Cumulative dose of hydroxychloroquine is associated with a decrease of resting heart rate in patients with systemic lupus erythematosus: a pilot study.

INTRODUCTION: The use of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE) offers a wide range of benefits. However, there are evidence in favour of cardiotoxicity, including heart conduction disturbances and congestive heart failure. OBJECTIVE: To determine the effects of HCQ in the resting heart rate (RHR) of SLE patients. PATIENTS AND METHODS: Included were patients with non active SLE, with a sedentary lifestyle and treated with HCQ. Excluded were patients on beta blocker treatment, trained patients, pacemaker's users and patients with clinical or analytical evidence of anemia, renal disease, obstructive pulmonary disease, obesity, uncontrolled thyroid disease, fever or current infection. Standard 12-lead electrocardiogram was performed in the resting condition (supine decubitus and orthostatic position). Comparison between groups was performed using Mann-Whitney U test. A multiple linear regression was performed. A p value <0.05 was considered statistically significant. RESULTS: 42 patients were included. Patients were divided in two groups based on the cumulative dose of HCQ (CD-HCQ), considering 365 g as cut-off. There were 24 patients with low-HCQ (<365 g) and 18 patients with high-HCQ (>365 g). Non significant differences were found in age, sex, prednisone dose or SLEDAI. The mean RHR was 73 ± 6 beats/min in the low-HCQ and 65 ± 7 beats/min in the high-HCQ, with a significant decrease of 11% (p = 0.003). In multiple linear regressions, there were non significant association between the decrease of RHR and prednisone dose, age, SLEDAI or TSH, but there was significant association between RHR and CD-HCQ (p = 0.024) and RHR and time of exposure to HCQ (p = 0.029). CONCLUSION: CD-HCQ higher than 365 g was associated with a significant decrease (11%) in RHR in non-active SLE patients, although a larger prospective study is required to allow more definitive conclusions.

Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect.

UNLABELLED: The influence of antimalarials on lipids in systemic lupus erythematosus (SLE) has been identified in several studies but not in many prospective cohorts. The aim of this study was to longitudinally determine the effect of antimalarials on the lipoprotein profile in SLE. PATIENTS AND METHODS: Fasting total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein cholesterol (LDL) plasma levels were determined at entry and after 3 months of hydroxychloroquine (HCQ) treatment in a longitudinal evaluation of 24 patients with SLE. RESULTS: a significant decrease in TC (198 ± 33.7 vs. 183 ± 30.3 mg/dl, p = 0.023) and LDL levels (117 ± 31.3 vs. 101 ± 26.2 mg/dl, p = 0.023) were detected after the 3 months of HCQ therapy. The reduction of 7.6% in TC (p = 0.055) and 13.7% in LDL levels (p = 0.036) determined a significant decrease in the frequency of dyslipidemia (26% vs. 12.5%, p = 0.013) after HCQ therapy. CONCLUSION: This longitudinal study demonstrated the beneficial effect of antimalarials on lipids in SLE since this therapy induced a reduction of atherogenic lipoproteins.

[Mantova cell factory: a model for skin regeneration]. / Mantova cell-factory: un modello di rigenerazione cutanea.

Chronic wounds, including venous and arteriosclerotic leg ulcers, diabetic foot ulcers, decubitus and trauma-induced wounds, represent a major problem in our society. Because the incidence of chronic wounds is high, the socioeconomic impact is considerable. The problem increases as the average age of the population increases and so the research into wound healing is continuously on the move. The aim of our research was to develop an autologous skin substitute and to verify its efficacy in closing chronic ulcers that do not respond to the currently available wound-healing treatments (topical therapy, antibiotics, surgical cleansing, external compression). Keratinocytes were obtained from the patients' foreskins. All medical procedures were undertaken with the approval of the ethics committee and with the patient's consent. In our survey we evaluated the possibility to grow autologous keratinocytes both with the ''feeder-layer'' method and on a type I collagen substrate. Using the first method, we obtained a two-dimensional strip composed of a few layers of normally arranged keratinocytes; it was, however, very fragile and this may affect the efficacy in clinical use. When cells were grown on an appropriately treated type I collagen substrate, we obtained more layers of normally arranged keratinocytes which were also differentiated into basal, spinous, granular and keratin layers. In addition to keratinocyte reproduction, we obtained reproduction of melanocytes in the correct basal position. The new skin substitute provides a new treatment option for chronic wounds that are refractory to conventional therapies. Adequate cytohistological and immunohistochemical analysis to evaluate the cells' correct morphology and phenotype is important in this technique.