Subacute toxicity evaluation of a hydroalcoholic extract of Pterodon pubescens seeds in mice with collagen-induced arthritis

When the immune system is stimulated there is a concomitant decrease in drug biotransformation and elimination that may results in unwanted drug response and toxic side effects. We investigated the subacute toxicity of a hydroalcoholic extract of Pterodon pubescens seeds (HEPp) to DBA1/J mice with collagen II-induced arthritis. The oral treatment with HEPp reduced the arthritic index without any concomitant alteration in their hematological examination, histopathological analysis and relative or absolute weight of several organs and in several clinical biochemical parameters when compared with the control group. We concluded that daily administration of anti-arthritic doses of HEPp did not induce any detectable subacute toxic side-effect in mice whose host defense mechanisms is active as we can observe in mice with CIA.

Primary ankylosing spondylitis: patterns of disease in a Brazilian population of 147 patients

OBJECTIVE

To analyze patterns of disease in a population of Brazilian patients with primary ankylosing spondylitis (AS).

METHODS

Retrospective study (1988-98) analyzing 147 patients with a diagnosis of primary AS according to the modified New York criteria. Selected patients had complete clinical (initial symptom, axial and peripheral involvement, heel enthesitis, extraarticular manifestations) and radiological (sacroiliac, lumbar, thoracic, and cervical spine) investigations, and these data were compared with sex, race, age at onset, and HLA-B27.

RESULTS

There was a predominance of men (84.4%), Caucasian race (75.5%), adult onset (> 16 years, 85%), and positive HLA-B27 (78.2%). Family history of AS was noted in 14.3% of the patients. Pure axial AS was observed in 37 patients (25.2%). The predominant initial symptoms were inflammatory low back pain (61.9%) and peripheral arthritis (22.4%). Thoracic and cervical spine involvement was noted in 70.1% of the patients; radiological findings included syndesmophytes in 46.9% and "bamboo spine" in 20.4% of patients. The extraaxial joints most frequently involved were: ankles (39.5%), hips (36.1%), knees (29.3%), shoulders (19%), and sternoclaviculars (14.3%); heel enthesitis was present in 22.4%. Acute anterior uveitis was noted in 14.3% of patients. Male sex was associated with involvement of thoracic spine (p = 0.002), cervical spine (p = 0.002), and hips (p = 0.042), whereas female sex was associated with sternoclavicular (p = 0.024) involvement. Caucasian race presented higher frequency of positive family history (p = 0.023); there was no statistical significance of clinical and radiological variables compared with African-Brazilians. Juvenile onset AS presented higher frequency of ankle (p = 0.012) and knee (p = 0.001) involvement, heel enthesitis (p = 0.001), and total hip replacement (p = 0.038), whereas adult onset was associated with thoracic (p = 0.026) and cervical spine (p = 0.026) involvement and positive family history (p = 0.044). Positive HLA-B27 was associated with ankle involvement (p = 0.007) and heel enthesitis (p = 0.013).

CONCLUSION

In this population women showed a milder axial involvement, Caucasian race presented axial and peripheral involvement similar to African-Brazilians, juvenile onset AS was associated with articular involvement of the lower limbs, and positive HLA-B27 was associated with ankle involvement.

Methotrexate in the treatment of ankylosing spondylitis

The authors carried out an open prospective study analyzing methotrexate (MTX) efficacy and toxicity in 34 patients with ankylosing spondylitis (AS) for a period of one year. All the patients presented with active axial disease, characterized by inflammatory spinal pain, prolonged morning stiffness, erythrocyte sedimentation rate (ESR) > or = 25 mm, and failure on treatment with non-steroidal anti-inflammatory drugs for a period of more than two years. MTX was taken at a single weekly intramuscular dose of 12.5 mg. Thirty-one patients (91%) concluded treatment. Eighteen patients (53%) were considered responders to MTX; most of them presented peripheral arthritis. Despite clinical improvement, axial measures were unaltered at the end of the study. The mean value of ESR decreased significantly at the end of the treatment (p=0.0001), predominantly in the responders group. Side effects were observed in 23 patients (68%) and included dyspeptic syndrome, transient elevation of liver enzymes, and dizziness. The results of this one year open study suggest that MTX can be an efficient drug in the treatment of AS.

Quality of life at the initiation of maintenance dialysis treatment--a comparison between the SF-36 and the KDQ questionnaires

OBJECTIVE

To evaluate the construct validity of the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) and to assess the quality of life of patients with end-stage renal disease (ESRD) at the initiation of maintenance dialysis treatment.

METHODS

Cross-sectional study.

SETTING

Eight ambulatory dialysis units in São Paulo city, Brazil.

STUDY PARTICIPANTS

Eighty ESRD patients at the initiation of chronic dialysis program and consecutively accepted for treatment in selected units in 1998.

MAIN OUTCOME MEASURES

Quality of life as measured by the dimensions of the SF-36 questionnaire. The 'Kidney Disease Questionnaire' was used in a subgroup of patients to evaluate the validity of the SF-36.

RESULTS

Median (range) scores of the SF-36 dimensions (ranging from 0 to 100, higher scores representing better quality of life) were: Physical Function 70 (0-100), Role Limitations due to Physical Problems 25 (0-100), Bodily Pain 62 (0-100), General Health 57 (5-100), Vitality 55 (10-100), Social Function 63 (0-100), Role Limitations due to Emotional Problems 34 (0-100) and Mental Health 68 (0-100). SF-36 dimensions correlated significantly with those of the 'Kidney Disease Questionnaire' (correlation coefficients ranging from 0.23 to 0.68).

CONCLUSIONS

The SF-36 was shown to have construct validity when used in patients with ESRD in Brazil. The quality of life of ESRD patients is impaired at the initiation of dialysis treatment and this was clearly evidenced in the Role Limitations due to Physical Function and Emotional Function items. Greater attention should be given to interventions that could improve the quality of life parameters at the initiation of dialysis treatment.

Congenital abnormality of corpora cavernosa and erectile dysfunction: a case report

We report on a young man who had absence of the septum and muscle in the corpora cavernosa. He had no tumescence or erection with either the nocturnal penile tumescence test or intracorporeal injection of a combination of vasoactive drugs. No other urological or extra-urological congenital defects were found. A malleable penile prosthesis was implanted.

A "primary" thrombotic syndrome: absence of anti-phospholipid antibodies

A patient presenting fetal loss, livedo reticularis, severe migraine crises, myocardial infarction and thrombotic vasculopathy of both external iliac arteries is described. The serologic study showed absence of antiphospholipid antibodies (aPL), suggesting that in some cases the presence of these antibodies may be a consequence of tissue damage.

[Pseudogout: a contribution to laboratory diagnosis]

Calcium levels of synovial fluid were determined before and after addition of sodium citrate in a group of 15 patients with pseudogout syndrome. 15 patients with osteoarthritis served as control group. In 12 of the patients with pseudogout the calcium levels were statistically significantly different from the controls. the authors have reviewed the clinical, radiological and laboratory aspects of pseudogout and discussed the possible pathophysiological mechanisms which could account for the difference in calcium levels following the addition to the laboratory diagnosis of pseudogout syndrome.