training subset to establish a prediction model and a test sample subset for validation. Receiver Operating Characteristic (ROC) analyses of the training subset revealed the level of exhaled LTB₄ to be the most discriminative among all parameters, including FeNO, and a composite of exhaled LTB₄, LXA₄, together with FeNO and FEV₁, distinguishing asthma with high sensitivity and specificity. Further, the Youden index (J) indicated the cut point value of 0.598 for this composite of markers as having the strongest discriminatory ability (sensitivity = 85.2% and specificity = 83.6%). The predictive algorithm as "asthma classification ratio" was further validated in an independent test sample with sensitivity and specificity being 84.4% and 84.8%, respectively.

Conclusions

In a pediatric study population in Taiwan, the levels of exhaled LTB₄, LTE₄, LXA₄ and PGE₂ in asthmatic children were significantly different from those of healthy controls, and the combination of exhaled LTB₄ and LXA₄, together with FeNO and FEV₁, best characterized childhood asthma.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hqQ4lo