Medicine
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Review Meta Analysis
Intravenous immunoglobulin in the therapeutic armamentarium of systemic lupus erythematosus: a systematic review and meta-analysis.
Prepared from the plasma of thousands of blood donors, therapeutic intravenous immunoglobulin (IVIg) mostly consists of human polyspecific immunoglobulin G (IgG). The use of IVIg in systemic lupus erythematosus (SLE) is still considered experimental without any clear indications. The purpose of this systematic review is, therefore, to evaluate the available evidence to determine the therapeutic role of IVIg in SLE. ⋯ The effects of IVIg on other clinical outcome measures including anti-double-stranded DNA, antinuclear antibody, average steroid dose, and renal function could not be determined because of the limited numbers of trials. The limitations of this review were lack of well-designed controlled trials with adequate sample size on the use of IVIg in SLE. In conclusion, the use of IVIg is associated with significant reduction in SLE disease activity and improvement in complement levels.
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The purpose of this article is to perform a systematic review of the literature on the use of fecal microbiota transplantation (FMT) in inflammatory bowel disease (IBD). There is an increasing interest of both physicians and patients in assessing the possible role of the FMT in the treatment of IBD. Electronic and manual bibliographic searches were performed to identify original reports in which subjects with IBD were treated with FMT. ⋯ Moreover, FMT does not seem to provide the same safety profile showed for non-IBD individuals with C difficile infection. The available evidence is limited and weak. FMT has the potential to be somehow of help in managing patients with IBD, but considerable further efforts are necessary to make this procedure a valid option for these subjects.
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Exposure to levamisole-adulterated cocaine can induce a distinct clinical syndrome characterized by retiform purpura and/or agranulocytosis accompanied by an unusual constellation of serologic abnormalities including antiphospholipid antibodies, lupus anticoagulants, and very high titers of antineutrophil cytoplasmic antibodies. Two recent case reports suggest that levamisole-adulterated cocaine may also lead to renal disease in the form of pauci-immune glomerulonephritis. To explore this possibility, we reviewed cases of pauci-immune glomerulonephritis between 2010 and 2012 at an inner city safety net hospital where the prevalence of levamisole in the cocaine supply is known to be high. ⋯ Three of the 4 patients were treated with short courses of prednisone and cyclophosphamide, 2 of whom experienced stable long-term improvement in their renal function despite ongoing cocaine use. The remaining 2 patients developed end-stage renal disease and became dialysis-dependent. This report supports emerging concern of more wide spread organ toxicity associated with the use of levamisole-adulterated cocaine.
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Observational Study
New microbleeds after thrombolysis: contiguous thin-slice 3T MRI.
We aimed to determine the frequency of new microbleeds after intravenous thrombolysis using contiguous thin-slice 3T magnetic resonance imaging. We retrospectively examined clinical and imaging data from 121 consecutive acute ischemic stroke patients who underwent magnetic resonance imaging before and 24 hours after intravenous thrombolysis. Of the included patients, 44 (36.4%) were women, with a median age of 69 years (range, 35-94 years). ⋯ The frequency of neither symptomatic intracranial hemorrhage nor remote hemorrhage or any hemorrhagic transformation was different between patients with and without new microbleeds (0.0% vs 1.7%, P > 0.99; 0.0% vs 1.7%, P > 0.99; 50.0% vs 28.7%, P =0.36). New microbleeds developed rapidly 24 hours after intravenous thrombolysis. The significance of these new microbleeds and their effect on cognitive and functional outcome merits further investigation.
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Comparative Study
Comparison of the interferon-gamma release assay with the traditional methods for detecting Mycobacterium tuberculosis infection in children.
The purpose of the article is to compare the whole blood interferon-γ release assay (IGRA) with the traditional methods for detecting Mycobacterium tuberculosis (MTB) infection in children. Fifteen childhood patients with tuberculosis and 15 healthy children were recruited. Sputa samples and venous blood were collected, and according to different procedures, IGRA, sputum smear, colloidal gold assay (CGA), fluorescence quantitation polymerase chain reaction (FQ-PCR), and tuberculosis skin test (TST) were, respectively, performed. ⋯ From high to low, the specificities of the five methods were sputum smear (100%), IGRA (86.7%), FQ-PCR (86.7%), TST (40%), and CGA (26.7%). Although the specificities of sputum smear and FQ-PCR were more than or equal to that of IGRA, the relative sensitivities limited their applications in populations of children. IGRA is a sensitive and specific method, and could be taken as a first choice for detecting MTB infection in populations of children.