Concurrent presentation of IgG4-related tubulointerstitial nephritis and ANCA MPO crescentic glomerulonephritis.

Concurrent IgG4-related tubulointerstitial nephritis and anti-neutrophil cytoplasmic antibodies (ANCA) myeloperoxidase (MPO) crescentic glomerulonephritis is an uncommon scenario, and the link between the two conditions, if any, is incompletely understood. We report the case of a 58-year-old woman who presented with a 2-month history of malaise and joint pain and was found to have acute kidney injury and hemato-proteinuria. Initial immunological tests revealed positive anti-neutrophil cytoplasmic antibodies with a peri-nuclear pattern (pANCA). An enzyme-linked immunoassay (ELISA) for anti-MPO antibodies was also positive, leading to a tentative diagnosis of ANCA-associated small vessel vasculitis with renal involvement. Steroid treatment was commenced, and an urgent kidney biopsy was performed. This showed crescentic glomerulonephritis, but also demonstrated concurrent tubulointerstitial nephritis with a dominance of IgG4-producing plasma cells. Serum IgG4 levels were also elevated. The patient was initially treated with intravenous cyclophosphamide and steroids and then switched to rituximab. When last seen, she was well after 1 dose of rituximab, with kidney function, inflammatory parameters, and serum IgG4 levels returning to normal levels. The concurrent presentation of ANCA-associated vasculitis and IgG4 renal disease is rare with only few cases reported in the literature. More work is needed to understand pathophysiology, outcomes, and management options for this complex scenario.

Older driver safety: a report from the older drivers project.

Older driver safety is a growing public health concern for which interventions are currently being sought. Statistics show that older drivers suffer a disproportionately high rate of motor vehicle fatalities compared with other adult drivers. This disproportion is due to two factors: an increased crash rate per vehicle mile driven and an increased risk of fatality in the event of a crash. Traditionally, traffic safety efforts for the older population have focused on methods to identify unsafe drivers to enforce driving cessation, but driving cessation deprives the majority of older Americans of their primary form of transportation and has been associated with an increase in depressive symptoms. In response to these concerns, the Older Drivers Project, created by the American Medical Association in partnership with the National Highway Traffic Safety Administration, describes and advocates a more acceptable approach to traffic safety. The primary objective of this approach involves helping older drivers stay on the road safely to preserve their mobility and independence. This can be accomplished through three methods: (1) optimizing the driver, (2) optimizing the driving environment, and (3) optimizing the vehicle. In this approach, driving cessation is recommended only after the safety of the driver cannot be secured through any other means.

The neurocognitive effects of alcohol on adolescents and college students.

BACKGROUND: Adolescents and college students are at high risk for initiating alcohol use and high-risk (or binge) drinking. There is a growing body of literature on neurotoxic and harmful cognitive effects of drinking by young people. On average, youths take their first drink at age 12 years. METHODS: MEDLINE search on neurologic and cognitive effects of underage drinking. RESULTS: Problematic alcohol consumption is not a benign condition that resolves with age. Individuals who first use alcohol before age 14 years are at increased risk of developing alcohol use disorders. Underage drinkers are susceptible to immediate consequences of alcohol use, including blackouts, hangovers, and alcohol poisoning and are at elevated risk of neurodegeneration (particularly in regions of the brain responsible for learning and memory), impairments in functional brain activity, and the appearance of neurocognitive deficits. Heavy episodic or binge drinking impairs study habits and erodes the development of transitional skills to adulthood. CONCLUSIONS: Underage alcohol use is associated with brain damage and neurocognitive deficits, with implications for learning and intellectual development. Impaired intellectual development may continue to affect individuals into adulthood. It is imperative for policymakers and organized medicine to address the problem of underage drinking.