Hollow polymer nanocapsules are produced by the polymerization within hydrophobic interior of lipid bilayers that act as temporary self-assembled scaffolds. Pore-forming templates are codissolved with monomers in the bilayers to create pores with controlled size and chemical environment. Polymerization was monitored with UV spectroscopy and dynamic light scattering. High resolution magic angle spinning NMR characterization provided detailed structural information about nanocapsules. Spherical shape was confirmed by electron microscopy. Mediumsized molecules can be entrapped within porous nanocapsules. No release of encapsulated molecules was observed within 240 days.
Mast cell activation syndrome (MCAS) is a newly recognized collection of disorders that typically involves multiple organ systems and symptoms can include flushing, pruritus, angioedema, and dermatographism. 1 These symptoms are unified by the fact that they can be explained by the effects of mast cell-derived factors such as histamine, leukotrienes, and prostaglandins on various tissues. The proposed criteria for MCAS include episodic signs and symptoms consistent with mast cell activation involving multiple organ systems, increased markers of mast cell activation, and an appropriate response the medications that target mast cell activation or their effector molecules. 2,3,4 Markers of mast cell activation can include serum tryptase and/or urinary metabolites of mast cell-derived mediators such as histamine, prostaglandin D 2 (PGD 2 ), 11β-PGF 2, and leukotriene E 4 . 2,3,4 Recent criteria indicate that certain markers of mast cell activation such as serum tryptase may be more specific than others and thus the role of various factors are still emerging in the MCAS literature. 3,4 However, tests such as the prostaglandin metabolite 11β-PGF 2 may be useful when serum tryptase is inconclusive, and the results of prostaglandin metabolite tests can be used to guide therapy. 2 We present a case of generalized pruritus presenting in the setting of MCAS that was responsive to the non-steroidal anti-inflammatory drug (NSAID) ibuprofen.
Commonly used in clinical practice, doxycycline has been known to produce a cutaneous phototoxic reaction in combination with sunlight. Several mechanisms have been proposed to contribute to its pathogenesis such as UVA oxidation of cellular components, the formation of photoproducts, and altered melanogenesis. We describe a case of a phototoxic rash in a patient taking doxycycline 100 mg daily for the treatment of rosacea. We present several photos of the rash from erythema to desquamation several weeks later. The clinical presentation of a doxycycline-induced phototoxic rash varies from a sunburn like sensation to diffuse erythematous plaques on sun exposed areas. Treatment involves discontinuing the drug and providing symptomatic relief. Although sunscreen may prevent a doxycycline-induced phototoxic reaction, it is important to educate the patient to use a sunscreen with protection in the 340-400 nm range in which phototoxic reactions are thought to occur. As doxycycline-induced phototoxicity is poorly understood, it may be best to advise the patient to avoid sun exposure altogether while taking the drug.
ObjectiveTo assess improvement in autonomic symptoms and functional impairment following immunotherapy with subcutaneous immunoglobulin (SCIG) or plasmapheresis (PLEX) in patients with postural orthostatic tachycardia syndrome (POTS).BackgroundPOTS is a common autonomic disorder defined by an increased heart rate of at least 30 bpm within 10 minutes of standing or a tilt table test, accompanied by orthostatic intolerance, fatigue, dizziness, and headache. Despite pharmacologic and non-pharmacologic therapy, the marked functional impairment associated with POTS reflects great need for improved treatment. Autoimmunity has emerged as a leading etiology of POTS, with case series describing successful treatment with IVIG. To our knowledge, treatment with SCIG has not been described previously.Design/MethodsClinical history of seven patients with POTS treated with SCIG or PLEX was reviewed. Response to treatment was assessed using COMPASS-31 and functional ability scale (FAS) completed retrospectively pre- and 3-12 months post-treatment with SCIG or PLEX. Patients with comorbid defined autoimmune disorders or immune deficiency requiring treatment with immunotherapy were excluded from the study.ResultsOf seven patients, all female, ages 28-57, five received SCIG and two received PLEX. Four had comorbid small fiber neuropathy and five had various positive antibodies at low titers. Across all patients, COMPASS-31 and FAS scores improved an average of 50% and 217%, respectively. Six patients were able to discontinue or reduce oral medications and five reported being able to return to work or school. No serious adverse events were reported.ConclusionsPatients with POTS experienced significant functional improvement with reduction in autonomic symptoms following immunotherapy with SCIG or PLEX. This case series suggests that SCIG and PLEX may be safe and effective treatments for patients with severe POTS refractory to standard therapies. Randomized controlled trials are needed to determine the efficacy and safety of these long-term therapies.
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