Pityriasis lichenoides chronica associated with use of HMG-CoA reductase inhibitors.

Herein, we present three cases of Pityriasis lichenoides chronica (PLC) in patients who developed the rash after use of 3-hydroxy-3-methyl-glutaryl-Coenzyme A (HMG-CoA) reductase inhibitors. The patients had complete resolution after standard treatment by dermatologists and withdrawal of the offending agents. In one case, the patient had a previous episode of a similar rash that occurred with HMG-CoA reductase inhibitors use many years previously. Pityriasis lichenoides chronica is a condition of unknown aetiology. Several agents have been associated with its presentation. We postulate HMG-CoA reductase inhibition in skin presents a final common pathway for the presentation of PLC in select patients.

Fetal cocaine exposure and neonatal bilirubinemia.

To assess the effect of fetal exposure to cocaine on neonatal serum bilirubin values, we compared 17 infants whose cocaine exposure was confirmed by urine toxicology studies, with no evidence of other drug exposure by history or urinalysis, with 31 sequentially born healthy term infants without evidence of maternal drug use. The mean (+/- SD) bilirubin concentration in control infants was 110 +/- 32 mumol/L (6.5 +/- 1.9 mg/dl) at 30.5 +/- 5.4 hours of age, compared with 55 +/- 26 mumol/L (3.2 +/- 1.5 mg/dl) at 30.8 +/- 5.3 hours in cocaine-exposed infants (p < 0.001). We also compared the abilities of cocaine and clofibrate, a known inducer of bilirubin uridine diphosphate-glucuronosyl transferase (BGT), to induce drug and bilirubin metabolizing pathways in young male Sprague-Dawley rats. Animals received drugs or saline solution for 7 days, and livers were assayed for cytochrome P-450, peroxisomal beta-oxidase, delta 5-3-ketosteroid isomerase (KSI), glutathione-S-transferase (GST), and BGT. Cocaine was a weak inducer of GST but a strong inducer of KSI, a member of the GST family of enzymes that is closely associated with bilirubin transport (ligandin) in liver, and a moderately strong inducer of BGT. Neither drug increased cytochrome P-450 levels, and only clofibrate induced peroxisomal beta-oxidase. We conclude that cocaine appears to induce bilirubin metabolizing pathways, resulting in a lower risk of neonatal hyperbilirubinemia.

Profile of teenage mothers and their parents' attitudes to teenage sexuality and pregnancy - abstract

The purpose of this study was to obtain a profile of the Barbadian pregnant teenager and to ascertain from them their parents' attitudes to teenage sexuality and pregnancy. From April 1 to July 31, 1989, information was obtained by questionnaire from 160 teenage mothers during hospitalization. Pregnant teenagers ranged in age from 13 to 19 years, and 131 (82 per cent) were over 16 years, the legal age of consent. All attended, but only 84 per cent completed secondary schooling. They were predominantly of lower socio-economic class and 65 per cent had teenage mothers. Seventy-one per cent lived in homes with no resident male authority, and 54 per cent reported strict parental discipline. Fifty-nine per cent had their first sexual encounter before 16 years of age (legal consent age), only 2 per cent were married and 22 per cent were in commom-law union. Most teenagers (94 per cent) had some knowledge of contraception before becoming pregnant but only 19 per cent practised family planning. Pregnancy was unplanned in 82 per cent and 80 per cent wished to have delayed pregnancy. Sex education was received from school (78 per cent) and mother (33 per cent), but 78 per cent felt it was inadequate. Mothers of pregnant teenagers were mostly single parents (71 per cent), of lower socio-economic class, and 50 per cent were < 40 years of age. Mothers' reaction to the boyfriend were reportedly angry (25 per cent), approving (23 per cent), not angry (15 per cent) and no reaction, (38 per cent). Only 2.5 per cent of teenagers were evicted from the home, and 90 per cent of parents were supportive (AU)