Respiratory effects of amyotrophic lateral sclerosis: problems and solutions

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease. Most patients die from respiratory complications. Fortunately, there are a growing number of treatment options that can improve both survival and quality of life for patients with ALS. This review discusses the respiratory evaluation and treatment of patients with ALS, about which a great deal is known. It also includes material on related problems, such as speech and swallowing difficulties and end-of-life care.     

Infectious diseases of severe weather-related and flood-related natural disasters

PURPOSE OF REVIEW: The present review will focus on some of the possible infectious disease consequences of disastrous natural phenomena and severe weather, with a particular emphasis on infections associated with floods and the destruction of infrastructure. RECENT FINDINGS: The risk of infectious diseases after weather or flood-related natural disasters is often specific to the event itself and is dependent on a number of factors, including the endemicity of specific pathogens in the affected region before the disaster, the type of disaster itself, the impact of the disaster on water and sanitation systems, the availability of shelter, the congregating of displaced persons, the functionality of the surviving public health infrastructure, the availability of healthcare services, and the rapidity, extent, and sustainability of the response after the disaster. Weather events and floods may also impact disease vectors and animal hosts in a complex system. SUMMARY: Weather or flood-related natural disasters may be associated with an increased risk of soft tissue, respiratory, diarrheal, and vector-borne infectious diseases among survivors and responders.     

A midline cyst containing clear fluid in an infant and review of management

A 3-month-old healthy girl had a cyst present from birth, located in the midline, in the area of the anterior fontanel. A magnetic resonance imaging was performed at age 7 months, which did not show communication between the cyst and the central nervous system. At a subsequent examination, while the cyst was being probed, it broke and expressed clear fluid. The cyst was subsequently removed surgically and was found histopathologically to be an epidermal inclusion cyst without communication with the central nervous system. Epidermal inclusion cysts very rarely occur on the midline in the area of the anterior fontanel, and none have been reported to contain clear fluid. Their proper management requires focused clinical assessment, noninvasive imaging, and consideration of surgical removal, in particular, if they communicate with the intracranial space.     

Abatacept: A review of a new biologic agent for refractory rheumatoid arthritis for dermatologists

Abatacept is a newly approved treatment for rheumatoid arthritis refractory to other agents. Abatacept is a fusion protein of the cytotoxic T-lymphocyte antigen (CTLA) molecule and immunoglobulin (Ig) G1 that blocks CD28. Specifically, abatacept blocks the CD80 and CD86 ligands on the surface of antigen-presenting cells that must interface with the T-cell's CD28 receptor to activate T cells. Abatacept seems to be more immunosuppressive than tumor necrosis factor alpha blockers. The combination of abatacept and a tumor necrosis factor alpha blocking agent does not seem more effective than either agent alone. Because abatacept has the ability to suppress T-cell function, it has the potential to be a treatment for psoriasis and other autoimmune conditions involving pathologic processes driven by T cells.     

Dalbavancin: a review for dermatologists

Most complicated skin and skin structure infections (cSSSI) are caused by Staphylococcus aurens (SA) and streptococcus (SC). More and more isolates of SA and SC are resistant to methicillin (MRSA) and there are concerns that SA will become resistant to vancomycin (VRSA), the current standard of treatment. Dalbavancin (BI397) is a novel semisynthetic lipoglycopeptide that was designed to improve uon the natural glycopeptides currently available, vancomycin and teicoplanin. Phase-III clinical trials comprising more than 1,500 patients evaluating once-weekly dalbavancin in skin and soft tissue infections (SSTIs) associated with Gram-positive bacteria met the primary endpoint of non-inferiority in patients whose clinical response was evaluated at 2 weeks following therapy when compared to linezolid, cefazolin, or vancomycin, the three most widely administered standard-of-care agents for SSTIs. The side effect profile of dalbavancin is mild, with headache and pyrexia being the most adverse effects. Once-a-week dosing with dalbavancin may obviate the need for the continued presence of IV lines in some patients, which could translate into fewer local infections and blood stream infections and which could facilitate transfer of the patients to skilled nursing facilities. Unlike other new antibiotics, such as oritavancin and tigecycline, dalbavancin is not active against vancomycin-resistant enterococcus or VRSA. Its approval by the FDA is expected soon. The extent to which dalbavancin will supplant vancomycin and whether it will be preferred other newer agents such as linezolid.     

A review of rituximab in cutaneous medicine

The rituximab antibody is a genetically engineered chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. Rituximab is indicated for the treatment of patients with relapsed or refractory, low-grade or follicular, CD20-positive, B-cell non-Hodgkin lymphoma. Rituximab is also commonly used to treat chronic lymphocytic leukemia, Waldenstrom's macroglobulinemia, and immune or idiopathic thrombocytopenic purpura (ITP). Rituximab is an effective treatment for primary cutaneous B-cell lymphoma and other cutaneous lymphomas. Rituximab is an effective treatment for mixed cryoglobulinemia. Rituximab is a promising treatment for systemic lupus erythematosus, dermatomyositis, pemphigus, vasculitis, and a variety of hematologic diseases. Black-box warnings on rituximab include fatal infusion reactions, tumor lysis syndrome, and severe mucocutaneous reactions. A variety of cardiac, pulmonary, renal, and hematologic side effects can occur. It commonly causes mild cutaneous side effect and rarely has caused paraneoplastic pemphigus, Stevens-Johnson syndrome, lichenoid dermatitis, vesiculobullous dermatitis, and toxic epidermal necrolysis.     

Protective role of neutrophils in mice experimentally infected with Rhodococcus equi

Neutrophils are important in controlling early infections with the intracellular bacterium Rhodococcus equi. Antineutrophil monoclonal antibody (RB6-8C5)-induced neutrophil deficiency during the first week after experimental infection of mice with R. equi resulted in more severe disease and significantly increased tissue concentrations of R. equi.     

Germ cell tumors: an update of recent data and review of active protocols in stage I and metastatic disease

Germ cell tumors are highly curable malignancies even when metastatic. Investigations currently focus on curtailing toxicity in low-risk patients and improving cure rates in poor-risk individuals. Reduced dose radiation schedules and short-course chemotherapy regimens have been evaluated in stage I disease. In metastatic disease, several new nonplatinum agents offer promise for patients with poor risk or relapsed disease. In addition, high-dose chemotherapy regimens with autologous stem cell transplant provide potential for further improvements in survival. This review will highlight recent developments and currently active clinical trials pertinent to the treatment of patients with germ cell tumors.