Diagnosis of mast cell activation syndrome: a global "consensus-2"

The concept that disease rooted principally in chronic aberrant constitutive and reactive activation of mast cells (MCs), without the gross MC neoplasia in mastocytosis, first emerged in the 1980s, but only in the last decade has recognition of "mast cell activation syndrome" (MCAS) grown significantly. Two principal proposals for diagnostic criteria have emerged. One, originally published in 2012, is labeled by its authors as a "consensus" (re-termed here as "consensus-1"). Another sizable contingent of investigators and practitioners favor a different approach (originally published in 2011, newly termed here as "consensus-2"), resembling "consensus-1" in some respects but differing in others, leading to substantial differences between these proposals in the numbers of patients qualifying for diagnosis (and thus treatment). Overdiagnosis by "consensus-2" criteria has potential to be problematic, but underdiagnosis by "consensus-1" criteria seems the far larger problem given (1) increasing appreciation that MCAS is prevalent (up to 17% of the general population), and (2) most MCAS patients, regardless of illness duration prior to diagnosis, can eventually identify treatment yielding sustained improvement. We analyze these proposals (and others) and suggest that, until careful research provides more definitive answers, diagnosis by either proposal is valid, reasonable, and helpful.

Treatment of Torulopsis glabrata peritonitis with intraperitoneal amphotericin B

Torulopsis glabrata peritonitis occurred in a patient after surgery for a ruptured abdominal viscus. The infection was successfully treated with intraperitoneal amphotericin B alone. Pharmacokinetic information regarding the distribution and clearance of amphotericin B administered by this route is presented, and the clinical manifestations and treatment modalities for T glabrata and Candida peritonitis are reviewed.

Citation analysis in the literature of tropical medicine

A brief historical account of tropical medicine as a science is given, followed by a short survey of the development of the literature in the field. The citations indexed in Tropical Diseases Bulletin for a forty-eight-month period (1972-1975) were analyzed according to the journal in which they were published and the language in which they appeared. The results of the study conformed to Bradford's law of bibliographic distribution. The reference scattering coefficient was determined to be 0.504, which indicated a high concentration of articles in relatively few journal titles. A rank order list of sixty-one journal titles is given in an appendix. The study showed English to be the most important language in the literature in terms of productivity. The results of the study may be used as an acquisition tool for developing a journal collection in tropical medicine.