PReS-FINAL-2041: Macrophage activation syndrome in the children with systemic juvenile idiopathic arthritis during the course of tocilizumab

Background Trauma exposure and posttraumatic stress disorder (PTSD) are common among individuals with a mental disorder, but symptoms often go undetected and untreated. Methods The aim of this study was to determine the prevalence of PTSD among a large sample of adults with psychiatric diagnoses and to establish factors associated with symptoms going undetected. Participants were 1,946 adults recruited by the National Centre for Mental Health. Structured interviews and validated self-report questionnaires were used to ascertain clinical and demographic information for analysis. Results The prevalence of participants screening positive for PTSD that had not been detected by clinical services was 13.9% [12.4–15.5%, 95% confidence interval]). Factors associated with undetected PTSD were female gender, younger age of first contact with psychiatric services, and lower household income. Especially, poor rates of detection were observed after traumatic events, such as child abuse and sexual assault. Conclusions Our findings demonstrate the need for routine assessment of trauma histories and symptoms of PTSD among individuals with anymental disorder

Detection of theophylline utilising portable electrochemical sensors

The electrochemical oxidation of theophylline (TP) is investigated utilising screen-printed electrodes. Through thorough investigation of pH, we propose a reaction mechanism, finding that the oxidation of TP is stable over a wide pH range, in particular under acidic conditions. Conversely under alkaline conditions, theophylline fouls the electrode surface. The screen-printed carbon sensors are applied towards the electroanalytical sensing of TP with a remarkable amount of success in aqueous solution at physiological pH. The screen-printed sensors have been shown to be applicable to the detection of TP at unharmful, medicinally relevant (55–110 mM), and toxic concentrations in aqueous media at physiological pH. Thus this work presents a proof-of-concept approach towards TP detection utilising sensors commonly implemented in point-of-care applications

ОПЫТ ПРИМЕНЕНИЯ РИТУКСИМАБА У БОЛЬНОЙ СИСТЕМНЫМ ЮВЕНИЛЬНЫМ ИДИОПАТИЧЕСКИМ АРТРИТОМ

The article presents a case of early onset and severe systemic form of juvenile idiopathic arthritis refractory to classical immunosuppressive therapy, including pulse therapy with methotrexate and combined therapy with methotrexate and cyclosporine. There is described the successful use of chimeric antibodies to CD20 on B lymphocytes — Rituximab — a dose of 375 mg/m2 of body surface in the form of intravenous infusions of 1 time per week for 4 weeks. The child has got one course of treatment with rituximab. By the 12th week of treatment the extraarticular disease manifestations and acute inflammatory changes in the joints stopped, the range of motion in affected joints significantly increased. 22 weeks later the drug induced the development of clinical and laboratory remission, the duration of which is 2.5 years.В статье представлен случай раннего дебюта и тяжелого течения системного варианта ювенильного идиопатического артрита, рефрактерного к терапии классическими иммунодепрессантами, включая пульс-терапию метотрексатом и комбинированное лечение метотрексатом и циклоспорином. Описано успешное применение химерных антител к CD20 на В лимфоцитах — ритуксимаба — в дозе 375 мг/м2 поверхности тела в виде внутривенных инфузий 1 раз в нед в течение 4 нед. У ребенка был проведен 1 курс лечения ритуксимабом. К 12-й нед от начала лечения купировались экстраартикулярные проявления болезни и островоспалительные изменения в суставах, значительно нарос объем движений в пораженных суставах. Через 22 нед препарат индуцировал развитие клинико-лабораторной ремиссии, длительность которой составляет 2,5 года.

Serum mast cell tryptase measurements: Sensitivity and specificity for a diagnosis of anaphylaxis in emergency department patients with shock or hypoxaemia

© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Objective: Clinical diagnosis of anaphylaxis is principally based on symptoms and signs. However, particularly for patients with atypical symptoms, laboratory confirmation of anaphylaxis would be useful. This study investigated the utility of mast cell tryptase, an available clinical biomarker, for differentiating anaphylaxis from other causes of critical illness, which can also involve mast cell activation. Methods: Tryptase was measured (ImmunoCAP) in serum from patients with anaphylaxis and non-anaphylactic critical illness (controls) at ED arrival, and after 1–2, 3–4 and 12–24 h. Differences in both peak and delta (difference between highest and lowest) tryptase concentrations between groups were investigated using linear regression models, and diagnostic ability was analysed using Receiver Operating Characteristic curve analysis. Results: Peak tryptase was fourfold (95% CI: 2.9, 5.5) higher in anaphylaxis patients (n = 67) than controls (n = 120) (P < 0.001). Delta-tryptase was 5.1-fold (95% CI: 2.9, 8.9) higher in anaphylaxis than controls (P < 0.001). Optimal test characteristics (sensitivity: 72% [95% CI: 59, 82] and specificity: 72% [95%CI: 63, 80]) were observed when peak tryptase concentrations were >11.4 ng/mL and/or delta-tryptase =2.0 ng/mL. For hypotensive patients, peak tryptase >11.4 ng/mL had improved test characteristics (sensitivity: 85% [95% CI: 65, 96] and specificity: 92% [95% CI: 85, 97]); the use of delta-tryptase reduced test specificity. Conclusion: While peak and delta tryptase concentrations were higher in anaphylaxis than other forms of critical illness, the test lacks sufficient sensitivity and specificity. Therefore, mast cell tryptase values alone cannot be used to establish the diagnosis of anaphylaxis in the ED. In particular, tryptase has limited utility for differentiating anaphylactic from non-anaphylactic shock