Color vision loss in patients treated with chloroquine

Patient that make use of chloroquine or hydroxychloroquine, drugs which are frequently administered for treatment of rheumatoid arthritis, lupus erithromatosus or malaria, may suffer alterations in color vision and in contrast sensitivity. The present work evaluates the visual functions of these patients in a joint study of the University of São Paulo (USP), in São Paulo, and of the Federal University of Pará (UFPA), in belém. Thirty two chloroquine user patients without alterations in the eye fundus exam were evaluated in São Paulo (n=10; aged 38 to 71 years; mean=55,8 years) and in Belém (n=22; aged 20 to 67; mean=40 years). The described accumulated chloroquine dose was 45 to 430g (mean=213g; as=152g) for the São Paulo group, and 36 to 540g (mean=174g; sd=183g) for the Belém group. Tests were performed monocularly corrected eye refractive state. Color discrimination was evaluated using the Cambridge Colour Test (CCT): the color discrimination threshold was measured first in the protan, deutan and tritan axes and , in succession, three MacAdamÆs ellipses were determined. The patientÆs color vision was also evaluated with color arrangement tests: the Farnsworth-Munsell 100 Hue (FM100), the Farnsworth-Munsell D15, and the Lanthony Desaturated (D15d) tests. We also measured the contrast sensitivity for black-and-white sine wave grating of twenty two patients. The results were compared with control without ophthalmologic or neuro-ophthalmologic pathologies. Twenty four patients presented acquired dyschromatopsia. There were cases of selective loss (11 patients) and of diffuse loss (13 patients). Although losses were present in the FM100 there was no correlation between the FM100 error score and the ellipse area measured by the CCT. Moreover, three patients that scored normal in the FM100, failed to reach normal threshold in the CCT. The Lanthony test was less sensitive than the other two tests, since it failed to indicate loss in about half the patients, and the D15 was the least sensitive test, having failed to indicate loss in 9 out of 10 patients. Contrast sensitivity was within normal values for patients submitted to this test. The extent of losses in color discrimination was positively correlated with the accumulated dose. The CCT is recommended for follow up since it provides quantitative data that can be directly interpreted in CIE (Commission Internationalle dÆÉclairage) color space.

Avaliaçäo em larga escala do diclofenaco colestiramina em síndromes dolorosas lombares / Post-marketing of diclofenac cholestyramine in low back pain

Os autores descrevem os resultados da observaçäo em larga escala, relatando a experiência pós-comercializaçäo de uma nova formulaçäo galênica de um AINE (diclofenaco-colestiramina - Flotac) utilizado como terapia em casos de síndrome dolorosa lombar. Foram observados por cerca de 500 médicos generalistas de todo o Brasil um total de 1.852 pacientes com lombalgia inespecífica. Os pacientes receberam o diclofenaco-colestiramina na dose de uma capsula a cada doze horas durante 10 dias. Todos os sintomas regrediram após o tratamento de forma estatísticamente significativa, com 80 porcento dos pacientes voltando a ter atividades diárias normais ao final do tratamento. O escore médio de dor no início do tratamento foi de 6,81 pela Escala Visual Analógica e, ao final do tratamento, foi de 1,42, uma reduçäo estatísticamente significativa. Considerando-se a avaliaçäo global de eficácia, 93,7 porcento dos médicos e 91,3 porcento dos pacientes relataram o tratamento como sendo eficaz. Em relaçäo à avaliaçäo global de tolerabilidade, 90,9 porcento dos médicos e 88,7 porcento dos pacientes relataram o tratamento como sendo bem tolerado. Os eventos adversos ocorridos foram os esperados para um AINE e foram considerados leves e somente 1,8 porcento dos pacientes interromperam o tratamento por causa deles. Em conclusäo, o diclofenaco colestiramina (FLOTAC) foi considerado um tratamento adjuvante eficaz para os quadros de síndrome dolorosa lombar onde a sintomatologia inflamatória-dolorosa é um grande incomodo para o paciente, e bem tolerado, tanto para a avaliaçäo do médico como pelo paciente, sem nenhum evento adverso que näo fosse desconhecido.(au)