scholarly journals Immune-Mediated Tissue Injury (Hypersensitivity Reactions)

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Gerald J Prud'homme

Hypersensitivity is synonymous with immune-mediated tissue injury. Hypersensitivity reactions occur in several forms and give rise to numerous conditions including allergies, autoimmune disease, allograft rejection, granulomatous inflammation, and a variety of acute or chronic inflammatory disorders (vasculitis, glomerulonephritis, arthritis, pneumonitis, encephalitis, etc.). While hypersensitivity is usually detrimental, in some cases it represents a normal response to a pathogen (e.g., the granulomatous inflammation of tuberculosis). Several years ago, Gell and Coombs divided hypersensitivity states into four basic types (1), and this classification remains useful today (Table 1). Type I hypersensitivity reactions result from IgE-dependent degranulation of mast cells or basophils. Type II, or "cytotoxic" hypersensitivity, results from the binding of IgG or IgM antibodies to cell membranes or fixed tissue antigens, causing activation of the complement system. Type III, or "immune-complex" hypersensitivity, results from the formation of immune complexes that precipitate in tissues (or form in situ), also with activation of complement. Type IV, or "cell-mediated" reactions, can be subdivided into two basic types: type IV-A is synonymous with delayed-type hypersensitivity (DTH) and usually occurs in response to soluble antigens; type IV-B results from the direct killing of target cells by cytotoxic T lymphocytes (CTL). Stimulation of cells by anti-receptor autoantibodies (such as the anti-TSH receptor antibodies of Graves' disease) has been designated as type V hypersensitivity by some authors. In addition, there are syndromes caused by massive cytokine release that are not usually referred to as hypersensitivity reactions, although (in accord with the definition) they should be included in that category. Examples are anti-CD3 mAb therapy, superantigen- (superAg) induced diseases (toxic shock syndrome, scalded skin syndrome), and shock caused by endotoxins (gram negative septicemia). Despite the occurrence of tissue injury, it should be understood that hypersensitivity mechanisms evolved as a means of fighting infectious agents. The mechanisms underlying these hypersensitivity states will be described and some clinical examples will be mentioned. In particular, the important role of cytokines, which is an area where considerable progress has occurred in recent years, will be emphasized.

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 122 ◽  
Author(s):  
Jenana H. Maker ◽  
Cassandra M. Stroup ◽  
Vanthida Huang ◽  
Stephanie F. James

Antibiotics are commonly prescribed to treat a variety of bacterial infections. As with all medications, hypersensitivity reactions may occur and clinicians should be able to recognize them accurately and recommend appropriate management. Antibiotic related hypersensitivity reactions may be one of four different types: Type I reactions, which are IgE mediated and may lead to anaphylaxis; Type II reactions that are antibody-mediated and may result in thrombocytopenia, neutropenia, or hemolytic anemia; Type III reaction that involves an immune complex formation such as vasculitis; and Type IV reactions that consist of four subtypes and typically include a rash of varying level of severity with or without systemic signs and symptoms. Herein, we describe the mechanisms of different types of allergic reactions to commonly prescribed antibiotics and offer recommendations for management. Further, we briefly refer to antibiotic reactions that mimic hypersensitivity reactions but are not immune mediated, such as pseudoallergies and serum sickness-like reactions.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Deepshikha Bhowmik ◽  
Shiela Chetri ◽  
Bhaskar Jyoti Das ◽  
Debadatta Dhar Chanda ◽  
Amitabha Bhattacharjee

Abstract Objective This study was designed to discover the dissemination of virulence genes in Methicillin-resistant Staphylococcus aureus from clinical, community and environmental settings. Results This study includes 1165 isolates collected from hospital, community and environmental settings. Among them sixty three were confirmed as MRSA with varied SCCmec types viz; type I, type II, type III, type IV, type V, type VI, type VII, type VIII and type XII. The virulence gene such as sea (n = 54), seb (n = 21), eta (n = 27), etb (n = 2), cna (n = 24), ica (n = 2) and tst (n = 30) was also revealed from this study. The study underscores coexistence of resistance cassette and virulence genes among clinical and environment isolates which is first of its kind from this part of the world.


2005 ◽  
Vol 94 (12) ◽  
pp. 1265-1269 ◽  
Author(s):  
Susanne Alban ◽  
Roland Kaufmann ◽  
Edelgard Lindhoff-Last ◽  
Wolf-Henning Boehncke ◽  
Ralf J. Ludwig ◽  
...  

SummaryEczematous lesions, resulting from type IV sensitizations are well-known and relatively frequent cutaneous adverse effects of s.c. heparin therapy. If anticoagulation is further required intravenous heparin, heparinoids or lepirudin may be used as a substitute. However, these alternatives are not optimal in terms of practicability and/or safety-profiles. As molecular weight of different heparin preparations has repetitively been implied to determine the frequency of sensitization, we hypothesized, that due to its low molecular weight the pentasaccharide fondaparinux may provide a practicable and safe anticoagulant therapy in patients with delayed type hypersensitivity reactions (DTH) to heparin and other oligosaccharides. To test this concept, patients referred for diagnosis of cutaneous reactions after s.c. anticoagulant treatment underwent a series of in vivo skin allergyand challenge-tests with unfractionated heparin, a series of low molecular weight heparins (nadroparin, dalteparin, tinzaparin, enoxaparin and certoparin), the heparinoid danaparoid and the synthetic pentasaccharide fondaparinux. In total, data from twelve patients was evaluated. In accordance with previously published data, we report a high crossreactivity among heparins and heparinoids. In contrast – and in support of our initial hypothesis – sensitization towards the synthetic pentasaccharide fondaparinux was rarely observed. Plotting the cumulative incidence against the determined molecular weight of the individual anticoagulant preparations, shows that molecular weight generally is a key determinant of sensitization towards heparins and other oligosaccharides (r2=0.842, p=0.009). Hence, fondaparinux may be used as a therapeutic alternative in patients with cutaneous DTH relations towards heparin and other polysaccharides.


2016 ◽  
Vol 3 (5) ◽  
pp. 814
Author(s):  
Suhag Patel ◽  
Sunita Garg ◽  
Sumit Sabharwal ◽  
Neetika Jain ◽  
Shadabul Islam ◽  
...  

AIM: The purpose of this study was to describe the external and internal anatomy of the mandibular premolars. MATERIAL AND METHODS: 100 extracted human permanent mandibular first and second premolars teeth were collected. The length of the tooth from the cusp tip to root apex was measured with the help of Vernier calliper. In case of curved roots, ligature wire was adapted to the root and then straightened and measured. Each tooth was examined for the number of roots, curvature of root, presence of root canal invagination. India ink was injected into the pulp chamber through the access opening with a no.27 gauge needle mounted on a disposable syringe. The ink was then drawn through the root canal system by applying negative pressure to the apical end of tooth with the use of central suction system. RESULTS: The average (mean) length of mandibular first premolar was 22.25 mm. Average (mean) length of mandibular second premolar was 21.90 mm. Mandibular first premolar had a ribbon shaped root canal orifice in 35% of teeth. Mandibular second premolar had a ribbon shaped of root canal orifice in 44% teeth. Mesial invagination of the root was found in 18% of first and 8% second mandibular premolar teeth. 78% had a Type I canal pattern with Type II, Type IV, Type V, Type VI and Type VII canals being identified in 1%, 2%, 13%, 2% and 1% of the teeth respectively. CONCLUSIONS: Complex root canal anatomy frequently found with mandibular premolars among which more common with mandibular first premolars in Indian population.


2021 ◽  
Vol 8 ◽  
Author(s):  
Masanori Abe ◽  
Ikuto Masakane ◽  
Atsushi Wada ◽  
Shigeru Nakai ◽  
Kosaku Nitta ◽  
...  

Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality.Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis.Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications.Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.


reportaendo ◽  
2018 ◽  
Vol 1 (4) ◽  
Author(s):  
JENNY GUERRERO FERRECCIO ◽  
CAMILA ADRIANA PERALTA MIER

Introducción: El tratamiento endodontico representa en la actualidad una gran rama en el área de la odontología de importancia para la preservación de piezas dentales, que se verían afectadas por el ataque de agentes externos y que comprometen su funcionabilidad y estética, pero la complejidad de la anatomía de los conductos de todos los dientes en general aún sigue siendo un problema, más aun en los premolares, ya que estos a diferencia de las demás piezas dentarias, tienen diferentes formas y cantidad de conductos radiculares. (6) Propósito: El propósito de este estudio es demostrar la importancia del conocimiento sobre la anatomía radicular y sus variaciones anatómicas, para minimizar el fracaso al realizar una terapia endodontica. Objetivo: El objetivo directo de este estudio es determinar las variaciones anatómicas de premolares superiores e inferiores y su relación con estructuras anatómicas de pacientes atendidos endodónticamente, el año 2016, en la clínica Nexodent de la ciudad de Guayaquil, mediante el uso de sus tomografías previas a  su tratamiento.Materiales y métodos: Se analizaron 70 tomografías de 41 pacientes atendidos en el año 2016 en la clínica Nexodent de la ciudad de Guayaquil. Al momento de analizar cada tomografía se tomaron tres fotografías de cortes tomografcos: coronal, axial y sagital para obtener una información variada de su anatomía. Resultados: De las tomografías revisadas, el 71% fue de género femenino. El 29% de género masculino. Los resultados encontrados del número de conductos en las piezas dentales registradas señalan que el 56% de los casos presenta 1 sólo conducto. En cuanto a la variación anatómica de las piezas dentales estudiadas, se utilizó la clasifcación de Vertucci. El 56% de las piezas dentales es de Tipo I, el 26% es de Tipo IV, el 11% es de Tipo II, y el restante son de Tipo V. Se analizó la distancia entre cada premolar maxilar hasta el seno maxilar y en promedio la distancia fue de 5,3 mm. La distancia promedio de los premolares mandibulares hasta el foramen mentoniano fue de 6,21 mm. La principal localización encontrada para el orifcio del foramen apical fue el centro con el 58% de los casos.Discusión: Se obtuvo mayoría de aciertos sobre los estudios realizados con los estudios de las referencias bibliográfcas excepto en; La incidencia de los conductos en los segundos premolares superiores en que se obtuvo mayoria de un conducto en lugar de dos. En la distancia promedio del apice de los primeros premolares mandibulares con el agujero mentoniano en donde las distancias promedios fueron mayores. En la localizacion del foramen apical en la pieza #35, en que hubo mayor localizacion del foramen en el centro y no hacia distal.Conclusión: Se puede concluir que el mejor examen complementario para analizar la anatomía de conductos es la tomografía y que los resultados obtenidos en esta investigación no fueron muy distintos en comparación a investigaciones realizadas por otros autores.    AbstractIntroduction: Endodontic treatment currently represents a large branch in the area of dentistry of importance for the preservation of dental pieces, which would be afected by the attack of external agents and compromise its functionality and aesthetics, but the complexity of the root Canals anatomy of all teeth in general still remains a problem, even more so in the premolars as these unlike other teeth, have diferent forms and quantity of root Canals. 6 Purpose: The purpose of this study is to demonstrate the importance of knowledge about the root canal anatomy and its anatomical variations, in order to minimize the failure in an endodontic therapy.Objective: The direct objective of this study is to determine the anatomical variations of upper and lower premolars and their relationship with anatomical structures of endodontically treated patients, in 2016, at the Nexodent Clinic of the city of Guayaquil, using their tomography prior to its treatment. Materials and methods: We analyzed 70 CT scans of 41 patients seen in 2016 at the Nexodent clinic in the city of Guayaquil. At the moment of analyzing each tomography three photographs were taken: coronal, axial and sagittal to obtain al the information of its anatomy. Results: Of the CT scans reviewed, 71% were female, 29% male. The results found of the number of root canals in the registered dental pieces indicate that 56% of the cases present 1 only conduit. Regarding the anatomical variation of the studied dental pieces, the Vertucci classifcation was used 56% of the teeth are Type I, 26% are Type IV, 11% are Type II, and the rest are Type V. The average distance between the maxillary premolars to the maxillary sinus was 5.3 mm. The mean distance from the mandibular premolars to the mental foramen was 6.21 mm. The main location found for the apical foramen was the center with 58% of the cases. Discussion: the mayority of the studies carried out with the studies of the bibliographical references where equal except in; The incidence of root canals in the upper second premolars where the mayority of one root was obtained instead of two. In the average distance of the apex of the frst mandibular premolars with the mental foramen where the average distances were greater. In the location of the apical foramen in # 35, in which there was greater location of foramen in the center and not distal. Conclusion: It can be concluded that the best complementary exam to analyze the anatomy of root Canals is the tomography and that the results obtained in this investigation were not very diferent  in comparison to investigations realized by other authors. 


2020 ◽  
Author(s):  
Deepshikha Bhowmik ◽  
Shiela Chetri ◽  
Bhaskar Jyoti Das ◽  
Debadatta Dhar Chanda ◽  
Amitabha Bhattacharjee

Abstract Objective: This study was designed to discover the dissemination of virulence genes in Methicillin-resistant Staphylococcus aureus from clinical and environmental settings. Results: The virulence gene such as sea (n=54), seb (n=21), eta (n=27), etb (n=2), cna (n=24), ica (n=2) and tst (n=30) was revealed from this study. Different SCCmec types such as type I, type II, type III, type IV, type V, type VI, type VII, type VIII and type XII were detected among sixty three MRSA isolates where SCCmec type II having ST1551 and type V with ST2416 were found to be associated with multidrug resistance and were highly prevalent in the study area.


PEDIATRICS ◽  
1977 ◽  
Vol 59 (4) ◽  
pp. 513-525
Author(s):  
Peter O. Kwiterovich ◽  
J. Ramsay Farah ◽  
W. Virgil Brown ◽  
Paul S. Bachorik ◽  
Stephen B. Baylin ◽  
...  

Primary type V hyperlipoproteinemia was identified in two preadolescent children. The propositus (kindred N) was a 10-year-old girl with severely creamy plasma, lipemia retinalis, hypertriglyceridemia (triglyceride level, 6,800 mg/100 ml), and hypercholesterolemia (cholesterol level, 490 mg/100 ml). Her parents and an 8-year-old sister all had endogenous hypertriglyceridemia (type IV hyperlipoproteinemia). In kindred A, an 11-year-old boy had triglyceride levels as high as 1,100 mg/100 ml and recurrent abdominal pain. His father had type V hyperlipoproteinemia; his mother was normal. All three of his older teenage siblings had type IV hyperlipoproteinemia. The enzymatic activities of lipoprotein lipase (LPL), hepatic triglyceride lipase (HTL), and histaminase (H) were studied in postheparin plasma. The LPL level was low in the children and both parents in kindred N. LPL level in kindred A was normal, except for one child with type IV hyperlipoproteinemia. HTL level was normal to above normal in both kindreds. Most patients had a normal H level, but one parent (kindred N) had no preheparin H and very low levels of postheparin H. There was a strong correlation (r = 0.58, significant at < 1% level) between the release of LPL and H but not between HTL and H (r = 0.22). The mean (± 1 S.D.) levels of the enzymes were as follows: LPL, 2.8 ± 0.7 µmol/ml/hr in kindred N and 5.4 ± 2.2 µmol/ml/hr in kindred A; H, 13.4 ± 6.8 units/ml in kindred N and 22.0 ± 11.9 units/ml in kindred A; and HTL, 18.0 ± 7.1 µmol/ml/hr in kindred N and 14.9 ± 6.3 µmol/ml/hr in kindred A. The enzymatic activities of kindreds N and A were significantly different for LPL (P < .001) and H (.025 < P < .05) but not for HTL. All but one child had at least one high insulin level, which was accompanied by hyperglycemia in two children. The hypertriglyceridemia in all but one child was ameliorated on therapeutic diets. These data suggest that the genetic basis of the hypertriglyceridemia in these two families is different and that hyperchylomicronemia in childhood is not confined to the rare type I hyperlipoproteinemia.


Synthesis ◽  
2019 ◽  
Vol 51 (14) ◽  
pp. 2737-2758 ◽  
Author(s):  
Hyeonggeun Lim ◽  
Sikwang Seong ◽  
Sunkyu Han

Post-iboga alkaloids are secondary metabolites that are biosynthetically derived from iboga-type alkaloids via rearrangements of the indole and/or isoquinuclidine moieties. Herein, we categorize post-iboga alkaloids into five types based on the biosynthetic mode of transformation of the iboga scaffold. We then describe reported syntheses of post-iboga alkaloids, including our laboratory’s recent contributions, based on our own categorization.1 Introduction1.1 Iboga and Post-Iboga Alkaloids1.2 Classification of Post-Iboga Alkaloids1.2.1 Introduction to Type I Post-Iboga Alkaloids1.2.2 Introduction to Type II Post-Iboga Alkaloids1.2.3 Introduction to Type III Post-Iboga Alkaloids1.2.4 Introduction to Type IV Post-Iboga Alkaloids1.2.5 Introduction to Type V Post-Iboga Alkaloids2 Syntheses of Post-Iboga Alkaloids2.1 Syntheses of Type I Post-Iboga Alkaloids2.1.1 Syntheses of Monomeric Type I Post-Iboga Alkaloids2.1.2 Syntheses of Dimeric Type I Post-Iboga Alkaloids2.2 Syntheses of Type II Post-Iboga Alkaloids2.3 Synthetic Studies Toward Type III Post-Iboga Alkaloids2.4 Syntheses of Type IV Post-Iboga Alkaloids2.5 Synthesis of Type V Post-Iboga Alkaloids3 Conclusion and Outlook


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Timothy Charlton ◽  
Danielle Thomas ◽  
David Thordarson ◽  
Melodie Metzger ◽  
Trevor Nelson

Category: Midfoot/Forefoot Introduction/Purpose: The flexor hallucis longus (FHL) tendon is commonly used for tendon transfers in reconstructive Achilles tendon procedures. A subset of patients who undergo this procedure complain of first great toe weakness and loss of push off strength after FHL tendon transfer. Despite the frequency of this procedure, there is currently little information available to surgeons to help understand this potential complication. Therefore, the objective of this biomechanical cadaveric study was to quantify plantar flexion strength after FHL harvest and correlate it to variations in anatomy to determine if distinct tendon crossover patterns at the Knot of Henry are more likely to lead to forefoot weakness. Methods: Cadaveric specimens were procured from an approved tissue bank. The proximal end of the tibia was potted and secured to the Mechanical Testing System. A pressure mapping system was used to measure plantar force though the great toe and lesser toes. The Achilles, FHL, and flexor digitorum longus (FDL) tendons were attached to linear actuators for load application. Pressure under the toes was measured with the Achilles alone, Achilles with FHL, Achilles with FDL, and Achilles with both FHL and FDL. The resultant loading patterns were recorded in the greater and lesser toes and compared between the different states. After biomechanical testing, all specimens were carefully dissected and the tendinous slips between the FHL and FDL were documented and classified based on a previously determined system (Types I-V, LaRue; Edama) Functional and anatomical relationship between the classification type and loading patterns were statistically analyzed using repeated measures ANOVA. Results: 23 specimens (13M / 10F) with a mean age of 71 years (range: 54-90) were used in this study. 61% were anatomically classified as type I, followed by type II (26%), IV (9%), and type V (4%), and type III (0%). Simulated FHL harvest in type I specimens resulted in a 29% decrease in great toe flexion pressure and an 21% decrease in total forefoot flexion pressure, p<0.05. In type II feet, FHL harvest led to a greater reduction in flexion pressure in the great toe (34%) and forefoot (25%), p<0.05. Type IV specimens also had a decrease in flexion pressure in both the great toe (21%) and forefoot (15%), p<0.05. Type V specimens trended similar to type I specimens. Conclusion: This study is the first to quantify loss of great toe and lesser toe flexion pressure after FHL harvest. In addition, it is the first to correlate these losses to variations in anatomic crossover patterns at the Knot of Henry. Specimens classified as type II had the greatest reduction in flexion pressure, followed by type I and type IV. This information is clinically important for preoperative discussions about post-surgical expectations and surgical planning.


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