Oral lichenoid drug eruptions

OBJECTIVES: To identify, from amongst drugs reported as causing lichenoid drug eruptions, those affecting the oral mucous membranes and to review the clinical, histo-logical and immunological features of such oral lichenoid drug eruptions in comparison to oral lichen planus, amalgam contact lesions and lichen planus-like eruption in graft-versus-host disease (GVHD).
DATA SOURCES: Ovid® Medline data searches on CD-Rom were carried out for the years 1966–1996 to identify reports of oral lichenoid drug eruptions and their clinical, histological and immunological featureS. Articles retrieved were examined for further appropriate references in the period 1940–1996.
DATA EXTRACTION AND SYNTHESIS: Each paper was critically examined for evidence of a clinically verifiable lichenoid drug eruption affecting the oral mucous membranes and the effects of subsequent drug withdrawal. Available clinical, histological and immunological features were recorded. The papers examined were too diverse in nature to permit a structured criticism. The extracted data have been tabulated where appropriate.
CONCLUSIONS: The reports of oral lichenoid drug eruptions are considerably fewer than those of cutaneous eruptions and fewer drugs have been reported as causing oral rather than cutaneous lichenoid eruptionS. Histology and immunology cannot be used reliably to differentiate lichenoid drug eruptions from idiopathic lichen planus, amalgam contact lesions and lichen planus-like eruption in GVHD. Lichenoid drug eruptions may also show some histological characteristics of oral discoid lupus erythematosuS. An accepted protocol agreed by a number of international centres would permit the gathering of substantial information on LDE and could lead to a greater understanding of the mechanisms involved.     

lnterleukin-1β and phenytoin reduce α1 (1) procollagen mRNA expression in human gingival fibroblasts

Effects of and interactions between interleukin-1β (IL-1 β) and phenytoin (PHT) on α1 (I) procollagen gene and protein expression in human gingival fibroblasts and its relation to prostaglandin E₂ (PGE₂) formation were studied. IL-1β (300 pg/ ml) reduced the steady-state level of αl(I) procollagen mRNA by 50% and decreased the amount of procollagen I by 35%. PHT (10 μg/ml) reduced the level of α1(I) procollagen mRNA by 40% but the amount of procollagen I in the medium was unchanged. In combination with IL-1β, PHT potentiated the inhibitory effect of IL-1β on αl(I) procollagen mRNA level that was accompanied by an increased PGE₂ formation. Preincubation with indomethacin (10^-6m) partially reduced the inhibitory effect of IL-1β as well as of IL-1β in combination with PHT on the mRNA level of αl(I) procollagen. The inhibitory effect of PHT was unaffected by indomethacin treatment. Addition of exogenous PGE₂ (≥10 nm) dose-dependently reduced steady-state level of α1(I) procollagen mRNA as well as the amount of procollagen 1. The study indicates that IL-1 reduces the expression of αl(I) procollagen mRNA in human gingival fibroblasts partly by a prostaglandin endoperoxide (PGH) synthase-mediated pathway and partly by a PGH-synthase independent pathway, whereas PHT reduces α1(I) procollagen gene expression by a PGH-synthase independent pathway. The potentiation of the inhibitory effect of IL-1 induced by PHT was mediated mainly by a PGH-synthase dependent pathway.     

Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of Women in Gothenburg

Objectives

To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968–1969, 1980–1981, 1992–1993 and 2004–2005.

Design

Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years.

Setting

Gothenburg, Sweden with ∼450 000 inhabitants.

Subjects

Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59–90%, n =1901).

Main outcome measures

Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol.

Results

There was no significant difference in mean BMI from 1968–1969 versus 2004–2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004–2005 versus 1968–1969. HDL-cholesterol (not measured until 1992–1993), showed a significantly higher mean level in 2004–2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity.

Conclusions

Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.     

Resolution of infection status of human immunodeficiency virus (HIV)- seroindeterminate donors and high-risk seronegative individuals with polymerase chain reaction and virus culture: absence of persistent silent HIV type 1 infection in a high-prevalence area

To address concerns over the prevalence of silent (antibody-negative) infections among blood donors and high-risk populations, a combination of proviral amplification by polymerase chain reaction (PCR) and viral isolation by co-culture techniques was employed to resolve the human immunodeficiency virus type 1 (HIV-1) infection status of well-characterized groups of suspect blood donors and others identified in the blood bank setting. No silent infections were found in 65 follow-up samples from 26 persistently HIV-1-seroindeterminate blood donors, 16 persistently seronegative heterosexual partners of infected transfusion recipients, and 6 high-risk seronegative homosexual men identified through donor look-back investigations. In contrast, 21 seropositive controls tested positive. These results suggest a low prevalence of persistently silent infections in at-risk populations, even in high HIV prevalence regions. The PCR assay, with a co-detected internal positive control, and appropriate confirmatory algorithms, was found to be a useful direct assay to rule out infection, especially in concert with confirmatory virus isolation.     

Plasma lipid changes in the female in aging and the menopause. Results from three population studies.

Postabsorbtive plasma lipid levels have been analyzed in studies of the female population in the Swedish city of Gothenburg. The population samples cover the ages 15, 23, 30, 38, 40, 45, 46, 50, 54, 60 and 70. In some groups data are available from both cross-sectional and prospective longitudinal studies. Cross-sectional studies showed a successive increase in total plasma cholesterol from 15 to 54 years of age. Longitudinal studies showed a further increase at least up to 60 years of age. The triglyceride level remained rather constant between 15 and 30 years of age, then increased but was again rather similar in the 40--50-year olds and reached the highest level in the 60- and 70-year samples. The total phospholipid curve was approximately parallel with the cholesterol curve at younger ages but nearer the cholesterol curve at higher ages. The composition of the plasma phospholipid fraction apparently changed at the ages around the menopause, mainly due to an increase in the proportions of lecithin and lysolecithin. Data available allowed considerations concerning possible influences on plasma lipids by age, by changes in dietary habits and body composition, as well as by gonadal steroid hormones.     

Irresponsible responsibility

The Medical Association for Prevention of War (UK) submitted the following written statement to the Third Special Session on Disarmament of the United Nations General Assembly, which was held at UN headquarters in New York on 31 May‐25 June 1988.     

Age and Angina as Predictors of Quality of Life after Myocardial Infarction. A Prospective Comparative Study

Objectives - The objectives were to compare quality of life (QoL) after first myocardial infarction with an age- and sex-adjusted normative population and to test whether the 1-month QoL had predictive properties. Design - QoL was assessed by self-administered questionnaires (SF-36 and Cardiac Health Profile) 1, 3 and 6 months after index-event. Participants were 60 consecutive patients (20% women) with a mean age of 58 &#45 7.4 years. Results - Patients &#83 59 years improved in Physical (PCS) and Mental Component Summary (MCS), scoring comparable to community norms at 6 months. However, patients <59 years improved in PCS but not in MCS, and scored significantly below community norms in both PCS (x- macron = 44.7, CI 40.6-48.7 vs x- macron = 50.3, CI 49.3-51.4) and MCS (x- macron = 45.9, CI 41.8-49.9 vs x- macron = 51.3, CI 50.3-52.4) at 6 months. Predictors for MCS were age ( p = 0.025) and Vitality ( p = 0.020) both positively related to QoL. Predictors for PCS were Physical Function ( p = 0.003) and CCS score ( p < 0.001) where angina grade was negatively related to QoL. Conclusion - Because of impaired mental recovery in younger post-infarction patients, their need of special attention in the rehabilitation process must not be overlooked.