Skin tests and challenge-based drug allergy diagnosis: a retrospective study of patients with confirmed drug allergy

Summary

Objectives. To describe clinical manifestations and performed diagnostic workup, focusing drug challenge tests (DCT), in patients with drug allergy. Methods. Retrospective study including all patients with skin tests (STs) or DCT-based drug allergy diagnosis, between 01/2014 - 06/2018 in a Portuguese allergy unit. Data were collected from electronic and paper-based clinical records. Results. We had 75 drug allergy diagnoses. Most index reactions were mild and major or equal 1 hour after drug intake. 59 (78%) diagnoses were based on DCTs, all based on multistep protocols with major or equal 3 predicted steps. Only 10% of the DCT were positive during up-dosing; timing and severity of the index reaction predicted DCT interruption during up-dosing. Conclusions. Most drug allergy diagnoses were based on multistep DCT. The identified predictors of DCT interruption during up-dosing can support the development of more personalized DCTs protocols.

1/f noise and long-term memory of coherent structures in a turbulent shear flow

A shear flow of liquid metal (Galinstan) is driven in an annular channel by counter-rotating traveling magnetic fields imposed at the end caps. When the traveling velocities are large, the flow is turbulent and its azimuthal component displays random reversals. Power spectra of the velocity field exhibit a 1/f^{α} power law on several decades and are related to power-law probability distributions P(τ)∼τ^{-β} of the waiting times between successive reversals. This 1/f type spectrum is observed only when the Reynolds number is large enough. In addition, the exponents α and β are controlled by the symmetry of the system; a continuous transition between two different types of Flicker noise is observed as the equatorial symmetry of the flow is broken, in agreement with theoretical predictions.

The influence of the morphological characteristics of nanoporous anodic aluminium oxide (AAO) structures on capacitive touch sensor performance: a biological application

This work is devoted to the study of the influence of different anodic aluminium oxide (AAO) morphologies on the sensitivity and performance of an AAO-based capacitive touch sensor. The AAO structures were fabricated in a cylindrical homemade anodization cell made from a solid polycarbonate billet via a lathe machining process. The AAO morphologies were obtained from the anodization of Al foil by using three different types of electrolyte (sulphuric acid, oxalic acid and phosphoric acid) and their morphologies are reported and compared using scanning electron microscopy (SEM) micrographs and current–time characteristic curves. The sensors were fabricated by integrating the AAO structure with a nanotextured gold thin film deposited over the AAO layer by thermal evaporation, thus realizing a type of metal/insulator/metal parallel-plate capacitance sensor. It is demonstrated that AAO morphologies have influence on the performance of the AAO-based capacitive touch sensors. The variation of the capacitance of the sensors is investigated in this work for the AAO structures produced from anodization in an attempt to select anodizing conditions for a biological application aiming to detect small microorganisms such as bacterial colonies of Escherichia coli.

This work is devoted to the study of the influence of different anodic aluminium oxide (AAO) morphologies on the sensitivity and performance of an AAO-based capacitive touch sensor.

Sarna sarcóptica en cerdos criados en cama profunda. Reporte de caso clínico

La sarna sarcóptica en los cerdos es causada por Sarcoptes scabiei var. suis el cual se distribuye ampliamente en los cinco continentes. Los productores porcícolas en general están preocupados por las infecciones parasitarias internas e ignoran las infestaciones parasitarias externas; estas últimas, causadas por S. scabiei tienen gran importancia económica ya que causa morbilidad, mortalidad, disminución de la fertilidad y de la tasa de conversión alimenticia. Este trabajo permitió determinar la presencia de sarna sarcóptica en cerdos criados bajo sistema de producción con cama profunda de una granja en el estado Guárico (Venezuela), utilizando las técnicas parasitológicas directas de flotación-concentración y microscopía directa. Los resultados demostraron que dos de siete muestras evaluadas fueron positivas con S. scabiei var. suis. El 100% de los animales presentaron lesiones de piel compatibles con la presencia del ácaro, pero el mismo solo pudo ser detectado en el 28,6% de ellos. La técnica de flotación-concentración fue más efectiva que la de microscopía directa. En este estudio describimos la primera detección de S. scabiei var. suis en cerdos domésticos en Venezuela criados en cama profunda.

Plasma level of club-cell (CC-16) predicts outcome in amyotrophic lateral sclerosis

OBJECTIVES

The club cell protein (CC-16) is a biomarker associated with respiratory distress and pulmonary inflammation. We evaluated CC-16 as a candidate biomarker for respiratory failure in amyotrophic lateral sclerosis (ALS).

MATERIALS AND METHODS

We studied 81 ALS patients and 30 matched controls. We used an ALS-related measure of functional capacity, and tested forced vital capacity (FVC) and the amplitude of the diaphragmatic response by phrenic nerve stimulation (PhrenAmpl). Plasma CC-16 levels were measured in venous blood. Kaplan-Meier survival curves were plotted to evaluate risk to non-invasive ventilation and death in patients with abnormal CC-16 levels.

RESULTS

CC-16 levels were significantly raised in ALS patients (10.56 ng/mL ± 6.84 vs 8.34 ng/mL ± 3.10, P = .02), and in 17% of them, CC-16 level was above the upper cutoff value (mean + 2.5SD). CC-16 levels did not correlate with age, onset region, disease duration, functional status, FVC, and PhrenAmpl. In patients with increased CC-16 level, the risk of non-invasive was greater in the following 6 months (P = .01) and tended to have higher mortality in the following 30 months (P = .07).

CONCLUSIONS

We propose that increased CC-16 levels is a marker of lung inflammatory response that associated with ventilatory insufficiency are related to impending respiratory failure, not fully predicted by conventional respiratory tests. The latter are limited by the moment of testing.

Characterization of a Monoclonal Antibody, D73H, that Maps to a Highly Conserved Region on Fibrinogen Bβ Chain

The primary structure of fibrinogen is highly conserved across species, yet often times monoclonal antibodies produced against the fibrinogen of one species will not crossreact with the fibrinogen of another. Herein, we describe the production and characterization of murine MAb, D73H, raised against human fibrinogen. D73H crossreacts with a highly conserved epitope on the Bβ chain of fibrinogen from human, rat, bovine, guinea pig, and mouse. Western blotting revealed that D73H reacted with the Bβ chain of plasmin fragment D, localizing its epitope to Bβ134-461. A 7 kDa band was identified by D73H in Western blots of reduced fibrinogen CNBr-fragments. N-terminal sequencing mapped this fragment to Bβ243-253, further localizing the epitope to Bβ243-305. In silico analysis indicated that Bβ243-305 is predominantly hydrophilic, and surface probability prediction indicated three potential antigenic determinants corresponding to Bβ252-258, Bβ262-269, and Bβ279-286. Further in silico analysis of the crystal structure of fibrinogen fragment D-D indicated that Bβ262-269 (FGRKWDPY) is predominantly α-helical and located on the surface of the molecule adjacent to a bend imposed in the β chain at residue 260, which is near the junction between the rigid coiled-coil domain and the globular C-terminus. A synthetic peptide corresponding to Bβ261-272 competitively inhibited the binding of D73H to the Bβ chain of denatured intact fibrinogen and reduced and denatured Bβ chain in Western blots, experimentally proving the validity of these predictive algorithms. Together these data indicate that, although plasmin resistant, Bβ chain residues Bβ261-272 comprising the D73H epitope are highly conserved across species, surface exposed, and immunogenic.

Predictive Factors of Acute Rejection in Low Immunologic Risk Kidney Transplant Recipients Receiving Basiliximab

INTRODUCTION

The optimal immunosuppressive induction therapy in kidney transplant recipients with low immunologic risk of acute rejection (AR) is still controversial. The use of basiliximab (BSX) has led to a significant decrease of AR with a low side effect profile.

OBJECTIVE

This study sought to evaluate predictive risk factors for AR in low immunologic risk patients subjected to immunosuppressive induction therapy with BSX.

METHODS

We reviewed all low immunologic risk patients (panel reactive antibody [PRA] level <50%, who had undergone a first deceased-donor transplant) subjected to immunosuppressive induction therapy with BSX, calcineurin inhibitor, mycophenolate mofetil, and prednisolone (n = 346). AR was defined as any rejection occurring until 12 months posttransplantation. Predictive risk factors for AR were evaluated by logistic regression and, to find the best cut-off of PRA related to a higher incidence of AR, receiver-operator characteristic (ROC) curve analysis was performed.

RESULTS

The rate of AR was 7.8%. Multivariate logistic regression analysis identified age at the time of transplantation (P = .040) and PRA level (P = .001) as independent risk factors for AR. ROC curve analysis confirmed that PRA >10% was related to an increased incidence of AR (19.2% vs 6.0%, P = .005).

CONCLUSIONS

A higher incidence of AR was observed in low immunologic risk kidney transplant patients with a PRA level >10%. These data support the use of more intensive immunosuppressive induction therapy in patients with low immunologic risk and a PRA level >10%.

Is the use of long-acting injectable antipsychotic extended in the outpatient treatment of bipolar disorder? A brief description

Aims

Obtain and analyze information on treatment guidelines, with particular emphasis on the use of antipsychotics, in patients diagnosed with bipolar disorder I and bipolar disorder II who are treated at a mental health center in a district of Madrid (Spain) under the conditions of habitual clinical practice.

Then, compare with recently published literature.

Methods

We performed a descriptive study of a sample of 100 patients diagnosed with bipolar disorder (type I and type II) at any stage of the disease who receive regular treatment in a mental health center in a district of Madrid. Information regarding the treatment used, especially the use of antipsychotics (either in a single therapy or in combination with other drugs such as mood stabilizers, antidepressants, hypnotics or anxiolytics), was collected retrospectively from the data obtained from the medical record.

Results

Ninety-four percent of patients are taking mood stabilizer treatment (68% lithium, 24% valproate, 1% and 1% carbamazepine and lamotrigine). Four percent take lithium and valproate in combination. Forty-eight percent of patients are taking some antipsychotic (atypical about 90%). Of these, only 10% in injectable form, and 5% take both oral and injectable antipsychotics.

Conclusions

The diminished use of injectable antipsychotics, well below recent publications, draws the attention. You can probably explain this low proportion of injectable medication because we are generally dealing with stable patients with a long-term disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Sclerostin does not play a major role in the pathogenesis of skeletal complications in type 2 diabetes mellitus

In contrast to previously reported elevations in serum sclerostin levels in diabetic patients, the present study shows that the impaired bone microarchitecture and cellular turnover associated with type 2 diabetes mellitus (T2DM)-like conditions in ZDF rats are not correlated with changes in serum and bone sclerostin expression.

INTRODUCTION

T2DM is associated with impaired skeletal structure and a higher prevalence of bone fractures. Sclerostin, a negative regulator of bone formation, is elevated in serum of diabetic patients. We aimed to relate changes in bone architecture and cellular activities to sclerostin production in the Zucker diabetic fatty (ZDF) rat.

METHODS

Bone density and architecture were measured by micro-CT and bone remodelling by histomorphometry in tibiae and femurs of 14-week-old male ZDF rats and lean Zucker controls (n = 6/group).

RESULTS

ZDF rats showed lower trabecular bone mineral density and bone mass compared to controls, due to decreases in bone volume and thickness, along with impaired bone connectivity and cortical bone geometry. Bone remodelling was impaired in diabetic rats, demonstrated by decreased bone formation rate and increased percentage of tartrate-resistant acid phosphatase-positive osteoclastic surfaces. Serum sclerostin levels (ELISA) were higher in ZDF compared to lean rats at 9 weeks (+40 %, p < 0.01), but this difference disappeared as their glucose control deteriorated and by week 14, ZDF rats had lower sclerostin levels than control rats (-44 %, p < 0.0001). Bone sclerostin mRNA (qPCR) and protein (immunohistochemistry) were similar in ZDF, and lean rats at 14 weeks and genotype did not affect the number of empty osteocytic lacunae in cortical and trabecular bone.

CONCLUSION

T2DM results in impaired skeletal architecture through altered remodelling pathways, but despite altered serum levels, it does not appear that sclerostin contributes to the deleterious effect of T2DM in rat bone.