Hydroxychloroquine compared with placebo in rheumatoid arthritis. A randomized controlled trial

OBJECTIVE

To assess the efficacy of hydroxychloroquine, 400 mg daily, for rheumatoid arthritis.

DESIGN

Six-month, double-blind, randomized trial.

SETTING

Ambulatory referral clinic in a Mexico City, Mexico, teaching hospital.

PATIENTS

A total of 126 patients with early rheumatoid arthritis were randomly assigned to receive hydroxychloroquine, 400 mg/d, or placebo; 121 patients completed the study.

RESULTS

Hydroxychloroquine showed a clinically and statistically significant improvement over placebo in joint score (20% greater mean improvement; 10% more patients improved by > 50%); pain (40% greater mean improvement; 19% more patients improved by > 50%); grip strength (22% greater mean improvement; 21% more patients improved by > 50%); patient global assessment (16% more patients stated they had improved); and physician global assessment (12% more patients were judged to have improved). Side effects were mild, and no patients in the hydroxychloroquine group required discontinuation of therapy. Patient compliance with the study medication was high.

CONCLUSION

Hydroxychloroquine is moderately effective in early rheumatoid arthritis.

Direct membrane-damaging effect of sertaconazole on Candida albicans as a mechanism of its fungicidal activity

The direct action of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy- methyl]benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) on the membrane integrity of C. albicans is studied by quantifying the leakage of intracellular adenosine triphosphate (ATP) into the medium as an index of the changes in membrane permeability and integrity and cell viability of the culture used. Sertaconazole caused a dose-dependent decrease in intracellular ATP after only 10-min exposure and a concomitant significant increase in extracellular ATP. This behaviour is characteristic of antifungals which are fungicidal as a result of a direct membrane damage. Thus sertaconazole, in addition to the mechanism of action responsible for its fungistatic activity (inhibition of ergosterol synthesis), has a second mechanism of action providing a significant fungicidal activity due to direct cell membrane damage.

[Prevalence, physiopathology and processes associated with hypouricemia in a hospitalized population: analysis of 27,987 analytic determinations]

A prospective analysis of 27,987 serum samples revealed a uricemia less than 2.0 mg/dl in 172 patients (prevalence of 0.61%). One hundred and six patients were being treated with more than one drug. Amongst the 21 hypouricemic patients receiving only one drug the more frequently associated drugs were beta-lactamases, salicylates at high doses, and carbamazepine. Out of the 45 hypouricemic patients who were under no treatment, there were 12 cases of pregnancies, 6 had a neoplastic disease, 2 suffered chronic hepatopathy and one presented hereditary xanthinuria. Out of 7 non treated patients, 6 were uric acid hypersecretors and only one was hyposecretor. The results indicate that hypouricemia: a) is usually associated with an elevated renal excretion of uric acid and b) it is frequently associated with the administration of drugs although it can also be included in the context of multiple systemic disease.

[Carbon tetrachloride poisoning: a report of 3 cases]

Carbon tetrachloride is a toxic solvent easily obtained in our country. 3 cases of poisoning by accidental inhalation at place of work. The main clinical manifestations were acute renal failure and toxic hepatopathy. All patients, had a good evolution with dialysis therapy after a few weeks. We comment on some possible additional therapies to be used in treating patients with severe poisoning due to carbon tetrachloride.

[Hemorrhagic syndrome associated with a factor VIII:C inhibitor in a patient with lymphoma]

Acquired hemophilia (idiopathic or secondary) is an uncommon clinical condition. A 70-year-old male had a severe hemorrhagic disorder, and an IgG inhibitor of the factor VIII:C was detected in plasma. During the acute phase he was treated with packed red blood cells, frozen fresh plasma and polyvalent immunoglobulins. The hemorrhagic features subsided but the circulating anticoagulant persisted. The administration of an activated prothrombin complex permitted to make the diagnosis of the underlying disease, a highly malignant T type lymphoma. During the treatment with corticosteroids and polychemotherapy the inhibitor activity disappeared.

[Asymmetric septal myocardial hypertrophy associated with pheochromocytoma: reversibility of cardiopathy after extirpation of chromaffin tumor]

Left adrenal pheochromocytoma and mesenteric paraganglioma were diagnosed in a 52-year-old female with diabetes mellitus (fasting blood glucose 14.5 mmol/l), hypertension and myocardial asymmetric septal hypertrophy (septal/left ventricular free wall thickness 1.31). Carbohydrate metabolism and cardiac disease returned to normal after the resection of both tumors (fasting blood glucose 5.2 mmol/l, septal/left ventricular free wall thickness 1.10). This is the first patient reported in the Spanish literature in whom asymmetric septal hypertrophy has been correlated with the hypersecretion of catecholamines.

Effects of antidepressants on histamine H2 receptors in rat isolated uterus

The antagonist effect of various antidepressants, both tricyclic and non-tricyclic, and of thiothixene on the histamine H2 receptors has been studied in the rat isolated uterus. All the drugs studied inhibit the effect of histamine, acting as competitive antagonists. Trimipramine and mianserin were the antidepressants which showed the highest activity, superior to cimetidine, whereas nomifensine, viloxazine, trazodone and maprotiline were those which showed the lowest antihistamine H2 activity. These results suggest that there is an interaction between antidepressants and histamine H2 receptors in rat isolated uterus similar to the interaction existing between antidepressants and histamine H2 receptors in brain and other tissues.