High- and low-dose allergen challenges in asthmatic patients using inhaled corticosteroids.

AIMS: The inhaled allergen challenge model has been used previously to investigate the effects of novel anti-inflammatory drugs in inhaled corticosteroid (ICS)-naïve asthmatics. The aim of this study was to characterize high- and low-dose allergen challenges in asthmatic patients using ICS. METHODS: Twenty-eight asthmatic patients taking ICS (beclomethasone equivalent <1000 µg day(-1) ) were recruited for high-dose allergen challenge, of whom 10 subsequently also had a repeat low-dose challenge comprising seven allergen challenges. Induced sputum was collected for measurements of cell counts and supernatant biomarkers. RESULTS: The high-dose allergen challenge caused an early and late asthmatic response in 19 of 28 patients; the mean maximal fall in the forced expiratory volume in 1 s (FEV1 ) was 29.1% (SD 6.2%) and 25.1% (SD 9.6%), respectively. There was also an increase in sputum eosinophils of 6.2% (P = 0.0004), as well as supernatant eosinophil cationic protein levels. The low-dose allergen challenge caused an acute fall in FEV1 , but had no effect on FEV1 at 24 h after challenge or sputum measurements. CONCLUSIONS: The high-dose allergen challenge in asthmatics using ICS induces a late asthmatic response associated with an increase in eosinophilic airway inflammation. This may be a suitable model for studying the effects of novel anti-inflammatory drugs added to maintenance ICS treatment.

A case report of dermatomyositis associated with small cell lung cancer.

Dermatomyositis associated with lung cancer is uncommon. Dermatomyositis associated with small cell lung cancer is very rare and carries a poor prognosis. We present a case of a patient with dermatomyositis associated with small cell carcinoma of the lung and review the literature.

Isoniazid-resistant intracranial tuberculoma treated with a combination of moxifloxacin and first-line anti-tuberculosis medication.

We report a case of a previously healthy 23-year-old Somalian care assistant. She presented with a 4 month history of persistent occipital headaches associated with intermittent nausea and vomiting. Computed tomography and magnetic resonance imaging of the brain showed a large enhancing lesion in the right cerebellar hemisphere with surrounding ring lesions, suggestive of an intracranial neoplasm with metastases. However, tuberculoma of the brain was confirmed based on histology of the excision biopsy and cerebrospinal fluid (CSF) culture results: Mycobacterium tuberculosis resistant to isoniazid (INH) with sensitivity to other standard drugs, including fluoroquinolones, was cultured from CSF. No primary focus to suggest spread from elsewhere was found. The patient was treated successfully with moxifloxacin, rifampicin, pyrazinamide and ethambutol. Isolated INH-resistant intracranial tuberculoma is rare in adults. It can mimic other intracranial masses and should be kept in mind, especially in populations with a high risk of tuberculosis. Clinical use of moxifloxacin in INH-resistant tuberculomas is limited in humans and this case demonstrates that moxifloxacin may be an effective alternative treatment.

Unifying kohlberg with information integration: the moral algebra of recompense and of kohlbergian moral informers

In order to unify two major theories of moral judgment, a novel task is employed which combines elements of Kohlberg´s stage theory and of the theory of information integration. In contrast to the format of Kohlberg´s moral judgment interview, a nonverbal and quantitative response which makes low demands on verbal facility was used . Moral informers differing in value, i.e. high and low, are presented. The differences in effect of those two pieces of information should be substantial for a person at that specific moral stage, but small for a person at a different stage. Hence, these differences may diagnose the person's moral stage in the simplest possible way as the two levels of each of the thoughts were about typical content of the four Kohlbergian preconventional and conventional stages. The novel task allowed additionally to measure the influence of another moral concept which was about the non-Kohlbergian moral concept of recompense. After a training phase, pairs of those thoughts were presented to allow for the study of integration and individual differences. German and Korean children, 8, 10, and 12 years in age, judged deserved punishment. The patterns of means, correlations and factor loadings showed that elements of both theories can be unified, but produced unexpected results also. Additive integration of each of the two pairs of moral informers appeared, either with two Kohlbergian moral informers or with another Kohlbergian moral informer in combination with information about recompense. Also cultural independence as well as dependence, developmental changes between 8 and 10 years, and an outstanding moral impact of recompense in size and distinctiveness were observed(AU)