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Sample records for susan stevens hummel

  1. Dedication - Susan L Greenblatt

    Science.gov (United States)

    Guberman, Steven L.

    2011-07-01

    Photo of Susan L Greenblatt Figure 1. Susan in May, 1994 This volume is dedicated to the memory of Susan L Greenblatt, the wife of Steven L Guberman. Susan attended 6 of the 8 dissociative recombination (DR) meetings. Her advice and wise counsel played a vital role in the organization of several of these meetings. The fifth meeting in Chicago in 2001 was her idea and it would not have occurred without her encouragement. Susan was always amused by the memory of the first group dinner at the second DR meeting at St Jacut in 1992. As we went around the dinner table identifying ourselves, it soon became her turn. Susan was a sociologist and after introducing herself she said: "I am not a chemist". A spontaneous chorus of attendees proclaimed "Neither are we!". Her husband and a few other chemists abstained. In 1983, Susan and I established the Institute for Scientific Research (ISR). The name was chosen so as to span sociology and chemical physics. Four years prior, an ophthalmologist had diagnosed a rare retinal condition of unknown origin and advised her to change her profession to one that did not involve reading. (She was able to read for the rest of her life.) Twenty years later we learned that the cause of the retinal and all her other health problems was a recently discovered rare mitochondrial mutation. Her experience with ophthalmologists and her life-long keen sense of injustice, led her to write a grant proposal to the US Department of Education to survey all ophthalmologists in the US to determine whether they were aware of and whether they told their patients about resources and aids that could help them to continue reading and participating in everyday activities. As part of the grant and based upon the survey results, she proposed to set up low-vision training programs for ophthalmology residents. We knew that the competition for funding was intense and included several well-known and more established organizations. Nevertheless, the proposal was funded

  2. Susan Smith

    African Journals Online (AJOL)

    Owner

    Soveel lesers soveel lokmiddele soveel re- sponse kan gelys word om toegang tot die lees van poësie te registreer. 'n Resep om ge- trou of in ontrou na te volg, bestaan nie. Ge- lukkig nie. Susan Smith se (debuut)bundel lok my helaas nie deur die voorblad as vertrek- punt te neem nie. Aan visuele prikkelkrag gaan.

  3. Steven Moffat and Sue Vertue visits CERN

    CERN Multimedia

    Caraban Gonzalez, Noemi

    2016-01-01

    Steven William Moffat, OBE is a Scottish television writer and producer, known for his work as showrunner, writer and producer of the British television series Doctor Who and Sherlock. Susan "Sue" Nicola Vertue is an English television producer, mainly of comedy shows, including Mr. Bean and Coupling.

  4. Susan Flannery lahkub? / Harro Puusild

    Index Scriptorium Estoniae

    Puusild, Harro

    2008-01-01

    Ameerika teleseriaali "Vaprad ja ilusad" Stephanie Forresteri osatäitja Susan Flannery (1943) on seriaalis mänginud algusest peale s.o. 21 aastat. Lisatud intervjuu näitlejatariga. Sama ka Teleleht nr. 15, lk. 8-9 : ill

  5. X-0557 modified Steven tests : series I and II /.

    Energy Technology Data Exchange (ETDEWEB)

    Straight, J. W. (James W.); Osborn, M. A. (Michael A.); Coulter, W. L. (William L.); Mang, J. T. (Joseph T.); Anderson, M. C. (Mark C.); Idar, D. J. (Deanne J.)

    2002-01-01

    Low-velocity mechanical impact leading to unintentional reaction is of concern in accident scenarios involving the handling, transport, and storage of high explosives (HE). These have been investigated using different experimental techniques, from small- to large-scale, including, but not limited to the drop weight impact, Taylor anvil impact, Susan,1 and more recently, the Steven and Modified Steven tests.2-8 Ideally, the data will be used to further advance 3-D finite element analysis predictive capability with improved bulk constitutive HE models for the assessment of HE response to mechanical insult. Our overall objectives for these experiments were to (1) evaluate the HE reaction threshold behavior for two different lots of X-0557, and (2) characterize the degree of reaction violence relative to a detonation. This report summarizes our single impact test results on the two different lots of X-0557 in Modified Steven targets.

  6. In Conversation with Susan Holtz | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-11-26

    Nov 26, 2010 ... Susan Holtz is a private consultant and Adjunct Professor in the Environmental Planning Department of the Nova Scotia College for Art and Design. As a consultant, Ms. Holtz specializes in energy, environment, and sustainable development policy, and works on related issues as a mediator and facilitator.

  7. Roberts, Dennis C. & Komives, Susan R.

    African Journals Online (AJOL)

    Enhancing Student Learning and Development in Cross-Border Higher Education, edited by. Dennis C. Roberts and Susan R. Komives, is a book that resulted from a short-term study-abroad experience between the Universities of Maryland and San Diego with the Qatar Foundation's Education City in Doha in 2010.

  8. Design package lazy susan for the fuel retrieval system

    Energy Technology Data Exchange (ETDEWEB)

    TEDESCHI, D.J.

    1999-09-10

    This is a design package that contains the details for a Lazy Susan style small tool for the Fuel Retrieval System. The Lazy Susan tool is used to help rotate an MCO Fuel Basket when loading it. This document contains requirements, development design information, tests and test reports that pertain to the production of Lazy Susan small tool.

  9. Stevens-Johnson Syndrome

    Science.gov (United States)

    ... susceptible to developing Stevens-Johnson syndrome too. The HLA-B*1502 gene. If you have a gene called HLA-B 1502, you have an increased risk of ... disorder and other conditions. But people with a gene called HLA-B*1502 have an increased risk of Stevens- ...

  10. Psychoanalytic Interpretation of Blueberries by Susan Gibb

    OpenAIRE

    Zalbidea Paniagua, Maya

    2014-01-01

    [ES] La obra de ficción digital titulada Blueberries (2009) de Susan Gibb, publicada en la ELO (Organización de literatura electrónica) invita al lector/a a viajar dentro de la mente de la protagonista para descubrir sus experiencias reales e imaginarias en las que se examinan las nociones de género, sexo, cuerpo e identidad de una mujer traumatizada. En este artículo se exploran los modos verbales y visuales en esta ficción digital breve siguiendo patrones semióticos así como se interpretan ...

  11. 75 FR 38837 - Susan Harwood Training Grant Program, FY 2010

    Science.gov (United States)

    2010-07-06

    ...: Notification of Funding Opportunity for Susan Harwood Training Grant Program, FY 2010. Funding Opportunity No... project performance period is $250,000. DATES: Targeted Topic training grant applications must be received... Links section, and then select ``Susan Harwood Training Grant Program''. Please note that on the Harwood...

  12. Susan Lindquist: Visionary scientist and peerless mentor.

    Science.gov (United States)

    Bevis, Brooke J

    2017-01-02

    The science universe is dimmer after one of our brightest stars, Susan Lee Lindquist, was taken by cancer on October 27, 2016. Sue was an innovative, creative, out-of-the-box scientific thinker. She had unique biological intuition-an instinct for both the way things worked and the right questions to ask to uncover new research insights. Her wide-ranging career began with the study of protein folding and molecular chaperones, and she went on to show that protein folding can have profound and unexpected biological effects on such diverse processes as cancer, evolution, and neurodegenerative disease. As Sue's laboratory manager, I would like to offer a ground-floor perspective on what made her an exceptional scientist, mentor, and leader. She created a harmonious, collegial environment where collaborative synergy fueled meaningful progress that will impact science for decades to come. © 2017 Bevis.

  13. Psychoanalytic Interpretation of Blueberries by Susan Gibb

    Directory of Open Access Journals (Sweden)

    Maya Zalbidea Paniagua

    2014-06-01

    Full Text Available Blueberries (2009 by Susan Gibb, published in the ELO (Electronic Literature Organization, invites the reader to travel inside the protagonist’s mind to discover real and imaginary experiences examining notions of gender, sex, body and identity of a traumatised woman. This article explores the verbal and visual modes in this digital short fiction following semiotic patterns as well as interpreting the psychological states that are expressed through poetical and technological components. A comparative study of the consequences of trauma in the protagonist will be developed including psychoanalytic theories by Sigmund Freud, Jacques Lacan and the feminist psychoanalysts: Melanie Klein and Bracha Ettinger. The reactions of the protagonist will be studied: loss of reality, hallucinations and Electra Complex, as well as the rise of defence mechanisms and her use of the artistic creativity as a healing therapy. The interactivity of the hypermedia, multiple paths and endings will be analyzed as a literary strategy that increases the reader’s capacity of empathizing with the speaker.

  14. Susan Sontag — A Forgotten Mother?

    Directory of Open Access Journals (Sweden)

    Kludia Ziewiec

    2013-01-01

    Full Text Available The article discusses new and republished translations of Susan Sontag’s work, recently launched by the Karakter publishing house: Regarding the Pan of Others, On Photography, and Against Interpretation and Other Essays. The article focuses on the elements of Sontag’s thought that make her a forgotten mother of feminist and gender theoreticians, as well as such influential critics as Michel Foucault and Roland Barthes. The article points out to continuations of Sontag’s thought in contemporary theoretical and social projects, and to the pertinence of her critical observations on theories based on metaphysics of presence: psychoanalysis, Marxism, or hermeneutics. The article also touches upon history of war photography and related war journalism, and upon the ambivalent quality of imaging of the misery of war. It also present historical and cultural circumstances of the development of Sontag’s thought in the intellectual milieu of New York in the 1960s. The discussion recapitulates the main statements of Sontag’s essays, relating them to a wider theoretical context, which is aimed at a reappraisal of the forgotten intelectual in the history of literature.

  15. Meet EPA Scientist Susan Yee, Ph.D.

    Science.gov (United States)

    Susan Yee, Ph.D., is an ecologist at EPA's Gulf Ecology Division. She is working on the Puerto Rico Sustainable Communities program, developing decision support tools to evaluate how alternative decisions impact coastal ecosystem goods and services

  16. Susan swan and the female grotesque Susan swan and the female grotesque

    Directory of Open Access Journals (Sweden)

    Suzana Bornéo Funck

    2008-04-01

    Full Text Available Introduced to readers as “the tallest woman freelance writer in Canada”, Susan Swan belongs to a generation of writers whose experimental, innovative fiction has proved vital in the contemporary project of de/re/constructing narrative practice. Her 1983 novel The Biggest Modern Woman of the World constitutes an excellent example of what critic Linda Hutcheon has termed “historiographic metafiction”—”fiction that is intensely, self-reflexively art, but is also grounded in historical, social, and political realities” (Canadian 13. As a conscious engagement with social and historical contexts, such fiction aims at destabilizing and subverting accepted patterns of belief by reconceptualizing and narrating possible subjectivities. By means of intertextuality, especially parody, it engages in an ideological critique in terms of both sexual and national politics. Introduced to readers as “the tallest woman freelance writer in Canada”, Susan Swan belongs to a generation of writers whose experimental, innovative fiction has proved vital in the contemporary project of de/re/constructing narrative practice. Her 1983 novel The Biggest Modern Woman of the World constitutes an excellent example of what critic Linda Hutcheon has termed “historiographic metafiction”—”fiction that is intensely, self-reflexively art, but is also grounded in historical, social, and political realities” (Canadian 13. As a conscious engagement with social and historical contexts, such fiction aims at destabilizing and subverting accepted patterns of belief by reconceptualizing and narrating possible subjectivities. By means of intertextuality, especially parody, it engages in an ideological critique in terms of both sexual and national politics.

  17. Steven Weinberg visits CERN

    CERN Multimedia

    2009-01-01

    Steven Weinberg visiting the ATLAS cavern accompanied by Peter JenniIt was no surprise that the CERN audience arrived early in the Globe of Science and Innovation for the colloquium on 7 July. Nobel laureate Steven Weinberg is one of the major contributors to the Standard Model of particle physics. He received the Nobel Prize for Physics in 1979 for his work on the unified theory of the electromagnetic and weak interactions, one of the essential pillars of the Standard Model. After lunch at CERN and a visit to ATLAS, Weinberg gave a colloquium on "The Quantum Theory of Fields: Effective or Fundamental" to a packed audience. In his talk, he looked at how the use of quantum field theory in particle physics has fluctuated in popularity since Paul Dirac first introduced the approach to describe the interaction of particles with electromagnetic fields in the late 1920s. In particular, he posed the question: Is quantum field theory fundamental or does it a...

  18. Collaborative Internet Projects: An Interview with Susan Silverman about Her Passion and Hobby.

    Science.gov (United States)

    Strangman, Nicole

    2002-01-01

    Outlines an interview with Susan Silverman, an instructional technology integration teacher in the Comsewogue school district in Port Jefferson Station, New York. Describes Susan's transformation from technophobe to an innovator of collaborative Internet projects. (PM)

  19. ACYCLOVIR INDUCED STEVEN JOHNSON SYNDROME

    Directory of Open Access Journals (Sweden)

    Praveena

    2015-04-01

    Full Text Available Acyclovir, anti - viral drug rarely causes Stevens - Johnson syndrome (SJS. Steven Johnson syndrome is a rare, life threatening disorder characterized by skin condition with bullous formation, ocular lesions, genital and anal lesions/ulcers. It’s usually a reaction to a medication or an infection. Often Steven Johnson syndrome begins with flu - like symptoms followed by a painful red or purplish rash that spreads and blisters. Then the top layer of the affected skin dies and sheds. This case report is about a 40 year old male patient who came to the medicine out p atient department with blisters on palms and soles and characteristic hemorrhagic crusting of mouth and lips. Initial diagnosis of Steven Johnson Syndrome was made and treated with steroids. Eruption usually healed without sequelae

  20. LX-04 Violence Measurements-Steven Tests Impacted by Projectiles Shot from a Howitzer Gun

    Science.gov (United States)

    Chidester, Steven K.; Vandersall, Kevin S.; Switzer, Lori L.; Tarver, Craig M.

    2006-07-01

    Characterization of the reaction violence of LX-04 explosive (85% HMX and 15% Viton A by weight) was obtained from Steven Impact Tests performed above the reaction initiation threshold. A 155 mm Howitzer propellant driven gas gun was used to accelerate the Steven Test projectiles in the range of approximately 170-300 m/s to react (ignite) the LX-04 explosive. Blast overpressure gauges, acoustic microphones, and high-speed photography characterized the level of high explosive reaction violence. A detonation in this velocity range was not observed and when comparing these results (and the Susan test results) with that of other HMX based explosives, LX-04 has a more gradual reaction violence slope as the impact velocity increases. The high binder content (15%) of the LX-04 explosive is believed to be the key factor to the lower level of violence.

  1. LX-04 VIOLENCE MEASUREMENTS- STEVEN TESTS IMPACTED BY PROJECTILES SHOT FROM A HOWITZER GUN

    Energy Technology Data Exchange (ETDEWEB)

    Chidester, S K; Vandersall, K S; Switzer, L L; Tarver, C M

    2005-07-18

    Characterization of the reaction violence of LX-04 explosive (85% HMX and 15% Viton A by weight) was obtained from Steven Impact Tests performed above the reaction initiation threshold. A 155 mm Howitzer propellant driven gas gun was used to accelerate the Steven Test projectiles in the range of approximately 170-300 m/s to react (ignite) the LX-04 explosive. Blast overpressure gauges, acoustic microphones, and high-speed photography characterized the level of high explosive reaction violence. A detonation in this velocity range was not observed and when comparing these results (and the Susan test results) with that of other HMX based explosives, LX-04 has a more gradual reaction violence slope as the impact velocity increases. The high binder content (15%) of the LX-04 explosive is believed to be the key factor to the lower level of violence.

  2. Susan Dicklitch. The Elusive Promise of NGO's | Heck | Uganda ...

    African Journals Online (AJOL)

    Susan Dicklitch. The Elusive Promise of NGO's. Simon Heck. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/uj.v46i1.23044 · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about ...

  3. Steven-Johnson Syndrome

    Directory of Open Access Journals (Sweden)

    Pauline Joy F. Santos

    2017-07-01

    Full Text Available History of present illness: 72-year-old female with a history of hypertension and rheumatoid arthritis who presented to the emergency department (ED with a chief complaint of rash for the past ten days. Her primary care provider prescribed azithromycin two weeks prior to her arrival in the ED for a sore throat. The rash started on her bilateral lower extremities and spread cephalad. She also noted a prodrome of subjective fevers and malaise. Significant findings: At presentation to the ED, a macular rash was notable on all four extremities, trunk and face, and involved mucous membranes of the oropharynx and vaginal introitus. The rash was painful, erythematous and purpuric with targetoid lesions. There were also multiple areas of sloughing and desquamation with a positive Nikolsky sign. Denudement totaled approximately 2% of total body surface area. Discussion: Stevens-Johnson syndrome (SJS is a dermatolobullous disease on a spectrum of disease that includes toxic epidermal necrolysis (TEN. The distinguishing characteristic is percentage of body surface area (BSA involvement, with SJS involving less than 10% of BSA while TEN involves greater than 30% of BSA.1 Medications are the most common cause of SJS with sulfonamides and penicillin being the most likely culprits (26%. Other medications include acetaminophen, carbamazepine, non-steroidal anti-inflammatory drugs (NSAIDs, phenytoin, and corticosteroids. Malignancy and immunosuppression are both risk factors for SJS.2 Onset of symptoms typically occurs four to twenty-eight days after starting a new medication, and typically presents with a prodrome that may include fever, upper respiratory infection symptoms, headache, and malaise.2 The rash is usually an atypical target lesion that first appears centrally.3 The rash may be painful and almost always has mucous membrane involvement. A positive Nikolsky sign is also seen, which is the sloughing off of epidermis when a shearing force is applied.1

  4. James Stevens / James Stevens ; interv. Tilman Baumgärtel

    Index Scriptorium Estoniae

    Stevens, James

    2006-01-01

    Inglise disainerist James Stevensist (sünd. 1962) ja tema tegevusest. J. Stevens 2000. a. Amsterdamis tehtud intervjuus koos Jon Bainsi ja Kim Bulliga 1995. a. Londonis avatud Interneti-agentuurist Obsolete, 1996-2000 tegutsenud Interneti-kohvikust Backspace, mittekommertsiaalse juhtmeteta nerworki Consume.net rajamisest Londonis

  5. Steven Vogel (1940–2015)

    Indian Academy of Sciences (India)

    IAS Admin

    ber and Reynolds number which are helpful in appreciating the Classics article by Vogel repro- duced in this issue. Steven Vogel was an eminent American biophysicist. He made seminal contributions which resulted in more than. 100 journal articles and 10 very insightful books that cover a variety of topic in biomechanics.

  6. Steven Moffat and Sue Vertue

    CERN Multimedia

    2016-01-01

    Steven William Moffat, OBE is a Scottish television writer and producer, known for his work as showrunner, writer and producer of the British television series Doctor Who and Sherlock. Sue Vertue is an English television producer, mainly of comedy shows, including Mr. Bean and Coupling, famous fans of CERN, famous,

  7. Steven Hawking with Robert Aymar

    CERN Multimedia

    Maximilien Brice

    2006-01-01

    Steven Hawking is seen meeting with CERN's Director-General, Robert Aymar. Hawking visited CERN between 24 September and 1 October 2006. During his stay he gave two lectures and toured the LHC, which may provide insights into Hawking's most famous area of study, black holes.

  8. Unwrapping the Thick Coat of Armor: A Conversation with Susan Albrecht

    Science.gov (United States)

    Kaff, Marilyn; Teagarden, Jim; Zabel, Robert

    2017-01-01

    Susan Albrecht's career has spanned more than 40 years. During those years she has served as an English teacher, school psychologist, behavior consultant, coordinator of services, and special education faculty member. Her contributions to the field include leadership positions with the Council for Children with Behavioral Disorders. Susan shared…

  9. Practitioner Profile: An Interview with Susan Bross, AFC®

    Directory of Open Access Journals (Sweden)

    Susan Bross

    2011-04-01

    Full Text Available

    Susan Bross is a nationally accredited financial counselor who established her private practice in 1992. She currently lives in San Rafael, California. She brings a multi-faceted background and a combination of skills to her work. As a financial counselor, she works with individuals, couples, and entrepreneurs throughout the nation to help clients develop a practical and emotionally healthy relationship with money. When asked, she will tell you that she is passionate about her work because it mirrors her own hard-won path with money. Readers of the Journal will find Ms. Bross’s approach to financial therapy inspiring. She teaches simple tools for effortless and sustainable cash flow and money management. She also guides her clients to balanced attitudes and beliefs about money and success.

  10. [The Durkheim Test. Remarks on Susan Leigh Star's Boundary Objects].

    Science.gov (United States)

    Gießmann, Sebastian

    2015-09-01

    The article reconstructs Susan Leigh Star's conceptual work on the notion of 'boundary objects'. It traces the emergence of the concept, beginning with her PhD thesis and its publication as Regions of the Mind in 1989. 'Boundary objects' attempt to represent the distributed, multifold nature of scientific work and its mediations between different 'social worlds'. Being addressed to several 'communities of practice', the term responded to questions from Distributed Artificial Intelligence in Computer Science, Workplace Studies and Computer Supported Cooperative Work (CSCW), and microhistorical approaches inside the growing Science and Technology Studies. Yet the interdisciplinary character and interpretive flexibility of Star’s invention has rarely been noticed as a conceptual tool for media theory. I therefore propose to reconsider Star's 'Durkheim test' for sociotechnical media practices.

  11. Susan J. Quaal: the global and local impact of a transformational leader.

    Science.gov (United States)

    Finlay, L D

    1998-01-01

    To be a transformational leader in nursing, one must have forever changed the course of our practice. This article highlights the qualities of a great leader, Susan J. Quaal, PhD, APRN, CVS, CCRN. Described are examples of Susan's incredible clinical expertise and also the attributes that make her such a dynamic leader in all domains of the clinical nurse specialist role: Practitioner, educator/mentor, consultant, leader/administrator, and researcher. Interwoven in this article, you will also find the threads of humility and charity that make Susan such an extraordinary human being and a blessing to all the lives she touches.

  12. THRESHOLD STUDIES ON TNT, COMPOSITION B, C-4, AND ANFO EXPLOSIVES USING THE STEVEN IMPACT TEST

    Energy Technology Data Exchange (ETDEWEB)

    Vandersall, K S; Switzer, L L; Garcia, F

    2006-06-20

    Steven Impact Tests were performed at low velocity on the explosives TNT (trinitrotolulene), Composition B (63% RDX, 36% TNT, and 1% wax by weight), C-4 (91% RDX, 5.3% Di (2-ethylhexyl) sebacate, 2.1% Polyisobutylene, and 1.6% motor oil by weight) and ANFO (94% ammonium Nitrate with 6% Fuel Oil) in attempts to obtain a threshold for reaction. A 76 mm helium driven gas gun was used to accelerate the Steven Test projectiles up to approximately 200 m/s in attempts to react (ignite) the explosive samples. Blast overpressure gauges, acoustic microphones, standard video and high-speed photography were used to characterize the level of any high explosive reaction violence. No bulk reactions were observed in the TNT, Composition B, C-4 or ANFO explosive samples impacted up to velocities in the range of 190-200 m/s. This work will outline the experimental details and discuss the lack of reaction when compared to the reaction thresholds of other common explosives. These results will also be compared to that of the Susan Test and reaction thresholds observed in the common small-scale safety tests such as the drop hammer and friction tests in hopes of drawing a correlation.

  13. LX-04 Violence Measurments: Steven Tests Impacted By Projectiles Shot From A Howitzer Gun

    Science.gov (United States)

    Chidester, Steven K.

    2005-07-01

    Characterization of the reaction violence of LX-04 explosive (85% HMX and 15% Viton by weight) was obtained from Steven Impact Tests performed above the reaction initiation threshold. A 155 mm Howitzer propellant driven gas gun was used to accelerate the Steven Test projectiles in the range of approximately 150-300 m/s to react (ignite) the LX-04 explosive. Blast overpressure gauges, acoustic microphones, and high-speed photography characterized the level of high explosive reaction violence. A detonation in this velocity range was not observed and when comparing these results (and the Susan test results) with that of other HMX based explosives, LX-04 has a more gradual reaction violence slope as the impact velocity increases. The high binder content (15%) of the LX-04 explosive is believed to be the key factor to the lower level of violence. This work was performed under the auspices of the U. S. Department of Energy by the University of California, Lawrence Livermore National Laboratory under Contract No. W-7405-Eng-48.

  14. Magnuson-Stevens Fishery Conservation Act

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Magnuson-Stevens Fishery Conservation and Management Act (MSA) is the primary law governing marine fisheries management in U.S. federal waters. It has since been...

  15. Steven Spielberg hädas Peeter Paaniga / Timo Diener

    Index Scriptorium Estoniae

    Diener, Timo

    2004-01-01

    Steven Spielbergi raskused J.M. Barrie "Peeter Paani" ekraniseerimisel, tulemuseks mängufilm "Hook" : Ameerika Ühendriigid 1991. Järgneb 16. aug. 2004, lk. 38 pealkirja all "Rahulolematu Steven Spielberg"

  16. Stevens-Johnson syndrome after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Howell, W.R.; Knight, A.L.; Scruggs, H.J. (Roanoke Memorial Hospitals, VA (USA))

    1990-06-01

    We have reported a case of classic Stevens-Johnson syndrome in association with treatment using a cobalt radiation therapy unit. Previous reports of such an association have been extremely rare. At the time of the reaction, the patient's only medications were methyldopa and trichlormethiazide. Other drugs in the thiazide class have been associated with such a reaction. We feel this is an unlikely association in our patient, however, because she had been on trichlormethiazide for a number of years. This report suggests the role of radiotherapy as a rare cause of Stevens-Johnson syndrome. 14 references.

  17. Textual Rhetorics and Textual Carnivals: Susan Miller and the "Subjects" of Rhetoric and Composition.

    Science.gov (United States)

    Reynolds, Nedra

    1991-01-01

    Reviews two books by Susan Miller: "Rescuing the Subject: A Critical Introduction to Rhetoric and the Writer" (1989) and "Textual Carnivals: The Politics of Composition" (1991). Notes how she rereads dominant histories of rhetoric and writing instruction, argues for a theory of textuality, and illustrates how attention to…

  18. Don't Take Touch for Granted: An Interview with Susan Lederman.

    Science.gov (United States)

    Verry, Rene

    1998-01-01

    Presents an interview with Susan Lederman that contains a fascinating and informative overview of the recent developments in neuropsychological research concerning the sense of touch. Discusses the physiological processes that support this sensory experience and reveals them to be much more flexible, intricate, and adaptive than previously…

  19. Re-Establishing Social Studies as a Core Subject: An Interview with Susan Griffin

    Science.gov (United States)

    Griffin, Susan

    2014-01-01

    NCSS Executive Director Susan Griffin was chair of the Task Force of Professional Organizations that worked with the Social Studies Assessment, Curriculum, and Instruction Collaborative (SSACI) of the Council of Chief State School Officers to initiate and guide the development of the "College, Career and Civic Life (C3) Framework for Social…

  20. Teaching Students About Stereotypes, Prejudice, and Discrimination: An Interview with Susan Fiske

    Science.gov (United States)

    Hackney, Amy

    2005-01-01

    Susan T. Fiske is professor of psychology, Princeton University (PhD, Harvard University; honorary doctorate, Universite Catholique de Louvain-la-Neuve, Belgium). She wrote Social Cognition (with Taylor) on how people make sense of each other. Currently, she investigates emotional prejudices (pity, contempt, envy, and pride) at cultural,…

  1. Inside the Sex Ed Studio: An Interview with Susan N. Wilson

    Science.gov (United States)

    Taverner, William J.

    2007-01-01

    "Inside the Sex Ed Studio" profiles leaders in the field of sexuality education. Susan N. Wilson, former Executive Coordinator of the Network for Family Life Education, long-time advocate for sexuality education, and the driving force behind New Jersey's K-12 mandate for comprehensive sexuality education was the first such leader to be…

  2. Stevens Johnsons syndrom og toksisk epidermal nekrolyse

    DEFF Research Database (Denmark)

    Kaur-Knudsen, Diljit; Zachariae, Claus; Thomsen, Simon Francis

    2013-01-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are acute mucocutaneous diseases primarily due to drug intake. The diseases are characterised by the separation of epidermis from dermis which can be life-threatening. Mortality is often caused by sepsis and multiple organ failure. The most...

  3. The Steven Johnson syndrome. A case study.

    Science.gov (United States)

    Baby, S; Doris, S

    1999-07-01

    Steven Johnson's Syndrome is a serious systemic disorder in which there are vesicobullous lesions involving the skin and mucous membranes. It can result as an immune response to an antigen or as a drug reaction. Most often it is considered as an allergic reaction. It is a self-limiting condition which responds to immediate management or may result in fluid loss, sepsis and death.

  4. Imatinib-induced Stevens-Johnsons syndrome.

    Science.gov (United States)

    Jha, Praveen; Himanshu, D; Jain, Nirdesh; Singh, Ajay Kumar

    2013-01-23

    Imatinib mesylate is a tyrosine kinase inhibitor used widely as the first-line treatment for chronic myeloid leukaemia (CML). The side-effect profile of this drug includes fluid retention, muscle cramps, diarrhoea, myelosuppression and skin rashes. Of these, rashes of the type maculo-papular eruptions and oedema developed most commonly. The cutaneous adverse reactions other than maculo-papular eruptions are rare with imatinib. Severe and life-threatening cutaneous reactions can occur in 5% cases. Here, the author reports a case of newly diagnosed CML that developed Steven-Johnsons syndrome due to imatinib therapy. Patient responded and discharged successfully on withdrawal of the culminating drug.

  5. Drugs Induced Stevens-Johnson Syndrome

    Directory of Open Access Journals (Sweden)

    Elif ÖNDER

    2010-05-01

    Full Text Available Stevens Johnson Syndrome (SJS is a life threatening mucocutaneous skin disease that mostlydeveloped after using some drug. SJS mostly appear between 2-4th decades. Mucocutaneouslesions were seen between 1-14 days of drug intake. And these lesions spread diffusely all aroundthe body. First treatment choice is the stopping of drug that cause SJS and giving supportingtreatment. After understanding of underlying cytotoxic and immunological mechanism of SJS,new treatment approaches were developed and mortality of disease was reduced. We hereinreport a short review of drug induced SJS and its treatment.

  6. Steven-Johnson syndrome due to unknown drugs [corrected].

    Science.gov (United States)

    Shivamurthy, Raghu Prasada M; Kallappa, Ravindra; Reddy, Shashikala G H; Rangappa, Druva Kumar B

    2012-01-01

    Steven-Johnson syndrome may be considered as a cytotoxic immune reaction to drugs, infections etc. This is a case report of Steven-Johnson syndrome due to an ayurvedic preparation which was used in the treatment of mental retardation in a young girl.

  7. Steven-Johnson syndrome due to ayurvedic drugs

    OpenAIRE

    Shivamurthy, Raghu Prasada M.; Kallappa, Ravindra; Reddy, Shashikala G. H.; Rangappa, Druva Kumar B.

    2012-01-01

    Steven?Johnson syndrome may be considered as a cytotoxic immune reaction to drugs, infections etc. This is a case report of Steven?Johnson syndrome due to an ayurvedic preparation which was used in the treatment of mental retardation in a young girl.

  8. Co-amoxiclav-induced Stevens Johnson Syndrome in a child ...

    African Journals Online (AJOL)

    Stevens-Johnson Syndrome is an uncommon life threatening disease generally induced by drugs. Antibiotics, mainly sulphonamides, are the most involved drugs in Stevens-Johnson Syndrome in children. Co-amoxiclav is a well tolerated antibiotic. It has never been reported to cause, lonely this syndrome in children.

  9. Allopurinol induced Stevens - Johnson syndrome in a Nigerian ...

    African Journals Online (AJOL)

    Stevens-Johnson syndrome is an adverse muco-cutaneous complication arising from a number of conditions which include the administration of some drugs. A female Nigerian with chronic lymphocytic leukaemia, (Binet stage C) who developed Stevens-Johnson syndrome following commencement of allopurinol is ...

  10. Stevens-Johnson syndrome from tetrazepam.

    Science.gov (United States)

    Sánchez, I; García-Abujeta, J L; Fernández, L; Rodríguez, F; Quiñones, D; Duque, S; López, R; Jerez, J

    1998-01-01

    We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines.

  11. Stevens-Johnson Syndrome: a Case Report

    Science.gov (United States)

    Castana, O.; Rempelos, G.; Anagiotos, G.; Apostolopoulou, C.; Dimitrouli, A.; Alexakis, D.

    2009-01-01

    Summary The Stevens-Johnson syndrome has the appearance of a partial-thickness burn that may lead to a 100% loss of epidermis, requiring the same resuscitation as a severe burn. A 38-yr-old male patient was admitted to the neurosurgery department of the Evangelismos General Hospital in Athens, where immediately after administration of an antiepileptic drug he developed sloughing of total epidermis, high fever, and the clinical picture of a severe burn patient. He was treated as a burn patient with massive cutaneous injuries and the concomitant systemic effects. Fluid resuscitation was important and the Parkland formula was used, as in a burn patient. Steroid medications were initially administered. Systemic antibiotics were discontinued after signs of sepsis and documented infection had been overcome. Improved treatment techniques and critical burn care have decreased mortality and morbidity in cases of the Stevens-Johnson syndrome. Prompt recognition of the disease and cure of the patient by the appropriate staff of the burns centre contribute to the successful treatment of such patients. PMID:21991171

  12. "A hint of it, with initials": adultery, textuality and publicity in Jane Austen's Lady Susan.

    Science.gov (United States)

    Russell, Gillian

    2010-01-01

    In spite of Jane Austen's professed “eye” for an adulteress, comparatively little attention has been paid to adultery and divorce as themes and contexts of her fiction. Her unpublished epistolary novel Lady Susan has a distinctive status in Austen's oeuvre, recognized as being exemplary of her “style” and yet atypical of her later achievement. A neglected context for the novel is the extensive reporting of adultery trials in contemporary print culture and the moral panic concerning adultery in the 1780s and 1790s, focusing initially on the adulteress as the brazen woman of fashion and later as a figure of sentimentalized abjection. A particularly notorious case, that involving Lady Henrietta Grosvenor and George III's brother, the Duke of Cumberland, is directly alluded to in Lady Susan. The textual strategies of adultery trial literature, particularly its emphasis on indirection through the use of detail or “hint”, had a long-term influence on the development of Austen's fiction and her positioning of herself as a professional writer after the 1790s.

  13. Stevens-Johnson syndrome in childhood.

    Science.gov (United States)

    Blanco, N; Gutiérrez, B; Valls, I; Puertas, D; Martín, C; Rivera, M; Hernández, Á; Torrelo, A

    2017-05-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are two serious immune diseases within the context of bullous mucocutaneous syndrome. These have varying degrees of involvement of the skin and usually at least two mucous membranes. Three clinical cases are presented, two of them with significant ophthalmological sequelae, who had received drug treatment as a possible trigger, and another milder clinical case caused by Mycoplasma pneumoniae. The ophthalmologist plays a crucial role in the outcome and eye care of the patient in order to try to avoid the appearance of sequelae and subsequent loss of vision. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. [Systemic lupus erythematosus presenting as Stevens-Johnson syndrome].

    Science.gov (United States)

    Bellakhal, S; Ben Kaab, B; Teyeb, Z; Souissi, A; Derbel, F; Douggui, M-H

    2015-09-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening dermatological conditions. Their most common cause is medication. However, in a small proportion of patients these dermatological conditions could be the first presentation of systemic lupus erythematosus. We now describe a 34-year-old patient who presented with manifestations of Stevens-Johnson as a first feature of systemic lupus erythematosus. Systemic lupus erythematosus reveled by Stevens-Johnson syndrome has been infrequently reviewed in the previous literature. This diagnosis should be considered when cutaneous adverse drug reactions occur without clear drug causality. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. In the postmodern mirror: intertextuality in Angels and Insects by Antonia Susan Byatt

    Directory of Open Access Journals (Sweden)

    Buda Agata

    2015-05-01

    Full Text Available The aim of the paper is to analyse the novel Angels and Insects by Antonia Susan Byatt in terms of intertextual references. The author’s assumptions are based on the categorisation by Ryszard Nycz, who distinguishes three major types of intertexts: text versus text, text versus literary genre and text versus mimesis. Byatt uses intertextuality mainly to comment on the role of nature in the world, as well as to enhance the importance of human relationship with nature. Moreover, the writer moves towards literary criticism, discussing poems by famous artists, such as Alfred Tennyson or John Milton. In this way, the novel by Byatt is also an example of metafiction. All the narration techniques used by the English writer make the novel a typically postmodern work of art.

  16. Intermittent large amplitude internal waves observed in Port Susan, Puget Sound

    Science.gov (United States)

    Harris, J. C.; Decker, L.

    2017-07-01

    A previously unreported internal tidal bore, which evolves into solitary internal wave packets, was observed in Port Susan, Puget Sound, and the timing, speed, and amplitude of the waves were measured by CTD and visual observation. Acoustic Doppler current profiler (ADCP) measurements were attempted, but unsuccessful. The waves appear to be generated with the ebb flow along the tidal flats of the Stillaguamish River, and the speed and width of the resulting waves can be predicted from second-order KdV theory. Their eventual dissipation may contribute significantly to surface mixing locally, particularly in comparison with the local dissipation due to the tides. Visually the waves appear in fair weather as a strong foam front, which is less visible the farther they propagate.

  17. (REREADING INDEX CARDS: THE ARCHIVIST AS INTERPRETER IN SUSAN PUI SAN LOK'S 'NEWS'

    Directory of Open Access Journals (Sweden)

    Sandra Camacho

    2018-01-01

    Full Text Available Looking at susan pui san lok's projects News (2005 and RoCH (2013, this paper contemplates the notions put forward by Michel-Rolph Trouillot and Jacques Derrida on the power of archivists, not solely as guardians of documents but also as their interpreters. Taking into consideration that photographic and moving image archives present unique difficulties in their cataloguing processes, I examine silences that might be generated by a thematic classification that is not impervious to archivists' biases. Moreover, I consider if the silences created by manual processes of classification and retrieval might be surpassed through digital technologies, or if it is possible that new technologies simply create different types of silencing.

  18. Phenytoin induced Stevens-Johnson syndrome exacerbated by cefepime

    OpenAIRE

    Prabhu, Varsha A.; Doddapaneni, Sahiti; Thunga, Girish; Thiyagu, Rajakannan; Prabhu, M. Mukyaprana; Naha, Kushal

    2013-01-01

    Steven Johnson syndrome (SJS) is a rare drug induced mucocutaneous reaction. Here, we present an elaborate report of a 28-year-old female patient who developed Phenytoin induced SJS, which was exacerbated by cefepime.

  19. Phenytoin induced Stevens-Johnson syndrome exacerbated by cefepime.

    Science.gov (United States)

    Prabhu, Varsha A; Doddapaneni, Sahiti; Thunga, Girish; Thiyagu, Rajakannan; Prabhu, M Mukyaprana; Naha, Kushal

    2013-10-01

    Steven Johnson syndrome (SJS) is a rare drug induced mucocutaneous reaction. Here, we present an elaborate report of a 28-year-old female patient who developed Phenytoin induced SJS, which was exacerbated by cefepime.

  20. "I Am Not a Fairy Tale": Contextualizing Sioux Spirituality and Story Traditions in Susan Power's "The Grass Dancer"

    Science.gov (United States)

    Diana, Vanessa Holford

    2009-01-01

    Standing Rock Sioux writer Susan Power's best-selling novel "The Grass Dancer" (1994) includes depictions of the supernatural and spiritual that do not conform to the Judeo-Christian or, in some cases, the atheist or rationalist worldviews of many readers. Power writes of ghost characters and haunted places, communication between the living and…

  1. 78 FR 75676 - Mark W. Dobronski and Susan K. Dobronski-Acquisition of Control Exemption-Adrian & Blissfield...

    Science.gov (United States)

    2013-12-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Surface Transportation Board Mark W. Dobronski and Susan K. Dobronski--Acquisition of Control Exemption... Company, Lapeer Industrial Railroad Company and Jackson & Lansing Railroad Company Mark W. Dobronski and...

  2. Wallace Stevens in the Hermetic tradition

    Directory of Open Access Journals (Sweden)

    Maria Luísa Fumaneri

    2016-06-01

    Full Text Available Wallace Stevens (1879-1955 poetry was always reputable as a challenge to interpretation, coherent with the tradition of the modernism of Stéphane Mallarmé’s A throw of dice thanks to its obscurity and philosophical content. The aim of this work is to show how this parallel can elucidate some problems that round the interpretation of modern poetry, namely: the links between language and reality and the poetry part in knowledge. First of all there is an analysis of the meaning of the problem as it appears in Stéphane Mallarmé’s masterpiece. Afterwards, an attempt to demonstrate in some poems of the American author how the problem is formulated in other terms in his theory of poetry as Supreme Fiction. For these purposes the poems chosen were “Thirteen ways of looking at a blackbird” and “The man with the blue guitar”, insofar they demonstrate two different forms of approaching the question.

  3. An interview with Steven J. Lindauer

    Science.gov (United States)

    Lindauer, Steven J.

    2017-01-01

    There are so many compliments to Dr. Steven Lindauer that is hard for one to figure where to start from… Well, travelling backwards in time, all the way to the year 2000, I went to Virginia to study English at Virginia Commonwealth University (VCU), in Richmond, Virginia, USA. During my daily walks to the English school, I used to pass by the School of Dentistry, where the Department of Orthodontics was. That was the place where my very first “contact” with the VCU happened. In 2015, 15 years later, I had the pleasure to go back to the VCU and spend two days with Dr. Steven Lindauer. I have to confess that I was anxious and nervous to get to know not only the Chair of the Department, but also the Editor-in-chief of “The Angle Orthodontist”. Since the very first moment I could experience how incredibly positive and pro-active the environment within the Department was. Staff members, Residents and Faculty members used to work very gladly and in perfect synergy. After a quick chat with the residents, I heard from them: “Dr. Lindauer is an unprecedented human being! Besides a brilliant Professor, Researcher and Administrator, he is like a father to all of us!” Besides this touching testimony, I also heard flattering compliments from workmates to the great friend, leader and partner Dr. Lindauer was. Here goes some food for thought, though. Unfortunately, the leader is often compelled to resort to unpopular measures in order to enforce compliance. Dr Lindauer is the living proof that a boss, a leader, can be a light, humble, friendly and highly charismatic human being. In 2016, I was given a second chance to enjoy Dr. Lindauer’s company when he visited Brazil as a guest lecturer in Salvador, at the Federal University of Bahia and the Brazilian Association of Orthodontics (Bahia Chapter). I noticed, once again, that besides an excellent lecturer and careful clinician, he mastered orthodontic mechanics very proficiently. And needless to say at length about

  4. An interview with Steven J. Lindauer

    Directory of Open Access Journals (Sweden)

    Steven J. Lindauer

    Full Text Available There are so many compliments to Dr. Steven Lindauer that is hard for one to figure where to start from… Well, travelling backwards in time, all the way to the year 2000, I went to Virginia to study English at Virginia Commonwealth University (VCU, in Richmond, Virginia, USA. During my daily walks to the English school, I used to pass by the School of Dentistry, where the Department of Orthodontics was. That was the place where my very first “contact” with the VCU happened. In 2015, 15 years later, I had the pleasure to go back to the VCU and spend two days with Dr. Steven Lindauer. I have to confess that I was anxious and nervous to get to know not only the Chair of the Department, but also the Editor-in-chief of “The Angle Orthodontist”. Since the very first moment I could experience how incredibly positive and pro-active the environment within the Department was. Staff members, Residents and Faculty members used to work very gladly and in perfect synergy. After a quick chat with the residents, I heard from them: “Dr. Lindauer is an unprecedented human being! Besides a brilliant Professor, Researcher and Administrator, he is like a father to all of us!” Besides this touching testimony, I also heard flattering compliments from workmates to the great friend, leader and partner Dr. Lindauer was. Here goes some food for thought, though. Unfortunately, the leader is often compelled to resort to unpopular measures in order to enforce compliance. Dr Lindauer is the living proof that a boss, a leader, can be a light, humble, friendly and highly charismatic human being. In 2016, I was given a second chance to enjoy Dr. Lindauer’s company when he visited Brazil as a guest lecturer in Salvador, at the Federal University of Bahia and the Brazilian Association of Orthodontics (Bahia Chapter. I noticed, once again, that besides an excellent lecturer and careful clinician, he mastered orthodontic mechanics very proficiently. And needless to

  5. An interview with Steven J. Lindauer.

    Science.gov (United States)

    Lindauer, Steven J

    2017-01-01

    There are so many compliments to Dr. Steven Lindauer that is hard for one to figure where to start from… Well, travelling backwards in time, all the way to the year 2000, I went to Virginia to study English at Virginia Commonwealth University (VCU), in Richmond, Virginia, USA. During my daily walks to the English school, I used to pass by the School of Dentistry, where the Department of Orthodontics was. That was the place where my very first "contact" with the VCU happened. In 2015, 15 years later, I had the pleasure to go back to the VCU and spend two days with Dr. Steven Lindauer. I have to confess that I was anxious and nervous to get to know not only the Chair of the Department, but also the Editor-in-chief of "The Angle Orthodontist". Since the very first moment I could experience how incredibly positive and pro-active the environment within the Department was. Staff members, Residents and Faculty members used to work very gladly and in perfect synergy. After a quick chat with the residents, I heard from them: "Dr. Lindauer is an unprecedented human being! Besides a brilliant Professor, Researcher and Administrator, he is like a father to all of us!" Besides this touching testimony, I also heard flattering compliments from workmates to the great friend, leader and partner Dr. Lindauer was. Here goes some food for thought, though. Unfortunately, the leader is often compelled to resort to unpopular measures in order to enforce compliance. Dr Lindauer is the living proof that a boss, a leader, can be a light, humble, friendly and highly charismatic human being. In 2016, I was given a second chance to enjoy Dr. Lindauer's company when he visited Brazil as a guest lecturer in Salvador, at the Federal University of Bahia and the Brazilian Association of Orthodontics (Bahia Chapter). I noticed, once again, that besides an excellent lecturer and careful clinician, he mastered orthodontic mechanics very proficiently. And needless to say at length about his

  6. Mollie Stevens Smart (1916-2012).

    Science.gov (United States)

    Smart, Laura S; Prochaska, James O

    2013-09-01

    Presents an obituary for Mollie Stevens Smart (1916-2012). Mollie attended the University of Toronto, from which she graduated with honors in psychology at age 20 in 1936. She studied and worked at the Merrill-Palmer Institute in Detroit, earning a master's degree in child development from the University of Michigan in 1941. She earned her doctorate in educational psychology at the University of Delhi in 1969. An author, teacher, and mentor, Mollie won Fulbright research grants to India and New Zealand and lectured in the United States, India, New Zealand, Canada, and China. She wrote 26 books, most co-authored with her husband, Russell (Rus) C. Smart. Beginning in the 1940s, when Freudian theory had a strong grip on the popular view of child development, the books placed the developing child in the context of family and community systems. The Smarts' best-selling college textbook Children: Development and Relationships (1967, 1973, 1977, 1982) was based on the theories of Erik Erikson and Jean Piaget. Mollie was a member of the American Psychological Association throughout her professional career and held memberships also in the Society for Research in Child Development, the National Council on Family Relations, the Groves Conference on Marriage and Family, and the Fulbright Association. After moving to Ridgefield, Washington, in 2003 with her daughter Ellen following Rus's death in 1996, she applied her great knowledge to advise a community-based organization that serves the needs of new babies born into destitute families. Mollie died at home in Ridgefield on October 22, 2012, at age 96. © 2013 APA, all rights reserved.

  7. Russian Keratoprosthesis in Stevens-Johnson Syndrome.

    Science.gov (United States)

    Ma, Xiao; Xiang, Ran; Meng, Xiaoli; Qin, Limin; Wu, Ying; Tain, Lei; Jiang, Yanming; Huang, Yifei; Wang, Liqing

    2017-03-01

    To evaluate the efficacy and safety of Moscow Eye Microsurgery Complex in Russia (MICOF) keratoprosthesis (KPro) implantation in patients with Stevens-Johnson syndrome (SJS). This was a retrospective case series. Fourteen eyes of 13 patients with SJS underwent KPro implantation at the Chinese People's Liberation Army General Hospital between April 1, 2000, and December 24, 2014. The visual outcome, KPro retention rate, and incidence of postoperative complications and their management were recorded and investigated. The mean age and follow-up duration were 61.5 ± 17.3 years (range: 27-87 yrs) and 62 ± 39.1 months (range: 13-144 mo). Thirteen eyes (92.9%) achieved a best-corrected visual acuity of 20/200 or better, and 8 eyes (57.1%) achieved a best-corrected visual acuity of 20/40 or better after surgery. However, 71.4% (10/14) experienced visual decline because of different postoperative complications. Common complications included corneal melting, glaucoma, vitritis, superficial tissue overgrowth, and retroprosthetic membrane, and the incidence of these complications was 71.4%, 28.6%, 35.7%, 14.3%, and 28.6%, respectively. After repair and autoauricular cartilage reinforcement, all cases had stable anatomical retention at the last visit. The MICOF KPro improved vision of patients with SJS, but lifelong surveillance is necessitated because of a high rate of postoperative complications. Corneal melting was the main reason for KPro failure. Infectious endophthalmitis and glaucoma were the main risk factors for visual loss.

  8. Hummel's Digital Transformation Toward Omnichannel Retailing

    DEFF Research Database (Denmark)

    Hansen, Rina; Sia, Siew Kien

    2015-01-01

    With the phenomenal growth of mobile and social media, many organizations are realizing they need an online presence to reach out to digitally savvy customers. But delivering a seamless customer experience across various online and offline channels is increasingly challenging. This article...

  9. A Journey, the Pain of Others, and Historical Experience: Susan Silas

    Directory of Open Access Journals (Sweden)

    Sendyka, Roma

    2014-12-01

    Full Text Available The author interprets Susan Silas' Helmbrechts walk (1998-2003, a unique series of forty-five photographs and supplementing visual and textual materials collected during the walk along the route of two hundred and twenty-five miles. The walk repeats the route which in 1945 had to undertake women prisoners from the concentration camp in Helmbrechts near Flossenbürg in their death march to Prachatice in Czech Republic. The pictures Silas takes, the people she meets, and finally the trees, the very materiality of the road become the factors of creating her own, individual memory of the event from the past. Silas selects an object from "the margins of the Holocaust" – a forgotten event that she re-presents by reacting to contemporary objects placed along the route of the event. Silas' work offers an opportunity to critically review the concept of memory landscapes (where is memory located in a landscape? and the phenomenon of dark tourism (is following in the footsteps of the prisoners a kind of pilgrimage, tourism, or therapy?. Silas problematises the question of memory, as well as examines different kinds of non-memory. Her camera is directed at locations that can be termed "the non-sites of memory."

  10. Incomplete Stevens-Johnson syndrome secondary to atypical pneumonia.

    Science.gov (United States)

    Ramasamy, Anantharaman; Patel, Chiraush; Conlon, Christopher

    2011-10-04

    Steven-Johnson syndrome is a common condition characterised by erythematous target lesions on the skin and involvement of the oral mucosa, genitals and conjunctivae. It has been documented as one of the extra-pulmonary manifestations of Mycoplasma pneumoniae infection. Recently, there has been several documentation of an incomplete presentation of this syndrome - without the typical rash but with mucosal, conjunctival and genital involvement. Our case illustrates that the incomplete Steven-Johnson syndrome may present with oral mucosal and conjunctival involvement alone without skin or genital involvement. This important clinical diagnosis should not be missed due to its atypical presentation. Treatment of Steven-Johnson syndrome remains supportive along with treating the underlying infection if recognised.

  11. Cefepime Associated With Phenytoin Induced Stevens-Johnson Syndrome.

    Science.gov (United States)

    Marco-Del Río, José; Domingo-Chiva, Esther; Cuesta-Montero, Pablo; Valladolid-Walsh, Ana; García-Martínez, Eva María

    We describe a recent case of Stevens-Johnson Syndrome. A 49-year-old man was admitted to the Intensive Care Unit of an Anaesthesia and Resuscitation Department because of a Fournier gangrene that derived in a sepsis, ventilator-associated pneumonia, and renal failure. He was under treatment with cefepime and suffered a generalized status epilepticus, so started treatment with phenytoin. The next day he developed a "maculous cutaneous eruption in trunk and lower limbs" compatible with a Stevens-Johnson Syndrome. Stevens-Johnson Syndrome is a very severe and potentially fatal multiorganic disease, especially when present in critically ill patients, with a strong drug-related etiology, especially with antiepileptic drugs.

  12. UNDERSTANDİNG SUSAN BORDO AND HER WORK; UNBEARABLE WEİGHT :FEMİNİSM, WESTERN CULTURE, BODY

    Directory of Open Access Journals (Sweden)

    ÇAĞLAR DEMİR

    2017-02-01

    Full Text Available Throughout history of thought, there have been many views about the women, their status in society, their struggle with patriarchy, and inequality  applied to them in all areas. There are different ways of oppression on women, such as confinement to home, inequality in wages between both sexes.  However, few scholars have written and declared their own views about how the patriarchal world and companies form women as they wish. Susan Bordo is one of  the most outstanding and distinguished feminist writers in the world who focuses on  how patriarchal capitalist understanding works on women’s body in terms of weight and weakness. According to Susan Bordo, male dominated capital world decides on women about what to wear and what to eat and women try to lose weight to be in the form men wish. State of  starving all the time leads to an illness called anorexia. The writer bases her views on the thoughts of literary critic and thinker, Foucault. The  objective of this article is to help the readers understand Susan Bordo’s views and analyse her impressive work; Unbearable Weight: Feminism, Western Culture and  the Body  and make her known in academic world.

  13. Tables of Products of Tensor Operators and Stevens Operators

    DEFF Research Database (Denmark)

    Lindgård, Per-Anker

    1975-01-01

    Numerical tables of products of tensor (Racah) operators, Rl,m(J), and Stevens operators Olm(J), working within a J-multiplet are given as a function of X=J(J+1). Examples of the use of the tables, such as the calculation of commutation relations and thermal averages are given.......Numerical tables of products of tensor (Racah) operators, Rl,m(J), and Stevens operators Olm(J), working within a J-multiplet are given as a function of X=J(J+1). Examples of the use of the tables, such as the calculation of commutation relations and thermal averages are given....

  14. Bárbara Mujica, ed., Shakespeare and the Spanish «Comedia». Translation, Interpretation, Performance. Essays in Honor of Susan L. Fischer

    Directory of Open Access Journals (Sweden)

    Alejandro García-Reidy

    2016-01-01

    Full Text Available Reseña de Bárbara Mujica, ed., Shakespeare and the Spanish «Comedia». Translation, Interpretation, Performance. Essays in Honor of Susan L. Fischer, Bucknell University Press, Lewisburg, 2013, 298 pp. ISBN 9781611485172.

  15. 75 FR 24549 - Merchant Marine Act and Magnuson-Stevens Fishery Conservation and Management Act (Magnuson...

    Science.gov (United States)

    2010-05-05

    ... Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) Provisions; Fishing Vessel... rule; request for comments. SUMMARY: The Fisheries Finance Program (FFP or the Program) provides long... Magnuson-Stevens Fishery Conservation and Management Reauthorization Act, (MSRA), 46 U.S.C. 53706(a)(7...

  16. 75 FR 78619 - Shipping Act, Merchant Marine, and Magnuson-Stevens Fishery Conservation and Management Act...

    Science.gov (United States)

    2010-12-16

    ..., and Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) Provisions... well as the Magnuson-Stevens Act. These regulations revise the operating rules of the Fisheries Finance... Finance Program, 301-713-2390. SUPPLEMENTARY INFORMATION: Electronic Access This final rule is also...

  17. Podróż, cudze cierpienie i doświadczenie historyczne: Susan Silas

    Directory of Open Access Journals (Sweden)

    Sendyka, Roma

    2014-12-01

    Full Text Available Autorka interpretuje pracę Susan Silas Helmbrechts walk (1998-2003, szczególny cykl czterdziestu pięciu zdjęć i dołączonych do nich materiałów wizualnych oraz tekstowych zbudowany podczas przejścia trasy dwustu dwudziestu pięciu mil, które w 1945 roku musiały przebyć kobiety pędzone w marszu śmierci z Helmbrecht koło Flossenbürga do czeskich Prachatic. Wykonywane zdjęcia, napotykani ludzie, w końcu – drzewa, sama materialność drogi stają się czynnikami wytwarzania własnej, indywidualnej pamięci wydarzenia sprzed lat. Silas wybiera szczególny obiekt "z marginesów Zagłady" – zapomniane zdarzenie, które przedstawia obserwując współczesne obiekty położone wzdłuż trasy tego zdarzenia. Praca Silas pozwala przyjrzeć się krytycznie koncepcji memory landscapes (gdzie w krajobrazie umiejscawia się pamięć? i zjawisku dark tourism (czy podążanie śladami więźniarek to pielgrzymka, turystyka czy terapia?. Silas problematyzuje nie tylko kwestię pamięci, bada również rodzaje nie-pamiętania. Jej kamera zostaje zwrócona ku lokalizacjom, które można nazwać "nie-miejscami pamięci".

  18. Treasure Your Exceptions: An Interview with 2017 George Beadle Award Recipient Susan A. Gerbi.

    Science.gov (United States)

    Gerbi, Susan A

    2017-12-01

    THE Genetics Society of America's (GSA) George W. Beadle Award honors individuals who have made outstanding contributions to the community of genetics researchers and who exemplify the qualities of its namesake. The 2017 recipient is Susan A. Gerbi, who has been a prominent leader and advocate for the scientific community. In the course of her research on DNA replication, Gerbi helped develop the method of Replication Initiation Point (RIP) mapping to map replication origins at the nucleotide level, improving resolution by two orders of magnitude. RIP mapping also provides the basis for the now popular use of λ-exonuclease to enrich nascent DNA to map replication origins genome-wide. Gerbi's second area of research on ribosomal RNA revealed a conserved core secondary structure, as well as conserved nucleotide elements (CNEs). Some CNEs are universally conserved, while other CNEs are conserved in all eukaryotes but not in archaea or bacteria, suggesting a eukaryotic function. Intriguingly, the majority of the eukaryotic-specific CNEs line the tunnel of the large ribosomal subunit through which the nascent polypeptide exits. Gerbi has promoted the fly Sciara coprophila as a model organism ever since she used its enormous polytene chromosomes to help develop the method of in situ hybridization during her Ph.D. research in Joe Gall's laboratory. The Gerbi laboratory maintains the Sciara International Stock Center and manages its future, actively spreading Sciara stocks to other laboratories. Gerbi has also served in many leadership roles, working on issues of science policy, women in science, scientific training, and career preparation. This is an abridged version of the interview. The full interview is available on the Genes to Genomes blog, at genestogenomes.org/gerbi. Copyright © 2017 by the Genetics Society of America.

  19. Holokaust Steven Spielbergi pilgu läbi / Andres Laasik

    Index Scriptorium Estoniae

    Laasik, Andres, 1960-2016

    2000-01-01

    Oscari võitnud dokumentaalfilm "Need viimased päevad" ("The Last Days") : režissöör James Moll : Tootja Steven Spielbergi loodud Survivors of the Shoah Visual History Foundation : Ameerika Ühendriigid 1999. Filmi esitlusest Eesti Vabariigi Välisministeeriumis

  20. Steven Vogel and His Theory of Comparative Biomechanics

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 21; Issue 5. Steven Vogel and His Theory of Comparative Biomechanics. Book Review Volume 21 Issue 5 May 2016 pp 467-471. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/021/05/0467-0471. Abstract ...

  1. Steven Johnson syndrome in a patient with Cushing's disease.

    Science.gov (United States)

    Mustafa, N; Periyasamy, P; Kamaruddin, N

    2009-09-01

    Cushing's syndrome is a pathological condition associated with excessive cortisol production, the commonest etiology being Cushing's disease. Corticosteroids in high doses have been used in the management of Steven Johnson Syndrome (SJS) with favourable outcome. We describe a patient with Cushing's disease who developed SJS, one week after taking sperulina a product from sea-weed while waiting for transphenoidal surgery.

  2. Steven MacCall: Winner of LJ's 2010 Teaching Award

    Science.gov (United States)

    Berry, John N., III

    2010-01-01

    This article profiles Steven L. MacCall, winner of "Library Journal's" 2010 Teaching Award. An associate professor at the School of Library and Information Studies (SLIS) at the University of Alabama, Tuscaloosa, MacCall was nominated by Kathie Popadin, known as "Kpop" to the members of her cohort in the online MLIS program at SLIS. Sixteen of…

  3. How Does the Brain Develop? A Conversation with Steven Petersen.

    Science.gov (United States)

    D'Arcangelo, Marcia

    2000-01-01

    Neuropsychology professor Steven Petersen describes what scientists are finding out about brain development, synaptic growth and wiring, intentional and incidental learning, the role of emotion in learning, and declarative and implicit memory systems. Neuroscience has only the broadest outline of principles to offer today's educators. (MLH)

  4. Award for Distinguished Scientific Contributions: Steven F. Maier

    Science.gov (United States)

    American Psychologist, 2009

    2009-01-01

    Steven F. Maier, winner of the Award for Distinguished Scientific Contributions, is cited for his work in the fields of learned helplessness; cytokines, depressed mood, and cognitive interference; and the brain structures that produce and counteract learned helplessness. In addition to the citation, a biography and selected bibliography of Maier's…

  5. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis ...

    African Journals Online (AJOL)

    Stevens-Johnson syndrome (SJS) is a form of toxic epidermal necrolysis (TEN) a rare but life-threatening hypersensitivity reactions that affect the skin and mucous membranes. The most common triggers are drugs, ... Carbamazepine, phenytoin, phenobarbitone, lamitrogine. Antigout. Allopurinol. Antimalarials. Chloroquine.

  6. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis ...

    African Journals Online (AJOL)

    Stevens-Johnson syndrome (SJS) is a form of toxic epidermal necrolysis (TEN) a rare but life-threatening hypersensitivity reactions that affect the skin and mucous membranes. The most common triggers are drugs, but they can also be triggered by infections. Granulysin has been recently identified as the major molecule ...

  7. Stevens-Johnson syndrome associated with antimicrobial agent

    Directory of Open Access Journals (Sweden)

    Ivo Cavalcanti Pita Neto

    2008-01-01

    Full Text Available Among the severe reactions to medications, immune-mediated Mucocutaneous Disorders are widely represented. Steven-Johnson’s syndrome, or great multiform erythema, appears as a systemic disturbance, involving the skin and mucous membranes, and is related to several factors, such as, viral or bacterial infections and particularly the administration of medicines, in general painkillers and antibiotics. The objective of this article is report the onset of ulcerative vesicle –blister lesions in the regions of the lips, gums, tongue and genital mucosa membrane in a 26 year-old patient, a leukoderm man, being treated with sulfamethoxazole trimethoprim for a respiratory infection, after being diagnosed as having the Steven-Johnson syndrome. SSJ1 558187121279.

  8. Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap.

    Science.gov (United States)

    Khawaja, Ali; Shahab, Ahmed; Hussain, Syed Ather

    2012-05-01

    Steven Johnson Syndrome and Toxic Epidermal Necrolysis are rare but severe form of hypersensitivity inflammatory reactions to multiple offending agents including drugs. Acetaminophen is extensively used due to its analgesic and anti-pyretic properties. It is rendered to be relatively safe, with hepatotoxicity considered to be the major adverse effect. However, very few cases of Steven Johnson Syndrome and Toxic Epidermal Necrolysis have been reported with acetaminophen usage in the past. We present the case of a 40 years old lady who developed an overlap of the two condition after taking several doses of acetaminophen for fever. She presented with widespread maculopapular rash, stinging in the eyes, oral mucosal ulcerations and high grade fever. She was successfully treated with corticosteroid therapy along with the supportive treatment. This case addresses the fact, that severe hypersensitivity reactions can occur with acetaminophen which can be potentially life threatening.

  9. Steven johnsons syndrome and toxic epidermal necrolysis: A review

    OpenAIRE

    Sri ram Anne; Sreya Kosanam; Lakshmi Prasanthi N

    2014-01-01

    Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infection...

  10. Ivermectin induced Steven-Johnsons syndrome: case report.

    Science.gov (United States)

    Aroke, Desmond; Tchouakam, Diego Nitcheu; Awungia, Alexis Tazinya; Mapoh, Sylvester Yari; Ngassa, Stewart Ndutard; Kadia, Benjamin Momo

    2017-05-08

    Stevens-Johnson syndrome is one of the manifestations of mucocutaneous adverse drug reactions. Although antimicrobials are responsible for greater than 50% of these adverse drug reactions, there is no documented case implicating ivermectin as the culprit. A 38 year old adult Cameroonian male presented to our health facility with facial rash, painful oral sores, black eschars on lips and red tearing eyes 3 days following ingestion of ivermectin received during a nationwide anti-filarial campaign. He had no known chronic illness, no known allergies and was not on any medications prior to the campaign. Physical examination revealed discharging erythematous eyes, crusted and blister-like lesions with cracks on his lips and oral mucosa. His laboratory tests were unremarkable but for a positive Human Immunodeficiency Virus (HIV) test. A diagnosis of Ivermectin induced Stevens-Johnson syndrome in a newly diagnosed HIV patient was made. The patient was managed with supportive therapy and the evolution thereafter was favourable. Stevens-Johnson syndrome is a potential side effect of ivermectin and susceptibility to this adverse effect may be increased in HIV infection.

  11. 75 FR 52300 - Merchant Marine Act and Magnuson-Stevens Fishery Conservation and Management Act Provisions...

    Science.gov (United States)

    2010-08-25

    ...-Stevens Fishery Conservation and Management Act Provisions; Fishing Vessel, Fishing Facility and... the Fisheries Finance Program's programmatic regulations. The proposed rule was published with an...

  12. Susan Magoffin’s Santa Fe Days in 1846: The Value of Testimony Les journées de Santa Fé en 1846 de Susan Magoffin : la valeur du témoignage

    Directory of Open Access Journals (Sweden)

    Susanne Berthier-Foglar

    2009-11-01

    Full Text Available Susan Magoffin, la jeune épouse d’un commerçant de la piste de Santa Fe, accompagna son mari en 1846 pour un voyage où la caravane suivait de près l’Armée de l’Ouest et pendant lequel elle tint un journal. Cet article traite des 37 jours que dura la pause de la caravane à Santa Fe et aborde plus spécifiquement la façon dont l’auteur appréhendait l’altérité dans un environnement inhabituel et parfois dangereux. Pour apprécier la valeur du témoignage, je combine une analyse du discours avec une évaluation statistique du contenu. La description, parfois naïve, de Santa Fe sous l’occupation américaine illustre les raisons de la guerre contre le Mexique. En tant qu’agent de la destinée manifeste, Susan Magoffin admirait le général Kearny en lui attribuant des qualités surhumaines et en participant à ses efforts de propagande. Alors qu’elle était enracinée dans sa classe et sa culture, elle voyait la population mexicaine et les Amérindiens avec un esprit ouvert bien que ses motifs pour apprendre l’espagnol, ainsi que le métier de commerçante, avaient une fonction plus prosaïque.

  13. Musical Metaphors in the Poetry of Wallace Stevens

    Directory of Open Access Journals (Sweden)

    Victor Kennedy

    2016-06-01

    Full Text Available Wallace Stevens’s “The Man with the Blue Guitar” (1937 is widely recognized as one of the most important and influential poems of the 20th century. Inspired by Picasso’s painting The Old Guitarist, the poem in turn inspired Michael Tippett’s sonata for solo guitar, “The Blue Guitar” (Tippett 1983 and David Hockney’s The Blue Guitar: Etchings by David Hockney who was inspired by Wallace Stevens who was inspired by Pablo Picasso (Hockney and Stevens 1977. Central to “The Man with the Blue Guitar,” the metaphor of the musical instrument as a transformational symbol of the imagination is common in Stevens’s poems. The structure of “The Man with the Blue Guitar,” according to J. Hillis Miller, is the structure of stream-of-consciousness. Stevens’s poem creates what has been called “the deconstructed moment in modern poetry,” “an attempt to project a spatialized time that can be viewed from the privileged position of a timeless, static moment capable of encompassing a life at a glance” (Jackson 1982. This consciousness, which Derrida refers to as the “trace,” Stevens calls “the evasive movement of language.” The trace is the perception of the absence of meaning after the word or perception has passed, the glimpse of a hidden meaning that immediately vanishes. Stevens’s poem influenced not only other poets, artists and composers; references to and echoes of his ideas and techniques can be seen in popular music and culture well into the 21st century.

  14. [Stevens-Johnson's syndrome following ingestion of gunpowder].

    Science.gov (United States)

    Kouotou, E-A; Defo, D; Zoung-Kanyi Bissek, A-C; Ndjitoyap Ndam, E-C; Beylot-Barry, M

    2012-10-01

    A cutaneous adverse drug reaction is a skin eruption secondary to the intake of a drug, be it prescribed by a medical practitioner or taken as auto-medication for a given ailment. In this document we present an original case of Stevens-Johnson's syndrome secondary to the ingestion of gunpowder. A 22-year-old female student was hospitalised for diffuse and painful skin eruptions for the previous three days. She had complained six days earlier of an allergic reaction to pineapples, an allergy she had presented for quite a long time. In an attempt to remedy the situation, her mother made her drink a solution made of gunpowder bought at a market mixed with some water. On the third day of this "treatment", the patient noticed eruptions on her skin. These were initially maculopapular, later becoming erosive, and she had a mild fever. Later, a variety of eruptions appeared on the skin, from hyper-pigmented macular papules to blisters and erosive lesions with no Nicolsky sign. These lesions spared the palms of the hands and the soles of the feet. The mucosa of the conjunctivae, nose, buccal cavity, vulva, vagina and anus were severely affected. This clinical presentation was typical of Steven Johnson syndrome. The patient had stopped taking the "treatment" when she noticed the first lesions. On therapy, the outcome was favourable, except for severe complications such as synechiae with diffuse dyschromia. To the best of our knowledge this is the first time gunpowder has been incriminated in Stevens-Johnson's syndrome. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  15. First case of Stevens-Johnson syndrome after rabies vaccination.

    Science.gov (United States)

    Ma, Li; Du, Xusheng; Dong, Yu; Peng, Lirong; Han, Xiaonian; Lyu, Jianhua; Bai, Hehe

    2018-01-15

    We describe the first case of Stevens-Johnson syndrome (SJS) occurring 8 days after the first dose of a three-dose rabies vaccination series. She had no history of vaccine-related rash or other adverse drug reactions, nor had she received any other drug therapy. The temporal relationship between the development of SJS and the vaccination suggests that the rabies vaccination probably was the causal agent. This case serves as a warning of a distinct cutaneous reaction of rabies vaccination. © 2018 The British Pharmacological Society.

  16. Phacoemulsification in total white cataract with Stevens-Johnson syndrome

    Directory of Open Access Journals (Sweden)

    Vasavada Abhay

    2007-01-01

    Full Text Available Cataract surgery with Stevens-Johnson syndrome (S-J is associated with a high incidence of complications and can worsen the primary disease. We report a case of phacoemulsification of a total, white cataract barely visible through the vascularized, keratinized cornea in the only seeing eye of a patient with S-J syndrome. We describe the intra-operative difficulties encountered during phacoemulsification and the surgical tools and techniques employed to overcome the surgical difficulties. The postoperative course was uneventful and the patient regained useful, navigational vision.

  17. The Open Academic Model for the Systems Engineering Graduate Program at Stevens Institute of Technology

    Science.gov (United States)

    Lasfer, Kahina

    2012-01-01

    The Systems Engineering Program at Stevens Institute of Technology has developed the Open Academic Model (OAM) to guide its strategic planning and operations since its founding in 2001. Guided by OAM, the Stevens Systems Engineering Program (SSEP) has grown from inception in 2001 into one of the largest in the US. The main objectives of the…

  18. Stevens Johnson syndrome in Pakistan: a ten-year survey.

    Science.gov (United States)

    Ahmed, Y I; Azeem, S; Khan, O; Majid, T H; Ahmed, D; Amin, A; Mahmood, A; Hameed, K

    2004-06-01

    A pre-tested questionnaire-based, retrospective study to highlight the causative factors, mode of presentation, complications and outcome of patients with Stevens Johnson syndrome. Aga Khan University Hospital over a 10 year period. All case records with a diagnosis of Steven Johnson Syndrome in the period 1990 to 2000 were retrospectively reviewed. Data was retrieved on a comprehensive questionnaire. The demographic variatbles and drugs taken within the previous 21 days were noted. Date analysis was done by Epi-Info Version 6.0. Of the 101 studied patient files, the most common offender was found to be the Penicillins as a group and Sulfadoxine-Pyrimethamine (Fansidar) when considering all drugs individually. Most common complications included electrolyte disturbances (13.9%) and congestive heart failure (6.9%). Mortality rate was high at 10.1%. SJS was found to be a rare condition but having a mortality rate of 10.1%. As it can be induced by a large number of drugs, caution should be practiced while prescribing.

  19. [Lyell syndrome and Stevens-Johnson syndrome caused by lamotrigine].

    Science.gov (United States)

    Bocquet, H; Farmer, M; Bressieux, J M; Barzegar, C; Jullien, M; Soto, B; Roujeau, J C; Revuz, J

    1999-01-01

    Lamotrigine is a new anticonvulsant belonging to the triazine family. Several cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been described in patients taking this drug. We report 2 cases in children attending the same hospital. Two children, aged 9 and 13 years, developed SJS and TEN respectively, 3 and 28 days after lamotrigine was added to their usual anticonvulsant regimen. In both cases, outcome was favorable despite major decline in psychomotor capacity in one. In the first case, chronological attributability was plausible for lamotrigine and doubtful for sodium valproate, clonazepam and hydrocortisone. In the second case, chronological attributability was probable for amoxicillin, plausible for lamotrigine and doubtful for sodium valproate, but the numerous previous absorptions of amoxicillin made lamotrigine more suspect. The risk of Steven-Johnson syndrome and toxic epidermal necrolysis is high with lamotrigine with an estimated frequency of 1/1000. This risk is probably higher than with other anticonvulsants. Associating lamotrigine with sodium valproate increases the frequency of adverse skin reactions.

  20. STEVENS JOHNSON SYNDROME DURING TREATMENT WITH LITHIUM AND VALPROATE IN MOOD DISORDER: A REPORT OF TWO CASES

    OpenAIRE

    Misra, B.N.; Mohapatra, P.K.; Roy, D.

    2002-01-01

    Very rarely Stevens Johnson Syndrome develops following drug therapy particularly Lithium and Valproate. Worldwide, the reports regarding Lithium and Valproate induced Stevens Johnson Syndrome are very few. Here, we present two cases of Stevens Johnson Syndrome following treatment with Lithium and Valproate for Mood Disorder.

  1. Strontium ranelate related Stevens-Johnson syndrome: a case report.

    Science.gov (United States)

    Yang, C-Y; Chen, C-H; Wang, H-Y; Hsiao, H-L; Hsiao, Y-H; Chung, W-H

    2014-06-01

    Strontium ranelate is a relatively new medication with good safety profile for the treatment of postmenopausal osteoporosis. However, severe cutaneous adverse drug reactions have been reported, such as drug rash with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). We report the case of a 70-year-old woman who developed multiple itching erythematous macules and plaques about 1 month after beginning strontium ranelate medication. The cutaneous lesions progressed over the entire body with severe oral and ocular mucosa involvement. Probable mild SJS was diagnosed, compatible with the pathology findings, and strontium ranelate was discontinued immediately. Systemic methylprednisolone was administered to suppress the overactive immune system and ameliorate cutaneous symptoms. With early recognition and prompt treatment, the patient's prognosis was good.

  2. Paracetamol induced Steven-Johnson syndrome: A rare case report.

    Science.gov (United States)

    Rajput, Rajan; Sagari, Shitalkumar; Durgavanshi, Astha; Kanwar, Alpana

    2015-09-01

    In the contemporary era, use of drugs is the dominant paradigm of health care. The most quotidian drug used for fever and pain is paracetamol. Although adverse reactions to paracetamol in India are rare, at times they can cause life-threatening situations. Stevens-Johnson syndrome (SJS) is one such potentially lethal adverse drug reaction. The most reported cases of analgesic-induced SJS were due to oxicams or propionic acid derivatives. There are very few detailed reports of SJS due to the use of paracetamol. We report a case of SJS, which occurred due to the use of paracetamol. The clinical features of this condition and multidisciplinary management of the patient are described in brief.

  3. Stevens-Johnson syndrome and abuse of anabolic steroids.

    Science.gov (United States)

    Cocca, Serena; Viviano, Massimo

    2017-02-01

    Stevens-Johnson syndrome (SJS) is characterized by mucocutaneous tenderness and typical hemorrhagic erosions, erythema and epidermal detachment presenting as blisters and areas of denuded skin. SJS is often observed after drug use as well as after bacterial or viral infections. Several drugs are at high risk of inducing SJS, but there are no cases in the English literature regarding anabolic steroid use triggering SJS. In our paper, we describe a case in which use of anabolic androgenic steroids (AAS) was associated with SJS. The patient participated in competitive body-building and regularly took variable doses of AAS. Initial symptoms (headache, weakness, pharyngodynia, and fever) were ignored. After a week he presented to the Emergency Department with a burning sensation on the mouth, lips, and eyes. Painful, erythematous, maculopapular, and vesicular lesions appeared all over the body, including on the genitals. During hospitalization, he also developed a cardiac complication. The patient had not taken any drugs except AAS.

  4. Oxcarbazepine-induced Stevens-Johnson Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Lung-Chang Lin

    2009-02-01

    Full Text Available Although carbamazepine (CBZ is the most common cause of Stevens-Johnson syndrome (SJS, a new anticonvulsant, oxcarbazepine, which is structurally related to carbamazepine, has been shown to induce SJS, although extremely rarely. Recently, a strong association was found between human leukocyte antigen (HLA B*1502 and CBZ-induced SJS/TEN in a Han Chinese population. Here, we report a case with SJS, which was induced by oxcarbazepine. HLA genotyping in the patient showed HLA-B*1518/B*4001. HLA-B*1518 is a HLA-B15 variant. The genetic significance of HLA-B*1518 in association with oxcarbazepine-induced SJS needs to be further studied.

  5. Autoimmune Progesterone Dermatitis Presenting as Stevens-Johnson Syndrome.

    Science.gov (United States)

    Drayer, Sara M; Laufer, Larry R; Farrell, Maureen E

    2017-10-01

    Autoimmune progesterone dermatitis is an uncommon disease presenting with cyclical skin eruptions corresponding with the menstrual cycle luteal phase. Because symptoms are precipitated by rising progesterone levels, treatment relies on hormone suppression. A 22-year-old nulligravid woman presented with symptoms mistaken for Stevens-Johnson syndrome. A cyclic recurrence of her symptoms was noted, and the diagnosis of autoimmune progesterone dermatitis was made by an intradermal progesterone challenge. After 48 months, she remained refractory to medical management and definitive surgical treatment with bilateral oophorectomy was performed. Autoimmune progesterone dermatitis is a challenging diagnosis owing to its rarity and variety of clinical presentations. Treatment centers on suppression of endogenous progesterone and avoidance of exogenous triggers. When these modalities fail, surgical management must be undertaken.

  6. Paracetamol induced Steven-Johnson syndrome: A rare case report

    Directory of Open Access Journals (Sweden)

    Rajan Rajput

    2015-01-01

    Full Text Available In the contemporary era, use of drugs is the dominant paradigm of health care. The most quotidian drug used for fever and pain is paracetamol. Although adverse reactions to paracetamol in India are rare, at times they can cause life-threatening situations. Stevens-Johnson syndrome (SJS is one such potentially lethal adverse drug reaction. The most reported cases of analgesic-induced SJS were due to oxicams or propionic acid derivatives. There are very few detailed reports of SJS due to the use of paracetamol. We report a case of SJS, which occurred due to the use of paracetamol. The clinical features of this condition and multidisciplinary management of the patient are described in brief.

  7. [Diagnostic problems of Stevens-Johnson syndrome. A case report].

    Science.gov (United States)

    Djordjević, N; Sarović, N; Pasić, S; Dujić, A

    1994-01-01

    Stivens-Johnson Syndrome is a rare, severe, bullose form of erythema multiforme of unknown etiology. The role of immunological factors in its pathogenesis elucidates. A patients (Sh.V.), nine years of age, was admitted for reccurent streptococcal infections with skin and mucose membrane lesions. In June 1990 streptococcal pharyngitis, fever (38.8-39,9 degrees C) were registered. Penicillin was given. Next day bullous lesions on lips, left ear, trunk and lower extremities and vesiculose lesions with a wide, erythematose base ("iris") and then conjuctivitis were registered. Laboratory tests: SR70.; Leu - 11,0; anti-herpes Ab IgG 1/64, IgM 1/8. Stevens-Johnson was diagnosed. There was a recidivation two years after - oral lesions followed by necrosis and bleeding, after half a year a second recidivation with spreading of bullous and vesiculous lesions to penis gland with prepuce of the penis. Last recidivation in February 1993. Anamnesis: Viral meningitis in 1988. mother suffers from herpes labialis. Peripheral blood immunophenotiping lymphocite extremly indicated decreasing values of B Ly, NK and IL-2R+ cells. Bacteriological tests showed an increase of anti-Chlamidia Ab titer (IgG 1/128, IgA and IgM +). In virological testing there was no increase of titer of Abs against viral antigens (Herpes simplex virus, Varicella-Zoster virus, Citomegalovirus, Adenovirus). We conclude that Stevens-Johnson Sy to be diagnosed by characteristic clinical features, aspecialy by frequent reccurences. Immunological testing during the last recidivation showed that parameters of humoral immune reactivity were within normal ranges while revealed defects of cellular immune reactivity cannot elucidate the ethiopathogenesis of this disease.

  8. ‘Speaking Kleinian’: Susan Isaacs as Ursula Wise and the Inter-War Popularisation of Psychoanalysis

    Science.gov (United States)

    Shapira, Michal

    2017-01-01

    How did the complex concepts of psychoanalysis become popular in early twentieth-century Britain? This article examines the contribution of educator and psychoanalyst Susan Isaacs (1885–1948) to this process, as well as her role as a female expert in the intellectual and medical history of this period. Isaacs was one of the most influential British psychologists of the inter-war era, yet historical research on her work is still limited. The article focuses on her writing as ‘Ursula Wise’, answering the questions of parents and nursery nurses in the popular journal Nursery World, from 1929 to 1936. Researched in depth for the first time, Isaacs’ important magazine columns reveal that her writing was instrumental in disseminating the work of psychoanalyst Melanie Klein in Britain. Moreover, Isaacs’ powerful rebuttals to behaviourist, disciplinarian parenting methods helped shift the focus of caregivers to the child’s perspective, encouraging them to acknowledge children as independent subjects and future democratic citizens. Like other early psychoanalysts, Isaacs was not an elitist; she was in fact committed to disseminating her ideas as broadly as possible. Isaacs taught British parents and child caregivers to ‘speak Kleinian’, translating Klein’s intellectual ideas into ordinary language and thus enabling their swift integration into popular discourse. PMID:28901872

  9. Idiopathic Stevens-Johnson Syndrome in a Child: a Case Report

    Directory of Open Access Journals (Sweden)

    Amir Hossein Goudarzian

    2016-07-01

    Full Text Available Background Stevens-Johnson syndrome (SJS is one of potentially fatal disorders that often occur after taking certain types of medication. There are reports of this disease after some infections. This paper presents the case of a young boy with idiopathic Stevens-Johnson syndrome. Case Report A six-year-old male patient with complaint of fever and skin lesions was transferred to emergency department of Bu-Ali Sina hospital (Center of Mazandaran province, Iran. After further evaluations (Physical examination and laboratory reports, the patient did not show any common causes of Stevens - Johnson syndrome. Fortunately he was discharged in a good condition after duration of treatment. Conclusion Further studies need to be done in the field of risk factors of Stevens-Johnson syndrome.

  10. Prompt versus delayed amniotic membrane application in a patient with acute Stevens-Johnson syndrome

    Science.gov (United States)

    Ciralsky, Jessica B; Sippel, Kimberly C

    2013-01-01

    Background Stevens-Johnson syndrome is often associated with blinding ocular surface cicatricial sequelae. Recent reports have described markedly improved clinical outcomes with the application of amniotic membrane to the ocular surface during the acute phase. Here we describe the clinical outcome of a patient with acute Stevens-Johnson syndrome and severe ocular surface involvement in whom the evolving medical condition and family consent resulted in amniotic membrane application to each eye at differing intervals from disease onset. Methods We undertook a retrospective chart review of a woman with Stevens-Johnson syndrome who presented within hours of disease onset. She underwent application of amniotic membrane to the ocular surface of the left eye during the hyperacute phase (Stevens-Johnson syndrome proved superior. Application of amniotic membrane as soon as possible after disease onset, preferably in the hyperacute phase, appears to result in a significantly better clinical outcome than application later in the disease course. PMID:23754867

  11. Bilateral conjunctival retention cysts in the aftermath of Stevens-Johnson syndrome

    Directory of Open Access Journals (Sweden)

    Singh Gurdeep

    2008-01-01

    Full Text Available In this case report, we describe the rare occurrence of bilateral conjunctival retention cysts in a child with Stevens-Johnson syndrome. The case was managed conservatively as there were no functional or cosmetic problems.

  12. Scleral contact lens for ocular rehabilitation in patients with Stevens-Johnson syndrome

    OpenAIRE

    Ana Carolina Punzi de Siqueira; Myrna Serapião dos Santos; Charles Costa de Farias; Telma Regina Maria Pereira Barreiro; José Álvaro Pereira Gomes

    2010-01-01

    PURPOSE: To evaluate the efficacy of scleral contact lenses use on the management of ocular sequelae from Stevens-Johnson syndrome patients. METHODS: In a retrospective study, patients who suffered sequelae of Stevens-Johnson syndrome and started the use of scleral contact lenses were followed. Patients were submitted to an evaluation of symptoms through a questionnaire; ophthalmologic exam (visual acuity measurement, biomicroscopy, ocular surface staining with fluorescein drops, Schirmer tes...

  13. Steven Johnson syndrome due to I.V Ceftriaxone--a case report.

    OpenAIRE

    Narayanan Veena; Mamatha G; Ashok L; Rajashekar N

    2003-01-01

    Steven-Johnson syndrome (SJS) is a rare vesiculobullous disease characterized by an acute cutaneous eruption that ivolves the skin and mucous membranes including those of the oral cavity. A rare case of Steven-Johnson syndrome, an unexpected treatment response, in a 25-year-old female patient due to administration of intravenous Cefriaxone (1 gm), a third generation cephalosporin has been reported and literature reviewed.

  14. Incidence, outcomes, and resource use in children with Stevens-Johnson syndrome and toxic epidermal necrolysis.

    Science.gov (United States)

    Antoon, James W; Goldman, Jennifer L; Lee, Brian; Schwartz, Alan

    2018-01-09

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening cutaneous reactions, typically to drugs or infection. The incidence and outcomes of these conditions in children are unknown. The objective of this study was to report the overall burden of Stevens-Johnson syndrome and toxic epidermal necrolysis in children in the United States. We performed a retrospective cohort analysis of children and adolescents younger than 18 years of age using the 2009 and 2012 Kids' Inpatient Database. We identified 1486 children and adolescents hospitalized with a diagnosis of Stevens-Johnson syndrome or toxic epidermal necrolysis. The national incidence per 100 000 was 6.3 for Stevens-Johnson syndrome, 0.7 for Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome, and 0.5 for toxic epidermal necrolysis. The highest incidence in children was in those aged 11-15 years (38.4 per 100 000). Toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome were associated with longer stay, greater mortality, and higher hospital charges than those with Stevens-Johnson syndrome. Hospital mortality was highest in children with toxic epidermal necrolysis and in children aged 0-5 years. The incidence of Stevens-Johnson syndrome and toxic epidermal necrolysis in children is higher than reported in adults, and there are significant age-based variations in incidence and outcomes across the pediatric population. Further study is needed to determine the most effective treatment strategies to reduce costs and improve outcomes in children hospitalized with severe cutaneous reactions. © 2018 Wiley Periodicals, Inc.

  15. Bronchiolitis obliterans in children with Stevens-Johnson syndrome: follow-up with high resolution CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M.J. [Dept. of Diagnostic Radiology, Severance Hospital, Seoul (Korea, Republic of); Lee, K.Y. [Dept. of Pediatrics, Severance Hospital, Yonsei University Coll. of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    About one third of children with Stevens-Johnson syndrome have pulmonary involvement. As a consequence of airway epithelial injury, bronchiolitis obliterans can occur in these patients. Two cases of Stevens-Johnson syndrome-associated bronchiolitis obliterans in children were diagnosed and followed by high resolution CT without open lung biopsy. Serial changes of high resolution CT features of bronchiolitis obliterans are discussed and the literature is reviewed. (orig.)

  16. Diasporic Reconciliations of Politics, Love and Trauma: Susan Abulhawa’s Quest for Identity in Mornings in Jenin

    Directory of Open Access Journals (Sweden)

    Ayman M Abu-Shomar

    2015-04-01

    Full Text Available Negotiating human conditions is an emblematic critical impetus of diaspora informed by multiple cultural possibilities practiced through the creation of multiple spaces that cross the realm of the ‘self’ to that of the ‘other’. It offers a locale to cross from the oppressed ‘self’ to an understanding of an oppressor ‘other’. Yet, diasporic negotiation is politically involved in the most responsible manner; it engages the contextual social realities in order to enable creative possibilities for overcoming the logic of the politics altogether. It invites a kind of political involvement that assures the ‘situatedness of the ethical’ in a framework of moral humanistic realisations. The realisation of diasporic negotiations is dialogically engaged in manners that will give birth to new possibilities for human togetherness. In this essay, I trace the signs of diasporic negotiations of politics, love and trauma in Susan Abulhawa’s Mornings in Jenin by focusing on the Diasporic identity of Amal (the central character. I consider the intersections between diaspora, dislocation of identity and the creation of negotiating spaces that qualify an 'epistemology of Diaspora' against essentialised and ethnocentric construction of realities. I argue that Abulhawa creates diasporic spaces and immense moral scenes to transcend a particular stance of politics via transcending love in opposition to suffering and tribulation. I contend that Abulhawa’s conceptualisation of Diasporic negotiations enables her to depict and gauge two extreme human sentiments: love and trauma, yet, without yielding or compromising the right of just resistance and dissent. Keywords: Diaspora, humanism, Trauma, identity, negotiating difference, and 'Otherness'

  17. Oral Acetazolamide after Boston Keratoprosthesis in Stevens Johnson Syndrome

    Science.gov (United States)

    2012-01-01

    Background Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare but severe and sometimes fatal condition associated with exposure to medications; sulfamethoxazole is among the most common causes. We sought to address the safety of acetazolamide, a chemically related compound, in patients with prior SJS/TEN and glaucoma. A retrospective case series is described of patients at the Massachusetts Eye and Ear Infirmary who underwent keratoprosthesis surgery for corneal blindness from SJS/TEN, and later required oral acetazolamide for elevated intraocular pressure. Findings Over the last 10 years, 17 patients with SJS/TEN received a Boston keratoprosthesis. Of these, 11 developed elevated intraocular pressure that required administration of oral acetazolamide. One of 11 developed a mild allergic reaction, but no patient experienced a recurrence of SJS/TEN or any severe adverse reaction. Conclusion Although an increase in the rate of recurrent SJS/TEN due to oral acetazolamide would not necessarily be apparent after treating only 11 patients, in our series, acetazolamide administration was well tolerated without serious sequela. PMID:22546532

  18. Oral Acetazolamide after Boston Keratoprosthesis in Stevens Johnson Syndrome

    Directory of Open Access Journals (Sweden)

    Kumar Radhika

    2012-04-01

    Full Text Available Abstract Background Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN is a rare but severe and sometimes fatal condition associated with exposure to medications; sulfamethoxazole is among the most common causes. We sought to address the safety of acetazolamide, a chemically related compound, in patients with prior SJS/TEN and glaucoma. A retrospective case series is described of patients at the Massachusetts Eye and Ear Infirmary who underwent keratoprosthesis surgery for corneal blindness from SJS/TEN, and later required oral acetazolamide for elevated intraocular pressure. Findings Over the last 10 years, 17 patients with SJS/TEN received a Boston keratoprosthesis. Of these, 11 developed elevated intraocular pressure that required administration of oral acetazolamide. One of 11 developed a mild allergic reaction, but no patient experienced a recurrence of SJS/TEN or any severe adverse reaction. Conclusion Although an increase in the rate of recurrent SJS/TEN due to oral acetazolamide would not necessarily be apparent after treating only 11 patients, in our series, acetazolamide administration was well tolerated without serious sequela.

  19. Steven-Johnson Syndrome (SJS and Toxic Epidermal Necrolysis

    Directory of Open Access Journals (Sweden)

    Erkan Alpsoy

    2010-12-01

    Full Text Available Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are rare, life-threatening conditions with a high mortality rate. SJS and TEN are used to denote a group of disorders closely related to each other, characterized by extensive epidermal necrolysis, and usually induced by drugs. Keratinocyte apoptosis is the main reason for widespread epidermal detachment. Drugs or their methobolites can act as a hapten after binding to the keratinocyte surface and initiate cytotoxic immunological attack. Drug-specific CD8+cytotoxic T cells mediate keratinocyte apoptosis by the Fas/FasL pathway and perforin/granzyme pathway. Although numerous drugs have been noted as responsible, sulfonamide class of antibiotics, anticonvulsants, beta-lactam antibiotics, allopurinol, nonsteroidal anti-inflammatory drugs, nevirapine and thiacetazone are the most frequently reported causative ones. Early diagnosis and withdrawal of suspected drug or drugs are one of the most important steps in the treatment. Other diseases resembling SJS/TEN should be excluded as soon as possible. Although various topical and systemic treatments have recently been used, ideal supportive care is still the most important and effective therapeutic approach. SCORTEN, a scoring system used to predict mortality in TEN, has been widely used in recent years. Transfer to a burn unit or intensive care unit is recommended for patients with a SCORTEN 3 (mortality rate; 35.3% or over. In this paper, we aimed to review clinical findings, aetiopathogenesis and treatment of these syndromes in the light of current literature.

  20. Steven johnsons syndrome and toxic epidermal necrolysis: A review

    Directory of Open Access Journals (Sweden)

    Sri ram Anne

    2014-12-01

    Full Text Available Toxic epidermal necrolysis (TEN and Stevens Johnson Syndrome (SJS are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infections are well documented causes alongside rare cases in which the etiology remains unknown. Several drugs are at "high" risk of inducing TEN/SJS including: Allopurinol, Trimethoprim-sulfamethoxazole and other sulfonamide-antibiotics, aminopenicillins, cephalosporins, quinolones, carbamazepine, phenytoin, phenobarbital and NSAID's of the oxicam-type. Differential diagnosis includes linear IgA dermatosis and paraneoplastic pemphigus, pemphigus vulgaris and bullous pemphigoid, acute generalized exanthematous pustulosis (AGEP, disseminated fixed bullous drug eruption and staphyloccocal scalded skin syndrome (SSSS. Due to the high risk of mortality, management of patients with SJS/TEN requires rapid diagnosis, identification and interruption of the culprit drug, specialized supportive care ideally in an intensive care unit, and consideration of immunomodulating agents such as high-dose intravenous immunoglobulin therapy.

  1. Stevens-Johnson syndrome: The role of an ophthalmologist.

    Science.gov (United States)

    Jain, Rajat; Sharma, Namrata; Basu, Sayan; Iyer, Geetha; Ueta, Mayumi; Sotozono, Chie; Kannabiran, Chitra; Rathi, Varsha M; Gupta, Nidhi; Kinoshita, Shigeru; Gomes, José A P; Chodosh, James; Sangwan, Virender S

    2016-01-01

    Stevens-Johnson syndrome (SJS) is an acute blistering disease of the skin and mucous membranes. Acute SJS leads to the acute inflammation of the ocular surface and chronic conjunctivitis. If not properly treated, it causes chronic cicatricial conjunctivitis and cicatricial lid margin abnormalities. Persistent inflammation and ulceration of the ocular surface with cicatricial complications of the lids leads to chronic ocular sequelae, ocular surface damage, and corneal scarring. The destruction of the glands that secrete the tear film leads to a severe form of dry eye that makes the management of chronic SJS difficult. The option that is routinely used for corneal visual rehabilitation, keratoplasty, is best avoided in such cases. We describe the management strategies that are most effective during the acute and chronic stages of SJS. Although treatments for acute SJS involve immunosuppressive and immunomodulatory therapies, amniotic membrane transplantation is also useful. The options for visual rehabilitation in patients with chronic SJS are undergoing radical change. We describe the existing literature regarding the management of SJS and highlight recent advances in the management of this disorder. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

    Directory of Open Access Journals (Sweden)

    Anthony Wong

    Full Text Available SUMMARY Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are uncommon, acute and potentially life-threatening adverse cutaneous drug reactions. These pathologies are considered a hypersensitivity reaction and can be triggered by drugs, infections and malignancies. The drugs most often involved are allopurinol, some antibiotics, including sulfonamides, anticonvulsants such as carbamazepine, and some non-steroid anti-inflammatory drugs (NSAIDs. Necrosis of keratinocytes is manifested clinically by epidermal detachment, leading to scalded skin appearance. The rash begins on the trunk with subsequent generalization, usually sparing the palmoplantar areas. Macular lesions become purplish, and epidermal detachment occurs, resulting in flaccid blisters that converge and break, resulting in extensive sloughing of necrotic skin. Nikolsky's sign is positive in perilesional skin. SJS and TEN are considered to be two ends of the spectrum of one disease, differing only by their extent of skin detachment. Management of patients with SJS or TEN requires three measures: removal of the offending drug, particularly drugs known to be high-risk; supportive measures and active interventions. Early diagnosis of the disease, recognition of the causal agent and the immediate withdrawal of the drug are the most important actions, as the course of the disease is often rapid and fatal.

  3. Vozvrashtshenije "Ekzorsista" / Susan Howard

    Index Scriptorium Estoniae

    Howard, Susan

    2001-01-01

    William Friedkini 1973.a. valminud õudusfilm "Exorcist", selle järjed ja selle hiljuti restaureeritud ja taas ekraanile paisatud versioon ning nende mõju näitlejanna Linda Blair'i elukäigule, kes filmis mängis saatanast vaevatud teistmelist

  4. Two new tropolonic alkaloids from Colchicum speciosum Steven bulbs

    Directory of Open Access Journals (Sweden)

    S. Tayyeb*

    2017-11-01

    Full Text Available Background and objectives: The genus Colchicum belongs to the family Colchicaceae, which comprises of 19 genera, and 225 species worldwide. They have been recognized for more than 2000 years for their noticeable biological properties. The Colchicum species are well known for presence of tropolonic alkaloids, mainly colchicine. Colchicine, is still the drug of choice for treatment of gout, and is used for the treatment of a number of proinflammatory disorders, such as familial Mediterranean fever, and Behcet’s disease. Clinical studies have proved colchicine to posses potent anti-tumor activity. Colchicum speciosum Steven is an indigenous perennial herbaceous plant widely distributed in northern, central and western regions of Iran.  Methods: In the present study, the phytochemical composition of MeOH extract from bulbs of C. speciosum collected fromSavadkouh region, Iranwas investigated by combination of HPLC-PDA-MS spectrometry and NMR specroscopy. The fractionation of MeOH extract was carried out by partitioning on CH2Cl2, EtOAc and water. Results: The isolation and purification of CH2Cl2 portion by combination of reverse and normal phase chromatography resulted in the isolation, purification and identification of two new tropolonic alkaloids, compounds (1 and (2, as well as two known compound colchicine (3 and demecolcine (4. Their structures were established by extensive spectroscopic methods, including 1D (1H NMR and 2D-NMR (COSY, HSQC and HMBC. The absolute configurations of isolated compounds were established by aid of circular dichroism. Conclusion: Phytochemical investigation of CH2Cl2 extract of C. speciosum by combination of HPLC, column chromatography and hyphenated spectroscopic techniques led to identification two new alkaloids with potential as lead compounds.

  5. Cheminformatics-aided pharmacovigilance: application to Stevens-Johnson Syndrome.

    Science.gov (United States)

    Low, Yen S; Caster, Ola; Bergvall, Tomas; Fourches, Denis; Zang, Xiaoling; Norén, G Niklas; Rusyn, Ivan; Edwards, Ralph; Tropsha, Alexander

    2016-09-01

    Quantitative Structure-Activity Relationship (QSAR) models can predict adverse drug reactions (ADRs), and thus provide early warnings of potential hazards. Timely identification of potential safety concerns could protect patients and aid early diagnosis of ADRs among the exposed. Our objective was to determine whether global spontaneous reporting patterns might allow chemical substructures associated with Stevens-Johnson Syndrome (SJS) to be identified and utilized for ADR prediction by QSAR models. Using a reference set of 364 drugs having positive or negative reporting correlations with SJS in the VigiBase global repository of individual case safety reports (Uppsala Monitoring Center, Uppsala, Sweden), chemical descriptors were computed from drug molecular structures. Random Forest and Support Vector Machines methods were used to develop QSAR models, which were validated by external 5-fold cross validation. Models were employed for virtual screening of DrugBank to predict SJS actives and inactives, which were corroborated using knowledge bases like VigiBase, ChemoText, and MicroMedex (Truven Health Analytics Inc, Ann Arbor, Michigan). We developed QSAR models that could accurately predict if drugs were associated with SJS (area under the curve of 75%-81%). Our 10 most active and inactive predictions were substantiated by SJS reports (or lack thereof) in the literature. Interpretation of QSAR models in terms of significant chemical descriptors suggested novel SJS structural alerts. We have demonstrated that QSAR models can accurately identify SJS active and inactive drugs. Requiring chemical structures only, QSAR models provide effective computational means to flag potentially harmful drugs for subsequent targeted surveillance and pharmacoepidemiologic investigations. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  6. Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

    Science.gov (United States)

    Watkins, Louise K. Francois; Demirjian, Alicia; Lin, Xia; Robinson, Christine C.; Pretty, Kristin; Benitez, Alvaro J.; Winchell, Jonas M.; Diaz, Maureen H.; Miller, Lisa A.; Foo, Teresa A.; Mason, Melanie D.; Lauper, Ursula L.; Kupfer, Oren; Kennedy, Jeffrey; Glodé, Mary P.; Kutty, Preeta K.; Dominguez, Samuel R.

    2015-01-01

    BACKGROUND: Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children’s Hospital Colorado. METHODS: Outbreak cases were children aged 5–21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection. RESULTS: During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8–16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR–positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 10.0, confidence interval [CI] 1.3–5.1), preceding respiratory symptoms (OR 30.0, CI 1.6–72.6), an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1–244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2–17.4) than non–Mp-associated SJS episodes (n = 23). CONCLUSIONS: We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection. PMID:26216320

  7. Dennis C. Roberts & Susan R. Komives (Eds. (2016. Enhancing Student Learning and Development in Cross-Border Higher Education. San Francisco: Jossey-Bass.

    Directory of Open Access Journals (Sweden)

    Munita Dunn-Coetzee

    2017-07-01

    Full Text Available Enhancing Student Learning and Development in Cross-Border Higher Education, edited by Dennis C. Roberts and Susan R. Komives, is a book that resulted from a short-term study-abroad experience between the Universities of Maryland and San Diego with the Qatar Foundation’s Education City in Doha in 2010. This partnership challenged the way in which higher education internalisation was viewed – in such a way that the visit was replicated in 2012 and this book was authored.

  8. Contact lens management of a case of Stevens-Johnson syndrome: a case report.

    Science.gov (United States)

    Fine, Philip; Savrinski, Boris; Millodot, Michel

    2003-10-01

    Stevens-Johnson syndrome (SJS) is an extreme, systemic allergic reaction with potentially morbid ocular complications. The main ocular complications include severe dry eyes, corneal scarring, symblepharon, and keratopathy. Stevens-Johnson syndrome developed in a 69-year old man as a result of a hypersensitivity reaction to the drug allopurinol three years before his referral to our clinic. He had been treated, but was left with corneal scarring, hyperemia, and sore, chronic dry eyes, which necessitated continuous lubrication. The patient was fit with RGP sealed scleral contact lenses of high oxygen permeability, which produced a remarkable improvement of his signs and symptoms and allowed him to completely cease the use of artificial tears. Stevens-Johnson syndrome is a serious systemic condition in which the foremost ocular complication is severe dry eyes. This report shows that it can be managed successfully with RGP sealed scleral lenses of high permeability.

  9. Stevens-Johnson Syndrome triggered by chemical hair relaxer: a case report

    Science.gov (United States)

    Booker, Matthew J

    2009-01-01

    This case report describes a 41-year-old Afro-Caribbean lady presenting with a constellation of pyrexia, conjunctivitis, arthralgia, sterile dysuria, apthous ulceration, labial crusting and widespread erythema multiforme. A diagnosis of Stevens-Johnson Syndrome was made. She had taken no medications recently (the most common precipitant of Stevens-Johnson Syndrome) and a full screen for the common and atypical bacterial and viral triggers was negative. The identified trigger was the use of a chemical hair relaxant treatment a few days previously. With supportive measures and a course of oral prednisolone, the patient quickly improved and made a full recovery. This case highlights the importance of considering occupational and recreational precipitants of Stevens-Johnson Syndrome. PMID:19918477

  10. Bronchiolitis obliterans associated with Stevens-Johnson syndrome: a case report.

    Science.gov (United States)

    Park, Hyungchul; Ko, Young Bo; Kwon, Hyouk-Soo; Lim, Chae-Man

    2015-03-01

    We report a case of bronchiolitis obliterans associated with Stevens-Johnson syndrome. A 59-year-old man presented with respiratory distress that gradually worsened over 3 months. He had been diagnosed with Stevens-Johnson syndrome 3 months before admission. He had no history of previous airway disease. On physical examination, expiratory breathing sounds were not audible, and a chest X-ray revealed a hyperinflated lung. A pulmonary function test indicated a severe obstructive pattern. Computed tomography scans of inspiratory and expiratory phases of respiration showed oligemia and air trapping, and both were more prominent on expiration view than on inspiration view. The pathogenesis of bronchiolitis obliterans associated with Stevens-Johnson syndrome is largely unknown.

  11. Diagnosis and management of drug-induced stevens-johnson syndrome: Report of two cases

    Directory of Open Access Journals (Sweden)

    M Venkateshwarlu

    2011-01-01

    Full Text Available Erythema multiforme (EM is a typically mild, self-limiting and recurring mucocutaneous reaction characterized by target or iris lesions of the skin and mucous membranes. It is most often a recurring phenomenon with great variability in the interval between episodes. It is much more common in persons under 40 years of age. In contrast, Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are less common and more severe conditions that typically occur in adults. SJS and TEN are severe variants of EM usually caused by a drug exposure. We report two cases of Stevens-Johnsons syndrome following drug intake. There is an increased incidence of SJS and TEN in the HIV-infected population. 1 Herewith, we report two cases of Stevens-Johnson syndrome in one patient following drug intake and other in a HIV-infected patient.

  12. Toxic epidermal necrolysis and Stevens-Johnson syndrome

    Science.gov (United States)

    2010-01-01

    Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Currently, TEN and SJS are considered to be two ends of a spectrum of severe epidermolytic adverse cutaneous drug reactions, differing only by their extent of skin detachment. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infections are well documented causes alongside rare cases in which the aetiology remains unknown. Several drugs are at "high" risk of inducing TEN/SJS including: Allopurinol, Trimethoprim-sulfamethoxazole and other sulfonamide-antibiotics, aminopenicillins, cephalosporins, quinolones, carbamazepine, phenytoin, phenobarbital and NSAID's of the oxicam-type. Genetic susceptibility to SJS and TEN is likely as exemplified by the strong association observed in Han Chinese between a genetic marker, the human leukocyte antigen HLA-B*1502, and SJS induced by carbamazepine. Diagnosis relies mainly on clinical signs together with the histological analysis of a skin biopsy showing typical full-thickness epidermal necrolysis due to extensive keratinocyte apoptosis. Differential diagnosis includes linear IgA dermatosis and paraneoplastic pemphigus, pemphigus vulgaris and bullous pemphigoid, acute generalized exanthematous pustulosis (AGEP), disseminated fixed bullous drug eruption and staphyloccocal scalded skin syndrome (SSSS). Due to the high risk of mortality, management of patients with SJS/TEN requires rapid diagnosis, evaluation of the prognosis using SCORTEN

  13. Interleukin-15 Is Associated with Severity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

    NARCIS (Netherlands)

    Su, Shih-Chi; Mockenhaupt, Maja; Wolkenstein, Pierre; Dunant, Ariane; Le Gouvello, Sabine; Chen, Chun-Bing; Chosidow, Olivier; Valeyrie-Allanore, Laurence; Bellon, Teresa; Sekula, Peggy; Wang, Chuang-Wei; Schumacher, Martin; Kardaun, Sylvia H.; Hung, Shuen-Iu; Roujeau, Jean-Claude; Chung, Wen-Hung

    Early diagnosis and prognosis monitoring for Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN) still remain a challenge. This study aims to explore any cytokine/chemokine with prognostic potential in StevensJohnson syndrome/TEN. Through screening a panel of 28 serological factors, IL-6,

  14. Amniotic membrane transplantation for severe acute cases of chemical ocular burn and Stevens-Johnson syndrome

    OpenAIRE

    José Reinaldo da Silva Ricardo; Sabrina Leite de Barros; Myrna Serapião dos Santos; Luciene Barbosa de Souza; José Álvaro Pereira Gomes

    2009-01-01

    OBJETIVO: Investigar o potencial terapêutico do transplante de membrana amniótica nos casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson. MÉTODOS: Foram analisados retrospectivamente os prontuários de oito pacientes, com um total de dez olhos, submetidos a transplante de membrana amniótica para tratamento de queimadura ocular química e síndrome de Stevens-Johnson na fase aguda entre janeiro de 1999 e maio de 2008 no Departamento de Oftalmologia da UNIFESP. Dados re...

  15. Stevens-Johnson Syndrome: A Review and Report of Two Cases.

    Science.gov (United States)

    Gandhi, Roopa P; Klein, Ulrich

    2017-01-15

    Stevens-Johnson syndrome (SJS) is a rare condition, characterized by its dramatic involvement of the skin and various mucosal surfaces including the oral mucosae, that severely impairs the affected patient's ability to speak, chew, or swallow. The purpose of this report was to present two cases with significant variations in the clinical presentation of Stevens-Johnson syndrome. In both situations, the patients' conditions were not immediately recognized. Pediatric dentists should be aware of these variations in the clinical manifestations of SJS, as the signs and symptoms can initially mimic common viral conditions. Appropriate diagnosis can result in timely referral to a hospital environment, optimizing patient management and recovery.

  16. Investigation of Monnose-Binding Lectin gene Polymorphism in Patients with Erythema Multiforme, Stevens-Johnson Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Syndrome.

    Science.gov (United States)

    Karkucak, Mutlu; Bülbül, Emel Başkan; Turan, Hakan; Yakut, Tahsin; Toka, Sevil; Sarıcaoğlu, Hayriye

    2012-09-01

    Monnose-Binding lectin (MBL) appears to play an important role in the immune system. The genetic polymorphisms in the MBL2 gene can result in a reduction of serum levels, leading to a predisposition to recurrent infection. The aim of this study is to investigate the influence of a polymorphism in codon 54 of the MBL2 gene on the susceptibility to Erythema Multiforme, Stevens-Johnson Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Syndrome (EM, SJS and SJS/TEN overlap syndrome). Our study included 64 patients who were clinically and/or histopathologically diagnosed with EM, SJS, and SJS/TEN overlap syndrome and 66 healthy control subjects who were genotyped for the MBL2 gene codon 54 polymorphism using the PCR-RFLP method. For all statistical analyses, the level of significance was set at poverlap syndrome. However, these findings should be confirmed in studies with a larger sample size.

  17. 75 FR 23620 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2010-05-04

    ... via the Internet at the Office of the Federal Register's Web site at http://www.gpoaccess.gov/fr/index... rule. NMFS acknowledges the WCSPA perspective that 16,000 mt to the Quileute Tribe in their first year...-Stevens Act, 16 U.S.C. 1852(b)(5), one of the voting members of the Council must be a representative of an...

  18. Play and the History of American Childhood: An Interview with Steven Mintz

    Science.gov (United States)

    American Journal of Play, 2010

    2010-01-01

    An authority on the history of American children and families, Steven Mintz is a professor of history at Columbia University, where he also directs the Graduate School of Arts and Sciences Teaching Center. Previously, he was a fellow at the Center for Advanced Study in the Behavioral Sciences at Stanford University and the Moores Professor of…

  19. 78 FR 21913 - Magnuson-Stevens Act Provisions; General Provisions for Domestic Fisheries; Application for...

    Science.gov (United States)

    2013-04-12

    ... Marine Science and Technology. Regulations under the Magnuson-Stevens Fishery Conservation and Management... lb (1,633 kg) of whole monkfish per RSA DAS. This amount of monkfish was the equivalent of a double... adjusted the tail-to-whole-weight conversion factor from 3.32 to 2.91, which essentially reduced the whole...

  20. 78 FR 25214 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2013-04-30

    ... Magnuson-Stevens Act, and cannot rely upon draft reports, news articles, personal communications, or... harm resulting from substantial reductions to the 2013 annual catch limits for several stocks managed....regulations.gov without change. All personal identifying information (e.g., name, address, etc.), confidential...

  1. 78 FR 63892 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2013-10-25

    ... the Magnuson-Stevens Act, and cannot rely upon draft reports, news articles, personal communications... mitigate expected adverse economic and social harm resulting from substantial reductions to the 2013 annual... serious management problems and result in substantial economic and social harm for the groundfish and...

  2. Mycoplasma Pneumoniae with Atypical Stevens-Johnson Syndrome: A Diagnostic Challenge

    OpenAIRE

    Ralph Yachoui; Kolasinski, Sharon L.; David E. Feinstein

    2013-01-01

    The Stevens-Johnson syndrome (SJS) classically involves a targetoid skin rash and the association of the oral mucosa, genitals, and conjunctivae. Recently, there have been several documentations of an incomplete presentation of this syndrome, without the typical rash, usually associated with the mycoplasma pneumoniae infection. Our case illustrates that this important clinical diagnosis should not be missed due to its atypical presentation.

  3. Mycoplasma pneumoniae-induced pneumonia with Stevens-Johnson syndrome of acute atypical course.

    Science.gov (United States)

    Walicka, Magdalena; Majsterek, Magdalena; Rakowska, Adriana; Słowińska, Monika; Sicińska, Justyna; Góralska, Beata; Ptasińska, Marta; Rudnicka, Lidia; Marcinowska-Suchowierska, Ewa

    2008-01-01

    We present a case of Stevens-Johnson syndrome of acute clinical course with massive occupation of the mucus membranes of the respiratory system, oral cavity, genitals and conjunctiva in a patient with pneumonia. A probable etiological factor was infection with Mycoplasma pneumoniae, however clarithromycin could be another potential inducing factor.

  4. Steven Spielberg peab oma uut filmi koostööks Stanley Kubrickuga

    Index Scriptorium Estoniae

    2001-01-01

    30. juunil üheaegselt Jaapanis ja USAs esilinastub Steven Spielbergi "Tehisintellekt" ("A.I. Artificial Intelligence"), mille kohta režissöör Tokyos pressikonverentsil väitis, et see on õieti Stanley Kubricku film, kuna põhineb temast järelejäänud 90-leheküljelisel ideeprojektil

  5. Genetics Home Reference: Stevens-Johnson syndrome/toxic epidermal necrolysis

    Science.gov (United States)

    ... TEN. Variations in several other HLA and non-HLA genes have also been studied as potential risk factors ... associated with Stevens-Johnson syndrome/toxic epidermal necrolysis HLA-B Related Information What is a gene? What is a gene mutation and how do ...

  6. Eliminating cancer stem cells: an interview with CCR’s Steven Hou | Center for Cancer Research

    Science.gov (United States)

    Steven Hou, Ph.D., senior investigator in the Basic Research Laboratory at the Center for Cancer Research describes his latest research that has uncovered potential ways to eliminate cancer stem cells and may offer hope to patients with reoccurring tumors.  Learn more...

  7. Steven Spielberg's "Amistad": Film as History and the Trivializing of History Teaching.

    Science.gov (United States)

    Butchart, Ronald E.

    1999-01-01

    Asserts that Steven Spielberg's film "Amistad" fictionalizes the overall facts of the case by inaccurately portraying many of the events that occurred. Explains that the myth-making tradition of Hollywood changes the messages derived from the Amistad court case. Critiques the teaching kit that corresponds to the movie. (CMK)

  8. 76 FR 16614 - Magnuson-Stevens Act Provisions; General Provisions for Domestic Fisheries; Application for...

    Science.gov (United States)

    2011-03-24

    ... Magnuson-Stevens Fishery Conservation and Management Act require publication of this notification to...-9135. FOR FURTHER INFORMATION CONTACT: Carly Knoell, Fisheries Management Specialist, 978-281-9224... addition, if the EFP is approved, NEFSC and participatory vessels would be notified that spiny dogfish and...

  9. Wallace Stevens: A Collection of Critical Essays. Twentieth Century Views Series.

    Science.gov (United States)

    Borroff, Marie, Ed.

    One of a series of works aimed at presenting contemporary critical opinion on major authors, this collection includes essays by Marie Borroff, Wallace Stevens, Joseph N. Riddle, Hi Simons, Sister M. Bernetta Quinn, C. Roland Wagner, Harold Bloom, Ralph J. Mills, Jr., Roy Harvey Pearce, Louis L. Martz, Morton Dauwen Zabel, and Northrop Frye--all…

  10. 77 FR 25630 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2012-05-01

    ... measures for the 2012 Gulf of Maine (GOM) Atlantic cod fishery on April 3, 2012. These measures were... interested in the 2012 GOM cod fishery. Because the effective date in the April 3 rule is inconsistent with... National Oceanic and Atmospheric Administration 50 CFR Part 648 RIN 0648-BB89 Magnuson-Stevens Fishery...

  11. Carbamazepine-induced Life-threatening Stevens-Johnson Syndrome and Agranulocytosis: The Maiden Case.

    Science.gov (United States)

    Avinash, A; Amberkar, V Mohanbabu; Kunder, Sushil Kiran; Madhyastha, Sharath; Meenakumari, K

    2016-12-01

    Stevens-Johnson syndrome is one of the few dermatological emergencies in clinical practice. The syndrome is often secondary to the usage of drugs, of which allopurinol, penicillins, sulfa drugs, ibuprofen, sodium valproate, phenytoin, lamotrigine and carbamazepine are commonly implicated. Agranulocytosis is the existence of a clinically significant reduction in neutrophil count. This condition is a serious threat to the patient, as he/she is at a greater risk of contracting bacterial or fungal infections, which may prove to be fatal. The co-existence of Stevens-Johnson syndrome and agranulocytosis in the same patient further increases the risk of morbidity and mortality. To the best of our knowledge, there are no reports available in the existing literature, of cases that were reported with both these life-threatening conditions in a single patient, at the same point of time. This is a case narrative of a patient who presented with both Stevens-Johnson syndrome and agranulocytosis, following the administration of carbamazepine The patient's differential leucocyte count revealed a neutrophil proportion of 2.33%. A causality assessment done using Naranjo's algorithm showed that carbamazepine "definitely" caused Agranulocytosis and "probably" caused Stevens-Johnson syndrome.

  12. Stevens-Johnson syndrome progressing to toxic epidermal necrolysis with haloperidol and carbamazepine combination

    Directory of Open Access Journals (Sweden)

    Ajay Kumar

    2011-01-01

    Full Text Available Carbamazepine and other anticonvulsants are commoner cause of severe adverse cutaneous drug reactions such as erythema multiforme, toxic epidermal necrolysis (TEN, and Stevens-Johnson syndrome (SJS. We report a case of SJS rapidly progressing to TEN with a combination of haloperidol and carbamazepine in a patient with bipolar affective disorder. The pathophysiological mechanism underlying this reaction is discussed.

  13. Conjunctival inflammation in the chronic phase of Stevens-Johnson syndrome

    Science.gov (United States)

    Kawasaki, S.; Nishida, K.; Sotozono, C.; Quantock, A.; Kinoshita, S.

    2000-01-01

    AIMS—To understand the immunopathogenesis of the corneal conjunctivalisation in Stevens-Johnson syndrome.
METHODS—Conjunctivalised corneas from five patients with Stevens-Johnson syndrome were studied immunohistochemically for several cell surface antigens and two cytokines. Chemical injury specimens were also studied.
RESULTS—In all cases, immunohistochemistry revealed LFA-1, CD4, CD8, and CD68 on subepithelial infiltrating cells. Also, HLA-DR and ICAM-1 were found on the surfaces of epithelial cells, subepithelial infiltrating cells, subepithelial fibroblasts, and endothelial cells in blood vessels. IFN-γ was found in basal epithelial cells; subepithelial cells and subepithelial extracellular matrix CD19 and IL4 were not detected.
CONCLUSIONS—The infiltrating cell population in the Stevens-Johnson syndrome samples includes macrophages, CD4 positive T cells, and CD8 positive T cells. The cytokine expression pattern suggests CD4 positive T cells are Th1 cells. The infiltrating cell population is similar in Stevens-Johnson syndrome and chemical injury conjunctivalised corneas.

 PMID:11004109

  14. Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis

    NARCIS (Netherlands)

    Kardaun, Sylvia H.; Jonkman, Marcel F.

    2007-01-01

    Mortality in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) is high. Apart from intensive supportive therapy, no generally accepted specific treatment regimen exists. The role of corticosteroids in SJS/TEN is controversial. It is possible that high-dose pulse therapy with

  15. Comprehensive Survival Analysis of a Cohort of Patients with Stevens Johnson Syndrome and Toxic Epidermal Necrolysis

    NARCIS (Netherlands)

    Sekula, Peggy; Dunant, Ariane; Mockenhaupt, Maja; Naldi, Luigi; Bavinck, Jan Nico Bouwes; Halevy, Sima; Kardaun, Sylvia; Sidoroff, Alexis; Liss, Yvonne; Schumacher, Martin; Roujeau, Jean-Claude

    Stevens Johnson syndrome and toxic epidermal necrolysis are severe cutaneous adverse reactions that are of major concern because of high mortality rates. On the basis of data collected in the RegiSCAR study, the aim was to assess risk factors (including modalities of patient management) for

  16. 75 FR 12141 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2010-03-15

    ... National Oceanic and Atmospheric Administration 50 CFR Part 648 RIN 0648-AY01 Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the Northeastern United States; Monkfish Fishery AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA...

  17. 75 FR 81505 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2010-12-28

    ... National Oceanic and Atmospheric Administration 50 CFR Part 648 RIN 0648-BA42 Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the Northeastern United States; Tilefish Fishery AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA...

  18. Bokanmeldelse: "Freakonomics : a rogue economist explores the hidden side of everything" / Steven D. Levitt and Stephen J. Dubner

    OpenAIRE

    Sommervoll, Dag Einar

    2006-01-01

    Artikkelen er gjengitt med tillatelse fra Samfunnsøkonomenes Forening. Bokanmeldelse av: Levitt, Steven D. & Dubner, Stephen J. (2005): "Freakonomics : a rogue economist explores the hidden side of everything", [New York]: Harper Collins Inc.

  19. Stevens-Johnson Syndrome Patient Received Combination Chemotherapy Gemcitabine, Cisplatin, and 5-FU for Biliary Tract Cancer.

    Science.gov (United States)

    Aznab, Mozaffar; Khazaei, Mansour

    2016-06-01

    Stevens-Johnson syndrome has been an acute, usually self-limiting disease of the skin and mucous membranes. This case report has presented an evidence of the development Stevens - Johnson syndrome associated with combination chemotherapy administration of 5FU, gemcitabin and cisplatin in a patient with biliary tract cancer. Our case was a 54-year-old woman patient, a case of biliary tract cancer who has developed more severe symptoms of Stevens-Johnson syndrome. Diagnosis has confirmed by skin biopsy of an affected area .The patient has improved with supportive care, and during 25 day occurred recovery. Although Stevens-Johnson syndrome has been a rare toxicity, physicians should pay a special attention to the monitoring of biliary tract cancer patients on combination chemotherapy with 5FU, cisplatin and gemcitabin.

  20. Evaluation of the patients diagnosed with Stevens Johnson syndrome and toxic epidermal necrolysis: a single center experience.

    Science.gov (United States)

    Çekiç, Şükrü; Canıtez, Yakup; Sapan, Nihat

    2016-09-01

    Stevens Johnson syndrome and toxic epidermal necrolysis are severe acute mucocutaneous diseases. In this study, we evaluated the clinical aspects of Steven Johnson syndrome, toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap patients who admitted to our clinics in the last five years. Eleven patients diagnosed as Stevens-Johnson syndrome, toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in Department of Pediatric Allergy in Uludağ University School of Medicine were included in this study. Clinical findings, laboratory tests and response to treatments were evaluated via electronic files. Two of the patients had Stevens-Johnson syndrome, four had Stevens-Johnson syndrome/toxic epidermal necrolysis overlap, and five had toxic epidermal necrolysis. The median period for drug usage was 10 days (2-44 days). Herpes simpleks virus IgM antibody was detected two patients. The median healing time was 38 days 26-94 days). Maculopapular eruptions and oral mucositis were seen in all patients. Vesicul or bullae, epidermal detachment and ocular involvement in 10 of patients. Wound care, H1 antihistamine and methyl prednisolon were used in all patients, intravenous immunoglobulin were used in 7 patients and cyclosporine in 1 patient. Sequel lesions developed in 2 of the patients and there was no death. Anticonvulsants, antibiotics and non steroid anti-inflammatory drugs play a major role in the etiology of Stevens-Johnson syndrome and toxic epidermal necrolysis. Anticonvulsants are associated with severe disease. The patients with proper wound care and treatment with immunosuppressive drugs can be recovered without or with minimal sequelae.

  1. Threshold Studies on TNT, Composition B, and C-4 Explosives Using the Steven Impact Test

    Energy Technology Data Exchange (ETDEWEB)

    Vandersall, K S; Switzer, L L; Garcia, F

    2005-09-26

    Steven Impact Tests were performed at low velocity on the explosives TNT, Comp B, and C-4 in attempts to obtain a threshold for reaction. A 76 mm helium driven gas gun was used to accelerate the Steven Test projectiles up to approximately 200 m/s in attempts to react (ignite) the explosive samples. Blast overpressure gauges, acoustic microphones, standard video and high-speed photography were used to characterize the level of any high explosive reaction violence. No bulk reactions were observed in the TNT, Composition B, or C-4 explosive samples impacted up to velocities in the range of 190-200 m/s. This work will outline the experimental details and discuss the lack of reaction when compared to the reaction thresholds of other common explosives.

  2. Measurement of Low Level Explosives Reaction in Gauged Multi-Dimensional Steven Impact Tests

    Energy Technology Data Exchange (ETDEWEB)

    Niles, A M; Garcia, F; Greenwood, D W; Forbes, J W; Tarver, C M; Chidester, S K; Garza, R G; Swizter, L L

    2001-05-31

    The Steven Test was developed to determine relative impact sensitivity of metal encased solid high explosives and also be amenable to two-dimensional modeling. Low level reaction thresholds occur at impact velocities below those required for shock initiation. To assist in understanding this test, multi-dimensional gauge techniques utilizing carbon foil and carbon resistor gauges were used to measure pressure and event times. Carbon resistor gauges indicated late time low level reactions 200-540 {micro}s after projectile impact, creating 0.39-2.00 kb peak shocks centered in PBX 9501 explosives discs and a 0.60 kb peak shock in a LX-04 disk. Steven Test modeling results, based on ignition and growth criteria, are presented for two PBX 9501 scenarios: one with projectile impact velocity just under threshold (51 m/s) and one with projectile impact velocity just over threshold (55 m/s). Modeling results are presented and compared to experimental data.

  3. Stevens-Johnson syndrome in a boy with macrolide-resistant Mycoplasma pneumoniae pneumonia.

    Science.gov (United States)

    Atkinson, T Prescott; Boppana, Suresh; Theos, Amy; Clements, L Scott; Xiao, Li; Waites, Ken

    2011-06-01

    Mycoplasma pneumoniae is a highly specialized parasitic bacterium that is a significant cause of community-acquired pneumonia in children. Although most such respiratory infections are mild, a minor percentage of patients require hospitalization and, occasionally, intensive treatment for respiratory failure. A variety of extrapulmonary sequelae of M pneumoniae infections have been described, including Stevens-Johnson syndrome. Macrolide resistance in M pneumoniae has developed rapidly in Asia, particularly in China, over the past decade and is now appearing in the United States. Emerging resistance to macrolides creates a therapeutic conundrum, particularly for pediatricians caring for young children in whom absolute or relative contraindications exist for the use of tetracyclines or fluoroquinolones, the 2 other main classes of drugs shown to be efficacious for M pneumoniae. We describe here the case of a child with a prolonged febrile illness associated with Stevens-Johnson-like mucocutaneous involvement who was found to have a respiratory infection with macrolide-resistant M pneumoniae.

  4. Drug-mediated rash: erythema multiforme versus Stevens-Johnson syndrome.

    Science.gov (United States)

    Hidajat, Cassandra; Loi, Duncan

    2014-09-22

    A 92-year-old woman presented with an acute onset generalised maculopapular rash with associated mucosal involvement, on a background of recent start of griseofulvin. The rash progressed rapidly over 2 days to involve most of her body, however, mucosal involvement was limited to her oral mucosa. Characteristic target lesions appeared at 72 h, and a diagnosis of erythema multiforme secondary to griseofulvin was made after further investigation and skin biopsy. The patient was monitored closely for progression of the rash and other indicators of more severe dermatological conditions such as Stevens-Johnson syndrome. She was managed symptomatically, with resolution of the rash in 4 weeks and full recovery to her premorbid level of functioning. This case details the diagnostic and management approach to erythema multiforme, a condition that warrants thorough consideration for the differential of Stevens-Johnson syndrome. 2014 BMJ Publishing Group Ltd.

  5. [Stevens-Johnson syndrome followed by Gougerot-Sjögren syndrome].

    Science.gov (United States)

    de Roux Serratrice, C; Serratrice, J; Granel, B; Weiller-Merli, C; Rey, J; Lepidi, H; Disdier, P; Weiller, P J

    2001-03-24

    Sicca syndrome after Stevens-Johnson syndrome is classically described. However, to our knowledge, authentic Sjögren's syndrome following epidermal necrolysis has not been described previously. A 36-year-old woman with Steven-Johnson syndrome developed transient hepatitis and a persistent sicca syndrome. Fourteen years later an authentic Sjögren's syndrome was identified with presence of antinuclear and anti-SSA antibodies and lymphocytes infiltration of the accessory salivary glands, i.e. grade IV disease in the Chisholm classification. The initial mucosal destruction observed in our patients may have laid the ground for Sjögren's syndrome via abnormal antigen presentation in a predisposed dysimmune context.

  6. Stevens Johnson Syndrome in a patient with systemic lupus erythematosus on tuberculostatic treatment

    Directory of Open Access Journals (Sweden)

    Alius Cahyadi

    2012-11-01

    Full Text Available A 22-year-old woman was admitted to the hospital because of 5-days history of redness and itch on her face. Additional complains were swelling on her feet, sore throat, and cough. Patient was on treatment for systemic lupus erythematosus and pulmonary tuberculosis (since 12 days. On physical examination, patient was alert, stable hemodynamic, anasarca edema, multiple purpuric macules lesion spread on her body, conjunctivitis of both eyes, multiple oral ulcers, erythema on genital mucosa. Laboratory results were anemia, leucopenia, hypoalbuminemia, proteinuria. We suspected this patient as Stevens Johnson syndrome due to tuberculostatic drugs. During treatment, we stopped the tuberculostatic drugs, and gave her parenteral methylprednisolone, with other supportive treatments. The patient was discharge after improvement of clinical condition and capable of self mobilization. (Med J Indones. 2012;21:235-9Keywords: Stevens Johnson Syndrome, systemic lupus erythematosus

  7. Fatal Stevens-Johnson syndrome/toxic epidermal necrolysis induced by allopurinol-rituximab-bendamustine therapy.

    Science.gov (United States)

    Fallon, Michael J; Heck, Jessica N

    2015-10-01

    Stevens-Johnson syndrome/toxic epidermal necrolysis overlap is an acute hypersensitivity reaction that compromises the integrity of mucous membranes and cutaneous tissue. While the pathophysiology of this syndrome has not been fully elucidated, it is commonly associated with the medication use and carries a significant mortality risk of approximately 30%. No commonalities among causative medications have been identified, and determining the offending agent can be challenging. This case report describes fatal Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in a patient after receiving his first cycle of allopurinol, rituximab, and bendamustine treatment for non-Hodgkin's B-cell lymphoma. An analysis of FDA Medwatch adverse reaction case reports involving allopurinol, rituximab, and bendamustine is also presented. © The Author(s) 2014.

  8. Concurrence of Stevens-Johnson Syndrome and Bilateral Parotitis after Minocycline Therapy

    Directory of Open Access Journals (Sweden)

    Jimi Yoon

    2010-06-01

    Full Text Available Minocycline is an antibiotic of tetracycline derivatives that is commonly used in the treatment of moderate to severe acne vulgaris. It has been reported to cause rare adverse events from mild cutaneous eruption to severe forms including drug-induced lupus, serum sickness-like reaction, and hypersensitivity reactions, etc. The risks of adverse events attributed to minocycline have not been ascertained reliably and there are concerns about the safety of minocycline which could possibly result in life-threatening events such as the Stevens-Johnson syndrome. Here we demonstrate an unusual case of Stevens-Johnson syndrome in conjunction with bilateral parotitis after the intake of minocycline in a Korean boy suggesting discreet use of the drug.

  9. Investigation of Monnose-Binding Lectin gene Polymorphism in Patients with Erythema Multiforme, Stevens-Johnson Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Syndrome

    Directory of Open Access Journals (Sweden)

    Sevil Toka

    2012-09-01

    Full Text Available Objective: Monnose-Binding lectin (MBL appears to play an important role in the immune system. The genetic polymorphisms in the MBL2 gene can result in a reduction of serum levels, leading to a predisposition to recurrent infection. The aim of this study is to investigate the influence of a polymorphism in codon 54 of the MBL2 gene on the susceptibility to Erythema Multiforme, Stevens-Johnson Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Syndrome (EM, SJS and SJS/TEN overlap syndrome. Material and Methods: Our study included 64 patients who were clinically and/or histopathologically diagnosed with EM, SJS, and SJS/TEN overlap syndrome and 66 healthy control subjects who were genotyped for the MBL2 gene codon 54 polymorphism using the PCR-RFLP method. For all statistical analyses, the level of significance was set at p<0.05. Results: The prevalence of the B allele was 18% in the EM, SJS and SJS/TEN patient groups and 13% in the control group. No significant differences in allele frequencies of any polymorphism were observed between the patient and control groups, although the B allele was more frequent in the patient groups (p=0.328.Conclusion: Our results provide no evidence of a relationship between MBL2 gene codon 54 polymorphism and the susceptibility to EM, SJS and SJS/TEN overlap syndrome. However, these findings should be confirmed in studies with a larger sample size.

  10. Pediatric Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the US

    OpenAIRE

    Hsu, Derek Y

    2016-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening blistering disorders. Few studies have addressed SJS/TEN in children. We sought to determine risk factors, comorbidities, inpatient burden and mortality in US children with SJS, SJS-TEN and TEN. We analyzed data from the 2009-2012 Nationwide Inpatient Sample (NIS), containing a representative 20% sample of all hospitalizations in the US. SJS, SJS-TEN and TEN were identified by a validated algorithm using ...

  11. Oral lesions associated with nevirapine-related Stevens Johnson syndrome: A report of four cases.

    Science.gov (United States)

    Balasundaram, S; Ranganathan, K; Umadevi, K; Gunaseelan, R; Kumaraswamy, N; Solomon, Sunithi; Devaleenol, Bella; Ambrose, Pradeep

    2011-01-01

    Nevirapine is a non-nucleoside reverse transcriptase inhibitor, widely used in combination with other antiretroviral agents for treatment of HIV infection. Steven Johnson syndrome (SJS) is the major toxicity of nevirapine. We describe here four cases of SJS in HIV seropositive patients following nevirapine therapy. In all four cases cutaneous hypersensitivity reaction was seen with extreme oral lesions, three patients presented clinically with elevated liver enzymes and hepatitis, and two patients had ocular involvement.

  12. Fox-Fordyce Disease after Steven-Johnson Syndrome: case report

    Directory of Open Access Journals (Sweden)

    Havva Yildiz Seckin

    2016-09-01

    Full Text Available Fox-Fordyce Disease (FFD is a rare, chronic disorder of the apocrin sweat glands and characterized by pruritic papules. The disease primarily affects females and the etiology is unclear. A 19-year-old male patient developed FFD in his lips with a history of Steven-Johnson Syndrome is presented in this report. [J Contemp Med 2016; 6(3.000: 214-217

  13. Possible Role of Drugs and Herbal Medicines in Stevens-Johnson ...

    African Journals Online (AJOL)

    Il est advoqué que tous les patients se présentant avec des symptomes suggerant l'érytheme multiformes majeur (syndrome de Stevens-Johnson) devrons etre transférés sans delai dans une institution tertiaire où ce types de patients béneficiérons d'un traitement multi-diciplinaire en vue de prévenir la cessite et d'autre ...

  14. Carbamazepine-induced Life-threatening Stevens-Johnson Syndrome and Agranulocytosis: The Maiden Case

    OpenAIRE

    Avinash, A.; Amberkar, V. Mohanbabu; Kunder, Sushil Kiran; Madhyastha, Sharath; Meenakumari, K.

    2016-01-01

    Stevens-Johnson syndrome is one of the few dermatological emergencies in clinical practice. The syndrome is often secondary to the usage of drugs, of which allopurinol, penicillins, sulfa drugs, ibuprofen, sodium valproate, phenytoin, lamotrigine and carbamazepine are commonly implicated. Agranulocytosis is the existence of a clinically significant reduction in neutrophil count. This condition is a serious threat to the patient, as he/she is at a greater risk of contracting bacterial or funga...

  15. Antiepileptic Drugs-induced Stevens?Johnson syndrome: A case Series

    OpenAIRE

    Trivedi, Bhavi S.; Darji, Nishita H.; Malhotra, Supriya D.; Patel, Pankaj R.

    2016-01-01

    Stevens?Johnson syndrome (SJS) is an acute life-threatening mucocutaneous reaction, characterized by extensive necrosis and detachment of the epidermis from the skin. The overall incidence of SJS is seen in five cases per million people per year. SJS is typically caused by drugs and is a kind of idiosyncratic reaction. Adverse drug reactions such an SJS have a remarkable effect on patient's safety issues. We encountered nine cases of antiepileptic drug (AED)-induced SJS, specifically with car...

  16. Pediatric Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Halted by Etanercept.

    Science.gov (United States)

    Gavigan, Geneviève M; Kanigsberg, Nordau D; Ramien, Michele L

    2018-02-01

    We report a case of an 11-year-old female with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) overlap, most likely triggered by sulfamethoxazole-trimethoprim, who was treated with the combination of methylprednisolone, cyclosporine, and etanercept. Her condition stabilized and her skin involvement did not progress after the addition of etanercept. To our knowledge, this is the first report of etanercept for pediatric SJS/TEN.

  17. Mycoplasma Pneumoniae with Atypical Stevens-Johnson Syndrome: A Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    Ralph Yachoui

    2013-01-01

    Full Text Available The Stevens-Johnson syndrome (SJS classically involves a targetoid skin rash and the association of the oral mucosa, genitals, and conjunctivae. Recently, there have been several documentations of an incomplete presentation of this syndrome, without the typical rash, usually associated with the mycoplasma pneumoniae infection. Our case illustrates that this important clinical diagnosis should not be missed due to its atypical presentation.

  18. Síndrome de Stevens-Johnson: Presentación de 1 caso

    Directory of Open Access Journals (Sweden)

    Luisa María Pacheco Álvarez

    2001-12-01

    Full Text Available El síndrome de Stevens-Johnson, es una enfermedad inflamatoria aguda, originada por una hipersensibilidad, que incluye la piel y las membranas mucosas; en una forma mayor pone en peligro la vida del paciente. Puede ser inducida por muchos factores precipitantes, desde los medicamentos hasta una infección. La afección se caracteriza por una súbita erupción morfológicamente variable, acompañada de estomatitis y oftalmia. En este trabajo se presenta un niño de 8 años de edad, con la entidad clínica en forma muy severa, el síndrome de Stevens-Johnson, que involucra manifestaciones cutáneas, oculares y de la mucosa oral, acompañada de otras complicaciones graves, por lo que requirió terapéutica en cuidados intensivos, y se logró una evolución satisfactoria del paciente.Stevens-Johnson syndrome is an acute inflammatory disease caused by a hypersensibility that includes the skin and the mucous membranes and that in a severe form endangers the patient’s life. It may be induced by many precipitating factors, from drugs to infection. The affection is characterized by a sudden morphologically variable rash, accompanied with stomatitis and ophthalmia. An 8-year-old boy suffering from this clinical entity in a very severe form, Stevens-Johnson syndrome, with skin , ocular and oral mucosa manifestations and with other serious complications, is presented in this paper. He had to be treated at the ICU and a satisfactory evolution was attained.

  19. [Stevens-Johnson syndrome plus intrahepatic cholestasis caused by clindamycin or chlorpheniramine].

    Science.gov (United States)

    Sahagún Flores, J E; Soto Ortiz, J A; Tovar Méndez, C E; Cárdenas Ochoa, E C; Hernández Flores, G

    2009-05-15

    A 48-year-old woman was hospitalized with the diagnosis of hepatitis. She presented with symptoms of jaundice, headache, elevated bilirubin, and elevated hepatic enzymes. She related a recent episode of a bronchial infection that was treated during the previous eight days with paracetamol (500mg, 2 doses only), chlorpheniramine, betamethasone and clindamycin. After an initial clinical and laboratorial improvement, she began to complain of pruritus of the palms and soles. Thereafter, vesicles evolving to blisters developed and a deterioration of her general health ensued. Serologies for hepatitis A, B, and C viruses were negative. Intrahepatic cholestasis and Stevens Johnson Syndrome (SJS) were the final diagnosis. The association of the Stevens Johnson Syndrome and intrahepatic cholestasis simultaneously, related to adverse drug reactions, is very rare. The drugs reportedly involved are mainly antibiotics, such as ampicillin, vancomycin, amoxicillin/clavulinic acid and erythromycin. Other drugs involved are non-steroidal anti-inflamatory drugs, such as mefenamic acid, ibuprofen, and sulindac. The reactions can be minor or severe and can even cause death, an outcome that has been reported in patients of all races and ethnic groups, but appears to be more rare in patients of Latin origin. We present a discussion of this case and review the main characteristics of the Stevens Johnson Syndrome.

  20. Stevens-Johnson syndrome caused by a health drink (Eberu) containing ophiopogonis tuber.

    Science.gov (United States)

    Mochitomi, Y; Inoue, A; Kawabata, H; Ishida, S; Kanzaki, T

    1998-10-01

    Stevens-Johnson syndrome is considered to be a severe type of erythema exsudativum multiforme. It is characterized by erythema with bullous and eroded lesions of skin and mucous membranes. We report a case of Steven-Johnson syndrome following consumption of a health drink containing ophiopogonis tuber. A 66-year-old female took an O.T.C. health drink for fever. The next morning, she noted erythema and swelling of her face, neck, and chest. She started to develop bullous and eroded lesions on the skin of her entire body and the mucous membranes of her oral cavity, conjunctiva, and cornea, and she became feverish. She had high degrees of corneal erosion and liver dysfunction. Skin biopsy showed diffuse necrosis of the epidermis. After admission to the hospital, steroid pulse therapy (1000 mg/day of methylprednisolone sodium succinate) was continued for 5 days. The health drink induced a positive drug lymphocyte stimulation test (DLST) and patch test. A challenge test was done with a one hundredth dose, and it was positive. We did patch tests with all components of the drink and found that Mai-Meu-Dong-Tang (ophiopogonis) alone was positive at 72 hours. There is no previous report of Stevens-Johnson syndrome caused by a health drink or Mai-Meu-Dong-Tang. Even though it is a health drink, we should be aware of the possibility of a severe reaction.

  1. Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals*

    Science.gov (United States)

    Arantes, Luana Bernardes; Reis, Carmélia Santiago; Novaes, Alice Garbi; de Carvalho, Marta Rodrigues; Göttems, Leila Bernarda Donato; Novaes, Maria Rita Carvalho Garbi

    2017-01-01

    Background Adverse drug reactions are harmful and involuntary responses to drugs that occur at doses normally used for a given condition. Among them are Stevens-Johnson syndrome and toxic epidermal necrolysis, both rare and potentially fatal conditions. Objectives To analyze the epidemiological and clinical characteristics related to patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in public hospitals in the Federal District - Brazil. Methods Retrospective, cross-sectional and descriptive study, in which data were collected referring to patients hospitalized in the public healthcare system of the Federal District from 1999 to 2014. Results: Between 1999 and 2014, 86 cases of hospitalized patients with diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in the Federal District were reported. The majority of patients were women; the most affected age group was 0 to 10 years. Patients older than 60 years (elderly) represent 6.98% of the cases. Most patients admitted to the referral hospital were discharged. However, occurrence of deaths exceeded that of discharge in elderly patients. Limitations of the study There is fragility in the registry of hospitalization of patients, both in the hospital information system and in the medical records of the reference hospital. Conclusion There is a need for greater production and better dissemination of information on the incidence of adverse drug reactions. PMID:29166503

  2. Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals.

    Science.gov (United States)

    Arantes, Luana Bernardes; Reis, Carmélia Santiago; Novaes, Alice Garbi; Carvalho, Marta Rodrigues de; Göttems, Leila Bernarda Donato; Novaes, Maria Rita Carvalho Garbi

    2017-01-01

    Adverse drug reactions are harmful and involuntary responses to drugs that occur at doses normally used for a given condition. Among them are Stevens-Johnson syndrome and toxic epidermal necrolysis, both rare and potentially fatal conditions. To analyze the epidemiological and clinical characteristics related to patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in public hospitals in the Federal District - Brazil. Retrospective, cross-sectional and descriptive study, in which data were collected referring to patients hospitalized in the public healthcare system of the Federal District from 1999 to 2014. Results: Between 1999 and 2014, 86 cases of hospitalized patients with diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in the Federal District were reported. The majority of patients were women; the most affected age group was 0 to 10 years. Patients older than 60 years (elderly) represent 6.98% of the cases. Most patients admitted to the referral hospital were discharged. However, occurrence of deaths exceeded that of discharge in elderly patients. There is fragility in the registry of hospitalization of patients, both in the hospital information system and in the medical records of the reference hospital. There is a need for greater production and better dissemination of information on the incidence of adverse drug reactions.

  3. [Stevens-Johnson syndrome and Hodgkin's disease: A fortuitous association or paraneoplastic syndrome?].

    Science.gov (United States)

    Schoeffler, A; Levy, E; Weinborn, M; Cuny, J-F; Schmutz, J-L; Barbaud, A; Cribier, B; Bursztejn, A-C

    2014-02-01

    Hodgkin's disease has been associated with a variety of cutaneous symptoms. We report two cases of Stevens-Johnson syndrome (SJS) associated with Hodgkin's disease. Case 1: a 22-year-old man was hospitalized for a second erythematous vesicular eruption with intense mucosal involvement. Histopathological examination confirmed the diagnosis of Stevens-Johnson syndrome. He also developed enlarged cervical lymph nodes that revealed Hodgkin's disease. The latter diagnosis was followed by two recurrent rashes. Treatment consisted of systemic chemotherapy. Complete remission was obtained with no signs of cutaneous recurrence after 24 months of regular follow-up. Case 2: a 29-year-old man was admitted for a generalized erythematous and bullous rash with intense mucosal involvement. Histopathological examination confirmed the diagnosis of Stevens-Johnson syndrome. He then developed muco-cutaneous icterus that was secondary to Hodgkin's disease. Under specific hematologic treatment, no cutaneous relapse was noticed. These cases illustrate the rare association of SSJ revealing Hodgkin's disease. In these cases, no evidence was found of infectious disease or drug-induced cutaneous effects. Only one case of toxic epidermal necrolysis associated with Hodgkin's disease had previously been reported. The link between both diseases may be immunosuppression induced by Hodgkin's disease, which could favor infection inducing SJS or secretion by tumor cells granulysin, a mediator responsible for damage to keratinocytes. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  4. Síndrome de Stevens-Johnson con afectación mucosa predominante Stevens-Johnson's Syndrome with predominant mucous membrane involvement

    OpenAIRE

    S. Rekarte García; C. Montalvo Ávalos; A. López Martínez; L. Mantecón Fernández; P. Fernández González

    2012-01-01

    Introducción. El síndrome de Stevens-Johnson es una reacción idiosincrásica mucocutánea secundaria mayoritariamente a fármacos y a ciertos agentes infecciosos. En algunas ocasiones, como los dos casos que aquí se presentan, cursa con mínima afectación cutánea, predominando el compromiso mucoso en forma de ampollas, erosiones y costras. Caso clínico 1. Niño de 8 años con lesiones aftosas, vesículo-ampollosas y costrosas en mucosa oral, labial y endonasal; eritema violáceo periocular bilateral,...

  5. Fundamental Flaws In The Derivation Of Stevens' Law For Taste Within Norwich's Entropy Theory of Perception

    Science.gov (United States)

    Nizami, Lance

    2010-03-01

    Norwich's Entropy Theory of Perception (1975-present) is a general theory of perception, based on Shannon's Information Theory. Among many bold claims, the Entropy Theory presents a truly astounding result: that Stevens' Law with an Index of 1, an empirical power relation of direct proportionality between perceived taste intensity and stimulus concentration, arises from theory alone. Norwich's theorizing starts with several extraordinary hypotheses. First, "multiple, parallel receptor-neuron units" without collaterals "carry essentially the same message to the brain," i.e. the rate-level curves are identical. Second, sensation is proportional to firing rate. Third, firing rate is proportional to the taste receptor's "resolvable uncertainty." Fourth, the "resolvable uncertainty" is obtained from Shannon's Information Theory. Finally, "resolvable uncertainty" also depends upon the microscopic thermodynamic density fluctuation of the tasted solute. Norwich proves that density fluctuation is density variance, which is proportional to solute concentration, all based on the theory of fluctuations in fluid composition from Tolman's classic physics text, "The Principles of Statistical Mechanics." Altogether, according to Norwich, perceived taste intensity is theoretically proportional to solute concentration. Such a universal rule for taste, one that is independent of solute identity, personal physiological differences, and psychophysical task, is truly remarkable and is well-deserving of scrutiny. Norwich's crucial step was the derivation of density variance. That step was meticulously reconstructed here. It transpires that the appropriate fluctuation is Tolman's mean-square fractional density fluctuation, not density variance as used by Norwich. Tolman's algebra yields a "Stevens Index" of -1 rather than 1. As "Stevens Index" empirically always exceeds zero, the Index of -1 suggests that it is risky to infer psychophysical laws of sensory response from information theory

  6. Measurement of Low Level Explosives Reaction in the Two-Dimensional Steven Impact Test

    Energy Technology Data Exchange (ETDEWEB)

    Forbes, J.W.; Tarver, C.M.; Chidester, S.K.; Garcia, F.; Greenwood, D.W.; Garza, R.

    2000-10-10

    The two-dimensional Steven impact test has been developed to be reproducible and amenable to computer modeling. This test has a hemispherical projectile traveling at tens of m/s impacting a metal cased explosive target. To assist in the understanding of this safety test, two-dimensional shock wave gauge techniques were used to measure the pressures of a few kilobars and times of reactions less than a millisecond. This work is in accord with a long-term goal to develop two-dimensional shock diagnostic techniques that are more than just time of arrival indicators. Experiments were performed where explosives were impacted at levels below shock initiation levels but caused low level reactions. Carbon foil and carbon resistor pressure gauges were used to measure pressures and time of events. The carbon resistor gauges indicate a late time low level reaction at 350 {micro}s after impact of the hemispherical projectile creating 0.5-6 kb peak shocks at the center of PBX 9501 (HMX/Estane/BDNPA-F; 95/2.5/2.5 wt %) explosive discs. The Steven test calculations are based on an ignition and growth criteria and found that the low level reaction occurs at 335 {micro}s, which is in good agreement with the experimental data. Some additional experiments simulating the Steven impact test were done on a gas gun with carbon foil and constantan strain gauges in a PMMA target. Hydrodynamic calculations can be used to evaluate the gauge performance in these experiments and check the lateral strain measurements.

  7. Stevens-Johnson syndrome and toxical epidermal necrolysis in intensive care medicine

    OpenAIRE

    Ana Carolina Pedigoni Bulisani; Giselle Domingues Sanches; Helio Penna Guimarães; Renato Delascio Lopes; Letícia Sandre Vendrame; Antonio Carlos Lopes

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: A Síndrome de Stevens Johnson (SSJ) e Necrólise Epidérmica Tóxica (NET) são reações cutâneas graves, com potencial para morbidade e mortalidade elevadas acometendo a pele e a membrana mucosa necessitando de cuidados de medicina intensiva. O objetivo deste artigo foi apresentar revisão da literatura sobre SSJ e NET. CONTEÚDO: Este artigo revisa os conceitos básicos, diagnóstico, quadro clínico e o princípio de tratamento em Unidade de Terapia Intensiva da SSJ e NET. ...

  8. Síndrome de Stevens-Johnson: Presentación de 1 caso

    OpenAIRE

    Luisa María Pacheco Álvarez; Marcos Antonio Sánchez Salcedo; Delia Luisa Sánchez Pacheco

    2001-01-01

    El síndrome de Stevens-Johnson, es una enfermedad inflamatoria aguda, originada por una hipersensibilidad, que incluye la piel y las membranas mucosas; en una forma mayor pone en peligro la vida del paciente. Puede ser inducida por muchos factores precipitantes, desde los medicamentos hasta una infección. La afección se caracteriza por una súbita erupción morfológicamente variable, acompañada de estomatitis y oftalmia. En este trabajo se presenta un niño de 8 años de edad, con la entidad clín...

  9. Vanishing bile duct and Stevens-Johnson syndrome associated with ciprofloxacin treated with tacrolimus

    Science.gov (United States)

    Okan, Gokhan; Yaylaci, Serpil; Peker, Onder; Kaymakoglu, Sabahattin; Saruc, Murat

    2008-01-01

    Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We report a case of a patient with ciprofloxacin-induced SJS and acute onset of VBDS, and reviewed the related literature. It is the first case of ciprofloxacin-induced VBDS successfully treated with tacrolimus. This case reminds physicians of the importance of drug reactions, their severity, techniques for diagnosis and methods of management. PMID:18698687

  10. Low amplitude impact of PBX 9501: Modified Steven spigot gun tests

    Energy Technology Data Exchange (ETDEWEB)

    Idar, D.J.; Lucht, R.A.; Straight, J.W. [and others

    1998-12-01

    Low-velocity mechanical impact and subsequent high explosive (HE) reaction are of concern in credible accident scenarios involving the handling, transport, and storage of nuclear weapons. Using modified Steven spigot gun tests, the authors have investigated the high-explosive violent-reaction (HEVR) potential of PBX 9501 to low-amplitude insult. Reliable modeling predictions require that one identify the relevant parameters and behavioral responses that are key to the reaction mechanism(s) in PBX 9501. Additional efforts have been targeted at identifying relevant differences in the response between baseline and stockpile-aged PBX 9501 to low-velocity impacts.

  11. [The application of highly hydrophilic contact lenses in the Fuchs-Steven-Johnson syndrome (author's transl)].

    Science.gov (United States)

    Schulz, E

    1979-01-01

    In 3 patients with status after Fuchs-Steven-Johnson syndrome highly hydrophilic contact lenses (72% H2O-up take) were adapted and worn permanently. 2 patients had worn already for a long time usual HEMA-lenses. The lenses showed themselves to be favorable against mechanical irritation from cilia and accessory eyelashes and from scarring conjunctival conditions, and they affected favorably the signs of dessication of the cornea. Corneal defects healed, and the patients had subjectively no complaints. It is sometimes necessary to replace the tears. An increase in the corneal vascularisation already present could not be observed during the 18 months observation time.

  12. Research Directions in Genetic Predispositions to Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Manolio, Teri A; Hutter, Carolyn M; Avigan, Mark; Cibotti, Ricardo; Davis, Robert L; Denny, Joshua C; Grenade, Lois La; Wheatley, Lisa M; Carrington, Mary N; Chantratita, Wasun; Chung, Wen-Hung; Dalton, Andrea D; Hung, Shuen-Iu; Lee, Ming Ta Michael; Leeder, J Steven; Lertora, Juan J L; Mahasirimongkol, Surakameth; McLeod, Howard L; Mockenhaupt, Maja; Pacanowski, Michael; Phillips, Elizabeth J; Pinheiro, Simone; Pirmohamed, Munir; Sung, Cynthia; Suwankesawong, Wimon; Trepanier, Lauren; Tumminia, Santa J; Veenstra, David; Yuliwulandari, Rika; Shear, Neil H

    2018-03-01

    Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is one of the most devastating of adverse drug reactions (ADRs) and was, until recently, essentially unpredictable. With the discovery of several risk alleles for drug-induced SJS/TEN and the demonstration of effectiveness of screening in reducing incidence, the stage is set for implementation of preventive strategies in populations at risk. Yet much remains to be learned about this potentially fatal complication of commonly used drugs. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  13. Guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis: An Indian perspective.

    Science.gov (United States)

    Gupta, Lalit Kumar; Martin, Abhay Mani; Agarwal, Nidheesh; D'Souza, Paschal; Das, Sudip; Kumar, Rajesh; Pande, Sushil; Das, Nilay Kanti; Kumaresan, Muthuvel; Kumar, Piyush; Garg, Anubhav; Singh, Saurabh

    2016-01-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor-α inhibitors. The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. The aim of this article is to comprehensively review the published medical literature and frame management guidelines suitable in the Indian perspective. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these guidelines to its special interest group on cutaneous adverse drug reactions. The group performed a comprehensive English language literature search for management options in Stevens-Johnson syndrome/toxic epidermal necrolysis across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for keywords (alone and in combination) and MeSH items such as "guidelines," "Stevens-Johnson syndrome," "toxic epidermal necrolysis," "corticosteroids," "intravenous immunoglobulin," "cyclosporine" and "management." The available evidence was evaluated using the strength of recommendation taxonomy and graded using a three-point scale. A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 104 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], previous guidelines [including Indian guidelines of 2006] and case series) were critically evaluated and the evidence

  14. Mycoplasma pneumoniae-Induced-Stevens Johnson Syndrome: Rare Occurrence in an Adult Patient

    Directory of Open Access Journals (Sweden)

    Samad Rasul

    2012-01-01

    Full Text Available Stevens-Johnson syndrome (SJS is an uncommon occurrence in Mycoplasma pneumoniae (M. pneumoniae infection (1–5% and has been mainly reported in children and young adults. We present a case of SJS in a 32-year-old male induced by M. pneumoniae infection. This patient presented with fever, cough, and massive occupation of mucus membranes with swelling, erythema, and necrosis accompanied by a generalized cutaneous rash. He clinically responded after treatment with antibiotics and IVIG. SJS is usually a drug-induced condition; however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis.

  15. Burn Center Care of Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Cartotto, Robert

    2017-07-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are rare, life-threatening, cutaneous drug reactions. Medications are the most common cause, although an infection may be responsible. A link between genetics and certain medications has been established. Clinical diagnosis should be confirmed with biopsy. When the area of epidermal detachment approaches 30%, burn center care is advisable. An ophthalmologist should be consulted to optimize ocular care. Pharmacologic interruption has been sought but there is little consensus on the most appropriate agent and no high-quality studies have been conducted to demonstrate if any of these agents lead to improved survival. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  16. "If you thought this story sour, sweeten it with your own telling" - a feminist poetics of rewriting in Susan Price's Ghost dance

    Directory of Open Access Journals (Sweden)

    Sanna Lehtonen

    2010-01-01

    Full Text Available The attempts to challenge conventional gendered discourses in children's fantasy have often resulted in feminist rewritings of earlier stories. Ghost dance (1994 by the English author Susan Price is a novel that reflects a specific feminist poetics of rewriting: metafictional passages highlight the constructedness of the narrative and at the end readers are invited to tell their own versions of the story. Moreover, the rewriting freely combines and recontextualises elements from different source texts and reformulates them to create a narrative that challenges conventional discourses of gender. While this poetics has an appeal from a feminist perspective, the play with cross-cultural intertexts and gender becomes more complex when the novel is examined in a postcolonialist framework in relation to ethnicity and the issue of cultural appropriation. Ghost dance is situated in a setting that has a real-world equivalent (Russia, involves characters that are identified with names of real-world ethnic groups (Lapps (Sámi, Russian, and mixes elements from Russian wonder tales, Nordic mythology and an Ojibwe legend. The novel does not aim at historical accuracy in its representations nor is it a direct retelling of any of the pre-texts but combines motifs, themes, names, characters and settings freely from each source. In this textual melting pot, the protagonist Shingebiss is, on one level, a revision of the witch Baba Yaga, but also described as a Lappish shaman with an Ojibwe name. To rewrite gendered discourses, certain elements from the pretexts are chosen and others left out – the question is, then, what effects does this recontextualisation have on the representation of ethnicity? Or, are the feminist rewriting strategies actually a form of cultural appropriation?

  17. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Analysis of Triggers and Implications for Improving Prevention.

    Science.gov (United States)

    Miliszewski, Monica A; Kirchhof, Mark G; Sikora, Sheena; Papp, Anthony; Dutz, Jan P

    2016-11-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis are severe mucocutaneous adverse drug reactions characterized by extensive epidermal detachment. The mortality rates have been reported to vary between 1% and 5% for Stevens-Johnson syndrome and 25% and 35% for patients with toxic epidermal necrolysis. Studies have shown that early recognition and prompt withdrawal of the causative agent leads to increased patient survival. A retrospective chart review was conducted on 64 patients admitted to Vancouver General Hospital with a diagnosis of Stevens-Johnson syndrome or toxic epidermal necrolysis from 2001 to 2011. The aim of this study was to identify the medications most often implicated in triggering Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as to delineate the timeline of identification and removal of these triggers. A trigger was identified in 75% of cases. Allopurinol was the single most common offending agent (20% of cases). Anticonvulsants and antibiotics were common triggers. The offending agent was often removed at time of hospital admission/diagnosis but not at onset of symptoms. A history of prior culprit drug exposure with previous mucocutaneous adverse reaction was noted in 19% of cases with identified triggers. Asians and Native North Americans had a higher mortality than whites, and Asians more frequently had allopurinol as a trigger. The onset and high mortality rate of Stevens-Johnson syndrome/toxic epidermal necrolysis may be related to unawareness of the early signs and symptoms of Stevens-Johnson syndrome and toxic epidermal necrolysis, the common drug triggers that cause it, and what investigations (human leukocyte antigen typing in Asians) can be done to prevent it. Copyright © 2016. Published by Elsevier Inc.

  18. STEVENS-JOHNSON SYNDROME — TOXIC EPIDERMAL NECTROLYSIS IN CHILDREN. PART I. DETERMINATION, ETIOLOGY, PATHOGENESIS, CLINICAL MANIFESTATIONS, SYSTEMIC TREATMENT

    Directory of Open Access Journals (Sweden)

    V.F. Zhernosek

    2011-01-01

    Full Text Available Part I of the literature review provides modern terminology and classification of Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN, which is now considered different ways of treating the single pathological process induced in children by infections, drugs, malignant and autoimmune diseases. It illustrates in detail the latest data on pathogenesis, describes clinical manifestations of both scenarios and their transition forms. Special emphasis is made on the organisation of care for patients with SJS and TEN. It details various aspects of systemic therapy.Key words: Stevens-Johnson syndrome, toxic epidermal necrolysis, systemic treatment, children.

  19. POLITENESS STRATEGIES USED BY COLTER STEVENS AS THE MAIN CHARACTER IN SOURCE CODE MOVIE

    Directory of Open Access Journals (Sweden)

    Retnowaty Retnowaty

    2017-04-01

    Full Text Available Politeness phenomena can usually be found in language. The objectives of this study are to describe what kind of politeness strategies used by the main character, Colter Stevens in the movie entitled Source Code and to explain the factors that might influence his choice of different politeness strategies. This study was using descriptive qualitative approach. Source of data in this research were every Colter‘s utterance in Source Code movie which contained politeness strategies. Furthermore, the data were classified with accordance to kind of politeness strategies suggested Brown and Levinson (1987. Based on the analysis, it can be described that Colter applied all kind of politeness strategies (bald on record, positive politeness strategies, negative politeness strategies and off record. Related to the data, all factors, like social distance, power and rank of imposition influenced his choice of strategies. From all utterances by Colter Stevens from the first until the end of movie, most appeared to use positive politeness strategies. This study indicates that there is a tendency that Colter tried to minimize the threat to the hearer‘s face to avoid conflict. Furthermore, most utterances denoted to social distance between him and the hearers as the main factor that influence his choices of politeness strategies. Therefore, we can say that he was careful enough in selecting politeness strategies to sustain a good communication.

  20. Experimental and Modeling Studies of Crush, Puncture, and Perforation Scenarios in the Steven Impact Test

    Energy Technology Data Exchange (ETDEWEB)

    Vandersall, K S; Chidester, S K; Forbes, J W; Garcia, F; Greenwood, D W; Switzer, L L; Tarver, C M

    2002-06-28

    The Steven test and associated modeling has greatly increased the fundamental knowledge of practical predictions of impact safety hazards for confined and unconfined explosive charges. Building on a database of initial work, experimental and modeling studies of crush, puncture, and perforation scenarios were investigated using the Steven impact test. The descriptions of crush, puncture, and perforation arose from safety scenarios represented by projectile designs that ''crush'' the energetic material or either ''puncture'' with a pinpoint nose or ''perforate'' the front cover with a transportation hook. As desired, these scenarios offer different aspects of the known mechanisms that control ignition: friction, shear and strain. Studies of aged and previously damaged HMX-based high explosives included the use of embedded carbon foil and carbon resistor gauges, high-speed cameras, and blast wave gauges to determine the pressure histories, time required for an explosive reaction, and the relative violence of those reactions, respectively. Various ignition processes were modeled as the initial reaction rate expression in the Ignition and Growth reaction rate equations. Good agreement with measured threshold velocities, pressure histories, and times to reaction was calculated for LX-04 impacted by several projectile geometries using a compression dependent ignition term and an elastic-plastic model with a reasonable yield strength for impact strain rates.

  1. Are steroids effective in toxic epidermal necrolysis and Stevens-Johnson syndrome?

    Directory of Open Access Journals (Sweden)

    Rodrigo Meza

    2017-06-01

    Full Text Available Resumen La necrólisis epidérmica tóxica y el síndrome de Stevens-Johnson son reacciones cutáneas adversas graves a medicamentos e infecciones. Los corticoides se describen como una alternativa terapéutica, sin embargo, su uso es aún controvertido. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen once estudios primarios que responden la pregunta de interés. Extrajimos los datos y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si los corticoides disminuyen la mortalidad o la estadía hospitalaria en la necrólisis epidérmica tóxica y el síndrome de Stevens-Johnson porque la certeza de la evidencia es muy baja.

  2. Complications of Stevens-Johnson syndrome beyond the eye and skin.

    Science.gov (United States)

    Saeed, Hajirah; Mantagos, Iason S; Chodosh, James

    2016-02-01

    Ocular and cutaneous disease are common chronic sequelae of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and have been well described in the literature. Long-term complications affecting other organ systems have not been so well described. The purpose of this review article is to highlight non-ocular and non-cutaneous chronic complications of SJS/TEN. The PubMed database was searched for the keywords "Stevens-Johnson syndrome" and "toxic epidermal necrolysis" through September 1, 2014. Relevant articles were then reviewed in full. 138 articles in the English language were found that described chronic sequelae of SJS/TEN. Our search revealed six affected organ systems other than the eyes and integument, with chronic sequelae from SJS/TEN: respiratory, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic/genitourinary, and renal. Complications involving these organs systems appeared likely to reduce the quality of life for SJS/TEN survivors. SJS/TEN is a multi-organ disease requiring multidisciplinary care from a variety of specialists. Affected patients have complex hospital stays, and their quality of life may be severely impacted by multiple long-term complications. We believe that preventative care in the acute setting might limit the development and progression of many of the sequelae described above. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  3. Idufirma Silicon Valleyta / Susan Adams

    Index Scriptorium Estoniae

    Adams, Susan

    2014-01-01

    Tarkvarafirma Apprenda toodab teenindusplatvormi tarkvara, mis võimaldab klientidel luua ja hoida käigus uusi mobiilseid ja pilvetehnoloogiapõhiseid rakendusi. Oma töötajatele pakub odavaid elamispindu ja madalaid makse

  4. 77 FR 2720 - Proposed Agreement and Covenant Not To Sue for the Colville Post & Poles Superfund Site, Stevens...

    Science.gov (United States)

    2012-01-19

    ... From the Federal Register Online via the Government Publishing Office ENVIRONMENTAL PROTECTION AGENCY Proposed Agreement and Covenant Not To Sue for the Colville Post & Poles Superfund Site, Stevens..., Seattle, Washington 98101; (206) 553-0242. Comments should refer to the Colville Post & Poles Superfund...

  5. Asymmetric [1,2] Stevens Rearrangement of (S)-N-Benzylic Proline-derived Ammonium Salts under Biphasic Conditions

    National Research Council Canada - National Science Library

    Tayama, Eiji; Nanbara, Shintaro; Nakai, Takeshi

    2006-01-01

    The Stevens rearrangement of (S)-N-benzylic proline-derived ammonium salt with cesium hydroxide in 1,2-dichloroethane is shown to proceed with a high degree of the N-to-C chirality transmission to afford the α...

  6. Stevens-Johnson syndrome induced by combined treatment: carbamazepine and cranial radiation therapy. A case of EMDART?

    Directory of Open Access Journals (Sweden)

    Anna Waśkiel

    2017-07-01

    Full Text Available Introduction . In 1988, Delattre et al. described the first case of erythema multiforme associated with phenytoin and cranial radiation therapy. In 2004, Ahmed et al. coined the term EMPACT syndrome (Erythema Multiforme associated with Phenytoin And Cranial Radiation Therapy. Case report. A 61-year-old patient with glioblastoma was admitted to our hospital with mucosal and cutaneous involvement diagnosed as Stevens-Johnson syndrome induced by combined treatment consisting of carbamazepine and radiation therapy. The cutaneous and mucosal lesions were successfully treated with prednisone and discontinuation of carbamazepine, chemotherapy and radiation therapy. Conclusions. A discussion is ongoing in the literature about a possible association between radiation therapy, anticonvulsant treatment and Stevens-Johnson syndrome. We present a rare case of Stevens-Johnson syndrome induced by carbamazepine combined with radiation therapy and suggest a new acronym – EMDART (Erythema Multiforme associated with Drug And Radiation Therapy for the description of this entity, as a wider term compared to EMPACT. The newly suggested term includes all diseases in the spectrum of erythema multiforme (also Stevens-Johnson syndrome and toxic epidermal necrolysis induced by all drugs (not only phenytoin in association with radiation therapy in all locations.

  7. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis : Are Drug Dictionaries Correctly Informing Physicians Regarding the Risk?

    NARCIS (Netherlands)

    Haddad, Cynthia; Sidoroff, Alexis; Kardaun, Sylvia H.; Mockenhaupt, Maja; Creamer, Daniel; Dunant, Ariane; Roujeau, Jean-Claude

    Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are severe drug reactions associated with high mortality and multiple incapacitating sequelae. In the past 20 years, two large multinational case control studies, published in 1995 and 2008, had identified different degrees of drug

  8. Qualidade de vida dos pacientes portadores de síndrome de Stevens-Johnson

    OpenAIRE

    Nogueira Ruth; Franca Maciel; Lobato Marcelo G.; Belfort Ricardo; Souza Camila B.; Gomes José Álvaro P.

    2003-01-01

    OBJETIVO: Avaliar a qualidade de vida dos pacientes portadores de síndrome de Stevens-Johnson. MÉTODOS: Foram avaliados 14 pacientes com SSJ no período de 1998 e 1999 no Setor de Córnea do Departamento de Oftalmologia da UNIFESP. Empregou-se o questionário S. F. 36 - pesquisa em saúde. A pontuação indica melhor condição de saúde. A mesma avaliação foi repetida quatro vezes em intervalo de três meses. RESULTADOS: As médias das médias das 4 avaliações dos 14 pacientes apresentaram importante re...

  9. Bronchiolitis obliterans complicating a pneumothorax after Stevens-Johnson syndrome induced by lamotrigine

    Directory of Open Access Journals (Sweden)

    Wu-ping Wang

    2015-03-01

    Full Text Available Bronchiolitis obliterans (BO was defined as a nonreversible obstructive lung disease in which the bronchioles are always compressed and narrowed by fibrosis or inflammation. In the severe event of lung collapse after BO, surgical intervention is often recommended, and conservative therapy is thought to be ineffective. Here, we report the case of a 9-year old girl clinically diagnosed as having bronchiolitis obliterans with abrupt occlusion of the right B4b bronchus. After a lamotrigine-induced Stevens-Johnson syndrome (SJS occurred, she presented with total collapse of the right lung on admission, which was subsequently complicated by a pneumothorax during conservative treatment, but with the re-expansion of the right upper lobe after intervention. The case indicates the possibility of reversing pulmonary atelectasis in BO. Thus, surgery may not be necessary.

  10. Bronchiolitis obliterans complicating a pneumothorax after Stevens-Johnson syndrome induced by lamotrigine.

    Science.gov (United States)

    Wang, Wu-ping; Ni, Yun-feng; Wei, Yao-ning; Li, Xiao-fei; Cheng, Qing-shu; Lu, Qiang

    2015-03-01

    Bronchiolitis obliterans (BO) was defined as a nonreversible obstructive lung disease in which the bronchioles are always compressed and narrowed by fibrosis or inflammation. In the severe event of lung collapse after BO, surgical intervention is often recommended, and conservative therapy is thought to be ineffective. Here, we report the case of a 9-year old girl clinically diagnosed as having bronchiolitis obliterans with abrupt occlusion of the right B4b bronchus. After a lamotrigine-induced Stevens-Johnson syndrome (SJS) occurred, she presented with total collapse of the right lung on admission, which was subsequently complicated by a pneumothorax during conservative treatment, but with the re-expansion of the right upper lobe after intervention. The case indicates the possibility of reversing pulmonary atelectasis in BO. Thus, surgery may not be necessary. Copyright © 2012. Published by Elsevier B.V.

  11. [Stevens-Johnson Syndrom and Toxic Epidermal Necrolysis--based on literature].

    Science.gov (United States)

    Łoboda, Joanna; Dudzik, Agata; Chomyszyn-Gajewska, Maria

    2015-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis syndrome (TEN) also known as Lyell's syndrome, are acute autoimmune dermatoses, which are potentially life threatening. They are both forms of necrotic skin reactions which causes epidermis to separate from dermis as a result of abnormal process induced by drugs or infections. Historically they were classified as a form of exudative erythema multiforme, but nowadays they are categorized as different disease entities. The reason is more severe clinical course in case of SJS and TEN, and known causes (medicines, infections). The criterion for distinguishing the two forms is based on the quantitative evaluation of the surface of affected skin. In case of SJS the affected area comprise up to 10% of body surface area, while in Lyell's syndrome it is over 30%. If affected skin surface ranges from 10% to 30%, it is defined as overlapping syndrome.

  12. International Outcomes of the Boston Type I Keratoprosthesis in Stevens-Johnson Syndrome.

    Science.gov (United States)

    Alexander, Jamie K; Basak, Samar K; Padilla, Ma Dominga B; Yu, Fei; Aldave, Anthony J

    2015-11-01

    To determine the factors influencing outcomes of Boston type I keratoprosthesis implantation in Stevens-Johnson syndrome (SJS) and to compare the results with those of individuals without SJS. This is a multicenter, retrospective, comparative consecutive case series of patients undergoing keratoprosthesis implantation in Los Angeles, Kolkata, and Manila. Statistical analysis was performed to identify significant differences in visual acuity, complications, and retention between SJS and non-SJS populations. A total of 234 keratoprosthesis procedures were performed in 209 eyes, including 40 performed in 27 eyes of 26 patients with SJS. Procedures in patients with SJS were more frequently performed as repeat keratoprostheses (33% vs. 8%, P keratoprosthesis (82% vs. 89%, P = 0.34). The Boston type I keratoprosthesis is an effective means to restore vision in individuals with SJS. Although retention failure and several postoperative complications are more common in SJS, sight-threatening complications such as endophthalmitis and retinal detachment are not.

  13. Delayed Stevens-Johnson Syndrome Secondary to the Use of Lamotrigine in Bipolar Mood Disorder.

    Science.gov (United States)

    Jha, Kunal Kishor; Chaudhary, Durgesh Prasad; Rijal, Tshristi; Dahal, Semanta

    2017-01-01

    Lamotrigine is a mood-stabilizing drug used in maintenance treatment of bipolar I disease. There are adverse effects with lamotrigine such as a headache, blurred vision, diplopia, somnolence, ataxia, dizziness, rash, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis. SJS is a life-threatening, blistering mucocutaneous disease. SJS is characterized by the presence of flat, diffuse erythematous maculopapular rashes with the involvement of <10% of the body surface area. Standard trigger is drugs including anticonvulsants, antibiotics, and Mycoplasma pneumoniae infection. We report a case where a patient developed SJS secondary to delayed-type hypersensitivity reaction after 6 months of the use of lamotrigine, while his initial response during the first 6 months did not show any sign of SJS.

  14. A case of pediatric Steven-Johnson Syndrome associated with albuterol consumption.

    Science.gov (United States)

    Maggini, Valentina; Lombardi, Niccolò; Lenti, Maria Carmela; Masi, Stefano; Trapani, Sandra; Pugi, Alessandra; Mugelli, Alessandro; Vannacci, Alfredo

    2015-07-01

    We describe a case of Steven-Johnson Syndrome (SJS) associated with albuterol exposure in a 6-year-old male. A possible contributing role of albuterol in SJS occurrence in the present case is strongly suggested by the temporal relationship between the event and the initiation of drug therapy as well as by the positive rechallenge. To the best of our knowledge, albuterol had not been previously associated with SJS in medical literature. It can be therefore possible that physicians, pediatricians in particular, probably not aware of the possible risk of albuterol-induced SJS, might underestimate skin reactions in children taking the drug, thus underreporting this kind of severe adverse drug reaction. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Combination of Steven-Johnson syndrome and neuroleptic malignant syndrome following carbamazepine therapy: a rare occurrence.

    Science.gov (United States)

    Sharma, Bhawna; Sannegowda, Raghavendra Bakki; Gandhi, Pankaj; Dubey, Parul; Panagariya, Ashok

    2013-06-11

    Stevens-Johnson syndrome (SJS) is a severe, episodic, acute mucocutaneous reaction that is most often elicited by drugs and occasionally by infections. The drugs commonly implicated as the cause of SJS are anticonvulsants, sulfonamides, non-steroidal anti-inflammatory drugs and antibiotics. Carbamazepine (CBZ) has been commonly implicated in SJS. Neuroleptic malignant syndrome (NMS) is a rare, life-threatening but potentially treatable condition. Among the neuroleptics, haloperidol (parenteral) is implicated as a most common drug for NMS. Though rare, association of NMS with CBZ and association of NMS with toxic epidermal necrolysis (TEN) in a single patient after administration of neuroleptics has been reported in the literature before. However, a combination of NMS and SJS in a single patient after administration of CBZ has not been reported so far. We present a patient with seizure who developed SJS and NMS following administration of CBZ.

  16. Trimethoprim-sulfamethoxazole-induced Steven Johnson syndrome in an HIV-infected patient.

    Science.gov (United States)

    Taqi, Syed Ahmed; Zaki, Syed Ahmed; Nilofer, Angadi Rajasab; Sami, Lateef Begum

    2012-01-01

    Trimethoprim-sulfamethoxazole (TMP/SMX) is a widely prescribed antimicrobial for the management of several uncomplicated infections. It is commonly used for the treatment and prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in the HIV-infected population. The adverse reaction to TMP/SMX is more frequent and severe in HIV-infected patients as compared to the general population. Here, we report a case of Stevens-Johnson syndrome (SJS) secondary to TMP/SMX. The patient had a generalized cutaneous reaction with involvement of the eyes, oral cavity, and genitals. He had elevated hepatic alanine aminotransferase and aspartate aminotransferase enzyme. TMP/SMX therapy was stopped and supportive treatment was started. His condition improved after eight days of stopping TMP/SMX therapy.

  17. Toxic epidermal necrolysis and Steven Johnson syndrome: 11-years experience and outcome.

    Science.gov (United States)

    Gravante, G; Delogu, D; Marianetti, M; Trombetta, M; Esposito, G; Montone, A

    2007-01-01

    Toxic epidermal necrolysis and Steven Johnson syndrome are rare diseases that usually follow drug-exposures. The authors present one retrospective study with their management and focus their retrospective analysis on finding prognostic factors. We reviewed charts of admitted patients from January 1995 to December 2005. Only those with an histologic-proved diagnosis were included in the study. Causative drugs, symptoms, management and outcome were recorded and analysed. We found 32 patients that met inclusion criteria. Mortality rate was 34.4% (11/32). Age, delay of referral, Total Burn Surface Area, white blood cells, creatinine, blood sodium, immunoglobulins therapy and more than two different types of blood bacterial species isolated were significantly correlated with death (p < 0.05). These data confirm prognostic factors already present in literature and find that the number of different bacterial species isolated from blood increase mortality. Further prospective studies are necessary to confirm these findings.

  18. Steven Feld, "Jazz Cosmopolitanism in Accra. Five Musical Years in Ghana", Duke University Press, Durham, 2013

    Directory of Open Access Journals (Sweden)

    Fabio Calzia

    2014-07-01

    Full Text Available Steven Feld non ha certo bisogno di presentazioni per il lettore italiano. Il suo ruolo di innovatore nelle discipline musicologiche è noto a tutti, sia per la sua presenza continuativa nelle Università italiane dove ha svolto numerosi seminari e conferenze, sia per l’interesse nei confronti di alcune pratiche musicali sulle quali ha svolto ricerca sul campo in Basilicata, Sardegna, Toscana. Feld è un autore tra i più interessanti del panorama internazionale e i suoi contributi alla disciplina sono tanto innovativi quanto sorprendenti; il suo classico, Sound and Sentiment, recentemente tradotto in italiano per Il Saggiatore (2009, è considerato uno dei capisaldi dell’etnomusicologia. Il suo approccio originale e creativo, tanto nella metodologia quanto nelle tecniche di documentazione, costituisce un punto di riferimento per tanti ricercatori e studenti del nostro Paese.

  19. Representations of nurses and individuals in psychological distress in the photographic exhibit USAnatomy, by Steven Klein.

    Science.gov (United States)

    Carvalho, Evanilda Souza de Santana; Araújo, Edna Maria de; Santos, Silvone Santa Bárbara da Silva; Santos, Alexandro Gesner Gomes Dos

    2016-06-01

    Objectives To analyze the representations of the nurse and individual in mental suffering portrayed in the photographic work by Steven Klein, in the USAnatomy exhibit held at the Museum of Sculpture (Museu da escultura) in São Paulo, in 2011. Methods Qualitative study carried out in 2012. Three photographs were submitted to iconographic analysis. The interpretation of the findings was based on theoretical frameworks of Foucault and Bourdieu on power relations. Results The nurse is represented as a sensual, insensitive person, with the power to control and torture while the person in psychological distress is represented as dirty, imprisoned and subjected to an asymmetrical relationship of power with the nurse. Final considerations Relationships of submission and symbolic dominance, in which the person in psychological distress has their body molded by discipline imposed by the nurse. Stereotypes of the image of the nurse oppose the ideology of the profession, which is to ensure the integrity of those being cared for.

  20. Antiepileptic Drugs-induced Stevens-Johnson syndrome: A case Series.

    Science.gov (United States)

    Trivedi, Bhavi S; Darji, Nishita H; Malhotra, Supriya D; Patel, Pankaj R

    2016-12-01

    Stevens-Johnson syndrome (SJS) is an acute life-threatening mucocutaneous reaction, characterized by extensive necrosis and detachment of the epidermis from the skin. The overall incidence of SJS is seen in five cases per million people per year. SJS is typically caused by drugs and is a kind of idiosyncratic reaction. Adverse drug reactions such an SJS have a remarkable effect on patient's safety issues. We encountered nine cases of antiepileptic drug (AED)-induced SJS, specifically with carbamazepine, oxcarbazepine, and phenytoin. To manage the reaction, the clinician withdrew the drug in all 8 cases, and in 1 case, the patient was shifted to valproate and symptomatic treatment was provided. There is still a controversy whether or not all AEDs can cause SJS. Recent studies have investigated the role of genetic factors - HLAB*502 allele in the development of AED-induced SJS in patients of Asian ancestry.

  1. Phenytoin-induced Stevens-Johnson syndrome with myocarditis: a rare case report.

    Science.gov (United States)

    Kodliwadmath, Ashwin

    2017-01-01

    Stevens-Johnson syndrome (SJS) is an acute life-threatening mucocutaneous reaction caused by excessive necrosis and detachment of the epidermis. It is commonly drug induced and phenytoin is a common precipitant. Phenytoin, an antiepileptic drug, is also known to cause myocarditis. Phenytoin causing both myocarditis and SJS in the same patient is very rare and can lead to increased morbidity and mortality. Here, we describe the case of a 43-year-old male who developed SJS and myocarditis secondary to phenytoin. In spite of aggressive resuscitative efforts, the patient could not be revived. Thus, a combination of myocarditis with SJS increases the mortality and should be considered in patients with SJS secondary to phenytoin and associated shock.

  2. Long-term Sequelae of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Yang, Che-Wen; Cho, Yung-Tsu; Chen, Kai-Lung; Chen, Yi-Chun; Song, Hsiang-Lin; Chu, Chia-Yu

    2016-05-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reactions characterized by different extents of epidermal necrosis and mucosal breakdown. A limited number of studies have reported the long-term patterns of SJS and TEN complications in patient populations over long follow-up periods. The aim of this retrospective study was to collect data on long-term sequelae in patients admitted for SJS, SJS/TEN overlap, or TEN between 1998 and 2012. Among all 102 patients eligible for analysis, the 2 most common sequelae were cutaneous and ocular problems, both with incidences of 44.1%. Visceral organ involvement was observed in 2 patients with irreversible deterioration of chronic kidney disease and in one patient with interstitial lung disease. Autoimmune disease was present in 6 patients: Sjögren's syndrome or Sjögren-like syndrome in 5 patients and concomitant systemic lupus erythematosus and Hashimoto thyroiditis in one patient.

  3. Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: A case report.

    Science.gov (United States)

    Zaidi, Maheen; Zaidi, Syeda Kashaf; Bhutto, Moomal; Umer, Mohammad Yasir

    2017-01-01

    Stevens-Johnson syndrome (SJS) is an immune mediated hypersensitivity reaction. Significant involvement of oral, nasal, eye, vaginal, urethral, GI and lower respiratory tract mucous membrane may develop. It is usually a reaction due to a medication or due to an infection. In 95 % of case reports, drugs were found to be an important cause for the development of SJS. In this case report, a 32 year old female reported chief complaint of itch skin eruptions all over the body along with erosive lesions on tongue, lips, buccal mucosa and genital mucosa. The reaction occurred after administration of augmentin (containing amoxycillin and clavulanic acid). She was treated with antimicrobials, antiallergics and conservative management. The patient improved and was discharged from the hospital. Causality assessment using Naranjo Adverse Drug Reaction Probability Scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the adverse reaction with a score of 4.

  4. Is intravenous immunoglobulin effective in toxic epidermal necrolysis and Stevens-Johnson syndrome?

    Directory of Open Access Journals (Sweden)

    Lucas Navajas

    2014-10-01

    Full Text Available Toxic epidermal necrolysis and Stevens-Johnson syndrome are severe cutaneous adverse drug reactions. Intravenous immunoglobulin is described as a therapeutic option, however its use is still controversial. Using Epistemonikos database, which is maintained by screening over 20 databases, we identified six systematic reviews, including 39 primary studies. We combined the evidence using tables for summary of findings, following the GRADE approach, and concluded there is uncertainty about the effects of intravenous immunoglobulin because the certainty of the evidence is very low; it probably leads to important adverse effects; and has high cost. Intravenous immunoglobulin should not be used outside the context of a clinical trial, or only in cases where other treatments have failed and there are no resource constraints.

  5. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis and Treatment With a Biologic: A Case Report

    Science.gov (United States)

    Chong, Ian; Chao, Alice

    2017-01-01

    Introduction One of the most dangerous dermatologic emergencies is Stevens-Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN). Although a rare disease, it can often lead to significant mortality. Case Presentation In this case report, we present a 77-year-old man who developed a sloughing rash that was secondary to a nonsteroidal anti-inflammatory drug. In addition to the recommended supportive care, the patient was treated with etanercept, a new, less commonly used intervention. Discussion We provide a brief review of SJS/TEN. Nonsteroidal anti-inflammatory drugs are a rare cause of SJS/TEN, and additionally, the use of biologics is a novel treatment modality for SJS/TEN. PMID:28488978

  6. Stevens-Johnson syndrome in patients on phenytoin and cranial radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Khafaga, Y.M.; Jamshed, A.; Allam, A.A.K.; Ezzat, A.; Gray, A.J.; Schultz, H. [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Oncology; Mourad, W.A. [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Pathology; Al Eisa, A. [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Medicine

    1999-05-01

    The use of phenytoin as a prophylactic anticonvulsant after brain surgery, particularly for brain tumors, is a common practice, regardless of whether the patient has a previous history of convulsions. This treatment policy assumes that the benefits exceed the risks. Four cases are described of adverse reactions of phenytoin during the cocomitant use of cranial radiotherapy. In one patient this proved fatal. There is increasing anecdotal support in the literature for a synergistic effect between phenytoin therapy and cranial radiotherapy that can result in the life-threatening Stevens-Johnson syndrome. While the association is uncommon, four cases within 24 months in one department suggest that the routine use of postoperative phenytoin as a prophylactic anticonvulsant in the absence of a history of seizures may not be warranted, particularly if the patient is to receive cranial radiotherapy. (orig.)

  7. Erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and phenytoin

    Energy Technology Data Exchange (ETDEWEB)

    Delattre, J.Y.; Safai, B.; Posner, J.B.

    1988-02-01

    In 15 months we encountered eight patients with intracranial tumors who developed erythema multiforme (EM) or erythema multiforme bullosa (Stevens-Johnson syndrome). All occurred shortly after use of phenytoin (DPH) and brain radiation therapy (WBRT). The clinical picture differed from the classic form of EM in that the erythema began on the scalp and spread to the extremities, progressing in three cases to extensive bullous formation. There were no cases of EM among patients who received either DPH or radiotherapy alone. The combination of DPH, WBRT, and tapering of steroids seems to predispose to EM. The pathogenesis of the disorder is probably immunologic. In the absence of seizures, anticonvulsants should not be given routinely to patients with brain tumors. When anticonvulsants are necessary in patients scheduled for WBRT, DPH may not be the drug of choice.

  8. Burn unit care of Stevens Johnson syndrome/toxic epidermal necrolysis: A survey.

    Science.gov (United States)

    Le, Hong-Gam; Saeed, Hajirah; Mantagos, Iason S; Mitchell, Caroline M; Goverman, Jeremy; Chodosh, James

    2016-06-01

    Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a systemic disease that can be associated with debilitating acute and chronic complications across multiple organ systems. As patients with acute SJS/TEN are often treated in a burn intensive care unit (BICU), we surveyed burn centers across the United States to determine their approach to the care of these patients. The goal of our study was to identify best practices and possible variations in the care of patients with acute SJS/TEN. We demonstrate that the method of diagnosis, use of systemic therapies, and involvement of subspecialists varied significantly between burn centers. Beyond supportive care provided to every patient, our data highlights a lack of standardization in the acute care of patients with SJS/TEN. A comprehensive guideline for the care of patients with acute SJS/TEN is indicated. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  9. Incidence of Stevens-Johnson Syndrome and Chemical Burns to the Eye.

    Science.gov (United States)

    White, Michelle L; Chodosh, James; Jang, Jisun; Dohlman, Claes

    2015-12-01

    This population-based observational study was designed to estimate the incidence and distribution of SJS-spectrum (Stevens-Johnson syndrome, toxic epidermal necrolysis, and toxic epidermal Necrolysis/Stevens-Johnson syndrome overlap) and chemical burns (alkali or acid burn of the cornea/conjunctiva) in the United States and extrapolate these numbers to the world. All patients evaluated in 961 hospital-based US emergency departments between July 1, 2010, and June 30, 2012 were identified retrospectively using the Nationwide Emergency Department Sample (NEDS) from the Agency for Healthcare Research and Quality. SJS-spectrum and chemical burn cases were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. A mean of 3834 new SJS-spectrum cases per year were identified in the United States, resulting in an incidence rate of 12.35 new cases per million per year. Similarly, a mean of 15,865 new chemical burn cases per year were identified, resulting in an incidence rate of 51.10 new cases per million per year. If the incidence of SJS-spectrum is approximately uniform the world-over, extrapolation from the US figure would amount to approximately 86,500 new cases per year in the world. Extrapolation of ocular chemical burns to the world is difficult because the incidence and severity are anticipated to be higher in the developing world than in the United States. Still, using a US incidence rate, a minimum of 357,710 burn accidents would be expected to occur worldwide every year; there are presently too few data available to calculate the degree of severity and bilaterality.

  10. Endoscopic cyclophotocoagulation in refractory glaucoma after osteo-odonto-keratoprosthesis in Stevens-Johnson syndrome: a case report.

    Science.gov (United States)

    Forlini, Matteo; Adabache-Guel, Tania; Bratu, Adriana; Rossini, Paolo; Mingaine, Mpekethu Sam; Cavallini, Gian Maria; Forlini, Cesare

    2014-01-01

    To report successful treatment of refractive glaucoma in a patient submitted to osteo-odonto-keratoprosthesis surgery for Stevens-Johnson syndrome. An interventional case report. The patient is a 62-year-old Indian man with known Stevens-Johnson syndrome since 1972 secondary to tetracycline therapy, with bilateral dry eye and corneal blindness. He underwent symblepharon release surgery with mucous membrane graft in both eyes. Osteo-odonto-keratoprosthesis surgery was later performed on the left eye. He was submitted to 2 Ahmed valve implants to control secondary glaucoma but visual fields continued to worsen; hence, he underwent endoscopic 140° cyclophotocoagulation with a good control of IOP. Endoscopic cyclophotocoagulation as alternative treatment provides good results in refractory glaucoma after osteo-odonto-keratoprosthesis surgery.

  11. Stevens - Johnson Syndrome Induced by Combination of Lamotrigine and Valproic Acid in a 9-Year-Old Boy

    LENUS (Irish Health Repository)

    Maduemem, K

    2017-06-01

    We describe the case history of a 9-year-old boy who developed Stevens-Johnson syndrome (SJS) following concomitant use of valproic acid and lamotrigine. He presented with rash and fever several weeks after introduction of lamotrigine, having been on valproic acid for seizure disorder. SJS happens to be one of the rare adverse reactions of antiepilepsy drugs (AED). Management is mainly supportive with care escalation when necessary because of the significant morbidity.

  12. Interleukin-15 Is Associated with Severity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Su, Shih-Chi; Mockenhaupt, Maja; Wolkenstein, Pierre; Dunant, Ariane; Le Gouvello, Sabine; Chen, Chun-Bing; Chosidow, Olivier; Valeyrie-Allanore, Laurence; Bellon, Teresa; Sekula, Peggy; Wang, Chuang-Wei; Schumacher, Martin; Kardaun, Sylvia H; Hung, Shuen-Iu; Roujeau, Jean-Claude; Chung, Wen-Hung

    2017-05-01

    Early diagnosis and prognosis monitoring for Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN) still remain a challenge. This study aims to explore any cytokine/chemokine with prognostic potential in Stevens-Johnson syndrome/TEN. Through screening a panel of 28 serological factors, IL-6, IL-8, IL-15, tumor necrosis factor-α, and granulysin were upregulated in patients with Stevens-Johnson syndrome/TEN and selected for the further validation in total 155 patients with Stevens-Johnson syndrome/TEN, including 77 from Taiwan and 78 from the Registry of Severe Cutaneous Adverse Reactions. Among these factors evaluated, the levels of IL-15 (r = 0.401; P < 0.001) and granulysin (r = 0.223; P = 0.026) were significantly correlated with the disease severity in 112 samples after excluding patients with insufficient data to calculate the score of TEN. In addition, IL-15 was also associated with mortality (P = 0.002; odds ratio, 1.09; 95% confidence interval, 1.03-1.14; P = 0.001; adjusted odds ratio, 1.10; 95% confidence interval, 1.04-1.16). Consistent results were obtained after the exclusion of Taiwanese patients with sepsis to rule out possible confounders. Moreover, IL-15 was shown to enhance cytotoxicity of cultured natural killer cells and blister cells from patients with TEN. Our findings highlight a usefulness of IL-15 in prognosis monitoring and therapeutic intervention of this devastating condition. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Fever in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Pediatric Cases: Laboratory Work-up and Antibiotic Therapy.

    Science.gov (United States)

    Paulmann, Maren; Mockenhaupt, Maja

    2017-05-01

    Fever is a symptom that often accompanies skin eruptions, especially in children. It can be a sign of an infectious condition presenting with exanthems or it may precede an exanthematous eruption. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe reactions affecting skin and mucosa with blisters and erosions. High fever occurs in these conditions, frequently before the skin and/or mucosa is affected.

  14. Clinical, Etiologic, and Histopathologic Features of Stevens-Johnson Syndrome During an 8-Year Period at Mayo Clinic

    Science.gov (United States)

    Wetter, David A.; Camilleri, Michael J.

    2010-01-01

    OBJECTIVE: To examine clinical, etiologic, and histologic features of Stevens-Johnson syndrome and to identify possible correlates of clinical disease severity related to etiologic and histopathologic findings. PATIENTS AND METHODS: This is a retrospective review of patients seen at Mayo Clinic between January 1, 2000, and December 31, 2007. RESULTS: Of 27 patients (mean age, 28.1 years), 22 (81%) had involvement of 2 or more mucous membranes, and 19 (70%) had ocular involvement. Medications, most commonly antibiotics and anticonvulsants, were causative in 20 patients. Mycoplasma pneumoniae infection caused 6 of the 27 cases. Corticosteroids were the most common systemic therapy. No patients with mycoplasma-induced Stevens-Johnson syndrome had internal organ involvement or required treatment in the intensive care unit, in contrast to 4 patients each in the drug-induced group. Three patients had chronic ocular sequelae, and 1 died of complications. Biopsy specimens from 13 patients (48%) showed epidermal necrosis (8 patients), basal vacuolar change (10 patients), and subepidermal bullae (10 patients). Biopsy specimens from 11 patients displayed moderate or dense dermal infiltrate. Histologic features in drug-induced cases included individual necrotic keratinocytes, dense dermal infiltrate, red blood cell extravasation, pigment incontinence, parakeratosis, and substantial eosinophils or neutrophils. CONCLUSION: Our clinical and etiologic findings corroborate those in previous reports. M pneumoniae—induced Stevens-Johnson syndrome manifested less severely than its drug-induced counterpart. The limited number of biopsies precludes unequivocal demonstration of histopathologic differences between drug-induced and M pneumoniae—induced Stevens-Johnson syndrome. PMID:20118388

  15. UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016.

    Science.gov (United States)

    Creamer, D; Walsh, S A; Dziewulski, P; Exton, L S; Lee, H Y; Dart, J K G; Setterfield, J; Bunker, C B; Ardern-Jones, M R; Watson, K M T; Wong, G A E; Philippidou, M; Vercueil, A; Martin, R V; Williams, G; Shah, M; Brown, D; Williams, P; Mohd Mustapa, M F; Smith, C H

    2016-06-01

    The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the diagnosis and management of the full spectrum of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS-TEN overlap in adults during the acute phase of the disease. The document aims to. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Threshold Studies of Heated HMX-Based Energetic Material Targets Using the Steven Impact Test

    Energy Technology Data Exchange (ETDEWEB)

    Switzer, L L; Vandersall, K S; Chidester, S K; Greenwood, D W; Tarver, C M

    2003-07-01

    Impact tests performed at low velocity on heated energetic material samples are of interest when considering the situation of energetic materials involved in a fire. To determine heated reaction thresholds, Steven Test targets containing PBX 9404 or LX-04 samples heated to the range of 150-170 C were impacted at velocities up to 150 m/s by two different projectile head geometries. Comparing these measured thresholds to ambient temperature thresholds revealed that the heated LX-04 thresholds were considerably higher than ambient, whereas the heated PBX 9404 thresholds were only slightly higher than the ambient temperature thresholds. The violence of reaction level of the PBX 9404 was considerably higher than that of the LX-04 as measured with four overpressure gauges. The varying results in these samples with different HMX/binder configurations indicate that friction plays a dominant role in reaction ignition during impact. This work outlines the experimental details, compares the thresholds and violence levels of the heated and ambient temperature experiments, and discusses the dominant mechanisms of the measured thresholds.

  17. Infectious Keratitis in Limbal Stem Cell Deficiency: Stevens-Johnson Syndrome Versus Chemical Burn.

    Science.gov (United States)

    Kang, Byeong Soo; Kim, Mee Kum; Wee, Won Ryang; Oh, Joo Youn

    2016-01-01

    To investigate the incidence, clinical and microbiological characteristics, risk factors, and therapeutic outcome of infectious keratitis in patients with limbal stem cell deficiency (LSCD) related to Stevens-Johnson syndrome (SJS) and corneal chemical burn. Medical records of 90 eyes of 59 patients who were diagnosed with LSCD resulting from SJS (52 eyes of 29 patients) or corneal chemical burn (38 eyes of 30 patients) were reviewed. Infectious keratitis developed in 35% of LSCD patients with SJS (18 eyes, 14 patients) and in 18% of those with chemical burn (7 eyes, 7 patients). The development of infectious keratitis in SJS was significantly associated with the severity of chronic ocular surface complications in the cornea, conjunctiva, and eyelids and with the use of topical corticosteroids during the disease course. All cases of infectious keratitis following chemical burn occurred in patients with grade III or IV burn by Roper-Hall classification. Approximately 83% of culture-proven cases of infectious keratitis were bacterial infection, most of which (80%) were caused by Gram-positive bacteria. For resolution of infection, 17 eyes (68%) received surgery in addition to medical treatment, whereas 8 eyes (32%) received medical treatment alone. After infection resolution, the final visual acuity was decreased in 10 eyes (40%) compared with before infection. Infectious keratitis is a common complication of LSCD associated with SJS or severe chemical burn to the cornea. Despite medical and surgical treatments, the visual outcome is poor.

  18. Contemporary perspectives in aesthetic theory: Steven Connor, Sianne Ngai and the edible world

    Directory of Open Access Journals (Sweden)

    Tom Lee

    2016-07-01

    Full Text Available This article interprets the work of cultural theorists Steven Connor and Sianne Ngai in terms of their efforts to reevaluate certain key presumptions of aesthetic theory that inherits the surprisingly resilient biases of the 18th century, in particular the work of Immanuel Kant and Edmund Burke. Focusing on the work of Ngai and Connor, I think through the implications this recent theory has for the previously peripheral position occupied by gustatory taste and the cultural objects and experiences it implicates. I discuss the possibility that ideas and examples drawn from the work of Connor and Ngai might form the basis for an alternative area of analysis that is better adapted to the peculiarities of gustatory taste and the culinary. In particular, I argue that the visceral element, which tends to accompany gustatory taste, ought to be interpreted in terms of its generative contribution to the creation of concepts through metaphor, rather than as a muddying influence that prevents clarity of discrimination. Similarly, the close relationship between the edible and the domestic is deserving of a more generous reading than is commonly found in aesthetic theory underwritten by the categories of the sublime and the beautiful.

  19. Bicycles, Airplanes and Peter Pans: Flying Scenes in Steven Spielberg's Films

    Directory of Open Access Journals (Sweden)

    Emilio Audissino

    2014-10-01

    Full Text Available In Steven Spielberg's cinema the flight is a recurring theme. Flying scenes can be sorted into two classes: those involving a realistic flight – by aircraft – and those involving a magical flight – by supernatural powers. The realistic flight is influenced by the war stories of Spielberg's father – a radio man in U.S. Air-force during WWII – and it is featured in such films as Empire of the Sun (1987, Always (1989, and 1941 (1979. The magical flight is influenced by James M. Barries' character Peter Pan (Peter and Wendy, 1911, which is quoted directly in E.T. the Extraterrestrial (1982 and, above all, in Hook (1991, which is a sequel to Barrie's story. These two types of flying scenes are analysed as to their meanings, compared to the models that influenced them, and surveyed as to their evolution across Spielberg's films. A central case study is the episode The Mission from Amazing Stories (1985, in which the realistic and the magical flights overlap.

  20. Comorbidity of Stevens-Johnson syndrome and neutropenia associated with lamotrigine: a case report.

    Science.gov (United States)

    Yasui-Furukori, Norio; Hashimoto, Kojiro; Tsuruga, Koji; Nakamura, Kazuhiko

    2014-01-01

    A 19-year-old woman with a medical history of depressive mood arrived and was treated with lamotrigine at 25 mg/day. On day 10, a high fever of 39.3 °C and a diffuse, erythematous, pruritic full-body rash involving the palms of her hands and the soles of her feet developed, and she was diagnosed with Stevens-Johnson syndrome (SJS). On day 17, white blood cell count (WBC) result was 1,240/μl with 54.1% neutrophils (670/μl), and the WBC decreased to 840/μl with 60.7% neutrophils (510/μl) on day 18. The trend toward improvement included skin symptoms after steroid pulse therapy using 1000 mg/day. Based on the clinical course, we concluded that the SJS and leukopenia and/or neutropenia are associated with lamotrigine. Monitoring of WBC should be kept in mind when administering lamotrigine. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Phenytoin induced Steven-Johnson syndrome and bronchiolitis obliterans - case report and review of literature.

    Science.gov (United States)

    Pannu, Bibek S; Egan, Ashley M; Iyer, Vivek N

    2016-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both rare but serious idiosyncratic drug reactions characterized by diffuse muco-epidermoid injury and high mortality. Keratinocytes in both skin and mucous membranes (including eyes, mouth and genitalia) are injured resulting in a diffuse maculopapular rash, blistering lesions and epithelial detachment with minimal force (Nikolsky's sign). SJS is typically diagnosed when less than 10% of the skin surface is involved and the term TEN is used in cases with more than 30% involvement. Respiratory involvement in SJS-TEN is common with 30-50% of cases demonstrating respiratory epithelial sloughing with severe short and long term complications. Patients who survive SJS-TEN are often left with impaired respiratory function and bronchiolitis obliterans. Cases of bronchiolitis obliterans with SJS/TEN have been very rarely reported. We report a case of phenytoin induced SJS/TEN followed by severe bronchiolitis obliterans in an adult patient. The presentation, pathophysiology and management of SJS/TEN related bronchiolitis obliterans is also reviewed.

  2. Mucous membrane grafting for the post-Steven-Johnson syndrome symblepharon: A case report

    Directory of Open Access Journals (Sweden)

    Jayanta Kumar Das

    2011-01-01

    Full Text Available An 18-year-old woman was referred with late sequelae of chloroquine-induced Steven-Johnson syndrome. At the time of presentation, the symblepharon was involving the upper lids to almost the whole of the cornea, and part of the lower bulbar conjunctiva with the lower lid bilaterally. Other ocular examinations were not possible due to the symblepharon. B-scan ultrasonography revealed acoustically clear vitreous, normal chorioretinal thickness, and normal optic nerve head, with an attached retina. Conjunctivo-corneal adhesion released by superficial lamellar dissection of the cornea. Ocular surface reconstruction was carried out with a buccal mucous membrane. A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization. Best corrected visual acuity of 20/120 in both sides after 1 month and 20/80 after 3 months was achieved and maintained till the 2.5-year follow-up.

  3. A Tribute to Professor Steven L. Wechsler (1948-2016): The Man and the Scientist.

    Science.gov (United States)

    Nesburn, Anthony B; BenMohamed, Lbachir

    2017-01-01

    Professor Steven L. Wechsler, a world-renowned eye researcher and virologist, passed away unexpectedly on June 12, 2016 at the age of 68. Many scientists came to know Professor Wechsler as a gifted researcher in the field of ocular Herpes Simplex Virus (HSV-1) latency, reactivation, and pathogenesis. Professor Wechsler published over 150 peer-reviewed scientific papers during his career, pushing forward the frontiers of his field eye research. His colleagues would say, 'Steve literally wrote the book on herpes latency and reactivation.' He was the first to show that the HSV-1 latency-associated transcript (LAT) is essential for the HSV-1 high spontaneous reactivation phenotype and that LAT has anti-apoptosis activity. This discovery of LAT's anti-apoptosis activity, which is a key factor in how the LAT gene enhances reactivation, was published in Science in 2000 and created a new paradigm that greatly increased understanding of HSV-1 latency and reactivation. In collaboration with Professor Lbachir BenMohamed, an immunologist, they later demonstrated that LAT also acts as an immune evasion gene. He was a caring scientist who truly enjoyed working and sharing his experience and expertise with young researchers. He will be remembered as a significant pillar within scientific and ocular herpes research communities worldwide. Professor Wechsler's dedication to science, his compassionate character, and wonderful sense of humor were exemplary. We, who were his friends and colleagues, will mourn his passing deeply.

  4. Mucous membrane grafting for the post-Steven-Johnson syndrome symblepharon: a case report.

    Science.gov (United States)

    Das, Jayanta Kumar; Medhi, Jnanankar; Chakravarty, Ranjay; Soibam, Ronel

    2011-01-01

    An 18-year-old woman was referred with late sequelae of chloroquine-induced Steven-Johnson syndrome. At the time of presentation, the symblepharon was involving the upper lids to almost the whole of the cornea, and part of the lower bulbar conjunctiva with the lower lid bilaterally. Other ocular examinations were not possible due to the symblepharon. B-scan ultrasonography revealed acoustically clear vitreous, normal chorioretinal thickness, and normal optic nerve head, with an attached retina. Conjunctivo-corneal adhesion released by superficial lamellar dissection of the cornea. Ocular surface reconstruction was carried out with a buccal mucous membrane. A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization. Best corrected visual acuity of 20/120 in both sides after 1 month and 20/80 after 3 months was achieved and maintained till the 2.5-year follow-up.

  5. Diff-Quik cytologic recognition of Chlamydophila psittaci in orolabial lesions of Stevens-Johnson Syndrome.

    Science.gov (United States)

    Reyes, Cesar V

    2010-01-01

    Chlamydophila psittaci causes psittacosis, an ornithosis acquired usually from infected birds. The disease is often focal and pneumonic but on rare instances can be protean and fatal. Diagnosis is by Chlamydophila serology, which may take as long as 21 days or more. The recovery of the organisms from mice, eggs or tissue culture inoculated with the patient's blood or sputum is tedious and dangerous for laboratory personnel. On occasion, C psittaci inclusion bodies have also been detected in infected cells by fluorescent antibody, Giemsa or Gimenez staining. This report describes heretofore not previously reported recognition of the causative organisms in Diff-Quik-stained clinical cytologic materials. A 17-year-old man presented with fever and sore throat, associated with Steven-Johnson syndrome, of 6 days' duration. In the touch and scrape smears of the orolabial mucosal lesions, C psittaci inclusion bodies were recognizable in Diff-Quik-stained but not with Papanicolaou-stained smears and Gram stain. There were few to numerous organisms per macrophage, which were enlarged or bloated and usually collared by polymorphonuclear leukocytes. The diagnosis was supported by a therapeutic trial with doxycycline and confirmed by a positive third serological tests for C psittaci 3 weeks after discharge. In a suspected or probable case of ornithosis, a rapid diagnosis of C psittaci inclusion bodies is possible in clinical cytology materials using Diff-Quik.

  6. Lectures on quantum mechanics; Quantenmechanik. Eine Einfuehrung des Nobelpreistraegers Steven Weinberg

    Energy Technology Data Exchange (ETDEWEB)

    Weinberg, Steven [Texas Univ., Austin, TX (United States). Dept. fuer Physik und Astronomie

    2015-07-01

    Quantum mechanics represents the central revolution of modern natural science and reaches in its importance farely beyond physics. Neither chemistry nor biology on the molecular scale would be understandable without it. Modern information technology from the laptop over the mobile telephone and the flat screen until the supercomputer would be unthinkable without quantum-mechanical effects. It desribes the world on the atomic and subatomic scale and is by this the starting point of our modern worldview. The Nobel-prize carrier Steven Weinberg has done ever among others by his theory of the unification of the weak and the electromagnetic interaction one of the most important contributions to this revolution. In this book he reproduces his personal view of quantum mechanics, which captivates by its strictly logic construction, precise linguistic representation, and mathematical clearness and completeness. This book appeals to studyings of natural sciences, especially of physics. Accompanied is the test by exercise problems, which allow the studying to apply immediately the knowledge, but also test their understanding. Because of its precision and clearness ''Lectures on Quantum Mechanics'' by Weinberg is also essentially suited for the self-study.

  7. Stevens-Johnson syndrome/erythema multiforme major and Chlamydia pneumoniae infection in young patients.

    Science.gov (United States)

    Duarte, Ana Filipa; Cruz, Maria João; Moreira, Elisabete; Baudrier, Teresa; Mota, Alberto; Azevedo, Filomena

    2010-01-18

    Erythema multiforme major (EMM) is an acute, self-limited mucocutaneous disease characterized by the abrupt onset of symmetrical fixed red papules evolving to target lesions. It is triggered mainly by infections, such as herpes simplex virus (HSV) and Mycoplasma pneumoniae, or drugs. In instances of extensive skin lesions with "giant" targets, prominent involvement of several mucous sites and fever, it may be difficult to distinguish from Stevens-Johnson syndrome (SJS), a rarer, life-threatening reaction which is mainly drug-induced. We report a 7-year old boy with SJS and Chlamydia pneumoniae infection and 3 patients with erythema multiforme (EM) and co-infection with Chlamydia pneumoniae: a 3-year old girl and a 29-year old man developed EMM lesions associated to Mycoplasma pneumoniae and Chlamydia pneumonia and a 20-year old woman with EMM associated to herpes simplex type 2 and Chlamydia pneumoniae infection. None of the 4 patients had history of drug intake in the last two months. Chlamydia pneumoniae is an intracellular bacteria responsible for respiratory infections. Despite the fact that its role in SJS/EMM has been rarely reported, our cases suggest that it may cause SJS and trigger EM when co-infecting a patient, either with Mycoplasma pneumoniae or herpes simplex. We conclude that infection by Chlamydia pneumoniae should be suspected and ruled out in every patient with SJS/EMM, especially in those with signs of respiratory infection.

  8. Stevens-Johnson syndrome induced by the cross-reactivity between teicoplanin and vancomycin.

    Science.gov (United States)

    Yang, L-P; Zhang, A-L; Wang, D-D; Ke, H-X; Cheng, Q; Wang, C

    2014-08-01

    The glycopeptide antibiotics, vancomycin and teicoplanin, are the mainstay of therapy for severe gram-positive organisms such as methicillin-resistant Staphylococcus aureus. We report a case of Stevens-Johnson syndrome (SJS) induced by sequential therapy with teicoplanin and vancomycin, in a patient with chronic obstructive pulmonary disease (COPD). A 74-year-old Han Chinese with 1-year history of COPD was admitted for treatment of infective endocarditis. After teicoplanin therapy for 12 days, he developed pruritus and maculopapular over his trunk and limbs. His rash spread rapidly to most parts of the body surface area, 7 days after his anti-infection therapy was switched to vancomycin. This was stopped, but he developed SJS when teicoplanin was re-introduced. This patient recovered from his drug eruptions when both teicoplanin and vancomycin were stopped. Pharmacogenetic analyses revealed he was heterozygous with respect to two variants (rs2844682 of MUC21 and rs750332 of BAG6). Cross-reactivity between vancomycin and teicoplanin is rare. SJS attributable to sequential treatment with these two antibiotics has not been reported previously. Care should be taken when prescribing vancomycin in patients with a previous documented skin eruption to teicoplanin, especially in those who carry any susceptibility alleles to SJS/TEN. © 2014 John Wiley & Sons Ltd.

  9. Stevens-Johnson syndrome in a patient receiving anticonvulsant therapy during cranial irradiation.

    Science.gov (United States)

    Eralp, Y; Aydiner, A; Taş, F; Saip, P; Topuz, E

    2001-08-01

    A 28-year-old female patient with a recent history of breast carcinoma was referred to our clinic with generalized necrotic skin eruptions and severe mucosal erosions, which developed right after the completion of cranial radiotherapy for brain metastases. She had been receiving prophylactic diphenylhydantoin treatment 100 mg three times daily during radiation therapy. The extensive involvement of the oral mucosa with conjunctivitis and synechiae of the eyelids, facial swelling, and extension of the rash over the trunk and shoulders with bullous detachment of less than 10% of the total body surface strongly suggested Stevens-Johnson syndrome caused by phenytoin treatment in our patient. There has been conflicting evidence on the role of radiotherapy in the increased risk of severe drug reactions. Although various authors have emphasized the augmented rate of severe mucocutaneous reactions caused by anticonvulsants given during radiotherapy and suggested discontinuing the prophylactic use of such drugs in patients with no history of seizures, others have argued in favor of prophylactic anticonvulsants. Given the high risk of seizures, reaching 20% in patients with brain tumors, and the low incidence of drug reactions, the suggestion of refraining from prophylactic anticonvulsants in the setting of primary or metastatic brain tumors is controversial.

  10. Role of Scleral Contact Lenses in Management of Coexisting Keratoconus and Stevens-Johnson Syndrome.

    Science.gov (United States)

    Rathi, Varsha M; Taneja, Mukesh; Dumpati, Srikanth; Mandathara, Preeji S; Sangwan, Virender S

    2017-10-01

    To report the rare coexistence of keratoconus and Stevens-Johnson syndrome (SJS) managed with scleral contact lenses (ScCLs). This is a retrospective case series. Five patients (9 eyes) who had coexisting SJS and corneal ectasia were identified from the database during the 2-year period. Diagnosis of SJS was based on a positive history of drug reactions, signs of ocular surface disease, and the presence of keratinization of lid margins. Keratoconus was diagnosed by slit-lamp biomicroscopy. Five eyes of 3 patients had coexisting SJS and keratoconus and were dispensed with ScCLs (PROSE, prosthetic replacement of the ocular surface ecosystem; Boston Foundation for Sight, Needham Heights, MA). All these patients had photophobia. Visual acuity improved in all these patients with ScCL wear. Two patients (4 eyes) were excluded from this study because they had SJS with generalized corneal thinning from limbus to limbus, corneal opacification, and pannus. One patient developed deep vessels in the cornea on prolonged ScCL wear. Reduction in the ScCL wear schedule and change of material with a higher Dk resulted in regression of vascularization. Case 3 developed conjunctival congestion and was uncomfortable wearing ScCLs, although visual acuity was 20/40. He discontinued using ScCL wear. Keratoconus, a noninflammatory condition of the cornea coexisted with inflammatory SJS. Managing such patients with ScCLs may improve vision and comfort.

  11. Effect of Infectious Diseases on the Pathogenesis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Okamoto-Uchida, Yoshimi; Nakamura, Ryosuke; Sai, Kimie; Imatoh, Takuya; Matsunaga, Kayoko; Aihara, Michiko; Saito, Yoshiro

    2017-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reactions. Recent studies have revealed that the prevalence of SJS/TEN is associated with genetic backgrounds, such as polymorphisms in human leukocyte antigens (HLAs). However, non-genetic factors contributing to the etiology of SJS/TEN are largely unknown. This study aimed to assess the involvement of concurrent infection on the pathological states of SJS/TEN, examining the severity of cutaneous symptoms and ocular involvement as well as the time to onset in drug-induced SJS/TEN patients. We recruited 257 Japanese SJS/TEN patients from June 2006 to September 2013 through a nationwide case collection network and participating hospitals and reviewed the clinical information including patient backgrounds, primary disease and medication status. Association between infection and pathological states of SJS/TEN was assessed using univariate and multivariate analyses. The concurrent infectious group of SJS/TEN patients showed a significantly higher rate of exhibiting severer dermatological and ophthalmological phenotypes and an earlier onset of SJS/TEN than the non-infectious group. Our results suggest that the infection could be a risk factor to cause severer symptoms and earlier onset of SJS/TEN.

  12. The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the UK.

    Science.gov (United States)

    Frey, Noel; Jossi, Janine; Bodmer, Michael; Bircher, Andreas; Jick, Susan S; Meier, Christoph R; Spoendlin, Julia

    2017-06-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening mucocutaneous diseases. SJS/TEN mostly manifest as a reaction to new drug use, but little is known about their incidence and epidemiology. We conducted a large observational study on the epidemiology of SJS/TEN using data from the UK-based Clinical Practice Research Datalink. Among 551 validated SJS/TEN patients, we calculated an incidence rate of 5.76 SJS/TEN cases per million person-years between 1995 and 2013, which was consistent throughout the study period and was highest in patients aged 1-10 years and 80 years or older. Within a 1:4 matched case-control analysis, black and Asian patients were at a 2-fold risk of SJS/TEN when compared with white patients. Among patients with epilepsy and gout, odds ratios for SJS/TEN were significantly increased only in the presence of recent new drug treatment with antiepileptics or allopurinol, respectively. We observed statistically significant associations between SJS/TEN and pre-existing depression, lupus erythematosus, recent pneumonia, chronic kidney disease, and active cancer, but confounding by drug use needs to be followed up. This large and longitudinal observational study on the epidemiology of SJS/TEN contributes to the understanding of this still underinvestigated severe skin disease in a European and largely white study population. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective

    Science.gov (United States)

    2013-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) to drugs which are associated with significant morbidity and mortality. High risk drugs in Asia are similar to those reported worldwide. Human leukocyte antigen (HLA)-related risk alleles for carbamazepine and allopurinol SCAR are unique to Asians. Although prognostic scoring systems like the SCORTEN have been used for more than a decade, pitfalls and caveats need to be recognized, in particular in patients with multiple medical co-morbidities and systemic features in SJS/TEN. In centres without a tertiary Burns Centre, SJS/TEN patients can still be managed successfully in general and dermatology wards with well-executed supportive/nursing care. Controversy remains regarding the effectiveness of immunomodulation in reducing SJS/TEN morbidity, mortality and hastening re-epithelialization. Despite paucity of robust evidence, intravenous immunoglobulins and ciclosporin remain the most commonly used modalities worldwide. Acute and long-term ocular effects are an important source of morbidity for which emerging ophthalmic therapies appear promising. Quality of life issues have now become an important outcome in patients with SJS/TEN as they often impact survivors' future attitudes towards pharmacotherapy. Even though pharmacogenetic testing for high-risk drugs appears to be the panacea for preventing carbamazepine- and allopurinol-induced SJS/TEN in ethnic Asians, many issues remain before health regulators in our region can conclusively determine whether testing should be made mandatory or highly recommended as standard of care. PMID:24260726

  14. Infliximab after Boston Keratoprosthesis in Stevens-Johnson Syndrome: An Update.

    Science.gov (United States)

    Robert, Marie-Claude; Črnej, Alja; Shen, Lucy Q; Papaliodis, George N; Dana, Reza; Foster, C Stephen; Chodosh, James; Dohlman, Claes H

    2017-06-01

    To report our experience using intravenous infliximab for the treatment of tissue melt after Boston keratoprosthesis (B-KPro) types I and II in patients with autoimmune disease. Case series. We identified four patients who were treated with intravenous infliximab in the context of tissue melt after B-KPro. Stevens-Johnson syndrome-associated corneal blindness was the primary surgical indication for B-KPro implantation in all patients. Two patients received a B-KPro type I and two patients received a B-KPro type II. The patients received intravenous infliximab for skin retraction around B-KPro type II, melting of the carrier graft or leak. Treatment resulted in a dramatic decrease in inflammation and, in some cases, arrest of the melting process. Cost and patient adherence were limiting factors to pursuing infliximab therapy. In addition, one patient developed infusion reactions. Intravenous infliximab may be considered as globe- and sight-saving therapy for tissue melt after B-KPro.

  15. Genetic Markers and Danger Signals in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

    Directory of Open Access Journals (Sweden)

    Wen-Hung Chung

    2010-01-01

    Full Text Available Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are life-threatening adverse reactions, which could be induced by a variety of drugs. It was proposed that human leukocyte antigen (HLA-restricted presentation of antigens (drugs or their metabolites to T lymphocytes initiates the immune reactions of SJS/ TEN. However, the genetic susceptibility and the exact pathogenesis were not clear until the recent studies. We first identified that HLA-B*1502 is strongly associated with carbamazepine (CBZ-induced SJS/TEN and HLA-B*5801 with allopurinol-SJS/TEN in Han Chinese. The same associations had been validated across different human populations. For the downstream danger signals, Fas-Fas ligand (FasL and perforin/granzyme B had been advocated as cytotoxic mediators for keratinocyte death in SJS/TEN. However, expression levels of these cytotoxic proteins from the skin lesions were too low to explain the distinct and extensive epidermal necrosis. Our recent study identified that the granulysin, a cytotoxic protein released from cytotoxic T cells or natural killer (NK cells, is a key mediator for disseminated keratinocyte death in SJS/TEN. This article aims to provide an overview of both of the genomic and immunologic perspectives of SJS/TEN. These studies give us a better understanding of the immune mechanisms, biomarkers for disease prevention and early diagnosis, as well as providing the therapeutic targets for the treatments of SJS/TEN.

  16. The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China

    Directory of Open Access Journals (Sweden)

    Shang-Chen Yang

    2018-01-01

    Full Text Available Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5% and anticonvulsants (24.1%. Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%. Chinese patent medicines accounted for 5.4%. There were 76 (45.8% patients receiving systemic steroid and intravenous immunoglobulin (IVIG in combination therapy, especially for TEN (80.3%, and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.

  17. Overlapping DRESS and Stevens-Johnson Syndrome: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Aneline Casagranda

    2017-05-01

    Full Text Available Drug-induced severe cutaneous adverse reactions (SCARs include acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms (DRESS, and epidermal necrolysis (Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis. The identification of the causal drug is crucial in order to avoid further exposure, but making the right differential diagnosis of the type of SCAR is equally important since treatment, follow-up, and prognosis of different SCARs are not the same. These syndromes are distinct entities with different clinical, biological, and histological patterns, but sometimes the early distinction between 2 SCARs can be extremely challenging, and overlapping conditions could therefore be taken into consideration, although true overlapping SCARs are very rare when using strict diagnostic criteria (described by the RegiSCAR group. Only a better understanding of the physiopathology of the SCARs could possibly explain these ambiguities and overlaps. We report a case of SCAR in an 86-year-old patient probably induced by allopurinol and simultaneously fulfilling the diagnostic criteria for DRESS and SJS, thus considered as an overlapping case of SCARs.

  18. Overlapping DRESS and Stevens-Johnson Syndrome: Case Report and Review of the Literature.

    Science.gov (United States)

    Casagranda, Aneline; Suppa, Mariano; Dehavay, Florence; Del Marmol, Véronique

    2017-01-01

    Drug-induced severe cutaneous adverse reactions (SCARs) include acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms (DRESS), and epidermal necrolysis (Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis). The identification of the causal drug is crucial in order to avoid further exposure, but making the right differential diagnosis of the type of SCAR is equally important since treatment, follow-up, and prognosis of different SCARs are not the same. These syndromes are distinct entities with different clinical, biological, and histological patterns, but sometimes the early distinction between 2 SCARs can be extremely challenging, and overlapping conditions could therefore be taken into consideration, although true overlapping SCARs are very rare when using strict diagnostic criteria (described by the RegiSCAR group). Only a better understanding of the physiopathology of the SCARs could possibly explain these ambiguities and overlaps. We report a case of SCAR in an 86-year-old patient probably induced by allopurinol and simultaneously fulfilling the diagnostic criteria for DRESS and SJS, thus considered as an overlapping case of SCARs.

  19. El primer paso del proceso creativo en la obra de Wallace Stevens y José Ángel Valente: "Notes on a Supreme Fiction" y "Cinco fragmentos para Antoni Tàpies"

    OpenAIRE

    Rodríguez Guerrero, Santiago

    2012-01-01

    Wallace Stevens y José Ángel Valente comparten ideas acerca del proceso creativo tales como la descreación o la importancia del amanecer. Esto no debe sorprender pues valente leyó a stevens quien pudo convertirse en un modelo importante para él. El términ Wallace Stevens and José Ángel Valente share some ideas, such as decreation or the role of early dawn regarding the creative process. This comes as no surprise since valente read stevens who then might have become a significant model for ...

  20. Qualidade de vida dos pacientes portadores de síndrome de Stevens-Johnson

    Directory of Open Access Journals (Sweden)

    Nogueira Ruth

    2003-01-01

    Full Text Available OBJETIVO: Avaliar a qualidade de vida dos pacientes portadores de síndrome de Stevens-Johnson. MÉTODOS: Foram avaliados 14 pacientes com SSJ no período de 1998 e 1999 no Setor de Córnea do Departamento de Oftalmologia da UNIFESP. Empregou-se o questionário S. F. 36 - pesquisa em saúde. A pontuação indica melhor condição de saúde. A mesma avaliação foi repetida quatro vezes em intervalo de três meses. RESULTADOS: As médias das médias das 4 avaliações dos 14 pacientes apresentaram importante redução dos seus valores em todos os subitens do S.F. 36 (41,04±22,38 para aspectos físicos, 53,82±22,82 para aspectos sociais, 26,24±22,46 para aspectos emocionais, 34,95±25,45 para capacidade funcional, 42,03±31,85 para dor, 46,33±18,37 para vitalidade, 46,18±24,83 para saúde mental e 50,26±16,29 para saúde geral. CONCLUSÃO: O questionário S.F. 36 representa método adequado de avaliação de aspectos físicos e emocionais em pacientes com baixa de acuidade visual, que nos permitiu detectar comprometimento importante nas funções básicas dos pacientes com SSJ. Mais pacientes com maior tempo de seguimento são necessários para aprimorar a análise de qualidade de vida nesses pacientes e avaliar os efeitos do acompanhamento psicológico.

  1. Sofosbuvir induced steven Johnson Syndrome in a patient with hepatitis C virus-related cirrhosis.

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    Verma, Nipun; Singh, Shreya; Sawatkar, Gitesh; Singh, Virendra

    2018-01-01

    Sofosbuvir is an imperative drug used in treatment regimens for hepatitis C virus (HCV). It is considered relatively safe with fewer adverse effects than other treatments. Here, we report a rare and potentially serious, dermatologic, adverse effect following the use of sofosbuvir. A 35-year-old man with genotype 3-related HCV cirrhosis presented with decompensated ascites and jaundice following 7 weeks of therapy with peginterferon alpha-2a and oral ribavirin. After peginterferon withdrawal and stabilization, oral sofosbuvir and ribavirin were started; 10 days later, he developed itching over the trunk and legs, followed by multiple papules and vesicles over an erythematous base. Over the next 15 days, the rash progressed with the formation of blisters and peeling skin. Simultaneously, the oral mucosa and lips developed crusting and painful erosions. Considering drug-induced Steven John Syndrome (SJS), sofosbuvir and ribavirin were withdrawn and the patient was treated with topical emollients, steroids, and supportive care. The lesions improved over the next 4 weeks, with some residual hyperpigmentation. Rechallenge with sofosbuvir alone at one eighth the dose resulted in similar skin and mucosal lesions after 2 months; these lesions also improved after sofosbuvir withdrawal. The Algorithm of Drug Causality for Epidermal Necrolysis score was 7, which suggested sofosbuvir as the very probable drug resulting in SJS in our patient. Conclusion: The appearance of SJS following sofosbuvir use is an important and potentially fatal complication from a drug that serves as the backbone of several HCV treatment regimens. Treating physicians must use sofosbuvir with caution and consider withholding or discontinuing this drug in patients with such severe dermatologic manifestations. ( Hepatology Communications 2018;2:16-20).

  2. Stevens Johnson Syndrome versus Jarisch Herxheimer Reaction in an HIV Positive Patient with Secondary Syphilis.

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    Micozzi, Sarah; Perez-Ezquerra, Patricia Rojas; Morales-Cabeza, Cristina; Diez, Cristina; De Barrio, Manuel

    2017-01-01

    HIV positive patients can suffer many complications due to infectious diseases. A sever drug reaction to some of the drugs involved in the treatment can overlap the symptoms of the infections, making the diagnosis very difficult. We present the case of a 28-year-old-man, HIV positive, with secondary syphilis, who developed a Stevens Johnson Syndrome (SJS) caused by one of the many drugs he received. The SJS was overlapped with a possible Jarisch Herxheimer Reaction, which complicated the diagnosis of the skin reaction. In HIV+ patients, the overlapping of severe drug reactions and infectious diseases could be fatal, thus an accurate diagnosis is mandatory. A Rapid Plasma Reagin Test (RPR), an ELISA test, a blood laboratory test, chest radiography and a skin biopsy were realized in order to diagnose the infectious disease and the cause of skin lesions. Intradermal tests and double blind challenge tests were realized in the allergy study. The laboratory tests confirmed the diagnosis of syphilis; the skin biopsy confirmed the cause of lesions, a severe allergic reaction as a SJS. The allergy study discharged all the drugs involved, except dypirone which wasn't proved in the study because of the severity of reaction, the high possibility to be the causative drug and the alternative of other similar drugs available. For the inflammatory response, HIV+ patients are especially susceptible to severe reaction, both infectious and allergic, as in this case. Thus, recent patents emphasize the interest in inflammatory molecules that cause inflammatory symptoms. Although the diagnose of SJS has established criteria, the possibility of overlapping with infectious illness and/or with its treatment, may complicate the diagnosis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  3. Improving mortality outcomes of Stevens Johnson syndrome/toxic epidermal necrolysis: A regional burns centre experience.

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    Nizamoglu, M; Ward, J A; Frew, Q; Gerrish, H; Martin, N; Shaw, A; Barnes, D; Shelly, O; Philp, B; El-Muttardi, N; Dziewulski, P

    2017-10-10

    Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. A retrospective case review was performed for all patients with a clinical diagnosis of TEN or SJS/TEN overlap admitted to our paediatric and adult burns centre between June 2004 and December 2016. Patient demographics, percentage total body surface area (%TBSA), mucosal involvement, causation, severity of illness score (SCORTEN), length of stay and survival were appraised with appropriate statistical analysis performed using Graph Pad Prism 7.02 Software. During the study period, 42 patients (M26; F: 16) with TEN (n=32) and SJS/TEN overlap (n=10) were managed within our burns service. Mean %TBSA of cutaneous involvement was 57% (range 10-100%) and mean length of stay (LOS) was 27 days (range 1-144 days). We observed 4 deaths in our series compared to 16 predicted by SCORTEN giving a standardised mortality ratio (SMR) of 24%. Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  4. Healthcare utilization and cost of Stevens-Johnson syndrome and toxic epidermal necrolysis management in Thailand.

    Science.gov (United States)

    Dilokthornsakul, P; Sawangjit, R; Inprasong, C; Chunhasewee, S; Rattanapan, P; Thoopputra, T; Chaiyakunapruk, N

    2016-01-01

    Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective. A retrospective study using an electronic health database from a university-affiliated hospital in Thailand was undertaken. Patients admitted with SJS/TEN from 2002 to 2007 were included. Direct medical cost was estimated by the cost-to-charge ratio. Cost was converted to 2013 value by consumer price index, and converted to $US using 31 Baht/ 1 $US. The healthcare resource utilization was also estimated. A total of 157 patients were included with average age of 45.3±23.0 years. About 146 patients (93.0%) were diagnosed as SJS and the remaining (7.0%) were diagnosed as TEN. Most of the patients (83.4%) were treated with systemic corticosteroids. Overall, mortality rate was 8.3%, while the average length of stay (LOS) was 10.1±13.2 days. The average cost of managing SJS/TEN for all patients was $1,064±$2,558. The average cost for SJS patients was $1,019±$2,601 while that for TEN patients was $1,660±$1,887. Healthcare resource utilization and cost of care for SJS/TEN in Thailand were tremendous. The findings are important for policy makers to allocate healthcare resources and develop strategies to prevent SJS/TEN which could decrease length of stay and cost of care.

  5. Immunoglobulin injection for the treatment of multiple oral ulcers in Stevens-Johnson syndrome.

    Science.gov (United States)

    Cicciù, M; Chiera, F; Gallizzi, R; Cicciù, A; Salpietro, C D

    2013-10-01

    Stevens-Johnson syndrome (SJS) is a rare genetic disorder. The syndrome presents with severe purulent conjunctivitis, stomatitis with mucosal necrosis, and purpuric macules. This syndrome is associated with hypersensitive reaction usually stimulated by infection, vaccination, systemic diseases, physical agents, foods or drugs. However, only few cases reported can be related to infectious agents, but the causative role of infectious microorganisms seems relevant in paediatric patients. Authors want to underline the positive response of a new way of therapy by immunoglobulin injection. This case describes a 10-year-old girl with several erosions disseminated in the oral cavity mucosa. The girl had skin erosions that led to the clinical diagnosis of SJS. The past medical history of the patient revealed that those symptoms occured every 6 months over the last 2 years with 2 consecutive weeks of acute manifestations. At that moment, the paediatrician decided for cortisone administration in order to manage the acute symptoms, but after 6 months a new acute episode was observed. For this reason the patient was referred to the Department of Genetics and Immunological Paediatrics. Oral ulcers had been topically treated with an oral balance gel. Intravenous injection of immunoglobulin was then applied and the patient was discharged after 5 days of treatment with the total symptoms in remission. The patient was followed up 3 monthly over the next 24 months. At that time no relapse of the SJS was observed. The seriousness of this condition imposes a prompt recognition. Paediatric dentists should recognise the clinical signs of possible SJS as soon as possible in order to perform a quick diagnosis and initiate treatment.

  6. Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis

    Science.gov (United States)

    CHANTAPHAKUL, HIROSHI; SANON, THANOMSAK; KLAEWSONGKRAM, JETTANONG

    2015-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are erythematous skin lesions with blister formation accompanied by mucosal involvement. These conditions are considered to be life-threatening illnesses. Understanding the clinical presentation, risk factors, treatment options and results will be advantageous for physicians in the management of patients in the future. The aim of the present study was to review and analyze the clinical manifestations, drug implications, treatment and outcome of patients with SJS and/or TEN who had been hospitalized in a tertiary care center. All hospitalized patients with SJS and/or TEN during a 5-year period were retrospectively reviewed. The clinical severity was graded according to the score of toxic epidermal necrolysis (SCORTEN) scale. Clinical symptoms, diagnosis, possible precipitating factors, management and outcome data were collected for analysis. A total of 43 patients (mean age, 49.5 years) were hospitalized and classified into the SJS group (55.8%), SJS/TEN overlap group (20.9%) and TEN group (23.3%). The majority of the patients (90.7%) had mucocutaneous eruptions associated with oral drug administration. Allopurinol, anticonvulsants and antibiotics were the most common causative agents for the mucocutaneous eruption. Twenty-eight patients (65.1%) were treated with corticosteroids. The mortality rate was 6.9%. Comparison between the survival group and the non-survival group revealed that patient age >70 years (P=0.014) and body surface area involvement >20% (P<0.01) were the significant factors associated with mortality. The use of systemic steroids was higher in the survival group in comparison with the non-survival group (65.1 vs. 0%, respectively; P=0.014). The mucocutaneous eruptions in SJS and TEN are mostly caused by medication. With early recognition and treatment, the mortality rate in this study was lower than that in previous reports. Patient age and the area of mucocutaneous involvement

  7. Retrospective Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 88 Chinese Patients.

    Science.gov (United States)

    Wang, Li; Mei, Xue-Ling

    2017-05-05

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifestations, complications, treatment, and prognosis of SJS/TEN and to explore the differences between surviving and deceased patients. SJS/TEN patients admitted to Beijing Friendship Hospital from January 2006 to December 2015 were included in the study. Patients' data were retrospectively analyzed. Comparative studies were performed on the survival group and the deceased group, and Fisher's exact probability test was used for statistical analysis. Among the 88 patients included, 40 (45.5%) were male with a mean age of 45 ± 18 years. Forty-eight (54.5%) had SJS, 34 (38.6%) had SJS/TEN, and 6 (6.8%) had TEN. Fifty-three (60.2%) cases were caused by medications, mainly antibiotics (n = 24) followed by traditional Chinese medicines (n = 7). Forty-two cases (47.7%) developed visceral damage. Eighty-two patients improved or recovered and were discharged from hospital, and six patients died. Comparative studies on the survival group and the deceased group showed that the presence of malignant tumor ( χ2 = 27.969,P 100 times/min ( χ2 = 6.347, P= 0.012), detached skin area >20% ( χ2 = 5.594, P= 0.018), concurrent mucosal involvement at the mouth, eyes, and external genitals ( χ2 = 4.945, P= 0.026), subsequent accompanying liver/kidney damage ( χ2 = 11.839, P= 0.001, and χ2 = 36.302,P 2 ( χ2 = 37.148,P < 0.001) increased the risk of death. SJS/TEN is mainly caused by medications, and nearly half of patients develop visceral damage. Multiple factors increase the mortality risk.

  8. Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children.

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    Catt, Caroline J; Hamilton, Gavin M; Fish, Joel; Mireskandari, Kamiar; Ali, Asim

    2016-06-01

    To describe the acute and chronic ocular manifestations of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap syndrome (Overlap syndrome) in children. Retrospective case series. Medical records of children admitted to the Hospital for Sick Children between 2001 and 2011 with SJS, TEN, and Overlap syndrome were reviewed. Demographic information, all abnormal ophthalmic findings (and median time to first diagnosis), visual acuities, and ophthalmic treatments prescribed were collected for each eye for every patient. Thirty-six children were identified for inclusion in the study. Twenty-nine (81%) had acute ocular involvement, including all patients with TEN (n = 7). Conjunctivitis was the most common (78%) clinical sign. This, together with conjunctival membranes and subconjunctival hemorrhage, were the earliest signs, presenting by a median of 1 day. The percentage of patients and median time to occurrence of complications were as follows: for lid margin ulceration and corneal epithelial defects, 25%, 3 days; conjunctival ulceration, 39%, 3.5 days; symblepharon, 28%, 4 weeks; corneal opacification, 11%, 4 months; limbal stem cell failure, 8%, 7 months; and corneal vascularisation, 8%, 10 months after admission. Over 90% of children maintain a visual acuity of 20/40 or better in each eye at a mean follow-up of 1.4 years. Ocular involvement in SJS, TEN, and Overlap syndrome is common and the ocular manifestations may develop many months after the initial presentation, mandating the need for long-term follow-up of these children. Despite the high frequency of sight-threatening disease, most children maintain good vision in the long term. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. New Grading System and Treatment Guidelines for the Acute Ocular Manifestations of Stevens-Johnson Syndrome.

    Science.gov (United States)

    Gregory, Darren G

    2016-08-01

    To describe a new grading system and associated treatment guidelines for the acute ocular manifestations of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Prospective case series. Seventy-nine consecutive patients (158 eyes) evaluated and treated for acute ocular involvement in SJS or TEN during hospitalization. Photographic and chart review of acute ocular findings, interventions received, and outcomes with regard to visual acuity, dry eye symptoms, and scarring sequelae at least 3 months after the acute illness. Visual acuity, dry eye severity, and scarring of the ocular surface and eyelids were assessed after follow-up of at least 3 months. Cases graded as mild or moderate were managed medically. All had best-corrected visual acuity (BCVA) of 20/20, no dry eye symptoms, and no scarring sequelae. Cases graded as severe or extremely severe were treated with urgent amniotic membrane transplantation (AMT) in addition to medical management. Severe cases all had BCVA of 20/20 and mild or no dry eye problems. Five of 28 patients had mild tarsal conjunctival scarring. No other scarring sequelae occurred. Nine of the 10 extremely severe cases had BCVA of 20/20 (1 was 20/30). Three of 10 had moderate scarring of the tarsal conjunctiva and lid margins and also moderate dry eyes with severe photophobia. Seven of 10 had only mild or no dry eye symptoms and scarring sequelae. This grading system facilitates decision making in the evaluation and management of the acute ocular manifestations of SJS and TEN. Mild and moderate cases have a low risk of significant scarring or visual sequelae and may be monitored and treated medically if not worsening. Severe and extremely severe cases should receive urgent AMT to decrease the risk of scarring and visual sequelae. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  10. A retrospective analysis of Stevens-Johnson syndrome/toxic epidermal necrolysis treated with corticosteroids.

    Science.gov (United States)

    Liu, Wenmin; Nie, Xiaojuan; Zhang, Li

    2016-12-01

    Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe mucocutaneous reactions that incur high mortality, and in which the systemic application of corticosteroids remains controversial. This study aimed to determine the optimal protocols for the use of corticosteroids and treatment measures. We performed a retrospective analysis of 70 patients with SJS/TEN who were hospitalized between January 2008 and May 2015 in the Department of Dermatology, Shandong Provincial Hospital, and treated with corticosteroids. Expected and actual mortality rates in patients treated with different doses of corticosteroids, according to SCORTEN, were compared. The diagnoses associated with initial corticosteroid use differed significantly between the low- and high-dose groups (P = 0.041). There were significant differences between expected and actual mortality rates according to the use of corticosteroid therapy (P = 0.0168, standardized mortality ratio [SMR] = 0.30). There was a statistical difference between expected and actual mortality rates in the low-dose group (P = 0.0145, SMR = 0.20). Serum albumin levels were significantly lower in patients administered corticosteroids additive therapy (31.12 ± 8.32 g/l vs. 35.54 ± 5.82 g/l; P = 0.016), and the rate of use of antibiotics was higher among patients in the additive therapy group than in the non-additive group (94.7% vs. 60.8%). Our research supports the use of corticosteroids for the systemic treatment of SJS/TEN. Corticosteroids should be used in a timely manner and in accordance with disease severity, age, underlying diseases, serum albumin level, and concurrent treatment with antimicrobial therapy. © 2016 The International Society of Dermatology.

  11. Topical Treatment for Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis: A Review

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    Schandra Purnamawati

    2016-08-01

    Full Text Available Background: Stevens - Johnson syndrome (SJS and Toxic Epidermal Necrolysis (TEN are currently regarded to be same disease entity which differs only in the extent and severity of epidermal sloughing. Both are potentially life-threatening mucocutaneous immunologic reaction, which are most frequently induced by drug consumption. The epithelial destruction of skin and mucosal membrane can cause both acute as well as chronic/ long term outcomes in term of  late sequelae during the course of the disease. Sequelae often occur during the late phase of SJS/TEN and become a significant problem due its chronicity and severe degree of impairment, which leads to deterioration of quality of life for the patients. This may prevented or decreased in terms of intensity if the patient’s received prompt and sufficient topical therapy, particularly in managing lesions on the mucosa of the eye, oral, and genital. Objective : This review underlines topical therapies which could be delivered for management of mucocutaneous lesions from SJS/ TEN, aimed to prevent late sequelae due to SJS – TEN in order to improve the life quality of SJS – TEN survivors. Conclusion: SJS/ TEN frequently lead to late sequeale which includes skin, ocular, oral, and genital involvement. These sequelaes are often severe and chonic. Thus, may cause significant decrease in quality of life of SJS/TEN survivors. It is therefore most important to detect them early in order to manage them adequately. To date, we still have an impression that the specific sequelae of SJS – TEN are often late diagnosed and insufficiently treated. Finally, we want to emphasize that for mucosal involvement in particular, such as ocular, genital and oral involvement, a careful topical treatment have to be taken into special consideration in order to prevent severe late sequelae. 

  12. Stevens-johnson syndrome associated with drugs and vaccines in children: a case-control study.

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    Umberto Raucci

    Full Text Available OBJECTIVE: Stevens-Johnson Syndrome (SJS is one of the most severe muco-cutaneous diseases and its occurrence is often attributed to drug use. The aim of the present study is to quantify the risk of SJS in association with drug and vaccine use in children. METHODS: A multicenter surveillance of children hospitalized through the emergency departments for acute conditions of interest is currently ongoing in Italy. Cases with a diagnosis of SJS were retrieved from all admissions. Parents were interviewed on child's use of drugs and vaccines preceding the onset of symptoms that led to the hospitalization. We compared the use of drugs and vaccines in cases with the corresponding use in a control group of children hospitalized for acute neurological conditions. RESULTS: Twenty-nine children with a diagnosis of SJS and 1,362 with neurological disorders were hospitalized between 1(st November 1999 and 31(st October 2012. Cases were more frequently exposed to drugs (79% vs 58% in the control group; adjusted OR 2.4; 95% CI 1.0-6.1. Anticonvulsants presented the highest adjusted OR: 26.8 (95% CI 8.4-86.0. Significantly elevated risks were also estimated for antibiotics use (adjusted OR 3.3; 95% CI 1.5-7.2, corticosteroids (adjusted OR 4.2; 95% CI 1.8-9.9 and paracetamol (adjusted OR 3.2; 95% CI 1.5-6.9. No increased risk was estimated for vaccines (adjusted OR: 0.9; 95% CI 0.3-2.8. DISCUSSION: Our study provides additional evidence on the etiologic role of drugs and vaccines in the occurrence of SJS in children.

  13. Stevens-Johnson Syndrome and Corneal Ectasia: Management and a Case for Association.

    Science.gov (United States)

    Saeed, Hajirah N; Kohanim, Sahar; Le, Hong-Gam; Chodosh, James; Jacobs, Deborah S

    2016-09-01

    To report the occurrence of corneal ectasia (ECT) in patients with history of Stevens-Johnson syndrome (SJS), and to make the case for an association between these 2 diagnoses. We also report the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment on visual acuity (VA) in these patients. Retrospective cohort study. A manufacturing database of PROSE patients from 2002 to 2014 at Boston Foundation for Sight (BFS), a single-center clinical practice, was reviewed to identify patients with diagnoses of both SJS and ECT. Nine patients were identified with diagnoses of both SJS and ECT. In each case, review of the medical record revealed that diagnosis of SJS preceded that of ECT. The prevalence of ECT in this population exceeded that in the general population (P < .0001). Videokeratography was available for 13 eyes in 7 patients; using Krumeich's classification of keratoconus, 3 eyes were found to be at stage 1, 3 at stage 2, 1 at stage 3, and 6 at stage 4. Sixteen of 18 eyes underwent PROSE treatment. Of these 16 eyes, initial median VA was 20/200 (range, count fingers to 20/20; logMAR 1.0). Median VA after PROSE customization was 20/30 (range, 20/60-20/15; logMAR 0.1761, P < .0025). ECT occurs at a higher-than-expected rate in patients with a history of SJS. PROSE treatment improves VA in these patients. The basis of the association between SJS and ECT is considered, as well as the role of plausible contributory factors such as corneal microtrauma and matrix metalloproteinases. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

  14. Effectiveness, safety and tolerability of cyclosporine versus supportive treatment in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A record-based study.

    Science.gov (United States)

    Mohanty, Swosti; Das, Anupam; Ghosh, Anupama; Sil, Amrita; Gharami, Ramesh Chandra; Bandyopadhyay, Debabrata; Das, Nilay Kanti

    2017-01-01

    Toxic epidermal necrolysis and Stevens-Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens-Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy. This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy. Medical records as bed-head tickets and laboratory investigation reports of Stevens-Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens-Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained. Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P Stevens-Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital.

  15. Stevens-Johnson syndrome and toxic epidermal necrolysis: efficacy of intravenous immunoglobulin and a review of treatment options.

    Science.gov (United States)

    Teo, L; Tay, Y K; Liu, T T; Kwok, C

    2009-01-01

    Toxic epidermal necrolysis (TEN) is a rare, severe adverse drug reaction. Steven-Johnson syndrome (SJS) represents the milder end of the spectrum. The exact pathogenesis of TEN and SJS is still unknown and many drugs, including prednisolone, cyclosporin and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of IVIG in particular is controversial. We share our experience with the use of IVIG in six patients with TEN. We will also review the various proposed mechanisms underlying TEN, the mechanism of action of IVIG in TEN and summarise useful treatment options.

  16. Oral lesions associated with Nevirapine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: A report of 10 cases.

    Science.gov (United States)

    Reddy, Ramana Bv; Shekar, P Chandra; Chandra, K Lalith Prakash; Aravind, Rs

    2013-09-01

    Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are closely related severe, acute mucocutaneous reactions usually caused by drugs. They are acute life-threatening conditions and cause widespread necrosis of the epithelium. There is persistence of a high risk of SJS or TEN in relation to human immunodeficiency virus (HIV) infection associated with exposure to nevirapine (NVP). In this article, we present nine cases of SJS and one case of TEN in HIV-seropositive individuals who developed cutaneous, oral, ocular and genital lesions while being treated with NVP.

  17. Steven E. Miller and Dmitri V. Trenin, eds., The Russian Military: Power and Policy, Cambridge, MA: MIT Press, 2004.

    Directory of Open Access Journals (Sweden)

    Mikhail Tsypkin

    2005-10-01

    Full Text Available The Russian military largely went below the radar of Western interest after the disintegration of the Soviet Union.  More than a decade after the creation of the Armed Forces of the Russian Federation, they have become again the object of interest for scholars – this time, both Western and Russian, as demonstrated by the reviewed volume, whose editors assembled a group of extraordinarily knowledgeable experts from Russia and the West.  In his introduction, Steven Miller explains that the purp...

  18. Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials*

    Science.gov (United States)

    Bloom, Romi; Amber, Kyle T.

    2017-01-01

    Lamotrigine is an antiepileptic drug used for the treatment of epilepsy, bipolar disorder and numerous off-label uses. The development of rash significantly affects its use. The most concerning of these adverse reactions is Stevens-Johnson syndrome/toxic epidermal necrolysis. We performed a systematic review of randomized controlled trials using lamotrigine as a monotherapy to quantify the incidence of cutaneous reactions, particularly Stevens-Johnson syndrome/toxic epidermal necrolysis. Of a total of 4,364 papers regarding lamotrigine, 122 studies met our inclusion and exclusion criteria. In total, 18,698 patients were included with 1,570 (8.3%) of patients experiencing an adverse dermatologic reaction. The incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis was 0.04%. PMID:28225977

  19. Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials.

    Science.gov (United States)

    Bloom, Romi; Amber, Kyle T

    2017-01-01

    Lamotrigine is an antiepileptic drug used for the treatment of epilepsy, bipolar disorder and numerous off-label uses. The development of rash significantly affects its use. The most concerning of these adverse reactions is Stevens-Johnson syndrome/toxic epidermal necrolysis. We performed a systematic review of randomized controlled trials using lamotrigine as a monotherapy to quantify the incidence of cutaneous reactions, particularly Stevens-Johnson syndrome/toxic epidermal necrolysis. Of a total of 4,364 papers regarding lamotrigine, 122 studies met our inclusion and exclusion criteria. In total, 18,698 patients were included with 1,570 (8.3%) of patients experiencing an adverse dermatologic reaction. The incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis was 0.04%.

  20. Síndrome de Stevens-Johnson e necrólise epidérmica tóxica em medicina intensiva Stevens-Johnson syndrome and toxical epidermal necrolysis in intensive care medicine

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    Ana Carolina Pedigoni Bulisani

    2006-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A Síndrome de Stevens Johnson (SSJ e Necrólise Epidérmica Tóxica (NET são reações cutâneas graves, com potencial para morbidade e mortalidade elevadas acometendo a pele e a membrana mucosa necessitando de cuidados de medicina intensiva. O objetivo deste artigo foi apresentar revisão da literatura sobre SSJ e NET. CONTEÚDO: Este artigo revisa os conceitos básicos, diagnóstico, quadro clínico e o princípio de tratamento em Unidade de Terapia Intensiva da SSJ e NET. CONCLUSÕES: Estas doenças caracterizam emergências dermatológicas e seu adequado manuseio e cuidado deve fazer parte do conhecimento rotineiro do médico intensivista.BACKGROUND AND OBJECTIVES: The Stevens Johnson Syndrome (SJS and Toxical Epidermal Necrolisys (TEN are important skin and mucosal lesions that need intensive care treatment. The aim of this article is to show a literature review about SJS and TEN. CONTENTS: This article reviews the concepts, diagnostic topics, clinical presentation and the principle of basic treatment in Intensive Care Unit for SJS and TEN. CONCLUSIONS: These illnesses are characterized as dermatological emergencies and its adequate management and cares must be part of the routine knowledge of the intensive care doctors.

  1. Steven Johnson Syndrome and Toxic Epidermal Necrolysis in a burn unit: A 15-year experience.

    Science.gov (United States)

    McCullough, M; Burg, M; Lin, E; Peng, D; Garner, W

    2017-02-01

    The diffuse epidermal exfoliation seen in Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is similar to skin loss in second degree burns, and many of these patients are referred for treatment at burn centers. Treatment can differ markedly from center to center, and mortality can range from 25% to 70%, including a considerable morbidity. However, our experience over a 15-year period from 2000 to 2015 with 40 patients found a mortality rate of only 10% (4/40). The purpose of this paper is to discuss our treatment algorithm as a model for other centers treating SJS/TENs patients. Records were reviewed for all patients admitted to the LAC+USC burn unit between 2000 and 2015 and 40 patients were identified with biopsy-proven SJS or TENS. These cases were reviewed for age, gender, initial and greatest TBSA, causative drug, pre-existing medical conditions, and morbidity and mortality. All data were entered into the SPSS statistical software package and all statistical analyses were performed using this program. Our treatment algorithm focused on early referral to a specialty burn unit, immediate discontinuation of the offending drug, fluid resuscitation, nutritional supplementation, and meticulous wound care. Average time to transfer to a burn unit was 3.36 days. Silver-releasing antimicrobial dressings were applied to the affected skin surface and changed every 3 days. Mupirocin coated petroleum gauze was used for facial involvement. Steroids were tapered and discontinued if initiated at an outside facility (58% of patients), and starting after 2001, all patients received a course of IVIG. All patients received fluid resuscitation and the majority received supplemental tube feedings (69%). Average length of total stay was 17.1 days and length of ICU stay 15.9 days. While 44% were transferred to another facility for further rehabilitative care, 37% of patients discharge to home. In patients discharged home with complete resolution of skin lesions, time

  2. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Lerch, Marianne; Mainetti, Carlo; Terziroli Beretta-Piccoli, Benedetta; Harr, Thomas

    2018-02-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered a delayed-type hypersensitivity reaction to drugs. They represent true medical emergencies and an early recognition and appropriate management is decisive for the survival. SJS/TEN manifest with an "influenza-like" prodromal phase (malaise, fever), followed by painful cutaneous and mucous membrane (ocular, oral, and genital) lesions, and other systemic symptoms. The difference between SJS, SJS/TEN overlap, and TEN is defined by the degree of skin detachment: SJS is defined as skin involvement of  30%, and SJS/TEN overlap as 10-30% skin involvement. The diagnosis of different degrees of epidermal necrolysis is based on the clinical assessment in conjunction with the corresponding histopathology. The mortality rates for SJS and TEN have decreased in the last decades. Today, the severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is available for SJS/TEN severity assessment. Drugs with a high risk of causing SJS/TEN are anti-infective sulfonamides, anti-epileptic drugs, non-steroidal anti-inflammatory drugs of the oxicam type, allopurinol, nevirapine, and chlormezanone. Besides conventional drugs, herbal remedies and new biologicals should be considered as causative agents. The increased risk of hypersensitivity reactions to certain drugs may be linked to specific HLA antigens. Our understanding of the pathogenesis of SJS/TEN has improved: drug-specific T cell-mediated cytotoxicity, genetic linkage with HLA- and non-HLA-genes, TCR restriction, and cytotoxicity mechanisms were clarified. However, many factors contributing to epidermal necrolysis still have to be identified, especially in virus-induced and autoimmune forms of epidermal necrolysis not related to drugs. In SJS/TEN, the most common complications are ocular, cutaneous, or renal. Nasopharyngeal, esophageal, and genital mucosal involvement with blisters, erosions as well as secondary development of strictures

  3. Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States.

    Science.gov (United States)

    Hsu, Derek Y; Brieva, Joaquin; Silverberg, Nanette B; Paller, Amy S; Silverberg, Jonathan I

    2017-05-01

    Little is known about the epidemiology of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children. We sought to determine the morbidity, mortality, and comorbid health conditions of SJS and TEN in US children. This was a cross-sectional study of the 2009 to 2012 Nationwide Inpatient Sample, which contains a representative 20% sample of all US hospitalizations. Sociodemographics, inflation-adjusted cost, length of stay, comorbidities, and mortality were analyzed using descriptive statistics and multivariate regression analyses. The incidences of SJS, SJS-TEN, and TEN were a mean 5.3, 0.8, and 0.4 cases per million children per year in the US, respectively. Prolonged length of stay and higher costs of care (SJS: 9.4 ± 0.6 days, $24,947 ± $3171; SJS-TEN: 15.7 ± 1.5 days, $63,787 ± $8014; TEN: 20.4 ± 6.3 days, $102,243 ± $37,588) were observed compared with all other admissions (4.6 ± 0.1 days, $10,496 ± $424). Mortality was 0% for SJS, 4% for SJS-TEN, and 16% for TEN. In regression models, predictors of mortality included renal failure (adjusted OR [aOR] 300.28, 95% confidence interval [CI] 48.59->999.99), malignancy (aOR 54.33, 95% CI 9.40-314.22), septicemia (aOR 30.45, 95% CI 7.91-117.19), bacterial infection (aOR 20.38, 95% CI 5.44-76.36), and epilepsy (aOR 5.56, 95% CI 1.37-26.2). Data regarding treatment were not available. Date of diagnosis of comorbidities was not present, precluding temporal analysis. Pediatric SJS/TEN poses a substantial health burden in the United States. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Genitourinary involvement and management in children with Stevens-Johnson syndrome and toxic epidermal necrolysis.

    Science.gov (United States)

    Van Batavia, J P; Chu, D I; Long, C J; Jen, M; Canning, D A; Weiss, D A

    2017-10-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are devastating hypersensitivity disorders that cause epidermal cell death and can affect all epidermal surfaces, including the urethra, vagina, labial and scrotal skin. Despite the well-described ocular and orofacial manifestations of SJS/TEN, there is a paucity of reports on the genitourinary (GU) symptoms and their management. Specifically, consulting services often ask the pediatric urology team if it is safe to place a urethral catheter, but there is no data in the literature to help guide management. The present study sought to review all pediatric cases of SJS/TEN in a tertiary care hospital to determine the incidence and optimal management of GU manifestations, including the use of urethral catheters. With IRB approval, cases of SJS and TEN that were managed as an inpatient between January 2008 and June 2015 were retrospectively reviewed in order to identify the extent of GU involvement/manifestations, the treatment provided, use of urethral catheterization and long-term follow-up or complications. Thirty-one patients (15 female, 16 male; age range 2-18 years) presented with SJS or TEN over the study period. Etiologies for SJS/TEN included mycoplasma infection (48%) and medications (45%). Incidences of GU manifestations at presentation and their management are shown in Summary Table. Overall, 74% of patients had genital involvement of skin lesions. In 12 cases (39%), urology consultation was obtained. Twenty patients (61%) complained of dysuria and one child had gross hematuria in the setting of meatal lesion. Petroleum jelly was used in the majority of patients. A urethral catheter was placed in eight patients (25.8%, four female, four male) with a range of duration of 7-23 days. No patient developed hematuria or any other complications (i.e. strictures or urinary symptoms) after catheter removal. One boy required lysis of penile adhesions in the short-term. One of each gender developed

  5. Estudo dos achados oculares na síndrome de Stevens-Johnson em pacientes de centro de referência de atendimento terciário

    OpenAIRE

    Franca, Marciel Dourado; Lima, Jane Palma Galrão; Freitas, Denise de; Cunha, Marcelo; Gomes, José Álvaro Pereira [UNIFESP

    2009-01-01

    OBJETIVO: Avaliar a epidemiologia, os possíveis fatores desencadeantes, complicações encontradas e as variedades de tratamentos administrados a um grupo de pacientes com complicações oculares secundárias à síndrome de Stevens-Johnson. MÉTODOS: Realizado estudo prospectivo, série de casos com 22 pacientes portadores de síndrome de Stevens-Johnson. Os pacientes foram estudados seguindo um protocolo com o objetivo de se buscar uma história detalhada sobre a doença, suas manifestações sistêmicas ...

  6. Management of ocular conditions in the burn unit: thermal and chemical burns and Stevens-Johnson syndrome/toxic epidermal necrolysis.

    Science.gov (United States)

    Lin, Amy; Patel, Neha; Yoo, David; DeMartelaere, Sheri; Bouchard, Charles

    2011-01-01

    Patients in burn intensive care units suffer from potentially life-threatening conditions including thermal or chemical burns and Stevens-Johnson syndrome/toxic epidermal necrolysis. There is often involvement of the ocular surface or adnexal structures which may be present at the time of hospital admission or may develop later in the hospital course. This article will describe the types of ocular burns, the mechanisms and manifestations of Stevens-Johnson syndrome/toxic epidermal necrolysis, the circumstances that may influence outcome, and acute and long-term treatment strategies, including new and evolving options.

  7. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Associations, Outcomes, and Pathobiology-Thirty Years of Progress but Still Much to Be Done.

    Science.gov (United States)

    Stern, Robert S; Divito, Sherrie J

    2017-05-01

    Although rare, Stevens-Johnson syndrome and toxic epidermal necrolysis remain among the most devastating of acute conditions involving the skin. In the past 30 years, tremendous progress has been made in understanding the causes and pathobiology of this often life-threatening condition. Su et al demonstrate associations between IL 15 serum levels and the outcome of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Their findings provide ideas for further investigations that may help us better understand the role of cytokines in this T-cell mediate disease and provides clues to possible new therapies. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Review of The Joy of x: A Guided Tour of Math, from One to Infinity by Steven Strogatz

    Directory of Open Access Journals (Sweden)

    Michael T. Catalano

    2014-07-01

    Full Text Available Strogatz, Steven. The Joy of x: A Guided Tour of Math, from One to Infinity, (New York, NY, Houghton Mifflin Harcourt, 2012. 316 pp. ISBN 978-0-547-51765-0 The Joy of x: A Guided Tour of Math, from One to Infinity, by Steven Strogatz, is an engaging and example-filled argument for mathematics as a valuable and enjoyable activity. The thirty chapters are divided into six parts, entitled Numbers, Relationships, Shapes, Change, Data, and Frontiers. The discussion ranges from intuitive explanations of basic concepts such as place value, the four arithmetic operations, percentage increase and decrease, and solving equations, to “higher” levels of mathematics such as calculus, probability and statistics, group theory, and the nature of infinity. As in John Allen Paulos’ work, Beyond Numeracy, the chapters are short and punchy, and they can be read independently. While the book is not specifically devoted to numeracy, several chapters, especially those in Part Five on Data, address ideas and examples relevant to quantitative literacy.

  9. Honoring the work and life of Leroy C. Stevens. A symposium as part of the International Stem Cell Initiative Workshop.

    Science.gov (United States)

    Graham, Christopher F; Solter, Davor; Gearhart, John D; Nadeau, Joseph H; Knowles, Barbara B

    2016-01-01

    In 2016, a symposium was convened in Leroy C. Stevens' honor, in association with a meeting of the International Stem Cell Initiative (ISCI). ISCI, funded internationally, is composed of a group of ~100 scientists from many countries, under the leadership of Peter Andrews, who have worked together to characterize a significant number of human pluripotent stem cell lines, to monitor their genetic stability and their differentiation into mature cell types and tissues in vitro and in vivo. Those at the ISCI meeting puzzled through one of the thorniest problems in the therapeutic use of the differentiated derivatives of pluripotent stem cells for human therapy; namely, pluripotent stem cells can differentiate into any cell type in the adult organism, but they also have the capacity for unlimited self-renewal, hence if mutated they may have tumorigenic potential. The meeting considered how these cells might become genetically or epigenetically abnormal and how the safety of these cells for human therapeutic uses could be assessed and assured. The symposium was an opportunity to pay tribute to Leroy Stevens and to the basic science origins of this newest aspect of regenerative medicine. It was a time to reflect on the past and on how it can influence the future of our field.

  10. Organizational Heritage and Entrepreneurship: Steven Klepper’s Theories Reflected in the Emergence and Growth of the Plastic Molds Industry in Portugal

    NARCIS (Netherlands)

    Costa, Carla|info:eu-repo/dai/nl/412425645

    2015-01-01

    This paper reviews the history of the emergence of the molds and plastics industries in Portugal, finding that this history fits nicely with the accounts—originally proposed in Steven Klepper’s various works—of new industries emerging from older, related industries, and regional clusters emerging

  11. Harry Stevens, the British "Correspondent" of David Rjazanov's Institute : On the History of Collecting at the Marx-Engels Institute (1927-1931)

    NARCIS (Netherlands)

    Novichenko, Irina; Blok, Aad; Lucassen, Jan; Sanders, Huub

    2014-01-01

    The article is devoted to the history of the acquisition of the Marx-Engels Institute in Great Britain in 1927-1931. The director of the Institute David Rjazanov organized the collectioning of the archives, books, serials with the help of Harry Stevens that gave the possibility to gather in Moscow

  12. Construction of a bacterial artificial chromosome (BAC) library of Lycopersicon esculentum cv. Stevens and its application to physically map the Sw-5 locus

    NARCIS (Netherlands)

    Spassova, MI; Prins, M; Stevens, MR; Hille, J; Goldbach, RW; Spassova, Mariana I.; Stevens, Mikel R.; Goldbach, Rob W.

    1999-01-01

    The Sw-5 gene is a dominantly inherited resistance gene in tomato and functional against a number of tospovirus species. The gene has been mapped on chromosome 9, tightly linked to RFLP markers CT220 and SCAR421. To analyse the Sw-5 locus, a BAC genomic library was constructed of tomato cv. Stevens,

  13. Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus : a descriptive study of 17 cases from a national registry and review of the literature

    NARCIS (Netherlands)

    Ziemer, M.; Kardaun, S. H.; Liss, Y.; Mockenhaupt, M.

    Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality. Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of

  14. Evaluation of SCORTEN on a Cohort of Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Included in the RegiSCAR Study

    NARCIS (Netherlands)

    Sekula, Peggy; Liss, Yvonne; Davidovici, Batya; Dunant, Ariane; Roujeau, Jean-Claude; Kardaun, Sylvia; Naldi, Luigi; Schumacher, Martin; Mockenhaupt, Maja

    2011-01-01

    The purpose of this study was to evaluate the severity-of-illness score called SCORTEN with respect to its predictive ability and by using data obtained in the RegiSCAR study, the most comprehensive European registry of patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis

  15. Steven Pinker. The Better Angels of Our Nature. Why violence has declined. Viking Adult, New York, 2011, 832 p.

    Directory of Open Access Journals (Sweden)

    Jairo Antonio Melo Flórez

    2011-05-01

    Full Text Available Aunque ya es una tesis bastante aceptada por los historiadores y sociólogos, la posibilidad de que, al contrario de la creencia popular, vivamos en tal vez una de las épocas más pacíficas de la historia es aún controvertida, más aún cuando llega un trabajo de una de las figuras públicas de la academia como es el profesor de Harvard Steven Pinker. Sin embargo, Pinker se había dedicado a psicología cognitiva y ganó fama al presentar al lenguaje como un instinto de la humanidad, y más aún al presentar sus resultados en libros dirigidos al público en general, algo bastante común entre los científicos norteamericanos.

  16. An Intractable Case of Prototheca Keratitis and Chronic Endophthalmitis in Stevens-Johnson Syndrome With Boston Type 1 Keratoprosthesis.

    Science.gov (United States)

    Ng, Jacqueline; Minckler, Don; Walsh, Thomas J; Farid, Marjan

    2016-09-01

    To report a case of recalcitrant Prototheca spp. keratitis and endophthalmitis in a patient with Stevens-Johnson syndrome (SJS) and Boston type 1 keratoprosthesis (B1 KPro). Case report. A 67-year-old female with a history of SJS with chronic severe ocular surface disease in her monocular left eye underwent placement of a B1 KPro. Her course was subsequently complicated by persistent Prototheca spp. keratitis and endophthalmitis requiring ongoing treatment with triazole and polyene antifungal agents and multiple surgical revisions of her keratoprosthesis. Protothecosis is an algal infection that is rarely pathologic in humans, but when present can be difficult to manage. We present the second known case of persistent chronic Prototheca spp. keratitis and endophthalmitis in a patient with long-standing SJS and B1 KPro.

  17. Boston type 1 based keratoprosthesis (Auro Kpro) and its modification (LVP Kpro) in chronic Stevens Johnson syndrome.

    Science.gov (United States)

    Basu, Sayan; Sureka, Shraddha; Shukla, Rashmi; Sangwan, Virender

    2014-03-24

    Two young women with completely dry and keratinised eyes post-Stevens Johnson Syndrome (SJS) underwent unilateral oral mucous membrane grafts (MMGs) in preparation for modified osteo-odonto keratoprosthesis (MOOKP) implantation. In both cases, the mucosal graft was deemed to be too tight to accommodate the MOOKP implant. Instead of proceeding with MOOKP, the first patient underwent Auro Kpro (Boston type 1-based keratoprosthesis) implantation under the MMG, while the second patient underwent implantation of a modification of Auro Kpro with a longer optical stem (LVP Kpro) exposed through the MMG. Both patients maintained a visual acuity of 20/20, N6 at 15 months post-implantation. The first patient needed repeated mucosal trimming because of mucosal overgrowth; while in the second patient, mucosal overgrowth did not occur. This report highlights the innovative and successful use of Boston type 1-based keratoprosthesis (Auro Kpro) and its modification (LVP Kpro) in completely dry and keratinised post-SJS eyes.

  18. Case of Steven-Johnson Syndrome in a male with breast cancer secondary to docetaxel/cyclophosphamide therapy.

    Science.gov (United States)

    Jarrett, Benjamin; Ghazala, Sehem; Chao, Joseph; Chaudhary, Sachin

    2016-11-15

    The mortality rate for Stevens-Johnson syndrome (SJS) is estimated to be ∼12% and for toxic epidermal necrolysis (TEN) it is around 30%. It continues to be a severe life-threatening drug reaction. We present a 60-year-old Caucasian man with a medical history significant for breast cancer status post mastectomy and chemotherapy with docetaxel and cyclophosphamide who presented with severe mucositis and a progressing skin rash consistent with SJS. He was started on high-dose corticosteroids and IVIG but continued to have worsening mucosal ulcerations and severe bleeding from the oral, conjunctival and genital mucosa. He underwent several rounds of plasmapheresis and additional high-dose steroids with mild improvement in the mucocutaneous manifestations. He subsequently developed respiratory failure, which required mechanical ventilation, as well as disseminated intravascular coagulation, diffuse alveolar haemorrhage, with Pneumocystis jirovecii pneumonia which led to his demise on hospital day 15. 2016 BMJ Publishing Group Ltd.

  19. Retrospective analysis of Steven Johnson syndrome and toxic epidermal necrolysis over a period of 5 years from northern Karnataka, India.

    Science.gov (United States)

    Naveen, Kikkeri Narayanasetty; Pai, Varadraj V; Rai, Vijetha; Athanikar, Sharatchandra B

    2013-01-01

    Cutaneous drug reactions are the most common type of adverse drug reactions. Adverse cutaneous drug reactions form 2-3% of the hospitalized patients. 2% of these are potentially serious. This study aims to detect the drugs commonly implicated in Steven Johnson Syndrome-Toxic Epidermal Necrosis (SJS-TEN). A retrospective analysis was done in all patients admitted in the last five years in SDM hospital with the diagnosis of SJS-TEN. A total of 22 patients with SJS-TEN were studied. In 11 patients anti-epileptics was the causal drug and in 7, anti-microbials was the causal drug. Recovery was much faster in case of anti epileptics induced SJS-TEN as compared to that induced by ofloxacin. SJS-TEN induced by ofloxacin has a higher morbidity and mortality compared to anti convulsants.

  20. Stevens Johnson syndrome, toxic epidermal necrolysis and SJS-TEN overlap: A retrospective study of causative drugs and clinical outcome

    Directory of Open Access Journals (Sweden)

    Sharma Vinod

    2008-01-01

    Full Text Available Background and Aims: Stevens Johnson syndrome (SJS, toxic epidermal necrolysis (TEN and SJS-TEN overlap are serious adverse cutaneous drug reactions. Drugs are often implicated in these reactions. Methods: A retrospective analysis of inpatients′ data with these dermatological diagnoses were carried out for three years, to study the causative drugs, clinical outcome, and mortality in these conditions. Results: Thirty patients (15 TEN, nine SJS-TEN overlap, and six SJS were admitted. In 21 cases, multiple drugs were implicated whereas single drugs were responsible in nine. Anticonvulsants (35.08% were the most commonly implicated drugs followed by antibiotics (33.33% and NSAIDS (24.56%. Twenty-five patients recovered whereas five died (four TEN, one SJS-TEN overlap. Conclusion: Anticonvulsants, antibiotics and NSAIDs were the most frequently implicated drugs. TEN causes higher mortality than both SJS and SJS-TEN overlap.

  1. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/Stevens-Johnson syndrome overlap.

    Science.gov (United States)

    Smith, Saxon D; Dodds, Annabel; Dixit, Shreya; Cooper, Alan

    2015-11-01

    Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe mucocutaneous eruptions. There is currently no defined optimal approach to wound care. The objective of this study was to evaluate silver dressings in the wound-care management of TEN and SJS/TEN syndrome overlap with a retrospective case review of nine patients with TEN and SJS/TEN overlap presenting to our institution. Nanocrystalline silver dressings appear to be useful in the rapid commencement of healing in these patients. TEN and SJS/TEN overlap are rare conditions. This contributed to a relatively small number of cases included in the study. The ease of application, antimicrobial properties and low frequency of change make nanocrystalline silver dressings ideal in TEN/SJS. © 2014 The Australasian College of Dermatologists.

  2. Association of HLA-BFNx011502 allele and carbamazepine-induced Stevens-Johnson syndrome among Indians

    Directory of Open Access Journals (Sweden)

    Mehta Timir

    2009-01-01

    Full Text Available Background: Stevens-Johnson Syndrome (SJS and toxic epidermal necrolysis are severe cutaneous reactions caused by certain drugs, including antiepileptic carbamazepine. A strong association has been reported between human leucocyte antigen (HLA-BFNx011502 and carbamazepine-induced SJS in Han Chinese patients. European studies suggested that HLA-BFNx011502 is not a universal marker but is ethnicity-specific for Asians. Aim: To study the association between HLA-BFNx011502 and carbamazepine-induced SJS in Indian patients. Methods: Eight individuals who fulfilled the diagnostic criteria of SJS induced by carbamazepine were identified and HLA-B molecular typing was performed. HLA-B genotyping was carried out by polymerase chain reaction using sequence-specific primers. Results: Out of eight patients studied for genotype, six patients were found to have the HLA-BFNx011502 allele. Conclusion: This study suggests an association between HLA-BFNx011502 and carbamazepine-induced SJS in Indian patients.

  3. VizieR Online Data Catalog: SABOCA NGC 3603 IRS 9A images (Hummel+, 2015)

    Science.gov (United States)

    Hummel, C. A.; Stanke, T.; Galvan-Madrid, R.; Koribalski, B. S.

    2015-10-01

    Observations of NGC 3603 MM2 at 350um with the SABOCA bolometer array attached to the APEX telescope on the Chajnantor plateau in Chile were carried out on September 15, 2011, providing a beam FWHM of 7.8". The precipitable water vapor column was about 0.2mm during the observations, which lasted about 15 minutes for a spiral raster map of about 1.5 arcminutes in radius centered on IRS 9A. (2 data files).

  4. Er gulvet grim og skummel, så ring til Hummel

    DEFF Research Database (Denmark)

    Brügger, Niels

    for at komme med et bud på. Bogen bygger på over 300 slogans, som forfatteren har indsamlet gennem flere år. Niels Brügger er lektor i medievidenskab ved Institut for Informations- og Medievidenskab, Aarhus Universitet. Til daglig forsker han i internettets historie — de sjove slogans er en hobby....

  5. Hydrogeology of the Little Spokane River Basin, Spokane, Stevens, and Pend Oreille Counties, Washington

    Science.gov (United States)

    Kahle, Sue C.; Olsen, Theresa D.; Fasser, Elisabeth T.

    2013-01-01

    A study of the hydrogeologic framework of the Little Spokane River Basin was conducted to identify and describe the principal hydrogeologic units in the study area, their hydraulic characteristics, and general directions of groundwater movement. The Little Spokane River Basin includes an area of 679 square miles in northeastern Washington State covering parts of Spokane, Stevens, and Pend Oreille Counties. The groundwater system consists of unconsolidated sedimentary deposits and isolated, remnant basalt layers overlying crystalline bedrock. In 1976, a water resources program for the Little Spokane River was adopted into rule by the State of Washington, setting instream flows for the river and closing its tributaries to further uses. Spokane County representatives are concerned about the effects that additional groundwater development within the basin might have on the Little Spokane River and on existing groundwater resources. Information provided by this study will be used in future investigations to evaluate the effects of potential increases in groundwater withdrawals on groundwater and surface-water resources in the basin. The hydrogeologic framework consists of eight hydrogeologic units: the Upper aquifer, Upper confining unit, Lower aquifers, Lower confining unit, Wanapum basalt unit, Latah unit, Grande Ronde basalt unit, and Bedrock. The Upper aquifer is composed mostly of sand and gravel and varies in thickness from 4 to 360 ft, with an average thickness of 70 ft. The aquifer is generally finer grained in areas farther from main outwash channels. The estimated horizontal hydraulic conductivity ranges from 4.4 to 410,000 feet per day (ft/d), with a median hydraulic conductivity of 900 ft/d. The Upper confining unit is a low-permeability unit consisting mostly of silt and clay, and varies in thickness from 5 to 400 ft, with an average thickness of 100 ft. The estimated horizontal hydraulic conductivity ranges from 0.5 to 5,600 ft/d, with a median hydraulic

  6. Estudo dos achados oculares na síndrome de Stevens-Johnson em pacientes de centro de referência de atendimento terciário Study of the ocular findings in Stevens-Johnson syndrome patients from a tertiary ophthalmologic center

    OpenAIRE

    Marciel Dourado Franca; Jane Palma Galrão Lima; Denise de Freitas; Marcelo Cunha; José Álvaro Pereira Gomes

    2009-01-01

    OBJETIVO: Avaliar a epidemiologia, os possíveis fatores desencadeantes, complicações encontradas e as variedades de tratamentos administrados a um grupo de pacientes com complicações oculares secundárias à síndrome de Stevens-Johnson. MÉTODOS: Realizado estudo prospectivo, série de casos com 22 pacientes portadores de síndrome de Stevens-Johnson. Os pacientes foram estudados seguindo um protocolo com o objetivo de se buscar uma história detalhada sobre a doença, suas manifestações sistêmicas ...

  7. Response to Dr Stevens' letter ref. Visitisen et al: "Short-term effects of night shift work on breast cancer risk: a cohort study of payroll data"

    DEFF Research Database (Denmark)

    Kolstad, Henrik A; Garde, Anne Helene; Hansen, Åse Marie

    2017-01-01

    We thank Dr Richard Stevens for his comments (1) on our recent article that showed no increased risk of breast cancer following recent night shift work when compared with recent day shift work (2). This finding was based on linkage of day-by-day information on working hours and breast cancer...... definitions of shifts affect the risk of breast cancer, which will be possible using this type of data. We only had information on working hours from 2007 and onwards, and night shift work prior to 2007 could have confounded our analyses towards no effect but only if inversely associated with night shift work...... rather robust evidence of no short-term breast cancer risk following recent night shift work. It must, however, be stressed that data did not allow assessment of a possible long-term risk. Reference 1. Stevens R. Letter ref. Vitisen et al: "Short-term effects of night shift work on breast cancer risk...

  8. The HLA-B*15:02 allele in a Spanish Romani patient with carbamazepine-induced Stevens-Johnson syndrome.

    Science.gov (United States)

    Bellón, Teresa; Ramírez, Elena; Borobia, Alberto M; Lerma, Victoria; Moreno-Hidalgo, Miguel A; Laosa, Olga; Aramburu, José A; González-Herrada, Carlos; de Abajo, Francisco J

    2016-04-01

    The HLA-B*15:02 allele is a risk factor for carbamazepine (CBZ)-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in populations where the allele is prevalent. Han Chinese and Thai patients are advised to take a genetic test before introducing CBZ. Such testing is not recommended for patients of European descent. We report the case of a Spanish Romani patient who developed Stevens-Johnson syndrome upon treatment with CBZ. In vitro assays confirmed CBZ as the culprit drug. HLA typing showed that the patient carried the HLA-B*15:02 allele. A public database search revealed that 2% of Spanish Romani people likely carry the risk variant HLA-B*15:02 and therefore may be included in the population to be tested prior to beginning treatment with CBZ.

  9. Susan G. Komen for the Cure

    Science.gov (United States)

    ... de sus senos:Consejos útiles para mujeres El Cancer de Mama y el Medio Ambiente: Preguntas y Respuestas Guía de herramientas de educación sobre el cancer de seno para comunidades hispanas/Latinas About Us ...

  10. Entretien avec Susan Holtz | IDRC - International Development ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Au seuil du prochain millénaire, le développement planétaire durable pose des défis complexes et d'envergure. Partout dans le monde, on cherche à relever ces défis en intégrant les politiques environnementales, sociales et économiques.

  11. “Inspired by real events”—Media (and Memory in Steven Spielberg’s MUNICH (2005

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    Thomas Nachreiner

    2016-02-01

    Full Text Available Steven Spielberg’s 2005 film Munich tells the story of an Israeli counter-terrorist team in the aftermath of the hijacking and massacre at the Olympic Games in 1972. The film spawned broad discussion about its historical accuracy and its political standpoint. While criticism primarily focused on the historiographical representation of the actions depicted, this paper analyzes in two steps the genuinely filmic mode of historical representation ofMunich. First, the analysis discusses the interplay of two conflicting narrative strategies that negotiate the character development with the political struggle. And second, analysis focuses on the two formal devices at the core of the narrative conflict: The reflexive framing of television in the depiction of the Munich massacre as a traumatic media event and the excessive transformation of its memory in a series of flashbacks. Such elaboration of the narrative and formal strategies reveals the implicit historiographical structures of the film and suggests that the notion of ‘cultural trauma’ serves as the preferential—but problematic—template in telling the history of terrorism and violence.

  12. Síndrome de Stevens Johnson, presentación de un caso en edad pediátrica

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    Maritza Morales Solís

    2015-11-01

    Full Text Available El síndrome de Stevens-Johnson (SSJ es una variante severa del eritema multiforme, consistente en una reacción de hipersensibilización que afecta piel y mucosa, además de otros órganos internos, y que se manifiesta con lesiones en zonas genitales, bucales y cutáneas, es idiopático en el 50% de los casos, generalmente producido por alergia a medicamentos. La muerte sobreviene en el 5-15% de los casos sin tratar. El riesgo de recurrencia es del 37% o más.  Al Hospital Pediátrico Provincial Docente “Mártires de Las Tunas”  fue  traído un niño de seis años  de edad, que tras el uso del Sulfaprín comenzó con lesiones que afectaban la piel y  todas las mucosas, además de toma del estado general. Inmediatamente fue admitido en la Unidad de Cuidados  Intensivos Pediátricos, donde fueron tomadas medidas que incluyeron supresión del agente causal,  corticoterapia endovenosa, antibioticoterapia endovenosa, tratamiento de las lesiones, vigilancia del balance hidromineral y atención oftalmológica, respondiendo favorablemente. Se presenta el caso, por ser una enfermedad poco frecuente y de muy mal pronóstico.

  13. Effectiveness of photodynamic therapy with verteporfin combined with intrastromal bevacizumab for corneal neovascularization in Stevens-Johnson syndrome.

    Science.gov (United States)

    Yoon, Hyeon Jeong; Kim, Mee Kum; Seo, Kyung Yul; Ueta, Mayumi; Yoon, Kyung Chul

    2017-12-18

    To investigate the effectiveness of combined photodynamic therapy with verteporfin and intrastromal injection of bevacizumab for the treatment of corneal neovascularization in patients with Stevens-Johnson syndrome (SJS). Eight eyes of eight patients with SJS having corneal neovascularization who were refractory to 1% prednisolone instillation received photodynamic therapy with verteporfin (6 mg/m 2 ) combined with intrastromal bevacizumab injection (2.5 mg/0.1 mL). Best-corrected visual acuity and intraocular pressure were assessed, and slit-lamp biomicroscopic examination was performed before treatment and at 1 week and every month. A chronic ocular manifestation score was assigned based on the involvement area or the severity before treatment. The cumulative length of corneal blood vessels and area of corneal neovascularization were measured by anterior segment photographs before and after treatment. At 3 and 6 months after treatment, all eyes showed regression of corneal neovascularization. Complete regression was achieved in five eyes (62.5%) and partial regression in three eyes (37.5%). Among five patients who were followed up for more than 1 year, two eyes maintained complete regression and one eye maintained partial regression at 1 year. However, two eyes with severe chronic ocular manifestation showed revascularization. Combined photodynamic therapy with intrastromal bevacizumab injection can effectively inhibit corneal neovascularization in patients with SJS. However, patients with severe chronic ocular manifestation may exhibit revascularization.

  14. Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Jongkhajornpong, Passara; Lekhanont, Kaevalin; Siriyotha, Sukanya; Kanokrungsee, Silada; Chuckpaiwong, Varintorn

    2017-01-01

    Purpose. To study the correlation between demographics and clinical variables and long-term severe visual impairment in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Methods. A retrospective chart review of SJS/TEN patients between 2004 and 2014 was conducted. Demographics, causative agents, ocular manifestations, and visual outcomes were collected. The data were analyzed using a multivariate logistic regression model. Results. Of the 89 patients including SJS (65, 73.03%), TEN (15, 16.85%), and SJS-TEN overlap (9, 10.11%), 55 were female. The mean age was 41.58 ± 19.17 years. The most common identified agents were medications. Among these groups, antibiotics were the most prevalent (47.19%). Three patients (3.7%) had unknown etiology. Antibiotics and nonpharmaceutical triggers were significantly associated with long-term severe visual impairment (odds ratio 4.32; P = 0.015 and 7.20; P = 0.037, resp.). There was a significant negative relationship between HIV infection and long-term severe visual impairment (P = 0.021). Among all chronic ocular complications, only corneal neovascularization significantly correlated with severe visual impairment (P = 0.001). Conclusions. SJS/TEN patients caused by nonpharmaceutical triggers or antibiotics have an increased risk of developing long-term severe visual impairment from corneal neovascularization. HIV infection might be a protective factor against long-term poor visual outcomes.

  15. Systemic lupus erythematosus presenting as Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of three cases.

    Science.gov (United States)

    Lee, H Y; Tey, H L; Pang, S M; Thirumoorthy, T

    2011-05-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucositis, epidermal detachment and erosions. The underlying etiology in SJS and TEN is almost invariably secondary to drugs. Rarely, other causes such as systemic lupus erythematosus (SLE), infections and vaccinations have been implicated. This report describes three patients with SLE who presented with manifestations of SJS/TEN without a clear drug causality. All three patients presented with photodistributed macular exanthema, which evolved to target lesions, bullae, erosions or sheet-like detachment. This was associated with oral mucositis and conjunctivitis. The onset of the rash was insidious with a protracted clinical course. Ultraviolet exposure and steroid tapering appear to be precipitating factors. In two of the patients, SJS and TEN were the initial presentation of lupus. Although SJS and TEN are almost invariably due to medications, they may, rarely, be an initial presentation of lupus, particularly when associated with an initial photodistribution, absence of genital involvement and a prolonged clinical course.

  16. The Pitfalls of Picturing Atlantic Slavery: Steven Spielberg’s Amistad vs Guy Deslauriers’s The Middle Passage

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    Lars Eckstein

    2011-04-01

    On the one hand, the arts are particularly called for in this situation to fill the documentary gaps and silences through acts of experiment and imagination, and they may indeed have a redemptive effect by offering, in Hayden White’s terms, successful ‘emplotments’ of a traumatic past. One the other hand, this redemptive potential simultaneously poses a serious ethical challenge: As Theodor W. Adorno has warned with reference to the Holocaust, it is precisely by making ‘sense’ of human suffering, and by making accessible to the ‘senses’ what is utterly senseless and incomprehensible, that injustice may be done to the victims. In this paper, I will try to illustrate this problematic by looking at two recent films that have attempted to represent the horrors of the middle passage – Steven Spielberg’s canonical Amistad (a terrible failure, in my view, and Guy Deslauriers’ film The Middle Passage [Passage du Milieu]. Based on a script by the Martiniquean novelist and poet Patrick Chamoiseau, the latter example uses an aesthetic approach which may point at a way out of the dilemma outlined above.

  17. Indications for intubation and early tracheostomy in patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Williams, Rachael; Hodge, Juvonda; Ingram, Walter

    2016-04-01

    Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) result in epidermal sloughing and mucositis. There are no published guidelines for intubation and early tracheostomy in this patient population. A retrospective chart review of 40 patients admitted from 2010 to 2015 with SJS and TEN was conducted. Descriptive statistics and significance were calculated. Of the 43% of patients who underwent early tracheostomy, 100% had oral involvement while the initial total body surface area (TBSA) was 70% or more in 41% of patients (P < .05). TBSA progressed 15% or more in 53% of patients with 6% having airway involvement and a neurologic diagnosis mandating intubation. Mortality was 17%. Indications for intubation and early tracheostomy for SJS and TEN are documented oral involvement plus one of the following: initial TBSA 70% or more; progression of TBSA involved from hospital day 1 to hospital day 3, 15% TBSA or more; underlying neurologic diagnosis preventing airway protection; and documented airway involvement on direct laryngoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Cutaneous reactions simulating erythema multiforme and Stevens Johnson syndrome due to occupational exposure to a plant-growth regulator

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    Inamadar Arun

    2007-01-01

    Full Text Available Background: In India, hydrogen cyanamide (Dormex ® is a plant growth regulator used mainly for the bud-breaking of grapevines. The use of this chemical may result in severe cutaneous reactions simulating erythema multiforme (EM, Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN. Methods: Studies were conducted on four seasonal grapevine workers who developed severe cutaneous reactions following the unprotected use of Dormex ® (hydrogen cyanamide. Results: Two of the patients had EM-like skin lesions and the other two developed SJS-TEN-like skin lesions. A latent period of 5-7 days existed between the contact with the chemical and the development of the skin lesions. The histopathological picture was suggestive of EM. All the patients responded to systemic steroids and antihistamines. Conclusions: Hydrogen cyanamide may act as a hapten, initiating cytotoxic immunological attack on keratinocytes, resulting in EM- and SJS-TEN-like clinical picture. Awareness regarding such severe cutaneous reactions due to the inappropriate handling of Dormex ® is required. The use of personal protection equipments while handling agricultural chemicals is essential.

  19. [In vivoconfocal microscopic observation of corneal changes in patients with chronic Stevens-Johnson syndrome or toxic epidermal necrolysis].

    Science.gov (United States)

    Gao, T T; Li, Y; Liu, J; Long, Q

    2017-03-11

    Objective: To describe corneal alterations visible on in vivo confocal microscopy in patients with debilitating ocular sequelae caused by Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Methods: Twenty-two eyes of 11 consecutive patients suffering from chronic SJS or TEN were studied using slit lamp and in vivo confocal microscopy in the Ophthalmology Outpatient Department of Peking Union Medical College Hospital from March 2014 to April 2015. Results: Dry eye with meibomian gland dysfunction (19 eyes of 10 patients, 86.4%) was the most frequent clinical sequelae. Two patients (3 eyes, 13.6%) had severe vison loss with corneal neovascularization and conjunctivization. One patient had asymmetric binocular disease. Corneal epithelial cells were observed at an active state in 10 patients (19 eyes, 86.4%) and corneal stromal cells at an active state in all patients (22 eyes, 100%). Twenty eyes (10 patients, 91%) were noted with abnormal nerve layout and 10 eyes (5 patients, 45.5%) with dendritic cell infiltration around pathological nerve damages. Numerous inflammory cells were observed in 6 eyes (3 patients, 27.3%). Conclusions: The corneas of patients with chronic ocular sequelae associated with SJS or TEN present a number of abnormalities. In vivo confocal microscopy is a potetial useful tool for therapeutic indications and for follow-up of the debilitating chronic ocular problems linked to SJS and TEN. (Chin J Ophthalmol, 2017, 53:177-181) .

  20. Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013

    Science.gov (United States)

    Suwarsa, Oki; Dharmadji, Hartati Purbo; Sutedja, Endang

    2016-01-01

    Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) with high mortality and have a significant public health impact because of high mortality and morbidity. Objective To describe data the epidemiological features, etiology, and treatment of retrospectively reviewed data of all patients with SJS and TEN. Methods Retrospective study was conducted in patients with SJS and TEN treated from January 1, 2009 to December 31, 2013 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Results A total of 57 patients were enrolled in the study. Thirty-nine cases of SJS (21 males and 18 females), 7 cases of SJS overlapping TEN (4 males and 3 females), and 11 cases of TEN (5 males and 6 females) were reported. All cases of SJS and TEN were caused by drugs, such as paracetamol (16.56%), carbamazepine (7%), amoxicillin (5.73%), ibuprofen (4.46%), rifampicin (3.18%), and trihexyphenidyl (3.18%). All cases were treated systemically with corticosteroid alone (100%). Seven from 57 patients (12,28%) died; 5 cases developed sepsis and 2 cases developed respiratory failure. The mortality rate was 7.69% in SJS, 0% in SJS/TEN overlap, and 36.36% in TEN. Conclusion The role of systemic corticosteroids in SJS and TEN are still controversial, but with a prompt and earlier treatment reduces mortality and improves outcomes of SJS and TEN patients. PMID:26844219

  1. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN): Could Retinoids Play a Causative Role?

    Science.gov (United States)

    Mawson, Anthony R.; Eriator, Ike; Karre, Sridhar

    2015-01-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are overlapping manifestations on a spectrum of acute drug-induced conditions associated with severe blistering, skin peeling, and multi-organ damage. TEN is an eruption resembling severe scalding, with ≥30% skin detachment. SJS is a mild form of TEN, characterized histologically by epidermal keratinocyte apoptosis with dermo-epidermal separation and extensive small blisters with syndrome can be induced by numerous medications and typically occurs 1–4 weeks after the initiation of therapy. Granulysin is found in the lesions of patients with SJS/TEN and plays a significant pathogenic role in the condition, but the overall mechanisms linking medications, granulysin, and disease manifestations remain obscure. This paper reviews evidence suggesting that the different medications implicated in SJS/TEN have the common property of interacting and synergizing with endogenous retinoids (vitamin A and its congeners), in many instances causing the latter to accumulate in and damage the liver, the main storage organ for vitamin A. It is hypothesized that liver damage leads to the spillage of toxic retinoid compounds into the circulation, resulting in an endogenous form of hypervitaminosis A and cytotoxicity with widespread apoptosis, mediated by granulysin and recognized as SJS/TEN. Subject to testing, the model suggests that symptom worsening could be arrested at onset by lowering the concentration of circulating retinoids and/or granulysin via phlebotomy or plasmapheresis or by pharmacological measures to limit their expression. PMID:25579087

  2. Nine years of a single referral center management of Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome).

    Science.gov (United States)

    Monteiro, Diana; Egipto, Paula; Barbosa, Julia; Horta, Ricardo; Amarante, Jose; Silva, Pedro; Silva, Alvaro

    2017-06-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) corresponds to a rare and acute life-threatening mucocutaneous reactions characterized by extensive necrosis and epidermal detachment. There are no efficacious pharmaceutical interventions proven through large clinical trials. We sought to study clinical cases admitted in our institution in order to determine which drugs and medical comorbidities or treatments impacted the mortality. In a retrospective study over 9 years we evaluated all patients presenting biopsy-proven SJS or TEN for age, gender, total body surface area involved, causing agents, SCORTEN score, blood transfusion, steroid administration, intubation, length of intensive care stay and death rate. Statistical analysis was done using SPSS statistical software. The highest incidence of SJS and TEN was in age group of 71-80 years. Of the 30 patients, 30% died from SJS/TEN, mainly due sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality was from antibiotic treatment as causing agent. Step-wise regression analysis identified mechanical ventilation requirement and age over 65 years as mortality high-risk factors. The most crucial interventions are discontinuation of the offending drug and prompt referral to a burn unit, which helps in early diagnosis and decrease mortality in these diseases. When SJS/TEN is caused by antibiotics suspicion of developing fatal sepsis should be high, independently of patients' medical condition.

  3. [Stevens-Johnson syndrome and toxic epidermal necrolysis (SJSTEN) related to insecticide: Second case in the literature and potential implications].

    Science.gov (United States)

    Moullan, M; Ahossi, V; Zwetyenga, N

    2016-06-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis (SJSTEN) is a rare acute drug reaction characterized by the brutal destruction of the superficial layer of the skin and mucosa. SJSTEN is favoured by some drugs (90 % of cases) and genetic factors. It occurs at any age in both sexes. The pathophysiology is not completely understood. To our knowledge, only one case linked to an insecticide has been described. We present the second case involving a combination of lambdacyhalothrin and thiamethoxam. A 34-year-old farmer was admitted in emergency for a severe allergic reaction occurring few days after the use of an insecticide to treat his field with no particular precaution. The disease progression was swift: deterioration of general condition, generalized itching, blisters, bubbles, hyperthermia, tachycardia, significant oral pain and oral lesions and dysphagia. Hands, feet were concerned and external genitalia was responsible for burning urination. Oral lesions have rapidly evolved from edema to infected lesions. The diagnosis of SJSTEN was confirmed by histopathology. After complete assessment and adequate treatment, the patient was discharged after 17 days of hospitalization. The etiological research concluded to a probable poisoning by lambdacyhalothrin and thiamethoxam. This is the second published case of a SJSTEN linked to an insecticide combining lambdacyhalothrin and thiamethoxam. Manufacturers, users, regulators and physicians should take these data into account. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

    Directory of Open Access Journals (Sweden)

    Passara Jongkhajornpong

    2017-01-01

    Full Text Available Purpose. To study the correlation between demographics and clinical variables and long-term severe visual impairment in patients with Stevens-Johnson syndrome (SJS or toxic epidermal necrolysis (TEN. Methods. A retrospective chart review of SJS/TEN patients between 2004 and 2014 was conducted. Demographics, causative agents, ocular manifestations, and visual outcomes were collected. The data were analyzed using a multivariate logistic regression model. Results. Of the 89 patients including SJS (65, 73.03%, TEN (15, 16.85%, and SJS-TEN overlap (9, 10.11%, 55 were female. The mean age was 41.58 ± 19.17 years. The most common identified agents were medications. Among these groups, antibiotics were the most prevalent (47.19%. Three patients (3.7% had unknown etiology. Antibiotics and nonpharmaceutical triggers were significantly associated with long-term severe visual impairment (odds ratio 4.32; P=0.015 and 7.20; P=0.037, resp.. There was a significant negative relationship between HIV infection and long-term severe visual impairment (P=0.021. Among all chronic ocular complications, only corneal neovascularization significantly correlated with severe visual impairment (P=0.001. Conclusions. SJS/TEN patients caused by nonpharmaceutical triggers or antibiotics have an increased risk of developing long-term severe visual impairment from corneal neovascularization. HIV infection might be a protective factor against long-term poor visual outcomes.

  5. Ethosuximide-induced Stevens-Johnson syndrome: Beneficial effect of early intervention with high-dose corticosteroid therapy.

    Science.gov (United States)

    Tachibana, Kota; Hamada, Toshihisa; Tsuchiya, Hiroki; Shibata, Takashi; Fujii, Kazuyasu; Kobayashi, Katsuhiro; Iwatsuki, Keiji

    2018-02-11

    We report two rare cases of childhood epilepsy patients who developed ethosuximide-induced Stevens-Johnson syndrome (SJS). Unlike typical SJS, the initial eruption of both patients presented well-demarcated, infiltrating firm papules mainly on the cheeks and the extensor aspects of the arms (case 1), and multiple vesicles on the soles and oral aphthosis (case 2), which closely mimicked viral exanthema. We diagnosed both patients with ethosuximide-induced SJS, based on the dosing period and the positive results of drug-induced lymphocyte stimulation test. Systemic corticosteroids are usually selected as a standard therapy for SJS, despite controversial results regarding their effectiveness. In case 1, an i.v. pulse therapy of methylprednisolone (30 mg/kg, 3 days consecutively) was initiated on day 7 from the onset of illness, and an i.v. immunoglobulin (400 mg/kg, 5 days consecutively) was added the following day. In case 2, an i.v. prednisone treatment (1 mg/kg, for 1 week) was initiated on day 4 from the onset. Eventually, the early therapeutic interventions resulted in good outcomes in both patients. © 2018 Japanese Dermatological Association.

  6. Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

    Science.gov (United States)

    Siriyotha, Sukanya; Kanokrungsee, Silada; Chuckpaiwong, Varintorn

    2017-01-01

    Purpose. To study the correlation between demographics and clinical variables and long-term severe visual impairment in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Methods. A retrospective chart review of SJS/TEN patients between 2004 and 2014 was conducted. Demographics, causative agents, ocular manifestations, and visual outcomes were collected. The data were analyzed using a multivariate logistic regression model. Results. Of the 89 patients including SJS (65, 73.03%), TEN (15, 16.85%), and SJS-TEN overlap (9, 10.11%), 55 were female. The mean age was 41.58 ± 19.17 years. The most common identified agents were medications. Among these groups, antibiotics were the most prevalent (47.19%). Three patients (3.7%) had unknown etiology. Antibiotics and nonpharmaceutical triggers were significantly associated with long-term severe visual impairment (odds ratio 4.32; P = 0.015 and 7.20; P = 0.037, resp.). There was a significant negative relationship between HIV infection and long-term severe visual impairment (P = 0.021). Among all chronic ocular complications, only corneal neovascularization significantly correlated with severe visual impairment (P = 0.001). Conclusions. SJS/TEN patients caused by nonpharmaceutical triggers or antibiotics have an increased risk of developing long-term severe visual impairment from corneal neovascularization. HIV infection might be a protective factor against long-term poor visual outcomes. PMID:28458921

  7. Multifocal Stevens-Johnson syndrome after concurrent phenytoin and cranial and thoracic radiation treatment, a case report

    Directory of Open Access Journals (Sweden)

    Wu Julian K

    2010-06-01

    Full Text Available Abstract A 46 year old male patient with metastatic prostate cancer developed Stevens-Johnson syndrome (SJS, initially in three well-demarcated areas on his scalp, chest and back, corresponding to ports of radiation therapy while on phenytoin. The rash spread from these locations and became more generalized and associated with pain and sloughing in the mucous lining of the mouth. There is a documented association between phenytoin administration with concurrent cranial radiation therapy and development of SJS. Erythema multiforme (EM associated with phenytoin and cranial radiation therapy (EMPACT is the term that describes this reaction. However, this term may not cover the full spectrum of the disease since it describes EM associated with phenytoin and only cranial radiation therapy. This case report presents evidence that SJS may be induced by radiation to other parts of the body in addition to the cranium while phenytoin is administered concomitantly. With increasing evidence that phenytoin and levetiracetam are equally efficacious for seizure treatment and prophylaxis, and since there is no link identified so far of an association between levetiracetam and SJS, we believe that levetiracetam is a better option for patients who need anticonvulsant medication(s while undergoing radiation therapy, especially cranial irradiation.

  8. Plasma Lipid Profiling of Patients with Chronic Ocular Complications Caused by Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Saito, Kosuke; Ueta, Mayumi; Maekawa, Keiko; Sotozono, Chie; Kinoshita, Shigeru; Saito, Yoshiro

    2016-01-01

    Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are drug-induced acute inflammatory vesiculobullous reactions of the skin and mucous membranes, including the ocular surface. Even after recovery from skin symptoms, some SJS/TEN patients continue to suffer with severe ocular complications (SOCs). Therefore, this study aims to understand the pathophysiology of chronic SOCs. Because plasma lipid profiling has emerged as a useful tool to understand pathophysiological alterations in the body, we performed plasma lipid profiling of 17 patients who suffered from SJS/TEN-associated chronic SOCs. A lipidomics approach yielded 386 lipid molecules and demonstrated that plasma levels of inflammatory oxylipins increased in patients with SJS/TEN-associated chronic SOCs. In addition, oxidized phosphatidylcholines and ether-type diacylglycerols increased in the patients with chronic SOCs, while phosphoglycerolipids decreased. When we compared these lipidomic profiles with those of patients with atopic dermatitis, we found that patients with chronic SOCs, specifically, had decreased levels of ether-type phosphatidylcholines (ePCs) containing arachidonic acid (AA), such as PC(18:0e/20:4) and PC(20:0e/20:4). To confirm our finding, we recruited additional patients, who suffered from SOC associated with SJS/TEN (up to 51 patients), and validated the decreased plasma levels of AA-containing ePCs. Our study provides insight into the alterations of plasma lipidomic profiles in chronic SOCs and into the pathophysiology of SJS/TEN-associated chronic SOCs.

  9. Microbiological findings and antibacterial therapy in Stevens-Johnson syndrome/toxic epidermal necrolysis patients from a Swedish Burn Center.

    Science.gov (United States)

    Tocco-Tussardi, Ilaria; Huss, Fredrik; Presman, Benjamin

    2017-05-01

    Superimposed infections/sepsis are the major cause of morbidity/mortality in Stevens-Johnson syndrome/Toxic Epidermal Necrolysis (SJS/TEN). It is a delicate balance between avoiding new pharmaceuticals and prophylactically treat an incipient infection. The objective of this study was to investigate the rates and types of infection-microbials and antibiotics involved in SJS/TEN patients. Microbiology and clinical data were collected for SJS/TEN patients admitted to our Burn Center from January 2010 through January 2016. A total of 24 patients were admitted over the study period. There were 303 bacterial cultures taken whereof 113 (37.3%) were positive (median of 4.4 per patient). Twenty-two (91.7%) patients had at least 1 positive sample recorded. Fifteen (62.5%) patients had a confirmed episode of sepsis with skin being the most common source of colonization (77.8%). Eleven (45.8%) patients received empiric antibiotic therapy at referral facility/prior to admission to our Center. Patients who grew a higher number of different species were significantly less likely to have received early empiric antimicrobial therapy (P < .001). Secondary bacterial infection and sepsis were a highly common finding in our patient population. Despite the risk of resistance and further immunological provocation, empirical antibiotic treatment might have a place in clinical management. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Estudo dos achados oculares na síndrome de Stevens-Johnson em pacientes de centro de referência de atendimento terciário Study of the ocular findings in Stevens-Johnson syndrome patients from a tertiary ophthalmologic center

    Directory of Open Access Journals (Sweden)

    Marciel Dourado Franca

    2009-06-01

    Full Text Available OBJETIVO: Avaliar a epidemiologia, os possíveis fatores desencadeantes, complicações encontradas e as variedades de tratamentos administrados a um grupo de pacientes com complicações oculares secundárias à síndrome de Stevens-Johnson. MÉTODOS: Realizado estudo prospectivo, série de casos com 22 pacientes portadores de síndrome de Stevens-Johnson. Os pacientes foram estudados seguindo um protocolo com o objetivo de se buscar uma história detalhada sobre a doença, suas manifestações sistêmicas e oftalmológicas, bem como o tratamento realizado, dando ênfase aos possíveis fatores desencadeantes. RESULTADOS: Foram avaliados 22 pacientes com síndrome de Stevens-Johnson. Quinze pacientes (68% eram do sexo feminino e 7 (32% do sexo masculino. Dez pacientes eram brancos (45,4%, 9 pardos (22%, 2 negros (9% e 1 amarelo (4,5%. A média de idade foi de 27,1 anos (variação entre 8 e 62 anos. A associação com drogas foi o principal fator etiológico. Em 20 pacientes (90,9% o desenvolvimento da doença esteve associado ao uso de medicações, 1 (4,5% por infecção herpética cutânea e 1 (4,5% idiopático. A dipirona (36,3% foi o agente mais associado à síndrome de Stevens-Johnson seguido por anticonvulsivantes (22,7%, anti-inflamatórios não hormonais (13,6%, sulfonamidas (9,0%, penicilinas (4,5%, espironolactona (4,5% e anticoncepcional injetável (dihidroprogesterona e estradiol (4,5%. Vinte e um pacientes (95,4% desenvolveram complicações oculares e 16 pacientes (72,7% foram submetidos a procedimentos cirúrgicos oftalmológicos. CONCLUSÃO: Os resultados observados neste estudo mostram aspectos epidemiológicos importantes da síndrome de Stevens-Johnson em nosso meio, principalmente em relação à idade, etiologia e complicações.PURPOSE: To evaluate the epidemiology, possible etiologic factors, complications and treatment of a group of patients with ocular complications secondary to Stevens-Johnson syndrome. METHODS

  11. Correlation between drug-drug interaction-induced Stevens-Johnson syndrome and related deaths in Taiwan.

    Science.gov (United States)

    Cheng, Fu-Jen; Syu, Fei-Kai; Lee, Kuo-Hsin; Chen, Fu-Cheng; Wu, Chien-Hung; Chen, Chien-Chih

    2016-04-01

    Concomitant use of some drugs can lead to interactions between them resulting in severe adverse effects. To date, there are few reports of incidences of Stevens-Johnson syndrome (SJS) associated with combination drug administration. Therefore, we studied the relationship between drug combinations and SJS-related mortality, with the hope that a retrospective study of this nature would provide information crucial for the prevention of future drug-drug interaction related deaths attributable to SJS. This retrospective longitudinal study used mortality cases from 1999 to 2008 that were diagnosed as erythema multiforme (International Classification of Diseases, Ninth Revision, Clinical Modification 695.1) from the National Health Insurance database in Taiwan. Statistical comparisons of the results were performed using analysis of variance (ANOVA), independent sample t-tests, and odds ratio (OR). In this way, the relationship between combinations of SJS-inducing drugs and mortality could be determined. A total of 111 patients who had died, including 63 males and 48 females (66.0 ± 20 and 70.0 ± 17.7 years, respectively), were suspected of having experienced drug-drug interaction-related adverse effects. The associated drug combinations included allopurinol and ampicillin (p = 0.049), carbamazepine and sulfamethoxazole/trimethoprim (TMP) (p drugs that may possibly induce SJS. In addition, attention should be paid to ensure prompt identification of possible drug-drug interactions, and patients should be closely monitored. Furthermore, medications should be immediately discontinued at the first sign or symptom suggesting the occurrence of drug-related SJS, and then prompt, adequate supportive care should be provided. Copyright © 2016. Published by Elsevier B.V.

  12. Risk of toxic epidermal necrolysis and Stevens-Johnson syndrome associated with benzodiazepines: a population-based cohort study.

    Science.gov (United States)

    Martín-Merino, Elisa; de Abajo, Francisco J; Gil, Miguel

    2015-06-01

    We aim to estimate the incidence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) among tetrazepam users and compare it with benzodiazepine users in a Spanish primary care database (BIFAP). The incidence in the general population (GenPop) and among phenytoin new users (as a positive control) was also estimated. We identified a cohort of GenPop free of SJS/TEN (N = 3,155,364). Cohort entry was the date after 1 year of register with the physician during 2001-2011. No age restrictions were applied. Patients were followed from entry up to the first of the following: a record of SJS/TEN (potential cases), death, end of information, or December 2011. History of potential cases were manually reviewed blinded to exposure and considered "probable" when diagnosed in referral reports. Three cohorts of patients newly prescribed with benzodiazepines (N = 531,813), tetrazepam (N = 343,568), or phenytoin (N = 4993) were extracted from the GenPop cohort. Incidence rate (cases per million person-years (py)) for the GenPop and cumulative incidence (per million new users) during the first 9 weeks after each drug prescription were computed. In the GenPop, 48 probable cases (38 SJS and 10 TEN) were identified (3.21/million py; 3.37 in men and 2.94 in women). In the benzodiazepines cohort, 2 probable TEN cases was identified (3.76/mill.). In the tetrazepam cohort, 1 probable SJS/TEN case was identified (2.91/mill.). In the phenytoin cohort, 4 probable cases (2 SJS and 2 TEN) were identified (801.12/mill.). The incidence of SJS/TEN in tetrazepam users was very rare and similar to benzodiazepines users. The incidence in the GenPop and among users of phenytoin agreed with the literature.

  13. Predicting Mechanical Ventilation and Mortality: Early and Late Indicators in Steven-Johnson Syndrome and Toxic Epidermal Necrolysis.

    Science.gov (United States)

    Beck, Anna; Cooney, Ryan; Gamelli, Richard L; Mosier, Michael J

    2016-01-01

    Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are characterized by loss of the epidermis, often accompanied by sloughing of the oral mucosa and airway, which may be associated with the need for mechanical ventilation. We retrospectively examined our SJS and TEN population for factors predictive of the need for mechanical ventilation and mortality. Over more than a 7-year period, 74 subjects of ≥18 years old with biopsy-confirmed SJS-TEN were identified. Variables within the first 3 days of admission and throughout the entire hospital stay were analyzed for their value in predicting the need for mechanical ventilation and mortality. Predictive variables were examined using univariate and multivariate logistic regression analyses. Of our 74 subjects, 28 (37.8%) required mechanical ventilation and 11 (13.9%) died, all of whom were intubated. Patients requiring ventilation had a significantly higher %TBSA loss of epidermis on admission and progressive epidermal loss after admission. On multivariate analysis, acute kidney injury within the first 3 days of admission and fewer days from symptom onset to admission were statistically significant in predicting need for mechanical ventilation. In addition, the early need for mechanical ventilation, early serum bicarbonate <20 mm/L, and older age were all associated with higher mortality on multivariate analysis. In conclusion, the need for mechanical ventilation in adult TEN subjects is associated with higher mortality. This is the first time that mechanical ventilation has been specifically examined in the recent U.S. SJS and TEN population. The early recognition of patients at risk for ventilation may help guide management, especially in those patients admitted early after symptom development with acute kidney injury and extensive, progressing epidermal loss.

  14. Inter population variability of frost-resistance in provenances of scot pines (Pinusylvestris L.R. hamata Steven in Turkey

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    Özel Halil Barış

    2016-01-01

    Full Text Available Frost-resistance variability of Scotch pine (Pinus sylvestris L. var. hamata Steven seedlings grown in nurseries conditions, originated from 10 provenances, have been analyzed. The provenances from Black Sea region, Central Anatolian region and Eastern Anatolian region in Turkey have been used in selection of seed zones. The results of frost-resistance tests indicated a strong relationship of implemented freezing degrees with injury degrees of Scotch pine needles and photosynthetic productivities. On the other hand, another significant relationship has been determined between chlorophyll fluorescence and ion leakage methods (r=-0.801. This result shows that those two methods can be safely used in determining the damages due to low temperatures. In frost resistance tests, Scotch pine seedlings from different provenances have been frozen at -10, -20, -30 and -40°C. According to the Duncan test results, it has been determined that damage increased as temperature decreased. The damage level at -10°C implementation is 3.5% which can be tolerated by plants. But when the temperature has been decreased to -20°C, the level of damage has increased to 51.25%. As a result of photosynthetic analyses in this phase, it has been determined that there is a statistically significant relationship between provenances and temperature levels. Under the light of those findings, they have determined that the photosynthetic productivity has significantly decreased at temperatures between -20°C and -40°C. This situation conforms to injury index values determined in this study. As a result of injury index and photosynthetic productivity tests used for determining the damage after frost-resistance tests, it has been determined that the provenances of Amasya-Kunduz, Bolu-Aladağ, Düzce-Yığılca, Samsun-Vezirköprü and Eskişehir-Çatacık are more sensitive to frost than other provenances.

  15. Validation of Stevens-Johnson syndrome or toxic epidermal necrolysis diagnoses in the Clinical Practice Research Datalink.

    Science.gov (United States)

    Frey, Noel; Bircher, Andreas; Bodmer, Michael; Jick, Susan S; Meier, Christoph R; Spoendlin, Julia

    2017-04-01

    To evaluate the validity of recorded diagnoses of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in the Clinical Practice Research Datalink (CPRD). We identified patients with a diagnosis of SJS or TEN between 1995 and 2013 in the CPRD. We reviewed information from patient records, free text, and hospital episode statistics (HES) data, and excluded patients with no indication of a secondary care referral. Remaining patients were classified as probable, possible, or unlikely cases of SJS/TEN by two specialised clinicians or based on pre-defined classification criteria. We quantified positive predictive values (PPV) for all SJS/TEN patients and for patients categorised as 'probable/possible' cases of SJS/TEN, based on a representative subsample of 118 patients for whom we had unequivocal information (original discharge letters or HES data). We identified 1324 patients with a diagnosis of SJS/TEN, among whom 638 had a secondary care referral recorded. Of those, 565 were classified as probable or possible cases after expert review. We calculated a PPV of 0.79 (95% CI, 0.71-0.86) for all SJS/TEN patients with a recorded secondary care referral, and a PPV of 0.87 (95% CI, 0.81-0.93) for probable/possible cases. After excluding 14 false positive patients, our study population consisted of 551 SJS/TEN patients. Diagnoses of SJS/TEN are recorded with moderate diagnostic accuracy in the CPRD, which was substantially improved by additional expert review of all available information. We established a large population-based SJS/TEN study population of high diagnostic validity from the CPRD. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Carbamazepine - The commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: A study of 7 years

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    Devi K

    2005-01-01

    Full Text Available Background : Toxic epidermal necrolysis (TEN and Stevens-Johnson syndrome (SJS are a group of severe life threatening drug reactions. The drugs commonly implicated as the cause of these drug reactions vary depending on host factors and the prescription pattern of drugs in that particular area. Aim : The aim of the study was to find the drugs implicated as the cause of SJS/TEN in the patients admitted in the dermatology ward at the Medical College, Thrissur and to find the clinical outcome. Methods : It was a retrospective study of 7 years from 1997 to 2004. The case records of all patients with a clinical diagnosis of TEN or SJS were studied in detail regarding the drugs implicated as the cause, the management and the clinical outcome. Results : During the study period, 41 patients in the age group ranging from 12 to 72 years were treated as inpatients, of which 20 were males and 21 were females. The commonest drug implicated as the cause of SJS/TEN was carbamazepine (44%. The indication for carbamazepine was control of pain in more than 50% of the cases. Presence of a major systemic disease before the onset of SJS/TEN was associated with a bad prognosis. Conclusion : The increased use of carbamazepine, especially for control of pain, may be the reason for the increased incidence of SJS/TEN due to the same drug. Awareness about the drugs implicated in life threatening drug reactions will help physicians in preventing them by judicious use of the drugs.

  17. Survey of Nonprescription Medication and Antibiotic Use in Patients with Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, and Overlap Syndrome

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    Katherine J. Sullivan

    2018-02-01

    Full Text Available Stevens-Johnson syndrome (SJS, toxic epidermal necrolysis (TEN, and overlap syndrome (SJS-TEN are rare, serious skin and mucosa break-down conditions frequently associated with antibiotic use. The role of nonprescription medications alone, or in combination with antibiotics in triggering SJS/TEN, is largely unknown. This study summarized data collected from patient surveys about nonprescription and antibiotic use prior to a SJS/TEN diagnosis. The survey was administered online to members of the U.S. SJS Foundation who had been diagnosed with SJS/TEN or were the parent of a child who had been diagnosed with SJS/TEN. Respondents were asked about nonprescription medications taken within the year before diagnosis, and the approximate point in time before diagnosis that they had taken them. They were also asked about specific prescription medications, including antibiotics, that they took before diagnosis. An estimated 4500 patients received an invitation to complete the survey. 251 patients completed it, resulting in a response rate of 5.6%. The mean age of respondents was 43 years (SD (standard deviation = 17.3 and 70% were female. 32.3% of respondents indicated that a prescription antibiotic triggered their reaction. 14.1% indicated a nonprescription medication had triggered their SJS/TEN, and 18.1% said a nonprescription medication may have triggered their SJS/TEN. 85.5% of respondents said they took a nonprescription medication within three months of their SJS/TEN diagnosis. Of those respondents who reported that an antibiotic triggered their SJS/TEN, 35.2% reported taking a nonprescription medication within the three months prior to their diagnosis. This survey captured valuable information about nonprescription and antibiotic use in SJS/TEN patients. It is important for future studies to estimate the impact of antibiotics on SJS/TEN, and account for nonprescription medication use in that relationship.

  18. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients--Treatment and outcome.

    Science.gov (United States)

    Yamane, Yumiko; Matsukura, Setsuko; Watanabe, Yuko; Yamaguchi, Yukie; Nakamura, Kazuko; Kambara, Takeshi; Ikezawa, Zenro; Aihara, Michiko

    2016-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe adverse drug reactions with high mortality. To present the clinical characteristics of SJS and TEN in Japan and evaluate the efficacy of treatments, we retrospectively analyzed cases of SJS and TEN treated in 2 university hospitals during 2000-2013. Fifty-two cases of SJS (21 males and 31 females; average age, 55.1 years) and 35 cases of TEN (17 males and 18 females; average age, 56.6 years) were included in this study. Twenty-eight cases of SJS (53.8%) and all cases of TEN were caused by drugs. Hepatitis was the most common organ involvement in both SJS and TEN. Renal dysfunction, intestinal disorder, and respiratory disorder were also involved in some cases. The major complication was pneumonia and sepsis. All cases except for 3 cases were treated systemically with corticosteroids. Steroid pulse therapy was performed in 88.6% of TEN. Plasmapheresis and/or immunoglobulin therapy was combined with steroid therapy mainly in TEN after 2007. The mortality rate was 6.9% and the rates for SJS and TEN were 1.9% and 14.3%, respectively. These were much lower than predicted mortality according to a severity-of-illness scoring system for TEN prognosis (SCORTEN) score. When comparing the mortality rate between 2000-2006 and 2007-2013, it was decreased from 4.5% to 0.0% in SJS and from 22.2% to 5.3% in TEN. Treatment with steroid pulse therapy in combination with plasmapheresis and/or immunoglobulin therapy seems to have contributed to prognostic improvement in SJS/TEN. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  19. Stevens-Johnson syndrome and toxic epidermal necrolysis in childhood-onset systemic lupus erythematosus patients: a multicenter study

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    Ana Paula Sakamoto

    2017-07-01

    Full Text Available Objective: To assess Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN in a large population of childhood-onset systemic lupus erythematosus (cSLE patients. Methods: Multicenter study including 852 cSLE patients followed in Pediatric Rheumatology centers in São Paulo, Brazil. SJS was defined as epidermal detachment below 10% of body surface area (BSA, overlap SJS-TEN 10-30% and TEN greater than 30% of BSA. Results: SJS and TEN was observed in 5/852 (0.6% cSLE female patients, three patients were classified as SJS and two patients were classified as overlap SJS-TEN; TEN was not observed. The mean duration of SJS and overlap SJS-TEN was 15 days (range 7-22 and antibiotics induced four cases. Regarding extra-cutaneous manifestations, hepatomegaly was observed in two cSLE patients, nephritis in two and neuropsychiatric involvement and conjunctivitis were observed respectively in one patient. Hematological involvement included lymphopenia in four, leucopenia in three and thrombocytopenia in two patients. The mean SLEDAI-2K score was 14.8 (range 6-30. Laboratory analysis showed low C3, C4 and/or CH50 in two patients and the presence of anti-dsDNA autoantibody in two patients. One patient had lupus anticoagulant and another one had anticardiolipin IgG. All patients were treated with steroids and four needed additional treatment such as intravenous immunoglobulin in two patients, hydroxychloroquine and azathioprine in two and intravenous cyclophosphamide in one patient. Sepsis was observed in three cSLE patients. Two patients required intensive care and death was observed in one patient. Conclusion: Our study identified SJS and overlap SJS-TEN as rare manifestations of active cSLE associated with severe multisystemic disease, with potentially lethal outcome.

  20. Survey of Nonprescription Medication and Antibiotic Use in Patients with Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, and Overlap Syndrome.

    Science.gov (United States)

    Sullivan, Katherine J; Jeffres, Meghan N; Dellavalle, Robert P; Valuck, Robert; Anderson, Heather D

    2018-02-01

    Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and overlap syndrome (SJS-TEN) are rare, serious skin and mucosa break-down conditions frequently associated with antibiotic use. The role of nonprescription medications alone, or in combination with antibiotics in triggering SJS/TEN, is largely unknown. This study summarized data collected from patient surveys about nonprescription and antibiotic use prior to a SJS/TEN diagnosis. The survey was administered online to members of the U.S. SJS Foundation who had been diagnosed with SJS/TEN or were the parent of a child who had been diagnosed with SJS/TEN. Respondents were asked about nonprescription medications taken within the year before diagnosis, and the approximate point in time before diagnosis that they had taken them. They were also asked about specific prescription medications, including antibiotics, that they took before diagnosis. An estimated 4500 patients received an invitation to complete the survey. 251 patients completed it, resulting in a response rate of 5.6%. The mean age of respondents was 43 years (SD (standard deviation) = 17.3) and 70% were female. 32.3% of respondents indicated that a prescription antibiotic triggered their reaction. 14.1% indicated a nonprescription medication had triggered their SJS/TEN, and 18.1% said a nonprescription medication may have triggered their SJS/TEN. 85.5% of respondents said they took a nonprescription medication within three months of their SJS/TEN diagnosis. Of those respondents who reported that an antibiotic triggered their SJS/TEN, 35.2% reported taking a nonprescription medication within the three months prior to their diagnosis. This survey captured valuable information about nonprescription and antibiotic use in SJS/TEN patients. It is important for future studies to estimate the impact of antibiotics on SJS/TEN, and account for nonprescription medication use in that relationship.

  1. Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis.

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    Lauren Knight

    Full Text Available Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are life-threatening drug reactions with a higher incidence in HIV-infected persons. SJS/TEN are associated with skin and mucosal failure, predisposing to systemic bacterial infection (BSI, a major cause of death. There are limited data on risk factors associated with BSI and and mortality in HIV-infected people with SJS/TEN.We conducted a retrospective study of patients admitted to a university hospital with SJS/TEN over a 3 year period. We evaluated their underlying illnesses, eliciting drugs, predictive value of bacterial skin cultures and other factors associated with mortality and BSI in a predominantly HIV-infected population by comparing characteristics of the patients who demised and those who survived.We admitted 86 cases during the study period and 67/86(78% were HIV-infected. Tuberculosis was the commonest co-morbidity, diagnosed in 12/86(14% cases. Skin cultures correlated with BSI by the same organism in 7/64(11% cases and 6/7 were Gram-negative. Two of the 8 cases of Gram-negative BSI had an associated Gram-negative skin culture, although not always the same organism. All 8 fatalities had >30% epidermal detachment, 7 were HIV-infected, 6 died of BSI and 6 had tuberculosis.Having >30% epidermal detachment in SJS/TEN carries an increased risk of BSI and mortality. Tuberculosis and BSI are associated with higher risk of death in SJS/TEN. Our data suggests there may be an association between Gram-negative BSI and Gram-negative skin infection.

  2. Causes and Treatment Outcomes of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 82 Adult Patients

    Science.gov (United States)

    Kim, Hye-In; Park, Ga-Young; Kwon, Eu-Gene; Kim, Hyo-Hoon; Jeong, Ju-Young; Chang, Hyun-Ha; Lee, Jong-Myung; Kim, Neung-Su

    2012-01-01

    Background/Aims Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. Methods The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. Results A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of ≥ 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). Conclusions Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes. PMID:22707893

  3. Epidemiology and Molecular Characteristics of Mycoplasma pneumoniae During an Outbreak of M. pneumoniae-associated Stevens-Johnson Syndrome.

    Science.gov (United States)

    Watkins, Louise K Francois; Olson, Daniel; Diaz, Maureen H; Lin, Xia; Demirjian, Alicia; Benitez, Alvaro J; Winchell, Jonas M; Robinson, Christine C; Bol, Kirk A; Glodé, Mary P; Dominguez, Samuel R; Miller, Lisa A; Kutty, Preeta K

    2017-06-01

    An increase in Mycoplasma pneumoniae-associated Stevens-Johnson syndrome (SJS) cases at a Colorado pediatric hospital led to an outbreak investigation. We describe the epidemiologic and molecular characteristics of M. pneumoniae among SJS case-patients and surrounding community members during the outbreak. M. pneumoniae polymerase chain reaction-positive respiratory specimens from 5 Colorado hospitals and 4 referral laboratories underwent confirmatory polymerase chain reaction testing; positive specimens then underwent multilocus variable-number tandem-repeat analysis (MLVA) and macrolide resistance testing. Three SJS-M. pneumoniae case-patient households were surveyed using a standardized questionnaire, and nasopharyngeal/oropharyngeal swabs were obtained from all consenting/assenting household contacts. International Classification of Diseases, 9th revision codes were used to identify pneumonia cases among Colorado patients 5-21 years of age from January 2009 to March 2014. Three different M. pneumoniae MLVA types were identified among the 5 SJS case-patients with confirmed infection; MLVA type 3-X-6-2 was seen more commonly in SJS case-patients (60%) than in 69 non-SJS community specimens (29%). Macrolide resistance was identified in 7% of community specimens but not among SJS case-patients. Of 15 household contacts, 5 (33%) were M. pneumoniae positive; all MLVA types were identical to those of the corresponding SJS case-patient, although the specimen from 1 contact was macrolide resistant. Overall pneumonia cases as well as those caused by M. pneumoniae specifically peaked in October 2013, coinciding with the SJS outbreak. The outbreak of M. pneumoniae-associated SJS may have been associated with a community outbreak of M. pneumoniae; clinicians should be aware of the M. pneumoniae-SJS relationship. Household transmission of M. pneumoniae was common within the households investigated.

  4. Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug-related hospitalisations in a national administrative database.

    Science.gov (United States)

    Sousa-Pinto, Bernardo; Araújo, Luís; Freitas, Alberto; Correia, Osvaldo; Delgado, Luís

    2018-01-01

    Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and erythema multiforme (EM) are immunologically-mediated dermatological disorders commonly triggered by drug exposure and/or other external agents. We aimed to characterise SJS/TEN- and EM-drug-related hospitalisations in a nationwide administrative database, focusing on demographic and clinical characteristics, and in the most frequently implicated drug classes. We analysed all drug-related hospitalisations with associated diagnosis of SJS/TEN or EM in Portuguese hospitals between 2009 and 2014. We compared gender, age, comorbidities, length of stay, and in-hospital mortality and estimated the number of episodes per million packages sold of drug classes. Predictors of in-hospital mortality were investigated in both conditions by logistic regression. There were 132 SJS/TEN-related and 122 EM-related hospitalisations. Incidence and in-hospital mortality of SJS/TEN episodes (24.2%) were consistent with previous studies. HIV co-infection was more common among SJS/TEN hospitalisations (9 vs. 2% with EM; P  = 0.009). Liver disease, advanced age, and a TEN diagnosis, were significantly associated with higher risk of mortality in patients with SJS/TEN. The highest numbers of SJS/TEN and EM episodes per million drug packages sold were observed for antivirals (8.7 and 1.5, respectively), antineoplastic/immunosuppressive drugs (5.6 and 3.9, respectively) and hypouricaemic drugs (5.0 and 2.4, respectively). SJS/TEN in-hospital mortality is high, and its risk factors include advanced age, liver disease, and TEN diagnosis. The drug classes most frequently associated with these conditions include antivirals, hypouricaemic drugs and antineoplastic/immunosuppressive drugs. Administrative databases seem useful in the study of SJS/TEN drug-related hospitalisations, yielding results consistent with previous studies and on a nationwide basis.

  5. Lente de contato escleral na reabilitação ocular de pacientes com síndrome de Stevens-Johnson

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    Ana Carolina Punzi de Siqueira

    2010-10-01

    Full Text Available OBJETIVO: Avaliar a eficácia do uso das lentes de contato esclerais no manejo das sequelas oculares de pacientes portadores de síndrome de Stevens-Johnson. MÉTODOS: Foram avaliados, retrospectivamente, pacientes com sequelas oculares da síndrome de Stevens-Johnson que iniciaram o uso de lente de contato escleral. Os pacientes foram submetidos a avaliação subjetiva dos sintomas através de um questionário; exame oftalmológico (medida da acuidade visual, biomicroscopia, coloração da superfície ocular com colírio de fluoresceína, teste de Schirmer. RESULTADOS: Dez olhos de 7 pacientes foram analisados. A acuidade visual dos pacientes variou de movimentos de mão a 20/25. Todos os pacientes apresentavam algum grau de opacidade corneal e simbléfaro leve. A lente de contato escleral foi adaptada com sucesso em 90% dos olhos. Em todos estes casos os pacientes referiram melhora dos sintomas e da visão. Com relação aos achados biomicroscópicos observou-se melhora da hiperemia conjuntival e da ceratite, e diminuição da secreção mucosa em 90% dos olhos. CONCLUSÕES: Foi possível uma adaptação bem sucedida da lente de contato escleral em grande parte dos pacientes, com melhora dos sintomas e da acuidade visual provavelmente consequentes à melhora da regularização da superfície ocular. As lentes de contato esclerais representam uma importante e acessível alternativa para a redução da limitação ocasionada pelos danos sequelares da síndrome de Stevens-Johnson.

  6. Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal

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    Mariane Ferreira Barbosa Emerick; Mayra Martins Toledo Rodrigues; Daniella Melo Arnaud Sampaio Pedrosa; Maria Rita Carvalho Garbi Novaes; Leila Bernarda Donato Gottems

    2014-01-01

    Objetivou-se analisar as características demográficas e clínicas dos clientes diagnosticados com Síndrome de Stevens Johnson (SSJ) e Necrólise Epidérmica Tóxica (NET), bem como identificar as ações dos profissionais de saúde para o manejo das Reações Adversas a Medicamentos (RAM) em um hospital público do Distrito Federal. Pesquisa descritiva, retrospectiva, com abordagem quantitativa. Dados coletados em todos os prontuário...

  7. Milliste plaanidega lähed vastu uuele õppeaastale? / Triinu Lepp, Gleb Tšurbanov, Erik Paemurru, Steven Huang...[jt.

    Index Scriptorium Estoniae

    2008-01-01

    Küsimusele vastavad hariduskolleegiumi algkooli 3. klassi õpilane Egert, prantsuse lütseumi 12. klassi õpilane Triinu Lepp, Sillamäe kutsekooli 3. kursuse õpilane Gleb Tšurbanov, Tallinna reaalkooli 11. klassi õpilane Erik Paemurru, Toronto Crescenti keskkooli õpilane Steven Huang, kunstiakadeemia muinsuskaitse- ja restaureerimisosakonna õppejõud Jaan Tamm, Tartu Miina Härma gümnaasiumi 2. a klassi õpilane Erki Külaots, Tallinna 21. kooli 11. klassi õpilane Sander Kaur ja Tapa gümnaasiumi 7. klassi õpilane Evelin Orgse

  8. Nimesulide induced Stevens Johnson syndrome (SJS; managed successfully with combined approach of steroids, intravenous immunoglobulin and placentrex gel: A case report

    Directory of Open Access Journals (Sweden)

    Rakesh Tilak Raj

    2014-10-01

    Full Text Available There is a high mortality rate in Stevens Johnson Syndrome (SJS and it ranges between 5%-15%. At present, there is no definite consensus regarding treatment in SJS although the effectiveness of intravenous immunoglobulin’s (IVIg and immunosuppressive like cyclosporine have generated new hopes in the lives of these patients. But the options of combination therapy of steroids, IVIg and Placentrex gel have not been fully exercised in SJS. Henceforth, we report a case of Nimesulide induced SJS; managed successfully with a combined approach without any recurrence during a 12 months follow-up.

  9. Síndrome de Stevens-Johnson: repercussões oculares e possíveis tratamentos

    Directory of Open Access Journals (Sweden)

    José Victor de Miranda Pedroso

    2016-10-01

    Full Text Available Introdução: A síndrome de Stevens-Johnson (SSJ caracteriza-se por um  processo imunológico que provoca lesões mucocutâneas inflamatórias que progridem para necrose, acometendo principalmente a face e o tronco e pode ocorrer por uma reação de hipersensibilidade tardia a medicamentos. Objetivos: relatar o caso de um paciente portador da SSJ que faz acompanhamento oftalmológico devido a defeito epitelial persistente do olho esquerdo. Metodologia: O caso foi acompanhado no serviço de Oftalmologia do Hospital Oftalmológico de Sorocaba (BOS e sua descrição embasada na literatura. Relato de Caso: Paciente do sexo masculino, 20 anos, procurou atendimento oftalmológico devido à baixa de acuidade visual (BAV de olho esquerdo (OE há 40 dias. Relatou histórico de SSJ há 4 anos atribuído ao uso de fenobarbital, com acometimento principalmente da face, resultando em perda total da visão do olho direito (OD. Ao exame biomiscroscópico de OE, observou-se simbléfaro, edema corneano e erosão epitelial corneana. Optou-se por encaminhar o paciente para seguimento no ambulatório de córnea, onde foi indicada realização de patch de córnea. Em sua evolução desfavorável, paciente passou pelos procedimentos de tarsorrafia temporal e nasal e atualmente aguarda cirurgia para implante de ceratoprótese. Conclusão: O caso apresentado reforça a hipótese de que a SSJ é uma reação imunológica desencadeada por medicamentos. O tratamento completo das repercussões oculares dessa síndrome ainda é difícil, o que corrobora com a necessidade de um diagnóstico precoce, encaminhamento para unidade de terapia intensiva ou de queimados e o acompanhamento por oftalmologista.

  10. Neutrophil collagenase, gelatinase, and myeloperoxidase in tears of patients with stevens-johnson syndrome and ocular cicatricial pemphigoid.

    Science.gov (United States)

    Arafat, Samer N; Suelves, Ana M; Spurr-Michaud, Sandra; Chodosh, James; Foster, C Stephen; Dohlman, Claes H; Gipson, Ilene K

    2014-01-01

    To investigate the levels of matrix metalloproteinases (MMPs), myeloperoxidase (MPO), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in tears of patients with Stevens-Johnson syndrome (SJS) and ocular cicatricial pemphigoid (OCP). Prospective, noninterventional cohort study. Four SJS patients (7 eyes), 19 OCP patients (37 eyes), and 20 healthy controls who underwent phacoemulsification (40 eyes). Tear washes were collected from all patients and were analyzed for levels of MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, MPO, and TIMP-1 using multianalyte bead-based enzyme-linked immunosorbent assays. Total MMP activity was determined using a fluorometric assay. Correlation studies were performed between the various analytes within study groups. Levels of MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, MPO, and TIMP-1 (in nanograms per microgram of protein) and total MMP activity (in relative fluorescent units per minute per microgram of protein) in tears; MMP-8-to-TIMP-1 ratio; MMP-9-to-TIMP-1 ratio; and the correlations between MMP-8 and MMP-9 and both MMP and MPO. MMP-8, MMP-9, and MPO levels were elevated significantly in SJS and OCP tears (SJS>OCP) when compared with controls. The MMP activity was highest in SJS patients, whereas OCP patients and controls showed lower and similar activities. The TIMP-1 levels were decreased in SJS and OCP patients when compared with those in controls, with levels in OCP patients reaching significance. The MMP-8-to-TIMP-1 and MMP-9-to-TIMP-1 ratios were markedly elevated in SJS and OCP tears (SJS>OCP) when compared with those of controls. Across all study groups, MMP-9 levels correlated strongly with MMP-8 and MPO levels, and MMP-8 correlated with MPO, but it did not reach significance in SJS patients. There was no relationship between MMP-7 and MPO. Because MMP-8 and MPO are produced by inflammatory cells, particularly neutrophils, the correlation data indicate that they may be the common source of elevated enzymes, including MMP-9

  11. Neutrophil Collagenase, Gelatinase and Myeloperoxidase in Tears of Stevens-Johnson Syndrome and Ocular Cicatricial Pemphigoid Patients

    Science.gov (United States)

    Arafat, Samer N.; Suelves, Ana M.; Spurr-Michaud, Sandra; Chodosh, James; Foster, C. Stephen; Dohlman, Claes H.; Gipson, Ilene K.

    2013-01-01

    Objective To investigate the levels of matrix metalloproteinases (MMPs), myeloperoxidase (MPO) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in tears of patients with Stevens-Johnson syndrome (SJS) and ocular cicatricial pemphigoid (OCP). Design Prospective non-interventional cohort study. Participants Four SJS patients (7 eyes), 19 OCP patients (37 eyes) and 20 post-phacoemulsification healthy controls (40 eyes). Methods Tear washes were collected from all patients and were analyzed for levels of MMP-2, -3, -7, -8, -9, -12, MPO and TIMP-1 using multi-analyte bead-based enzyme-linked immunosorbent assays (ELISA). Total MMP activity was determined using a fluorimetric assay. Correlation studies were performed between the various analytes within study groups. Main Outcome Measures Levels of MMP-2, -3, -7, -8, -9, -12, MPO and TIMP-1 (in ng/µg protein), total MMP activity (in relative fluorescent units/min/µg protein) in tears, MMP-8/TIMP-1, MMP-9/TIMP-1 ratios and the correlations between MMP-8 and MMP-9 and each MMP and MPO. Results MMP-8, MMP-9 and MPO levels were significantly elevated in SJS and OCP tears (SJS > OCP) when compared to controls. MMP activity was highest in SJS while OCP and controls showed lower and similar activities. TIMP-1 levels were decreased in SJS and OCP when compared to controls with OCP levels reaching significance. MMP-8/TIMP-1 and MMP-9/TIMP-1 ratios were markedly elevated in SJS and OCP tears (SJS > OCP) when compared to controls. Across all study groups, MMP-9 levels correlated strongly with MMP-8 and MPO levels and MMP-8 correlated with MPO but did not reach significance in SJS. There was no relationship between MMP-7 and MPO. Conclusions Since MMP-8 and MPO are produced by inflammatory cells, particularly neutrophils, the correlation data indicate that they may be the common source of elevated enzymes including MMP-9 in SJS and OCP tears. Elevated MMP/TIMP ratios and MMP activity suggest an imbalance in tear MMP regulation

  12. Systemic Immunomodulating Therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zimmermann, Stefanie; Sekula, Peggy; Venhoff, Moritz; Motschall, Edith; Knaus, Jochen; Schumacher, Martin; Mockenhaupt, Maja

    2017-06-01

    Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare but severe adverse reactions with high mortality. There is no evidence-based treatment, but various systemic immunomodulating therapies are used. To provide an overview on possible immunomodulating treatments for SJS/TEN and estimate their effects on mortality compared with supportive care. A literature search was performed in December 2012 for articles published in MEDLINE, MEDLINE Daily, MEDLINE Inprocess, Web of Science, EMBASE, Scopus, and the Cochrane Library (Central) from January 1990 through December 2012, and updated in December 2015, in the English, French, Spanish, and German languages looking for treatment proposals for SJS/TEN. Other sources were screened manually. Initially, 157 randomized and nonrandomized studies on therapies (systemic immunomodulating therapies or supportive care) for SJS/TEN were selected. Relevant data were extracted from articles. Authors were contacted for further information. Finally, 96 studies with sufficient information regarding eligibility and adequate quality scores were considered in the data synthesis. All steps were performed independently by 2 investigators. Meta-analyses on aggregated study data (random-effects model) and individual patient data (IPD) (logistic regression adjusted for confounders) were performed to assess therapeutic efficacy. In the analysis of IPD, 2 regression models, stratified and unstratified by study, were fitted. Therapy effects on mortality were expressed in terms of odds ratios (ORs) with 95% CIs. Overall, 96 studies (3248 patients) were included. Applied therapies were supportive care or systemic immunomodulating therapies, including glucocorticosteroids, intravenous immunoglobulins, cyclosporine, plasmapheresis, thalidomide, cyclophosphamide, hemoperfusion, tumor necrosis factor inhibitors, and granulocyte colony-stimulating factors. Glucocorticosteroids were associated with a survival benefit for patients in all

  13. CYP2C19*2 status in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis

    Directory of Open Access Journals (Sweden)

    Laska AJ

    2017-05-01

    Full Text Available Amanda J Laska,1 Marie J Han,1 Josh A Lospinoso,2 Patrick J Brown,1 Thomas M Beachkofsky1 1Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, 2780th Military Intelligence Brigade, Ft Meade, MD, USA Purpose: Genetic polymorphisms have been linked to an increased predisposition to developing certain diseases. For example, patients of Han-Chinese descent carrying the HLA-B*1502 allele are at an increased risk of developing Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN if given carbamazepine. Given the complexity of in vivo drug metabolism, it is plausible that the activity of enzyme systems unrelated to specific drug metabolism may be important. Although multiple biomarkers have been identified in unique ethnic groups, there has yet to be a study investigating the presence of the slow metabolizing allele of CYP2C19, denoted CYP2C19*2, in diverse groups and the risk of developing SJS/TEN. Patients and methods: This study looked into the carrier status of CYP2C19*2, a poor metabolizing variant of CYP2C19, in patients diagnosed with SJS/TEN. We looked at its status in our series as a whole and when patients were divided by ethnicity. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue of patients with biopsy-proven SJS/TEN and real-time polymerase chain reaction was used to assess for the presence of CYP2C19*2. Results: CYP2C19*2 status was determined in 47 patients. Twenty-nine of these 47 patients had a single medication implicated as causing their disease, and eight of these patients were heterozygous or homozygous for CYP2C19*2. There was insufficient evidence to conclude that the presence of CYP2C19*2 is an independent predictor of risk for developing SJS/TEN in our series as a whole. This analysis also confirmed that the frequency of the CYP2C19*2 polymorphism within the different ethnicities in our series did not vary statistically from reported ethnic

  14. The risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptic drugs.

    Science.gov (United States)

    Frey, Noel; Bodmer, Michael; Bircher, Andreas; Rüegg, Stephan; Jick, Susan S; Meier, Christoph R; Spoendlin, Julia

    2017-12-01

    Older antiepileptic drugs (AEDs) are known to cause Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). However, evidence for newer AED is sparse. We quantified risks of SJS/TEN in association with use of all AEDs in the United Kingdom. In a matched case-control study of 480 previously validated SJS/TEN cases (1995-2013) we used conditional logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs), and calculated absolute risks of SJS/TEN within separate cohorts of new users of 28 AEDs. We assessed causality between drugs and SJS/TEN in each exposed case, using an adapted version of the algorithm of drug causality for epidermal necrolysis (ALDEN) score. We observed a strong association between SJS/TEN and new use of carbamazepine (OR 92.57, 95% CI 19.89-∞), phenytoin (OR 49.96, 95% CI 10.13-∞), and lamotrigine (OR 26.90, 95% CI 4.88-∞), where causality, according to the ALDEN score, was very probable or probable for most exposed cases. Absolute risks for SJS/TEN were highest for phenytoin (45.86 cases/100,000 exposed), lamotrigine (44.17 cases/100,000 exposed), and carbamazepine (20.38 cases/100,000 exposed). Despite increased ORs for valproate (40,941 exposed), gabapentin (116,037 exposed), pregabalin (59,967 exposed), and clobazam (4,300 exposed), ALDEN suggested no causal association. There were no observed cases of SJS/TEN among new users of levetiracetam (n = 96,77), clonazepam (n = 18,075), or topiramate (n = 11,307). The results of our study are consistent with those of previous studies of SJS/TEN, which found increased risks of SJS/TEN in new use of carbamazepine, phenytoin, and lamotrigine. Despite frequent use, no ALDEN-score confirmed cases were observed in new users of valproate, gabapentin, pregabalin, levetiracetam, topiramate, or clonazepam. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  15. Quel(s sens pour les structures du type  ?  (avec application à un corpus de nouvelles de Steven Millhauser

    Directory of Open Access Journals (Sweden)

    Catherine DELESSE

    2012-03-01

    Full Text Available Cet article examine certains verbes de dire ou d’opinion au passif, qui peuvent se construire, soit avec une montée de sujet , soit avec extraposition de complétive . Après un rappel des caractéristiques syntaxiques et sémantiques de ces verbes, ainsi qu’un résumé historique, sont examinés les emplois en contexte des deux types de structure dans un corpus de nouvelles de Steven Millhauser où elles figurent en grand nombre.This article aims at studying verbs of reporting and opinion which can be used in the passive with two different structures : one with subject raising , the other with extraposition of a that-clause . The characteristics of those verbs, both syntactic and semantic, are described, as well as a brief summary of historical data. Then the study focuses on the use of both structures in a corpus of short stories by Steven Millhauser who uses them in an interesting way.

  16. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review.

    Science.gov (United States)

    Canavan, Theresa N; Mathes, Erin F; Frieden, Ilona; Shinkai, Kanade

    2015-02-01

    Mycoplasma pneumoniae infection is associated with extrapulmonary complications, including mucocutaneous eruptions. These eruptions, which have been termed either "Stevens-Johnson syndrome" or "erythema multiforme" in the literature, may differ from drug-induced Stevens-Johnson syndrome or viral-associated erythema multiforme. We sought to review the literature characterizing morphology and disease course of M pneumoniae-associated mucocutaneous disease. A comprehensive literature search identified 95 articles with 202 cases. Patients were often young (mean age: 11.9 years) and male (66%). Cutaneous involvement ranged from absent (34%), to sparse (47%), to moderate (19%). Oral, ocular, and urogenital mucositis was reported in 94%, 82%, and 63% of cases, respectively. Treatments included antibiotics (80%), systemic corticosteroids (35%), supportive care alone (8%), and/or intravenous immunoglobulin (8%). Complications included mucosal damage (10%), cutaneous scarring (5.6%), recurrence (8%), and mortality (3%). Mild cases may not have been published; thus this review may have a bias toward more severe disease. M pneumoniae-associated mucocutaneous disease has prominent mucositis and sparse cutaneous involvement, although cutaneous involvement varies. Because of the distinct morphology, mild disease course, and potentially important clinical implications regarding treatment, we propose a revision of the nomenclature system and suggest the term "Mycoplasma-induced rash and mucositis" for these cases. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Steven-Johnson Syndrome

    OpenAIRE

    Santos, Pauline JF; Sylwanowicz, Lauren

    2017-01-01

    History of present illness: 72-year-old female with a history of hypertension and rheumatoid arthritis who presented to the emergency department (ED) with a chief complaint of rash for the past ten days. Her primary care provider prescribed azithromycin two weeks prior to her arrival in the ED for a sore throat. The rash started on her bilateral lower extremities and spread cephalad. She also noted a prodrome of subjective fevers and malaise. Significant findings: At presentation to...

  18. Purupaljaks / Steven Bertoni

    Index Scriptorium Estoniae

    Bertoni, Steven

    2013-01-01

    Duty Free Shoppersi asutaja Chuck Feeney on oma sihtasutusega Atlantic Philanthropies 30 aasta jooksul annetanud juba üle 6 miljardi dollari toetades erinevaid meditsiini, haridust ning päästeprojekte kogu maailmas, tehes seejuures kõik, et tema isik avalikuks ei tuleks

  19. Causative drugs and clinical outcome in Stevens Johnson Syndrome (SJS, Toxic Epidermal Necrolysis (TEN, and SJS-TEN overlap in children

    Directory of Open Access Journals (Sweden)

    Gomathy Sethuraman

    2012-01-01

    Full Text Available Background : Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are the most severe adverse drug reactions in children. Objectives : The objective was to study the causative drugs and outcome in children with SJS, SJS-TEN overlap, and TEN. Materials and Methods : Retrospective analysis of all the in-patient records of children below 18 years of age with the diagnosis of SJS, SJS-TEN overlap, and TEN was carried out. Results and Conclusions : Twenty children were identified, eight patients each were diagnosed as SJS and TEN and four as SJS-TEN overlap. Multiple drugs were implicated in 15 cases while single drug was responsible in 5 cases. Antibiotics (40.7% were implicated as the commonest cause followed by NSAIDS (25.9% and anticonvulsants (7.4%. Seventeen patients recovered completely and three patients died.

  20. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Concise Review with a Comprehensive Summary of Therapeutic Interventions Emphasizing Supportive Measures.

    Science.gov (United States)

    Schneider, Jeremy A; Cohen, Philip R

    2017-06-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two of the most severe dermatologic conditions occurring in the inpatient setting. There is a lack of consensus regarding appropriate management of SJS and TEN. The scientific literature pertaining to SJS and TEN (subsequently referred to as SJS/TEN) is summarized and assessed. In addition, an interventional approach for the clinician is provided. PubMed was searched with the key words: corticosteroids, cyclosporine, etanercept, intravenous immunoglobulin, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The papers generated by the search, and their references, were reviewed. Supportive care is the most universally accepted intervention for SJS/TEN. Specific guidelines differ from the care required for patients with thermal burns. Adjuvant therapies are utilized in most severe cases, but the data are thus far underwhelming and underpowered. Using systemic corticosteroids as sole therapy is not supported. A consensus regarding combined corticosteroids and intravenous immunoglobulin (IVIG) has not been reached. Data regarding IVIG, currently the standard of care for most referral centers, is conflicting. Newer studies regarding cyclosporine and tumor necrosis factor inhibitors are promising, but not powered to provide definitive evidence of efficacy. Data regarding plasmapheresis is equivocal. Thalidomide increases mortality. Clinicians who manage SJS/TEN should seek to employ interventions with the greatest impact on their patients' condition. While supportive care measures may seem an obvious aspect of SJS/TEN patient care, providers should understand that these interventions are imperative and that they differ from the care recommended for other critically ill or burn patients. While adjuvant therapies are frequently discussed and debated for hospitalized patients with SJS/TEN, a standardized management approach is not yet clear based on the current data. Therefore, until further data

  1. Cuidados enfermeros en paciente geriátrico con síndrome de Stevens-Johnson relacionado con levofloxacino: a propósito de un caso Nursing care in elderly with Stevens-Johnson Syndrome related to levofloxacin: case approach

    Directory of Open Access Journals (Sweden)

    Manuel Burgos Arguijo

    2010-09-01

    Full Text Available El Síndrome de Stevens-Johnson (SSJ es una enfermedad dermatológica rara con afectación mucocutánea y sistémica, siendo la forma más grave de eritema exudativo multiforme y presentándose como una variante de la necrólisis epidérmica tóxica relacionado con etiología múltiple. Presentamos el caso de una paciente geriátrica de 84 años de edad, presentado SSJ relacionado con la toma de levofloxacino. La complejidad de cuidados que requirió en una unidad de hospitalización, así como la escasez de referentes bibliográficos en nuestro medio nos conllevaron a elaborar este plan de cuidados enfermeros.Stevens-Johnson Syndrome (SJS is a rare dermatological disease with mucocutaneous and systemic involvement, with the mose severe forme of SJS, presenting as a variant of toxic epidermal necrolysis related to a multiple etiology. We report a case of geriatric patient 84 years of age present the syndrome associated with taking levofloxacin. The complexity of care require in an inpatient unit, and the paucity of references in our environment led us to develop this plan of nursing.

  2. Transplante de membrana amniótica em casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson Amniotic membrane transplantation for severe acute cases of chemical ocular burn and Stevens-Johnson syndrome

    Directory of Open Access Journals (Sweden)

    José Reinaldo da Silva Ricardo

    2009-04-01

    Full Text Available OBJETIVO: Investigar o potencial terapêutico do transplante de membrana amniótica nos casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson. MÉTODOS: Foram analisados retrospectivamente os prontuários de oito pacientes, com um total de dez olhos, submetidos a transplante de membrana amniótica para tratamento de queimadura ocular química e síndrome de Stevens-Johnson na fase aguda entre janeiro de 1999 e maio de 2008 no Departamento de Oftalmologia da UNIFESP. Dados referentes a sexo, idade, grau da queimadura, etiologia, olho acometido, achados oftalmológicos, extensão da membrana amniótica, operações adicionais, tempo em dias entre a lesão e a cirurgia, acuidade visual antes e depois da cirurgia, defeito epitelial em dias, complicações e tempo de seguimento em meses foram coletados. RESULTADOS: A idade média dos pacientes foi de 35,7 ± 23,04 anos, dos quais seis eram homens e dois eram mulheres. Três pacientes (quatro olhos apresentaram síndrome de Stevens-Johnson e cinco pacientes (seis olhos apresentaram queimadura ocular química. O defeito epitelial foi cicatrizado em média de 27,8 ± 4,7 dias (variando de 20 a 35 dias. Todos os pacientes evoluíram com deficiência límbica em seguimento médio de 7,8 ± 2,8 meses (variando entre cinco e doze meses e quatro olhos desenvolveram simbléfaro. CONCLUSÕES: Os resultados sugerem que o transplante de membrana amniótica representa um aditivo que pode ser realizado nos casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson com a finalidade de promover a epitelização e suprimir a inflamação e suas consequências, se comparado a outros trabalhos que trataram casos semelhantes com terapia medicamentosa somente. Por outro lado, não é capaz de evitar a deficiência límbica nesses casos, que futuramente necessitarão de transplante de células-tronco do limbo ou outras cirurgias para correção da superfície ocular

  3. An attempt to reconstruct the natural and cultural history of the webbing clothes moth Tineola bisselliella Hummel (Lepidoptera: Tineidae

    Directory of Open Access Journals (Sweden)

    Rudy Plarre

    2011-08-01

    Full Text Available It is generally accepted that the natural habitats of most pest insects can be found outside the synanthropic environment in layers of leaf litter, under bark, as well as in rodent or bird nests. Indeed, most of the common pests have been reported as being facultative nidicolous. Therefore infestation of commodities by pest insects out of these reservoirs is one considerable possibility. However, the likelihood of a pest´s occurrence and survival out-doors largely depends on its ecological potential and competitiveness against other species of the same ecological guild. Some pest species are rarely found in wild habitats, especially in those regions where they are not native and where they have been introduced by man. The fabric pest Tineola bisselliella serves as a good example. Most likely originating in Central or Southern Africa this insect was introduced into Europe probably not earlier than the late 18th century. Being more tolerant to dry environments than other fabric pests its economical importance increased during the 20th century when in-door climates changed because of central heating systems. Its occurrence in out-door natural habitats must be regarded as accidental. Reported founds of webbing clothes moth larvae in bird nests e.g. have been largely overstated in the literature. T. bisselliella should be regarded as an eusynanthropic species.

  4. Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal

    Directory of Open Access Journals (Sweden)

    Mariane Ferreira Barbosa Emerick

    2014-12-01

    Full Text Available Objetivou-se analisar as características demográficas e clínicas dos clientes diagnosticados com Síndrome de Stevens Johnson (SSJ e Necrólise Epidérmica Tóxica (NET, bem como identificar as ações dos profissionais de saúde para o manejo das Reações Adversas a Medicamentos (RAM em um hospital público do Distrito Federal. Pesquisa descritiva, retrospectiva, com abordagem quantitativa. Dados coletados em todos os prontuários de 22 clientes internados de janeiro de 2005 a setembro de 2012. Análise mediante estatística descritiva. Houve aumento gradativo de casos, com maior número nos anos de 2007 e 2012. Dos casos analisados, 9 foram diagnosticados com NET e 7 com SSJ; predominaram as mulheres (14 e a faixa etária de 21 aos 40 anos (10; 21 obtiveram cura. Os fármacos associados a RAM mais frequentes foram os antiepilépticos (10. Observou-se fragilidade nos registros clínicos nos prontuários e nas ações de monitoramento de RAM no serviço estudado.

  5. Three-year outcomes of cultured limbal epithelial allografts in aniridia and Stevens-Johnson syndrome evaluated using the Clinical Outcome Assessment in Surgical Trials assessment tool.

    Science.gov (United States)

    Shortt, Alex J; Bunce, Catey; Levis, Hannah J; Blows, Peter; Doré, Caroline J; Vernon, Amanda; Secker, Genevieve A; Tuft, Stephen J; Daniels, Julie T

    2014-02-01

    Limbal stem cell deficiency (LSCD) is an eye disorder in which the stem cells responsible for forming the surface skin of the cornea are destroyed by disease. This results in pain, loss of vision, and a cosmetically unpleasant appearance. Many new treatments, including stem cell therapies, are emerging for the treatment of this condition, but assessment of these new technologies is severely hampered by the lack of biomarkers for this disease or validated tools for assessing its severity. The aims of this study were to design and test the reliability of a tool for grading LSCD, to define a set of core outcome measures for use in evaluating treatments for this condition, and to demonstrate their utility. This was achieved by using our defined outcome set (which included the Clinical Outcome Assessment in Surgical Trials of Limbal stem cell deficiency [COASTL] tool) to evaluate the 3-year outcomes for allogeneic ex vivo cultivated limbal epithelial transplantation (allo-CLET) in patients who had bilateral total LSCD secondary to aniridia or Stevens-Johnson syndrome. The results demonstrate that our new grading tool for LSCD, the COASTL tool, is reliable and repeatable, and that improvements in the biomarkers used in this tool correlate positively with improvements in visual acuity. The COASTL tool showed that following allo-CLET there was a decrease in LSCD severity and an increase in visual acuity up to 12 months post-treatment, but thereafter LSCD severity and visual acuity progressively deteriorated.

  6. Response to Dr Stevens' letter ref. Visitisen et al: "Short-term effects of night shift work on breast cancer risk: a cohort study of payroll data"

    DEFF Research Database (Denmark)

    Kolstad, Henrik A; Garde, Anne Helene; Hansen, Åse Marie

    2017-01-01

    definitions of shifts affect the risk of breast cancer, which will be possible using this type of data. We only had information on working hours from 2007 and onwards, and night shift work prior to 2007 could have confounded our analyses towards no effect but only if inversely associated with night shift work......We thank Dr Richard Stevens for his comments (1) on our recent article that showed no increased risk of breast cancer following recent night shift work when compared with recent day shift work (2). This finding was based on linkage of day-by-day information on working hours and breast cancer...... incidence data. Results are thus less likely to have been biased by differential misclassification than findings from earlier studies relying on self-report (3). We defined a night shift as ≥3 hours of work between 24:00-05:00 hours and a day shift as ≥3 hours work between 6:00-20:00 hours. This day shift...

  7. Enrico Fermi Awards Ceremony for Dr. Mildred S. Dresselhaus and Dr. Burton Richter, May 2012 (Presentations, including remarks by Energy Secretary, Dr. Steven Chu)

    Energy Technology Data Exchange (ETDEWEB)

    Chu, Steven (U.S. Energy Secretary)

    2012-05-07

    The Fermi Award is a Presidential award and is one of the oldest and most prestigious science and technology honors bestowed by the U.S. Government. On May 7, 2012 it was conferred upon two exceptional scientists: Dr. Mildred Dresselhaus, 'for her scientific leadership, her major contributions to science and energy policy, her selfless work in science education and the advancement of diversity in the scientific workplace, and her highly original and impactful research,' and Dr. Burton Richter, 'for the breadth of his influence in the multiple disciplines of accelerator physics and particle physics, his profound scientific discoveries, his visionary leadership as SLAC Director, his leadership of science, and his notable contributions in energy and public policy.' Dr. John Holder, Director of the White House Office of Science and Technology Policy, opened the ceremony, and Dr. Bill Brinkman, Director of DOE's Office of Science introduced the main speaker, Dr. Steven Chu, U.S. Energy Secretary.

  8. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines: Results of a National Institutes of Health Working Group.

    Science.gov (United States)

    Maverakis, Emanual; Wang, Elizabeth A; Shinkai, Kanade; Mahasirimongkol, Surakameth; Margolis, David J; Avigan, Mark; Chung, Wen-Hung; Goldman, Jennifer; La Grenade, Lois; Pirmohamed, Munir; Shear, Neil H; Tassaeeyakul, Wichittra; Hoetzenecker, Wolfram; Klaewsongkram, Jettanong; Rerkpattanapipat, Ticha; Manuyakorn, Wiparat; Yasuda, Sally Usdin; Sharon, Victoria R; Sukhov, Andrea; Micheletti, Robert; Struewing, Jeff; French, Lars E; Cheng, Michelle Y

    2017-06-01

    Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS) are rare, acute, life-threatening dermatologic disorders involving the skin and mucous membranes. Research into these conditions is hampered by a lack of standardization of case reporting and data collection. To establish a standardized case report form to facilitate comparisons and maintain data quality based on an international panel of SJS/TEN experts who performed a Delphi consensus-building exercise. The elements presented for committee scrutiny were adapted from previous case report forms and from PubMed literature searches of highly cited manuscripts pertaining to SJS/TEN. The expert opinions and experience of the members of the consensus group were included in the discussion. Overall, 21 out of 29 experts who were invited to participate in the online Delphi exercise agreed to participate. Surveys at each stage were administered via an online survery software tool. For the first 2 Delphi rounds, results were analyzed using the Interpercentile Range Adjusted for Symmetry method and statements that passed consensus formulated a new case report form. For the third Delphi round, the case report form was presented to the committee, who agreed that it was "appropriate and useful" for documenting cases of SJS/TEN, making it more reliable and valuable for future research endeavors. With the consensus of international experts, a case report form for SJS/TEN has been created to help standardize the collection of patient information in future studies and the documentation of individual cases.

  9. Comparison of the acute ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis in Chinese eyes: a 15-year retrospective study.

    Science.gov (United States)

    Chow, Loraine L W; Shih, Kendrick C; Chan, Johnny C Y; Lai, Jimmy S M; Ng, Alex L K

    2017-05-12

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening conditions that initially affect the skin and mucous membranes. The aim of this study was to compare the acute ocular manifestations between SJS and TEN. The initial presenting ophthalmic records of patients with either SJS ( = 30% involvement), who were treated at one tertiary burn center in Hong Kong between 1999 and 2014, were retrospectively analyzed and compared. A total of 20 SJS and 12 TEN cases were included. All were drug-induced. The patient demographics and treatment received were comparable. Overall, 40% of SJS and 75% of TEN patients had acute ocular surface inflammation. When comparing the two groups, there was a significant difference in the number of cases with mild involvement (5% in SJS, 42% in TEN, p = 0.01), while no statistically significant differences were found (p > 0.05) comparing between the moderate (15% in SJS, 0% in TEN) and severe groups (20% in SJS, 33% in TEN). Ocular surface inflammation was common during the acute phase in both SJS and TEN. TEN had a significantly higher number of cases with mild ocular involvement when compared with SJS, but no significant difference between the number of moderate and severe cases between the two groups.

  10. Cyclosporine treatment for Stevens-Johnson syndrome/toxic epidermal necrolysis: Retrospective analysis of a cohort treated in a specialized referral center.

    Science.gov (United States)

    Lee, Haur Yueh; Fook-Chong, Stephanie; Koh, Hong Yi; Thirumoorthy, Tharmotharampillai; Pang, Shiu Ming

    2017-01-01

    Treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) remains controversial. We sought to evaluate the impact of cyclosporine on hospital mortality in patients with SJS/TEN. All patients with SJS and TEN admitted to our center from 2011 to 2014 were treated under a standardized protocol that allowed for cyclosporine therapy if the inclusion and exclusion criteria were met. Clinical data were reviewed retrospectively. Comparative analysis was made on mortality outcomes with patients treated with cyclosporine versus what was expected based on SCORTEN. In all, 44 patients were admitted during the study period. A total of 24 patients received cyclosporine and the remaining 20 patients were treated supportively. SCORTEN predicted 7.2 deaths and 3 were observed in the group treated with cyclosporine. In the group treated supportively, SCORTEN predicted 5.9 deaths and 6 deaths were observed. The standardized mortality ratio of SJS/TEN treated with cyclosporine was 0.42 (95% confidence interval 0.09-1.22). Small sample size, retrospective design, and referral bias are limitations. The use of cyclosporine may improve mortality in SJS/TEN and needs to be validated in controlled studies. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Spontaneous complete regression of hypothalamic pilocytic astrocytoma after partial resection in a child, complicated with Stevens-Johnson syndrome: a case report and literature review.

    Science.gov (United States)

    Samadian, Mohammad; Bakhtevari, Mehrdad Hosseinzadeh; Haddadian, Karim; Alavi, Hossein Afshin; Rezaei, Omidvar

    2016-04-01

    Pilocytic astrocytoma (PA) is the most common pediatric central nervous system glial neoplasm and the most common pediatric cerebellar tumor. The spontaneous regression that occurs after partial/subtotal resection is multifactorial, depending on multiple factors, as for the case of humoral and cell-mediated immune responses of the host to the implanted tumor. A 7-year-old boy was referred to a neurosurgery clinic with headache. Further imaging workup revealed hypothalamic PA. Partial resection of the lesions was performed with right-side pterional approach. The patient developed a severe panmucositis [Stevens-Johnson syndrome (SJS)] and respiratory failure plus conjunctivitis, due to phenytoin allergy. During the patient's 6-month follow-up, postoperative magnetic resonance imaging (MRI) revealed a residual tumor, and about 9 months later (at 15 months postoperatively), the MRI showed total regression of the tumor. Clinically, symptomatic PA may undergo spontaneous regression after partial resection. We report a well-documented case of spontaneous regression hypothalamic PA after partial resection that complicated with SJS. Immune system reaction in SJS may have a role in tumor behavior and spontaneous regression. Multiple studies confirmed spontaneous regression in PA after partial/subtotal resection. This phenomenon occurs due to humoral and cell-mediated host immune responses to the implanted tumor. The immune system reaction in SJS may have a role in tumor behavior and spontaneous regression.

  12. Fatal Toxic Epidermal Necrolysis Induced by Carbamazepine Treatment in a Patient Who Previously had Carbamazepine-induced Stevens-Johnson Syndrome

    Directory of Open Access Journals (Sweden)

    Li-Yen Huang

    2007-12-01

    Full Text Available Toxic epidermal necrolysis (TEN is a rare but life-threatening skin disease that is most commonly drug-induced. It has recently been suggested that Stevens-Johnson syndrome (SJS belongs to the same group of skin disorders, although it has a lower mortality rate than TEN. We report the case of a 26-year-old male schizophrenic patient with a history of carbamazepine-induced SJS 5 years earlier. At the time of his current admission, he was admitted to our psychiatry department with acute agitation due to schizophrenia. However, the patient and his family denied history of drug allergy. After 3 days of carbamazepine treatment, the patient developed TEN (body surface area > 90%. He was transferred to the burn center, but despite appropriate treatment, including intravenous hydrocortisone 200 mg q6h and being covered with sterile biological material, he died. It is important to note that re-administration of a drug that previously caused SJS may lead to TEN, which has a very high mortality rate.

  13. In Silico Risk Assessment of HLA-A*02:06-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Caused by Cold Medicine Ingredients

    Directory of Open Access Journals (Sweden)

    Hideto Isogai

    2013-01-01

    Full Text Available Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN are severe drug hypersensitivities with high mortality. Typical over-the-counter drugs of cold medicines are suggested to be causative. As multiple ingredients are generally contained in cold medicines, it is of particular interest to investigate which ingredients are responsible for SJS/TEN. However, experimental examination of causal relationships between SJS/TEN and a particular drug molecule is not straightforward. Significant association between HLA-A*02:06 and SJS/TEN with severe ocular surface complications has been observed in the Japanese. In the present study, we have undertaken in silico docking simulations between various ingredients contained in cold medicines available in Japan and the HLA-A*02:06 molecule. We use the composite risk index (CRI that is the absolute value of the binding affinity multiplied by the daily dose to assess the potential risk of the adverse reactions. The drugs which have been recognized as causative drugs of SJS/TEN in Japan have revealed relatively high CRI, and the association between SJS/TEN and HLA-A*02:06 has been qualitatively verified. The results have also shown that some drugs whose links to SJS/TEN have not been clinically recognized in Japan show the high CRI and suggested that attention should be paid to their adverse drug reactions.

  14. Skin rash in the intensive care unit: Stevens-Johnson syndrome, toxic epidermal necrolysis, or a rare manifestation of a hidden cutaneous malignancy: A case report.

    Science.gov (United States)

    Al-Saffar, Farah; Ibrahim, Saif; Patel, Pujan; Jacob, Rafik; Palacio, Carlos; Cury, James

    2016-03-01

    Skin rashes are infrequently encountered in the intensive care units, either as a result or as a cause of admission. The entities of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of desquamating skin diseases that have multiple etiologies, the most common being drug-related reactions; very rarely, the cause may be cutaneous malignancies. We herein present a unique case of a 54-year-old male patient with psoriasis treated with methotrexate, who presented with a cellulitis-like clinical picture, then developed a severe progressive systemic inflammatory response syndrome, and progressed clinically to SJS, then TEN even after discontinuing the antibiotics and methotrexate. A skin biopsy demonstrated an aggressive and rapidly-progressing T-cell lymphoma. The present case highlights the necessity of skin biopsy when encountering SJS and TEN in the ICU in order to identify potentially treatable/controllable causes. Although it appeared reasonable to correlate TEN solely to medications, the skin biopsies clearly demonstrated an aggressive T-cell skin lymphoma. In a patient with a better general condition it may have been helpful to treat this malignancy. TEN is a life-threatening condition and skin biopsy is the cornerstone of diagnosis, despite the presence of multiple risk factors and the typical physical findings of a drug-induced reaction.

  15. Response to Dr Stevens' letter ref. Visitisen et al: "Short-term effects of night shift work on breast cancer risk: a cohort study of payroll data".

    Science.gov (United States)

    Kolstad, Henrik A; Garde, Anne Helene; Hansen, Åse Marie; Frydenberg, Morten; Christiansen, Peer; Vistisen, Helene Tilma; Bonde, Jens Peter E

    2017-01-01

    We thank Dr Richard Stevens for his comments (1) on our recent article that showed no increased risk of breast cancer following recent night shift work when compared with recent day shift work (2). This finding was based on linkage of day-by-day information on working hours and breast cancer incidence data. Results are thus less likely to have been biased by differential misclassification than findings from earlier studies relying on self-report (3). We defined a night shift as ≥3 hours of work between 24:00-05:00 hours and a day shift as ≥3 hours work between 6:00-20:00 hours. This day shift definition did not exclude shifts starting before 05:00 or ending after 24:00 hours. However, this affected only 0.02% and 0.3% of all day shifts, respectively. This diminutive misclassification, that is expected to be non-differential, can hardly explain our negative findings. It is suggested that shifts that begin after 07:00 and end before 18:00 would constitute a more sensible baseline comparison group. Since the biological mechanism is not certain, it is not obvious to us if this will be a more appropriate reference than the present. However, we agree that future studies should test how different definitions of shifts affect the risk of breast cancer, which will be possible using this type of data. We only had information on working hours from 2007 and onwards, and night shift work prior to 2007 could have confounded our analyses towards no effect but only if inversely associated with night shift work in 2007 or later. We find this unlikely. Left truncation could also have biased findings towards the null. We therefore supplemented analyses of the total study population with analyses of the one-third of the population with first recorded employment in 2008 or later (the inception population). Even if the mean age was 35.5 years - and many undoubtedly had been working (with and without night shifts) prior to 2008 - this population should be less affected by such

  16. Prosthetic replacement of the ocular surface ecosystem scleral lens therapy for patients with ocular symptoms of chronic Stevens-Johnson syndrome.

    Science.gov (United States)

    Heur, Martin; Bach, Dianne; Theophanous, Christos; Chiu, Gloria B

    2014-07-01

    To evaluate the results of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lens treatment on visual acuity and function in patients with ocular symptoms of chronic Stevens-Johnson syndrome (SJS). Retrospective interventional case series. setting: Single multi-specialty institutional practice. study population: A chart review from July 2009 to July 2013 identified 19 patients with ocular symptoms from chronic SJS who were referred for PROSE fitting evaluation. Three patients deemed appropriate candidates were excluded because they were lost to follow-up during the fitting process. Only 1 eye was fitted in 4 patients because anatomic changes prohibited PROSE fitting in the fellow eye. Another patient chose to have PROSE fitting only in 1 eye. A total of 27 eyes of 16 patients who completed PROSE fitting were included in this study. intervention: PROSE scleral lens fitting. outcome measures: Visual acuity and visual function were assessed before and after PROSE fitting using Snellen acuity and Ocular Surface Disease Index (OSDI) survey. The OSDI survey is a validated questionnaire that assesses ocular surface disease in the context of vision-related function, ocular symptoms, and environmental triggers. Visual acuity improved from 0.43 ± 0.35 logMAR pre-PROSE to 0.14 ± 0.22 logMAR post-PROSE (P = .0007) in SJS patients. OSDI scores improved from 70.4 ± 19.0 pre-PROSE to 37.4 ± 23.2 post-PROSE (P = .0002) in the same cohort. The results of this study show that PROSE treatment is a viable option for improving visual acuity and function in SJS patients who failed conventional treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Risk of nevirapine-associated Stevens-Johnson syndrome among HIV-infected pregnant women: the Medunsa National Pharmacovigilance Centre, 2007 - 2012.

    Science.gov (United States)

    Dube, N; Adewusi, E; Summers, R

    2013-05-01

    Stevens-Johnson syndrome (SJS) is an acute life-threatening condition often elicited by drugs. The government's indecisiveness in deciding to stop the use of nevirapine (NVP) in HIV-infected pregnant women owing to the increase of SJS among this population group in South Africa prompted this investigation. To investigate if pregnancy is a risk factor for SJS among HIV-infected women taking NVP-containing regimens and registered within the Medunsa National Pharmacovigilance Centre database. A matched case-control study with 5:1 matching was conducted. Women with SJS (cases) taking NVP-containing regimens were matched with women without SJS (controls) taking NVP-containing regimens. Controls were randomly selected and matched to cases by hospital, age, treatment duration and CD4 count. Conditional logistic regression was used to determine if pregnancy was a risk factor for SJS. Six SJS cases were identified and 30 controls selected. The median age of both cases and controls was 29 years and the average CD4 counts were 237 and 234 cells/microl respectively. Subjects were on NVP treatment for 18 - 31 days before the onset of SJS. Controls did not develop SJS after treatment of between 1 and 365 days. Pregnancy increased the chances of developing SJS 14-fold (OR 14.28, p = 0.006, 95% CI 1.54 - 131.82). NVP-containing ARV regimens taken during pregnancy increase the risk of developing SJS. Healthcare workers are advised to offer informed consent to patients and recommend effective contraception methods if NVP treatment is considered. In the light of our findings, further studies of the association between NVP, pregnancy and SJS are necessary before general conclusions can be reached.

  18. Association of combined IL-13/IL-4R signaling pathway gene polymorphism with Stevens-Johnson syndrome accompanied by ocular surface complications.

    Science.gov (United States)

    Ueta, Mayumi; Sotozono, Chie; Inatomi, Tsutomu; Kojima, Kentaro; Hamuro, Junji; Kinoshita, Shigeru

    2008-05-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute-onset mucocutaneous diseases induced by infectious agents or inciting drugs. The authors previously reported an association between SJS/TEN and IL-4R gene polymorphism that is essential for IL-4 and IL-13 signaling. To examine IL-4 and IL-13 gene polymorphisms and the combination of these polymorphisms with IL-4R polymorphism, the authors performed polymorphism analysis. In 76 Japanese SJS/TEN patients with ocular surface complications and 160 healthy controls, the authors analyzed polymorphisms of the promoter -590C/T in the IL-4 gene and of the promoter -1111C/T and Arg110Gln in the IL-13 gene and assessed Gln551Arg in the IL-4R gene. Because Arg110Gln affects serum IL-13, plasma IL-13 levels were also examined. In the SJS/TEN patients, the Arg110Gln SNP of IL-13 was significantly associated with the disease, and the frequency of Arg110 alleles was significantly higher than that in the controls. Plasma IL-13 tended to be lower in SJS/TEN patients than in the controls. Analysis of the genotype pattern of IL-4R SNP Gln551Arg and IL-13 SNP Arg110Gln showed that the Gln551Gln(A/A)-Arg110Arg(G/G) genotype pattern was also associated with SJS/TEN. IL-13 gene polymorphisms might be associated with SJS/TEN with ocular surface complications. The present findings suggest that SJS/TEN is different from allergic diseases such as atopy and asthma because the ratio of each allele in the IL-13 SNP Arg110Gln was the opposite of the ratio in those diseases. They also reveal that combined polymorphisms in the IL-13/IL-4R signaling pathway were associated with SJS/TEN with ocular surface complications.

  19. Memory as a Category of Fiction: The Receptive Potential of the Novel “The Raw Shark Texts” by Steven Hall

    Directory of Open Access Journals (Sweden)

    Aliona Matiychak

    2013-12-01

    Full Text Available The article deals with the immersive novel “The Raw Shark Texts” by Steven Hall in the aspect of genre metamorphism. This approach allows to trace how genre matrices (horror, thriller, adventure etc. transformation and in particular the combination of fantasy and science fiction with both psychedelic and real images facilitates the creating of an immersive reality in the novel. The article analyses how the alternative conceptual worldview helps the protagonist to recreate the chronicle of his self-identification after the loss of memory as a consequence of psychological trauma. Human knowledge, experience and communication as well as his individual mind, ideas and thoughts are perceived by the protagonist’s dual personality as an aquatic environment inhabited by conceptual fish. His fear of the conceptual shark feeding on his memory generates distinctive psychedelic hydro-text in the form of specific narrative structures. The discreteness of narrative accents the protagonist’s distraction and is used by the author as a literary imitation of his psychical instability (dissociative amnesia. The interrelation of the novel’s homophonic title with the Rorschach’s Psychodiagnostic (Inkblot Tests, that are used to examine a person's personality characteristics and emotional functioning, is investigated. The idea that interpretation of Inkblot Tests results can be highly subjective allows drawing an analogy with Hall’s graphics in “The Raw Shark Texts” which bring up multiple associations and allusions. These author’s innovative graphic installations stimulate multileveled communication with a reader. Rich receptive potential (comprising metamorphosed genre and narrative structures of the novel with numerous literary and cinematographic allusions allows examining this hypertext narrative fiction both as an original intellectual and psychological testing of the reader.

  20. Racial disparities in the risk of Stevens-Johnson Syndrome and toxic epidermal necrolysis as urate-lowering drug adverse events in the United States.

    Science.gov (United States)

    Lu, Na; Rai, Sharan K; Terkeltaub, Robert; Kim, Seoyoung C; Menendez, Mariano E; Choi, Hyon K

    2016-10-01

    HLA-B*5801 allele carriage (a strong determinant of allopurinol hypersensitivity syndrome) varies substantially among races, which may lead to racial disparities in the risk of Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) in the context of urate-lowering drug adverse events (ULDAEs). We examined this hypothesis in a large, racially diverse, and generalizable setting. Using a database representative of US hospitalizations (2009-2013), we investigated the racial distribution of hospitalized SJS/TEN (principal discharge diagnosis) as ULDAEs (ICD-9-CM Classification of External Causes). Our reference groups included the US Census population, US allopurinol users, and ULDAE hospitalizations without SJS/TEN. We identified 606 cases hospitalized for SJS/TEN as ULDAEs (mean age = 68 years; 44% male), among which there was an overrepresentation of Asians (27%) and Blacks (26%), and an underrepresentation of Whites (29%) and Hispanics (% too-low-to-report), compared with the US Census population (5%, 12%, 67%, and 15%, respectively). The hospitalization rate ratios for SJS/TEN among Asians, Blacks, and Whites were 11.9, 5.0, and 1.0 (referent), respectively. These associations persisted using other national referents. According to the NHANES 2009-2012, allopurinol constituted 96.8% of urate-lowering drug use, followed by probenecid (2.1%). These national data indicate that Asians and Blacks have a substantially higher risk of SJS/TEN as ULDAEs than Whites (or Hispanics), correlating well with corresponding frequencies of HLA-B*5801 in the US population (i.e., 7.4%, 4%, 1%, and 1%, respectively). Given its market dominance and established association with SJS/TEN, our findings support the use of vigilance in these minorities when considering allopurinol. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Cicatrizing Conjunctivitis in a Patient Diagnosed With Drug Reaction With Eosinophilia and Systemic Symptoms/Drug-Induced Hypersensitivity Syndrome but With Features of Stevens-Johnson Syndrome.

    Science.gov (United States)

    Bohm, Kelley J; Ciralsky, Jessica B; Harp, Joanna L; Bajaj, Shirin; Sippel, Kimberly C

    2016-06-01

    Severe cutaneous adverse reactions to drugs (SCARs) such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DIHS) serve as one of the main reasons for inpatient ophthalmic consultation. Although it is well-recognized that SJS/TEN is associated with severe ocular mucosal inflammation and cicatrizing, potentially blinding, sequelae, this association has not been described in relation to other SCARs. We present a patient fulfilling the diagnostic criteria for probable DRESS/DIHS but not for SJS/TEN, yet exhibiting the severe ocular surface involvement characteristic of SJS/TEN. Case report. A 64-year-old man presented with bilateral pseudomembranous conjunctivitis and conjunctival denudation (sloughing) in the setting of a maculopapular rash, fever, liver dysfunction, and hematologic abnormalities 1 month after initiating several medications. A skin biopsy was not consistent with SJS/TEN. The patient was diagnosed with probable DRESS/DIHS and treated with high-dose systemic corticosteroids. The ocular surface inflammation was addressed with intensive topical corticosteroid ointment. The pseudomembranes resolved over a 6-week period, but the patient exhibited residual conjunctival scarring of all palpebral surfaces. The development of severe ocular surface mucosal inflammation and denudation with cicatrizing sequelae in a patient carrying a diagnosis of DRESS/DIHS has diagnostic and therapeutic implications for the ophthalmologist. Careful ophthalmic assessment is indicated in any SCAR patient with ophthalmic symptoms, regardless of formal diagnosis. Furthermore, the early therapeutic interventions recently recommended in SJS/TEN to limit the ophthalmic cicatricial sequelae, such as systemic or topical corticosteroids, may be indicated.

  2. The Effect of Intravenous Immunoglobulin Combined with Corticosteroid on the Progression of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis

    Science.gov (United States)

    Ye, Liang-ping; Zhang, Cheng; Zhu, Qi-xing

    2016-01-01

    Background Intravenous immunoglobulin (IVIG) treatment is commonly used to treat Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with controversial therapeutic effect. Methods We conducted a comprehensive meta-analysis through combining the published eligible studies to evaluate the effectiveness of IVIG on SJS and TEN treatment. Results A total of 26 studies were selected from public available databases. The combination of IVIG and corticosteroid markedly reduced the recovery time (by 1.63 days, 95% CI: 0.83–2.43, P < 0.001), compared with solo corticosteroid group. The favorable effects were greater in Asian (2.19, 95% CI: 1.41–2.97, P < 0.001), TEN (2.56, 95% CI: 0.35–4.77, P = 0.023) and high-dose IVIG treated individuals (1.78, 95% CI: 0.42–3.14, P = 0.010). The hospitalization length reduced by 3.19 days (95% CI: 0.08–6.30, P = 0.045), though the outcome was proven to be unstable. We found heterogeneities, which sources were probably regional factors. Besides, IVIG was inclined to decrease SJS/TEN mortality (SMR: 0.84, 95% CI: 0.66–1.08, P = 0.178). This impact was possibly more profound when patients were treated with high dose IVIG (SMR: 0.74, 95% CI: 0.50–1.08, P = 0.116), or when patients were diagnosed as TEN (SMR: 0.68, 95% CI: 0.45–1.01, P = 0.058). Conclusions Our current meta-analysis suggests that IVIG combined with corticosteroid could reduce recovery time for SJS and TEN. This effect is greater among Asian patients. Whereas, its impact on reducing mortality is not significant. PMID:27902746

  3. Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children: 20 years study in a tertiary care hospital.

    Science.gov (United States)

    Techasatian, Leelawadee; Panombualert, Sunee; Uppala, Rattapon; Jetsrisuparb, Charoon

    2017-06-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe lifethreatening skin conditions. The most common cause of these manifestations is medications. Beside discontinued of the culprit drug, systemic corticosteroids were used as a primary treatment option among pediatric population. This study aimed to explore causative drugs (drug group/ latent period), treaments, complications, and treatment outcome (morbidity, mortality, length of hospital stay) of SJS and TEN in children. A retrospective chart was reviewed during the period of 1992 to 2012 at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SJS and TEN were clinically diagnosed and confirmed by pediatric dermatologists. Other possible causes other than druginduced SJS and TEN were excluded. A total of 30 patients was recorded, including 24 (80%) SJS patients and 6 (20%) TEN patients. The mean age was 6.9 years (SD 4.4). Male to female ratio was 1.5:1. Antiepileptic drug group was the most common causative drug (n=18, 60%), followed by antibiotic drug group (n=8, 26.6%), and others (n=4, 13.3%) which included nonsteroidal antiinflammtory drugs (NSAIDs) and chemotherapy drugs. Systemic corticosteroids were used in 29 patients (96.6%). Intravenous immunoglobulin was used in one TEN patient (3.3%). There was a medium correlation between time to treatment (systemic corticosteroids) and the length of hospital stay (Spearman correlation coefficient=0.63, P=0.005). Two TEN patients (6.6%) died. Carbamazepine was the most common causative drug of SJS and TEN in our study. The severity of skin detachment is not correlated to severity of ocular findings. However, the persistent of ocular complications up to one year is suggested for promptly appropriate ocular treatment in all SJS and TEN patients. Our data suggested that early administration of systemic corticosteroid may reduce the length of hospital stay and should be considered for the treatment of pediatric

  4. HLA-B*15:21 and carbamazepine-induced Stevens-Johnson syndrome: pooled-data and in silico analysis

    Science.gov (United States)

    Jaruthamsophon, Kanoot; Tipmanee, Varomyalin; Sangiemchoey, Antida; Sukasem, Chonlaphat; Limprasert, Pornprot

    2017-03-01

    HLA-B*15:02 screening before carbamazepine (CBZ) prescription in Asian populations is the recommended practice to prevent CBZ-induced Stevens-Johnson syndrome (CBZ-SJS). However, a number of patients have developed CBZ-SJS even having no HLA-B*15:02. Herein, we present the case of a Thai patient who had a negative HLA-B*15:02 screening result but later developed CBZ-SJS. Further HLA typing revealed HLA-B*15:21/B*13:01. HLA-B*15:21 is a member of the HLA-B75 serotype and is commonly found in Southeast Asian populations. Based on this case, we hypothesised that if all HLA-B*15:02 carriers were prevented from CBZ prescription, another common HLA-B75 serotype marker would show its association with CBZ-SJS. To test this hypothesis, we pooled data from previous association studies in Asian populations, excluded all cases with HLA-B*15:02, and analysed the association significance of HLA-B75 serotype markers. A significant association was found between CBZ-SJS and HLA-B*15:21 and HLA-B*15:11. We also applied an in silico analysis and found that all HLA-B75 serotype molecules shared similar capability in binding the CBZ molecule. In summary, this report provides the first evidence of a positive association between HLA-B*15:21 and CBZ-SJS and the first in silico analysis of CBZ binding sites and details of the molecular behaviour of HLA-B75 molecule to explain its molecular action.

  5. IKZF1, a new susceptibility gene for cold medicine-related Stevens-Johnson syndrome/toxic epidermal necrolysis with severe mucosal involvement.

    Science.gov (United States)

    Ueta, Mayumi; Sawai, Hiromi; Sotozono, Chie; Hitomi, Yuki; Kaniwa, Nahoko; Kim, Mee Kum; Seo, Kyoung Yul; Yoon, Kyung-Chul; Joo, Choun-Ki; Kannabiran, Chitra; Wakamatsu, Tais Hitomi; Sangwan, Virender; Rathi, Varsha; Basu, Sayan; Ozeki, Takeshi; Mushiroda, Taisei; Sugiyama, Emiko; Maekawa, Keiko; Nakamura, Ryosuke; Aihara, Michiko; Matsunaga, Kayoko; Sekine, Akihiro; Gomes, José Álvaro Pereira; Hamuro, Junji; Saito, Yoshiro; Kubo, Michiaki; Kinoshita, Shigeru; Tokunaga, Katsushi

    2015-06-01

    Stevens-Johnson syndrome (SJS) and its severe form, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes, including the ocular surface, oral cavity, and genitals. These reactions are very rare but are often associated with inciting drugs, infectious agents, or both. We sought to identify susceptibility loci for cold medicine-related SJS/TEN (CM-SJS/TEN) with severe mucosal involvement (SMI). A genome-wide association study was performed in 808 Japanese subjects (117 patients with CM-SJS/TEN with SMI and 691 healthy control subjects), and subsequent replication studies were performed in 204 other Japanese subjects (16 cases and 188 control subjects), 117 Korean subjects (27 cases and 90 control subjects), 76 Indian subjects (20 cases and 56 control subjects), and 174 Brazilian subjects (39 cases and 135 control subjects). In addition to the most significant susceptibility region, HLA-A, we identified IKZF1, which encodes Ikaros, as a novel susceptibility gene (meta-analysis, rs4917014 [G vs. T]; odds ratio, 0.5; P = 8.5 × 10(-11)). Furthermore, quantitative ratios of the IKZF1 alternative splicing isoforms Ik1 and Ik2 were significantly associated with rs4917014 genotypes. We identified IKZF1 as a susceptibility gene for CM-SJS/TEN with SMI not only in Japanese subjects but also in Korean and Indian subjects and showed that the Ik2/Ik1 ratio might be influenced by IKZF1 single nucleotide polymorphisms, which were significantly associated with susceptibility to CM-SJS/TEN with SMI. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  6. The Effect of Intravenous Immunoglobulin Combined with Corticosteroid on the Progression of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Liang-Ping Ye

    Full Text Available Intravenous immunoglobulin (IVIG treatment is commonly used to treat Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN with controversial therapeutic effect.We conducted a comprehensive meta-analysis through combining the published eligible studies to evaluate the effectiveness of IVIG on SJS and TEN treatment.A total of 26 studies were selected from public available databases. The combination of IVIG and corticosteroid markedly reduced the recovery time (by 1.63 days, 95% CI: 0.83-2.43, P < 0.001, compared with solo corticosteroid group. The favorable effects were greater in Asian (2.19, 95% CI: 1.41-2.97, P < 0.001, TEN (2.56, 95% CI: 0.35-4.77, P = 0.023 and high-dose IVIG treated individuals (1.78, 95% CI: 0.42-3.14, P = 0.010. The hospitalization length reduced by 3.19 days (95% CI: 0.08-6.30, P = 0.045, though the outcome was proven to be unstable. We found heterogeneities, which sources were probably regional factors. Besides, IVIG was inclined to decrease SJS/TEN mortality (SMR: 0.84, 95% CI: 0.66-1.08, P = 0.178. This impact was possibly more profound when patients were treated with high dose IVIG (SMR: 0.74, 95% CI: 0.50-1.08, P = 0.116, or when patients were diagnosed as TEN (SMR: 0.68, 95% CI: 0.45-1.01, P = 0.058.Our current meta-analysis suggests that IVIG combined with corticosteroid could reduce recovery time for SJS and TEN. This effect is greater among Asian patients. Whereas, its impact on reducing mortality is not significant.

  7. Downregulation of interferon-γ-induced protein 10 in the tears of patients with Stevens-Johnson syndrome with severe ocular complications in the chronic stage.

    Science.gov (United States)

    Ueta, Mayumi; Nishigaki, Hiromi; Sotozono, Chie; Kinoshita, Shigeru

    2017-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute inflammatory vesiculobullous reactions of the skin and mucosa such as the ocular surface, oral cavity and genitals. Severe ocular complications (SOC) arise in some patients with SJS/TEN diagnosed by dermatologists. To investigate the pathophysiology of ocular surface inflammation in SJS/TEN with SOC in the chronic stage, we examined cytokines in the tears of patients with ocular surface diseases and healthy controls. SJS/TEN eyes in the chronic stage (n>30), healthy eyes (n>20, controls) and eyes (n>20) from patients with atopic keratoconjunctivitis representing different ocular surface inflammatory disorders. Tear samples were collected on Schirmer's measurement strips. To measure the level of various cytokines in the tears we used BD CBA Flex sets. An observational study (case-control study). We recorded the level of interleukin (IL)-6, IL-8, eotaxin, macrophage inflammatory protein (MIP)-1β, RANTES (regulated on activation, normal T cell expressed and secreted), interferon gamma (IFN)-γ, monocyte chemoattractant protein-1, IFN-γ-induced protein 10 (IP-10) and total IgE. We found that compared with the controls, in SJS/TEN with SOC, IL-6, IL-8, eotaxin and MIP-1β were significantly upregulated while IP-10 was significantly downregulated. Compared with atopic keratoconjunctivitis, IP-10 was significantly downregulated in SJS/TEN with SOC; on the other hand, total IgE was significantly upregulated in atopic keratoconjunctivitis compared with SJS/TEN with SOC. IP-10 in tears may be a biomarker to distinguish between chronic SJS/TEN with SOC and other ocular inflammatory disorders such as atopic keratoconjunctivitis.

  8. Incidence, causative factors and mortality rates of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in northern Italy: data from the REACT registry.

    Science.gov (United States)

    Diphoorn, Janouk; Cazzaniga, Simone; Gamba, Chiara; Schroeder, Jan; Citterio, Antonella; Rivolta, Alma Lisa; Vighi, Giuseppe Danilo; Naldi, Luigi

    2016-02-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse drug reactions. We assessed incidence, drug exposure and mortality, analysing data obtained from the Lombardy Registry of Severe Cutaneous Reactions (REACT). Data were collected from hospitals in the Italian Lombardy region (9,502,272 people). A trained monitor was sent to the reporting hospital to collect data on drug exposure and clinical features. The algorithm for drug causality for epidermal necrolysis algorithm was applied to assess drug causality. Defined Daily Dose (DDD) was used to express drug consumption. From April 2009 to November 2014, 17 cases of TEN and 59 cases of SJS were collected. The overall incidence rate was 1.40 cases (95%CI, 1.12-1.76) per million people per year. A total of 15 cases died during hospitalization with a mortality rate of 16.9% for SJS and 29.4% for TEN. Overall, 55.4% of cases had a probable or very probable relation with drug exposure. In a total of five patients (6.6%), no causative drug for the reaction was identifiable. Allopurinol contributed to the highest number of cases (23 cases), while the highest incidence based on more than one case reported was observed for cotrimoxazole and lamotrigine, with 5.37 cases (95%CI, 2.09-13.80) and 3.54 (95%CI, 1.21-10.42) per 10 million DDD/year, respectively. We confirmed that SJS and TEN are rare adverse cutaneous reactions. As expected, mortality was influenced by the degree of skin detachment. The profile of drugs associated with the reactions was in agreement with data from other surveillance systems. Copyright © 2015 John Wiley & Sons, Ltd.

  9. A decade of burn unit experience with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical pathological diagnosis and risk factor awareness.

    Science.gov (United States)

    Lim, Victoria M; Do, Annie; Berger, Timothy G; Nguyen, Austin H; DeWeese, Jeffrey; Malone, J David; Jordan, Kathleen; Hom, Fred; Tuffanelli, Lucia; Fillari, Paula; Siu, Shirley; Grossman, Richard

    2016-06-01

    Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) is a rare and often fatal spectrum of mucocutaneous diseases usually attributable to severe adverse drug reactions. Burn units are referral centers for patients at the most extreme end of the disease continuum. Our burn center admits a much higher percentage of TEN (>30% BSA) cases than reported in most prior reviews. The purpose of this study was to analyze the diagnostic and prognostic value of variables collected on referred SJS/TEN patients. We retrospectively analyzed 94 patients admitted to our unit with a presumptive SJS/TEN diagnosis made in most cases by the referring center. Most of the diagnoses were clinical. Fifty of the 94 patients underwent biopsy when the clinical diagnosis was questionable. Of the 50 patients who underwent biopsy, 18 (36%) received an alternative diagnosis. Analysis was therefore limited to 76 patients, i.e. 44 patients felt to have firm clinical diagnoses plus 32 patients with diagnoses confirmed by biopsy. Mean age was 54.3 years (17-93) and overall gender ratio was 43 F vs. 33 M (56.6% vs. 43.4%). Mean LOS was 15.2 days (1-48) and overall mortality was 23.7% (18/76). Univariate analysis revealed percent body surface area (%BSA) did not show statistically significant association with mortality. Histopathological correlation for diagnosis is not standardized across institutions worldwide. Due to challenges in the diagnosis of SJS/TEN and the high incidence of error in clinical diagnosis, it is recommended that all patients with presumed SJS/TEN receive skin biopsies with H&E and direct immunofluorescence. We propose a diagnostic approach in order to address this need. Lack of association between %BSA and mortality suggests that all biopsy-proven SJS/TEN cases belong in specialty centers due to the unstable nature of the disease and risk for rapid progression. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  10. Association of CYP2C9*3 with phenytoin-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review and meta-analysis.

    Science.gov (United States)

    Wu, X; Liu, W; Zhou, W

    2017-12-23

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions that can be induced by phenytoin (PHT). CYP2C9*3 is the key enzyme in PHT metabolism. The aim of this meta-analysis was to evaluate the association between CYP2C9*3 and PHT-induced SJS/TEN. An extensive search was performed in multiple databases, including the Cochrane Library, EMBASE, PubMed, OVID and EBSCO. Studies exploring the relationship between CYP2C9*3 and PHT-induced SJS and TEN were included. Odds ratios (ORs) with corresponding 95% confidence intervals (CI) were calculated for dichotomous data. Data analysis was performed using Review Manager (version 5.3). Four studies, with 117 PHT-induced SJS/TEN cases and 338 matched controls (PHT-tolerant patients) or 4231 population controls (general population), were identified. SJS and TEN were found to be significantly associated with the CYP2C9*3 allele, comparing both matched controls (OR, 8.93; 95% CI, 2.63-30.36; P = .0005) with substantial heterogeneity (I 2  = 46%) and population controls (OR, 8.88; 95% CI, 5.01-15.74; P < .00001). A significant association between CYP2C9*3 and PHT-induced SJS/TEN was identified, especially in a Thai population. CYP2C9*3 is thus a credible predictive genetic marker of PHT-induced SJS/TEN. Further multicenter studies and large prospective observational studies are, however, still required to determine the influence of CYP2C*3 on blood levels of PHT and its metabolites, and their association with SJS/TEN. © 2017 John Wiley & Sons Ltd.

  11. Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea.

    Science.gov (United States)

    Yang, Min-Suk; Lee, Jin Yong; Kim, Jayeun; Kim, Gun-Woo; Kim, Byung-Keun; Kim, Ju-Young; Park, Heung-Woo; Cho, Sang-Heon; Min, Kyung-Up; Kang, Hye-Ryun

    2016-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases; however, it is hard to estimate their incidence due to the rarity of these diseases. We evaluated the incidence of SJS and TEN using a nationwide administrative database. We used a national medical insurance review system (Health Insurance Review and Assessment) database which contained the claim data of the entire nation from 2009 to 2013 to estimate the accurate incidence of SJS and TEN in Korea. The diagnostic codes of L511 (SJS) or L512 (TEN) from the International Classification of Diseases-10th revision were used to define the target study population. We also retrospectively followed up a 2011 SJS and TEN cohort for 24 months in order to assess the in-hospital mortality, related complications and total claims cost due to SJS and TEN. A total of 1,167 (938 SJS and 229 TEN) cases were newly diagnosed from 2010 to 2013. The age- and sex-standardized annual incidences estimated in this study were 3.96 to 5.03 in SJS and 0.94 to 1.45 in TEN per million. There was no significant change in annual incidence throughout the study periods. When analyzed by 10-year age groups, the annual incidence was the lowest in group 20-29 years and the highest in group 70 for both SJS and TEN. Based on the 2011 cohort analysis, the in-hospital mortality were 5.7 and 15.1% for SJS and TEN, respectively. The mortality increased with age, particularly, after 40 years of age. Among the complications related with SJS or TEN, ocular sequelae was the most common (43.1 and 43.4% of SJS and TEN patients, respectively) followed by urethral sequelae (5.7 and 9.4% of SJS and TEN patients, respectively). Overall, our data suggest that SJS, and TEN are infrequent but constantly arise throughout the years.

  12. Retrospective Analysis of Corticosteroid Treatment in Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis over a Period of 10 Years in Vajira Hospital, Navamindradhiraj University, Bangkok

    Science.gov (United States)

    Prompongsa, Sirikarn

    2014-01-01

    Background. Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN) are uncommon and life-threatening drug reaction associated with a high morbidity and mortality. Objective. We studied SJS and/or TEN by conducting a retrospective analysis of 87 patients treated during a 10-year period. Methods. We conducted a retrospective review of the records of all patients with a diagnosis of SJS and/or TEN based on clinical features and histological confirmation of SJS and/or TEN was not available at the Department of Medicine, Vajira hospital, Bangkok, Thailand. The data were collected from two groups from 2003 to 2007 and 2008 to 2012. Results. A total of 87 cases of SJS and/or TEN were found, comprising 44 males and 43 females whose mean age was 46.5 years. The average length of stay was 17 days. Antibiotics, anticonvulsants, and allopurinol were the major culprit drugs in both groups. The mean SCORTEN on admission was 2.1 in first the group while 1.7 in second the group. From 2008 to 2012, thirty-nine patients (76.5%) were treated with corticosteroids while only eight patients (22.2%) were treated between 2003 and 2007. The mortality rate declined from 25% from the first group to 13.7% in the second group. Complications between first and second groups had no significant differences. Conclusions. Short-term corticosteroids may contribute to a reduced mortality rate in SJS and/or TEN without increasing secondary infection. Further well-designed studies are required to compare the effect of corticosteroids treatment for SJS and/or TEN. PMID:25024697

  13. Association of human leukocyte antigen variants and allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: A meta-analysis.

    Science.gov (United States)

    Li, Xingang; Zhao, Zhigang; Sun, Shu-Sen

    2017-05-01

    The association between human leukocyte antigen (HLA) variants and allopurinol-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) was evaluated through a pooled analysis of published studies. A comprehensive search was performed in multiple databases, including PubMed, MEDLINE, ISI Web of Knowledge, EMBASE, Cochrane Register of Controlled Trials, and Science Direct. Studies investigating the association between HLA alleles with allopurinol-induced SJS or TEN were retrieved, and the data were independently extracted. The overall odds ratios (ORs) with corresponding 95% confidence intervals were calculated to determine the association between the presence of HLA variant in at least one allele and allopurinol-induced SJS or TEN. To test the robustness of the meta-analysis results, a sensitivity analysis was performed by removing each study one at a time and calculating the pooled ORs of the remaining studies. The fixed-effects and random-effects models were used to pool the collected data. A total of 4 studies with 81 allopurinol-induced SJS or TEN cases and matched controls (allopurinol-tolerant patients) or population controls (general population) were identified. SJS and TEN were found to be significantly associated with HLA-A*33:03 and HLA-C*03:02 alleles in both groups of studies with matched controls and population controls. All of the pooled ORs were not significantly affected by the remaining studies and different modeling methods, indicating robust results. A strong association was found between HLA-A*33:03 and HLA-C*03:02 alleles and allopurinol-induced SJS or TEN, especially in an Asian population. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. [Factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa].

    Science.gov (United States)

    Saka, B; Dzidzinyo, K; Akakpo, S; Téclessou, J; Nouhou Diori, A; Maneh, N; Mahamadou, G; Gnassingbé, W; Abilogun-Chokki, A; Mouhari-Toure, A; Boubacar, Y Ali; Kombaté, K; Balo, K; Tchangai-Walla, K; Pitché, P

    2018-02-24

    The purpose of this study was to identify risk factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in sub-Saharan Africa. A retrospective study was carried out at the dermatology department in collaboration with the ophthalmology department for SJS/TEN patients between January 2000 and December 2016 in Lomé (Togo). The severity of acute ocular involvement was evaluated using the Power classification, and the drug eruption score was assessed using de Bastuji-Garin classification. A total of 107 cases of SJS/TEN (84 cases of SJS, 20 cases of TEN and 3 cases of overlap syndrome) were analyzed. There were 71 women and 36 men, with an average age of 32.3±12.5 years (range: 5 to 75 years). Sulfonamides (37.4%) were the most commonly used drugs followed by nevirapine (22.4%). HIV serology was positive in 46 (58.2%) of the 79 patients tested. A total of 54 (50.5%) patients had acute ocular involvement, which was mild in 29.9% of patients, moderate in 13.1% and severe in 7.5%. In multivariate analysis, exposure to sulfadoxine was the sole factor associated with moderate or severe acute ocular involvement in SJS/TEN (adjusted odds ratio=3.3; 95% CI=[1.1; 10.2]). Exposure to sulfadoxine was identified in our study as a risk factor associated with the severity of acute ocular involvement in SJS/TEN. Multicenter studies should be conducted in sub-Saharan Africa to confirm this associated risk factor. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  15. Is acetaminophen associated with a risk of Stevens-Johnson syndrome and toxic epidermal necrolysis? Analysis of the French Pharmacovigilance Database.

    Science.gov (United States)

    Lebrun-Vignes, Bénédicte; Guy, Claire; Jean-Pastor, Marie-Josèphe; Gras-Champel, Valérie; Zenut, Marie

    2018-02-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mostly drug-induced cutaneous reactions. Acetaminophen is an over-the-counter drug used worldwide to treat pain and reduce fever. In 2013, the US Food and Drug Administration informed the public that acetaminophen was associated with a rare risk of SJS/TEN. The aim of the present retrospective study was to analyse reports of acetaminophen as a possible suspect in the development of SJS/TEN from the French Pharmacovigilance Database (FPDB). Cases of TEN/SJS with acetaminophen as a suspect drug registered in the FPDB, collected from January 2002 to December 2013, were analysed by an expert group. The algorithm of drug causality for epidermal necrolysis (ALDEN) was used as a reference tool for SJS/TEN to assess the causality of each suspect drug. After exclusion of 16 nonvalidated cases, 112 cases (47 TEN, 51 SJS, 14 SJS/TEN overlaps) involving 574 suspected drugs (5⋅1/case) were analysed. In 80 cases, the acetaminophen ALDEN score was inferior or equal to that of other drugs, associated with a higher suspicion for causality. In 32 cases, acetaminophen had the highest score but matched with a 'very unlikely' or 'unlikely' causality in 12 cases. For the 20 remaining cases with a 'possible' or ' probable' causality, a protopathic or a confounding bias was likely in 14 cases. After analysis of the French pharmacovigilance data using the ALDEN algorithm, we found no obvious SJS/TEN risk related to the use of acetaminophen in this large national series. © 2017 The British Pharmacological Society.

  16. Variable levels of apoptotic signal-associated cytokines in the disease course of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.

    Science.gov (United States)

    Yang, Yongsheng; Li, Feng; Du, Juan; Shen, Yanyun; Lin, Jinran; Zhu, Xiaohua; Luo, Xiaoqun; Liang, Jun; Xu, Jinhua

    2017-08-01

    Keratinocyte death is a hallmark of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). Apoptotic signal-associated cytokines, such as TNF-α, sFasL, granulysin, sTRAIL and IFN-γ have been reported to participate in keratinocyte apoptosis. However, their levels are variable, which hampers the elucidation of the role of these cytokines. We sought to determine whether cytokine levels vary with disease course. The serum cytokine levels of 24 patients and blister fluid of 10 were analysed by enzyme-linked immunosorbent assay on the first day of their admission to hospital and were evaluated at different time points in the disease course. Meanwhile, surface markers (CD3, CD4, CD8, CD1a, CD14, CD16+56 and CD68) of blister fluid cells were measured by flow cytometry. The concentrations of all cytokines in the serum and blister fluid were higher than those in the controls and were more elevated in the blister fluid than in the serum. Moreover, sTRAIL, IFN-γ and TNF-α quantities were relatively stable, while those of sFasL and granulysin decreased rapidly in the disease course. On the first day, CD8+ T and natural killer cells were predominant in the blister fluid but their relative percentage diminished gradually, while that of CD14+ cells increased. Our study confirmed there are high but variable levels of these cytokines in SJS/TEN, especially in the early phase and different tendencies are manifested in the disease course. © 2016 The Australasian College of Dermatologists.

  17. A cross-sectional comparative study on chronic ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis in Chinese eyes: a 15-year case series.

    Science.gov (United States)

    Chow, Loraine L W; Ng, Alex L K; Chow, Sharon S W; Choy, Bonnie N K; Shih, Kendrick C; Wong, Ian Y H; Chan, Johnny C Y; Lai, Jimmy S M

    2017-05-25

    To compare the chronic ocular manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis patients from a 15-year cohort. All SJS and TEN patients admitted to our burn intensive care unit between 1999 and 2014 were invited for assessment. Slit-lamp examination was performed, and ocular condition was graded according to the Sotozono scoring System, which depended on the extent of cornea, conjunctiva and lid involvement. Tear osmolarity was also measured. A total of 18 SJS and 4 TEN cases with an average of 92 and 135 months from disease onset were included. The average age of onset was 46.4 ± 16.6 in SJS and 43.5 ± 19.3 in TEN patients. The LogMAR visual acuity was 0.209 ± 0.591 in SJS and 0.489 ± 0.688 in TEN patients (p = 0.048). The average total Sotozono score was 3.75 ± 7.32 in SJS and 6.88 ± 9.49 in TEN (p = 0.358). Neither the age of onset (p = 0.787), length of follow-up (p = 0.256) nor disease type (SJS vs TEN, p = 0.188) predicted the Sotozono score. There was a statistically significant correlation between Sotozono score and LogMAR VA (r s  = 0.437, p = 0.003). The average total Sotozono score was higher in the TEN group than in the SJS group, but the difference was not statistically significant. Nevertheless, the score correlated with the visual acuity which was statistically worse in the TEN group.

  18. ABC transporters and the proteasome complex are implicated in susceptibility to Stevens-Johnson syndrome and toxic epidermal necrolysis across multiple drugs.

    Directory of Open Access Journals (Sweden)

    Paola Nicoletti

    Full Text Available Stevens-Johnson syndrome (SJS and Toxic Epidermal Necrolysis (TEN represent rare but serious adverse drug reactions (ADRs. Both are characterized by distinctive blistering lesions and significant mortality rates. While there is evidence for strong drug-specific genetic predisposition related to HLA alleles, recent genome wide association studies (GWAS on European and Asian populations have failed to identify genetic susceptibility alleles that are common across multiple drugs. We hypothesize that this is a consequence of the low to moderate effect size of individual genetic risk factors. To test this hypothesis we developed Pointer, a new algorithm that assesses the aggregate effect of multiple low risk variants on a pathway using a gene set enrichment approach. A key advantage of our method is the capability to associate SNPs with genes by exploiting physical proximity as well as by using expression quantitative trait loci (eQTLs that capture information about both cis- and trans-acting regulatory effects. We control for known bias-inducing aspects of enrichment based analyses, such as: 1 gene length, 2 gene set size, 3 presence of biologically related genes within the same linkage disequilibrium (LD region, and, 4 genes shared among multiple gene sets. We applied this approach to publicly available SJS/TEN genome-wide genotype data and identified the ABC transporter and Proteasome pathways as potentially implicated in the genetic susceptibility of non-drug-specific SJS/TEN. We demonstrated that the innovative SNP-to-gene mapping phase of the method was essential in detecting the significant enrichment for those pathways. Analysis of an independent gene expression dataset provides supportive functional evidence for the involvement of Proteasome pathways in SJS/TEN cutaneous lesions. These results suggest that Pointer provides a useful framework for the integrative analysis of pharmacogenetic GWAS data, by increasing the power to detect

  19. Genotipificación de HLA-B en pacientes colombianos afectados por el síndrome Stevens-Johnson y la Necrólisis Epidérmica Tóxica

    OpenAIRE

    León Ruiz, Maria Juliana

    2014-01-01

    Las reacciones alérgicas a medicamentos cutáneas severas (RAM) como el Síndrome Stevens Johnson (SJS) y la Necrólisis Epidérmica Tóxica (NET),caracterizadas por exantema, erosión de la piel y las membranas mucosas, flictenas, desprendimiento de la piel secundario a la muerte de queratinocitos y compromiso ocular. Son infrecuentes en la población pero con elevada morbi-mortalidad, se presentan luego de la administración de diferentes fármacos. En Asia se ha asociado el alelo HLA-B*15:02 como m...

  20. Contravene, write ... About the pain of others of Susan Sontag

    Directory of Open Access Journals (Sweden)

    Lucía Belén Couso

    2014-08-01

    Full Text Available Regarding the pain of others challenges our knowledge, challenges what is held as true. We appreciate this attitude condensed in the verb “to defy”. We analyze how Sontag develops her hypothesis and, from that point onward, which is the idea of criticism that emerges from the writing of Regarding the pain of others. Our analysis focuses on three of its topics: the reviewing of the ideas about the war that Virginia Woolf establishes on Three Guineas, the discussion of her own text On photography, and the criticism about Sebastião Salgado’s photography.

  1. From Estonian Exile to Executive Office / Susan Frith

    Index Scriptorium Estoniae

    Frith, Susan

    2008-01-01

    Eesti Vabariigi Presidendi Toomas Hendrik Ilvese elukäigust, haridusteest, poliitilistest vaadetest. T. H. Ilves lõpetas Pennsylvania ülikooli psühholoogia alal magistrikraadiga 1978. a. Artiklis on kasutatud telefoniintervjuud presidendiga. T. H. Ilvese kohta avaldavad arvamust ülikoolikaaslane Brian Wandell ja Eesti Rahvuskomitee Ühendriikides endine president Juhan Simonson. Ülevaade artiklist ilmunud ka: Vaba Eesti Sõna, 24. jaan. 2008, lk. 7, 10: Vaga, Airi. Eesti president Toomas H. Ilves Pennsylvania ülikooli ajakirjas

  2. Reading Susan Isaacs: toward a radically revised theory of thinking.

    Science.gov (United States)

    Ogden, Thomas H

    2011-08-01

    The author views Isaacs's (1952) paper, The nature and function of phantasy, as making an important contribution to the development of a radically revised psychoanalytic theory of thinking. Perhaps Isaacs's most important contribution is the notion that phantasy is the process that creates meaning, and that phantasy is the form in which all meanings - including feelings, defense 'mechanisms,' impulses, bodily experiences, and so on - exist in unconscious mental life. The author discusses both explicit formulations offered by Isaacs as well as his own extensions of her ideas. The latter include (1) the idea that phantasying generates not only unconscious psychic content, but also constitutes the entirety of unconscious thinking; (2) the notion that transference is a form of phantasying that serves as a way of thinking for the first time (in relation to the analyst) emotional events that occurred in the past, but were too disturbing to be experienced at the time they occurred and (3) a principal aim and function of phantasy is that of fulfilling the human need to get to know and understand the truth of one's experience. The author concludes by discussing the relationship between Isaacs's concept of phantasy and Bion's concepts of alpha function and the human need for the truth, as well as the differences between Fairbairn's and Isaacs's conceptions of the nature of unconscious internal object relationships. Copyright © 2011 Institute of Psychoanalysis.

  3. A polarised SUSANS facility to study magnetic systems

    Indian Academy of Sciences (India)

    magnet, at a small angle to the diagonal of the rectangle. Neutrons were thus de- flected by the 'magnetic air prism' [5] of 90◦ apex angle. The magnet was fabricated by attaching eight rare earth permanent magnet slabs (2 cm wide, 5 cm long and. 1.25 cm high, maximum energy product BHmax > 30 MGOe) each, just ...

  4. A polarised SUSANS facility to study magnetic systems

    Indian Academy of Sciences (India)

    Spatial pair-distribution functions for the up- and down-spins as well as the nuclear and magnetic scattering length density distributions in the micrometer domain, have ... Solid State Physics Division, Bhabha Atomic Research Centre, Mumbai 400 085, India; Berlin Neutron Scattering Center, Hahn-Meitner-Institut, Glienicker ...

  5. Entretien avec Susan Holtz | CRDI - Centre de recherches pour le ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    26 nov. 2010 ... À l'échelle planétaire, toutes les institutions continueront d'évoluer et de changer, c'est sûr. C'est ce qui se passe présentement étant donné la conjugaison d'une intégration plus poussée de l'économie planétaire à l'évolution rapide des technologies, particulièrement dans le monde des communications.

  6. In Conversation with Susan Holtz | CRDI - Centre de recherches ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    In response to Chapter 8 of Agenda 21, "Integrating environment and development in decision making," IDRC undertook to research and document the practical, policy integration problems encountered in its development work. The Cornerstone of Development: Integrating Environmental, Social, and Economic Policies, ...

  7. Rene Valner ja Mikk Suursild - lihtsa elu tegelased / Susan Lahesalu

    Index Scriptorium Estoniae

    Lahesalu, Susan

    2007-01-01

    Arhitekt Rene Valner ja Mikk Suursild - tandem nimega UNITe - ehitavad ökonoomseid ja ökoloogilisi looduslikest materjalidest maju. Nende koostöös on valminud ka Peipsi ääres Nina külas 3 põhumaja. Ott Kadariku, Margit Mutso ja Kuido Kartau kommentaarid

  8. Representações da enfermeira e pessoa em sofrimento psíquico na mostra fotográfica USAnatomy de Steven KleinRepresentaciones de la enfermera y la persona en sufrimiento psíquico en exposición fotográfica USAnatomy de Steven Klein

    Directory of Open Access Journals (Sweden)

    Evanilda Souza de Santana Carvalho

    Full Text Available RESUMO Objetivos Analisar as representações da enfermeira e da pessoa em sofrimento psíquico retratadas na obra fotográfica de Steven Klein, na mostra USAnatomy realizada no Museu da Escultura em São Paulo, no ano de 2011. Métodos Estudo qualitativo realizado no ano de 2012. Três fotografias foram submetidas à análise iconográfica. A interpretação dos achados baseou-se no referencial teórico filosófico de Foucault e Bourdieu sobre as relações de poder. Resultados A enfermeira é representada como sensual, insensível, com poder de controlar e torturar, enquanto a pessoa em sofrimento psíquico é representada como suja, prisioneira e sujeitada à relação assimétrica de poder com a enfermeira. Considerações finais Foram evidenciadas relações de sujeição e de dominação simbólica nas quais a pessoa em sofrimento psíquico tem seu corpo moldado por uma disciplina imposta pela enfermeira. Estereótipos sobre a imagem da enfermeira se opõem ao ideário da profissão que é zelar pela integridade dos seres cuidados.

  9. Prosthetic replacement of the ocular surface ecosystem as treatment for ocular surface disease in patients with a history of Stevens-Johnson syndrome/toxic epidermal necrolysis.

    Science.gov (United States)

    Papakostas, Thanos D; Le, Hong-Gam; Chodosh, James; Jacobs, Deborah S

    2015-02-01

    To report the visual outcomes of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in patients with ocular surface disease related to Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Retrospective cohort study. We included 86 patients (167 eyes) with history of SJS/TEN who underwent PROSE treatment from January 1, 2006, to January 1, 2011. Etiology, previous interventions, change in visual acuity, change in visual function, and duration of follow-up are reported. Paired t test and Friedman test with Dunn's post hoc test for multiple comparisons were used for statistical analysis. Visual acuity at last follow-up and visual function based on the National Eye Institute 25-item Visual Functioning Questionnaire (NEI VFQ-25) at 6 months. We treated 35 males and 51 females with a history of SJS/TENS; median age was 36 years. The most common reported etiologies for SJS/TENS were antibiotics (n = 25), ibuprofen (n = 15), and lamotrigine (n = 11). The median visual acuity at the initial visit was 20/60 (range, 20/400-20/25; 0.48 logarithm of the minimum angle of resolution [logMAR]), and the visual acuity at completion of customization was 20/25 (range, 20/200-20/20; 0.096 logMAR; P < 0.001), with no decline in median acuity at the end of follow-up. Median duration of follow-up was 16 months. There was a significant improvement in the visual function of the patients based on the NEI VFQ-25 questionnaire (mean of 48 points at baseline vs. mean of 72 points at 6 months; P < 0.001). In addition, there was also an improvement in the self-reported general health of the patients (mean of 57 points at baseline vs. mean of 65 points at 6 months; P < 0.01). In a large cohort of patients with chronic ocular surface disease related to SJS/TEN, PROSE treatment offers sustained and significant large improvement in visual function and acuity. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  10. Antecedent Drug Exposure Aetiology and Management Protocols in Steven-Johnson Syndrome and Toxic Epidermal Necrolysis, A Hospital Based Prospective Study.

    Science.gov (United States)

    Farhat, Samina; Banday, Muddasir; Hassan, Iffat

    2016-01-01

    The study sought to identify the magnitude and characteristic of severe cutaneous adverse reactions (SCAR's) like Steven-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). A prospective study was conducted by the Department of Pharmacology in association with Department of Dermatology in SMHS hospital. The study was carried out from June 2013-June 2015 on hospitalized cases of cutaneous adverse drug reaction reporting in hospital. The SCAR's were reported in a structured questionnaire based on adverse drug reaction (ADR) reporting form provided by the Central Drug Standard Control Organization (CDSCO) Ministry of Health and Family welfare, Government of India. The SCAR's were analysed for their characteristics, causality, severity and prognosis. Causality assessment was done by using a validated ADR probability scale of Naranjo as well as WHO Uppsala Monitoring Center (WHO-UMC) system for standardized case causality assessment. The management protocol were analysed for their clinical outcome through a proper follow up period. A total of 52 hospitalized cases of cutaneous adverse drug reactions were reported during the study period. We identified a total of 15 cases (28%) of SCAR's involving 9(17%) of SJS and 6 (12%) of TEN. SJS was seen in 2(22%) males and 7(78%) females. TEN was seen in all females (100%) and in no male. Drugs implicated in causing these life threatening reactions were identified as anticonvulsant agents like carbamazepine (CBZ), phenytoin (PHT) and Lamotrigine (LTG), oxicam NSAID, Sulfasalazine and levofloxacin. Despite higher reported mortality rates in SJS and TEN all patients survived with 2 patients surviving TEN suffered from long term opthalmological sequelae of the disease. Present study suggest that drug induced cutaneous eruptions are common ranging from common nuisance rashes to rare life threatening diseases like SJS and TEN, SJS/TEN typically occur 1-3 weeks after initiation of therapy. Aromatic AED's, LTG, oxicam NSAID

  11. Relationship between the HLA-B*1502 allele and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis.

    Science.gov (United States)

    Tangamornsuksan, Wimonchat; Chaiyakunapruk, Nathorn; Somkrua, Ratchadaporn; Lohitnavy, Manupat; Tassaneeyakul, Wichittra

    2013-09-01

    The US Food and Drug Administration recommends screening for the HLA-B*1502 allele before initiation of carbamazepine therapy in patients of Asian ancestry, but there remains unclear evidence of a relationship between HLA-B*1502 and Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) among carbamazepine users, especially in some racial/ethnic populations. To determine the relationship between the HLA-B*1502 allele and carbamazepine-induced SJS and TEN. A comprehensive search of the following data sources was performed without language restriction from the inception of the database until January 8, 2013: EMBASE, PubMed, clinicaltrials.gov, Cochrane Library, IPA (International Pharmaceutical Abstracts), HuGENet (Human Genome Epidemiology Network), and CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the reference lists of identified studies. Inclusion criteria were studies that investigated the relationship between HLA-B*1502 and carbamazepine-induced SJS and TEN and that reported sufficient data for calculating the frequency of HLA-B*1502 carriers among cases and controls. The search yielded 525 articles, of which 16 met the inclusion criteria. The studies included 227 SJS or TEN cases, 602 matched control subjects, and 2949 population control subjects. Two reviewers independently extracted the following data: study design, eligibility criteria, diagnostic criteria, patient demographics, genotype distribution, HLA-B genotyping technique, selection of cases and controls, dosage of carbamazepine and duration of use, and results of Hardy-Weinberg equilibrium in the control group. The Newcastle-Ottawa Scale was used to assess the quality of studies. The overall odds ratios (ORs) with corresponding 95% CIs were calculated using a random-effects model. The primary analysis was based on matched control studies. Subgroup analyses by race/ethnicity were also performed. The primary outcome was carbamazepine-induced SJS and TEN. The

  12. Ocular surface cytokine profile in chronic Stevens-Johnson syndrome and its response to mucous membrane grafting for lid margin keratinisation.

    Science.gov (United States)

    Gurumurthy, Srividya; Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Angayarkanni, Narayanasamy

    2018-02-01

    To study the tear cytokine and the conjunctival and oral mucosal marker profile in chronic ocular Stevens-Johnson syndrome (SJS) and their alteration following mucous membrane grafting (MMG) for lid margin keratinisation (LMK). In a 1-year prospective study, SJS cases (n=25) and age-matched/sex-matched healthy controls (n=25) were recruited. Tear specimen (Schirmer's strip), conjunctival and oral mucosal imprints were collected from controls and SJS cases pre-MMG and post-MMG (at first follow-up, n=17). Tear cytokines were profiled using 27-bioplex array. Transforming growth factor-beta (TGF-β)-mediated extracellular matrix changes in conjunctival and oral mucosal cells were analysed by gene expression studies. 30 RESULTS: Tear cytokine profiling of chronic SJS cases at pre-MMG stage revealed significant upregulation of cytokines granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-8, IL-1β, monocyte chemoattractant protein-1, IL-15, IL-2, IL-17A and basic fibroblast growth factor (bFGF) with downregulation of IP-10 (interferon gamma-induced protein 10), tumour necrosis factor-α, interferon-γ, IL-10, vascular endothelial growth factor, regulated upon activation normal T-cell expressed and secreted (RANTES), IL-7, IL-12p70 and IL-13, with maximal increase in GM-CSF and maximal downregulation of IP-10, respectively. Of these, IL-2, IL-15, bFGF and IL-17A showed significant correlation with disease severity, pre-MMG. Conjunctival cells pre-MMG showed increase in TGF-β1, TGF-βRII, connective tissue growth factor and collagen-III gene expression by 10, 67, 173 and 184 folds, respectively, which dropped to 1.3, 11, 13.5 and 19 folds correspondingly, post-MMG. However, their expressions in oral mucosa were negligible. A proinflammatory, profibrotic, antiapoptotic ocular surface milieu characterises chronic ocular SJS. IP-10, an antifibrotic cytokine was noted to be maximally downregulated, unlike in other forms of chronic dry eye disease. The

  13. Haistes rotti / Steven Sitao Xu

    Index Scriptorium Estoniae

    Sitao Xu, Steven

    2007-01-01

    Paljud eksperdid muretsevad, et pärast olümpiamänge langeb Hiina majandus tagasi maa peale, riik on liiga kiiresti ja liiga kaua kasvanud nõrga rahaga. Hiina valitsus peaks alustama maksukärbetega ja kulutama rohkem raha avalikele kaupadele. Vt. samas: Lapsi pole, rohkem raha

  14. Human Leukocyte Antigen Class I Genes Associated With Stevens-Johnson Syndrome and Severe Ocular Complications Following Use of Cold Medicine in a Brazilian Population.

    Science.gov (United States)

    Wakamatsu, Tais H; Ueta, Mayumi; Tokunaga, Katsushi; Okada, Yukinori; Loureiro, Renata R; Costa, Karita A; Sallum, Juliana Maria F; Milhomens, José Arthur; Inoue, Chikara; Sotozono, Chie; Gomes, José Álvaro P; Kinoshita, Shigeru

    2017-04-01

    Describing the association with human leukocyte antigen (HLA) alleles could facilitate the understanding of increased risk factors for development of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in patients with severe ocular complications (SOCs). To investigate the association between HLA class I genes and cold medicine (CM)-associated SJS/TEN with SOCs. This case-control study was conducted between February 8, 2013, and August 29, 2014. Thirty-nine Brazilian patients with CM-SJS/TEN of 74 patients with SJS/TEN with SOCs and 133 healthy Brazilian volunteers were enrolled. Human leukocyte antigen class I genes (HLA-A, HLA-B, and HLA-C) were examined to determine whether there was a genetic predisposition for CM-SJS/TEN with SOC. Patients were interviewed to identify possible etiologic factors. Data analysis was performed from April 14, 2013, to August 29, 2014. Genetic predisposition for CM-SJS/TEN with SOCs by analysis of HLA class I genes. Of 74 patients included in the analysis, 32 (43%) were male; mean (SD) age was 36.01 [15.42] years. HLA-A*66:01 (odds ratio [OR], 24.0; 95% CI, 2.79-206.0; P < .001), HLA-B*44:03 (OR, 2.71; 95% CI, 1.11-6.65; P = .04), and HLA-C*12:03 (OR, 5.6; 95% CI, 1.67-18.80; P = .006) were associated with Brazilian CM-SJS/TEN with SOCs, and HLA-A*11:01 (OR, 0.074; 95% CI, 0.004-1.26; P = .008), HLA-B*08:01 (OR, 0.15; 95% CI, 0.02-1.15; P = .048), and HLA-B*51:01 (OR, 0.23; 95% CI, 0.05-1.03; P = .045) were inversely associated with Brazilian CM-SJS/TEN with SOCs (39 cases: 19 Pardo and 16 European ancestry; 14 males and 25 females; age, 35.2 [14.4] years; and 133 controls: 66 Pardo and 61 European ancestry; 55 males and 78 females; age, 41.2 [12.9] years). When multiple test correction within the HLA locus, HLA-A*66:01 and HLA-C*12:03 demonstrated associations. When participants were segregated into Pardo and locus is considered, HLA-A*66:01 was associated with CM-SJS/TEN with SOC among

  15. HLA-A*0206 with TLR3 polymorphisms exerts more than additive effects in Stevens-Johnson syndrome with severe ocular surface complications.

    Directory of Open Access Journals (Sweden)

    Mayumi Ueta

    Full Text Available BACKGROUND: Stevens-Johnson syndrome (SJS is an acute inflammatory vesiculobullous reaction of the skin and mucosa, often including the ocular surface, and toxic epidermal necrolysis (TEN occurs with its progression. Although SJS/TEN is thought to be initiated by certain types of medication coupled with possible infection. In the present study we examined the multiplicative interaction(s between HLA-A*0206 and 7 Toll-like receptor 3 (TLR3 Single-nucleotide polymorphisms (SNPs in patients with SJS/TEN. PRINCIPAL FINDINGS: We analyzed the genotypes for HLA-A and 7 TLR3 SNPs in 110 Japanese SJS/TEN patients with severe ocular complications and 206 healthy volunteers to examine the interactions between the two loci. We found that HLA-A*0206 exhibited a high odds ratio for SJS/TEN (carrier frequency: OR = 5.1; gene frequency: OR = 4.0 and that there was a strong association with TLR3 rs.5743312T/T SNP (OR = 7.4, TLR3 rs.3775296T/T SNP (OR = 5.8, TLR3 rs.6822014G/G SNP (OR = 4.8, TLR3 rs.3775290A/A SNP (OR = 2.9, TLR3 rs.7668666A/A SNP (OR = 2.7, TLR3 rs.4861699G/G SNP (OR = 2.3, and TLR3 rs.11732384G/G SNP (OR = 1.9. There was strong linkage disequilibrium (LD between rs.3775296 and rs.5743312 and between rs.7668666 and rs.3775290. The results of interaction analysis showed that the pair, HLA-A*0206 and TLR3 SNP rs3775296T/T, which exhibited strong LD with TLR3 rs.5743312, exerted more than additive effects (OR = 47.7. The other pairs, HLA-A*0206 and TLR3 rs.3775290A/A SNP (OR = 11.4 which was in strong LD with TLR3 rs7668666A/A SNP, and TLR3 rs4861699G/G SNP (OR = 7.6 revealed additive effects. Moreover, the combination HLA-A*0206 and TLR3 rs3775296T/T was stronger than the TLR3 rs6822014G/G and TLR3 rs3775290A/A pair, which reflected the interactions within the TLR3 gene alone. SIGNIFICANCE: By interaction analysis, HLA-A*0206 and TLR3 SNP rs3775296T/T, which were in strong LD with TLR3 SNP rs5743312T/T, manifested more than additive effects that

  16. Board of Education, Island Trees Union Free School District No. 26 et al., Petitioners, v. Steven A. Pico, by His Next Friend, Frances Pico et al. On Writ of Certiorari to the United States Court of Appeals for the Second Circuit. Supreme Court of the United States, No. 80-2043.

    Science.gov (United States)

    Supreme Court of the U. S., Washington, DC.

    The Supreme Court decision in the case of the Board of Education, Island Trees, New York, versus Steven A. Pico, addressed whether the First Amendment imposes limitations upon the exercise by a local school board of its discretion to remove library books from high school and junior high school libraries. Rejecting the recommendations of a…

  17. Genome-wide association study using the ethnicity-specific Japonica array: identification of new susceptibility loci for cold medicine-related Stevens-Johnson syndrome with severe ocular complications.

    Science.gov (United States)

    Ueta, Mayumi; Sawai, Hiromi; Shingaki, Ryosei; Kawai, Yusuke; Sotozono, Chie; Kojima, Kaname; Yoon, Kyung-Chul; Kim, Mee Kum; Seo, Kyoung Yul; Joo, Choun-Ki; Nagasaki, Masao; Kinoshita, Shigeru; Tokunaga, Katsushi

    2017-04-01

    A genome-wide association study (GWAS) for cold medicine-related Stevens-Johnson syndrome (CM-SJS) with severe ocular complications (SOC) was performed in a Japanese population. A recently developed ethnicity-specific array with genome-wide imputation that was based on the whole-genome sequences of 1070 unrelated Japanese individuals was used. Validation analysis with additional samples from Japanese individuals and replication analysis using samples from Korean individuals identified two new susceptibility loci on chromosomes 15 and 16. This study might suggest the usefulness of GWAS using the ethnicity-specific array and genome-wide imputation based on large-scale whole-genome sequences. Our findings contribute to the understanding of genetic predisposition to CM-SJS with SOC.

  18. Reações cutâneas graves adversas a drogas - aspectos relevantes ao diagnóstico e ao tratamento - Parte I - Anafilaxia e reações anafilactóides, eritrodermias e o espectro clínico da síndrome de Stevens-Johnson & necrólise epidérmica tóxica (Doença de Lyell Severe cutaneous adverse reactions to drugs - relevant aspects to diagnosis and treatment - Part I: Anaphylaxis and anaphylactoid reactions, erythroderma and the clinical spectrum of Stevens-Johnson syndrome & toxic epidermal necrolysis (Lyell´s disease

    Directory of Open Access Journals (Sweden)

    Paulo Ricardo Criado

    2004-08-01

    Full Text Available As reações cutâneas graves adversas a droga (RCGAD são as que geralmente necessitam de internação hospitalar, por vezes em unidade de terapia intensiva ou de queimados, com observação minuciosa dos sinais vitais e da função de órgãos internos. O objetivo é descrever essas reações, facilitando seu reconhecimento e tratamento. Fazem parte desse grupo a anafilaxia, a síndrome de Stevens-Johnson (SSJ, a necrólise epidérmica tóxica (NET e, dependendo do envolvimento sistêmico, as eritrodermias. Neste artigo, são abordados as características clínicas e o tratamento de algumas reações adversas a droga: anafilaxia, as eritrodermias, a síndrome de Stevens-Johnson (SSJ e a necrólise epidérmica tóxica (NET.Severe Cutaneous Adverse Reactions to drugs (SCARD generally require hospitalization, and at times in the intensive therapy or burn care unit for observation of the vital signs and the viscera function. The aim of this study is to describe these reactions in order to facilitate recognition and treatment. This group of drug reactions includes anaphylaxis, Stevens-Johnson syndrome (SJS, toxic epidermal necrolysis (TEN and, depending on the systemic involvement, erythroderma. In this article we approach the characteristics and treatment of some adverse reactions to drugs: anaphylaxis, erythroderma, Stevens-Johnson syndrome (SJS and toxic epidermal necrolysis (TEN.

  19. Efficacy of Hummel (Modified Schlumberger Arrays of Vertical Electrical Sounding in Groundwater Exploration: Case Study of Parts of Ibadan Metropolis, Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Micheal Oladunjoye

    2015-01-01

    Full Text Available This research compared the interpretation results of the Vertical Electrical Sounding data acquired using the conventional Schlumberger and modified Schlumberger arrays with a view to assessing the effectiveness of the modified Schlumberger arrays of vertical electrical sounding as an alternative to the conventional Schlumberger array at sites with space constraint during groundwater exploration. A total of thirty-seven (37 sounding locations were occupied and one hundred (100 sounding data for both conventional Schlumberger and modified Schlumberger arrays were collected across different rock units within Ibadan metropolis, south-western Nigeria, with electrode spacing (AB/2 ranging from 1 to 75 m. The field data were interpreted qualitatively by curve matching and computer iterative methods. Also, statistical analysis of subsurface units and the coefficient of correlation “R” of the statistical plots of the field data shows the relationship between the different arrays. The raw data plot of the different arrays shows significant similarities while statistical analysis of the geo-electric parameters obtained from the different arrays across varied lithologic units show that strong relationships exist between the different field methods. The coefficient of correlation R with values ranging from 0.7 to 0.99 implies that a good similarity exists between the different field methods employed in this study. Hence, modified Schlumberger arrays can be said to be a good alternative to the conventional Schlumberger array for groundwater exploration especially in urban settings where space constraint is a major challenge.

  20. Modernismi tõlgendamine jätkub / Reet Varblane

    Index Scriptorium Estoniae

    Varblane, Reet, 1952-

    2007-01-01

    Rahvusvaheline kunstiajalookonverents "Erinevad modernismid, erinevad avangardid. Kesk- ja Ida-Euroopa kunstiprobleemid pärast Teist maailmasõda" Kumu Kunstimuuseumis 27. ja 28. IX. Esinejad: Irena Buzhinska, David Crowley, Branislav Dmitrijevic, Sirje Helme, Henry Meyric Hughes, Jaak Kangilaski, Liljana Kolesnik, Andres Kurg, Vojtech Lahoda, Steven Mansbach, Pjotr Piotrowski, Stefanie Reetz, Susan E. Reid, Skaidra Trilupaite, Borut Vogelnik

  1. Report to Congress on the Indemnification of Contractors Performing Environmental Restoration. Appendices

    Science.gov (United States)

    1994-01-07

    Rhett Craig Schnee Carole Stern Henry Thomas Tony Thompson Susan Tonner Kenneth Weckstein Thomas Williamson Edward Zebrowski 51 DEPARTMENT OF THE ARMY...David Evans and Associates Inc. SEA Consultarz Inc. FRuor Daniel , Inc. SEC Donahue, Inc. Fullr. Mosabarger. Scott & May SSM/Spo= Stevens & McCoy, Inc

  2. Power Analysis as a Critique of Power Politics: Understanding Power and Governance in the Second Gulf War

    OpenAIRE

    Guzzini, Stefano

    1994-01-01

    Defence date: 1 December 1994 Examining board: Prof. David Baldwin (Columbia University, New York) ; Prof. Pierre Hassner (CERI, IEP, Paris) ; Prof. Steven Lukes (EUI, co-supervisor) ; Prof. Susan Strange (University of Warwick, supervisor) ; Prof. Ole Waever (Centre for Peace and Conflict Research, Copenhagen)

  3. Three Book Reviews

    OpenAIRE

    Kent Parades Scribner; Susan Haag; Steven J. Fountaine

    1993-01-01

    This issue of the Archives contains reviews of three books: Robert Leestma and Herbert J. Walberg (Eds.), Japanese Educational Productivity, reviewed by Steven J. Fountaine, Thomas Sowell, Inside American Education: The Decline, the Deception, the Dogmas, reviewed by Susan Haag, Chester E. Finn Jr. and Theodor Rebarbar (Eds.), Education Reform in the '90s, reviewed by Kent Parades Scribner

  4. Three Book Reviews

    Directory of Open Access Journals (Sweden)

    Kent Parades Scribner

    1993-04-01

    Full Text Available This issue of the Archives contains reviews of three books: Robert Leestma and Herbert J. Walberg (Eds., Japanese Educational Productivity, reviewed by Steven J. Fountaine, Thomas Sowell, Inside American Education: The Decline, the Deception, the Dogmas, reviewed by Susan Haag, Chester E. Finn Jr. and Theodor Rebarbar (Eds., Education Reform in the '90s, reviewed by Kent Parades Scribner

  5. Organization and Administration of Adult Education Programs: A Guide for Practitioners. Adult Education Special Topics: Theory, Research and Practice in LifeLong Learning

    Science.gov (United States)

    Schmidt, Steven W.; Biniecki, Susan M. Yelich

    2016-01-01

    Administrators of adult education programs work in dynamic and ever-changing environments. They are continually challenged with a myriad of issues related to program budgeting, marketing, strategic planning, funding, human resources, and other topics. With decades of real world experience in the field, Steven Schmidt and Susan Yelich Biniecki have…

  6. Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS).

    Science.gov (United States)

    Belver, M T; Michavila, A; Bobolea, I; Feito, M; Bellón, T; Quirce, S

    2016-01-01

    Severe delayed drug-induced skin reactions in children are not common but potentially serious. This article describes aspects concerning the etiology, pathogenesis and clinical manifestations of these processes; it presents three paediatric cases, namely STS (Steven Johnson Syndrome), TEN (toxic epidermal necrolysis), probably related to amoxicillin/clavulanate and ibuprofen and DRESS (a drug reaction with eosinophilia and systemic symptoms) secondary to phenytoin; and in relation to them, the diagnosis and the treatment of these processes are discussed and reviewed. The AGEP (acute generalised exanthematous pustulosis) is also reviewed. The aetiological diagnosis of severe non-immediate reactions is difficult, and the value of current allergological testing is not well defined in these cases. Diagnosis is based on clinical history, the empirical risk of drugs to trigger SJS/TEN or DRESS, and the in vivo and in vitro testing of the suspect drug. Skin biopsy confirms that the clinical diagnosis and delayed hypersensitivity tests, especially the patch test and the lymphoblastic transformation test (LTT), may be important to confirm the aetiological diagnosis, in our cases emphasising the latter. These diseases can be life threatening (especially DRESS and TEN) and/or have a high rate of major complications or sequelae (SJS/TEN). The three cases described progressed well without sequelae. All were treated with corticosteroids, which is the most currently accepted treatment although the effect has not been clearly demonstrated. Copyright © 2015 SEICAP. Published by Elsevier Espana. All rights reserved.

  7. Case Report: Stevens-Johnson syndrome following a single double dosing of nevirapine-containing regimen once in an HIV-infected woman on long-term antiretroviral therapy. [version 1; referees: 1 approved, 2 approved with reservations

    Directory of Open Access Journals (Sweden)

    Betty Kakande

    2015-06-01

    Full Text Available A 31-year old HIV-infected African woman on nevirapine, tenofovir and lamivudine for more than 4 years presented with an 8-day history of symptoms and signs of Stevens-Johnson syndrome. She was on no other medication. Her viral load was undetectable and she had maintained a CD4 count of between 356 and 387cells/mm3 in the preceding 2½ years. She missed her antiretrovirals 10 days before the onset of her symptoms and subsequently doubled her daily dose the following day. She had been on no other medication in the preceding 8 weeks. Her ARVs were stopped and she fully re-epithelialized with the exception of the lips, over the following 10 days. She was started on a daily single tablet of Odimune® (a fixed drug combination antiretroviral containing tenofovir, emtricitabine and efavirenz.   Nevirapine is the most common offender in cases of antiretroviral-associated SJS in published literature. Lamivudine is very rarely implicated while there are no similar reports with tenofovir.  We concluded that nevirapine was by far the most likely offender in this case. Nevirapine toxicity is associated with high CD4 counts, undetectable viral load and high drug plasma level. We postulate that the sudden increase of the plasma levels of nevirapine in a patient with a high CD4 count and undetectable viral load created a perfect storm for the development of SJS in our patient, who had been on the NVP-containing regimen for many years. Clinicians should be aware that severe adverse drug reactions are dynamic and can occur even when the drug has been in use for a long time.

  8. HLA-B*15:02 association with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in an Indian population: a pooled-data analysis and meta-analysis.

    Science.gov (United States)

    Khor, Amy Hui-Ping; Lim, Kheng-Seang; Tan, Chong-Tin; Wong, Su-Ming; Ng, Ching-Ching

    2014-11-01

    This study aimed to investigate the prevalence and association of HLA-B*15:02 with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in the Indian population in Malaysia, which mostly originated from Southern India. HLA-B alleles in five Indian case patients with CBZ-SJS/TEN and 52 CBZ-tolerant controls, and followed by a pooled sample of seven cases from two centers in Malaysia were analyzed. Positive association for HLA-B*15:02 with CBZ-SJS/TEN was detected in Indians (40% [2/5] vs. 3.8% [2/52], odds ratio [OR] 16.7, p = 0.0349), of which 80% (4/5) of the Indian patients originated from Southern India. A pooled sample of seven cases showed stronger association between HLA-B*15:02 and CBZ-SJS/TEN (57.1% [4/7] vs. 3.8% [2/52], OR 33.3, 95% confidence interval [CI] 4.25-162.21, p = 1.05 × 10(-3)). Subsequent meta-analysis on Indians from Malaysia and India further demonstrated a significant and strong association between HLA-B*15:02 and CBZ-SJS/TEN (OR 38.54; 95% CI 6.83-217.34, p < 1.0 × 10(-4)). Our study is the first on Indians predominantly from Southern India that demonstrated HLA-B*15:02 as a strong risk factor for CBZ-SJS/TEN despite a low population allele frequency. This stressed the importance of testing for HLA-B*15:02, irrespective of the ancestral background, including populations with low allele frequency. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  9. Structural modeling of HLA-B*1502/peptide/carbamazepine/T-cell receptor complex architecture: implication for the molecular mechanism of carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis.

    Science.gov (United States)

    Zhou, Peng; Zhang, Shilei; Wang, Yewang; Yang, Chao; Huang, Jian

    2016-08-01

    Drug-induced adverse reactions are a significant problem in healthcare worldwide and are estimated to cost billions of dollars annually in the United States. A portion of such reactions is observed to strongly associate with certain human leukocyte antigen (HLA) alleles; one of the strongest associations is the HLA-B*1502 protein with carbamazepine (CBZ)-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) - the odds ratio value can even be higher than one thousand. The particularly strong association in CBZ-induced SJS/TEN suggests that the HLA-B*1502 is not only a genetic marker but also a participant in the pathogenesis of the disease. In the current study, we attempt to computationally model the atomic-level structure of the complete HLA-B*1502/peptide/CBZ/T-cell receptor (TCR) complex architecture based on prior knowledge obtained from epidemiological investigations as well as in vitro and in vivo assays. The model tells a different story about the molecular mechanism of CBZ-induced SJS/TEN from that previously reported for abacavir (ABC)-induced hypersensitivity (HSR); the CBZ molecule is located at the interface between HLA-B*1502/peptide and TCR, directly contacts the P3-P6 residues of antigen peptide, and bound within a pocket region encompassed by two TCR CDR3 fingers. Molecular dynamics simulation and binding energy analysis further reveal that the CBZ shows considerably high affinity to TCR over HLA-B*1502/peptide, which can tightly interact with the former rather than the latter. From the model, two hypotheses are proposed that can well explain most previous observations and are expected to guide next wet-lab experiments. This study could help to promote our understanding of the molecular mechanism and pathological implication underlying CBZ-induced SJS/TEN.

  10. Comparative Analysis of Substrate-Free Cultured Oral Mucosal Epithelial Cell Sheets from Cells of Subjects with and without Stevens-Johnson Syndrome for Use in Ocular Surface Reconstruction.

    Directory of Open Access Journals (Sweden)

    Yun Hee Kim

    Full Text Available To compare the regenerative potential of cultured oral mucosal epithelial cells sheets (COMECs from Stevens-Johnson syndrome (SJS subjects with those from non-SJS subjects.Human oral mucosal epithelial cells from SJS and non-SJS subjects were cultured, and colony-forming efficiency (CFE, proliferative and migration potential, expression of cytokines/growth factors and stem cells were compared. COMECs from SJS and non-SJS subjects were transplanted into 12 limbal stem cell-deficient rabbits, and their regenerative potential was analyzed at 1 week after transplantation.CFE (p>0.05, student's t test, cell proliferation potential (p>0.05, two-way ANOVA and expression of the cytokeratins (K3, K4, K13, K19 in the oral mucosal epithelial cells from SJS subjects were similar to those of the cells from non-SJS subjects. The initial migratory potential of SJS cells was delayed compared to that of non-SJS cells (p 0.05, Mann-Whitney U test, and stem cell markers (p63; p>0.05, Mann-Whitney U test compared to non-SJS COMECs. The initial epithelial defects in vivo were larger in the eyes treated with SJS-COMECs on day 3 (p<0.01, RM two-way ANOVA, but no differences were observed by day 7 between SJS- and non-SJS-COMECs.These results suggest that, aside from differences in migratory potential, oral mucosal epithelial cells from SJS and non-SJS subjects are comparable in their regeneration potential in treating limbal stem cell deficiency.

  11. HLA-A*31: 01 and HLA-B*15:02 association with Stevens-Johnson syndrome and toxic epidermal necrolysis to carbamazepine in a multiethnic Malaysian population.

    Science.gov (United States)

    Khor, Amy Hui-Ping; Lim, Kheng-Seang; Tan, Chong-Tin; Kwan, Zhenli; Tan, Wooi-Chiang; Wu, David Bin-Chia; Ng, Ching-Ching

    2017-07-01

    The majority of the carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis CBZ-SJS/TEN are associated with HLA-B*15:02 in Asian populations where this allele is common. In contrast, the association with HLA-A*31:01 is only reported in Japanese and Europeans. This study aimed to further investigate the association with HLA-A*31:01 besides HLA-B*15:02 in a multiethnic Malaysian population. Twenty-eight CBZ-SJS/TEN cases and 227 CBZ-tolerant controls were recruited. Association was tested by comparing carrier frequencies of the alleles between cases and controls. Significant associations were detected between HLA-B*15:02 and CBZ-SJS/TEN in independent ethnic groups: Malays [P=2.00×10; odds ratio (OR): 49.0; 95% confidence interval (CI): 9.36-256.81], Chinese (P=0.0047; OR: 14.3; 95% CI: 2.38-86.03) and Indians (P=0.04; OR: 13.8; 95% CI: 1.51-124.99). Combined analysis of all ethnic groups showed a significant association with OR Cochran-Mantel-Haenszel (ORCMH) of 26.6 (95% CI: 12.80-55.25; PCMH=2.31×10). In Indians, HLA-A*31:01 was found to be associated significantly with CBZ-SJS/TEN (P=0.023; OR: 10.4; 95% CI: 1.64-65.79) and combined analyses of both variants, HLA-A*31:01 and HLA-B*15:02, increased the strength of the association (P=0.0068; OR: 14.3; 95% CI: 2.20-92.9). Besides HLA-B*15:02, our study found a new association between HLA-A*31:01 and CBZ-SJS/TEN in Indians.

  12. Validation of a novel real-time PCR assay for detection of HLA-B*15:02 allele for prevention of carbamazepine - Induced Stevens-Johnson syndrome/Toxic Epidermal Necrolysis in individuals of Asian ancestry.

    Science.gov (United States)

    Nguyen, Dinh Van; Vidal, Christopher; Chu, Hieu Chi; Do, Nga Thi Quynh; Tran, Tu Thi Linh; Le, Huong Thi Minh; Fulton, Richard B; Li, Jamma; Fernando, Suran L

    2016-12-01

    Screening for the HLA-B*15:02 allele has been recommended to prevent carbamazepine (CBZ) - induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) in individuals with Asian ancestry. We aimed, therefore, to develop and validate a robust and inexpensive method for detection of the HLA-B*15:02 allele. Real-time PCR using TaqMan® probes followed by SYBR® Green was used to detect the HLA-B*15:02 allele prior to treatment with CBZ therapy. A total of 121 samples were tested. The assay has a sensitivity of 100% (95% CI: 76.84-100.0%), a specificity of 100% (95% CI: 96.61-100%), a positive predictive value of 100% (95% CI: 76.84-100%) and a negative predictive value of 100.0% (95% CI: 96.61-100.0%), respectively. There was 100% agreement between our results and genotyping using Luminex SSO/SBT/SSP. The lowest limit of detection of the TaqMan® probe is 0.05ng/μl and the SYBR® Green is 0.5ng/μl of DNA. The unit cost of using the TaqMan® probe followed by SYBR® Green is only $4.7 USD. We developed a novel assay for the detection of the HLA-B*15:02 allele, which is robust, inexpensive and suitable for screening individuals of Asian ancestry in the prevention of CBZ-induced SJS/TEN. Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  13. Association of the HLA-B alleles with carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in the Javanese and Sundanese population of Indonesia: the important role of the HLA-B75 serotype.

    Science.gov (United States)

    Yuliwulandari, Rika; Kristin, Erna; Prayuni, Kinasih; Sachrowardi, Qomariyah; Suyatna, Franciscus D; Menaldi, Sri Linuwih; Wichukchinda, Nuanjun; Mahasirimongkol, Surakameth; Cavallari, Larisa H

    2017-12-01

    Carbamazepine (CBZ) is a common cause of life-threatening cutaneous adverse drug reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Previous studies have reported a strong association between the HLA genotype and CBZ-induced SJS/TEN. We investigated the association between the HLA genotype and CBZ-induced SJS/TEN in Javanese and Sundanese patients in Indonesia. Nine unrelated patients with CBZ-induced SJS/TEN and 236 healthy Javanese and Sundanese controls were genotyped for HLA-B and their allele frequencies were compared. The HLA-B*15:02 allele was found in 66.7% of the patients with CBZ-induced SJS/TEN, but only in 29.4% of tolerant control (p = 0.029; odds ratio [OR]: 6.5; 95% CI: 1.2-33.57) and 22.9% of healthy controls (p = 0.0021; OR: 6.78; 95% CI: 1.96-23.38). These findings support the involvement of HLA-B*15:02 in CBZ-induced SJS/TEN reported in other Asian populations. Interestingly, we also observed the presence of the HLA-B*15:21 allele. HLA-B*15:02 and HLA-B*15:21 are members of the HLA-B75 serotype, for which a greater frequency was observed in CBZ-induced SJS/TEN (vs tolerant control [p = 0.0078; OR: 12; 95% CI: 1.90-75.72] and vs normal control [p = 0.0018; OR: 8.56; 95% CI: 1.83-40]). Our findings suggest that screening for the HLA-B75 serotype can predict the risk of CBZ-induced SJS/TEN more accurately than screening for a specific allele.

  14. Cost-effectiveness analysis of HLA-B*58: 01 genetic testing before initiation of allopurinol therapy to prevent allopurinol-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in a Malaysian population.

    Science.gov (United States)

    Chong, Huey Yi; Lim, Yi Heng; Prawjaeng, Juthamas; Tassaneeyakul, Wichittra; Mohamed, Zahurin; Chaiyakunapruk, Nathorn

    2018-02-01

    Studies found a strong association between allopurinol-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and the HLA-B*58:01 allele. HLA-B*58:01 screening-guided therapy may mitigate the risk of allopurinol-induced SJS/TEN. This study aimed to evaluate the cost-effectiveness of HLA-B*58:01 screening before allopurinol therapy initiation compared with the current practice of no screening for Malaysian patients with chronic gout in whom a hypouricemic agent is indicated. This cost-effectiveness analysis adopted a societal perspective with a lifetime horizon. A decision tree model coupled with Markov models were developed to estimate the costs and outcomes, represented by quality-adjusted life years (QALYs) gained, of three treatment strategies: (a) current practice (allopurinol initiation without HLA-B*58:01 screening); (b) HLA-B*58:01 screening before allopurinol initiation; and (c) alternative treatment (probenecid) without HLA-B*58:01 screening. The model was populated with data from literature review, meta-analysis, and published government documents. Cost values were adjusted for the year 2016, with costs and health outcomes discounted at 3% per annum. A series of sensitivity analysis including probabilistic sensitivity analysis were carried out to determine the robustness of the findings. Both HLA-B*58:01 screening and probenecid prescribing were dominated by current practice. Compared with current practice, HLA-B*58:01 screening resulted in 0.252 QALYs loss per patient at an additional cost of USD 322, whereas probenecid prescribing resulted in 1.928 QALYs loss per patient at an additional cost of USD 2203. One SJS/TEN case would be avoided for every 556 patients screened. At the cost-effectiveness threshold of USD 8695 per QALY, the probability of current practice being the best choice is 99.9%, in contrast with 0.1 and 0% in HLA-B*58:01 screening and probenecid prescribing, respectively. This is because of the low incidence of

  15. Important role of prodromal viral infections responsible for inhibition of xenobiotic metabolizing enzymes in the pathomechanism of idiopathic Reye's syndrome, Stevens-Johnson syndrome, autoimmune hepatitis, and hepatotoxicity of the therapeutic doses of acetaminophen used in genetically predisposed persons.

    Science.gov (United States)

    Prandota, Joseph

    2002-01-01

    Upper respiratory tract febrile illnesses caused by various viruses, mycoplasma, chlamydia infections, and/or inflammatory diseases are usually observed a few days to a few (several) weeks before the onset of Reye's syndrome, Stevens-Johnson syndrome, autoimmune hepatitis (hepatotropic virus infections), or hepatotoxicity associated with therapeutic administration of acetaminophen in persons with varying degrees of deficits of important enzymatic activity. Activation of systemic host defense mechanisms by inflammatory component(s) results in depression of various induced and constitutive isoforms of cytochrome P-450 mixed-function oxidase system superfamily enzymes in the liver and most other tissues of the body. Because several cytochrome P-450 enzymes activities important for biotransformation of many endogenous and egzogenous substances show considerable variability between individuals, in some genetically predisposed persons, even the administration of therapeutic doses of a drug may result in serious clinical mishaps, if an important concomitant risk factor (eg, acute viral infection) is involved. Several inflammatory cytokines, such as interleukins, transforming growth factor beta1, human hepatocyte growth factor, and lymphotoxin, downregulate gene expression of major cytochrome P-450 enzymes with the specific effects on mRNA levels, protein expression, and enzyme activity observed with a given cytokine varying for each P-450 studied, thus eventually leading to metabolite-mediated adverse drug reactions and immunometallic diseases which sometimes result in tissue injury beyond the site(s) where metabolic bioactivation takes place. On the other hand, it must be emphasized that inhibition of metabolism of several drugs, as well as influence on the concentration and/or ratio of various cytokines in inflamed tissues, may exert beneficial effects in patients with different diseases, thus opening new therapeutic possibilities. Clinically relevant interactions may

  16. Reações cutâneas graves adversas a drogas - aspectos relevantes ao diagnóstico e ao tratamento - Parte I - Anafilaxia e reações anafilactóides, eritrodermias e o espectro clínico da síndrome de Stevens-Johnson & necrólise epidérmica tóxica (Doença de Lyell) Severe cutaneous adverse reactions to drugs - relevant aspects to diagnosis and treatment - Part I: Anaphylaxis and anaphylactoid reactions, erythroderma and the clinical spectrum of Stevens-Johnson syndrome & toxic epidermal necrolysis (Lyell´s disease)

    OpenAIRE

    Paulo Ricardo Criado; Roberta Fachini Jardim Criado; Cidia Vasconcellos; Rodrigo de Oliveira Ramos; Andréia Christina Gonçalves

    2004-01-01

    As reações cutâneas graves adversas a droga (RCGAD) são as que geralmente necessitam de internação hospitalar, por vezes em unidade de terapia intensiva ou de queimados, com observação minuciosa dos sinais vitais e da função de órgãos internos. O objetivo é descrever essas reações, facilitando seu reconhecimento e tratamento. Fazem parte desse grupo a anafilaxia, a síndrome de Stevens-Johnson (SSJ), a necrólise epidérmica tóxica (NET) e, dependendo do envolvimento sistêmico, as eritrodermias....

  17. Axiomatic approaches to Stevens' magnitude scaling

    DEFF Research Database (Denmark)

    Zimmer, Karin; Ellermeier, Wolfgang

    2006-01-01

    & Faulhammer, 2000), the authors found commutativity to hold and multiplicativity to fail in the majority of listeners, leading to the conclusion that, while respondents seem to be able to base their judgments on a ratio-scale of sensation strength, the numerals used in the assessments do not correspond...... and experimental tasks on the one hand, and on theories that are relaxing these axioms which are inherent in Stevens’ approach, on the other....

  18. Eluohtlikud arstid / Steven D. Levitt, Stephen Dubner

    Index Scriptorium Estoniae

    Levitt, Steven D.

    2010-01-01

    USA ühe meditsiiniinstituudi uuringu põhjal sureb arstide eksimuste tõttu igal aastal 44 000 kuni 98 000 inimest. Haiglas viibimise ajal saadud nakkused on üks tõsisemaid patsientide turvalisuse probleeme. Arstide vastutusest

  19. Kamikaze Paksas appoints Borisov / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Leedu presidendi Rolandas Paksase ümber vallandunud skandaali üks võtmeisikuid, Vene kodanik Juri Borissov teatas, et hakkab tööle presidendi ühiskondliku nõunikuna, mõni tund hiljem otsustas president distantseeruda oma valimiskampaania suursponsorist

  20. Paksas declares candidacy amid uncertainty / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Leedu ametieetika peakomisjon otsustas, et ametist tagandatud ekspresident Rolandas Paksas ei saa kolm aastat riigiametites töötada. See otsus võib takistada Paksase kandideerimist ennetähtaegsetel presidendivalimistel. Vt. samas: And here's the competition...

  1. Mayoral controversy resurrects political hostility / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Vilniuse linnapea Arturas Zuokas kuulati üle seoses võimaliku häälteostmisega kohalike omavalitsuste valimistel. A. Zuokas peab ülekuulamise põhjuseks president Rolandas Paksase survet uurimisorganitele

  2. Government promises billions for highways / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Läti transpordiministeerium avaldas riigi teedevõrgu arengukava järgmiseks 25 aastaks, mille kohaselt investeeritakse maanteede ja raudteede ehitusse kuni 18 miljardit litti. Leedu transpordiettevõtjate hinnangul ei ole uued suuremahulised projektid majandusarengu seisukohalt vajalikud

  3. In Appreciation of Claude Warren and Susan Rose's "William Pengelly's Techniques of Archaeological Excavation"

    Directory of Open Access Journals (Sweden)

    David L. Browman

    1997-11-01

    Full Text Available The short (40 pages pamphlet by Warren and Rose (1994 provides the answer to a complex question regarding credit for an important archaeological methodology, stratigraphic excavation. Let me set the stage for this appreciation. Continuing research on the beginnings of stratigraphic excavations in North America (Browman and Givens 1996, I sought the origins of the idea of actually excavating by strata, rather than post-facto interpretation, seen in North American as early as 1895 in the work of Henry Chapman Mercer, but not really introduced into the repertoire of American techniques until the work of Gamio, Kidder and Nelson between 1911 and 1914. The roots of the latter three seemed to lie with individuals such as Reisner, Boas, Uhle, who in turn seemed to rely on Hugo Obennaier, Gabriel de Mortillet, Marcellin Boule, and perhaps Pitt-Rivers, while Mercer's work could be traced to Boule and Albert Gaudry. Doggedly following back the roots, I found that Chapman (1989 could make a reasonable case that Pitt-Rivers had actually learned of the idea of strati­graphic excavation from Evans, Prestwich, and Lubbock, from the British scientists working with the Upper and Middle Paleolithic excavations during 1858-1868.

  4. Nõukogude "kaasaegne stiil" : sotsialistlik modernism = The Soviet "contemporary style" : a socialist modernism / Susan E. Reid

    Index Scriptorium Estoniae

    Reid, Susan E., 1959-

    2009-01-01

    Modernismile lähenemisest nõukogude kunstis. Nõukogude kunstikriitikast ja -praktikast. Kaasaegne stiil sünteesis arhitektuuriga. Nõukogude Palee teostamata projektist Moskvas. 1962. aastal valminud Moskva Pioneeride Paleest kui stalinistliku praktika hülgamise näitest

  5. Comment on "Revisiting the 1872 owens valley, California, earthquake" by Susan E. Hough and Kate Hutton

    Science.gov (United States)

    Bakun, W.H.

    2009-01-01

    Bakun (2009) argues that the conclusions of Hough and Hutton (2008) are wrong because the study failed to take into account the Sierra Nevada attenuation model of Bakun (2006). In particular, Bakun (2009) argues that propagation effects can explain the relatively high intensities generated by the 1872 Owens Valley earthquake. Using an intensity attenuation model that attempts to account for attenuation through the Sierra Nevada, Bakun (2006) infers the magnitude estimate (Mw 7.4–7.5) that is currently accepted by National Earthquake Information Center (NEIC).

  6. David Brailer on a private-public health information technology infrastructure. Interview by Susan V. White.

    Science.gov (United States)

    Brailer, David

    2004-01-01

    David Brailer, MD PhD, was appointed the first National Health Information Technology Coordinator by the U.S. Department of Health and Human Services Secretary Tommy Thompson on May 6, 2004. As National Coordinator he is to execute President Bush's Executive Order of April 27, 2004, calling for widespread deployment of health information technology (HIT) within 10 years. Dr. Brailer is an authority on clinical data sharing, local health information exchanges, and the use of peer-to-peer technologies in healthcare. He is a leader in the strategy and financing of quality and efficiency in healthcare, with a particular emphasis on HIT and health systems management. Previously, Dr. Brailer was a Senior Fellow at the Health Technology Center in San Francisco, advising a variety of regional and national data-sharing projects and several major corporations about the role of IT in improving the quality of healthcare. Dr. Brailer recently completed 10 years as Chairman and CEO of CareScience, Inc., a provider of care management services and Internet-based solutions that help reduce medical errors and improve physician and hospital-based performance. Dr. Brailer holds doctoral degrees in both medicine and economics. While in medical school, he was a Charles A. Dana Scholar at the University of Pennsylvania School of Medicine and the first recipient of the National Library of Medicine Martin Epstein Award for his work in expert systems. Dr. Brailer was among the first medical students to serve on the Board of Trustees of the American Medical Association.

  7. 77 FR 73663 - Susan F. Knott; Denial of Hearing; Final Debarment Order

    Science.gov (United States)

    2012-12-11

    ... seeking treatment with BOTOX/BOTOX Cosmetic (BOTOX) with a product, TRI-toxin, distributed by Toxic Research International, Inc. (TRI). BOTOX is a biological product derived from botulinum toxin type A that... approved for use, to be offered for sale as an approved drug product, BOTOX. This conduct clearly relates...

  8. Cracking the finger code: an interview with CCR’s Susan Mackem | Center for Cancer Research

    Science.gov (United States)

    The creation of the digits in our hand—the thumb, index-middle-ring fingers and pinky—begins early in development, but little is known about the exact programming that occurs to produce the different digit types. Investigators in the Cancer and Developmental Biology Laboratory, (CDBL), provide the first genetic evidence of how the tuning of signals sets digit identity by studying the effects of dysregulation (abnormal regulation) in several mutations. Read more…

  9. Kindlustushüvitise suuruse määramine kahjukindlustuses läbi kindlustussumma ja kindlustusväärtuse : [bakalaureusetöö] / Hannele Hummel ; Tartu Ülikool, õigusteaduskond ; juhendaja: Age Värv

    Index Scriptorium Estoniae

    Hummel, Hannele

    2010-01-01

    Kahju hüvitamise üldpõhimõtetest kahjukindlustuses, kindlustussumma ja kindlustusväärtuse määramisest kahjukindlustuslepingu sõlmimisel, hüvitise suuruse piiritlemisest kindlustusjuhtumi toimumise korral

  10. Ocular manifestations and outcome of treatment of Stevens-Johnson ...

    African Journals Online (AJOL)

    Final visual acuity depended on presenting visual acuity, how early in the disease patients presented, degree of inflammation and the degree of ocular surface cicatrisation. Conclusion: Ocular involvement in SJS results in widely differing degrees of ocular disability. Management involves medications and surgery.

  11. Report: Paksas scandal raises privacy concerns / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Inimõiguste ekspertide uuring näitab, et nii Leedu presidendi Rolandas Paksase administratsiooni töötajad, presidendi tegevuse uurijad kui ka Leedu ajakirjandus rikkusid mitmeid inimõigusi, eelkõige aga õigust privaatsusele

  12. The Stevens Integrated Maritime Surveillance Forecast System: Expansion and Enhancement

    National Research Council Canada - National Science Library

    Bruno, Michael S; Blumberg, Alan F

    2006-01-01

    ... for the real-time assessment of ocean, weather, environmental, and vessel traffic conditions throughout the New York Harbor region, and the forecast of conditions in the near and long-term and under specific threat scenarios...

  13. Steven Vogel and His Theory of Comparative Biomechanics

    Indian Academy of Sciences (India)

    IAS Admin

    Circuits (1993), Cats' Paws and Catapults. (1998), Prime Mover: a Natural History of. Muscle (2002), Comparative Biomechanics. (2003), Glimpses of Creatures in their Me- chanical World (2009), Life of a Leaf (2012), and so on. Vogel, an able wordsmith and a clever expositor of complicated ideas in simple terms, played ...

  14. Analysts : no need to panic over prices / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Pärast EL-iga liitumist on Balti riikides hinnad tõusnud keskmiselt 5,7%, pankade hinnangul on oodata ka inflatsiooni kiirenemist. Lisa: Thank you, accession: Consumer Price Index, percent increase, year-on-year

  15. Steven J. Ostro: Pioneer in Asteroid Lightcurve Inversion

    Science.gov (United States)

    Harris, Alan W.

    2009-09-01

    In 1906, Henry Norris Russell wrote a landmark paper (Astrophys. J. 24, 1-18, 1906) that set the field of lightcurve inversion back by more than three quarters of a century, until Steve Ostro and Robert Connolly published a paper on "convex profile inversion” (Icarus 57, 443-463, 1984). Russell's stifling contribution was innocent enough, and entirely correct: he showed that with "two cans of paint", one can decorate any arbitrarily shaped body in an infinite number of ways to yield any particular lightcurve, even, for example, a cigar shape that is brightest viewed end-on. This sufficed to discourage serious mathematical attack on the problem until Ostro & Connolly's landmark paper of 1984. They showed that if you have only "one can of paint", that is, in the absence of albedo variegation, the problem is tractable and one can make remarkable progress in lightcurve inversion to obtain shapes, or at least the "convex profile” of the real shape. As we now know, nature appears to have only one can of paint (per asteroid), that is, asteroids seem to paint themselves grey so that the uniform reflectivity assumption is quite excellent. Both radar and optical lightcurve inversion techniques are now quite mature, thanks to Steve's pioneering insights.

  16. Steven Vogel was an eminent American biophysicist. He made ...

    Indian Academy of Sciences (India)

    Resonance – Journal of Science Education. Current Issue : Vol. 23, Issue 2. Current Issue Volume 23 | Issue 2. February 2018. Home · Volumes & Issues · Categories · Special Issues · Search · Editorial Board · Information for Authors · Subscription ...

  17. Utility privatizations raise as many questions as cash / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2003-01-01

    Leedu valitsus seiskab tõenäoliselt elektrijaotusvõrgu Rytu Skirstomieji Tinklai (RTS) erastamise. Teise võrgufirma Vakaru Skirstomieji Tinklai (VST) erastamiskomisjon on palunud konkursil osalejatelt täpsustatud pakkumisi

  18. Vilnius mayor dragged into corruption scandal / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Vilniuse linnapea Arturas Zuokase suhtes on algatatud kriminaalmenetlus, süüdistuseks koos korporatsiooni Rubicon juhi Andrius Janukonisega altkäemaksu pakkumine linnavolikogu liikmele Vilmantas Dremale linnapea valimiste eel

  19. Commission : Paksas violated oath of office / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2003-01-01

    Leedu presidendi ümber puhkenud skandaali uuriv Seimi erikomisjon leidis, et president Rolandas Paksas oli ja on oma sidemete tõttu haavatav ning see kujutab ohtu riigi julgeolekule. Lisa: Commission conclusions

  20. A New Tree-Frog from Malawi (Hyperoliinae, Amphibia) | Stevens ...

    African Journals Online (AJOL)

    Hyperolius spinigularis sp. nov. from Mlanje district of Malawi at ca. 6SS metres, characterised by presence of prominent black asperities on male venter and particularly on gular disc. Descriptions and variations of external morphology, colour patterning, sexual dimorphism and dimensions. Juveniles described and ...

  1. Mazeikiu refinery to stay in Yukos' control / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Vene peaprokuratuur andis välja rahvusvahelise vahistamisorderi Mazheikiu Nafta juhatuse esimehe ja Jukose aktsionäri Mihhail Brudno suhtes. Leedu valitsus kaalub võimalikke samme, sealhulgas Mazheikiu Nafta aktsiate tagasiostmist

  2. Zuokas accuses paper of journalistic blackmail / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Vilniuse linnapea, Leedu Liberaaltsentristliku Liidu liider Arturas Zuokas süüdistab ajalehe Respublika peatoimetajat Vitas Tomkust väljapressimises. Ajaleht on avaldanud mitu Zuokase jaoks ebameeldivat artiklit, milles räägitakse tema väidetavatest sidemetest vastuolulise mainega ettevõtjatega

  3. 75 FR 9531 - Magnuson-Stevens Act Provisions; Correction

    Science.gov (United States)

    2010-03-03

    .... Because notice and opportunity for comment are not required pursuant to 5 U.S.C. 553, or any other law..., rod and reel, spear, trap, slurp gun, hand harvest. C. Charter fishery C. Bandit gear, buoy gear..., gillnet, hand harvest, seine, slurp gun, trap, spear, rod and reel, hook and line. 12. Recreational...

  4. Law and society [Review] Steven Vago (Fourth Edition: 1994)

    OpenAIRE

    Ghouri, Ahmad

    2012-01-01

    My primary interest in Sociology of Law is to analyse the interconnection between social and legal orders, and understand how the socio-legal environment reflects and influences different legal structures. I take up Vago’s book “Law & Society” with this avowed purpose, and also to refine, or perhaps to realign, my sociological imagination. I am also interested to learn research techniques employed in the socio-legal context, and possible uses of such techniques in the area of law I work in. T...

  5. Survival rates in West African savanna birds | Stevens | Ostrich ...

    African Journals Online (AJOL)

    Despite widespread interest in life histories and the comparison of parameters between tropical and temperate regions, there are still relatively few multispecies studies assessing annual survival in Afrotropical species. We used data from systematic mist-netting of savanna birds in Nigeria, between 2001 and 2008, ...

  6. Steven Hawking to visit Texas A&M in spring

    CERN Multimedia

    Xavier, D

    2002-01-01

    Stephen Hawking will visit Texas A&M University from Feb. 24 to March 21 2003 to participate in the inaugural meeting of the George P. and Cynthia W. Mitchell Institute for Fundamental Physics. This institute will bring several of the world's top physicists to A&M for a month-long exploration of the latest ideas on topics ranging from superstrings to M-theory and supergravity (1/2 page).

  7. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis ...

    African Journals Online (AJOL)

    tandfonline.com/oemd. 57. S Afr Fam Pract. ISSN 2078-6190 EISSN 2078-6204 ..... Syndrome and Toxic Epidermal Necrolysis: An Analysis of Triggers and Implications for Improving Prevention. The American journal of medicine. 2016 Apr 15.

  8. MEP : Political parties funded by bribes / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Leedu Sotsiaaldemokraatliku Partei liikme, Euroopa Parlamendi saadiku Aloyzas Sakalase hinnangul finantseeritakse Leedu parteisid altkäemaksudest ja korruptsioonis süüdistatavad parlamendiliikmed tegutsesid oma parteide nimel

  9. Stevens –Johnson syndrome due to nevirapine | Namayanja ...

    African Journals Online (AJOL)

    African Health Sciences. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 4 (2005) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here ...

  10. Lingual botryomycoma in the aftermath of Stevens-Johnson syndrome

    African Journals Online (AJOL)

    Johnson syndrome with severe mucosal impairment appeared three weeks after taking allopurinol (Zyloric®) for an hyperuricemia associated with arthralgia. She was put under symptomatic treatment after discontinuation of the offending molecule ...

  11. Ugly details of MP corruption come to light / Steven Paulikas

    Index Scriptorium Estoniae

    Paulikas, Steven

    2004-01-01

    Leedu Seimi korruptsioonivastase võitluse komisjon otsustas avalikustada parlamendiliikmete Vytenis Andriukaitise, Vytautas Kvietkauskase ja Arvydas Vidziunase telefonikõnede lindistused, mis tõendavad, et nad võtsid altkäemaksu kontserni Rubicon Group juhilt Andrius Janukoniselt

  12. Understanding Unlikeness, in John Chamberlain: Choices, Susan Davidson, ed. (New York: Solomon R. Guggenheim Museum, 2012), pp. 45–55

    OpenAIRE

    Adrian Kohn

    2017-01-01

    ere is just some of what we are given to understand John Chamberlain’s art as being like: car wrecks and dancers, artichokes and mummies and giant phalluses, drapery, a football player, ornaments for an immense Christmas tree and monstrous jungle-gyms, a sucked egg, and Titans beside themselves with rage. Next, a long list of the art-historical movements that his pieces have brought to mind: the baroque and rococo, neoclassicism, Cubism, Dada and Surrealism, both Abstract Expressionism and Po...

  13. Uncovering Our History, Teaching Primary Sources (Tarihimizi Keşfetme, Birincil Kaynaklarla Öğretim - Susan H. Veccia

    Directory of Open Access Journals (Sweden)

    Duygu Alphan Şentuna

    2014-05-01

    Full Text Available Okul yıllarından bahseden insanların büyük bir çoğunluğu için tarih dersi, not almak için isimlerin ve tarihlerin ezberlendiği, sınavdan sonra ise unutulduğu bir ders olarak hatıralarda yer alır. Günümüzde tarih öğretiminde önemli gelişmeler olmasına rağmen hala derslerde öğretmenlerin isim, tarih ve ders kitabı merkezli bir öğretim izledikleri görülmektedir. Öğrencilerin eleştirel ve tarihsel düşünme becerisi elde etmeleri için ilk önce bilgiye sahip olmaları gerektiği inancı, öğretmenlerin derslerde yenilikçi yöntemlere yeterli zaman ayırmalarını engellemektedir. Bu durum öğrencilerin tarih dersinden soğumalarına ve dersi zaman kaybı olarak görmelerine neden olmaktadır.

  14. 75 FR 22012 - Endangered and Threatened Wildlife and Plants; 12-Month Finding on a Petition to List Susan's...

    Science.gov (United States)

    2010-04-27

    ... that incidental dispersal via wind or adhesion to animals or humans could occur, but neither dispersal... species is imperiled (at a high risk of extinction) globally due to a very restricted range, very few... Spring may be impacted by poor water quality because of large amounts of filamentous algae in Trout Creek...

  15. Separated by Sex: A Critical Look at Single-Sex Education for Girls (edited by Susan Morse)

    Science.gov (United States)

    Ceraulo, Reviewed By Sandra C.

    1999-05-01

    As Cornelius Riordan states in his round-table paper, "The challenge of effective and equitable schooling in the next century is to overcome the resistance and recalcitrance of youth cultures in and out of school" (p 58). While this is admittedly not a new problem, it is more complex in its modern form and innovative ways to solve it are needed. In an old tradition, one such attempt has been single-sex schools, which have had particular success with the disadvantaged and white females in American society, with the notable involvement of Catholic religious communities. The report does not make clear whether their successes can be reproduced in some modification of the public school format. However, the AAUW report on single-sex schools sheds light on some of the characteristics that make true learning communities out of ordinary schools and on what it takes to reach disadvantaged girls. For these reasons, the AAUW report is good reading for educators at all levels.

  16. Interview with a quality leader. Linda Aiken on the healthcare industry and workplace issues. Interview by Susan V. White and Colleen J. Hewes.

    Science.gov (United States)

    Aiken, Linda

    2003-01-01

    Linda Aiken, PhD MSN, is director of the Center for Health Outcomes and Policy Research and The Claire M. Fagin Leadership Professor of Nursing and Professor of Sociology at the University of Pennsylvania in Philadelphia. Dr. Aiken's other appointments at the University of Pennsylvania include senior fellow at the Leonard Davis Institute for Health Economics and research associate in the Population Studies Center. Before joining the University of Pennsylvania faculty in 1988, Dr. Aiken served as vice president of the Robert Wood Johnson Foundation. She is a member of the Institute of Medicine, a fellow of the American Academy of Arts and Sciences and of the National Academy of Social Insurance, a former president of the American Academy of Nursing, a distinguished fellow of the Academy for Health Services Research and Health Policy (now AcademyHealth), and a member of the Council on the Economic Impact of Health System Change. Dr. Aiken served on the Medicare Physician Payment Review Commission for 6 years and was a member of the 1982 Social Security Advisory Council and of President Clinton's National Health Reform Task Force. Her recent work, for which she received the Sigma Theta Tau International Clinical Research Award in 1999, has focused on accounting for variation in hospital patient outcomes in the United States, Canada, the United Kingdom, and Germany. Dr. Aiken received her bachelor's and master's degrees in nursing from the University of Florida, Gainesville, and her doctorate in sociology and demography from the University of Texas at Austin.

  17. The Susan G. Komen for the Cure Tissue Bank at the IU Simon Cancer Center: a unique resource for defining the "molecular histology" of the breast

    National Research Council Canada - National Science Library

    Sherman, Mark E; Figueroa, Jonine D; Henry, Jill E; Clare, Susan E; Rufenbarger, Connie; Storniolo, Anna Maria

    2012-01-01

    "Molecular histology" of the breast may be conceptualized as encompassing the normative ranges of histologic structure and marker expression in normal breast tissues in relation to a woman's age and life experiences...

  18. The Greek Life of St. Leo bishop of Catania (BHG 981b), Text and Notes by Alexandros G. Alexakis, Translation by Susan Wessel

    OpenAIRE

    Peters-Custot, Annick

    2014-01-01

    Le dossier hagiographique de Léon, évêque de Catane en Sicile, est un des plus originaux et des plus complexes de l’hagiographie médiévale en langue grecque. Logiquement, les débats savants qui entourent le dossier sont intenses et stimulés par chaque nouvelle publication. Toutefois, l’intérêt du dossier hagiographique de Léon dépasse largement le cercle restreint des spécialistes de l’hagiographie iconoclaste, crypto-iconoclaste et iconodoule, tant le contenu de cette Vie et les mystères de ...

  19. Interview with a quality leader: Kent Bottles, MD, president of ICSI, on transforming care for the future. Interview by Susan V. White.

    Science.gov (United States)

    Bottles, Kent

    2010-01-01

    Kent Bottles, MD, President of the Institute for Clinical Systems Improvement (ICSI). Dr. Bottles is a board-certified pathologist who specialized in surgical and cyto-pathology. He earned a medical degree from Case Western Reserve University in Ohio. He has extensive experience in integrated healthcare delivery systems, research, academia, commercial laboratories, genomics, proteomics, and management of biotech start-up companies. Dr. Bottles was vice president and chief medical officer of the Iowa Health System. Before that, he served as president and CEO of Grand Rapids Medical Education and Research Center for Health Professions, a multi-institutional consortium of healthcare organizations, and as president of Genomics Repository and chief knowledge officer, Genomics Collaborative Inc. Dr. Bottles has extensive academic experience, serving as Professor and Acting Head, Department of Pathology and Laboratory Medicine at the University of Iowa. He was also the founding medical director of managed care plans for University of Iowa employees. Dr. Bottles has addressed topics ranging from quality and patient safety and disruptive technology to patient-physician relationships and the future of medicine. He has received numerous honors, including the Rodney T. West Literary Achievement Award for the most important article on medical management presented by the American College of Physician Executives. He has broad clinical experience with the University of Iowa and the San Francisco General Hospital, and has been a national leader in changing the practice of pathology and laboratory medicine to meet the challenges of managed care.

  20. 78 FR 43066 - Magnuson-Stevens Act Provisions; National Standard 2-Scientific Information

    Science.gov (United States)

    2013-07-19

    ... its major survey programs. Validation is the requirement to test scientific methodology and is also... Provisions; National Standard 2--Scientific Information AGENCY: National Marine Fisheries Service (NMFS... and Management Act (MSA) regarding scientific information. Consistent with the President's memo on...

  1. HLA-B Sequencing in Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

    Science.gov (United States)

    2017-03-03

    corresponding author CapU0-3 59 TRS/SGVT Lenz. Brittany b. Andrew Patterson CapU0-3 559 THLS/SGTT c. Patrick Brown MAJ /0-4 ~~~~-:~~op Command Bravo GI...d. Thomas Beachkofsky Maj /0-4 59 MDSP/SGMD e. I. g. I CERTIFY ANY HUMAN OR ANIMAL RESEARCH RELATED STUDIES WERE APPROVED AND PERFORMED IN STRICT

  2. Letters of Stone. From Nazi Germany to South Africa. Steven Robins ...

    African Journals Online (AJOL)

    social ostracisation experienced by Jews merely hint at the gruesome reality in Nazi Germany. With the hindsight granted to present-day readers, we know the fate that awaited these men and women as an elongated and agonising social death reached its culmination in systematic mass murder. In describing his journeys to ...

  3. 75 FR 65660 - Steven B. Brown, M.D.; Revocation of Registration

    Science.gov (United States)

    2010-10-26

    ... back from the patients after the illegal prescription was filled and dispensed.'' Id. at 2. The Order... (citing 21 CFR 1301.43); Gov't Not. of Svc. of Order. Since the date of service of the Order, 30 days have... with money to fill the prescriptions; in exchange, the CS gave Registrant half of the pills she...

  4. 77 FR 67973 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2012-11-14

    ..., biology of the stock, economic impacts, allocations, and the need for new or more restrictive management... updates that run new data through existing models without changing the model are also prepared. When... addition to any stock assessments or stock assessment updates, rebuilding analyses are also prepared. The...

  5. The Interpretive Constant: the Status of Material Objects in the Poetry of Wallace Stevens

    Directory of Open Access Journals (Sweden)

    Kacper Bartczak

    2012-01-01

    Full Text Available Stevens’s poems grant a curious status to material reality. Famously abstract, they refuse to abandon the realm of the material. Rather, “material reality” is inseparable from “abstract” concepts. Stevens’s position is pragmatist: the status and significance of material objects is founded by the entirely human linguistic/mental activity, which is also an interpretive activity. The poem is a site of initiating this activity. As such, Stevens’s poetics remains in opposition to other aesthetic posi­tions: the linguistic idealism of Mallarmé, the metaphysical realism of Miłosz and Herbert, and the material realism of Ponge and American “objectivists”. While the metaphysical positions tend to overcome the material, the realistic poets will reify it by “taking the side of things”. Stevens’s poetic pragmatism sees no lure in the extra-material, while also refusing to see matter as meaningful in itself, beyond the human interpretive activity.

  6. Sõrve 2008 / Nicholas Wurm, Steven Buchert, Mai Buchert, Sandra Buchert...[jt.

    Index Scriptorium Estoniae

    2008-01-01

    lapsed ja lapsevanemad Austraaliast meenutavad oma viibimist Sõrve lastelaagris: This is a story of a family from Sõrve; Nicholas Wurm - Age 9 (Adelaide); Alan and Debbie Mikkor (Melbourne); Jesse Mikkor's point of view: Age 8; Lauren Mikkor's point of view: Age 13

  7. 78 FR 34039 - Magnuson-Stevens Act Provisions; General Provisions for Domestic Fisheries; Application for...

    Science.gov (United States)

    2013-06-06

    ... Fishing Permit application submitted by the Northeast Fisheries Science Center contains all of the... regulations. The vessels would be authorized to retain specific amounts of particular species in whole or... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE...

  8. 77 FR 43803 - Confidentiality of Information; Magnuson-Stevens Fishery Conservation and Management...

    Science.gov (United States)

    2012-07-26

    ... National Oceanic and Atmospheric Administration 50 CFR Part 600 RIN 0648-AV81 Confidentiality of... regulations to revise existing regulations governing the confidentiality of information submitted in... some significant issues that concern NMFS' application of the MSA confidentiality provision to requests...

  9. 77 FR 30486 - Confidentiality of Information; Magnuson-Stevens Fishery Conservation and Management...

    Science.gov (United States)

    2012-05-23

    ... National Oceanic and Atmospheric Administration 50 CFR Part 600 RIN 0648-AV81 Confidentiality of... governing the confidentiality of information submitted in compliance with any requirement or regulation... address some significant issues that concern NMFS' application of the MSA confidentiality provision to...

  10. 77 FR 35349 - Confidentiality of Information; Magnuson-Stevens Fishery Conservation and Management...

    Science.gov (United States)

    2012-06-13

    ... National Oceanic and Atmospheric Administration 50 CFR Part 600 RIN 0648-AV81 Confidentiality of... regulations governing the confidentiality of information submitted in compliance with any requirement or... some significant issues that concern NMFS' application of the MSA confidentiality provision to requests...

  11. 76 FR 27507 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2011-05-11

    ... site at http://www.gpoaccess.gov/fr/index.html . Background information and documents are available at... slope north of 38 north latitude between 100 and 200 fm. Reductions in the darkblotched rockfish ACLs... continental slope would be restricted year round to a seaward RCA boundary of 250 fm. If the ACLs for...

  12. 76 FR 38313 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2011-06-30

    ... the Office of the Federal Register's Web site at http://www.gpoaccess.gov/fr/index.html . Background... seaward boundary of the trawl RCA boundary from the boundary line approximating the 200-fm (366-m) depth contour to the boundary line approximating the 150-fm (274-m) depth contour. In June 2010, the Council...

  13. 75 FR 8820 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2010-02-26

    ... Federal Register's Web site at http://www.gpoaccess.gov/fr/index.html . Background information and...-fm (55-m) depth contour on days that the primary halibut season is open. Under current regulations... year, seaward of the line approximating the 30 fm depth contour to reduce incidental impacts to...

  14. 75 FR 75417 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2010-12-03

    ... Internet at the Office of the Federal Register's Web site at http://www.gpoaccess.gov/fr/index.html... shift the seaward boundary of the trawl RCA from ``the boundary line approximating the 200 fm depth contour and modified to allow fishing for petrale sole'' to ``the boundary line approximating the 250 fm...

  15. 76 FR 72125 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2011-11-22

    ... close an area of Federal waters off the coasts of New Hampshire and Massachusetts to fishing for bivalve... enough quantity, can cause illness or death from PSP. On June 16, 2005, NMFS published an emergency rule... closing and opening of areas to certain types of fishing activity are collected from Federal, state, and...

  16. 78 FR 78783 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2013-12-27

    ... Massachusetts to fishing for bivalve shellfish intended for human consumption due to the presence in those... death from PSP. On June 16, 2005, NMFS published an emergency rule (70 FR 35047) closing the area... to as the Temporary PSP Closed Areas, which have been closed to bivalve fishing since 2005. NMFS has...

  17. 77 FR 72994 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2012-12-07

    ... of New Hampshire and Massachusetts to fishing for bivalve shellfish intended for human consumption... death from PSP. On June 16, 2005, NMFS published an emergency rule (70 FR 35047) closing the area... certain types of fishing activity are collected from Federal, state, and private laboratories. NOAA...

  18. The importance of a lasting impression / Linas Linkevicius ; interv. Steven Paulikas

    Index Scriptorium Estoniae

    Linkevicius, Linas

    2003-01-01

    Leedu kaitseminister Linas Linkevicius räägib rahvusvahelistes rahuvalveoperatsioonides osalemise tähtsusest, Leedu - USA tihedast koostööst ning käimasoleva presidendiskandaali mõjust Leedu rahvusvahelisele mainele

  19. 75 FR 39178 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2010-07-08

    ... the 2007 stock assessment with an F MSY proxy of F\\50%\\. The OY of 330 mt is based on the need to... assessment with an F MSY proxy of F\\50%\\. The 14 mt OY is based on the need to conform the 2010 yelloweye... darkblotched rockfish, NMFS notes that modifying the current 2010 OY of 291 mt by increasing it to the 2008 OY...

  20. 75 FR 38030 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

    Science.gov (United States)

    2010-07-01

    ... stock assessment with an F MSY proxy of F 50 . The 14 mt OY is based on the need to conform the 2010... from 17 mt to 14 mt. In the preamble to that rule, NMFS described that the Pacific Fishery Management... 14 mt yelloweye rockfish OY, projected impacts to yelloweye rockfish was 17.0 mt. In an effort to...