Elevation of serum hepatic aminotransferases during treatment of rheumatoid arthritis with low-dose methotrexate. Risk factors and response to folic acid.

Sixty-six rheumatoid arthritis (RA) patients were analyzed retrospectively to assess the incidence and risk factors for elevation of serum hepatic aminotransferases during methotrexate (MTX) therapy. The effect of folate supplementation on serum ALT and RA activity was evaluated prospectively in 14 patients who showed a sustained high serum level of ALT. The frequency of elevation of serum AST or ALT was 4-5 times greater than in patients taking other DMARDs. Multivariate linear regression analysis demonstrated that elevation of ALT was independently associated with sex (female), obesity, baseline ALT, MTX dose, and gastrointestinal side effects. Folate supplementation caused ALT levels to decrease in all patients within 3 months. Eleven patients showed no change of RA activity, but 3 patients dropped out of the study because of the exacerbation of RA. These results suggest that careful monitoring of serum hepatic aminotransferases is necessary in patients with predisposing factors, especially those receiving more than 0.15 mg/kg of MTX weekly. Folate supplementation can reverse the sustained elevation of ALT, but might cause exacerbation of RA in some patients.

Low prevalence of hepatitis C virus infection among hospital staff and acupuncturists in Kyushu, Japan.

During 1987 and 1988, samples of serum were collected from 1097 members of the staff of four prefectural hospitals in Miyazaki prefecture and from 183 acupuncturists in Fukuoka City, Japan. The staff included both surgical and non-surgical doctors, radiographers, physiotherapists, nurses, laboratory technicians and others. The samples were tested for the following hepatitis C virus (HCV) markers; antibodies to c100 (anti-c100) by means of enzyme-linked immunosorbent assay (ELISA) with supplementary recombinant immunoblot assay as well as antibodies to the GOR epitope (anti-GOR), also by means of ELISA. Anti-c100 was present in 1.7% of the doctors, radiographers and physiotherapists, in 1.3% of the nurses and in 2.2% of the acupuncturists. These prevalences were slightly higher than those in the controls but the differences were not statistically significant. Anti-c100 was not detected in any laboratory technician or other member of the hospital staff. For an accurate determination of the prevalence of HCV infection, the combined rate of anti-c100 and/or anti-GOR was also calculated. The combined prevalence of HCV infection was 4.3% in medical staff, 2.2% in nurses and 5.5% in acupuncturists. The prevalence of HCV infection among those with direct contact with patients was higher than that of the controls but without statistical significance. In the cohort we examined, the occupational risk of HCV infection was low.

[Mechanochemical solid state reactions of natural products for medicinal use containing hydroxyanthraquinone derivatives].

In commercial powdered natural products for medicinal use containing various combined forms of hydroxyanthraquinone derivatives such as Sennae Folium, Cassiae Semen, Rhei Rhizoma and Aloe a considerable amount of stable free radicals (ca. 10(17)-10(18) spin/g) was found to be contained by use of electron spin resonance (ESR) spectral measurements. It was also found that the vibratory milling of such powders in a metallic vessel enhanced the ESR spectral intensities, demonstrating the occurrence of mechanoradical formation. Separate experiments also demonstrated that the vibratory milling of various kinds of powdered hydroxyanthraquinone derivatives mixed with calcium oxalate has produced the mechanoradicals effectively, but they decayed gradually on standing at room temperature. It was suggested, therefore, that the mechanoradicals formed in the above natural products are metal complexes of the corresponding semiquinone anion radicals induced by solid state one electron transfer mechanism from the active metal surface, part of which is further immobilized in polymeric fibers or the like in the plant tissues.

Late infantile tetany and secondary hyperparathyroidism in infants fed humanized cow milk formula. Longitudinal follow-up.

Five full-term infants with birth weights appropriate for gestational age presented with hypocalcemic tetany at 5 to 9 days of age. All infants had been fed Similac 20, a cow milk formula. Initial mean serum calcium (Ca), phosphorus (P), and magnesium (Mg) levels of the tetanic infants were 6.8, 9.5, and 1.6 mg/dL, respectively. The mean serum parathyroid hormone (PTH) level was elevated at 79 mu LEq/mL (adult normal values, less than or equal to 57 mu LEq/mL). Following restoration of normocalcemia with Ca supplements, feeding was reinstituted with Similac 20 in two infants and Similac PM 60/40 in three infants. Serum biochemical and hormonal values were compared with those of 18 exclusively breast-fed infants followed up from three weeks to six months and 14 Similac 20-fed full-term infants followed up from one week to six months. In tetanic infants, serum Ca concentrations became elevated (10.4 +/- 0.05 mg/dL; mean +/- SEM) by six weeks (vs 9.2 +/- 0.3 mg/dL in breast-fed infants) (P less than .001) and serum Mg concentrations (2.26 +/- 0.01 mg/dL) by four weeks (vs 1.92 +/- 0.07 mg/dL in breast-fed infants) (P less than .01). Mean serum P concentrations declined progressively. Mean serum PTH concentrations were elevated and ranged from 74 to 143 mu LEq/mL at two to 16 weeks (vs mean 28 to 35 mu LEq/mL in breast-fed infants (P less than .0001). In 14 formula-fed-nontetanic full-term infants, serum PTH concentrations were intermediate between formula-fed-tetanic and breast-fed infants, mean serum Ca concentrations ranged from 10.2 to 10.4 mg/dL, and mean serum P concentrations declined from 8.3 to 7.1 mg/dL. We speculate that acute hypocalcemic tetany in the study infants was induced by the relatively high P load in cow milk formulas (vs human milk); with the continued P load, secondary hyperparathyroidism continued, maintaining P, Ca, and Mg homeostasis.