No abstract

In a tertiary referral centre, midazolam infusion was tried as treatment for 20 children with status epilepticus over a period of two years. The mean age of the children was 4.07 years. Twelve children with refractory status epilepticus had received intravenous or per rectal diazepam and intravenous phenytoin/ phenobarbitone or both before midazolam was given (0.15 mg/kg bolus followed by 1-5 µg/kg/min infusion). Eight children required only midazolam to control the established status epilepticus. The seizures were controlled in 19 children. The mean time required for complete cessation of seizures was 0.9 hours. The mean infusion rate required was 2.0 µg/kg/min. All children had regained full consciousness by a mean of 5.1 hours after discontinuation of midazolam treatment. No metabolic derangement or compromise of vital functions was noted in any of the children. Midazolam infusion is thus an eVective and safe therapeutic approach for the management of childhood status epilepticus. (Arch Dis Child 1997;76:445-448)

No abstract

Ulcerative lichen planus (ULP) is a rare variant of lichen planus. It is resistant to all therapeutic modalities, and most of the patients with this disorder described in the literature have been successfully treated only by surgical skin grafting. We report a case with ULP successfully treated with etretinate.

ObjectivesClinical trials of anti-TNF therapies have shown that concurrent methotrexate (MTX) therapy enhances the efficacy of TNF inhibitors. A scarcity of data exists on the benefits of combination therapy with IFX and MTX vs. leflunomide (LEF) in a real-world setting; therefore the BioTRAC Registry database was used to explore this question.MethodsBioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or golimumab as first biologics or after having been treated with a biologic for <6 months. RA patients treated with IFX who were enrolled between 2002-2014 were included in this analysis. Treatment durability was assessed with the Kaplan Meier (KM) estimator of the survival function and Cox regression.Results723 RA patients were included; at baseline 516 (71.4%) were on IFX+MTX, 115 (15.9%) on IFX+LEF, and 92 (12.7%) on IFX+MTX+LEF. The mean (SD) age was 55.5 (13.6) years, 76.2% were female and mean (SD) disease duration was 8.7 (9.2) years. The majority of patients were from Ontario (50.6%), followed by Western Canada (25.8%), and Quebec (20.9%). There were 217 (30.0%) patients who discontinued due to lack/loss of response, disease progression, adverse event (AE) or change in therapy with a KM-based mean (SE) time to discontinuation of 83.9 (3.0) months. Upon adjusting for potential confounders, higher durability was observed for the IFX+MTX group vs. IFX+LEF [hazard ratio -HR- (95% CI): 0.50 (0.25-1.01), P=0.055]. Moreover, factors independently associated with premature treatment termination were earlier enrolment period [HR2006-09 vs. 2002-05 (95% CI): 0.15 (0.02-1.15, P=0.068; HR2010-2014 vs. 2002-05 (95% CI): 0.09 (0.01-0.70), P=0.021], shorter baseline disease duration [HR (95% CI): 0.97 (0.93-1.00), P=0.054], and increased baseline pain levels [HR (95% CI): 1.14 (1.03-1.26), P=0.013]. 2,016 AEs were reported by 343 patients (106.8 events/100 patient-years) and 156 SAEs by 96 patients (8.3 events/100 patient-years). The incidence density ratio (IDR) (95% CI) was higher in the groups IFX+MTX vs. IFX+LEF for both AEs and SAEs with 1.44 (1.25-1.67) and 1.60 (0.94-2.73), respectively, however the latter was not statistically significant. When examining the triple combination therapy (IFX+MTX+LEF), higher durability was observed compared to both IFX+MTX [HR (95% CI): 3.68 (1.14-11.92); P=0.030] and IFX+LEF [HR (95% CI): 6.34 (1.72-23.34); P=0.006].ConclusionsThe results of this real-world observational study have shown that combination therapy with IFX+MTX is associated with significantly higher treatment durability compared to IFX+LEF in RA patients with increased risk for AEs but not for SAEs.Disclosure of InterestR. Faraawi Consultant for: Janssen, Speakers bureau: Janssen, R. Joshi: None declared, W. Bensen Consultant for: Janssen, D. Choquette Consultant for: AbbVie, Amgen, Celgene, BMS Canada, Janssen, Pfizer, W. Olszynski: None declared, R. Arendse Consultant for: Janssen, M. Sheriff: None declared, P. Rahman Consultant for: Abbott, AbbVie, Amgen, BMS, Ce...