The prevalence of elevated gamma-glutamyltransferase and sorbitol dehydrogenase activity in racing Thoroughbreds and their associations with viral infection.

BACKGROUND: In racehorses, serum gamma-glutamyltransferase (GGT) activity is positively correlated with cumulative days in training and, when ≥100 IU/L, has been associated with poor performance. The prevalence of increased GGT activity in North American Thoroughbreds and its aetiopathogenesis are unknown. Four emerging viruses, pegivirus E (PgV E; equine pegivirus), hepacivirus A (HcV A; equine hepacivirus), pegivirus D (PgV D; Theiler's disease virus), and equine parvovirus-hepatitis (EqPV-H) have been identified in horses with clinical and subclinical hepatopathy. Available prevalence data indicate these viruses may commonly infect racehorses and contribute to increased liver enzyme activity in this population. OBJECTIVES: To investigate the association between viral infection and increased liver enzyme activity in racing Thoroughbreds. STUDY DESIGN: Cross-sectional study. METHODS: Prerace blood samples were collected from 802 Thoroughbreds and tested for GGT and sorbitol dehydrogenase (SDH) activity, and the presence of PgV E, HcV A, PgV D and EqPV-H nucleic acid. RESULTS: Increased SDH and/or GGT were detected in 56.2% of the 802 serum samples. The infection prevalence and relative risk (RR) of having concurrently increased liver enzyme activity were: PgV E = 18.2% (RR = 0.820, 95% CI = 0.662-0.978, P = 0.03), HcV A = 2.5% (RR = 1.132, 95% CI = 0.719-1.466, P = 0.6), PgV D = 0.5% (RR = 0.875, 95% CI = 0.165-1.598, P>0.9), EqPV-H = 2.9% (RR = 0.916, 95% CI = 0.564-1.266, P = 0.7). MAIN LIMITATIONS: Longitudinal samples were not tested. CONCLUSIONS: While viral infection was common among Thoroughbreds in this study, infection did not explain the high prevalence of increased liver enzyme activity. In fact, PgV E infection was associated with a reduced risk of having increased liver enzyme activity, indicating PgV E is unlikely to be a cause of hepatitis in horses. Importantly, like GGT, increased SDH activity was highly prevalent in this study, and provides additional evidence that hepatocellular injury was occurring in these horses.

Women: sterilization guidelines.

PIP: The Department of Health, Education and Welfare (HEW) proposed a set of guidelines in December in an effort to stem the abuse of those being sterilized under HEW-funded programs. HEW explains that the guidelines are appropriate in light of the Department's experience with the present rules governing sterilizations and in light of the recent decision of the United States Court of Appeals for the District of Columbia Circuit in Relf versus Weinberger. The guidelines for federal reimbursement are the following: 1) the requirement that the patient sign a consent form in the patient's primary language indicating that the decision is voluntary and that the patient understands the nature of the procedure; 2) the requirement that the physician performing the sterilization certify in writing that the patient has been informed about the nature of the procedure and her rights to continued welfare benefits if she declines to be sterilized; 3) extension of the waiting period from the time of signing the consent form to the time of the operation from 72 hours to 30 days; 4) prohibiting payment for sterilization operations on anyone under the age of 2l; 5) prohibiting hysterectomy as a form of birth control; 6) prohibiting sterilization of mentally incompetent individuals; and 7) providing federal funding for sterilizations of individuals in penal or mental institutions only if they are approved by a special review committee and a court. The guidelines are good but very limited. If a physician is willing to forgo federal reimbursement, he or she may forgo the guidelines as well. The guidelines have received broad support.^ieng