Danuta Bobrowska-Snarska

What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review

Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.

Ocena EKG i parametrów holterowskich u pacjentów z zapaleniem wielomięśniowym i skórno-mięśniowym

Introduction. The aim of our study was to determine the electrocardiography (ECG) and holter abnormalities among patients with dermatomyositis (DM) or polymyositis (PM). Material and methods. We examined 19 patients with PM and 11 patients with DM (23 females) and 30 healthy subjects (22 females). Mean disease duration was 6.5 ± 4.7 years. ECG parameters (QRS, PQ, P wave, conduction disturbances) and heart rate variability data, QT/QTc, ventricular extra beats, creatine kinase, aldolase and lactate dehydrogenase activities were assessed. Results. We did not observe any statistically significant differences in parameters assessing the autonomic system function, the QT/QTc, ventricular rhythm disorders. Intraventricular conduction disturbances were observed in 16.6% of patients with PM/DM. Finally, there were significant differences when comparing enzyme activities. Higher enzyme activities in DM/PM did not correlate with the diurnal variability of cardiac rhythm. Conclusions. This suggests no tendency of DM and PM to involve the autonomic nervous system. Conduction disturbances in DM and PM affect mainly the His-Purkinje system.

[Therapy resistance antiphosholipid syndrome in the course of systemic lupus erythematosus: case report].

Antiphospholipid syndrome (APS) is one of the most common reasons of thromboembolic complications in the course of connective tissue diseases. There is a strong relationship between presence of antiphospholipid antibodies and the risk of thrombosis. APS related thromboembolic complications range from superficial vein thrombosis up to rapidly developing, life threatening, multi-organ embolism. We present a case of a 21-year old female who presented with myocardial infarction as the first symptom of systemic lupus erythematosus and APS. Afterwards she was consequently treated with antithrombotic and anti-aggregation agents but it did not prevent her from reoccurrence of middle retinal vein. During the 10-year follow up she presented with reoccurring neurological symptoms i.e.: headache, memory deficits, concentration loss and impairment of the cognitive functions. She was found many times to be positive for IgG and IgM anticardiolipin antibodies, anti-beta2glicoprotein-I antibodies and lupus anticoagulant.