Drug allergy

Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions with varying mechanisms and clinical presentations. This type of adverse drug reaction (ADR) not only affects patient quality of life, but may also lead to delayed treatment, unnecessary investigations, and even mortality. Given the myriad of symptoms associated with the condition, diagnosis is often challenging. Therefore, referral to an allergist experienced in the identification, diagnosis and management of drug allergy is recommended if a drug-induced allergic reaction is suspected. Diagnosis relies on a careful history and physical examination. In some instances, skin testing, graded challenges and induction of drug tolerance procedures may be required

β-lactam hypersensitivity involves expansion of circulating and skin-resident Th22 cells

Background: β-lactam hypersensitivity has been classified according to the phenotype and function of drug-specific T-cells; however, new T-cell subsets have not been considered. Objective: The objective of this study was use piperacillin as a model of β-lactam hypersensitivity to study the nature of the drug-specific T-cell response induced in the blood and skin of hypersensitive patients and healthy volunteers. Methods: Drug-specific T-cells were cloned from blood and inflamed skin and cellular phenotype and function was explored. Naïve T cells from healthy volunteers were primed to piperacillin, cloned and subjected to the similar analyses. Results: PBMC and T-cell clones (n=570, 84% CD4+) from blood of piperacillin hypersensitive patients proliferated and secreted Th1/2 cytokines alongside IL-22 following drug stimulation. IL-17A secretion was not detected. Drug-specific clones from inflamed skin (n=96, 83% CD4+) secreted a similar profile of cytokines, but displayed greater cytolytic activity, secreting perforin, granzyme B and Fas L when activated. Blood- and skin-derived clones expressed high levels of skin-homing chemokine receptors and migrated in the presence of the ligands CCL17 and CCL27. Piperacillin-primed naïve T-cells from healthy volunteers also secreted IFN-γ, IL-13, IL-22 and cytolytic molecules. Aryl hydrocarbon (ArH) receptor blockade prevented differentiation of the naïve T-cells into antigen-specific Il-22 secreting cells. Conclusion: Together our results reveal that circulating and skin resident antigen-specific IL-22 secreting T-cells are detectable in patients with β-lactam hypersensitivity. Furthermore, differentiation of naïve T-cells into antigen-specific Th22 cells is dependent on ArH receptor signalling

Toxic epidermal necrolysis and Stevens-Johnson syndrome

Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Currently, TEN and SJS are considered to be two ends of a spectrum of severe epidermolytic adverse cutaneous drug reactions, differing only by their extent of skin detachment. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infections are well documented causes alongside rare cases in which the aetiology remains unknown. Several drugs are at "high" risk of inducing TEN/SJS including: Allopurinol, Trimethoprim-sulfamethoxazole and other sulfonamide-antibiotics, aminopenicillins, cephalosporins, quinolones, carbamazepine, phenytoin, phenobarbital and NSAID's of the oxicam-type. Genetic susceptibility to SJS and TEN is likely as exemplified by the strong association observed in Han Chinese between a genetic marker, the human leukocyte antigen HLA-B*1502, and SJS induced by carbamazepine. Diagnosis relies mainly on clinical signs together with the histological analysis of a skin biopsy showing typical full-thickness epidermal necrolysis due to extensive keratinocyte apoptosis. Differential diagnosis includes linear IgA dermatosis and paraneoplastic pemphigus, pemphigus vulgaris and bullous pemphigoid, acute generalized exanthematous pustulosis (AGEP), disseminated fixed bullous drug eruption and staphyloccocal scalded skin syndrome (SSSS). Due to the high risk of mortality, management of patients with SJS/TEN requires rapid diagnosis, evaluation of the prognosis using SCORTEN, identification and interruption of the culprit drug, specialized supportive care ideally in an intensive care unit, and consideration of immunomodulating agents such as high-dose intravenous immunoglobulin therapy. SJS and TEN are severe and life-threatening. The average reported mortality rate of SJS is 1-5%, and of TEN is 25-35%; it can be even higher in elderly patients and those with a large surface area of epidermal detachment. More than 50% of patients surviving TEN suffer from long-term sequelae of the disease

Transformer stations on pylon - formerly and today

W artykule przedstawiono poszczególne typy słupowych stacji transformatorowych jakie obecnie są eksploatowane w energetyce zawodowej.In this article are presented a different kinds of transformer stations mounted on pylon, which are exploited at present in professional power industry

Medium - voltage electric supply lines as mortality and formal-technical problems aspect

W artykule przedstawiono problemy dotyczące eksploatacji linii średniego napięcia oraz oceny stanu technicznego sieci napowietrznej i kablowej. Część artykułu poświęcono awaryjności i porównano ze sobą linie kablowe z napowietrznymi w oparciu o dane, które zostały udostępnione przez Spółki Dystrybucyjne. Następnie omówiono aspekty formalno-techniczne odnośnie linii energetycznych. Ponadto przedstawiono nowe rozwiązania w budownictwie sieciowym, które w znaczny sposób mogą się przyczynić do ograniczenia: zajmowanego terenu przez słupy lub linie, liczby stanowisk słupowych oraz pasa wycinki drzew.This thesis presents problems strongly connected with medium-voltage electric line exploitation and overhead system and cabling technical state estimation. Part of the article was performed to mortality and compared with each other cabling and overhead system based on data that are provided by Distribution Companies. Then discusses formal-legal aspects with reference to electrical supply lines. In addition new solutions in network building that can significantly contribute to reducing: occupied land by overhead line towers or overhead lines, the number of tower posts and belt slices of trees has been presented

Aspects aesthetic - emotional and design - installation illuminations of sacred objects

Problematyka związana z tworzeniem projektów iluminacji jest bardzo złożona. Wymagana jest znajomość nie tylko danych fotometrycznych sprzętu oświetleniowego czy wytycznych projektowo - instalacyjnych, ale także, a może przede wszystkim, znajomość symboliki i sztuki. Projektant musi więc cechować się szeroką wiedzą, umożliwiającą kompleksową analizę wszystkich aspektów zagadnienia. Należy zaznaczyć, że nie ma jednego standardowego, uniwersalnego, sposobu iluminowania obiektów. Każdy projekt wymaga innego podejścia chociażby ze względu na różnorodność architektury, historii, środowiska, kultury, otoczenia czy funkcji budynków. Najważniejszym, z punktu widzenia iluminacji, znaczeniem światła jest estetyka i wpływ na psychikę, podświadomość człowieka poprzez kreowanie nastroju otoczenia i ukazywanie świata w całym jego pięknie i zróżnicowaniu. Wizualizacje wykonane w programach komputerowych, mimo swoich ograniczeń, ułatwiają pracę projektanta i przybliżają go do osiągnięcia zamierzonego efektu plastycznego i emocjonalnego. Celem artykułu jest prezentacja i analiza teorii iluminacji oraz zaleceń, zawartych w przepisach prawnych, normach i w literaturze, dotyczących projektowania oświetlenia iluminacyjnego obiektów sakralnych. Przestrzeganie tych założeń i spełnienie wymagań powinno zapewnić uzyskanie efektu zgodnego z celami iluminacji jak również aspektami estetyczno - emocjonalnymi i projektowo - instalacyjnymi.The problems associated with the creation of projects of illumination is very complex. Not only the knowledge about the photometric data of lighting equipment and design guidelines - the installation is needed, but also, and perhaps above all, the knowledge of symbolism and art. The designer must therefore be characterized by extensive knowledge which enables a comprehensive analysis of all aspects. It should be noted that there is no single standard and universal way of illumination objects. Each project requires a different approach, because of the diversity of architecture, history, environment, culture, surroundings and function of buildings. In terms of illumination, the most important meaning of the light is the aesthetics and impact on the psyche, on the human subconscious by creating of the ambience environment and showing the world in all its beauty and diversity. Renderings done in computer programs, despite their limitations, facilitate the work of designer and brings him closer to achieve the desired artistic and emotional effects. The aim of this article is to present and analyze the theory of illumination and the recommendations contained in the legislation, standards and literature which concerns the design of architectural illumination lighting. Obeying of these objectives and fulfilling of the requirements should provide the obtainment of the required effect which consists with the objectives of illumination as well as with aesthetic - emotional and design - installation effects

Earthings of pole stands with cable terminations

Praca zawiera analizę właściwości statycznych i udarowych uziemień stosowanych w systemie elektroenergetycznym do ochrony przeciwprzepięciowej. W końcowych rozdziałach dokonano analizy konstrukcji systemów uziemień z punktu widzenia skuteczności w systemie ochrony układu izolacyjnego od przepięć oraz podano szereg wskazówek dotyczących właściwego doboru uziemień stanowisk słupowych głowic kablowych. Wskazano też na błędy popełniane na etapie wykonywania uziemień.The work includes extensive discussion and comparison of the static and impulse properties of the earthing system used in the power surge protection system. The final chapters deal with the design of earthing systems from the point of view of effectiveness in the overvoltage protection system and provide a number of guidelines for the proper selection and construction of earthing pole stands for cable terminations. The errors made during the earthing phase were also indicated

Prestressed spun concrete poles in practical use and typical analyses

Artykuł składa się z dwóch części. W pierwszej części przedstawiono polską historię strunobetonowych żerdzi wirowanych w rozwiązaniach albumowych. W części drugiej podano wybrane aspekty praktyczne zastosowania żerdzi wirowanych przy remontach i budowie linii elektroenergetycznych.The article consists of two parts. The history of Polish prestressed spun concrete poles in album's solutions is presented in the first part. The second part are some aspects of practical application of prestressed spun concrete poles for renovation and in construction of power lines

In vitro diagnosis of T cell-mediated drug allergy

Diagnosis of drug hypersensitivity relies on history, skin tests, in vitro tests and provocation tests. In vitro tests are of great interest, due to possible reduction of drug provocation tests. In this review we focus on best investigated in vitro techniques for the diagnosis of T cell-mediated drug hypersensitivity reactions. As drug hypersensitivity relies on different pathomechanisms and as a single diagnostic test usually does not cover all possible reactions, it is advisable to combine different tests to increase the overall sensitivity. Recently, proliferation-based assays have been supplemented by a panel of novel in vitro tests including analysis of cytotoxic potential of effector cells (granzyme B, granulysin, CD107a), evaluation of cytokine secretion (IL-2, IL-5, IL-13, and IFN-γ) and up-regulation of cell surface activation markers (CD69). We discuss the latest findings and readout systems to identify causative drugs by detecting functional and phenotypic markers of drug-reacting cells, and their ability to enable a more conclusive diagnosis of drug allergy