Bullous pemphigoid induced by vildagliptin: a report of three cases

To report three cases of bullous pemphigoid in patients treated with vildagliptin. Case 1: An 86‐year‐old woman presented with bullous pemphigoid after 1 month of treatment with vildagliptin and metformin. After introduction of clobetasol, the symptoms resolved although vildagliptin was continued. However, the skin lesions reappeared 3 months later. Sustained remission was achieved only after definitive withdrawal of vildagliptin. Case 2: A 79‐year‐old man presented with bullous pemphigoid after 37‐month treatment with gliclazide, vildagliptin and metformin. The disease at first responded to clobetasol but 3 months later the lesions reappeared. They finally regressed when the gliptin was discontinued. Case 3: A 77‐year‐old woman, treated with gliclazide and vildagliptin for 26 months, presented with bullous pemphigoid, which responded well to discontinuation of the gliptin and topical clobetasol. Gliptins are new molecules for treatment of type 2 diabetes mellitus, which have been suspected of implication in bullous pemphigoid. Such cases have been described in the literature (seven with vildagliptin and three with sitagliptin). In nine of these cases, the gliptin was associated with metformin, but the latter had never been considered responsible. The mechanism implicated in the development of bullous pemphigoid has not yet been clearly identified, but may involve a modified immune response or alteration of the antigenic properties of the epidermal basement membrane. These reports support the risk of bullous pemphigoid in patients exposed to gliptins.     

Risk Factors for Adopting Extreme Weight-Control Behaviors among Public School Adolescents in Salvador,Brazil: A Case-Control Study

Objective: This study identifies the risk factors for extreme weight-control behaviors among adolescents in public school in Salvador, northeastern Brazil.

Methods: A case-control study nested to a cross-sectional study, including 252 adolescents of both sexes, age between 11 to 17 years, with 84 cases and 168 age-matched controls was conducted. The variable outcome is represented by extreme weight-control behaviors, integrated by following the variables: self-induced vomiting and the use of laxatives, diuretics, or diet pills. Covariables included body image dissatisfaction, dieting, prolonged fasting, and self-perception of body weight. The study also investigated the demographic and anthropometric variables and economic conditions of the students’ families. Conditional logistic regression was used to identify risk factors for the adoption of extreme weight-control behaviors among adolescents.

Results: Among the adolescents investigated, the conditional logistic regression explained 22% the occurrence of extreme weight-control behaviors and showed that these behaviors were positively associated to overweight (odds ratio [OR] = 3.61; 95% confidence interval [CI], 1.42–9.17), body image dissatisfaction (OR = 3.87; 95% CI, 1.75–8.54), and the adoption of a restrictive diet (OR = 2.83; 95% CI, 1.16–6.91).

Conclusions: The results of this study suggest that among adolescents, overweight, body image dissatisfaction, and restrictive diet are important risk factors to adoption of extreme weight-control behaviors.     

Contact allergy to oxidized geraniol among Swedish dermatitis patients—A multicentre study by the Swedish Contact Dermatitis Research Group

Background

Geraniol is a widely used fragrance terpene, and is included in fragrance mix I. Geraniol is prone to autoxidation, forming the skin sensitizers geranial, neral, and geraniol‐7‐hydroperoxide. Oxidized geraniol has previously been patch tested in 1 clinic, giving 1% to 4.6% positive reactions in consecutive patients when tested at 2% to 11%.

Aim

To compare test reactions to pure and oxidized geraniol, to compare 2 different test concentrations of oxidized geraniol and to investigate the pattern of concomitant reactions to fragrance markers of the baseline series in a multicentre setting.

Methods

One thousand four hundred and seventy‐six consecutive patients referred for patch testing were patch tested with geraniol 6% pet. and oxidized geraniol 6% and 11% pet.

Results

Pure geraniol 6% pet., oxidized geraniol 6% pet. and oxidized geraniol 11% pet. gave 1%, 3% and 8% positive patch test reactions and 0.7%, 3% and 5% doubtful reactions, respectively. Approximately 50% of the patients with doubtful reactions to oxidized geraniol 6% pet. had positive reactions to oxidized geraniol 11% pet.

Conclusions

Oxidized geraniol 11% pet. provides better detection than oxidized geraniol 6% pet. As most patients reacted only to oxidized geraniol, it is important to explore further whether oxidized geraniol should be included in a baseline patch test series.

     

Bohring-Opitz (Oberklaid-Danks) syndrome: clinical study, review of the literature, and discussion of possible pathogenesis

Bohring-Opitz syndrome (BOS) is a rare congenital disorder of unknown etiology diagnosed on the basis of distinctive clinical features. We suggest diagnostic criteria for this condition, describe ten previously unreported patients, and update the natural history of four previously reported patients. This is the largest series reported to date, providing a unique opportunity to document the key clinical features and course through childhood. Investigations undertaken to try and elucidate the underlying pathogenesis of BOS using array comparative genomic hybridization and tandem mass spectrometry of cholesterol precursors did not show any pathogenic changes responsible.     

CYP450-dependent biotransformation of the insecticide fipronil into fipronil sulfone can mediate fipronil-induced thyroid disruption in rats

In rats, the widely used insecticide fipronil increases the clearance of thyroxine (T(4)). This effect is associated with a high plasma concentration of fipronil sulfone, the fipronil main metabolite in several species including rats and humans. In sheep, following fipronil treatment, fipronil sulfone plasma concentration and thyroid disruption are much lower than in rats. We postulated that fipronil biotransformation into fipronil sulfone by hepatic cytochromes P450 (CYP) could act as a potential thyroid disruptor. The aim of this study was to determine if fipronil sulfone treatment could reproduce the fipronil treatment effects on T(4) clearance and CYP induction in rats. Fipronil and fipronil sulfone treatments (3.4 μmol/kg/day per os, 14 days) increased total and free T(4) clearances to the same extent in THX + T(3), euthyroid-like rats. Both treatments induced a 2.5-fold increase in Ugt1a1 and Sult1b1 messenger RNA (mRNA) expressions and a twofold increase in UGT1A activity suggesting that T(4) elimination was mediated, at least in part, by hepatic uridine 5'-diphospho-glucuronosyltransferases (UGT) and/or sulfotransferases (SULT) induction. Both treatments induced a 10-fold increase in Cyp3a1 and Cyp2b2 mRNA expressions concomitant with a threefold increase in CYP3A immunoreactivity and a 1.7-fold increase in antipyrine clearance, a biomarker of CYP3A activity. All these results showed that fipronil sulfone treatment could reproduce the fipronil treatment effects on T(4) clearance and hepatic enzyme induction in rats. The potential of fipronil sulfone to act as a thyroid disruptor is all the more critical because it persists much longer in the organism than fipronil itself.     

Racial disparities in the development of dysphagia after stroke: further evidence from the Medicare database

Bussell SA, González-Fernández M. Racial disparities in the development of dysphagia after stroke: further evidence from the Medicare database.

Objective

To describe the relationship between minority race/ethnicity and dysphagia after stroke in a national sample. Unlike the multiple studies that have examined racial disparities in stroke incidence, risk factors, outcomes, and quality of care, the influence of race or ethnicity on dysphagia after stroke has been understudied. We hypothesized that the odds of dysphagia would be higher for Asians compared with Caucasians in the United States given the results of a previous study in the U.S.

Design

Observational study.

Setting

Conducted using the U.S. National Medicare Medical Provider Analysis and Review Data.

Participants

Medicare beneficiaries admitted in 2007 with a stroke diagnosis.

Intervention

We selected 382,959 cases with cerebrovascular disease codes with self-identified race/ethnicity of Caucasian, African American, Asian, Hispanic, Native American, or other/unknown. Cases had a diagnosis of cerebrovascular disease, defined as International Classification of Disease, Ninth Revision codes 430 to 438.9. Self-reported race/ethnicity was recorded in the following categories: Caucasian, African American, Asian, Hispanic, Native American, and other/unknown.

Main Outcome Measure

Dysphagia after stroke as coded in the data.

Results

The adjusted odds ratio (OR) for poststroke dysphagia was higher for Asians and other minority groups compared with Caucasians (Asian: OR, 1.73; 95% confidence interval [CI], 1.60–1.88; Hispanic: OR, 1.50; 95% CI, 1.39–1.63; African American: OR, 1.42; 95% CI, 1.37–1.47; unknown/other: OR, 1.27; 95% CI, 1.16–1.38; Native American; OR, 1.44; 95% CI, 1.22–1.69).

Conclusions

Our findings confirm previous research suggesting an association between Asian race and dysphagia after stroke while adding evidence for increased odds in other racial/ethnic minority groups.