Anakinra for corticosteroid-dependent and colchicine-resistant pericarditis: The IRAP (International Registry of Anakinra for Pericarditis) study

Aims

Novel therapies are needed for recurrent pericarditis, particularly when corticosteroid dependent and colchicine resistant. Based on limited data, interleukin-1 blockade with anakinra may be beneficial. The aim of this multicentre registry was to evaluate the broader effectiveness and safety of anakinra in a ‘real world’ population.

Methods and results

This registry enrolled consecutive patients with recurrent pericarditis who were corticosteroid dependent and colchicine resistant and treated with anakinra. The primary outcome was the pericarditis recurrence rate after treatment. Secondary outcomes included emergency department visits, hospitalisations, corticosteroid use and adverse events. Among 224 patients (46 ± 14 years old, 63% women, 75% idiopathic), the median duration of disease was 17 months (interquartile range 9–33). Most patients had elevated C-reactive protein (91%) and pericardial effusion (88%). After a median treatment of 6 months (3–12), pericarditis recurrences were reduced six-fold (2.33–0.39 per patient per year), emergency department admissions were reduced 11-fold (1.08–0.10 per patient per year), hospitalisations were reduced seven-fold (0.99–0.13 per patient per year). Corticosteroid use was decreased by anakinra (respectively from 80% to 27%; P < 0.001). No serious adverse events occurred; adverse events consisted mostly of transient skin reactions (38%) at the injection site. Adverse events led to discontinuation in 3%. A full-dose treatment duration of over 3 months followed by a tapering period of over 3 months were the therapeutic schemes associated with a lower risk of recurrence.

Conclusion

In patients with recurrent pericarditis, anakinra appears efficacious and safe in reducing recurrences, emergency department admissions and hospitalisations.

Witkop tooth and nail syndrome: a case report

Witkop tooth and nail syndrome is an autosomal dominant ectodermal dysplasia characterized by hypodontia and nail dysplasia. Mutations in MSX-1 have been identified as being involved in the syndrome. Mandibular incisors, secondary molars and maxillary canines are the most frequently missing teeth. Tooth shape may vary, and conical and narrow crowns are common. Nail dysplasia affects finger- and toenails, and is often more severe in childhood. Nails may be spoon-shaped, rigid, slow-growing and easily broken. The clinical and radiographic features of a mother and child presenting with this rare condition are described.

A study of root canal morphology of human primary molars using computerised tomography: an in vitro study

Knowledge of the size, morphology and variation of the root canals of primary teeth are useful in visualizing the pulp cavity during treatment. This study was carried out to investigate the applicability of Computed Tomography in studying the root canal morphology of the primary molars. A total of 60 primary molars.without any macroscopic root resorption were collected and divided into four groups. The samples were arranged in wax block and then scanned for evaluation in the CT Scanner both in axial and coronal plane. The results obtained from the scanned images were statistically analyzed to know the frequency, mean and standard deviation for all the groups. The images showed the complexity of the root canals of the primary molars and also several capabilities of the CT Scan in advance Endodontic research in primary teeth were observed.

A compound composite odontoma associated with unerupted permanent incisor--a case report

Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Frequently it may interfere with the eruption of the teeth. This is a case report of a compound composite odontoma in a 9 year old girl, which results in failure of eruption of the permanent upper right central incisor while the contralateral tooth had erupted. A calcified mass was seen in the radiograph and was provisionally diagnosed as odontoma following which the odontoma was enucleated. Routine follow up was done for more than a year and no recurrence was seen. This case report indicates that early diagnosis and management ensures better prognosis.

Comparative evaluation of glass ionomer and resin based fissure sealant using noninvasive and invasive techniques--a SEM and microleakage study

The efficacy of using invasive and non-invasive techniques was assessed by Scanning electron microscopy, and by microleakage of Glass ionomer (GC VII, Fuji) and Resin based sealant (Helioseal-F, Ivoclar Vivadent). 100 young premolars were used for this study, and they were divided into four groups: Group I: non-invasive technique GC VII, Group II: Invasive GC VII, Group III: Non-Invasive Helioseal-F, Group IV: Invasive, Helioseal-F. 5 teeth from each group were evaluated under SEM. It was seen that the flow and adaptation of GC VII was slightly better than Helioseal F, and the invasive technique provided the best flow and adaptation. For microleakage analysis 5% methylene blue was used. It was seen that minimal microleakage was seen in Group IV (P<0.01). Considering the recent controversies using resin based sealants, it can be said that GC VII can be a viable alternative for pit and fissure sealants.

Enamel etching by carbon dioxide laser. An in-vitro comparative evaluation

The enamel surfaces etched with carbon dioxide laser and 37% phosphoric acid were compared with regard to surface topography. The shear bond strengths of composite bonded to enamel etched by laser and acid were also compared in the study. Out of the 72 human healthy premolars selected for the study, 12 teeth were used for studying the surface topography using scanning electron microscope. The shear bond strengths were evaluated using a Hounsfield Tensometer in the remaining 60 teeth. Under scanning electron microscope, carbon dioxide laser etching of enamel produced a poor etch pattern. The shear bond strengths of composite bonded to laser etched enamel appeared inferior as compared to those on acid etched enamel. Paired t-test gave a statistically significant difference between the shear bond strengths of composite bonded to laser etched and acid etched enamel surfaces.

Treatment of un-united fractures of the shaft of the humerus with bent nail

The results of operative treatment of 78 cases of un-united fractures of the humeral diaphysis are reported. The operation consisted of medullary nail fixation, the nail being bent at the fracture site in order to engage the cortex above and below the fracture, and was followed by plaster splintage. Forty-nine cases showed evidence of union within 20 weeks and 21 united between 20 and 30 weeks. Of the remaining cases, two had broken nails and five were lost to follow-up.

Effects of the muscarinic agonist McN-A-343 on responses to sympathetic nerve stimulation in the rabbit ear artery

1. Observations were made on the effects of 4-(m-chlorophenylcarbamoyloxy)-2-butynyltrimethylammonium chloride (McN-A-343) on responses of isolated segments of the central artery of the rabbit's ear to sympathetic nerve stimulation and noradrenaline.2. With low frequencies of nerve stimulation (2-5 Hz), McN-A-343 caused a decrease in responses to sympathetic nerve stimulation. This effect of McN-A-343 was abolished by dexamphetamine or atropine. In the presence of atropine, McN-A-343 caused an increase in responses to sympathetic nerve stimulation.3. With high frequencies of nerve stimulation (10-20 Hz), McN-A-343 caused an increase in responses. This effect was not qualitatively changed in the presence of atropine.4. When McN-A-343 had an inhibitory effect on responses to sympathetic nerve stimulation, responses to noradrenaline were unaffected.5. It is suggested that McN-A-343 acts on muscarinic receptors through which noradrenaline release may be inhibited; it may also act on the cholinergic stage in adrenergic transmission postulated by Burn & Rand (1959).

The effects of cholinomimetic drugs on responses to sympathetic nerve stimulation and noradrenaline in the rabbit ear artery

1. The effects of infusions of the cholinomimetic drugs acetylcholine, methacholine, muscarine, carbachol, arecoline and pilocarpine were examined on vasoconstrictor responses of the perfused rabbit ear artery to sympathetic nerve stimulation and to injections of noradrenaline.2. The first effect of very low concentrations of acetylcholine or muscarine was a slight enhancement of responses to sympathetic nerve stimulation, but when higher concentrations of acetylcholine, methacholine, muscarine, carbachol and arecoline were infused, these vasoconstrictor responses were decreased. With still higher concentrations the responses tended to increase in size during the infusion. After stopping an infusion, the depressed vasoconstrictor responses rapidly recovered and became enhanced.3. Infusions of pilocarpine in a wide range of concentrations generally caused enhancement of responses.4. The depressant effects of cholinomimetic drugs on the responses to sympathetic nerve stimulation were antagonized by atropine. Larger concentrations of the drugs overcame the blockade by atropine.5. The effects of acetylcholine, methacholine and muscarine on the responses to sympathetic nerve stimulation were more pronounced at low than at high frequencies of stimulation.6. Vasoconstrictor responses to injected noradrenaline were enhanced by acetylcholine or methacholine, whereas responses to sympathetic nerve stimulation were decreased by the same concentrations of these choline esters.7. It is suggested that cholinomimetic drugs may act on receptor sites associated with the adrenergic terminal axon and that they may facilitate or impair the release of noradrenaline and impair noradrenaline uptake.