Clinical Manifestations and Treatment of Vogt-Koyanagi-Harada Disease during Pregnancy and after Birth: A Case Report.

PURPOSE: To describe the clinical manifestations of Vogt-Koyanagi-Harada (VKH) disease during pregnancy and after birth and the therapeutic challenge of treating patients with this condition. METHODS: We describe the clinical manifestations of this disease, as well as the diagnostic tests and treatments performed. RESULTS: The patient was referred for evaluation due to a persistent headache. Examination revealed bilateral anterior uveitis, papillitis and yellowish-white choroidal lesions in both eyes. A tentative diagnosis of VKH disease was made. A multimodal imaging study was performed at the time of presentation and throughout the disease course. The patient was initially treated with intravenous corticosteroids, and subsequently, oral corticosteroids and cyclosporine were administered. Clinical manifestations increased in severity after childbirth. CONCLUSIONS: The clinical course of VKH disease can be modified by pregnancy. While clinical manifestations during gestation may be mild, these may be exacerbated after birth. Treatment with corticosteroids and cyclosporine can be effective.

Efficacy of Tocilizumab in Patients With Moderate-to-Severe Corticosteroid-Resistant Graves Orbitopathy: A Randomized Clinical Trial.

OBJECTIVE: To demonstrate the efficacy of the anti-interleukin-6 receptor monoclonal antibody tocilizumab in patients with moderate-to-severe corticosteroid-resistant Graves orbitopathy (GO). DESIGN: Double-masked randomized clinical trial. METHODS: Setting and Participants: Thirty-two adults with moderate-to-severe corticosteroid-resistant GO from 10 medical centers in Spain were randomized (1:1). INTERVENTION: Randomization to either 8 mg/kg body weight tocilizumab or placebo administered intravenously at weeks 0, 4, 8, and 12, and follow-up for an additional 28 weeks. Main Outcomes and Measures: The primary outcome was the proportion of patients with a change from baseline to week 16 of at least 2 in the clinical activity score (CAS). RESULTS: The primary outcome was met by 93.3% (95% confidence interval [CI] 70.1%-98.8%) of the patients receiving tocilizumab and 58.8% (36%-78.3%) receiving placebo (P = .04; odds ratio, 9.8 [CI 1.3-73.2]). A significant difference was also observed in the proportion of patients achieving a CAS < 3 (86.7% [CI 62.1%-96.2%] vs 35.2% [CI 17.3%-58.7%], P = .005; OR 11.9 [CI 2.1-63.1]) at week 16. Additionally, a larger proportion of patients with improvement in the European Group on GO-proposed composite ophthalmic score at week 16 (73.3% [CI 48%-89.1%] vs 29.4% [CI 13.2%-53.1%]; P = .03), and exophthalmos size change from baseline to week 16 (-1.5 [-2.0 to 0.5] mm vs 0.0 [-1.0 to 0.5] mm; P = .01) were seen with tocilizumab. One patient experienced a moderate increase in transaminases at week 8; another had an acute pyelonephritis at week 32 in the tocilizumab-treated group. CONCLUSION: Tocilizumab offers a meaningful improvement in activity and severity in corticosteroid-resistant GO. This trial justifies further studies to characterize the role of tocilizumab in GO.

[Long term consequences among children exposed to lead poisoning]. / Efectos clínicos a largo plazo en niños intoxicados con plomo en una región del sur de Chile.

BACKGROUND: In 1996 there was a massive lead poisoning in a southern rural community in Chile. The contamination source was a mill whose grinding stone was repaired with lead and contaminated the flour. AIM: To assess the presence of sequelae ten years later, among subjects that were exposed to lead on that occasion. MATERIAL AND METHODS: Cross sectional study of 77 individuals (47 males), aged 10 to 25 years, that were exposed to lead in 1996 and were treated with EDTA. RESULTS: Twenty one percent of subjects had a subnormal intelligence quotient (IQ). The risk of having a low IQ was significantly higher among those exposed before the age of six years. IQ was significantly lower among subjects that, immediately after the exposure, had a lead level over 48 microg/dl, compared with those that had a lead level below 43 microg/dl (86.7+/-7.3 and 93+/-11.6 respectively). No subjects with high blood pressure or evidences of nephrotoxicity were detected. CONCLUSIONS: Subjects aged less than six years at the moment of lead exposure had a lower IQ when assessed ten years later.

Efectos clínicos a largo plazo en niños intoxicados con plomo en una región del sur de Chile / Long term consequences among children exposed to lead poisoning

Background: In 1996 there was a massive lead poisoning in a southern rural community in Chile. The contamination source was a mill whose grinding stone was repaired with lead and contaminated the flour. Aim: To assess the presence of sequelae ten years later, among subjects that were exposed to lead on that occasion. Material and methods: Cross sectional study of 77 individuals (47 males), aged 10 to 25 years, that were exposed to lead in 1996 and were treated with EDTA. Results: Twenty one percent of subjects had a subnormal intellingence quotient (IQ). The risk of having a low IQ was significantly higher among those exposed before the age of six years. IQ was significantly lower among subjects that, immediately after the exposure, had a lead level over 48 fig/dl, compared with those that had a lead level below 43 fig/dl (86.7±7.3 and 93±11.6 respectively). No subjects with high blood pressure or evidences of nephrotoxicity were detected. Conclusions: Subjects aged ¡ess than six years at the moment of lead exposure had a lower IQ when assessed ten years later.

Quiste hidatídico interventricular: reporte de un caso / Interventricular hydatid cyst: a case report

La infección por echinococcus granulosus y la formación de quistes hidatídicos es aún una patología que se debe tener presente en pacientes de procedencia rural. Se presenta el caso de un escolar de trece años con múltiples quistes, detectados al realizar un ecocardiograma por estudio de un soplo.