An Unusual Presentation of Erythrodermic Psoriasis

Introduction Erythrodermic psoriasis is a rare form of psoriasis, occurring in less than 3% of patients with psoriasis. Limited information is known regarding diagnosis and treatment for this form of psoriasis, with most studies involving small groups or single patients. This unusual case of erythrodermic psoriasis outlines the presentation, diagnosis, and treatment that occurred in a 53-year-old patient who initially presented with dyspnea and a fever. Case Presentation The 53-year-old patient was originally admitted for dyspnea and a fever. A maculopapular rash developed diffusely on the upper extremities, lower extremities, trunk, and face. The rash then desquamated over several days, appearing as exfoliating and scaling skin. The patient underwent two punch biopsies for diagnosis and was treated with Hydrocortisone (2.5%) cream for the face and inguinal regions and Triamcinolone for the trunk. The patient continued this regimen daily for 2 weeks, and then alternated days for the following 2 weeks. Discussion There are many different causes and potential risk factors for a flare of erythrodermic psoriasis: history of psoriasis, systemic corticosteroids and excessive use of topical steroids, phototherapy complications, severe emotional stress, and preceding illness. The patient in this study had several precipitating factors worth noting, including recent diagnosis of colorectal cancer and infection with evidence of leukocytosis. She was also under a fair amount of emotional stress given her health issues and prolonged hospital stay. The patient was also receiving several medications that may have increased her risk of a flare, most notably being Vancomycin. Initial treatment is the use of topical corticosteroids and systemic therapy is considered if this does not improve symptoms. Prior case reports have shown that difficult to manage cases can be treated with Acitretin or systemic therapies such as Methotrexate. Key Words Erythroderma, psoriasis, dermatolog

Heterocyclic β-keto sulfide derivatives of carvacrol: Synthesis and copper (II) ion reducing capacity

Sixteen β-keto sulfide derivatives of carvacrol (4–19) incorporating phenyl or N, O and S heterocyclic moieties were synthesized in three steps. The relationships between heterocyclic structure and cupric, Cu(II), ion reducing antioxidant capacity (CUPRAC) were examined. Nine of the compounds (8–9 and 13–19) showed better CUPRAC activity than trolox at neutral pH, with trolox equivalent antioxidant capacity (TEAC) coefficients ranging between 1.20 and 1.75. Two derivatives (11–12) showed comparable reducing capacity to trolox, with TEAC values of 0.95 for 11 and 1.02 for 12. Compounds 8–9 and 11–19 were more effective at reducing the Cu (II) ion than ascorbic acid and the parent compound, carvacrol. The most effective antioxidants were those containing an oxadiazole, thiadiazole or triazole moiety. In particular, the methyl thiadiazole derivative (15) had the highest Cu(II) ion reducing capacity, with a TEAC coefficient of 1.73

Antioxidant and tyrosinase docking studies of heterocyclic sulfide derivatives containing a thymol moiety

Fourteen heterocyclic sulfide derivatives (4–17) containing a thymol moiety and oxadiazole, thiadiazole, triazole, oxazole, thiazole, imidazole, pyridine or purine heterocycles were synthesized in three steps. The cupric, Cu(II), ion reducing antioxidant capacity of the compounds was examined, and molecular docking studies were performed to determine whether the sulfur, thymol or heterocyclic moieties interact with the Cu ions in tyrosinase, a type-3 copper enzyme. Using the CUPRAC assay, eight compounds (5–8, 10, 15–17) showed equal or better Cu (II) reducing capacity than trolox at neutral pH, with trolox equivalent antioxidant capacity (TEAC) coefficients ranging between 1.00 and 1.48. The compounds containing a thiadiazole moiety were most effective, with the methyl thiadiazole derivative (8) having the highest Cu(II) reducing capacity. Molecular docking studies of the sulfide derivatives with tyrosinase revealed that there were no direct interactions between the sulfur atom and the active site copper ions. However, the compounds displayed two different binding interactions with the histidine-Cu catalytic center. For compounds 4–13, the thymol portion was embedded in the active site cavity, while for compounds 14–17 the heterocyclic portion of the molecule approached the cavity

Vaccine Elicitation of High Mannose-Dependent Neutralizing Antibodies against the V3-Glycan Broadly Neutralizing Epitope in Nonhuman Primates

Summary: Induction of broadly neutralizing antibodies (bnAbs) that target HIV-1 envelope (Env) is a goal of HIV-1 vaccine development. A bnAb target is the Env third variable loop (V3)-glycan site. To determine whether immunization could induce antibodies to the V3-glycan bnAb binding site, we repetitively immunized macaques over a 4-year period with an Env expressing V3-high mannose glycans. Env immunizations elicited plasma antibodies that neutralized HIV-1 expressing only high-mannose glycans—a characteristic shared by early bnAb B cell lineage members. A rhesus recombinant monoclonal antibody from a vaccinated macaque bound to the V3-glycan site at the same amino acids as broadly neutralizing antibodies. A structure of the antibody bound to glycan revealed that the three variable heavy-chain complementarity-determining regions formed a cavity into which glycan could insert and neutralized multiple HIV-1 isolates with high-mannose glycans. Thus, HIV-1 Env vaccination induced mannose-dependent antibodies with characteristics of V3-glycan bnAb precursors. : Most bnAb epitopes on HIV-1 Envelope include host glycans, but previous Env vaccines have not induced glycan-dependent antibodies. Saunders et al. describe here the ontogeny, crystal structure with glycan, and virion Man9GlcNAc2-dependent neutralization for glycan-reactive antibodies induced by envelope vaccination. Keywords: HIV, V3 glycan, vaccination, glycan, long-term immunizatio

A framework for examining leadership in extreme contexts

In this review, we develop a framework to guide future research and to examine the execution of leadership in extreme contexts. We start by defining and distinguishing extreme contexts from crisis and other contexts. A five component typology is developed comprised of magnitude of consequences, form of threat, probability of consequences, location in time and physical or psychological–social proximity. We discuss the unique influences these components have on leadership processes in extreme contexts examining the relevance of organization types such as critical action and high reliability organizations. Further, we present a set of factors that may attenuate or intensify the dimensions comprising an extreme context, thus influencing either a team or organization\u27s ability for adaptive leadership response. Ultimately this framework seeks to develop a richer understanding of extreme contexts to advance the future development of contextualized theories of leadership for extreme contexts