Hydroxychloroquine use associated with improvement in lipid profiles in rheumatoid arthritis patients

Objective

Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease‐modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.

Methods

All adult individuals with the initial diagnosis of RA between January 1, 2001, and March 31, 2008, were identified (n = 1,539). Only patients with at least one lipid level post–RA diagnosis were included (n = 706). Information on demographics, medical history, body mass index (BMI), laboratory measures, and medications were collected at office visits. Potential risk and protective factors for dyslipidemia were controlled for in linear mixed‐effects regression models for low‐density lipoprotein (LDL), high‐density lipoprotein (HDL), total cholesterol, triglycerides, LDL/HDL, and total cholesterol/HDL.

Results

Patients were 69% women and 98% white, with a median age of 65 years and a median BMI of 29.8 kg/m². In the adjusted regression models, HCQ use was associated with the following average differences in lipids: LDL decrease of 7.55 mg/dl (P < 0.001), HDL increase of 1.02 mg/dl (P = 0.20), total cholesterol decrease of 7.70 mg/dl (P = 0.002), triglycerides decrease of 10.91 mg/dl (P = 0.06), LDL/HDL decrease of 0.136 (P = 0.008), and total cholesterol/HDL decrease of 0.191 (P = 0.006), which were stable over time.

Conclusion

Use of HCQ in this RA cohort was independently associated with a significant decrease in LDL, total cholesterol, LDL/HDL, and total cholesterol/HDL. Considering these results, its safety profile, and low cost, HCQ remains a valuable initial or adjunct therapy in this patient population at high risk for CVD.     

Temporizing treatment for the respiratory-compromised gravida: an observational study of maternal and neonatal outcome

Acute lung disease may originate in pregnancy because of the pregnancy itself or because of an intercurrent etiology. The purpose of this study was to describe the effect of prolonged antepartum mechanical ventilatory support on the mother and the neonate when the strategy was to prolong the pregnancy rather than deliver preterm. Among 72 312 parturients over eight years, three gravidae required mechanical ventilation 12-48 h after admission for different conditions, 45-91 days before delivery. Gestational age at intubation was 21-28 weeks. Appropriate analgesia, broad-spectrum antibiotics, vasopressors and betamethsone for fetal lung maturity were used in all cases. None received tocolysis. Despite uterine distension, respiratory support provided adequate oxygenation and FiO2 could be maintained below critical levels, obviating the need for early delivery. All women survived, were weaned from ventilatory support, discharged, and delivered healthy neonates at term. Mode of delivery was dictated by obstetrical indicators only. All five infants (two sets of twins) are healthy at 12-36 months with appropriate developmental milestones. We conclude that when the maternal condition is amenable to therapy, and given the risks of labor induction and of prematurity, there is only limited benefit of delivery while on mechanical ventilation.     

The changes in renal function after a single dose of intravenous furosemide in patients with compensated liver cirrhosis

Background  

Patients with compensated Child-A cirrhosis have sub clinical hypovolemia and diuretic treatment could result in renal impairment.     

Gastroparesis in diabetes mellitus: an ultrasonographic study

BACKGROUND AND AIM: To investigate diabetic gastro-paresis, a complication of diabetes mellitus and its determinants. MATERIAL AND METHODS: A group of 36 patients with diabetes and 20 healthy controls, with comparable age and sex ratio were investigated with an established ultrasonographic method. A mixed test meal of 400 kcal was given. Antral fasting and postprandial area, postprandial distension and emptying time were assessed. Glucose control was estimated by the measurement of fasting and postprandial glucose as well as by assessing HbA1c. RESULTS: Antral area was nonsignificantly larger in diabetes mellitus. Postprandial antral area and postprandial antral distension were higher in diabetes than in the controls. The prevalence of gastroparesis was 52.7%, without differences between the two types of diabetes: 53.8% in type I and 52.2% in type II diabetes mellitus. Gastroparesis was associated with poor short and long time control of blood glucose and with positive parasympathetic tests. Gastroparesis did not correlate with symptoms. CONCLUSION. Gastroparesis is a real complication in diabetes mellitus and can be documented using an ultrasonographic method. Poor glucose control and autonomic neuropathy are associated with gastroparesis.     

Magnesium ion inhibits spontaneous and induced contractions of isolated uterine muscle.

AIM: Magnesium sulfate, mainly used in obstetrics to treat eclamptic convulsions, is currently questioned as to its clinical tocolytic effect. We aimed to study the relaxant action (if any) of magnesium sulfate on in vitro pregnant and non-pregnant myometrium. METHODS: Myometrial strips, harvested from five pregnant women (35-39 gestational weeks) during Cesarean procedures indicated for dystocia or scared uterus and five non-pregnant women during hysterectomy or myomectomy for benign conditions, were placed in a Krebs-Henseleit solution organ bath and the isometric force was registered. We assessed the effect of Mg2+ (magnesium sulfate) at different concentrations (0.50-10 mM) on spontaneous and oxytocin-induced (1 microM) myometrial contractility. RESULTS: Mg2+ temporarily reduced spontaneous myometrial contractions in a dose-dependent manner, with efficient regimens at 2.0-2.5 mM, and arrested contractility completely at 3 mM. Oxytocin-induced contractions were reduced by 30-40% at 8 mM and decreased further at 9-10 mM. Induced contractions were reduced, in a dose-dependent and time-dependent manner (maximum effect at 20 min), at higher Mg2+ concentrations and with non-significant proportional differences between pregnant and non-pregnant myometrium. CONCLUSIONS: The present in vitro study suggests a possible benefit of Mg2+ in the inhibition of spontaneous myometrial contractility, but not of uterine-induced hyperactivity.