Self-perceptions of age among 292 chemotherapy-treated cancer patients: Exploring associations with symptoms and survival

ObjectiveA growing literature suggests that older individuals who report feeling younger than their actual chronological age enjoy better health and survival. The purpose of this study was to explore similar associations in patients with cancer.MethodsChemotherapy-treated cancer patients completed a previously-validated questionnaire item on their self-perception of age. Concurrent patient-reported number of symptoms and pain severity were recorded. In addition, baseline and longitudinal data captured demographics and vital status, respectively.ResultsAmong 292 patients, 185 (63%) reported that they perceived themselves as younger than their actual age, 45 as older (15%), and 56 (19%) as the same age (unable to be determined in 6). The mean actual chronological age (standard deviation) among those who perceived themselves as younger, older, or the same age was 63 years (11), 54 (12), and 60 (10); (p < 0.0001). An inverse relationship was observed between self-perceived age and actual age (odds ratio 1.05 with 95% confidence interval of 1.02, 1.07; p = 0.0001) but, otherwise, no statistically significant relationships were observed with gender, cancer curability potential, number of symptoms, or pain severity. Improved survival was associated with fewer symptoms and the potential for curing the cancer, but not with patients' age perceptions. Qualitative themes such as positive thinking, staying engaged with life, the importance of family, and maintaining a sense of humor emerged among those who felt younger.ConclusionA substantial percentage of patients with cancer – particularly older ones – report feeling younger than their actual age; this perception appears to have no relevance to symptoms or survival.     

Management of pregnancy in women with genetic disorders, Part 1: Disorders of the connective tissue, muscle, vascular, and skeletal systems

Due to early diagnosis and increasingly effective medical advances, the number of women with various genetic syndromes who are undergoing pregnancy is increasing, and this represents an important issue for providers of obstetric care. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who may experience impaired fertility due to their underlying diagnosis. Management of these women requires coordination of care by healthcare providers from multiple specialties to optimize outcomes. Potentially serious medical issues specific to each diagnosis often exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be recognized to allow timely diagnosis and treatment. The fetus may also face issues related to risk for inheritance of the genetic disorder itself, as well as risks related to the chronic disease status of the mother. This article will explore the issues faced by women with various genetic disorders that may affect connective tissue, muscular, vascular, and skeletal systems. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After the completing the CME activity, physicians should be better able to classify the cardiovascular manifestations observed in Marfan syndrome and Ehlers-Danlos, evaluate prenatal diagnostic options and limitations for various genetic syndromes, assess the risks to the fetus in women with various genetic syndromes. Determine whether there is a preferred mode of delivery for pregnant patients with various genetic syndromes described in this paper.     

Acute myopericarditis after multiple vaccinations in an adolescent: case report and review of the literature

We report a case of postvaccination acute myopericarditis in an adolescent. The patient presented with acute chest pain, diffuse ST-segment elevation, and elevated cardiac enzyme levels. Cardiac MRI was consistent with acute myocarditis. He recovered within a few days with nonsteroidal antiinflammatory treatment and remains clinically stable, with improvement of MRI findings at the 10-week follow-up. Postvaccination cases of myopericarditis reported in the pediatric literature are also reviewed.     

Bilateral internuclear ophthalmoplegia—an unusual initial presenting sign of giant cell arteritis

A 63-year-old man presented six days after the sudden onset of horizontal double vision. His left eye became divergent two days later. On initial examination he had bilateral internuclear ophthalmoplegia with weakness of adduction and abducting nystagmus. Convergence was weak but there were no other neuro-ophthalmic signs. Constitutional signs included confusion and unsteadiness on his feet. A provisional diagnosis of arteritis was made. His ESR was 92 mm/h and a superficial temporal artery biopsy confirmed the diagnosis of giant cell arteritis. After two weeks or oral prednisolone his eye movements returned to normal. There have been no further relapses.
This would appear to be a unique presentation of giant cell arteritis. The causes of internuclear ophthalmoplegia are discussed along with a review of the ocular and neuro-ophthalmic signs of giant cell arteritis.     

Orotic acid, a promoter of liver carcinogenesis induces DNA damage in rat liver

Orotic acid, a precursor of pyrimidine nucleotide biosynthesisand a promoter for liver carcinogenesis, when fed at 1% levelin a diet for 5 weeks resulted in liver DNA damage. The damagecan be monitored as alkali-labile lesions using alkaline sucrosegradients as well as alkaline elution technique. Furthermore,the induced DNA damage persists for up to three weeks afterwithdrawal of the orotic acid diet. The fad that several skin-tumourpromoters also induce DNA damage raises the question whetherDNA damage is a component in tumour promotion.