ABSTRACT
INTRODUCTION: Propylthiouracil (PTU) is a synthetic antithyroid drug that can induce ANCA-associated vasculitis. OBSERVATION: A 27-year-old woman diagnosed with Graves' disease was on PTU for the past 10 years. She developed purpuric lesions of the legs and on the tip of the nose diagnosed as vasculitis. ANCAs were positive, with anti-MPO and anti-PR3 on blood ELISA. After discontinuation of PTU, she was able to fully recover. CONCLUSION: All synthetic antithyroid drugs can induce ANCA-associated vasculitis, more often PTU. In most cases, antibodies are directed against MPO. Dual anti-MPO and anti-PR3 positivity is possible, but rare. The mechanism could be through an accumulation of PTU in neutrophils, altering the structure of MPO and making it immunogenic. PTU can also induce ANCA-free or lupus vasculitis, maculopapular rashes or urticaria. Many other drugs can induce ANCA-associated vasculitis.
Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Hyperthyroidism , Purpura , Adult , Antibodies, Antineutrophil Cytoplasmic , Antithyroid Agents/adverse effects , Female , Humans , Hyperthyroidism/chemically induced , Hyperthyroidism/complications , Hyperthyroidism/diagnosis , Propylthiouracil/adverse effectsABSTRACT
Setting: Since 2011, tuberculosis (TB) clinics in Ho Chi Minh City (HCMC), Viet Nam, have been entering data from a paper-based TB treatment register into an electronic database known as VITIMES (Viet Nam TB Information Management Electronic System), which is currently used in parallel with the paper system. Objective: To evaluate the sensitivity, completeness and agreement of data in VITIMES with that of paper-based registers among TB patients co-infected with the human immunodeficiency virus (HIV) being treated for TB in HCMC. Design: This was a retrospective data review of all TB-HIV patients receiving anti-tuberculosis treatment in each of the 24 district TB clinics in HCMC in 2013. Data were abstracted from the paper-based TB treatment registers at district level and extracted electronically at the provincial level. Records were matched based on name, age and address. The sensitivity, completeness and agreement of the electronic data were compared with data from the paper system. Results: The findings showed that the electronic system had high sensitivity (99.2%), high completeness (87-99%) and high agreement (κ 0.78-0.97) for all variables. Conclusion: The results of this study suggest that data are being correctly entered into VITIMES and that patient data can be directly entered into VITIMES instead of having a parallel, paper-based system.
Contexte : Depuis 2011, les centres antituberculeux (TB) de Ho Chi Minh City (HCMC) ont entré les données émanant d'un registre papier de traitement de la TB dans une base de données électronique appelée VITIMES (Viet Nam TB Information Management Electronic System), qui est actuellement utilisée en parallèle au système papier.Objectif : Evaluer la sensibilité, l'exhaustivité et l'accord des données de VITIMES avec celles des registres papier parmi les patients TB co-infectés par le virus de l'immunodéficience humaine (VIH) et traités pour la TB à HCMC.Schéma : Cette étude est une revue rétrospective des données de tous les patients TB-VIH bénéficiant d'un traitement de TB dans chacun des 24 centres TB de district de HCMC en 2013. Les données ont été tirées du registre papier de traitement de la TB au niveau de chaque district et extraites électroniquement au niveau provincial. Les dossiers ont été appariés sur le nom, l'âge et l'adresse. La sensibilité, l'exhaustivité et l'accord des données ont été évalués par comparaison avec les données du système papier.Résultats : Les résultats ont montré que le système électronique avait une sensibilité élevée (99,2%), une exhaustivité élevée (8799%) et un degré d'accord élevé (κ 0,780,97) pour toutes les variables.Conclusion : Les résultats de cette étude suggèrent que les données sont entrées correctement sur VITIMES et que les données des patients peuvent y être entrées directement au lieu d'avoir un système papier en parallèle.
Marco de referencia: Desde el 2011, en los consultorios de atención de la tuberculosis (TB) de la ciudad de Ho Chi Minh, los datos del registro de tuberculosis en papel se están ingresando en un formato informático denominado VITIMES (por Viet Nam TB Information Management Electronic System). En la actualidad se utilizan ambos sistemas en paralelo.Objetivo: Evaluar la sensibilidad, el carácter integral y la concordancia de los datos del sistema VITIMES con respecto a los registros en papel sobre los pacientes con diagnóstico de coinfección por el virus de la inmunodeficiencia humana (VIH) y el bacilo de la TB que reciben tratamiento antituberculoso en la ciudad de Ho Chi Minh.Método: Fue este un análisis retrospectivo de los datos de todos los pacientes coinfectados por el VIH y la TB que habían recibido tratamiento antituberculoso en cada uno de los 24 consultorios distritales en la ciudad en el 2013. Se extrajeron los datos de los registros de tratamiento de la TB mantenidos en papel a escala distrital y de los registros electrónicos a escala de la provincia. Se emparejaron los archivos a partir del nombre, la edad y la dirección. Se evaluó la sensibilidad, el carácter integral y la concordancia de los datos electrónicos con respecto a los datos del sistema en formato de papel.Resultados: Se observó que el sistema electrónico ofrecía una alta sensibilidad (99,2%) y un alto grado de integridad (de 87% a 99%), con una alta concordancia para todas las variables (κ de 0,78 a 0,97).Conclusión: Los resultados del presente estudio indican que los datos se han ingresado de manera correcta en el sistema VITIMES y que es posible captar la información directamente en este formato, sin conservar en paralelo el sistema en papel.
ABSTRACT
The present experiments were designed to evaluate pharmacologically the role of three neuroanatomically related systems--dopamine, glutamate and GABA--in the motor-stimulant response to amphetamine and cocaine. The data indicate that stimulant-induced stereotypy is blocked by antagonists of all three systems and that agonists of all three systems administered into the striatum induce stereotypy. Furthermore, the interaction among them occurs in the striatum; and the reaction sequence, as determined by the effect of the relatively selective antagonists on agonist-induced stereotypy, appears to be a dopaminergic activation of a glutamatergic system which in turn activates a GABAergic system. Because the GABAergic system represents the major efferents from the striatum, the evidence suggests that the motor-stimulatory effects of amphetamine and cocaine result from a disinhibition of inhibitory systems in the thalamus, resulting in facilitation of excitation in the cortex.
Subject(s)
Amphetamine/pharmacology , Cocaine/pharmacology , Dopamine Agonists/pharmacology , GABA Agonists/pharmacology , Glutamic Acid/drug effects , Glutamic Acid/physiology , Animals , Bicuculline/analogs & derivatives , Male , Mice , Mice, Inbred Strains , Movement/drug effects , Neostriatum/drug effects , Piperazines , Stereotyped Behavior/drug effects , SulpirideABSTRACT
The behavioral effects of amphetamine and cocaine are generally considered to be the result of their indirect dopaminergic activity. Recent reports, however, suggest that the activity of the psychomotor stimulants involves not only the dopaminergic but also the glutamatergic system. In the present study the role of the glutamate system in the action of the stimulants was investigated in mice with the use of glutamatergic agonists and antagonists administered either intraperitoneally or intracranially into the striatum. CPP, an NMDA-type glutamate antagonist, given systemically or intrastriatally, blocked stereotypy induced by either amphetamine or cocaine. These results represent pharmacological evidence that the glutamate system is an essential component in the expression of the stereotypic effect of the psychomotor stimulants, and that a locus of this action of glutamate is in the striatum. These conclusions were supported further by the observation that NMDLA administered focally into the striatum caused stereotypy which was indistinguishable from that produced by either amphetamine or dopamine. Stereotypy induced by amphetamine injected into the striatum was blocked by CPP or sulpiride administered either systemically or directly into the striatum; in contrast, stereotypy induced by NMDLA given into the striatum was blocked by CPP but not by sulpiride, regardless of whether the antagonists were presented systemically or into the striatum. The data suggest that stereotypy induced by amphetamine or cocaine is mediated by a dopaminergic activation of a glutamatergic system within the striatum.
