Striking enhancement at the site of radiation for nivolumab-induced Stevens-Johnson syndrome

Stevens-Johnson syndrome is a rare adverse cutaneous drug reaction characterized by epidermal detachment of <10% body surface area with an average mortality rate of 1-5%. The mechanism of SJS is not fully understood. Nivolumab is a monoclonal antibody directed against programmed cell death-1 protein (PD-1), a receptor with immune checkpoint inhibitory and antineoplastic activities. We present a case of SJS in a patient being treated with anti-PD-1 therapy nivolumab for metastatic squamous cell carcinoma of the oropharynx. This case is unusual because of the severe accentuation with striking enhancement at his prior radiation site and in the cutaneous region with heavier tumor burden from his metastatic disease. This reaction may give insight to the underlying pathophysiology of SJS, suggesting that immune checkpoint inhibitors can activate T-cells to target keratinocytes and that external factors may be involved in creating distinct epitopes for T-cell recognition. We hope this case adds to the body of knowledge in the pathogenesis of Stevens-Johnson syndrome and cutaneous adverse events seen with checkpoint inhibitors

Educational Dimension of Woman's Character in the Narration's of Prophets as Stated in the Holy Qur'an

The Holy Qur'an has addressed the needs of women and their status in a way never done before in any other religious text. Woman's exalted position in Islam is due, primarily, to her role as a child rearer. It is she who is considered the "first madrasah" (first school) by Islam, and it is from her that children will learn about their responsibility as future 'standard bearers' of Islam and society. The research examines stories and biographies of women in the Qur'an, narrated by various prophets (peace be upon them) through the ages. These stories have been drawn from sound Islamic sources. not the doubtful narrations of Israelite scriptures, showing, through their life stories, women's attitude nature, some positive and others negative. This provides an authentic and comprehensive view of Muslim women from the Qur'anic perspective. It puts forward an educational model for women to realize their true role in the challenging times in which we live. By studying the attitudes and dispositions of women in the Holy Qur'an and the Sunna of the Prophet Muhammad (peace and blessings be upon him) the research illustrates the merits. morals and role of women as educators in the family, as well as society. It also shows the extent to which a Muslim women can harm or benefit each member of her family. The study also shows the scope of educational techniques in the Holy Qur'an and their impact on the attitudes and character of women. It delineates the educational role of women and the features of women's character through investigation of previous religions and comparison with those in Islam. In this way, we can become more acquainted with the characteristics of women, her tasks, rights, duties and the type of work suited to her outside the family

Single-crystal growth and dependences on the hole concentration and magnetic field of the magnetic ground state in the edge-sharing CuO2_2 chain system Ca2+x_{2+x}Y2−x_{2-x}Cu5_5O10_{10}

We have succeeded in growing large-size single-crystals of Ca$_{2+x}$Y$_{2-x}$Cu$_5$O$_{10}$ with $0 \le x \le 1.67$ and measured the magnetic susceptibility, specific heat and magnetization curve, in order to study the magnetic ground state in the edge-sharing CuO$_2$ chain as a function of hole concentration and magnetic field. In $0 \le x \le 1.3$, it has been found that an antiferromagnetically ordered phase with the magnetic easy axis along the b-axis is stabilized and that a spin-flop transition occurs by the application of magnetic fields parallel to the b-axis. The antiferromagnetic transition temperature decreases with increasing $x$ and disappears around $x =$ 1.4. Alternatively, a spin-glass phase appears around $x = 1.5$. At $x = 1.67$ where the hole concentration is $\sim$ 1/3 per Cu, it appears that a spin-gap state is formed owing to the formation of spin-singlet pairs. No sign of the coexistence of an antiferromagnetically ordered state and a spin-gap one suggested in Ca$_{1-x}$CuO$_2$ has been found in Ca$_{2+x}$Y$_{2-x}$Cu$_5$O$_{10}$.Comment: 13 pages, 12 figures, 1 tabl

Generating Individual Patient Preferences for the Treatment of Osteoarthritis Using Adaptive Choice-Based Conjoint (ACBC) Analysis.

INTRODUCTION: To explore how adaptive choice-based conjoint (ACBC) analysis could contribute to shared decision-making in the treatment of individual patients with osteoarthritis (OA). METHODS: In-depth case study of three individuals randomly selected from patients with OA participating in an ACBC analysis exercise. Eleven members of a research users' group participated in developing an ACBC task on medication preferences for OA. Individual medication priorities are illustrated by the detailed analysis of ACBC output from three randomly selected patients from the main sample. RESULTS: The case study analysis illustrates individual preferences. Participant 1's priority was avoidance of the four high-risk side effects of medication, which accounted for 90% of the importance of all attributes, while the remaining attributes (expected benefit; way of taking medication; frequency; availability) accounted only for 10% of the total influence. Participant 3 was similar to participant 1 but would accept a high risk of one of the side effects if the medication were available by prescription. In contrast, participant 2's priority was the avoidance of Internet purchase of medication; this attribute (availability) accounted for 52% of the importance of all attributes. CONCLUSIONS: Individual patients have preferences that likely lead to different medication choices. ACBC has the potential as a tool for physicians to identify individual patient preferences as a practical basis for concordant prescribing for OA in clinical practice. Future research needs to establish whether accurate knowledge of individual patient preferences for treatment attributes and levels translates into concordant behavior in clinical practice

Moving walls accelerate mixing

Mixing in viscous fluids is challenging, but chaotic advection in principle allows efficient mixing. In the best possible scenario,the decay rate of the concentration profile of a passive scalar should be exponential in time. In practice, several authors have found that the no-slip boundary condition at the walls of a vessel can slow down mixing considerably, turning an exponential decay into a power law. This slowdown affects the whole mixing region, and not just the vicinity of the wall. The reason is that when the chaotic mixing region extends to the wall, a separatrix connects to it. The approach to the wall along that separatrix is polynomial in time and dominates the long-time decay. However, if the walls are moved or rotated, closed orbits appear, separated from the central mixing region by a hyperbolic fixed point with a homoclinic orbit. The long-time approach to the fixed point is exponential, so an overall exponential decay is recovered, albeit with a thin unmixed region near the wall.Comment: 17 pages, 13 figures. PDFLaTeX with RevTeX 4-1 styl

Efficacy of chloroquine, sulphadoxine-pyrimethamine and amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria in Kajo Keji county, Sudan.

To provide advice on the rational use of antimalarial drugs, Médecins Sans Frontières conducted a randomized, an open label efficacy study in Kajo Keji, an area of high transmission of malaria in southern Sudan. The efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) were measured in a 28-day in vivo study, with results corrected by PCR genotyping. Of 2010 children screened, 115 children aged 6-59 months with uncomplicated Plasmodium falciparum malaria were randomized into each group to receive a supervised course of treatment. Of these, 114, 103 and 111 were analysed in the CQ, SP and AQ groups, respectively. The overall parasitological failure rates at day 28 were 93.9% [95% confidence interval (CI) 87.3-97.3] for CQ, 69.9% (95% CI 60.0-78.3) for SP, and 25.2% (95% CI 17.7-34.5) for AQ. These results provide important missing data on antimalarial drug efficacy in southern Sudan. They indicate that none of the drugs could be used in monotherapy and suggest that even in combination with artemisinin, cure rates might not be efficacious enough. We recommend a combination of artemether and lumefantrine as first-line treatment for uncomplicated P. falciparum malaria cases in Kajo Keji county

New insights in gastroesophageal reflux, esophageal function and gastric emptying in relation to dysphagia before and after anti-reflux surgery in children.

This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.In children with gastroesophageal reflux (GER) disease refractory to pharmacological therapies, anti-reflux surgery (fundoplication) may be a treatment of last resort. The applicability of fundoplication has been hampered by the inability to predict which patient may benefit from surgery and which patient is likely to develop post-operative dysphagia. pH impedance measurement and conventional manometry are unable to predict dysphagia, while the role of gastric emptying remains poorly understood. Recent data suggest that the selection of patients who will benefit from surgery might be enhanced by automated impedance manometry pressure-flow analysis (AIM) analysis, which relates bolus movement and pressure generation within the esophageal lumen