Age Predisposition Research Articles

Epidemiology of Postherpetic Neuralgia in Korea: An Electronic Population Health Insurance System Based Study.

Postherpetic neuralgia (PHN) is a disease entity defined as persistent pain after the acute pain of herpes zoster gradually resolves. It is associated with impaired daily activities, resulting in reduced quality of life. General epidemiological data on PHN is necessary for the effective management. However, data on the epidemiology of PHN in Korea is lacking. The aim of this study was to evaluate the epidemiological features of PHN in the general population.We used population-based medical data for 51,448,491 subscribers to the Health Insurance Service in the year of 2013 to analyze of PHN epidemiology in Korea, such as the incidence, regional distribution, seasonal variation, and healthcare resource utilization. Total number of patients and medical cost on PHN were analyzed from 2009 to 2013.Findings indicate that the incidence of PHN in Korea was 2.5 per 1000 person-years, which was strongly correlated with age and sex. There were no differences in seasonal variation or regional distribution. The medical cost increased steadily over the study period. When admitted to general hospitals, patients with PHN were mainly managed in the dermatology and anesthesiology departments.The incidence and prevalence rates of PHN in Koreans appear to be considerably higher compared to those in western populations, while the sex and age predisposition was similar. Considering that the pain associated with PHN can have a marked impact on a patient's quality of life resulting in a medicosocial economic burden, anesthesiology physicians have an important role in primary care in Korea. Future research on the cost-effectiveness of the management of PHN is needed.

Do Frames Emphasizing Harm to Age and Racial-Ethnic Groups Reduce Support for Voter ID Laws?*

Objectives Research suggests that issue frames emphasizing how voter ID laws might harm eligible voters can influence opinions toward the laws. This study examines the effects of frames emphasizing harm to specific groups of eligible voters—namely, elderly, college-aged, African-American, and Hispanic voters—on public support for such laws. Methods We analyze data from question wording experiments included in two state polls. Results We replicate the finding that emphasizing the harmful effects of the laws on eligible voters reduces support. We also find that a frame emphasizing harm to African Americans produces an additional reduction in support. Emphasizing harm to other specific groups (the elderly, college-aged, or Hispanics) does not produce discernible effects beyond the general framing effect. Within group analyses by race, age and political predispositions reveal additional patterns of effects. Conclusion The results suggest political communication about specific groups can shift public opinion for voter ID laws.

Secondary Malignancy Risk Following Proton Radiation Therapy.

Radiation-induced secondary malignancies are a significant, yet uncommon cause of morbidity and mortality among cancer survivors. Secondary malignancy risk is dependent upon multiple factors including patient age, the biological and genetic predisposition of the individual, the volume and location of tissue irradiated, and the dose of radiation received. Proton therapy (PRT) is an advanced particle therapy with unique dosimetric properties resulting in reduced entrance dose and minimal to no exit dose when compared with standard photon radiation therapy. Multiple dosimetric studies in varying cancer subtypes have demonstrated that PRT enables the delivery of adequate target volume coverage with reduced integral dose delivered to surrounding tissues, and modeling studies taking into account dosimetry and radiation cell biology have estimated a significantly reduced risk of radiation-induced secondary malignancy with PRT. Clinical data are emerging supporting the lower incidence of secondary malignancies after PRT compared with historical photon data, though longer follow-up in proton treated cohorts is awaited. This article reviews the current dosimetric and clinical literature evaluating the incidence of and risk factors associated with radiation-induced secondary malignancy following PRT.

Differential expression of estrogen receptor α and β isoforms in multiple and solitary leiomyomas

Uterine leiomyomas are benign myometrial neoplasms that function as one of the common indications for hysterectomy. Clinical and biological evidences indicate that uterine leiomyomas are estrogen-dependent. Estrogen stimulates cell proliferation through binding to the estrogen receptor (ER), of which both subtypes α and β are present in leiomyomas. Clinically, leiomyomas may be singular or multiple, where the first one is rarely recurring if removed and the latter associated to a relatively young age or genetic predisposition. These markedly different clinical phenotypes indicate that there may different mechanism causing a similar smooth muscle response. To investigate the relative expression of ERα and ERβ in multiple and solitary uterine leiomyomas, we collected samples from 35 Chinese women (multiple leiomyomas n = 20, solitary leiomyoma n = 15) undergoing surgery to remove uterine leiomyomas. ELISA assay was performed to detect estrogen(E2) concentration. Quantitative real-time PCR analysis was performed to detect ERα and ERβ mRNA expression. Western blot and immunohistochemical analysis were performed to detect ERα and ERβ protein expression. We found that ERα mRNA and protein levels of in multiple leiomyomas were significantly lower than those of solitary leiomyomas, whereas ERβ mRNA and protein levels in multiple leiomyomas were significantly higher than those in solitary leiomyomas, irrespectively of the menstrual cycle stage. In both multiple and solitary leiomyomas, ERα expression was higher than that of ERβ. E2 concentration in multiple and solitary leiomyomas correlated with that of ERα expression. ERα was present in nuclus and cytoplasma while estrogen receptor β localized only in nuclei in both multiple and solitary leiomyomas. Our findings suggest that the difference of ERα and ERβ expression between multiple and solitary leiomyomas may be responsible for the course of the disease subtypes.

Environmental and Genetic Factors on the Development of Onychomycosis.

Since the early 20th century, onychomycosis originated with the onset of war, the use of occlusive footwear, and the mass migration of people by transportation in the United States. Even though onychomycosis has a high prevalence in the US, other parts of the world including Canada, West Africa, Southeast Asia, Northern Australia, and Europe have been well documented with cases of fungal toenail infection in their environments. Trichophyton rubrum (T. rubrum) is the major dermatophyte responsible for toenail fungal infection and is typically diagnosed in conjunction with tinea pedis, especially in individuals older than 60 years. Gender roles, age, cultural habits, shoe gear, sports activities, and genetic predisposition all contribute to the different presentation of onychomycosis in these areas where organisms like dermatophytes, candida, and molds were isolated in a variety of cases. Despite the differences in isolated pathogens, treatment outcomes remained consistent. This literature review discusses the influence of tinea pedis, genetics, shoe gear, sports, and age on the development of onychomycosis.

A Pound of Cure Requires An Ounce (or More) of Prevention: Survivorship and Complications of Therapy for Hematologic Malignancies

Patients treated for a hematologic malignancy are at risk for treatment-related complications. As the goal of therapy is frequently curative, treatments are especially intensive and long-term toxicity is common. Chemotherapy and radiation are associated with increased risk for cardiac and pulmonary disease, endocrine disorders, infertility, sexual dysfunction, second cancers, and psychosocial distress. The risk for each complication is dictated by patient characteristics including age, co-morbidities, and genetic predispositions, as well as the specifics of therapy. Survivors of pediatric cancers and allogeneic hematopoietic stem cell transplantation have unique risks due to vulnerable age at time of toxic exposure and ongoing immune dysfunction, respectively.

Health-related quality of life and risk of hypertension in the community: prospective results from the Western New York Health Study.

Measures of health-related quality of life (HRQL) are strong predictors of health outcomes including cardiovascular disease (CVD). However, prospective evidence on the potential impact of these measures on hypertension risk is scant. We therefore examined the independent role of HRQL on the risk of hypertension in a 6-year longitudinal investigation among 979 women and men (mean age 54.3 years) from the community, who were free of hypertension, CVD and diabetes at the baseline examination. Baseline variables included socio-demographics, anthropometrics, blood pressure, behavioural risk factors and measures of HRQL, such as the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Incident hypertension was defined as blood pressure at least 140/90 mmHg or on antihypertensive medication at the follow-up visit. The cumulative 6-year incidence of hypertension was 21.9% (214/979). In bivariate analyses, there were several baseline correlates of incident hypertension, including age, abdominal height, BMI and baseline blood pressure levels in both sexes, whereas impaired fasting glucose, family history of hypertension and the SF-36 physical score were all significantly associated with hypertension among women only. After multivariate adjustment, the SF-36 physical scores [odds ratio (OR) 0.97, 0.94-0.99 for unit change] were still significant predictors of hypertension in women only, independent of age, anthropometrics, baseline SBP levels, behavioural risk factors and other covariates. Measures of HRQL may represent independent predictors of hypertension risk, at least among women, above and beyond the role of traditional risk factors, such as age, anthropometrics and genetic predisposition.

Prevalence of thermophilic Campylobacter species in Swedish dogs and characterization of C. jejuni isolates.

BackgroundThe aims of this study were to investigate the prevalence of Campylobacter species in Swedish dogs, to identify the species of the Campylobacter isolates and to genotype the C. jejuni isolates. Young and healthy dogs were targeted and the sampling was performed at 11 veterinary clinics throughout Sweden from October 2011 to October 2012. Faecal swab samples were collected and sent to the laboratory at the National Veterinary Institute (SVA) for isolation of Campylobacter, speciation and genotyping.ResultsCampylobacter spp. were isolated from 67 of the 180 sampled dogs which yields an overall prevalence of 37%. The most prevalent species of Campylobacter among the participating dogs was C. upsaliensis with 52 of the 67 identified isolates. A lower prevalence was observed for C. jejuni with seven identified isolates and one isolate was identified as C. helveticus. Multi-locus sequence typing (MLST) was carried out on the seven C. jejuni isolates and all sequence types that were found are also commonly found in humans. The dogs were divided into three age groups; 1) under 12 months, 2) 12 to 23 months and 3) 24 months and older. The highest prevalence was found in the two younger age groups. Dogs shedding C. jejuni were between 3–12 months of age while dogs shedding C. upsaliensis were found in all ages.ConclusionsThe present investigation finds that Campylobacter spp. known to cause campylobacteriosis in humans are present in Swedish dogs. The results suggest an age predisposition where dogs under 2 years of age are more likely to shed Campylobacter spp. than older dogs. The most commonly isolated species was C. upsaliensis followed by C. jejuni, which was only detected in dogs up to 12 months of age. All C. jejuni isolates identified in the present study were of the same MLST types that have previously been described both in humans and in animals. The awareness of the Campylobacter risk of healthy young dogs may be an important way to reduce the transmission from dogs to infants, young children and immunocompromised adults.

Antibody therapies and their challenges in the treatment of age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of vision loss in the western world. This multifactorial disease results from the combined contributions of age, environment and genetic predisposition. Antibody-based treatment of late-stage neovascular AMD with inhibitors of vascular endothelial growth factor has had great success, which is now the goal for currently untreatable AMD manifestations. The existence of an immune-privileged environment in the eye supports the feasibility of localized antibody therapy. Many different antibodies against various targets are being developed for the treatment of AMD, which reflects the etiological complexity of the disease. This review provides an overview of 19 potential therapeutic antibodies targeting angiogenesis, the complement system, inflammation or amyloid beta deposition in the eye. It summarizes the immunoglobulin structure, the specific target and study outcomes for each approach. The latter include beneficial results or adverse effects in AMD models and patients. Finally, this article discusses the challenges in the development of antibody-based drugs to treat degenerative processes in the posterior eye. In spite of these difficulties, to date, the following four antibodies have overcome the technical and preclinical hurdles and are being tested in active clinical studies: Lampalizumab, Sonepcizumab, GSK933776 and LFG316. We conclude that, while there are some antibody-based drugs that have made it into clinical practice, a successful transfer from bench to beside is still pending for many promising approaches.

Etiološki i predispozirajući faktori rizika karcinoma prostate

A risk factor is something that affects getting diseases such as cancer. Some risk factors, such as smoking, can be changed, while others, such as age or family predisposition can not be changed. As the incidence and mortality of prostate cancer increase and more investigating, we get a better insight into the risk factors for this cancer. Epidemiological studies emphasize the importance of race, fats in the diet and family predisposition, while the role of vasectomy, vitamins and minerals in the diet, smoking and physical activity are still debatable.

Periodontal Disease Awareness and Knowledge among Nigerian Primary School Teachers.

Background:Teacher-led oral health education is equally effective in improving the oral health knowledge and oral hygiene status of adolescents as dentist-led and peer-led strategies.Aim:The aim was to determine periodontal disease awareness and knowledge among Nigerian primary school teachers.Subjects and Methods:This cross-sectional study was conducted among primary school teachers in Edo State, Nigeria. A self-administered questionnaire which elicited information on demography, awareness of the periodontal disease and source of information, knowledge of etiology, and symptoms of the periodontal disease, was the data collection tool.. The test of association was done using either Chi-square or Fisher's exact statistics. P value was set at 0.05 for significance level.Results:Out of 180 teachers recruited from seven public primary schools in Benin City, Edo State, Nigeria, 151 of them fully participated by filling the study questionnaires giving a 83.9% (151/180) response rate. The majority 74.2% (112/151) of the participants reported having heard of the periodontal disease and the leading source of information was television. A total of 29.8% (45/151) of participants considered periodontal disease as the main cause of tooth loss among adult Nigerian. Only 12.6% (19/151) of the participants knew dental plaque as soft debris on teeth and 29.1% (44/151) attested that plaque can cause periodontal disease. The majority of the participants were not aware of age 81.5% (123/151) and gender 96.7% (146/151) predisposition to periodontal disease. The perceived manifestations of the periodontal disease reported by were mainly gum bleeding 35.1% (53/151) and swollen gum 20.5% (31/151). A total of 70.2% (106/151) of the participants considered periodontal disease as a preventable disease and about half 49.0% (74/151) of the participants considered daily mouth cleaning as the best preventive method. The majority 95.4% (144/151) of the participants expressed interest in learning about the periodontal disease and the most preferred methods were workshops and lectures.Conclusion:A significant proportion of the participants heard about periodontal disease from nondental clinic sources. There existed a poor awareness of etiology, age and gender predispositions, manifestation, complications, and the preventable nature of periodontal disease among the participants. However, the majority of them indicated interest in learning about periodontal disease which should be utilized in optimizing their knowledge.

Serum ionised calcium as a prognostic risk factor in the clinical course of pancreatitis in cats.

The aims of the study were to assess the possible effects of sex, age and breed on the evolution of pancreatitis, and to understand if low values of serum ionised calcium ([Ca(2+)i]) can be considered as a prognostic risk factor for determining the clinical course of the disease. A sample of 24 cats (n = 24) with pancreatitis was used and grouped according to the disease progress into two groups: (i) non-fatal (NF) for those that recovered and (ii) fatal (F) for those that died. Quantification of [Ca(2+)i] and feline pancreatic lipase (fPL) was carried out for each patient at two different times: T1 (day of diagnosis) and T2 (day of recovery or death). For statistical analysis, P values < 0.05 were considered significant. At T1, 58.3% of patients presented with hypocalcaemia, 33.3% with normocalcaemia and 8.3% with hypercalcaemia. The [Ca(2+)i] mean values were higher in the F group than in NF. At T2, 75.0% of patients showed normocalcaemia and 25.0% hypocalcaemia. The mean value of [Ca(2+)i] for F at T2 was 0.88 ± 0.23 mmol/l, whereas for NF it was 1.10 ± 0.11 mmol/l. There was no sex or age predisposition for disease development, but a breed effect was noted (domestic shorthair cats were more prone to developing pancreatitis). The results suggest that hypocalcaemia is common in patients with pancreatitis and that [Ca(2+)i] may be used as a prognostic risk factor for predicting the clinical course of the disease, with values ⩽ 1 mmol/l corresponding to a poor prognosis.

Nonthymoma-associated exfoliative dermatitis in 18 cats.

Exfoliative dermatitis has been described in cats as a paraneoplastic skin disease associated with thymoma. There are anecdotal reports of cases without thymoma, with various suspected aetiologies. To identify common features, underlying causes, response to therapy and outcome of nonthymoma-associated exfoliative dermatitis in cats. Retrospective analysis was carried out of cases presented to dermatology referral centres or cases submitted for histopathological examination. Detailed historical and clinical data were obtained and evaluated statistically. Histopathology was reviewed in a blinded fashion by three dermatopathologists, and PCR for herpesvirus was performed. Eighteen cats fulfilled all inclusion criteria. There was no sex, age or breed predisposition. All cats presented with severe generalized (77%) or multifocal exfoliation (23%); 12 cats were severely depressed. In all cats, thymoma was excluded radiographically and feline leukaemia virus tests were negative. Additional imaging procedures in 14 cats and postmortem examination in two cats did not detect neoplasia. Histopathology revealed interface dermatitis, mural interface folliculitis and sebaceous adenitis indistinguishable from findings in thymoma-associated cases. PCR for herpes DNA was negative. No aetiology was identified. Treatment in 12 cases consisted of immunosuppressive doses of corticosteroids and/or ciclosporin; one responded to antibiotics, one to shampoo, two went into spontaneous remission, and two did not receive any therapy and were euthanized. Nonthymoma-associated exfoliative dermatitis in cats is clinically and histopathologically indistinguishable from thymoma-associated cases. Most cases benefit from immunosuppressive therapy; therefore, an immunopathological response to an undefined trigger is suspected.

Abstract MP41: Health-related Quality of Life and Risk of Hypertension in the Community: A Prospective Analysis from the Western New York Health Study

Health-related Quality of Life and Risk of Hypertension in the Community: A Prospective Analysis from the Western New York Health Study Background: Measures of quality of life and health status are strong predictors of mortality and morbidity outcomes including cardiovascular disease (CVD). However, prospective epidemiological evidence from population-based studies on the potential impact of these measures on hypertension risk is scant. Objective: We sought to examine the independent role of measures of quality of life and health status on the risk of incident hypertension in a community-based sample from Western New York. Methods: A longitudinal analysis, over 6 years of follow-up, among 946 women and men (mean age 54.3 years) from the community, who were free of hypertension, CVD, and diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Baseline variables included socio-demographics, anthropometrics, blood pressure, biomarker data, major behavioural risk factors, and measures of quality of life and health status, such as the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Incident hypertension was defined as blood pressure &gt; or =140/90 or on antihypertensive medication at the follow-up visit. Results: The cumulative six year incidence of hypertension was 22.6% (214/942). In bivariate analyses, there were several baseline correlates of incident hypertension, including age, BMI, and baseline blood pressure levels in both sexes; whereas cigarette smoking, change in BMI, family history of hypertension, and the SF-36 physical score were all significantly associated with hypertension only among women. After multivariate adjustment, cigarette use at baseline (OR: 2.96, 1.35, 6.51), family history of hypertension (OR: 2.59, 1.52-4.42), BMI change since baseline (OR: 1.18, 1.06-1.31), and the SF-36 physical score (OR: 0.97, 0.94-0.99 for a unit change) were the only significant predictors of hypertension independent of age and baseline blood pressure levels in women. Conclusions: Results from this study suggest that measures of health-related quality of life may represent independent predictors of hypertension risk, at least among women, above and beyond the role of traditional risk factors, such as age, smoking, body weight, and familial predisposition.

Expanding upon the ‘extreme male brain’ theory of autism as a common link between other major risk factors: A hypothesis

On average, males have a stronger preference for physical systems and machines over interpersonal interactions; they have lower average levels of cognitive empathy or social cognition than females; and they have higher rates of ‘extreme’ intelligence when it comes to abstract concepts such as those found in mathematics and sciences. All three traits are also commonly associated with individuals with an autism spectrum disorder or ASD; clearly, it is not coincidental that incidence rates of autism are reportedly four times higher in males than in females.The common link between the majority of risk factors assessed in this review (including technological advancements, advanced parental age, socioeconomic status, and genetic predispositions towards ASDs in families of scientists and engineers) can be traced to a specific hormone, testosterone. It was established that traits which are typically associated with males are also typically associated with ASDs as well as individuals with antisocial personality disorder, or APD. The key distinction between individuals who are considered to be ‘autistic’ as opposed to those who are considered ‘sociopathic’ lies in the difference between their empathy deficits: whereas those who are ‘autistic’ are said to lack cognitive empathy (the ability to identify and understand the thoughts and feelings of others and to respond to these with appropriate emotions), those who are ‘sociopathic’ are said to lack emotional empathy (which is responsible for inhibiting acts of physical aggression or violence). This would explain why autistic individuals can have elevated testosterone levels without becoming physically aggressive.

Antiplatelet Therapies: Aspirin at the Heart of New Directions

When introduced over 100 years ago, aspirin was prescribed as an analgesic drug to arthritic patients for pain relief. The prevalence of users grew quite rapidly and to this day, aspirin remains widely used in clinical practice. The popularity of aspirin resulted not only from its analgesic properties but also from a second benefit recognized later as an anti-platelet effect. It was this important activity of aspirin that made it one of the most recommended drugs for the treatment and prevention of cardiovascular diseases. The anti-platelet effect of aspirin emerged from the first few case reports published in the early 1900s and was described as a mild bleeding. The molecular mechanisms involved were described in 1971 and constituted the irreversible inhibition of cyclooxygenase-1 enzyme and prevention of platelet aggregation. Today, the contribution of aspirin to our understanding of cardiovascular health persists and remains considerable. Observations from large cohorts of aspirin users generate massive amount of valuable information used in the identification of factors influencing the potential risk for cardiovascular diseases, including sex, age and genetic predisposition. Aspirin and the path of discovery leading to its anti-platelet activity has taken a hundred years was based on manifestations of effects observed in its users, and it remains a successful strategy for the identification of new avenues to treat cardiovascular diseases associated with hyper-platelet activity. The contribution of aspirin to the understanding of cardiovascular diseases and to the design of effective treatment and prevention strategies, remains of high importance in our society.

Microbial Dysbiosis Is Associated with Human Breast Cancer

Breast cancer affects one in eight women in their lifetime. Though diet, age and genetic predisposition are established risk factors, the majority of breast cancers have unknown etiology. The human microbiota refers to the collection of microbes inhabiting the human body. Imbalance in microbial communities, or microbial dysbiosis, has been implicated in various human diseases including obesity, diabetes, and colon cancer. Therefore, we investigated the potential role of microbiota in breast cancer by next-generation sequencing using breast tumor tissue and paired normal adjacent tissue from the same patient. In a qualitative survey of the breast microbiota DNA, we found that the bacterium Methylobacterium radiotolerans is relatively enriched in tumor tissue, while the bacterium Sphingomonas yanoikuyae is relatively enriched in paired normal tissue. The relative abundances of these two bacterial species were inversely correlated in paired normal breast tissue but not in tumor tissue, indicating that dysbiosis is associated with breast cancer. Furthermore, the total bacterial DNA load was reduced in tumor versus paired normal and healthy breast tissue as determined by quantitative PCR. Interestingly, bacterial DNA load correlated inversely with advanced disease, a finding that could have broad implications in diagnosis and staging of breast cancer. Lastly, we observed lower basal levels of antibacterial response gene expression in tumor versus healthy breast tissue. Taken together, these data indicate that microbial DNA is present in the breast and that bacteria or their components may influence the local immune microenvironment. Our findings suggest a previously unrecognized link between dysbiosis and breast cancer which has potential diagnostic and therapeutic implications.

On the possible interaction between vaccines and drugs

Dear Sirs, Reduction in the hepatic cytochrome P450 system activity has been described after a vaccination in previous studies [1, 2]. While the mechanism behind such reduction was explained as the consequence of the activity of inflammatory cytokines on the mRNA level of hepatic cytochromes [3], it is unclear what effect this interaction may have in the clinical practice. To date, only few reports describe significant changes in drug pharmacokinetics after the administration of a vaccine [4, 5], and small cohort studies reported contrasting results in patients treated with drugs that may be influenced by this interaction [6, 7, 10–12]. Moreover, it is unclear how the effects of vaccines on hepatic cytochrome P450 system activity affect patients who present risk factors such as age or genetic predisposition [1, 2]. To explore this issue further, we used the Vaccine Adverse Event Reporting System (VAERS) database, which collects information about adverse events following the administration of vaccines and is useful to detect rare vaccine-related adverse events [8]. We carried out a search of all reports consistent with a vaccine–drug interaction resulting in an adverse drug reaction, in a detectable increase of drug serum level, or in a change of drug-related biomarkers such as the International Normalized Ratio (INR). As the patients were treated with more than a single drug in many of the cases, we considered only those cases in which there was no mention of recent therapy variation, or there was an explicit statement about the absence of variations. As highlighted in Table 1, we retrieved and validated 28 reports. Among these, 12 were related to an increase of INR, and ten described an increase of serum level of phenytoin, carbamazepine and theophylline (Table 1). The remaining six cases described an adverse drug reaction attributed to an interaction between the vaccine and the drugs (Table 1). As expected, considering previous observations [1], we found that most of the cases occurred in elderly patients and within the first weeks after vaccine administration. Aitken et al. recently observed that human CYP2C8, 2C9, 2C18, 2C19, 2B6, and 3A4 mRNA expression is downregulated by inflammatory cytokines [3], which are also released as result of a vaccination [1, 2]. As one or more of these hepatic cytochromes metabolizes phenytoin, theophylline and carbamazepine, a reduction in their expression due to vaccination may explain the increased level of these drugs that we observed after vaccination. In agreement, other studies showed an increase in phenytoin serum level after vaccination with pertussis vaccine [10] and successive studies confirmed this finding in other drugs such as theophylline [11, 12]. The increased INR we observed with warfarin may also be explained by the vaccination. Warfarin is metabolized primarily by CYP2C9, and a reduction in the activity of this hepatic cytochrome may result in an increase of INR [9]. The reduced activity of this enzyme due to genetic polymorphisms [9], as well as the presence of other variants that may affect the cytokines response to vaccination, may create a subgroup of patients at higher risk for this interaction than the ones observed in our analysis. Paolo Pellegrino and Carla Carnovale contributed equally to this work.

Cutaneous adverse food reactions in cats: retrospective evaluation of 17 cases in a dermatology referral population (2001–2011)

To better characterise cutaneous adverse food reactions (AFR) in cats, including the diagnostic challenges. Retrospective evaluation of cases presenting to a dermatology referral service. Cats were identified by a computerised medical record search. AFR was confirmed by clear deterioration on normal food re-challenge after completing an elimination diet, followed by improvement returning to the test diet. Prevalence, and breed, sex or age predispositions were compared with the base referral population. Patient records were reviewed for historical features, clinical presentations, concurrent dermatoses and dietary details. A total of 17 cats were identified with cutaneous AFR, with no breed or sex predisposition determined. Age of onset ranged from 3 months to 9 years, with a mean of 3.5 years. Prevalence was 6% of dermatoses and 10% of cutaneous hypersensitivities in the referral cat population. Cats typically presented with severe, perennial, non-seasonally flaring pruritus affecting the face/head, neck and/or ventral abdomen. Concurrent hypersensitivities were confirmed in 6 cats and/or suspected in another 5 cats. Home-prepared elimination diets were completed by 16 cats; 8 cats had initial poor response to minimum 6-week commercial hydrolysed protein diets. Identified adverse foods included fish in 2 cats, and chicken, beef, commercial dry, and some canned foods, each in 1 cat. The prevalence of cutaneous AFR in the general cat population is likely to be greater than 6%. A range of clinical presentations occur and practical challenges to diagnosis include reliance on strict adherence to dietary exclusion/provocation trials and misleading responses related to concurrent dermatoses and owner perceptions.

Incidence of Sudden Cardiac Death in Minnesota High School Athletes 1993–2012 Screened With a Standardized Pre-Participation Evaluation

This study sought to determine the incidence of sudden cardiac death (SCD) during Minnesota State High School League (MSHSL) games and practices for high school (HS) athletes (12 to 19 years of age, with most age 15 to 18 years of age) using a uniform statewide pre-participation health screening examination (PPE) form every 3 years on a defined population across 19 academic years. Adding electrocardiographic screening is being considered by some to reduce cardiac death rates in athletes, but the death rates in defined groups screened by the current U.S. PPE recommendations are unknown. MSHSL participation records were surveyed to determine the number of unduplicated athletes for 1993/1994 through 2011/2012 academic years, and catastrophic insurance records were used to find cardiac deaths. There were 4 SCDs (2 cross country, 1 basketball, 1 wrestling), all male, during practice or games in 1,666,509 unduplicated athletes participating in ≥ 1 sports. The incidence of SCD in athletes screened every 3 years with a history and physical during MSHSL activities is 0.24 per 100,000 athlete-years over 19 years and 0.11 per 100,000 athlete-years over the past decade. The incidence of SCD in athletes screened every 3 years with standard PPE during MSHSL activities is 0.24 per 100,000 athlete-years in 19 academic years. This incidence is much lower than that observed in studies of Division 1 National Collegiate Athletic Association and Italian athletes (ages 18 to 25 and mean age 24 years, respectively). Our data do not warrant screening HS athletes with electrocardiography to prevent SCD episodes. The decision to screen athletes with electrocardiography should consider age, training intensity, and genetic predisposition.