V. Onatas. Cazenovia College.
In Germany purchase cleocin gel 20gm otc acne jokes, a nationwide multicenter therapy study to evaluate the efect of adjuvant im- munophoresis in active pemphigus is currently in the planning discount cleocin gel 20 gm on-line skincarerx. Tere are now two prospec- tive studies and a number of case studies reporting the successful use of rituximab in se- vere pemphigus (Ahmed et al order 20 gm cleocin gel with mastercard acne 911 zit blast reviews. Studies report complete and long-term B-cell depletion under therapy which was maintained for six to twelve months in peripheral blood cleocin gel 20gm amex skin care careers. Based on a recently published recommendation by German-speaking dermatologists, the indications for rituximab therapy are analogous to those for adjuvant immunoadsorp- tion (Hertl et al. Severe bacterial 3 Autoimmune Bullous Skin Disorders 59 or viral infections can also occur. Isolated reports of progressive, multifocal leukoenceph- alopathy have also been reported under adjuvant rituximab therapy in systemic lupus ery- thematosus and vasculitis (Hertl et al. In everyday clinical practice an easily overlooked complication in pemphigus are sec- ondary herpes simplex infections of lesional or perilesional skin (see Fig. Clinical symp- toms of secondary infection generally occur as disseminated herpetiform blisters or punc- tate erosions with a punched-out appearance. The possibility of herpes simplex superinfec- tion should also be recalled in sudden clinical recurrence of disease afecting the face or intertriginous areas. Summary Autoimmune bullous disorders of the pemphigus group present a major clinical challenge based on their severe clinical course and limited therapeutic options. Making the diagno- sis of pemphigus requires histology,direct and indirect immunofuorescence and eventu- ally, serological analyses with recombinant autoantigens. Currently, there is no consensus on generally accepted clinical partameters that help to measure disease activity and clinical responses or relapses. The therapeutic standard of pemphigus consists of a global non- specifc immunosuppression with systemic glucocorticoids and immunosuppressive adju- vants causing severe side-efects and comorbidity. Due to the relative rareness of pemphi- gus, only few evidence-based controlled therapeutic trials have been performed. In light of limited approved immunosuppressive in the treatment of pemphigus, the of-label-use of potent immunosuppressive drugs is daily routine. Novel treatments, such as immunad- sorption, rituximab and intravenous immunoglobulins bear the potential to induce clini- cal remissions in refractory pemphigus cases. Exp Dermatol 16:218A Enk A (2009) Guidelines on the use of high-dose intravenous immunoglobulin in dermatology. J Invest Dermatol 109:127131 Hertl M, Eming R, Veldman C (2006) T cell control in autoimmune bullous skin disorders. Br J Dermatol 146:836839 3 Autoimmune Bullous Skin Disorders 63 Senear F, Usher B (1926) An unusual type of pemphigus: combining features of lupus erythemato- sus. Arch Derm Syphilol 13:761781 Sitaru C, Zillikens D (2005) Mechanisms of blister induction by autoantibodies. We will also focus on recent progress in our understanding of the pathophysiology of this disorder and on the role of targeted autoanti- gens in the maintenance of epithelial-stromal adhesion. Patients complain of severe itch accompanied or not by excoriated, eczematous, papular and or urticated lesions that may persist for several weeks or months, or even remain the only signs of the disease. In the bullous stage vesicles and bullae develop on apparently normal or erythema- tous skin together with urticated and infltrated plaques that have occasionally an an- 66 Giovanni Di Zenzo, Emmanuel Laffitte, Giovanna Zambruno and Luca Borradori 3 Fig. Panel A: bullous lesions on the forearms; Panel B: widespread urticated papules and plaques on the trunk distributed in a figurate pattern; Panel C: prurigo nodularis-like presentation with generalized papular and excoriated lesions; Panel D: child- hood form of bullous pemphigoid with vesicular and bullous lesions arranged in jewel-like clusters. The blisters are tense, with a clear exudate, and may persist for several days, leaving eroded and crusted areas (Fig. The lesions are frequently dis- tributed symmetrically and predominate on the fexural aspects of the limbs, and abdo- men. Palmo-plantar involvement mimicking dyshidrosi- form eczema (dyshidrosiform pemphigoid) can also be observed. Several other variants, such as a prurigo nodularis-like (pemphigoid nodularis), erythroderma-like form, inter- trigo-like variants or forms mimicking severe bullous drug eruption have been described. Tese variants have all been reported with various terms: only dermatologists can aford to have so diferent names for the same condition! Panel A: pemphigoid gestationis: infiltrated plaques, vesicles and bullae in the perium- belical area and abdomen; Panel B: transplacentar passage of autoantibodies from a mother with gestational pemphigoid: neonate with a generalized eruption consisting of erythema- tous plaques with a figurate configuration and blisters; Panel C: bullous pemphigoid: light microscopy study shows a subepidermal blister with an inflammatory infiltrate in the blis- ter cavity and in the upper dermis consisting predominantly of eosinophils and neutrophils; Panel D: bullous pemphigoid: direct immunofluorescence microscopy depicting linear IgG deposits at the epidermal basement membrane. In the early phase, itchy papular and urticated lesions are observed, with later on development of vesicles and bullae (Fig. Relapses are frequently observed during subsequent pregnancies and they might also be triggered by either menstruation or intake of oral contraceptives. In a recent prospective study en- compassing the entire Swiss population, the incidence was found to be of 12. It rap- idly increases with aging and the relative risk for patients older than 90 years has been esti- mated to be approximately 300 fold higher than for subjects of 60 years of age or younger. Some reports have suggested an increased frequency of cer- tain cancers (such as of digestive tract, urinary bladder, and lung) and lymphoproliferative disorders. In a case-control study, an association was found with aldos- terone antagonists and neuroleptics (Bastuji-Garin et al. In these conditions, it has been speculated that the infammatory process at the dermo-epidermal junction is responsible for the exposure of antigens to autoreactive T lymphocytes leading to a secondary immune response (reviewed in Chan et al. However, immunofuorescence microscopy studies are very useful for an initial classifcation. Light microscopy studies of an early bulla show a subepidermal blister with a dermal in- fammatory infltrate composed predominantly of eosinophils and neutrophils (Fig. In early non-bullous phases, subepidermal clefs and eosinophilic spongiosis can be found. Direct immunofuorescence microscopy studies characteristically show linear deposits of IgG and or C3, and more rarely, of other Ig classes along the epidermal basement mem- brane (Fig. Indirect immunofuorescence studies demonstrate the presence of circulating IgG auto- antibodies in 60 to 80% of patients, that typically bind to the epidermal side of saline separated normal human skin (Gammon et al. The latter substrate has been found to be superior than intact skin and other substrates such as monkey esophagus. In gestational pemphigoid, patients have IgG1 and IgG3 complement-fxing antibodies which are best detectable by a complement-binding indirect method. Antigens are tested under native conditions and, by this mean, reactivities against conformational antigens are not missed. In contrast to previous published 70 Giovanni Di Zenzo, Emmanuel Laffitte, Giovanna Zambruno and Luca Borradori Table 1. Diseases within the pemphi- gus group can be easily diferentiated on the basis of distinctive immunopathological fea- tures. The distinction of the following subepidermal blistering disorders may be challenging: 1. In addition, in the course of the dis- ease, a mixture of infammatory and non infammatory features may be observed. The latter might be distributed in jewel-like clusters or string of pearls patterns. Anti-p200 pemphigoid, a recently identifed entity within the group of autoimmune subepidermal blistering diseases. Rarely, patients have a dermatitis herpetiformis-like grouped papulovesicles and oral and / or mucosal lesions can occur. Patients autoantibodies specifcally recog- nize a 200 kDa protein of the dermo-epidermal junction, the laminin gamma 1 chain (Dilling et al. Scarring is typical except for a subset of patients with disease restricted to the oral mucosa (Mutasim et al. Subsets of patients with either pure ocular involvement, predominant oral mucosal involvement without cutaneous lesions, or with both oral and cutaneous lesions have been identifed (Chan et al.
Scabies infection shows a cyclical Classical scabies is transmitted via direct pattern with a periodicity of 1030 years buy cleocin gel 20gm on line acne with mirena. In crusted scabies transmission can in nursing and residential homes where both also occur via skin scales on bedding best 20 gm cleocin gel skin care 1006, clothes patients and staff may be affected best cleocin gel 20gm acne quistico. Practitioners reported a mean weekly inci- Scabies remains infectious until treated purchase cleocin gel 20 gm free shipping skin care routine for dry skin. This proba- passed to humans but only causes a temporary bly underestimates the true incidence. Diagnosis Prevention Theremaybenosignofinfectionfor24weeks Prevention of scabies depends on early recog- after exposure, when an allergy develops to nitionofcasesandprompteffectivetreatment. The rash comprises small, sional education and a high level of awareness red papules and is seen anywhere on the body. If the person has had scabies before, the rash may appear within a few days of re-exposure. Surveillance Burrows are the only lesions caused directly by the mite and may be seen in the webs of Scabies is not notifiable; however, clusters of the fingers and on wrists and elbows. In in- cases of scabies in residential and day-care set- fants, young children, the elderly and the im- tings should be reported to the local public munocompromised, mites can also infect the health team. Usually only about 12 mites are present on an affected person at any one time but if there is impaired immu- Response to a case nity or altered skin sensation large numbers of mitesmaybepresentandtheskinisthickened Aqueous malathion lotion or permethrin and scaly. This condition is known as atypical, dermal cream should be applied to the whole crusted or Norwegian scabies. A hot bath prior to application should be discouraged as it increases systemic absorp- Transmission and acquisition tion. Ideally the scabicide should be left on for 24 hours and should be reapplied if the The pregnant female, which is about 0. Thepatient long, burrows in the epidermis and lays 23 should then have a bath or shower, dress in eggseachdaybeforedyingafter45weeks. Diagnose, treat and follow up cases of scabies amongst their patients and contacts. Residential and nursing home Remain vigilant to the possible diagnosis of scabies. Inform all close contacts, particularly those in a day-care or nursing setting if scabies is suspected. Itching may continue for 23 weeks af- Clusters of cases of scabies may be reported ter successful treatment and may require treat- from hospitals, nursing homes or other resi- ment with anti-pruritics. Confir- All household, close and sexual contacts mation of the diagnosis is important in these should receive simultaneous treatment, even settings. He/she may ask for a sec- conditions mites will become dehydrated and ond opinion from a consultant dermatologist. Normal hygiene and vacuuming of chairs, A high level of diagnostic suspicion should beds and soft furnishings will minimise envi- be maintained. Use of standard precautions isnecessary,whichmaybecontinuedforsome including gloves and aprons will minimise time. Shigella 203 Staff can return to work once treatment has very severe illness due to production of an ex- been completed. Suggested on-call action If the case is a member of staff, treatment is recommended for his/her close household Ifthecaseisinriskgroupforfurthertrans- contacts. Most years since 1980 have be advised and a search should be made seen less than 5000 reports, with the excep- for an unrecognised source case of crusted tion of a small epidemic in the mid-1980s and scabies. Oftenwithothersim- Shigellosis is primarily a disease of children, ilar cases reported amongst household and with the highest rates reported in those less other close contacts. Boys have higher rates than girls, but the reverse is seen in those aged 1544 years. Approxi- tory seats, towels and any other vehicle that mately 4050% then develop mucus and/or could become contaminated by faeces, either frank blood in the stool (dysentery). Flies may also oped countries illness is usually self-limiting, transfer the organism from faeces to food. Recent out- uraemic disease and has a case-fatality rate of breaks in Europe have been due to imported 1020%. Asymptomatic Shigella infection and iceberg lettuce (several countries), imported excretion may also occur. Laboratory conrmation Acquisition Diagnosis is usually confirmed by isolation of the organism from faeces; testing is routine The incubation period is between 12 and 96 in most laboratories. The infectious period is primarily dur- should always be carried out as control mea- ingthediarrhoealillness;however,casesmain- sures vary between species. Serotyping based tain a low level of infectivity for as long as the onOantigensisalsoavailableifepidemiolog- organism is excreted in the stool, which is 2 ically indicated, e. Transmission to other humans is via the faecooral route either directly or by contam- Adequate personal hygiene, particularly ination of food, water or the environment. Direct person-to-person spread is extremely Adequate toilet facilities in schools. Super- common in households and institutions, par- vised handwashing in nursery and infant ticularlythosewithyoungchildren:3050%of schools. Shigella 205 Care with food and water for travellers to de- Investigation of a cluster veloping countries. Surveillance Does epidemic curve suggest point source (plus secondary cases) or continuing expo- All clinical cases of diarrhoea or dysentery sure? Doesage/sex/ethnic/geographicanalysis should be reported to local public health of cases suggest common factor? Laboratory isolates of Shigella eries, schools, social clubs, care facilities and species from symptomatic patients should be links between affected families via child net- reported to the relevant national surveillance works. Response to a case For non-sonnei species, look for social net- works that include travellers to developing Hygiene advice to case and contacts. Supervised handwashing for sonnei,excludeuntil48hoursafterfirstnormal children aged under 8 years. Increase cleaning of risk areas in toi- shigellae, exclude until 2 consecutive negative lets (e. Checktoseeifothercasesand Provide hygiene advice to families of those reinforce hygiene measures. Ifnolinkabroad,obtaindetailsof pain with Shigella species of outbreak contacts and full food history for 4 days before strain identified in faeces. Clinical: diarrhoea in member of popula- Mild cases will recover without antibiotics tion of affected institution, without al- and multiple drug resistance is increasing. Naturally oc- flu-like symptoms fever, headache, malaise curring infection has been eradicated world- and aching head and back. The distinctive wide, so its public health importance now lies vesicular rash then appears over the next 1 in the potential of a deliberate release in a 2 days, eventually covering the whole body. The vesicles develop into pustules over the next week; these crust and fall off over the next 34 weeks, leaving per- Suggested on-call action manent pitted scars. There is no spe- If diagnosis is likely, isolate at the point cificeffectivetreatment,althoughvaccination of contact and notify national surveillance early in the incubation period can modify the unit. In malignantsmallpox,themostsevereform,the rash is haemorrhagic and the case fatality rate is over 90%. Epidemiology Smallpoxmaybeconfusedwithchickenpox: diagnostic clues are given in Table 3.
Correlation between disease phenotype and genetic herogeneity in rheumatoid arthritis buy cleocin gel 20gm with visa acne lotion. Incidence generic 20 gm cleocin gel otc skin care 30 anti aging, prevalence buy generic cleocin gel 20 gm online acne cure, outcome purchase 20 gm cleocin gel skincare for 25 year old woman, and first symptoms; the high prevalence in black women. The epidemiology of systemic lupus erythematosus and other connective tissue diseases in Rochester, Minnesota, 1950 through 1979. Estimating the incidence of systemic lupus erythematosus in a defined population using multiple sources of retrieval. Systemic lupus erythematosus on the Caribbean island of Curacao: an epidemiological investigation. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. Symptomatic hand osteoarthritis in the United States: prevalence and functional impairment estimates from the third U. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants of the Framingham Study. Estrogen replacement therapy and worsening of radio- graphic knee osteoarthritis: the Framingham Study. Do antioxidant micronutrients protect against the devel- opment and progression of osteoarthritis? Key Words: Antioxidant; fish oil; folate; methotrexate; nonsteroidal anti-inflammatory drugs; proinflammatory cytokines; prostaglandin E2 1. Treatment plans for rheumatic diseases vary depending on the type of disease and the patients condition. Medications for the treatment of rheumatic diseases are often used to relieve symptoms and prevent further worsening of the disease rather than to cure the disease. Lyme disease, infectious arthritis, and gout are some of the exceptions in which case symptoms of arthritis can be prevented or cured with early intervention and proper medications. Drugnutrient interactions can change both the therapeutic efficacy of medications and the nutritional requirements of patients. Therefore, understanding potential drug and food or nutrient interactions is crucial for maximizing biological effectiveness and minimizing the side effects of medications while ensuring optimal nutritional status of patients. Anticytokine-based therapies have emerged recently and are often used in combi- nation with conventional therapies. Potential drugnutrient interactions are reviewed in relation to these different categories of therapies. Alteration of Pharmacokinetics by Food Foods may interfere with or alter the absorption or metabolism of drugs and cause a change in pharmacokinetics (1). Physicochemical interactions between nutrients and drug components include adsorption, complex formation, precipitation, and change in stability. Physicochemical interaction requires the simultaneous presence of the drug and the food component at the site of interaction. Therefore, timing of medication use in relation to food intake can influence the absorption of the drug. Drugs absorbed only in the upper intestine have a greater potential for reduced absorption when given with food (2). Certain rheumatic disease medications such as methotrexate and penicillamine should be taken in a fasting state to prevent a decrease in absorption (1). Modulation of Biological Mediators of Rheumatic Diseases by Nutrients Nutrients can modulate the course of therapy by their effects on biological mediators of rheumatic diseases such as cytokines and prostaglandins. Nutrients may have their own effect on the symptoms associated with rheumatic diseases, and as such, may influence the dose requirements of drugs. Nutrients may also affect side effects of the drugs to make the medication more or less tolerable. Omega-3 (n-3) fatty acids have been shown to have a significant impact on the production of eicosanoids and proinflammatory cytokines, which play a crucial role in the pathology of rheumatic diseases (3). Change in Nutritional Status by Drugs Drugs can often change the nutrient status of the patient. Drugs can also cause low levels of certain nutrients by interfering with nutrient absorption. Therefore, dietary intake and the nutritional status of patients should be monitored during the course of therapy to ensure adequate intake of nutrients and to prevent nutritional imbalance associated with drug therapy. A lower peak plasma concentration and a delayed absorption of ibuprofen were observed when the drug was administered in a fed state (30 minutes after continental breakfast consumption) compared with a fasting state. When administered with food, the maximum plasma concentration and the area under the plasma level curve of the metabolite of nabumetone increased (10). Although the time to reach maximal plasma concentration was delayed by 1 hour when adminis- tered with a high-fat food, the observed peak plasma concentration was increased by concomitant food intake. Therefore, in patients with arthritis, celecoxib can be given either with or without food. For acute therapy, it may be preferable that celecoxib is given in the fasting state to avoid the food-induced lag time in its absorption (7). Supplementation of n-3 fatty acids results in increased production of prostaglandins and thromboxanes in three series and leukotrienes in five series. Clinical Benefits of n-3 Fatty Acids in Rheumatoid Arthritis Dietary n-3 fatty acids are one of the most extensively studied dietary therapies in relation to rheumatic diseases. They reported that there was no effect of n-3 fatty acids on patient reports of pain, swollen joint count, damage, and patients global assessment. However, in a qualitative analysis of seven studies that assessed the effect of n-3 fatty acids on anti-inflammatory drug or corticosteroid requirements, six demonstrated a reduced requirement for these drugs. At 3 years, 18 patients who consumed either bottled fish-oil juice or fish-oil capsules (71gcapsules twice daily) to provide 4 to 4. In animal models, feeding fish oil was shown to impair host resistance against Listeria monocytogenes (18) and to delay virus clearance in mice infected with influenza virus (19). Greater weight loss and suppression of appetite were observed following influenza infection in mice fed the fish oil diet for 14 days. However, the high level of vitamin E used (300 M) in combination with aspirin in this study makes it hard to extend these findings to clinical practice. In a 62 Part I / Introduction to Rheumatic Diseases and Related Topics double-blind, placebo-controlled, randomized study, Edmonds et al. Vitamin E did not have any effect on joint inflammation assessed by the Ritchie articular index, the duration of morning stiffness, or the number of swollen joints. Vitamin E significantly decreased pain parameters, suggesting some analgesic effects. They also increase the expression of adhesion molecules on the endothelium contributing to the emigration of inflammatory cells and lymphocytes from the systemic circulation (26). These factors contribute to the destruction of cartilage and bone, and the worsening of inflammation. Infliximab is a chimeric monoclonal antibody with mouse Fv1 and human immunoglobulin (Ig)G1, whereas adalimumab is a recombinant human IgG1 monoclonal antibody. Modulation of Proinflammatory Cytokines by n-3 Fatty Acid Supplementation Fish-oil supplementation can modulate inflammation by decreasing the production of proinflammatory cytokines. When nine young healthy subjects consumed 18 g of fish- oil concentrate per day (to provide 2.
The age of the animals was established according to weight generic cleocin gel 20 gm with visa skin care 4men palm bay, dentition discount cleocin gel 20gm mastercard acne questions, fur and certain body characteristics cleocin gel 20gm on-line acne information. They were divided into kittens (<3 months) 20 gm cleocin gel visa acne hydrogen peroxide, juveniles (between three and nine months), subadults (between nine months and two years) and adults (>2 years). However, due to the low number of kittens sampled (3), in order to establish biochemical values in the different ages classes, it was decided to group kittens with the juvenile class. Fifty six samples came from lynx captured in the wild (54%), 42 from animals in captivity (40%), and six from animals still in quarantine (6%), in specifc facilities for a period of two months to evaluate their health in terms of suitability for the Ex situ captive Breeding Programme). Although the majority of the lynx were captured using cage traps (87), other methods included capture with nets (9), manual immobilization for kittens (6) and darts containing anaesthetic, fred using a blowpipe (2). Se r u m biochemical v a l u e S f r o m 104 ib e r i a n ly n x e S (ly n x pa r d i n u S ). Therefore, a total of 130 samples from 104 lynx were analysed to obtain the biochemical values in different situations according to age (tables 2, 3 and 4). Most individuals were anaesthetised using a combination of ketamine (Imalgene 1000) and medetomidine (Domtor) (Martnez et al. Males who underwent electroejaculation were anaesthetised with tiletamine and zolazepan. Only samples from healthy individuals that did not show any of the clinical signs previously mentioned, and whose anaesthetic parameters were within the normal range, were included in the study. Se r u m biochemical v a l u e S in f r e e -r a n g i n g ib e r i a n ly n x e S (ly n x pa r d i n u S ). Finally, after separation of the serum, all the samples were sent by refrigerated courier and analysed within 24 hours of being extracted. Likewise, differences between groups were analyzed using the Tukey Post Hoc Multiple comparison Test. For each biochemical parameter, the normality in the distribution of values and the homogeneity of variance were determined using the Kolmogorov-Smirnov and Levenes tests, respectively. Se r u m biochemical v a l u e S in c a p T i v e ib e r i a n ly n x e S (ly n x pa r d i n u S ). Re s u l t s The biochemical reference values of the 21 parameters analyzed are shown in Table 1. The correlation analysis showed that sex and age were independent from the different variables included in the study. However a signifcant correlation was found between habitat condition, the population and the method of capture. Therefore, given the biological and clinical relevance, and the importance of the management of the situation in which the animal is found, the variables population and capture method were eliminated in order to determine statistical differences. The levels of alkaline phosphatase, phosphorus and cholesterol were higher in young animals, whereas creatinine, total protein and pancreatic amylase were higher in adults. Se r u m biochemical v a l u e S f o r ib e r i a n ly n x e S (ly n x pa r d i n u S ) in q u a r a n T i n e. The concentration of phosphorus was signifcantly higher in males than in females, whereas urea was greater in females. Animals sampled in different situations showed statistically signifcant differences in several biochemical parameters. Furthermore, they showed signifcantly higher concentrations of glucose in captive and quarantined individuals compared with the free-living lynx analyzed in this study. In the present study, the sample size could be considered representative of the total population due to the large number of animals analysed. The results are also similar to those published by our team in a previous study based on 31 individuals sampled between 2004 and 2006 (Garca et al. These results agree with those reported in other species of wild cat and are possibly a result of increased levels of stress suffered by these species during capture (Kocan et al, 1985; Hawkeye and Hart, 1986; Weaver and Johnson, 1995; Miller et al. The high levels of glucose obtained in Iberian lynx in comparison with the domestic cat have also been described in other wild feline species (currier and Russell, 1982; Fuller et al. The process of immobilisation and manipulation during capture has a greater adverse effect on wild species than on domestic cats. Stress and the use of anaesthetics during capture decrease the reduction of hepatic glycogen, and therefore, increase the concentration of glucose in blood (Miller et al. Urea levels in the Iberian lynx are also above the established ranges in the domestic cat (Kaneko et al. The high concentrations found in canada lynx (Lynx canadensis) adults by Weaver and Johnson (1995) were attributed to chronic renal dysfunction and, similarly, autoimmune membranous glomerulonephritis has recently been described in Iberian lynx (Jimnez et al. Although this study revealed higher levels of urea in adults compared with juveniles and subadults, these differences were not statistically significant. These fndings coincide with those previously observed in the Iberian lynx (Beltrn et al. The concentration of serum creatinine is directly related to muscle mass, so it is normal for levels obtained in adults to be higher. Likewise, increased physical activity and nutritional factors are also associated with high levels of creatinine, total protein and pancreatic amylase found in adults (Weaver and Johnson, 1995; Dunbar et al. Recently, Jimenez et al,(2008) found elevated levels of creatinine in Iberian lynx affected by membranous glomerulonephritis, which is more prevalent in adult animals. These results do not match those previously reported for this species (Beltrn et al. The higher levels of albumin previously reported in female Iberian lynx (Garca et al. The increase in levels of creatinine and glucose in captive lynx could be related to diet. The data is representative of the total population as it has been obtained from more than half of the existing lynx population, including animals of different ages, sexes, habitat conditions and metapopulations. This work has been possible thanks to the Environment Ministry of the Andalusian Government, which has commissioned the study and provided samples. Diseases of the Iberian serum biochemical reference intervals for Florida panthers. Interdisciplinary Methods in the Iberian lynx (Lynx pardinus) conservation Breeding Programme, in: Vargas, Meyer, D. Serologic survey and serum biochemical reference ranges of the free-ranging mountain lion (Felis concolor) in california. Histopathological and immunohistochemical fndings in lymphoid tissues of the endangered Iberian lynx (Lynx pardinus). Patterns and causes of non- natural mortality in the Iberian lynx during a 40 year period of range contraction. Los estudios iniciales revelaron la presencia de deplecin linfoide, glomerulonefritis y hialinosis folicular esplnica entre otros hallazgos menos frecuentes como tuberculosis y carcinomas de clulas escamosas. Muestras de tejidos fjados en formol de 40 linces ibricos fueron procesadas, teidas con hematoxilina y eosina y evaluadas. Adems, se emplearon tinciones especiales, inmunohistoqumica y microscopa electrnica en los tejidos renales y linfoides de casos seleccionados. El estado inmune fue evaluado mediante tcnicas de linfoproliferacin y fenotipado de clulas mononucleares sanguneas, utilizando muestras de sangre de 23 linces ibricos. Para evaluar la funcin renal fueron recogidas muestras de sangre (n=23) y orina (n=17) de forma prospectiva. En la mayora de los animales de este estudio se observ una deplecin variable de clulas T y B en los tejidos linfoides perifricos. Por su parte, los ensayos de linfoproliferacin y citometra de fujo mostraron una respuesta reducida y reduccin en el nmero de las poblaciones linfocitarias, respectivamente, en la mayora de los animales. Tambin se observaron depsitos de hialina en muchos de los folculos esplnicos evaluados.