Drug-induced pemphigoid: a review of the literature Stavropoulos, P.G.; Soura, E.; Antoniou, C.
Journal of the European Academy of Dermatology and Venereology,
September 2014, Letnik:
28, Številka:
9
Journal Article
Recenzirano
Bullous pemphigoid is an acquired autoimmune disease that is characterized by subepidermal blistering and affects mainly the elderly. The pathogenesis of the condition has not yet been fully ...elucidated, but it is widely accepted that a strong correlation with various medications may exist. In reality, more than 50 different drugs have been associated with the appearance of bullous pemphigoid and as new therapies emerge, this number is very likely to increase. A number of pathogenetic mechanisms have been proposed in the past. It is true that a delicate immunological balance is disturbed in all patients with the disease. The variable effects that may be exhibited by the use of biological drugs could shed some light in this complex immunological behaviour. At the same time, drug‐induced bullous pemphigoid is difficult to differentially diagnose from its idiopathic counterpart, as the clinical picture and histopathological findings in both conditions may only have subtle differences. Patients who present with bullous pemphigoid and receive multiple regimens should always be suspected of suffering from the drug‐induced variant of the condition. This possibility must be considered, as after the withdrawal of the suspect medication most patients respond rapidly to treatment and do not experience relapses.
The primary objective of this work was the examination of modified activated carbons with tailored adsorption capacity properties. Production of activated carbons with desired properties was ...accomplished by modification of surface functional groups and introduction of acidic/basic properties. Modification of an activated carbon was performed using partial oxygen gasification, nitric acid treatment, urea impregnation followed by pyrolysis and pyrolysis in a urea saturated stream. The surface properties of the produced samples were estimated by the multibasic titration method of Boehm and by the CO/CO
2 gas evolution profiles, while pore structure development was measured by the N
2 and CO
2 gas adsorption isotherms. Oxygen gasification resulted in samples with surface area slightly lower that the raw activated carbon; the introduction of surface functional groups depended upon the severity of the treatment: carbonylic and phenolic type groups were introduced in all partially gasified samples, while low temperatures and short reaction times enhanced the basic character of the carbon. However, nitric acid treatment resulted in the introduction of high nitrogen amounts in the samples, the reduction of surface area and the development of a surface containing carboxylic, lactonic, phenolic and carbonylic groups with negligible HCl neutralization capacity. Treatment of activated carbon by urea supported the formation of basic groups and carbonyls. The presence of surface functional groups affected the adsorption capacity of the produced samples for the removal of specific pollutants such as phenols. Urea treated samples with a basic character and high nitrogen content presented the highest phenol uptake capacity; nitric acid treated carbons and oxygen gasified samples presented an acidic surface functionality and a low phenol adsorption capacity. The beneficial role of nitrogen on phenol adsorption was attributed to adsorbate–adsorbent interactions.
Reactive Arthritis Stavropoulos, P.G.; Soura, E.; Kanelleas, A. ...
Journal of the European Academy of Dermatology and Venereology,
March 2015, Letnik:
29, Številka:
3
Journal Article
Recenzirano
Reactive arthritis (ReA) is an immune‐mediated seronegative arthritis that belongs to the group of spondyloarthropathies and develops after a gastrointestinal or genitourinary system infection. The ...condition is considered to be characterized by a triad of symptoms (conjunctivitis, arthritis and urethritis) although a constellation of other manifestations may also be present. ReA is characterized by psoriasiform dermatological manifestations that may resemble those of pustular psoriasis and, similar to guttate psoriasis, is a post‐infectious entity. Also, the articular manifestations of the disorder are similar to those of psoriatic arthritis and both conditions show a correlation with HLA‐B27. These facts have led several authors to suggest that there is a connection between ReA and psoriasis, listing ReA among the disorders related to psoriasis. However, the pathogenetic mechanism behind the condition is complex and poorly understood. Bacterial antigenicity, the type of host response (i.e. Th1/Th2 imbalance) and various genetic factors (i.e. HLA‐B27 etc.) play an important role in the development of the disorder. It is unknown whether all the aforementioned factors are part of a mechanism that could be similar to, or share basic aspects with known psoriasis pathogenesis mechanisms.
Agricultural residues and waste tires constitute an important source of precursors for activated carbon production. Activated carbons offer a potential tool for mercury emissions control. In this ...work, pine and oak wood, olive seed and tire wastes have been used for the preparation of activated carbons, in order to be examined for their mercury removal capacity. In the case of activated carbons produced from pine/oak woods and tire wastes, a two stage physical activation procedure was applied. Activated carbons derived from olive seeds were prepared by chemical activation using KOH. Pore structure of the samples was characterized by N
2 and CO
2 adsorption, while TPD-IR experiments were performed in order to determine surface oxygen groups. Hg° adsorption experiments were realized in a bench-scale adsorption unit consisting of a fixed-bed reactor. The influence of activation technique and conditions on the resulted activated carbon properties was examined. The effects of pore structure and surface chemistry of activated carbons were also investigated. Activated carbons produced from olive seeds with chemical activation possessed the highest BET surface area with well-developed micropore structure, and the highest Hg° adsorptive capacity. Oxygen surface functional groups (mainly lactones) seem to be involved in Hg° adsorption mechanism.
Background and Objective
The aim of this study was to evaluate the effects of administration of avocado/soybean unsaponifiable (ASU), a drug that is commonly used in the treatment of rheumatoid ...arthritis, on ligature‐induced bone loss and bone repair after ligature removal in rats.
Material and Methods
Eighty‐four rats were randomly assigned to four groups of equal size and received a daily gavage of either sterile saline control (CTR) or ASU (0.6 mg/kg), starting 7 d before (ASU/−7), on the day of (ASU/0) or 7 d after (ASU/+7) periodontitis induction. Periodontitis was induced by placing silk ligatures into the gingival sulcus of the second maxillary molars for 7 d; after 7 d, the ligatures were removed. Seven rats from each group were sacrificed, 7, 15 or 30 d after ligature removal. Bone resorption was evaluated by histomorphometry and micro‐computed tomography (micro‐CT). Immunohistochemistry was used to evaluate the expression of TRAP, RANKL and alkaline phosphatase (ALP), and quantitative PCR (qPCR) was used to evaluate the levels of interleukin‐1beta (Il1β), tumor necrosis factor alpha (Tnfα), interleukin‐6 (Il‐6), Rankl and Alp. Statistical analysis was performed using the Shapiro–Wilk test, ANOVA and Tukey's test for normal data, and using the Kruskall–Wallis and Dunnet's tests for non‐normal data (p < 0.05).
Results
Histomorphometry and micro‐CT analysis showed greater bone resorption in the CTR group than in the ASU/0 (15 d) and ASU/+7 (7 and 15 d) groups. The CTR group also presented with a higher expression of TRAP (15 and 30 d) and RANKL (7 and 15 d) compared with ASU/0 and ASU/+7 groups. Similarly, qPCR analysis showed higher levels of Rankl and Il1β mRNAs, and lower levels of Alp mRNA, in the CTR group compared with all other groups (for all periods).
Conclusion
ASU exhibited a positive effect on bone repair following ligature‐induced periodontitis in rats.
This work attempts to shed light on molecular hydrogen adsorption in carbonaceous microporous materials by exploiting molecular dynamics simulations combined with geometry optimization calculations ...of the solid structures. Carbon structures were considered here because of evidence suggesting that they may be efficient media for hydrogen storage. The inclusion of oxygen functional groups in these solid structures was also examined since they could affect hydrogen adsorption. Insertion of oxygen functional groups causes a decrease in hydrogen adsorption and this effect is more evident in narrow pores. Hydrogen molecules adsorb in the pores as structured layers, depending on pore slit width. The amount of hydrogen adsorbed reached 4.41%
w/w for the purely carbonaceous materials, whereas for the oxygenated materials adsorption was limited to 3.30%
w/w. The estimated adsorption density inside the pores exceeded the liquid hydrogen density for both solid structures investigated.
Abstract In composite arterial coronary grafts (CACGs), transport phenomena and geometry may considerably alter blood flow dynamics. CACGs aim at revascularizing pathological arteries according to ...the human anatomy. However, the exact mechanisms causing the failure of coronary bypass grafting are not yet well elucidated. In the present study, computational fluid dynamics (CFD) techniques are applied for the simulation of multi-branched CACGs under physiologically realistic inflow waveforms. The numerical solution is obtained by a finite-volume method formulated in non-orthogonal, curvilinear coordinates and a multi-grid approach. The geometrical models, consisting of idealized and rigid vessels, include the typical T- and a rather new Π-graft configuration. The stenotic effect is also investigated by comparing computational results for three different degrees of area constriction, namely 25%, 50% and 75%, as well as the case without stenosis. Different grafting distances and various inflow rate ratios are imposed, to give an insight into haemodynamical alterations of CACGs and to study the process of restenosis. The results focus on the interaction between the grafts and coronary flows in terms of spatial and temporal variations of velocity and wall shear stress (WSS) distribution. Prominent variations among the different geometries, concerning the velocity profiles and secondary flow motion, are shown. Moreover, the residual flow emerging from different degrees of area constriction shows that low and oscillating shear stresses may arise for even moderate stenotic fields.
Abstract This paper presents a comparative study of simulated blood flow in different configurations of simplified composite arterial coronary grafts (CACGs). Even though the composite arterial ...grafting is increasingly used in cardiac surgery, it is still questionable whether or not the blood flow in such grafts can adequately meet the demands of the native myocardial circulation. A computational fluid dynamics (CFD) model was developed to conduct computer-based studies of simulated blood flow in four different geometric configurations of CACGs, corresponding to routinely used networks in cardiac surgery coronary grafts (T, Y, Π and sequential). The flow was assumed three-dimensional, laminar and steady and the fluid as Newtonian, while the vessel walls were considered as inelastic and impermeable. It was concluded that local haemodynamics, practically described by velocity, pressure drop, wall shear stress (WSS) and flow rates, may be strongly influenced by the local geometry, especially at the anastomotic sites. The computations were made at mean flow rates of 37.5, 75 and 150 ml/min. The side-branch outflow rates, computed for each bypass graft, showed noticeable differences. The results, which were found both qualitatively and quantitatively consistent with other studies, indicate that the Π -graft exhibits significantly less uniform distribution of outflow rates than the other geometric configurations. Moreover, prominent variations in WSS and velocity distribution among the assessed CACGs were predicted, showing remarkable flow interactions among the arterial branches. The lowest shear stress regions were found on the lateral walls of bifurcations, which are predominantly susceptible to the occurrence of coronary artery disease (CAD). In contrast, the highest WSS were observed at the turn of the arterial branches.
Background The use of ELISA testing of antibodies to desmogleins 1 and 3 (anti‐Dsg1 and anti‐Dsg3) and indirect immunofluorescence (IIF) has been strongly supported for the serologic diagnosis of ...pemphigus. The purpose of this study was to correlate anti‐Dsg1 and anti‐Dsg3 with IIF values, disease localization, treatment and clinical course in Greek patients with pemphigus vulgaris (PV).
Methods A total of 54 patients with PV had ELISA serum testing for the presence and titers of anti‐Dsg1, anti‐Dsg3 and IIF. Anti‐Dsg1, anti‐Dsg3 and IIF were correlated with treatment and disease localization. For 40 patients, titers of anti‐Dsg1 and anti‐Dsg3 were assessed in relation to treatment and clinical course after 12 months.
Results Anti‐Dsg3 and anti‐Dsg1 positivity in patients with negative IIF was 70.6% and 58.8%, respectively. Anti‐Dsg1 and anti‐Dsg3 were positive in 89.3% and 100% of patients with mucocutaneous disease, respectively, 88.9% and 66.7% of patients with skin limited disease, respectively and 52.9% and 76.5% of patients with mucosal limited disease, respectively. Both antibody titers showed significant correlation with IIF and treatment status. Improvement of clinical status was associated with significant decrease of both anti‐Dsg1 and anti‐Dsg3 after 12 months.
Conclusions Serum testing of anti‐Dsg1 and anti‐Dsg3 in PV patients not only provides significant correlations with IIF, treatment and disease type, but may serve as a monitoring tool for clinical course and treatment guidance.
Background Calcineurin inhibitors show potent anti‐inflammatory effects and favorable safety profile when used in the treatment of cutaneous lupus erythematosus (CLE).
Objective The present study ...investigates the change in clinical parameters of erythema, desquamation and edema, when calcineurin inhibitors are used as monotherapy or in combination with hydroxychloroquine in CLE for a period of 60 days.
Methods 18 patients were treated with topical tacrolimus and 20 patients with topical pimecrolimus, as monotherapy or in combination with hydroxychloroquine. Clinical parameters of erythema, desquamation and edema were assessed on a scale from 0 to 3 for erythema and edema and 0 to 2 for desquamation.
Results Statistically significant improvement in erythema, desquamation and edema was observed in patients on monotherapy with calcineurin inhibitor and combination treatment with hydroxychloroquine, regardless of disease type. Combination treatment resulted in improvement of edema in 100% of patients, while monotherapy did so in 75% of patients.
Conclusions Topical calcineurin inhibitors enhance the therapeutic effect of systemic agents in cutaneous lupus erythematosus, and result in improvement of the clinical parameters studied.
