Broad-spectrum ginsentides are principal bioactives in unraveling the cure-all effects of ginseng

Stress and illness connection is complex and involves multiple physiological systems. Panax ginsengs, reputed for their broad-spectrum "cure-all" effect, are widely prescribed to treat stress and related illnesses. However, the identity of ginseng's "cure-all" medicinal compounds that relieve stress remains unresolved. Here, we identify ginsentides as the principal bioactives that coordinate multiple systems to restore homeostasis in response to stress. Ginsentides are disulfide-rich, cell-penetrating and proteolytic-stable microproteins. Using affinity-enrichment mass spectrometry target identification together with in vitro, ex vivo and in vivo validations, we show that highly purified or synthetic ginsentides promote vasorelaxation by producing nitric oxide through endothelial cells via intracellular PI3K/Akt signaling pathway, alleviate α1-adrenergic receptor overactivity by reversing phenylephrine-induced constriction of aorta, decrease monocyte adhesion to endothelial cells via CD166/ESAM/CD40 and inhibit P2Y12 receptors to reduce platelet aggregation. Orally administered ginsentides were effective in animal models to reduce ADP-induced platelet aggregation, to prevent collagen and adrenaline-induced pulmonary thrombosis as well as anti-stress behavior of tail suspension and forced swimming tests in mice. Together, these results strongly suggest that ginsentides are the principal panacea compounds of ginsengs because of their ability to target multiple extra- and intra-cellular proteins to reverse stress-induced damages.

Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis

Rhino orbital Mucormycosis caused by filamentous fungus of mucoraceae family was considered a rare disease affecting immunocompromised and diabetics with ketoacidosis until the recent COVID 19 pandemic. We are presenting a series of six cases of Rhino orbital cerebral Mucormycosis with central retinal artery occlusion. All six cases had common history of COVID 19 infection in recent past with sinusitis, proptosis and total ophthalmoplegia with central retinal artery occlusion on presentation. MR imaging showed invasive pan sinusitis with orbital and cerebral involvement. Urgent debridement was done and histopathological examination showed broad, filamentous aseptate fungi suggestive of Mucormycosis. All patients inspite of intravenous Amphotericin B with local debridement did not show any improvement and expired within a week of presentation. Hence our study shows poor prognosis of post covid 19 associated Mucormycosis with central retinal artery occlusion.

STABILITY TOLERANCE OF SUNFLOWER OIL -IN-WATER EMULSION EMULSIFIED BY SOYA LECITHIN FOR FOOD GRADE ACIDS

Oil-in-water emulsion has promised values in food, pharmaceutical, drug, cosmetic and allied industries. The stable emulsion with long shelf life increases its utility. Many avouring agents are used to increase shelf life as preservative or commercial value. Food grade acids are used to in the emulsion preparation which enhances the taste or avour. The present study focuses the usage of acetic acid, phosphoric acid and oxalic acid. The emulsions for different acids are prepared ranging concentration from 0.001 to 0.003M using lecithin as emulsier and sunower oil. Experiments were done to study organoleptic properties with respect to basicity and dissociation constant values. The colour of the primary emulsion was creamy white and sustainable for acetic acid emulsion to 28 day at experimental temperature 10, 25 and 40 0C. Oxalic acid is recorded a low pH value 1.88 for 0.003 M emulsion solution in compare with acetic acid (3.63) and phosphoric acid (2.32).The relative conductance measurement for oxalic acid shows a very high value 5.6mS to acetic acid 0.257mS and phosphoric acid 0.247 mS. The rst dissociation constant value 5.6x10-2 of oxalic acid is larger relatively compare to phosphoric acid 7.5 x 10-3 and acetic acid 1.8 x10-5. Basicity of acids increases from acetic acid (mono basic), oxalic acid (dibasic) to phosphoric acid (tri-basic).These results strongly supports that basicity and dissociation constant values of acids conspicuously inuence the stability of the emulsion. Higher value of dissociation constant value and basicity, lower the stability of the emulsion.

Spatially resolved expression landscape and gene-regulatory network of human gastric corpus epithelium

Molecular knowledge of human gastric corpus epithelium remains incomplete. Here, by integrated analyses using single-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and single-cell assay for transposase accessible chromatin sequencing (scATAC-seq) techniques, we uncovered the spatially resolved expression landscape and gene-regulatory network of human gastric corpus epithelium. Specifically, we identified a stem/progenitor cell population in the isthmus of human gastric corpus, where EGF and WNT signaling pathways were activated. Meanwhile, LGR4, but not LGR5, was responsible for the activation of WNT signaling pathway. Importantly, FABP5 and NME1 were identified and validated as crucial for both normal gastric stem/progenitor cells and gastric cancer cells. Finally, we explored the epigenetic regulation of critical genes for gastric corpus epithelium at chromatin state level, and identified several important cell-type-specific transcription factors. In summary, our work provides novel insights to systematically understand the cellular diversity and homeostasis of human gastric corpus epithelium in vivo.

Mechanisms of the Wnt Pathways as a Potential Target Pathway in Atherosclerosis

The proteins of the Wnt family are involved in a variety of physiological processes by means of several canonical and noncanonical signaling pathways. Wnt signaling has been recently identified as a major player in atherogenesis. In this review, we summarize the existing knowledge on the influence of various components of the Wnt signaling pathways on the initiation and progression of atherosclerosis and associated conditions. We used the PubMed database to search for recent papers on the involvement of the Wnt pathways in atherosclerosis. We used the combination of “Wnt” and “atherosclerosis” keywords to find the initial papers, and chose papers published after 2018. In the first section of the paper, we describe the general mechanisms of the Wnt signaling pathways and their components. The next section is dedicated to existing studies assessing the implication of Wnt signaling elements in different atherogenic processes, such as cholesterol retention, endothelial dysfunction, vascular inflammation, and atherosclerotic calcification of the vessels. Lastly, various therapeutic strategies based on interference with the Wnt signaling pathways are considered. We also compare the efficacy and availability of the proposed treatment methods. Wnt signaling can be considered a potential target in the treatment and prevention of atherosclerosis. Therefore, in this review, we reviewed evidences showing that wnt signaling is an important signal for developing appropriate treatment strategies for atherosclerosis.

Effect of Prunetin on Streptozotocin-Induced Diabetic Nephropathy in Rats - a Biochemical and Molecular Approach

In the modern era, chronic kidney failure due to diabetes has spread across the globe. Prunetin (PRU), a component of herbal medicines, has a broad variety of pharmacological activities; these may help to slow the onset of diabetic kidney disease. The anti-nephropathic effects of PRU have not yet been reported. The present study explored the potential nephroprotective actions of PRU in diabetic rats. For 28 days, nephropathic rats were given oral doses of PRU (20, 40, and 80 mg/kg). Body weight, blood urea, creatinine, total protein, lipid profile, liver marker enzymes, carbohydrate metabolic enzymes, C-reactive protein, antioxidants, lipid peroxidative indicators, and the expression of insulin receptor substrate 1 (IRS-1) and glucose transporter 2 (GLUT-2) mRNA genes were all examined. Histological examinations of the kidneys, liver, and pancreas were also performed.The oral treatment of PRU drastically lowered the blood glucose, HbA1c, blood urea, creatinine, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, alkaline phosphatase, lipid profile, and hexokinase. Meanwhile, the levels of fructose 1,6-bisphosphatase, glucose-6-phosphatase, and phosphoenol pyruvate carboxykinase were all elevated, but glucose-6-phosphate dehydrogenase dropped significantly. Inflammatory marker antioxidants and lipid peroxidative markers were also less persistent due to this administration. PRU upregulated the IRS-1 and GLUT-2 gene expression in the nephropathic group.The possible renoprotective properties of PRU were validated by histopathology of the liver, kidney, and pancreatic tissues. It is therefore proposed that PRU (80 mg/kg) has considerable renoprotective benefits in diabetic nephropathy in rats.

Estratégias para pessoas com deficiência em períodos de emergência em saúde pública, em especial a pandemia de COVID-19 / Strategies for persons with disabilities in public health emergencies, especially the COVID-19 pandemic

Resumo O objetivo foi descrever estratégias e políticas de atenção às pessoas com deficiência em períodos de emergência em saúde pública, em especial na COVID-19. Foram incluídos 29 estudos e 49 estratégias agrupadas em oito categorias: 1) habitação, mobilidade e infraestrutura; 2) trabalho, ocupação e renda; 3) assistência social; 4) telessaúde; 5) atenção integral à saúde; 6) planejamento e gestão; 7) comunicação; e 8) educação. O panorama das estratégias pode orientar políticas públicas, com ações viáveis que promovam equidade para as pessoas com deficiência.

Abstract This study aimed to describe strategies and policies necessary to provide care for people with disabilities during periods of public health emergencies, especially COVID-19. Twenty-nine studies and 49 strategies were included, grouped into eight categories: 1) housing, mobility, and infrastructure; 2) work, occupation, and income; 3) social assistance; 4) telehealth; 5) comprehensive health care; 6) planning and management; 7) communication; and 8) education. The overview of the strategies can help to guide public policies, with feasible actions that promote more significant equity for disabled people.

Perspectivas de uma comunidade universitária acerca da doação de corpos para estudo em anatomia humana / Perspectives of a university community about body donation for human anatomy study

Resumo: Introdução: O cadáver é uma peça insubstituível no aprendizado da anatomia humana, pois permite uma visão tridimensional das estruturas anatômicas. Entretanto, observa-se um cenário de escassez e aumento da demanda das peças cadavéricas nas universidades brasileiras. Logo, diversas instituições, amparadas no artigo 14 da Lei nº 10.406/2002 do Código Civil brasileiro, implementaram programas de doação de corpos interessados em trazer melhorias significativas na qualidade de ensino da disciplina de anatomia. Objetivo: Este estudo teve como objetivo analisar o grau de conhecimento e as perspectivas de uma comunidade universitária a respeito da doação voluntária de corpos cadavéricos para fins educacionais e de pesquisa. Método: Trata-se de um estudo observacional, transversal e prospectivo com abordagem quantitativa e coleta de dados por meio de questionário individual. Os sujeitos incluídos foram os docentes e discentes da Universidade Federal do Maranhão (Ufma), campus Dom Delgado. Os questionários eram relativos à obtenção de informações sobre o conhecimento e a opinião acerca da temática da doação de corpos. Resultado: Obteve-se um total de 264 questionários respondidos, os quais mostraram que 85,65% dos discentes e 87,1% dos docentes tinham conhecimento acerca da possibilidade da doação do próprio corpo. Contudo, observou-se que 94% dos entrevistados não sabiam que procedimentos eram necessários para a doação, e 86% não possuíam conhecimento acerca da legislação que permitia tal prática. Ademais, 27,65% dos participantes estavam aptos a doar o próprio corpo, 33,7% apontaram que não doariam e 38,9% informaram que não tinham opinião formada. O principal motivo apontado para doar foi: "para contribuir com o avanço da educação na área da saúde", e para não doar: "quero ser enterrado ou cremado". Conclusão: Existe um alto percentual de indivíduos que não conhecem os meios para realizar a doação de corpos, sendo evidenciado que os participantes apresentam baixa aptidão para doação. Contudo, existe um percentual significativo de indivíduos que não tem opinião formada sobre o assunto, demonstrando que a divulgação dessa temática é um meio para aumentar a adesão a tal prática. É importante realizar o desenvolvimento de programas de doação de corpos para solucionar a problemática.

Abstract: Introduction: The cadaver is an irreplaceable piece in the learning of human anatomy, allowing a three-dimensional view of anatomical structures. However, there is a scenario of scarcity and increased demand for cadaveric parts in Brazilian universities. Therefore, several institutions, supported by article 14 of Law 10.406/2002 of the Brazilian Civil Code, implemented body donation programs aimed at bringing significant improvements in the teaching quality of the anatomy discipline. Objective: To analyze the level of knowledge and perspectives of a university community regarding the voluntary donation of cadaveric bodies for educational and research purposes. Method: This is an observational, cross-sectional and prospective study with a quantitative approach and data collection through an individual questionnaire. The subjects included in the study were teachers and students from the Federal University of Maranhão, Campus Dom Delgado - UFMA. The questionnaires were related to obtaining information about knowledge and opinions on the topic of body donation. Result: A total of 264 answered questionnaires were obtained, which showed that 85.65% of students and 87.1% of teachers were aware of the possibility of donating their own bodies. However, it was observed that 94% of the interviewees did not know what procedures were necessary for the donation, and 86% did not have knowledge about the legislation that allowed this practice. Furthermore, 27.65% of the participants were able to donate their own body, 33.7% indicated that they would not donate and 38.9% reported that they had no formed opinion. The main reason given for donating was: "to contribute to the advancement of education in the health area", and for not donating: "I want to be buried or cremated". Conclusion: There is a high percentage of individuals who do not know how to carry out the donation of their own bodies, being evidenced that the participants have low aptitude for donation. However, there is a significant percentage of individuals who do not have a formed opinion on the subject, demonstrating that the dissemination of this topic is a means to increase adherence to this practice. It is important to carry out the development of body donation programs to solve the problem.

Factores asociados a la anosmia y ageusia en pacientes COVID-19 de una provincia peruana

Objetivo: identificar la presentación clínica y los factores asociados a la anosmia y ageusia en pacientes con la COVID-19 en un centro de salud de una provincia del Perú en el período de 2020-2021. Métodos: estudio transversal analítico a través de los datos del programa COVID-19 del Policlínico Essalud de Jauja - Perú. Se detallaron características sociodemográficas, sintomatología y comorbilidades de los pacientes. A través de un análisis bivariado se identificó los factores asociados a la anosmia y ageusia. Resultados: se identificó a 356 pacientes: 53,1 % fueron mujeres, la edad media fue 48,7 años (±17,8) y 261 (73,3 %) con COVID-19 leve. Del total, el 22,2 % presentó anosmia y 19,9 % ageusia; de los cuales la mayoría fueron menores de 65 años y del sexo femenino. Presentaron síntomas asociados un 86,1 % de los pacientes con anosmia y un 83,1% con ageusia. Los principales factores asociados a la anosmia fueron: la edad menor a 65 años (p=0,027), tos (p<0,001), cefalea (p<0,001), disnea (p<0,001), congestión nasal (p<0,001) y fiebre (p<0,001); y a la ageusia: edad menor a 65 años (p=0,006), tos (p=0,001), cefalea (p<0,001), disnea (p<0,001), congestión nasal (p<0,001) y diarrea (p<0,001). Conclusiones: la anosmia y ageusia son síntomas frecuentes de la COVID-19. La mayoría de pacientes presentaron estos síntomas asociados a los síntomas comunes. Gran parte de los que presentaban anosmia presentaron congestión nasal por lo que es recomendable considerar diferenciarlos al momento de realizar el diagnóstico.

Summary Objective: To identify the clinical presentation and factors associated with anosmia and ageusia in patients with COVID-19 in a health center in a province of Peru for the period 2020-2021. Methods: Cross-sectional analytical study through data from the COVID-19 program of the Essalud Polyclinic in Jauja, Peru. Sociodemographic characteristics, symptoms and comorbidities of the patients were detailed. A bivariate analysis identified the factors associated with anosmia and ageusia. Results: 356 patients were identified: 53.1 % were women, mean age was 48.7 years (±17.8) and 261 (73.3%) with mild COVID-19. Of the total, 22.2% had anosmia and 19.9% ageusia; of which the majority were under 65 and female. Associated symptoms were found in 86.1% of patients with anosmia and 83.1% with ageusia. The main factors associated with anosmia were age younger than 65 years (p=0.027), cough (p<0.001), headache (p<0.001), dyspnea (p<0.001), nasal congestion (p<0.001) and fever (p<0.001); and ageusia: age younger than 65 years (p=0.006), cough (p=0.001), headache (p<0.001), dyspnea (p<0.001), nasal congestion (p<0.001) and diarrhea (p<0.001). Conclusion: Anosmia and ageusia are common symptoms of COVID-19. Most patients had these symptoms associated with common symptoms. Many of those who had anosmia had nasal congestion, so it is advisable to consider differentiating them when making the diagnosis.

A comparison of sub-tenon block with peribulbar block in small-incision cataract surgery

Purpose: To compare the efficacy and safety of sub?tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small?incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub?tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub?tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.

Saúde Cardiovascular e Fibrilação ou Flutter Atrial: Um Estudo Transversal do ELSA-Brasil / Cardiovascular Health and Atrial Fibrillation or Flutter: A Cross-Sectional Study from ELSA-Brasil

Resumo Fundamento A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares. Objetivos Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05. Resultados A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA. Conclusões Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.

Abstract Background The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. Results The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis. Conclusions No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.

DRESS syndrome: Tricky to diagnose but easy to treat

A 27-year-old female presented to us with a short history of fever, jaundice, rash, and worsening hepatic dysfunction subsequent to treatment with intravenous antibiotics and alternative medicine for a urinary tract infection. The eosinophilia, lymphadenopathy, and transaminitis prompted us to consider a diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) which can be fatal if not treated. The patient showed improvement in clinical and laboratory parameters after a course of steroids. This case is presented as DRESS syndrome that can prove rapidly fatal if not diagnosed and treated immediately.

Adaptation needs and concerns of senior citizens living in old age homes

Context: Adaptation needs of senior citizens are not well explored in research, especially among people living in old age homes situated in developing countries like India. Aim: The aim of the study was to understand the needs and concerns of senior citizens living in old age homes and its effect on their adaptation. Subjects and Methods: Using the purposive sampling method, fifteen residents of an old age home and their three caregivers were interviewed to describe their views and experiences. The tools used were the Montreal Cognitive Assessment and an in-depth interview schedule. Statistical Analysis: Qualitative data were analyzed using Atlas ti. 7 for identifying major themes and subthemes. Results: The results showed that the major needs and concerns of senior citizens were unmet medical needs, difficulty to handle negative attitudes of staff, difficulty to adapt with new environment and culture, and emotional issues. Conclusion: Findings indicate the importance of addressing the adaptation needs of the elderly living in old age homes.

Spectrum of drug-induced liver injury in a tertiary hospital in southern India

BACKGROUND Anti-tuberculosis drugs are thought to account for about 50% of drugs that cause liver injury in India. We show that the spectrum of drugs is much wider than previously reported. METHODS We evaluated all patients with unexplained acute liver injury presenting during 2006–2016 using a structured proforma for drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method was used to assess causality. RESULTS DILI was found in 143 of 2534 patients with acute liver injury. Nineteen patients had probable ayurvedic DILI. The other common causes of DILI were statins (16 patients) and anti-tuberculosis drugs (11 patients). Eight patients had DILI post-liver transplant. Fluconazole was the most common cause of post-liver transplant DILI. Chronic DILI (abnormal liver function test after 12 months of stopping the suspected drug) was found in 2 patients. CONCLUSION In otherwise unexplained acute liver injury, DILI due to ayurvedic drugs should be sought. DILI should be considered in post-liver transplant patients. Patients with DILI should be monitored for at least 12 months to exclude progression to chronic DILI.

Tele-rehabilitation for persons with vision impairment during COVID-19: Experiences and lessons learned

Purpose: The COVID?19 pandemic imposed challenges to access rehabilitation intervention to individuals with visual impairment, thereby increasing their disability effects. This study explored the viability maintaining the continuum of care through telerehabilitation. Methods: This study is a retrospective analysis of individuals with vision impairment who underwent telerehabilitation at the center of excellence in eye care at Hyderabad, Telangana, India, between April and September 2020. The International Classification of Functioning, Disability and Health framework was followed to provide services such as counseling for mental well?being, information and resources, educational interventions, Assistive Technology programs, therapeutic interventions for children with multiple disabilities, access to digital audio books and rehabilitation helpline. A team of professionals involved in the service care. Phone and what’s app calls were used to facilitate the training. The duration and the number of training sessions were individual need?based with an average of 45 minutes per session and 175 training sessions. Results: Three hundred and fifty individuals and their families benefited. The service include early intervention (n = 129), and low vision care (n = 176) inclusive of computer training (n = 53), soft skills (n = 53), digital books (n = 55). Nearly two?thirds of the participants were male (n = 205). Conclusion: Evidence from this study suggests telerehabilitation as a successful model of care. A well?planned telerehabilitation approach can expand the scope of reaching the visually impaired from geographically isolated areas where scarcity of service providers and service centers.

Efficacy and safety of hydroxychloroquine in osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

Background/Aims@#Conventional disease-modifying anti-rheumatic drugs have been trialed in osteoarthritis (OA). Hydroxychloroquine (HCQ), which has shown its effectiveness in rheumatoid arthritis, has been trialed for the treatment of OA; however, its efficacy and safety remain unclear. This systematic review and meta-analysis evaluate efficacy and safety of HCQ for the treatment of OA. @*Methods@#MEDLINE, EMBASE, and Cochrane Central were searched from inception through June 2020. Two reviewers independently screened for randomized controlled trials (RCTs) comparing HCQ with placebo or other active-comparators for the treatment of knee, hand, or hip OA, extracted data, and performed Cochrane risk of bias assessments. @*Results@#Six RCTs, four in hand OA, two in knee OA, consisting of 842 patients (436 in HCQ arm, 406 in control arm) were included. RCTs were conducted between 2012 and 2020, one each at UK, Netherlands, Germany, Italy, Iran, and Egypt; follow-up period ranged 24 to 52 weeks. High-quality evidence showed no clinically important pain reduction with HCQ compared to placebo/active-control in hand OA (standardized mean difference [SMD], 0.14; 95% confidence interval [CI], –0.20 to 0.48). Effect on pain reduction in knee and hand OA was small and non-significant (SMD, –0.09; 95% CI, –0.44 to 0.25). High-quality evidence showed no improvement in dysfunction with HCQ compared to placebo in hand OA patients (SMD, 0.08; 95% CI, –0.23 to 0.40). Effect on dysfunction improvement in knee and hand OA was modest and statistically non-significant (SMD, –0.20; 95% CI,–0.57 to 0.18). No improvement in quality of life was observed in hand OA. @*Conclusions@#HCQ has no benefit in reducing pain and improving physical function in hand or knee OA patients.