Free recall of the word list and other psychological and physical

Free recall of the word list and other psychological and physical responses were assessed on day 3.

Results: Oral administration of propranolol before reactivation of the word list impaired reconsolidation of drug-related positive and negative but not neutral words in abstinent heroin addicts, and these impairments critically depended on reactivation of the word list.


This study extends earlier reports that a p-adrenergic receptor antagonist affects the drug-related memory reconsolidation process. learn more Our findings may have important implications for the understanding and treatment of persistent and abnormal drug-related memories in abstinent heroin addicts. (C) 2011 Elsevier Ireland Ltd. All rights reserved.”
“Background: Obese individuals may be at increased risk of iron deficiency (ID), but it is unclear whether this is due to poor dietary iron intakes or to adiposity-related inflammation.

Objective: The aim of this study was to examine the relations between body

mass index (BMI), dietary iron, PF-3084014 and dietary factors affecting iron bioavailability, iron status, and inflammation [C-reactive protein (CRP)] in a transition country where obesity and ID are common.

Design: Data from the 1999 Mexican Nutrition Survey, which included 1174 children (aged 5-12 y) and 621 nonpregnant women (aged 18-50 y), were analyzed.

Results: The prevalence of obesity was 25.3% in women and 3.5% in children. The prevalence of ID was significantly (P < 0.05) higher in obese women and children compared with normal-weight subjects [odds ratios (95% CIs): 1.92 (1.23, 3.01) and 3.96 (1.34, 11.67) for women and children, respectively]. Despite similar dietary iron intakes in the 2 groups, serum iron concentrations were lower in obese women than Small molecule library molecular weight in normal-weight women (62.6 +/- 29.5 compared with 72.4 +/- 34.6 mu g/dL; P = 0.014), and total-iron-binding capacity was higher in obese

children than in normal-weight children (399 +/- 51 compared with 360 +/- 48 mu g/dL; P < 0.001). CRP concentrations in obese women and children were 4 times those of their normal-weight counterparts (P < 0.05). CRP but not iron intake was a strong negative predictor of iron status, independently of BMI (P < 0.05).

Conclusions: The risk of ID in obese Mexican women and children was 2-4 times that of normal-weight individuals at similar dietary iron intakes. This increased risk of ID may be due to the effects of obesity-related inflammation on dietary iron absorption. Thus, ID control efforts in Mexico may be hampered by increasing rates of adiposity in women and children. Am J Clin Nutr 2011;93:97583.”
“We report a case series of 11 patients with severe E. faecium infections treated with daptomycin. All strains were resistant to ampicillin (MIC >8 mg/l), but susceptible to vancomycin. Seven out of 11 strains were also highly resistant to gentamicin (MIC >500 mg/l).

4, 93 5, 91 2 and 90 3% respectively The limit of quantification

4, 93.5, 91.2 and 90.3% respectively. The limit of quantification was 25 ng/mL for I and IV, 10 ng/mL for II and III and 100 ng/mL for V respectively. The within

day and day-to-day precision for all the compounds were < 10%. The validated HPLC method herein was applied for pharmacokinetic studies and the main pharmacokinetic parameters were: t(1/2) (hr) 5.8, 4.3, 2.9, 5.7 and 7.3, C-max (ng/mL) 594.9, 1542.9 1659.9, 208.9 and 3040.4; T-max (hr) 4.7, 1.0, 1.0, 3.5 and 2.3; AUC(0-infinity). (ng hr/mL) 5040, 5893, 9260, 1064 and 27233 for I, II, III, IV and V respectively. The developed method was suitable for pharmacokinetic studies and this preliminary study also revealed significant absorption after oral dosing in rats.”
“The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and AL3818 ic50 systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable,

and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact LY2157299 cell line on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic learn more infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol.”
“Recent research in cerebellar cognitive and linguistic functions makes plausible the idea that the cerebellum is involved in processing temporally contiguous linguistic

input. In order to assess this hypothesis, a simple lexical decision task was constructed to study whether the effect of transcranial magnetic stimulation on two different cerebellar sites would have a selective impact on associative as opposed to semantic priming. This is the first experiment applying transcranial magnetic stimulation of the cerebellum to a linguistic task. The results show a selective drop in lexical decision accuracy after stimulation of a medial cerebellar site in the first session of participation. Most importantly, they also demonstrate a selective increase of associative priming sizes after stimulation of the same site that cannot be attributed to changes in sensorimotor performance or in accuracy rates. The finding is discussed within the context of domain-general associative cerebellar computations.

In this case, HPMCAS can form H bonds with griseofulvin directly;

In this case, HPMCAS can form H bonds with griseofulvin directly; the addition of PHPMA click here to the solid dispersion may enhance the stability of the amorphous griseofulvin due to greater interaction with griseofulvin. The X-ray powder diffraction results showed that griseofulvin (binary and ternary solid dispersions) remained amorphous for more than 19 months stored at 85% RH compared with the spray-dried griseofulvin which crystallized totally within 24 h at ambient conditions. The Fourier transform infrared scan showed that

griseofulvin carbonyl group formed hydrogen bonds with the hydroxyl group in the HPMCAS, which could explain the extended stability of the drug. Further broadening in the peak could be seen when PHPMA was added to the solid dispersion, which indicates stronger interaction. The glass transition

temperatures increased in the ternary solid dispersions regardless of HPMCAS grade. The dissolution rate of the drug in the solid dispersion (both binary and ternary) has significantly increased when compared with the dissolution profile of the spray-dried griseofulvin. These results reveal significant stability of the amorphous form due to the hydrogen bond formation with the polymer. The addition of the third polymer improved the stability but had a minor impact on dissolution.”
“Onion anthracnose, caused by Colletotrichum gloeosporioides, is one of the main diseases of onions in the State of Pernambuco. We examined the pathogenicity of 15 C. gloeosporioides strains and analyzed their genetic variability using RAPDs and internal

transcribed this website spacers (ITS) of the rDNA region. Ten of the strains were obtained from substrates and hosts other than onion, including chayote (Sechium edule), guava (Psidium guajava), pomegranate (Punica granatum), water from the Capibaribe River, maracock (Passiflora AC220 sp), coconut (Cocus nucifera), surinam cherry (Eugenia uniflora), and marine soil; five isolates came from onions collected from four different regions of the State of Pernambuco and one region of the State of Amazonas. Pathogenicity tests were carried out using onion leaves and bulbs. All strains were capable of causing disease in leaves, causing a variable degree of lesions on the leaves; four strains caused the most severe damage. In the onion bulb tests, only three of the above strains caused lesions. Seven primers of arbitrary sequences were used in the RAPD analysis, generating polymorphic bands that allowed the separation of the strains into three distinct groups. The amplification products generated with the primers ITS1 and ITS4 also showed polymorphism when digested with three restriction enzymes, DraI, HaeIII and MspI. Only the latter two demonstrated genetic variations among the strains. These two types of molecular markers were able to differentiate the strain from the State of Amazonas from those of the State of Pernambuco.

Copyright (c) 2013 John Wiley & Sons, Ltd “
“Study Design S

Copyright (c) 2013 John Wiley & Sons, Ltd.”
“Study Design. Systematic review.

Objective. To document the incidence

and consequences of vascular injury in lumbosacral surgery, to identify factors contributing to this injury, and to determine whether there are any effective measures to decrease the occurrence of vascular injury.

Summary of Background Data. Anterior lumbosacral surgery encompasses all aspects of spine surgery, including trauma, deformity, and degenerative conditions. Although it has theoretical advantages, anterior lumbosacral surgery carries with it certain definite risks, one of the most critical click here of which is injury to the surrounding vasculature. It is important for both the patient and the surgeon to understand the risks, patterns, and outcomes of injury to the vascular structures associated with this surgery.

Methods. A systematic review of the English-language literature was undertaken for articles published between January 1993 and December

2008. Electronic databases and reference lists of key articles were searched to identify published studies examining vascular injury in anterior lumbosacral surgery. Vascular injury was defined as any case in which a suture was required to control bleeding. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation LXH254 concentration criteria assessing quality, quantity, and consistency of results. Disagreements

were resolved by consensus.

Results. A total of 88 articles were initially screened, and 40 ultimately met the predetermined inclusion criteria. Vascular injuries after anterior lumbosacral surgeries were rare (<5%). Venous laceration was more common than arterial laceration, and most venous injuries occurred during retraction of the great vessels. In most cases, the overall clinical outcome after vascular injury was not adversely affected. L4-L5 exposure was associated with increased vascular injury in some studies but not others. Vascular injury occurred Galardin in vitro more frequently in laparoscopic compared with open anterior lumbar interbody fusion.

Conclusion. Vascular injury in anterior lumbosacral surgery remains low, with reports being <5%. The consequences of injury seem rare, but may include thrombosis, pulmonary embolism, and prolonged hospitalization. Exposure and surgery at L4-L5 may be associated with a higher risk of injury than that at L5-S1, though the data are not consistent.”
“During pregnancy the maternal immune system is modified in order to achieve immune tolerance toward paternal antigen expressed on foetal cells. These modifications, which occur both at the foeto-maternal interface and in the systemic circulation, are driven by oestrogens and progesterone whose blood concentrations increase during pregnancy. The cytokine profile is also modified. Th2 cytokines are enhanced while the Th1 response is inhibited.

Follow-up analyses including

Follow-up analyses including AZD1480 solubility dmso ROC curves were used to further examine the ability of the DRI to identify short-term DUI recidivists.

Results: In the final model controlling for all variables, the DRI

driver risk scale was the single strongest predictor of rapid DUI recidivism. The DSM-IV substance abuse and dependence classifications were also significant predictors of DUI recidivism. A number of the DRI risk scales and the DSM-IV classifications exhibited significant predictive validity and exhibited sensitivity in identifying recidivists similar to other popular DUI offender assessment instruments.

Conclusions: The DRI provides useful identification of DUI recidivists in a sample able to capture only the most rapid DUI recidivists. The results of this research warrant further examination of the DRI’s ability to identify DUI recidivists using longer intervals of time between DUI arrests. (C) 2011 Elsevier Ireland Ltd. All rights reserved.”
“Boron/Neutron/Capture/Therapy. Background and Purpose: B-10 deriving from B-10-para-boronophenylalanine (BPA) and B-10-borocaptate sodium (BSH) have been detected in blood samples of patients undergoing boron neutron capture therapy (BNCT) using prompt gamma ray spectrometer or Inductively Coupled Plasma (ICP) method, respectively. However. the concentration of cacti

compound cannot be ascertained because boron atoms in both molecules are the target in these assays. Here, we propose a simple and rapid method to measure

only BPA by detecting fluorescence based on the characteristics of phenylalanine. Selleckchem GF120918 Material and Methods; B-10 concentrations of blood samples from human or mice were estimated by the fluorescence intensities at 275 nm of a BPA excited by light of wavelength 257 run using a fluorescence spectrophotometer. Results: The relationship between fluorescence to increased BPA concentration showed a positive linear con-elation. Moreover, we established an adequate condition for BPA measurement in blood samples containing BPA, and the estimated B-10 concentrations of blood samples derived from BPA treated mice were similar between the values obtained by our method and those by ICP method. Conclusions This new assay will be useful to estimate Protein Tyrosine Kinase inhibitor BPA concentration in blood samples obtained from patients Undergoing BNCT especially in a combination use of BSH and BPA.”
“Hydrophobic polyvinylidene fluoride (PVDF) membrane has been successfully developed using dual coagulation bath system in which first coagulation bath produced membrane with nodular structure whereas second water coagulation bath provided membrane with porous structure. The effects of coagulation time, polymer concentration, and isopropanol/water ratio in first coagulation bath on membrane wettability were studied.

Main Outcome Measures: Success rate, defined as a reduction of pe

Main Outcome Measures: Success rate, defined as a reduction of perforation size of 50% or more to determine relative changes of the perforation size; effect of initial size and location of TM perforation on success rate; and air and bone conduction thresholds to determine air-bone gap measured before treatment.

Results: Randomization

made matching pretreatment perforation size of the 2 study groups impossible, and the initial rate perforation/TM was significantly smaller in the PDGF group. No difference between the 2 groups was found for perforation/TM less than 10%. However, success rate did not differ significantly between the 2 groups (power = 0.8), and the effect of PDGF Selumetinib was found to be small (-2%; standard deviation, +/- 49%). Initial size and position of the TM perforation were not significant factors determining success. Mean air-bone gap for the frequencies of 0.5, 1, 2, and 4 kHz was 22.5 dB.

Conclusion: The topical application of PDGF as an office treatment for chronic otitis media is not a Screening Library molecular weight favorable alternative to surgery.”
“Purpose: To identify the prevalence of potential drug-drug interactions (pDDIs) in a psychiatric ward, their levels and association with risk factors.

Methods: This study was conducted in the psychiatric

ward of Ayub Teaching Hospital, Abbottabad, Pakistan. Medical records of 415 patients were retrospectively reviewed for pDDIs using Micromedex Drug-Reax software. Logistic regression was applied to determine association of pDDIs with age, gender, hospital stay and number of drugs.


In our study, we identified total number of 825 pDDIs of 126 types, with median number of 1 pDDIs per patient. Overall 64.8% of the patients had at least one pDDI; 27.2% at least one major pDDI; and 58.5% patients at least one moderate pDDI. Among 825 identified pDDIs, most were of moderate (75.6%) or major (20.8%) severity, good (66.4%) or fair (29%)type of scientific evidence; and delayed onset (71%). The most frequent major and moderate pDDIs included haloperidol + procyclidine (127 cases), haloperidol + olanzapine (49), haloperidol + promethazine see more (47), haloperidol + fluphenazine (41), diazepam + divalproex sodium (40), haloperidol + trihexyphenidyl (37), lorazepam + divalproex sodium (34), fluphenazine + procyclidine (33) and olanzapine + divalproex sodium (32). There was significant association of occurrence of pDDIs with hospital stay of 7 days or longer (p = 0.005) and taking 7 or more drugs (p < 0.001).

Conclusion: A high prevalence of pDDIs in the psychiatric ward was recorded, a majority of which were of moderate severity. Patients with long hospital stay and increased number of drugs were more exposed to pDDIs.

We suggest that poor LQAS performance is due, in part, to variati

We suggest that poor LQAS performance is due, in part, to variation in the true underlying distribution. However, until now the role of the underlying distribution in expected performance has not learn more been adequately examined.

Methods We present Bayesian-LQAS (B-LQAS), an approach to incorporating prior information into the choice of the LQAS sample size and decision rule, and explore its properties through a numerical study. Additionally, we analyse vaccination coverage data from UNICEF’s State of the World’s Children in 1968-1989 and 2008 to exemplify the performance of LQAS and B-LQAS.

Results Results of our numerical study show

that the choice of LQAS sample size and decision rule is sensitive to the distribution of prior information, as well as to individual beliefs about the importance of correct classification. Application of the B-LQAS approach to the UNICEF data improves specificity and PPV in both time periods (1968-1989 Proteases inhibitor and 2008) with minimal reductions in sensitivity and negative predictive value.

Conclusions LQAS

is shown to be a robust tool that is not necessarily prone to poor specificity and PPV as previously alleged. In situations where prior or historical data are available, B-LQAS can lead to improvements in expected performance.”
“A spindle cell lipoma (SCL) is a relatively common tumor that can be challenging to the radiologist, pathologist, or surgeon to diagnose, 3-MA purchase particularly when internal fat content is scant or absent. Although these lesions may be found at various locations, the typical presentation for this lesion is a well-circumscribed and non-aggressive subcutaneous mass in the posterior neck presenting in a middle-aged to elderly man. In this article, the typical and atypical imaging characteristics of a spindle cell lipoma (SCL) will be reviewed. Knowledge of the common imaging and pathologic features of SCLs can help suggest the diagnosis and guide patient management.”
“Objective: Nasal obstruction is a common symptom in childhood. It may be frequently observed in children with allergic rhinitis and/or adenoidal

hypertrophy. However, its assessment is very difficult. The aim of the study was to compare the use of both a Face Related Scale (FRS), recorded by children and their parents, and a simplified Visual Analogue Scales (sVAS) with nasal endoscopy in children complaining nasal obstruction.

Methods: 121 children (75 males, mean age 7.5 years) were studied. FRS and sVAS for nasal obstruction and endoscopy were performed in all patients.

Results: A moderate correlation has been observed between FRS and sVAS and obstruction of nasal anterior segment (r = 0.51 for FRS; r = 0.52 for sVAS), a strong correlation was observed with nasal posterior segment (r = 0.60 for FRS; r = 0.61 for sVAS) assessed by endoscopy.

(c) 2011 American Institute of Physics [doi:10 1063/1 3565996]“<

(c) 2011 American Institute of Physics. [doi:10.1063/1.3565996]“
“Partial androgen insensitivity syndrome (PAIS) is the milder variant of androgen receptor (AR) defects. The subtle effects of AR mutations present in a patient with micropenis, peno-scrotal hypospadias, infertility, clitoromegaly and posterior labial fusion. We studied the association of isolated micropenis with the genetic defects resulting in androgen resistance,

that is, AR gene defects and 5-alpha reductase type 2 (SRD5A2) deficiency. We describe two cases of isolated micropenis: one in a 14-year-old boy and the other in a 3-year-old boy who was followed until he was 10 years BI 2536 supplier old. There were no findings of hypospadias, cryptorchidism or gynecomastia in either of these patients. Serum gonadotrophin and androgen levels were obtained and karyotyping was done. Human chorionic gonadotropin (hCG) stimulation testing assessed the functional capacity of the testes. DNA was extracted from peripheral

leukocytes, and all exons of the SRD5A2 and AR genes were amplified by polymerase chain reaction and sequenced. In both patients, baseline testosterone (T) level was low and the values were elevated after hCG testing. The sequence of the SRD5A2 gene was normal in patient 1, and a heterozygous polymorphism, V89L, was found in patient 2. Two known mutations, P390S and A870V, were identified in patients 1 and 2, respectively. Mutations in the AR gene can be associated with isolated micropenis without other features of PAIS, such as hypospadias or gynecomastia. This underlines the importance of including AR gene analysis in the evaluation of isolated micropenis Gamma-secretase inhibitor with normal

Apoptosis inhibitor plasma T to ensure proper management of the patient and appropriate genetic counseling for the family.”
“The authors describe the neuropsychiatric spectrum of voltage-gated potassium-channel complex (VGKC) autoimmunity among 67 sero positive patients; 2 had initially been assigned a primary psychiatric diagnosis. Diverse manifestations were recorded, often affective-predominant. Symptoms for 24 patients with florid presentations included confusion, 92%; memory impairment, 75%; personality change, 58%; depression, 33%; and anxiety, 29%. Of 15 who received immunotherapy, 67% improved. Forty-three patients with milder presentations or low positive VGKC complex Ab values are also described. Neuropsychiatric presentations were significantly associated with higher autoantibody values. Improvements were most evident in patients treated early, which emphasizes the need for early diagnosis and immunotherapy initiation. (The Journal of Neuropsychiatry and Clinical Neurosciences 2011; 23:425-433)”
“Chemical coating, hot compaction, and hot deformation techniques have been applied to prepare bulk anisotropic SmCo5/alpha-Fe nanocomposite magnets. The effects of alpha-Fe content on the structure and magnetic properties of the magnets were studied.

Furthermore, DHMEQ significantly ameliorated TNBS colitis as asse

Furthermore, DHMEQ significantly ameliorated TNBS colitis as assessed by body-weight changes and histological scores.

Conclusion: DHMEQ ameliorated experimental colitis in mice. These results indicate that DHMEQ appears to be an attractive therapeutic agent for IBD. (C) 2011 European Crohn’s and Colitis Organisation. Published by Elsevier B.V. All rights reserved.”
“Background: It has been shown that glucose degradation products (GDP) generated during heat sterilization

of peritoneal dialysis (PD) fluids impair the peritoneal membrane locally, then enter the systemic circulation and cause damage to the remnant kidney. Here we examined in subtotally nephrectomized (SNX) rats whether GDP also affect the cardiovascular system.

Materials and Methods: Standard 5/6 nephrectomy was carried out in Sprague-Dawley rats; other rats were sham operated and left untreated for 3 weeks. Through an osmotic mini-pump, SNX+GDP group received GDP intravenously Angiogenesis inhibitor for 4 weeks; the SNX and the sham-operated groups remained

without GDP. The experiment was terminated for all groups 7 weeks postoperatively. We analyzed cardiovascular damage by serum analyses and immunohistochemical investigation.

Results: In SNX+GDP animals, expression of the advanced glycation end product (AGE) marker carboxymethyllysine and receptor of AGE (RAGE) were significantly higher in the myocardium and the aorta compared to the SNX rats. We also found significantly higher levels of apoptosis measured by caspase 3 staining in the BI-D1870 mouse cardiovascular system in the SNX+GDP

group. Moreover, we observed a more pronounced expression of oxidative stress in the SNX+GDP rats compared to the SNX rats. In serum analyses, advanced oxidation protein products and reactive oxygen species were increased, as was immunohistochemical endothelial nitric oxide synthase.

Conclusions: In addition to local toxic effects, GDP cause systemic toxicity. Here we showed that, in SNX rats, administration of GDP increased cardiovascular damage. In particular, we found increased levels of AGE, RAGE, oxidative stress, and apoptosis. Whether these findings are of clinical relevance has to be further investigated.”
“Background and aims: Leukocyte infiltration, up-regulation of proinflammatory cytokines and severe oxidative stress caused by increased amounts of reactive oxygen species are characteristics of inflammatory bowel disease. The catechin (2R,3R)-2-(3,4,5-Trihydroxyphenyl)-3,4-dihydro-1(2H)-benzopyran-3,5,7-triol-3-(3,4,5-trihydroxybenzoate), named epigallocatechin-3-gallate, EGCG, has been demonstrated to exert anti-inflammatory and antioxidative properties, reducing reactive oxygen species in the inflamed tissues. The aim of this study was to evaluate the therapeutic effects of EGCG in a murine model of colitis induced by oral administration of dextran sodium sulfate.

Methods: Mice received a daily oral administration of 6.9 mg/kg body weight EGCG or Piper nigrum (L.

CNI nephrotoxicity occurs soon after initiation of therapy, is mo

CNI nephrotoxicity occurs soon after initiation of therapy, is more clearly dose-dependent. This scenario presents a clear need for new strategies that produce adequate GKT137831 immunosuppression

to prevent acute rejection and simultaneously reduce adverse effects associated with CNI-related therapies. To obtain significant long-term improvement in renal allograft outcomes, it may be necessary to adopt new immunosuppressive regimens that rely less on CNIs.”
“Inhaled nitric oxide (iNO) has been used not only for pulmonary vasodilation in term neonates with hypoxemic respiratory failure, but also in preterm ones at risk of chronic lung disease (CLD) with variable results in prevention and treatment of CLD and/or brain injury. However, meta analysis of clinical trials does not support that iNO should be used routinely in preterm infants with hypoxic respiratory failure as it has no convincing long-term follow-up data to show its advantages in neurodevelopment.

Investigation of extra-pulmonary effects of iNO through nitrosothiol hemoglobin-associated hypoxic vasodilation, as well as its intra-and extra-pulmonary anti-inflammation effect, would have biological and physiological potential in the management of the lung and brain injury of prematurity. selleckchem The eligibility and safety of iNO in these premature infants at high risk of neurodevelopmental disability require more clinical and LY2835219 nmr follow-up effort to test its pharmacological benefit over harm.”
“Objective: To review the literature regarding the interaction among amiodarone therapy, thyroid hormone levels, and warfarin metabolism.

Methods: A 73-year-old male with type 2 after describing an unusual case of amiodarone-induced thyrotoxicosis (AIT) who experienced a severe rise in international normalized ratio (INR) values after initiating warfarin therapy due to an unusual combination of excessive thyroid hormones, amiodarone

therapy, and a genetic abnormality affecting warfarin metabolism.

Results: Genetic analysis revealed that the patient was CYP2C9*2 wild-type, CYP2C9*3/*3 homozygous mutant, and VKORC1*3/*3 homozygous mutant. A review of the literature revealed that both mutations can independently affect warfarin metabolism. In addition, amiodarone therapy and the presence of thyrotoxicosis per se can affect warfarin metabolism and reduce the dose needed to maintain INR in the therapeutic range. The association of the 2 genetic polymorphisms in a patient with AIT is extremely rare and strongly impairs warfarin metabolism, exposing the patient to a high risk of overtreatment.

Conclusions: In patients with AIT, warfarin therapy should be gradually introduced, starting with a very low dose, because of the significant risk of warfarin overtreatment. Whether the genetic analysis of CYP2C9 and VKORC1 polymorphisms should be routinely performed in AIT patients remains conjectural.