Contact allergy to local anaesthetics–value of patch testing with a caine mix in the baseline series

BACKGROUND: Contact allergy to local anaesthetics is relatively common. Patch testing with benzocaine in the European baseline series is recommended for diagnosis, even though a caine mix has been previously suggested to be superior. OBJECTIVES: To assess the frequency and patterns of contact allergy to local anaesthetics by using a caine mix (benzocaine, tetracaine, and cinchocaine) in the baseline series, and evaluate its efficiency as compared with benzocaine alone. METHODS: We reviewed the results of 2736 patch tests performed between 2000 and 2010, identifying patients with positive reactions to caine mix or to one of seven local anaesthetics. RESULTS: One hundred and twelve patients (4.1%) had at least one allergic reaction to local anaesthetics; 86 were tested with all seven local anaesthetics, resulting in 71 reactions in 53 patients. Cinchocaine gave the most reactions (50.7%); these occurred as a single reaction in 83.3% of patients, mostly with current or past relevance (97%). Benzocaine represented 22.5% of reactions, many of which were non-relevant (44%) or resulting from cross-reactions with para-compounds. CONCLUSIONS: Almost 70% of allergic reactions to local anaesthetics would have been missed if benzocaine had been used as a screening allergen. This study supports a recommendation to replace benzocaine with a caine mix containing cinchocaine in the baseline patch test series

Hamiltonian thermodynamics of three-dimensional dilatonic black holes

The action for a class of three-dimensional dilaton-gravity theories with a cosmological constant can be recast in a Brans-Dicke type action, with its free $\omega$ parameter. These theories have static spherically symmetric black holes. Those with well formulated asymptotics are studied through a Hamiltonian formalism, and their thermodynamical properties are found out. The theories studied are general relativity ($\omega\to\infty$), a dimensionally reduced cylindrical four-dimensional general relativity theory ($\omega=0$), and a theory representing a class of theories ($\omega=-3$). The Hamiltonian formalism is setup in three dimensions through foliations on the right region of the Carter-Penrose diagram, with the bifurcation 1-sphere as the left boundary, and anti-de Sitter infinity as the right boundary. The metric functions on the foliated hypersurfaces are the canonical coordinates. The Hamiltonian action is written, the Hamiltonian being a sum of constraints. One finds a new action which yields an unconstrained theory with one pair of canonical coordinates $\{M,P_M\}$, $M$ being the mass parameter and $P_M$ its conjugate momenta The resulting Hamiltonian is a sum of boundary terms only. A quantization of the theory is performed. The Schr\"odinger evolution operator is constructed, the trace is taken, and the partition function of the canonical ensemble is obtained. The black hole entropies differ, in general, from the usual quarter of the horizon area due to the dilaton.Comment: 34 pages, 3 figures, references added, minor changes in the revised versio

Exome Sequencing and Complex Disease: Practical Aspects of Rare Variant Association Studies

Genetic association and linkage studies can provide insights into complex disease biology, guiding the development of new diagnostic and therapeutic strategies. Over the past decade, genetic association studies have largely focused on common, easy to measure genetic variants shared between many individuals. These common variants typically have subtle functional consequence and translating the resulting association signals into biological insights can be challenging. In the last few years, exome sequencing has emerged as a cost-effective strategy for extending these studies to include rare coding variants, which often have more marked functional consequences. Here, we provide practical guidance in the design and analysis of complex trait association studies focused on rare, coding variants

Dermatoses Específicas da Gravidez

During pregnancy immunological, metabolic, hormonal and vascular changes occur, and can cause specific skin diseases. The specific dermatoses of pregnancy have undergone numerous changes in nomenclature and classification, partly due to advances in the knowledge of the pathogenesis of these skin diseases. Currently the following diseases are considered specific dermatoses of pregnancy: pemphigoid gestations, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Timely diagnosis and specific and safe treatment are essential to prevent complications which, although rare, may be associated with significant maternal-fetal comorbidity

Charged shells in Lovelock gravity: Hamiltonian treatment and physical implications

Using a Hamiltonian treatment, charged thin shells in spherically symmetric spacetimes in d dimensional Lovelock-Maxwell theory are studied. The coefficients of the theory are chosen to obtain a sensible theory, with a negative cosmological constant appearing naturally. After writing the action and the Lagrangian for a spacetime comprised of an interior and an exterior regions, with a thin shell as a boundary in between, one finds the Hamiltonian using an ADM description. For spherically symmetric spacetimes, one reduces the relevant constraints. The dynamic and constraint equations are obtained. The vacuum solutions yield a division of the theory into two branches, d-2k-1>0 (which includes general relativity, Born-Infeld type theories) and d-2k-1=0 (which includes Chern-Simons type theories), where k gives the highest power of the curvature in the Lagrangian. An additional parameter, chi, gives the character of the vacuum solutions. For chi=1 the solutions have a black hole character. For chi=-1 the solutions have a totally naked singularity character. The integration through the thin shell takes care of the smooth junction. The subsequent analysis is divided into two cases: static charged thin shell configurations, and gravitationally collapsing charged dust shells. Physical implications are drawn: if such a large extra dimension scenario is correct, one can extract enough information from the outcome of those collapses as to know, not only the actual dimension of spacetime, but also which particular Lovelock gravity, is the correct one.Comment: 25 pages, 9 figure

Epicutaneous patch testing in drug hypersensitivity syndrome (DRESS)

BACKGROUND: In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients. OBJECTIVE: The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS. PATIENTS/METHODS: Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%). RESULTS: A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug. CONCLUSIONS: In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism

Allergic contact dermatitis to shoes induced by dimethylfumarate: A new allergen imported from China

BACKGROUND: In the last two years several cases of severe contact dermatitis related to newly acquired sofas and armchairs originating from China have been published. The responsible allergen is dimethylfumarate (DMF), an extremely potent sensitizer and irritant found in sachets inside the furniture. Recently, cases of contact dermatitis related to shoes and riding helmets have also been described. METHODS: We evaluated two patients with allergic contact dermatitis related to shoes manufactured in China that were contaminated by dimethylfumarate found in sachets placed inside the shoeboxes. RESULTS: Patch tests with DMF extracted from the sachets inside the shoeboxes showed positive reactions. Postitive reactions were also obtained using small fragments of the shoes and tissue of the "MouldProof" sachet. The patients were instructed to avoid the suspected shoes and were treated with topical corticosteroids. CONCLUSIONS: Contact dermatitis induced by dimethylfumarate should be suspected in appropriate cases. It is important to remember that this allergen is not included in most series for patch testing