Ruptured hemorrhagic corpus luteum as a presenting symptom of systemic lupus erythematous.

A young female presented to the emergency room with ruptured hemorrhagic corpus luteum (RHCL). Her workup revealed a new diagnosis of SLE with nephritis and positive lupus anticoagulant (LAC) test without thrombocytopenia. We reviewed the literature and found one similar case of a 23-year-old subject who presented with a RHCL that was found to be the presenting symptom of SLE; unlike the current case, the patient presented with severe anemia (Hg 6.7 g/dl) and thrombocytopenia (10,000/ml). Possible mechanisms are discussed.

Effect of Tomato Nutrient Complex on Blood Pressure: A Double Blind, Randomized Dose⁻Response Study.

Oxidative stress is implicated in the pathogenesis of essential hypertension, a risk factor for cardiovascular morbidity and mortality. Tomato carotenoids such as lycopene and the colorless carotenoids phytoene and phytofluene induce the antioxidant defense mechanism. This double-blind, randomized, placebo-controlled study aimed to find effective doses of Tomato Nutrient Complex (TNC) to maintain normal blood pressure in untreated hypertensive individuals. The effect of TNC treatment (5, 15 and 30 mg lycopene) was compared with 15 mg of synthetic lycopene and a placebo over eight weeks. Results indicate that only TNC treatment standardized for 15 or 30 mg of lycopene was associated with significant reductions in mean systolic blood pressure (SBP). Treatment with the lower dose standardized for 5 mg of lycopene or treatment with 15 mg of synthetic lycopene as a standalone had no significant effect. To test carotenoid bioavailability, volunteers were treated for four weeks with TNC providing 2, 5 or 15 mg lycopene. The increase in blood levels of lycopene, phytoene, and phytofluene was dose dependent. Results suggest that only carotenoid levels achieved by the TNC dose of 15 mg lycopene or higher correlate to a beneficial effect on SBP in hypertensive subjects while lower doses and lycopene alone do not.

Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes.

AIMS: Observational studies report inconsistent associations between moderate alcohol intake and blood pressure (BP). In a sub-study of a larger randomized controlled trial, we assessed the effect of initiating moderate red wine consumption on 24-h BP recordings and the effect of a common genetic variant of alcohol dehydrogenases (ADH) among patients with type 2 diabetes. METHODS: Fifty-four type 2 diabetes, alcohol abstainers were randomized to consume 150 ml/dinner dry red wine or mineral water. Both groups were guided to adhere to a Mediterranean diet, without caloric restriction. We measured 24-h ambulatory BP monitoring (ABPM) at baseline and after 6 months. RESULTS: Participants (age = 57 years; 85% men; mean 24-h BP = 129/77 mm Hg) had 92% 6-month retention. After 6 months of intervention, the average 24-h BP did not differ between the wine and water groups. A transient decrease in BP was observed in the red wine group at midnight (3-4 hours after wine intake: systolic BP: red wine = -10.6mm Hg vs. mineral water = +2.3 mm Hg; P = 0.031) and the following morning at 7-9 am (red wine: -6.2mm Hg vs. mineral water: +5.6mm Hg; P = 0.014). In a second post hoc sub-analysis among the red wine consumers, individuals who were homozygous for the gene encoding ADH1B*2 variant (Arg48His; rs1229984, TT, fast ethanol metabolizers), exhibited a reduction in mean 24-h systolic BP (-8.0mm Hg vs. +3.7 mm Hg; P = 0.002) and pulse pressure (-3.8 mm Hg vs. +1.2 mm Hg; P = 0.032) compared to heterozygotes and those homozygous for the ADH1B*1 variant (CC, slow metabolizers). CONCLUSIONS: Initiating moderate red wine consumption at dinner among type 2 diabetes patients does not have a discernable effect on mean 24-h BP. Yet, a modest temporal BP reduction could be documented, and a more pronounced BP-lowering effect is suggested among fast ethanol metabolizers. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT00784433.

Duplex study of the carotid and femoral arteries of patients with systemic lupus erythematosus: a controlled study.

OBJECTIVE: To identify atherosclerosis in the common carotid (CCA) and common femoral arteries (CFA) of patients with systemic lupus erythematosus (SLE) and matched controls. METHODS: Fifty-one consecutive patients with SLE were enrolled in the study. Controls were matched by age, sex, ethnicity, and atherosclerosis risk factors. All patients and controls underwent ultrasonic biopsy (U-B) of the CFA and CCA, a noninvasive screening technique that detects early atherosclerotic plaques and changes. The U-B features were classified and scored as follows: class A: normal (score 0); class B: interface disruption (score 2); class C: intima-media granulation (score 4); class D: plaque without hemodynamic disturbance (score 6); class E: stenotic plaque (score 8); and class F: plaque with symptoms (score 10). Total score was calculated. Classes A and B indicate an intact media; classes D to F point to a significant medial involvement; class C signifies a borderline lesion with a potential for regression to normal or progression to a plaque. RESULTS: Mean ages were 40.5 years for SLE patients and 41 years for controls (p = 0.6). Ninety-six percent of the patients and controls were women. The mean disease duration of SLE was 8.65 years. Frequencies of risk factors among the SLE patients compared to controls were hypertension (30% vs 24%), smoking (23% vs 24%), and dyslipidemia (17.7% vs 17%). No patient had diabetes mellitus or family history of cardiovascular disease. A 3.17-fold increased rate of atherosclerotic plaques was detected in the SLE patients compared with controls (95% CI 1.08-10.9). Twenty-eight percent of SLE patients had at least a single class D-F lesion in one of the 4 vessels tested, compared with 10% in the control group (p = 0.02). In addition, the mean total U-B score of the SLE patients was significantly higher than that of the controls (5.65 vs 3.14; p = 0.02). Univariate analyses showed that the development of plaques in SLE was associated with a history of ischemic heart disease, hypertension, cardiovascular accident, and anemia. Multivariate analysis found plaques to be strongly associated with age, particularly in those older than 50 (OR 2.66, p = 0.000). CONCLUSION: Patients with SLE have a high rate of atherosclerotic changes compared to controls. The development of atherosclerosis is strongly associated with age.