Behaviour sequelae following acute Kawasaki disease.

BACKGROUND: Kawasaki disease is a systemic vasculitis and may affect cerebral function acutely. The aim of the present study was to measure a number of behaviour and social parameters within a cohort of Kawasaki disease patients. METHODS: Parents of children with past diagnosis of Kawasaki disease were recruited to complete several behaviour screening questionnaires. Sixty five sets of questionnaires relating to the patient cohort received were eligible for inclusion. Two control groups were used, a hospital (HC) control and a sibling control (SC) group. RESULTS: 40% of the Kawasaki disease group showed elevated internalising scores in the clinical or borderline-clinical range. This compared with 18% of hospital controls and 13% of sibling controls. Additionally, the Kawasaki disease (KD) group were shown to be experiencing greater overall total difficulties when compared with the controls (KD 13.7, HC 8.6, SC 8.9). The KD group attained higher behavioural scores within the internalising sub-categories of somatic problems (KD 61, HC 57, SC 54) and withdrawn traits (KD 56, HC 53, SC 51). The KD group were also shown to be suffering more thought problems (KD 57, HC 53, SC 50) compared with the controls. Further difficulties relating to conduct (KD 3.3, HC 1.4) and social interactions (KD 6.7, HC 8.3) are also highlighted for the KD group compared with hospital controls. Positron emission tomograms were performed on nine patients to investigate severe behavioural problems. Three showed minor changes, possibly a resolving cerebral vasculopathy. CONCLUSION: Kawasaki disease can be associated with significant behavioural sequelae. This is an important consideration in the long-term follow up and referral to a clinical psychologist may be necessary in selected patients

Platelet-Activating Factor Receptor Plays a Role in Lung Injury and Death Caused by Influenza A in Mice

Influenza A virus causes annual epidemics which affect millions of people worldwide. A recent Influenza pandemic brought new awareness over the health impact of the disease. It is thought that a severe inflammatory response against the virus contributes to disease severity and death. Therefore, modulating the effects of inflammatory mediators may represent a new therapy against Influenza infection. Platelet activating factor (PAF) receptor (PAFR) deficient mice were used to evaluate the role of the gene in a model of experimental infection with Influenza A/WSN/33 H1N1 or a reassortant Influenza A H3N1 subtype. The following parameters were evaluated: lethality, cell recruitment to the airways, lung pathology, viral titers and cytokine levels in lungs. The PAFR antagonist PCA4248 was also used after the onset of flu symptoms. Absence or antagonism of PAFR caused significant protection against flu-associated lethality and lung injury. Protection was correlated with decreased neutrophil recruitment, lung edema, vascular permeability and injury. There was no increase of viral load and greater recruitment of NK1.1+ cells. Antibody responses were similar in WT and PAFR-deficient mice and animals were protected from re-infection. Influenza infection induces the enzyme that synthesizes PAF, lyso-PAF acetyltransferase, an effect linked to activation of TLR7/8. Therefore, it is suggested that PAFR is a disease-associated gene and plays an important role in driving neutrophil influx and lung damage after infection of mice with two subtypes of Influenza A. Further studies should investigate whether targeting PAFR may be useful to reduce lung pathology associated with Influenza A virus infection in humans

The role of nuclear medicine in the evaluation of neuropsychiatric systemic lupus erythematosus: comment on the article by Sibbitt et al

It was with great interest that we read the recent review by Sibbitt et al on neuroimaging in neuropsychiatric systemic lupus erythematosus (NPSLE) (1), which underlined the unquestionable role played by anatomic and functional imaging—along with careful clinical evaluation—in the diagnosis of NPSLE. In light of our own experience, however, we believe the role of nuclear medicine techniques in NPSLE diagnosis requires further consideration. As has been widely demonstrated, both positron emission tomography (PET) and single-photon emission computed tomography (SPECT) reveal alterations in flow and metabolism in NPSLE patients who have negative findings on magnetic resonance imaging (MRI) (2–4). The possibility that these PET and SPECT results are false-positive findings has been ruled out both by the fact that there are correlations with the results of other functional studies (5) and by the evidence of an ability to predict the neuropsychiatric evolution (6). Both SPECT and PET are rapidly developing technologies that are in constant evolution; moreover, both are increasingly available for clinical use, which has, predictably, reduced operating costs (7). Nevertheless, it must be emphasized that SPECT and PET both study cerebral function, and not its anatomy. They must therefore be integrated with some other morphologic imaging technique, in particular MRI, since an alteration in function (i.e., blood flow, cerebral metabolism) can understandably presage, or be closely related to, anatomic damage. Therefore, it is our opinion that correct use of neuroimaging techniques in NPSLE must, first of all, call for morphologic imaging (preferably with MRI) to rule out or confirm anatomic damage. Then, if the morphologic imaging result is negative and the neuropsychiatric status is still in doubt, functional imaging should be applied. The choice of technique should also be based on evidence found in the literature, availability, and local experience

Single photon emission computed tomography in neuropsychiatric systemic lupus erythematosus

In comparison to MRI, SPECT detect more hypoperfused areas. The reliance on a multeplicity of diagnostic tests will be required for the foresseble future in NPSLE

Scintigrafia surrenalica

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Ruolo della Medicina Nucleare nella patologia reumatica

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Bioeffetti da ultrasuoni

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Integrazione della medicina nucleare nella diagnostica di laboratorio

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