Caplacizumab for Acquired Thrombotic Thrombocytopenic Purpura.

BACKGROUND Acquired thrombotic thrombocytopenic purpura (TTP) is caused by aggregation of platelets on ultralarge von Willebrand factor multimers. This microvascular thrombosis causes multiorgan ischemia with potentially life-threatening complications. Daily plasma exchange and immunosuppressive therapies induce remission, but mortality and morbidity due to microthrombosis remain high. METHODS Caplacizumab, an anti-von Willebrand factor humanized single-variable-domain immunoglobulin (Nanobody), inhibits the interaction between ultralarge von Willebrand factor multimers and platelets. In this phase 2, controlled study, we randomly assigned patients with acquired TTP to subcutaneous caplacizumab (10 mg daily) or placebo during plasma exchange and for 30 days afterward. The primary end point was the time to a response, defined as confirmed normalization of the platelet count. Major secondary end points included exacerbations and relapses. RESULTS Seventy-five patients underwent randomization (36 were assigned to receive caplacizumab, and 39 to receive placebo). The time to a response was significantly reduced with caplacizumab as compared with placebo (39% reduction in median time, P=0.005). Three patients in the caplacizumab group had an exacerbation, as compared with 11 patients in the placebo group. Eight patients in the caplacizumab group had a relapse in the first month after stopping the study drug, of whom 7 had ADAMTS13 activity that remained below 10%, suggesting unresolved autoimmune activity. Bleeding-related adverse events, most of which were mild to moderate in severity, were more common with caplacizumab than with placebo (54% of patients vs. 38%). The frequencies of other adverse events were similar in the two groups. Two patients in the placebo group died, as compared with none in the caplacizumab group. CONCLUSIONS Caplacizumab induced a faster resolution of the acute TTP episode than did placebo. The platelet-protective effect of caplacizumab was maintained during the treatment period. Caplacizumab was associated with an increased tendency toward bleeding, as compared with placebo. (Funded by Ablynx; ClinicalTrials.gov number, NCT01151423.).

Purpura docta seu vitae, legationes, res gestae, obitus, aliaque scitu, ac memoratu digna &c. S.R.E. Cardinalium qui ingenio, doctrina, eruditione, scriptis... desumpta ex Alphonso Ciaconio, Andrea Victorello, Augustino Oldoino... in sex libros... /

Mode of access: Internet.

Iohannis Bernhardi de Fischer ... De febre miliari, purpura alba dicta, e veris principiis eruta, et confirmata tractatus, per longam experientiam collectus.

Mode of access: Internet.

Pauli Neucrantzi Rostochiensis ...De purpura liber singularis : in quo febrium malignarum natura [et] curatio proponitur ...

Mode of access: Internet.

De purpura liber singularis, in quo febrium malaignarum natura & curatio proponitur ...

Mode of access: Internet.

A Case of Infectious Purpura Fulminans: An Unusual Organism and Method of Diagnosis

Infectious purpura fulminans is a rapidly progressive skin necrosis that carries a mortality rate of 30%. Here, we described a case of infectious purpura fulminans caused by Capnocytophaga diagnosed by a blood film.

Glatiramer Acetate-associated Refractory Immune Thrombocytopenic Purpura

We present a case of glatiramer acetate-associated refractory immune thrombocytopenic purpura (ITP) in a female patient with multiple sclerosis. A search of MEDLINE/PubMed did not find any connection between glatiramer acetate and thrombocytopenia, specifically ITP. The autoimmune reaction was resistant to conservative ITP treatment, and was eventually managed only by splenectomy. To the best of our knowledge, this is the first report of glatiramer acetate-associated ITP. Physicians should be aware of this condition, and consider performing routine blood counts at the beginning of glatiramer acetate treatment.

Prasugrel and Acquired Thrombotic Thrombocytopenic Purpura Associated with ADAMTS13 Activity Deficiency

We report a case of a 64-year-old male who, 44 days after starting treatment with prasugrel, presented with severe thrombocytopenia, anemia, renal failure, and severe ADAMTS13 activity deficiency, along with a high titer of autoantibodies to this protease.

Penile Skin Involvement as the First Presentation of Henoch-Schonlein Purpura Report of Nine Cases and Review of Literature

Introduction: Involvement of penis is a rare presentation in henoch-schonlein purpura (HSP). The presentations are mainly due to the deposition of immunoglobulin A (IgA) into the vessel walls. In this report, we present the clinical history of nine HSP cases that presented with penile skin involvement. Case Presentation: All patients were referred in the acute phase of HSP. Penile skin involvement was evident as erythema, edema, ecchymosis, or induration of prepuce and/or penile shaft, that appeared simultaneously with skin rash in seven patients. Gastrointestinal involvement was positive in six patients. Patients were treated with steroids and follow up visits were normal except for one patient that developed crescentic glomerulonephritis. Conclusions: We present nine cases of HSP with penile involvement in order to indicate another rare aspect of HSP and its possible complications as well as its appropriate treatment.

Diagnose e controle alternativo de doenças em alface, alho, cebola e brássicas.

Esse trabalho pretende-se apresentar uma breve descrição dos sintomas das principais doenças em alface, alho, cebola e bássicas que facilitarão sua diagnose e a determinação de métodos alternativos de controle a serem empregados, semelhante ao que se pratica na agricultura orgânica.

Doenças de soja: diagnose, epidemiologia e controle.

Mildio da soja (Peronospera manshurica); Oidio da soja (Microsphaera diffusa); Mancha parda da folha (Septoria glycines); Mancha alvo (Corynespora cassiicola); Mancha de alternaria (Alternaria spp.); Mancha olho-de-rã (Cercospora sojina); Mancha purpura (Cercospora kikuchii); Seca da haste e da vagem (Phomopsis spp.); Antracnose (Colletotrichum truncatum); Cancro da haste (Phomopsis phaseoli f. sp. meridionalis); Podridão parda da haste (Phialophora gregata); Podridão vermelha da raiz (Fusarium solani); Mofo branco da haste (Sclerotinia sclerotiorum); Murcha de esclerotium (Sclerotium rolfsii); Podridão da raiz e da haste (Phytophthora megasperma f. sp. glycinea); Mela da folha (Rhizoctonia solani); Tombamento (Rhizoctonia solani); Morte em reboleira (Rhizoctonia solani); Roseliniose (Dematophora necatrix); Podridão negra da raiz (Macrophomina phaseolina); Nematoide de cisto (Heterodera glycines); Nematoide de galha (Meloidogyne incognita); Mosaico comum da soja; Queima do broto; Pustula bacteriana (Xanthomonas campestris pv. glycines); Fogo selvagem (Pseudomonas syringae pv. tabaci); Crestamento bacteriano (Pseudomonas syringae pv. glycinea); Aspergillus spp.; Penicillium spp.; Bacillus subtilis; Créditos fotográficos; Estádios vegetativos da planta de soja; Estádios produtivos da planta de soja.