ABSTRACT
The past decade has seen a surge of reports and investigations into cases of autoimmune-mediated encephalitis. The increasing recognition of these disorders is especially of relevance to the fields of neurology and psychiatry. Autoimmune encephalitis involves antibodies against synaptic receptors, neuronal cell surface proteins and intracellular targets. These disorders feature prominent symptoms of cognitive impairment and behavioural changes, often associated with the presence of seizures. Early in the clinical course, autoimmune encephalitis may manifest as psychiatric symptoms of psychosis and involve psychiatry as an initial point of contact. Although commonly associated with malignancy, these disorders can present in the absence of an inciting neoplasm. The identification of autoimmune encephalitis is of clinical importance as a large proportion of individuals experience a response to immunotherapy. This review focuses on the current state of knowledge on n-methyl-d-aspartate (NMDA) receptor-associated encephalitis and limbic encephalitis, the latter predominantly involving antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor, the γ-aminobutyric acid (GABA)B receptor and leucine-rich glioma-inactivated 1 (LGI1) protein. In addition, we briefly describe anti-dopamine D2 receptor encephalitis. A summary of the literature will focus on common clinical presentations and course, diagnostic approaches and response to treatment. Since a substantial proportion of patients with autoimmune encephalitis exhibit symptoms of psychosis, the relevance of this disorder to theories of psychosis and schizophrenia will also be discussed.
Subject(s)
Affective Symptoms/immunology , Autoimmune Diseases of the Nervous System/immunology , Encephalitis/immunology , Mental Disorders/immunology , Neuroimmunomodulation/immunology , Autoantibodies/blood , Autoimmune Diseases of the Nervous System/diagnosis , Autoimmune Diseases of the Nervous System/therapy , Brain/immunology , Encephalitis/diagnosis , Encephalitis/therapy , Humans , Prognosis , Psychotic Disorders/diagnosis , Psychotic Disorders/immunology , Psychotic Disorders/therapy , Receptors, Neurotransmitter/immunology , Schizophrenia/diagnosis , Schizophrenia/immunology , Schizophrenia/therapyABSTRACT
BACKGROUND: Safety profiles of biologics for treatment of psoriasis are limited to data from randomized controlled trials. There is a need for comparative safety reports of biologics based on data from clinical practice. OBJECTIVE: We sought to estimate and compare the incidence of adverse events (AEs) leading to withdrawal of biologics (etanercept, infliximab, adalimumab, and ustekinumab) in the treatment of psoriasis. METHODS: We conducted a multicenter retrospective chart review from September 2005 to September 2014. Incidence proportion and rate of AEs leading to withdrawal by biologic agent and AE were calculated. RESULTS: For 545 treatments administered in 398 patients, 22 (4.04%) AEs were associated with withdrawal, for a rate of 1.97/100 patient-years (95% confidence interval [CI] 1.32-2.94). Common AEs were injection-/infusion-site reactions (0.55%, 0.92%, 0%, and 0% for etanercept, infliximab, adalimumab, and ustekinumab, respectively); infections (0%, 0.18%, 0.55%, 0.18%); and malignancies (0.18%, 0.18%, 0%, 0.37%). LIMITATIONS: Possible incompleteness of chart details and small study population limit the conclusiveness of findings. CONCLUSION: Biologic agents for treatment of psoriasis are safe; AEs associated with withdrawal occurred in 4% of all administered biologic therapies. It does not appear that real-world patients encounter more AEs with biologics than patients in clinical trials.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Biological Therapy/adverse effects , Drug-Related Side Effects and Adverse Reactions/epidemiology , Psoriasis/diagnosis , Psoriasis/drug therapy , Withholding Treatment/statistics & numerical data , Adalimumab , Adult , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized/administration & dosage , Biological Therapy/methods , Canada , Cohort Studies , Drug-Related Side Effects and Adverse Reactions/etiology , Etanercept , Female , Humans , Immunoglobulin G/administration & dosage , Immunoglobulin G/adverse effects , Incidence , Infections/chemically induced , Infections/epidemiology , Infliximab , Injections, Subcutaneous , Male , Middle Aged , Neoplasms/chemically induced , Neoplasms/epidemiology , Receptors, Tumor Necrosis Factor/administration & dosage , Retrospective Studies , Risk Assessment , Severity of Illness Index , UstekinumabABSTRACT
BACKGROUND: The gtring presence of dermatology platforms on Facebook has been acknowledged; however, little is known about the extent to which different types of content influence the level of engagement with online users. OBJECTIVE: To assess the level of public engagement with different types of content posted on Facebook pages devoted to dermatology. METHODS: A search on Facebook identified existing pages for dermatology academic journals, professional societies, and patient-centered groups. Then the engagement rate was calculated for each content type published on the selected pages. RESULTS: The median engagement rates were 63.8% for educational posts, 41.3% for interactive posts, 27.4% for news articles, 11.8% for academic articles, and 9.3% for others. CONCLUSION: Educational posts engaged with online users the most effectively. The level of engagement is a key determinant of knowledge dissemination via online tools, and the type of content may influence the level of engagement.
