Severe erosive gingivostomatitis in a patient treated by vedolizumab.

Vedolizumab is a humanized monoclonal antibody that binds to the human a4ß7 integrin and is approved for use in inflammatory bowel diseases. We describe a patient with severe, refractory erosive gingivostomatitis, which appeared a few days after the first dose of vedolizumab and resolved after discontinuation of the drug. We believe the gingivostomatitis to be a direct side effect of vedolizumab, rather than an extraintestinal manifestation of the underlying inflammatory bowel diseases. The clinicians need to be aware of this adverse event, which could be mistakenly considered as an extraintestinal manifestation of inflammatory bowel diseases.

[Cytopenia under topical imiquimod in two patients treated with oral hydroxyurea]. / Cytopénies sous imiquimod topique chez deux patients traités par hydroxyurée.

BACKGROUND: Aldara® is a topical immunomodulatory treatment. The risks of systemic passage are minimal. There have been rare reports of systemic adverse effects. PATIENTS AND METHODS: Case 1. Five sachets weekly of imiquimod were prescribed for Bowen's disease on the forearm in a patient known to have essential thrombocytosis under Hydrea®. His CBC was normal (6000 leukocytes/mm3, 2200 PMN/mm, 230,000 platelets/mm3). Imiquimod was given in 15 sachets weekly. Fifteen day later, the patient presented bicytopenia (3000 leukocytes/mm3, 1400 PMN/mm3, 119,000 platelets/mm3). Hydroxyurea and imiquimod were suspended until normalization of CBC. Hydroxyurea was resumed without recurrence of the bicytopenia. The patient's history included an identical episode following application of imiquimod. Case 2. Five sachets weekly of imiquimod were prescribed for actinic keratosis on the scalp in a patient known to have primary polycythemia under hydroxyurea. Her CBC was normal except for anemia (Hb 11.5g/L, 160,000 platelets/mm3, 1100 lymphocytes/mm3). Imiquimod was given in 12 sachets weekly. Ten days later, anemia increased (Hb 10g/dL) with lymphopenia (800/mm3) and thrombocytopenia (115,000/mm3). Suspension of imiquimod resulted in normalization of the previous CBC values. DISCUSSION: . The literature review identified reports of dose-dependent lymphopenia under oral imiquimod but not under Aldara®. The National Pharmacovigilance Database listed 10 cases of hematological disorders most likely caused by Aldara®. Hydroxyurea may induce cytopenia, and while it was not considered the sole causative agent in this case, it is likely to have had a triggering role in these patients with blood dyscrasias. Our findings show that misuse of imiquimod carries a potential risk of hematologic abnormality in patients receiving concomitant hydroxyurea, a commonly combined drug.

Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis.

BACKGROUND: The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A structured search was performed in the PubMed, Embase, and Medline databases up to Feb 2015 to identify studies reporting incidence, prevalence, health care utilization, morbidity, or mortality in COPD and asthma. RESULTS: A total of 19 studies were included in the present study. The pooled prevalence of overlap among COPD was 27% (95% CI: 0.16-0.38, p<0.0001) and 28% (95% CI: 0.09-0.47, p = 0.0032) in the population and hospital-based studies, respectively. We found no significant difference between ACOS and COPD in terms of gender, smoking status, lung function and 6mWD. However, in comparison to subject with only COPD, ACOS subjects were significantly younger, had higher BMI, healthcare utilization, and lower HRQoL. CONCLUSION: ACOS is a common condition that exists in a substantial proportion of subjects with COPD. ACOS represents a distinct clinical phenotype with more frequent exacerbations, hospitalization, worse health-related quality of life, and higher healthcare costs than either disease alone. There is a critical need to better define the management and treatment of this syndrome.

Correlation between optical coherence tomography and glaucomatous optic nerve head damage in children.

AIM: To compare analysis of macular and nerve fibre layer thickness by optical coherence tomography (OCT) with optic nerve head (ONH) morphology based on stereophotography. DESIGN: Prospective observational case-control series. METHODS: Normal and glaucomatous eyes of children (age 4-17 years) were scanned using Stratus OCT (Carl Zeiss Meditec, Dublin, California, USA). Fast macular and retinal nerve fibre layer (RNFL) thickness map were performed on 372 eyes of 222 children. ONH stereophotographs were taken and evaluated by two masked observers using a grading system of 0 to 5 based on both cupping ratio and morphology. OCT3 analyses were compared across ONH grades for different areas around the macula and the peripapillary RNFL. RESULTS: Analysis included OCT values and ONH grading for 139 eyes of 139 children. There was a negative correlation between ONH grade and both macular thickness and RNFL thickness in all areas measured. There was a difference in the correlation identified for black versus white children. CONCLUSION: OCT measurements of RNFL and macular thickness declined with increasing grade of glaucomatous damage seen on stereophotographs in black and white children. Further study will help quantify the value of OCT in the diagnosis and management of paediatric glaucoma.

Periocular corticosteroids in diabetic papillopathy.

PURPOSE: To ascertain the therapeutic effect of periocular corticosteroids in diabetic papillopathy. METHODS: Prospectively, five consecutive adult-onset diabetic patients with symptomatic diabetic papillopathy underwent visual fields and fluorescein angiography before and after superonasal subtenon injection of corticosteroids. RESULTS: The median duration of papillopathy was 2.5 weeks by ophthalmoscopy and 3 weeks by fluorescein angiography. The median recovery time of best-spectacle-corrected visual acuity was 2 weeks. Two patients developed sequential diabetic papillopathy, and both reported faster visual recovery and better subjective vision in treated eyes. In these two patients, the final best-spectacle-corrected visual acuity and visual evoked responses were comparable between the two eyes, while automated visual fields were less constricted in treated eyes. Complications included ocular hypertension, mild progression of cataract, and mild ptosis in one patient each. CONCLUSIONS: Periocular corticosteroids shortened the duration of diabetic papillopathy from a reported median of 5 months to 3 weeks in the present uncontrolled observational study, partly by their angiostatic and antioedema effects at the level of the anterior optic nerve. Intraocular pressure needs to be monitored in eyes receiving periocular corticosteroids.

Acrylamide as an inducer of metabolic activation system (S9) in rats.

The S9 fraction was prepared from rats i.p. injected with a single dose of 75 mg/kg acrylamide. The efficiency of the acrylamide induction procedure was verified on Salmonella mutagenicity testing (TA98 and TA100) using a number of known mutagens. These mutagens are aflatoxin B1, benzo[alpha]pyrene, 2-acetylaminofluorene and sodium azide. The activity of the mutagen is measured in terms of histidine revertant numbers which were found to be almost proportional to the concentration of acrylamide-induced S9. The maximum activation of the mutagens (except sodium azide) was recorded using around 50 microliters of S9 per plate. The efficiency of our prepared S9 fraction as a metabolic activator for some known mutagens is comparable to that of standard S9. On the basis of our results, acrylamide-induced S9 demonstrated considerable increase in the activation of the tested compounds. Accordingly, acrylamide could be used as an additional procedure for the induction of rat hepatic enzymes (S9).