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Old 09-15-2012
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Default Question at the end of SD curve !

A 32 year old African American woman presents to office complaining of increased shortness of breath for the past several weeks.She has been diagnosed with asthma by another physician, although she has not been responding to treatment. She also complain of weight loss,dry cough, fatigue and generalized malaise.There is no lower extremety edema.

Which of the following should be avoided in this patient

A Antibiotic
B Etanercept
C Infliximab
D Interferon
E Ribavirin
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Old 09-15-2012
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Quote:
Originally Posted by step_enhancer View Post
A 32 year old African American woman presents to office complaining of increased shortness of breath for the past several weeks.She has been diagnosed with asthma by another physician, although she has not been responding to treatment. She also complain of weight loss,dry cough, fatigue and generalized malaise.There is no lower extremety edema.

Which of the following should be avoided in this patient

A Antibiotic
B Etanercept
C Infliximab
D Interferon
E Ribavirin
C bro, could have TB. peace out
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Old 09-15-2012
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B or C...not sure.....both reactivate latent TB
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Old 09-15-2012
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The patient does not have TB ,nor there is risk of TB
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Quote:
Originally Posted by step_enhancer View Post
A 32 year old African American woman presents to office complaining of increased shortness of breath for the past several weeks.She has been diagnosed with asthma by another physician, although she has not been responding to treatment. She also complain of weight loss,dry cough, fatigue and generalized malaise.There is no lower extremety edema.

Which of the following should be avoided in this patient

A Antibiotic
B Etanercept
C Infliximab
D Interferon
E Ribavirin
She most likely have Sarcoidosis.

Quote:
IFNs belong to the large class of glycoproteins known as cytokines. Interferons are named after their ability to "interfere" with viral replication within host cells. IFNs have other functions: they activate immune cells, such as natural killer cells and macrophages; they increase recognition of infection or tumor cells by up-regulating antigen presentation to T lymphocytes; and they increase the ability of uninfected host cells to resist new infection by virus. Certain host symptoms, such as aching muscles and fever, are related to the production of IFNs during infection.
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Old 09-15-2012
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Looks like I was wrong earlier. This is what I found on search.
Quote:
Granulomatous inflammation is characterized primarily by accumulation of monocytes, macrophages and activated T-lymphocytes, with increased production of key inflammatory mediators, TNF-alpha, IFN-gamma, and IL-12, characteristic of a Th1-polarized response (T-helper lymphocyte-1 response). Sarcoidosis has paradoxical effects on inflammatory processes; it is characterized by increased macrophage and CD4 helper T-cell activation, resulting in accelerated inflammation, but immune response to antigen challenges such as tuberculin is suppressed. This paradoxic state of simultaneous hyper- and hypoactivity is suggestive of a state of anergy. The anergy may also be responsible for the increased risk of infections and cancer. The regulatory T-lymphocytes in the periphery of sarcoid granulomas appear to suppress IL-2 secretion, which is hypothesized to cause the state of anergy by preventing antigen-specific memory responses.[41]
While TNF-alpha is widely believed to play an important role in the formation of granulomas, sarcoidosis can be triggered by treatment with the TNF-alpha antagonist etanercept.
Possible explanation.

Quote:
It reduces the effect of naturally present TNF, and hence is a TNF inhibitor, functioning as a decoy receptor that binds to TNF.[10]
Tumor necrosis factor-alpha (TNFα) is a cytokine produced by lymphocytes and macrophages, two types of white blood cells. It mediates the immune response by increasing the transport of white blood cells to sites of inflammation, and through additional molecular mechanisms which initiate and amplify inflammation. Inhibition of its action by etanercept reduces the inflammatory response which is especially useful for treating autoimmune diseases.
There are two types of TNF receptors: those found embedded in white blood cells that respond to TNF by releasing other cytokines, and soluble TNF receptors which are used to deactivate TNF and blunt the immune response. In addition, TNF receptors are found on the surface of virtually all nucleated cells (red blood cells, which are not nucleated, do not contain TNF receptors on their surface). Etanercept mimics the inhibitory effects of naturally occurring soluble TNF receptors, the difference being that etanercept, because it is a fusion protein rather than a simple TNF receptor, has a greatly extended half-life in the bloodstream, and therefore a more profound and long-lasting biologic effect than a naturally occurring soluble TNF receptor.[11]
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Last edited by Novobiocin; 09-15-2012 at 04:56 PM.
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Yes the patient has Sarcoidosis
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Answer D Interferon worsen the non caseasting granuloma of sarcoidosis.

African american woman with dry cough ,fatigue and generalized malaise is Sarcoidosis.These patients have hilar lympadenopathy and interstitial lung disease.


http://www.ncbi.nlm.nih.gov/pubmed/16432996

http://www.ncbi.nlm.nih.gov/pubmed/12703026
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