Prévalence des effets indésirables de l’hydroxychloroquine (Plaquenil®) dans une population dermatologique : étude rétrospective sur 102 patients

Publication date: Available online 20 May 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Tétu, A. Hamelin, B. Lebrun-Vignes, A. Soria, A. Barbaud, C. Francès, F. Chasset
ButL'objectif de cette étude était d'étudier la prévalence des effets indésirables (EI) et celle de l'arrêt de l'hydroxychloroquine (HCQ) pour EI dans une population issue d'un recrutement dermatologique.Patients et méthodesIl s'agissait d'une étude rétrospective incluant consécutivement entre janvier 2013 et juin 2014 tous les patients traités ou ayant reçu de l'HCQ. Les EI étaient déclarés à partir d'un questionnaire standardisé puis évalués par un interrogatoire et un examen clinique systématique permettant de guider les éventuelles explorations paracliniques nécessaires. L'imputabilité médicamenteuse était évaluée par la méthode française de pharmacovigilance. Le critère de jugement principal était la prévalence des EI pour lesquels l'HCQ avait un score d'imputabilité intrinsèque « I » supérieur à 2.RésultatsAu total, 102 patients ont été inclus dont 93 femmes, d'âge médian 44,5 ans (22–90). L'indication de l'HCQ était principalement le lupus cutané (n=70). Cinquante-cinq patients ont déclaré au moins un EI. Parmi les 91 EI déclarés, 59 (65 %) étaient imputables (score I>2), avec une prédominance des EI digestifs (n=30) et cutanés (n=21). Les EI étaient responsables d'un arrêt définitif de l'HCQ dans 19 cas. Parmi eux, 8 (42 %) n'étaient pas imputables à l'HCQ. Parmi les 8 diagnostics de maculopathie, 5 ont été infirmés par une équipe ophtalmologique spécialisée.ConclusionPlus de la moitié des patients ont rapporté des EI sous HCQ et ces EI ont été responsables d'un arrêt définitif de l'HCQ dans un tiers des cas. Une évaluation précise de l'imputabilité est nécessaire, en particulier pour les EI oculaires car dans deux tiers des cas ils n'étaient pas imputables à l'HCQ.AimOur aim was to assess the prevalence of adverse effects (AEs) pertaining to the use and withdrawal of hydroxychloroquine (HCQ) in dermatological outpatients.Patients and methodsWe conducted a retrospective study between January 2013 and June 2014 that included consecutive patients currently or previously receiving HCQ seen in our department. AEs were collated using a standardized questionnaire and validated by clinical and laboratory examination. Drug causality was evaluated using the updated French drug reaction causality assessment method. The main evaluation criterion was the prevalence of AEs in which HCQ had an intrinsic imputability score of I>2.ResultsWe included 102 patients (93 of whom were women, with a median age of 44.5; range: 22–90years). HCQ was given for cutaneous lupus in most cases (n=70). At least one AE was reported for 55 patients. Among the 91 reported AEs, 59 (65%) had an HCQ intrinsic imputability score I>2. AEs were responsible for permanent HCQ discontinuation in 19 cases. Of these, 8 were unrelated to HCQ based on imputability score. The most common AEs associated with HCQ were gastrointestinal and cutaneous signs. Of the 8 patients diagnosed with retinopathy, only 3 were confirmed after reevaluation.ConclusionAEs associated with HCQ were reported for over 50% of patients and were responsible for permanent HCQ discontinuation in one-third of cases. A more in-depth evaluation of imputability seems necessary, particularly regarding ophthalmological symptoms, since in two thirds of cases the reasons for discontinuation were not related to HCQ.



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The basophil proteome in chronic spontaneous urticaria distinguishes responders to omalizumab from non‐responders

Clinical &Experimental Allergy, EarlyView.


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Effects of cardiac output on the onset of rocuronium-induced neuromuscular block in elderly patients

Abstract

Purpose

The aim of this study was to elucidate the relationship between the onset of rocuronium-induced neuromuscular block and arterial pressure-based cardiac output (CO) in elderly patients.

Methods

Forty elderly patients aged 65–83 years were enrolled in this study. After induction of anesthesia, contractions of the adductor pollicis muscle to ulnar nerve train-of-four stimulation were acceleromyographically evaluated and 1 mg/kg rocuronium was administered following CO measurement. The correlation between onset of rocuronium action and CO was analyzed.

Results

The mean [SD] CO reduced after induction of anesthesia from 5.1 [1.8] L/min to 3.8 [1.1] L/min. The onset time of rocuronium-induced neuromuscular block was 110.3 [23.9] s (range 60–165). There was a statistically significant inverse correlation between the onset time of rocuronium and CO [onset time (s) = − 13.2·CO + 159.7, R² = 0.376].

Conclusions

In the elderly, CO influences the onset of action of rocuronium.

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Endothelium-dependent vasodilation in the cerebral arterioles of rats deteriorates during acute hyperglycemia and then is restored by reducing the glucose level

Abstract

Purpose

Acute hyperglycemia in patients with traumatic brain injury correlates with a poor neurological outcome. We investigated the endothelium function of rat cerebral arterioles during acute hyperglycemia and after reducing the glucose levels using insulin. We also examined whether or not oxidative stress was involved in the cerebral arteriole response to acute hyperglycemia.

Methods

In isoflurane-anesthetized, mechanically ventilated rats, we used closed cranial window preparation to measure the changes in the pial arteriolar diameter following the topical application of acetylcholine (ACh) or adenosine. We examined the pial arteriolar vasodilator response before hyperglycemia, during hyperglycemia, and after reducing the glucose level using insulin. After intravenous pretreatment with an NADPH oxidase inhibitor (apocynin or diphenylene iodonium), we reexamined the pial arteriolar vasodilator response following the topical application of ACh.

Results

Under control conditions, the topical application of ACh dose-dependently dilated the cerebral arterioles. The vasodilatory responses to topical ACh were impaired during hyperglycemia and improved after the administration of insulin. The vasodilatory responses to topical adenosine were not affected by the glucose levels. In the apocynin or diphenylene iodonium pretreatment group, the topical application of ACh dilated the cerebral arterioles during hyperglycemia.

Conclusion

Acute hyperglycemia induces a dysfunction of the endothelium-dependent vasodilation of rat cerebral arterioles. The dysfunction can be reversed by improving the acute hyperglycemia and it can be prevented entirely by the administration of NADPH oxidase inhibitors. These results could suggest that controlling the glucose levels works protectivity to endothelium function of cerebral arterioles.

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To assess the efficacy of socket plug technique using platelet rich fibrin with or without the use of bone substitute in alveolar ridge preservation: a prospective randomised controlled study

Abstract

Aim

The purpose of this study is to evaluate the efficacy of Platelet Rich Fibrin (PRF) as a socket plug with or without use of Plaster of Paris (POP) as bone substitute to preserve the alveolar ridge post-extraction.

Material and methods

A prospective randomised single blind controlled study, was conducted for 18 months from November 2014 to May 2016 on 48 patients requiring extraction. All teeth were extracted atraumatically using periotomes and luxators without raising mucoperiosteal flap. Sockets were randomly allotted to groups A, B and C. Group A sockets were chosen as control, where figure of eight suture was placed. In group B sockets, PRF obtained by centrifugation was used as a socket plug and stabilised with figure of eight suture. Group C sockets were filled with POP and then covered with PRF. The socket was then closed with a figure of eight suture. Patients were informed of need for 6 months follow-up.

Results

Ninety sockets in 48 patients were subjected to our study. We found that results in the sockets where we have grafted POP showed better ridge preservation and post-operative comfort even though the difference in ridge resorption between the three groups was not statistically significant. Powered by Editorial Manager® and ProduXion Manager® from the Aries Systems Corporation.

Conclusion

Atraumatic extraction may minimise the post-operative pain and discomfort to patient as well as the post-extraction alveolar height and width changes. The use of PRF and/or bone substitute even though clinically contributes to better post-operative healing and minimal loss of alveolar width and height, the values were not statistically significant.

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Lower third molar displaced to lateral pharyngeal space after mandibular angle fracture: a case report

Abstract

The removal of displaced dental elements from deep anatomical spaces is a condition that requires the knowledge of the region and skills to perform the procedure. The lateral pharyngeal space contains important structures such as the internal carotid artery and close proximity with the cranium basis. The aim of this paper is to report a clinical case of a lower third molar displaced to the lateral pharyngeal space after a mandibular angle fracture and its treatment by surgical intervention. The tooth was removed under general anesthesia by direct approach and the fracture was reduced and fixed with a plate and screws. This case report illustrates the importance of an immediate procedure to avoiding severe complications and further damage to important anatomical structures.

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Radiographic study of mandibular third molars: evaluation of the position and root anatomy in Brazilian population

Abstract

Objectives

The root anatomy and position of mandibular third molars are important factors in assessing the level of difficulty of surgical removal procedures. In this light, this study aims to identify the most frequent position and the root anatomy of mandibular third molars.

Methods

The study sample comprised 1205 mandibular third molars from 710 panoramic radiographs evaluated. Regarding the position, all of them were based on Pell and Gregory's and Winter's classifications. The root anatomy was classified according to the type and number of roots, as well as the presence of laceration, fusion, or divergence. Gender and the quadrant were also considered. Following an interexaminer analysis, a statistical analysis was performed using the Kappa test.

Results

The results showed that the IA (40.3%) and mesioangular (53.8%) position was predominant in mandibular third molars. Regarding the anatomy, the most common were two roots (98.3%), of the conical simple type (88.9%), with absence of laceration (89.2%), divergence (84%), and fusion (80%).

Conclusion

The present study showed that the most prevalent mandibular third molar type in Brazilian patients was the IA and mesioangular position, with simple root anatomy. The result of this study can assist oral surgeons to better plan and assess the level of difficulty of surgical removal procedures.

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