Clinical vignette: Levamisole-tainted cocaine causing leukocytoclastic vasculitis

A 36-year-old woman presented to Emergency with 2.5 years duration of waxing and waning severe pain related to confluent necrotic lesions involving her lower extremities. Her medical history was significant for crack cocaine use for 12 years, resulting in a recent admission for febrile neutropenia consistent with levamisole toxicity. Last use was the night prior to this presentation, toxicology screen was positive for cocaine. Physical exam revealed a cachectic, malnourished woman in severe distress with painful non-blanching purpura noted along the helixes of both ears and tip of the nose. Her lower extremities had large, minimally retiform purpuric plaques with surrounding erythema, which later developed hemorrhagic bullae over the subsequent 10-day hospital course. At admission, her absolute neutrophil count was 2,200, reaching a nadir of 1,000. Inflammatory markers included C-reactive protein elevated at 6.9, erythrocyte sedimentation rate greater than 120. No evidence of infectious process was found during the hospital course, including viral serologies and bacterial cultures.ANA was positive (titer, 1:320), as well as P-ANCA positive (titer, 1:2560) with both PR3 and MPO significantly elevated at 441 and 289, respectively. Additional rheumatologic serologies included positive Lupus-like inhibitor, Beta-2 glycoprotein IgM, anti-cardiolipin IgM, and normal IgG levels. A skin biopsy was obtained and histopathology showed dilated venules with abundant small to medium-sized fibrin thrombi. (panel at Left) Direct immunofluorescence pattern had deposition of IgG, IgM, IgA, C3, and fibrinogen in venule walls diagnostic of leukocytoclastic vasculitis. (panel at Left) Treatment with steroids resulted in slow partial resolution of the lesions

The Sodium Graphite Reactor: Tommorrow's Power Plant

A description is given of the Advanced Sodium Graphite Reactor Power Plant, including the reactor, heat transfer systems, generatirg plant, control systems, and the economics of producing 256 Mw(e). The safety of this design is due to its unusually low operating pressure, absence of chemically incompatible materials in the core, and excellent stability under atatic and dynamic conditions. The reactor is being constructed at Hallam, Nebraska, at a probable cost of 0 to 0/kw, exclusive of the first core costs. The 151 fuel elements of uranium carbide are enriched to 2.75 at.% U/sup 235/ and clad in stainless steel. The average thermal neutron flux in the fuel is 8 x 10/sup 13/ n/cm/sup 2/sec. (B.O.G.

Framework for E‐Learning Assessment in Dental Education: A Global Model for the Future

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153544/1/jddj002203372013775tb05504x.pd

Biocompatibility and Biodegradation Studies of Subconjunctival Implants in Rabbit Eyes

Sustained ocular drug delivery is difficult to achieve. Most drugs have poor penetration due to the multiple physiological barriers of the eye and are rapidly cleared if applied topically. Biodegradable subconjunctival implants with controlled drug release may circumvent these two problems. In our study, two microfilms (poly [d,l-lactide-co-glycolide] PLGA and poly[d,l-lactide-co-caprolactone] PLC were developed and evaluated for their degradation behavior in vitro and in vivo. We also evaluated the biocompatibility of both microfilms. Eighteen eyes (9 rabbits) were surgically implanted with one type of microfilm in each eye. Serial anterior-segment optical coherence tomography (AS-OCT) scans together with serial slit-lamp microscopy allowed us to measure thickness and cross-sectional area of the microfilms. In vitro studies revealed bulk degradation kinetics for both microfilms, while in vivo studies demonstrated surface erosion kinetics. Serial slit-lamp microscopy revealed no significant inflammation or vascularization in both types of implants (mean increase in vascularity grade PLGA50/50 12±0.5% vs. PLC70/30 15±0.6%; P = 0.91) over a period of 6 months. Histology, immunohistochemistry and immuno-fluorescence also revealed no significant inflammatory reaction from either of the microfilms, which confirmed that both microfilms are biocompatible. The duration of the drug delivery can be tailored by selecting the materials, which have different degradation kinetics, to suit the desired clinical therapeutic application

A Core Curriculum in the Biological and Biomedical Sciences for Dentistry

INTRODUCTION: The biomedical sciences (BMS) are a central part of the dental curriculum that underpins teaching and clinical practice in all areas of dentistry. Although some specialist groups have proposed curricula in their particular topic areas, there is currently no overarching view of what should be included in a BMS curriculum for undergraduate dental programmes. To address this, the Association for Dental Education in Europe (ADEE) convened a Special Interest Group (SIG) with representatives from across Europe to develop a consensus BMS curriculum for dental programmes. CURRICULUM: This paper summarises the outcome of the deliberations of this SIG and details a consensus view from the SIG of what a BMS curriculum should include. CONCLUSIONS: Given the broad nature of BMS applied to dentistry, this curriculum framework is advisory and seeks to provide programme planners with an indicative list of topics which can be mapped to specific learning objectives within their own curricula. As dentistry becomes increasingly specialised, these will change, or some elements of the undergraduate curriculum may move to the post-graduate setting. So, this document should be seen as a beginning and it will need regular review as BMS curricula in dentistry evolve

Gaviscon® vs. omeprazole in symptomatic treatment of moderate gastroesophageal reflux. a direct comparative randomised trial

<p>Abstract</p> <p>Background</p> <p>Medical management of GERD mainly uses proton pump inhibitors. Alginates also have proven efficacy. The aim of this trial was to compare short-term efficacy of an alginate (Gaviscon^®, 4 × 10 mL/day) and omeprazole (20 mg/day) on GERD symptoms in general practice.</p> <p>Methods</p> <p>A 14-day multicentre randomised double-blind double-dummy non-inferiority trial compared Gaviscon^®(4 × 10 mL/day) and omeprazole (20 mg/day) in patients with 2-6 day heartburn episodes weekly without alarm signals. The primary outcome was the mean time to onset of the first 24-h heartburn-free period after initial dosing. Secondary outcomes were the proportion of patients without heartburn by D7, pain relief by D7, and reduction in pain intensity by D7 and D14.</p> <p>Results</p> <p>278 patients were recruited; 120 were included in the Gaviscon^®group and 121 in the omeprazole group for the per protocol non-inferiority analysis. The mean time to onset of the first 24-h heartburn-free period after initial dosing was 2.0 (± 2.2) days for Gaviscon^®and 2.0 (± 2.3) days for omeprazole (<it>p </it>= 0.93); mean intergroup difference was 0.01 ± 1.55 days (95% CI = -0.41 to 0.43): i.e., less than the lower limit of the 95% CI of -0.5 days predetermined to demonstrate non-inferiority. The mean number of heartburn-free days by D7 was significantly greater in the omeprazole group: 3.7 ± 2.3 days vs. 3.1 ± 2.1 (<it>p </it>= 0.02). On D7, overall quality of pain relief was slightly in favour of omeprazole (<it>p </it>= 0.049). There was no significant difference in the reduction in pain intensity between groups by D7 (<it>p = </it>0.11) or D14 (<it>p = </it>0.08). Tolerance and safety were good and comparable in both groups.</p> <p>Conclusion</p> <p>Gaviscon^®was non-inferior to omeprazole in achieving a 24-h heartburn-free period in moderate episodic heartburn, and is a relevant effective alternative treatment in moderate GERD in primary care.</p> <p>Trial registration</p> <p><a href="http://www.controlled-trials.com/ISRCTN62203233">ISRCTN62203233</a>.</p