Familial Mediterranean fever: perspective on female fertility and disease course in pregnancy from a multicenter nationwide network.

The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine.

Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study.

To evaluate of hepatitis serology and reactivation frequency in patients with rheumatic disease receiving biologic agents. Our study included patients with inflammatory rheumatic diseases from 23 centers, who were followed up with biological therapy. Demographic and clinical characteristics of the patients, duration of drug use and hepatitis serology and the state of viral reactivation were analyzed. A total of 4060 patients, 2095 being males, were included in our study. Of the patients, 2463 had Ankylosing Spondylitis (AS), 1154 had Rheumatoid Arthritis (RA), 325 had Psoriatic Arthritis (PsA), and 118 had other inflammatory rheumatic diseases. When the viral serology of the patients was evaluated, 79 patients (2%) who were identified as HBs Ag positive, 486 (12%) patients who were HBs Ag negative and anti-HBc IgG positive and 20 patients (0.5%) who were anti-HCV positive. When evaluated on a disease-by-disease basis, the rate of HBsAg was found to be 2.5% in RA, 2% in AS and 0.9% in PsA. Viral reactivation was detected in 13 patients while receiving biologic agents. HBs Ag was positive in nine patients with reactivation and negative in four patients. Anti-HBc IgG, however, was positive. Six of these patients had AS, four had RA, and three had PsA. The development of hepatitis reactivation in 11.4% of HBs Ag positive patients and 0.82% of anti-HBc IgG positive patients due to the use of biologic agents is an important problem for this group of patients. Antiviral prophylaxis is recommended to be started especially in patients who are HBs Ag positive and who are using biologic agents due to viral reactivation. Therefore, it is important to carry out hepatitis screenings before biologic agent treatment and to carefully evaluate the vaccination and prophylaxis requirements.

Evaluation of clinical relationship of serum niacin and dopamine levels in patients with fibromyalgia syndrome.

Objectives: The aim of this study was to investigate the role of serum niacin and dopamine (DA) levels and their clinical importance in fibromyalgia syndrome (FMS) patients. Patients and methods: Between April 2018 and October 2018, a total of 53 female patients (mean age: 38.3±5.5 years; range, 21 to 45 years) with a clinical diagnosis of FMS and 35 healthy female controls (mean age: 36.7±5.2 years; range, 25 to 44 years) were included in this cross-sectional study. The Visual Analog Scale (VAS), Beck Depression Inventory (BDI), and Fibromyalgia Impact Questionnaire (FIQ) were applied to the patients. Serum levels of niacin and DA were measured by high-performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay (ELISA) methods, respectively. Results: Niacin and DA levels of the patient group were significantly lower than those of control group (p=0.003 and p=0.02, respectively). A very strong positive correlation was found between niacin and DA levels (r=0.96 p<0.001). Evaluation of the diagnostic performance of niacin and DA by the receiver operating characteristic analysis yielded an area under the curve (AUC) of 0.73 (p<0.001, 95% confidence interval [CI]: 0.62-0.85) and an AUC of 0.68 (p=0.004, 95% CI: 0.56-0.80), respectively. Conclusion: Serum niacin and DA levels decrease in FMS patients in relation to the tender point numbers. It can be suggested that the levels of these two markers can be considered additional tools in the diagnosis of FMS.

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort.

OBJECTIVES: This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients. PATIENTS AND METHODS: This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale. RESULTS: The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT. CONCLUSION: Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

Effect of transcutaneous electrical nerve stimulation on quality of recovery and pain after abdominal hysterectomy.

BACKGROUND AND AIMS: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive complementary therapy for postoperative pain management. The effect of TENS on quality of recovery (QoR) and pain treatment in the early postoperative period is not well documented. The aim of this study was to evaluate the effect of TENS on postoperative QoR and pain in patients who had undergone a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO). MATERIAL AND METHODS: Fifty-two patients were randomized into two groups: control (sham TENS treatment) and TENS (TENS treatment). QoR, dynamic pain, and static pain were evaluated after surgery. RESULTS: The QoR score was significantly higher in the TENS group as compared with that in the control group (P = 0.029). Pain scores during coughing (dynamic pain) were significantly less in TENS group compared to control group (P <0.001). However, there was no between-group difference in pain scores at rest (static pain) or total analgesic consumption (P = 0.63 or P = 0.83, respectively). CONCLUSION: TENS may be a valuable tool to improve patients' QoR and dynamic pain scores after TAH + BSO.

The impact of COVID-19 on familial Mediterranean fever: a nationwide study.

The study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) in patients with familial Mediterranean fever (FMF) and to assess the relationships between FMF characteristics and severe COVID-19 outcomes such as hospitalization. The study was planned within a national network of 21 different centers. Demographics, FMF-related clinical and genetic characteristics, and COVID-19 outcomes were obtained. A total of 822 patients with FMF (mean age of 36 years) were included in the study. Fifty-nine of them (7%) had a COVID-19 diagnosis confirmed by real-time PCR test or chest CT findings. Most FMF patients with COVID-19 (58) had mild and moderate disease activity. All patients were on colchicine treatment. However, 8 of them (13.6%) were not compliant with colchicine use and 9 of them (15.3%) were colchicine resistant. Twelve FMF patients with COVID-19 were hospitalized. There were 4 patients requiring oxygen support. COVID-19 related complications were observed in 2 patients (1 thromboembolism, 1 acute respiratory distress syndrome). Hospitalized COVID-19 patients with FMF were older than non-hospitalized patients (median ages: 51 and 31 years, respectively; p: 0.002). Other FMF-related characteristics were similar between the groups. FMF-related characteristics were not found to be associated with poor outcomes in COVID-19. Thus, FMF may not be a risk factor for poor COVID-19 outcomes.

Association between Shoulder Range of Motion and Pain Catastrophizing Scale in Breast Cancer Patients after Surgery.

BACKGROUND: Prolonged survival period as a result of early diagnosis and treatment in breast cancer has increased the importance of postoperative morbidities. The aim of the present study was to investigate the association of pain ca-tastrophizing with shoulder pain in patients with decreased shoulder range of motion in the postoperative period. PATIENTS AND METHODS: The present study included 53 patients who underwent surgery due to breast cancer. Patients who had bilateral mastectomy, distant metastases, cervical-cranial originated lesions, patients with problems involving one of the shoulders or upper extremities before the operation, and patients with cognitive impairment, heart failure, or low albumin levels (liver parenchyma disease or renal failure) were excluded. Shoulder range of motion was measured in the postoperative period, and two study groups were established: one with a limited shoulder range of motion level and the other with a normal level. Effects of pain catastrophizing and shoulder pain severity on shoulder range of motion limitation were compared between the two groups. RESULTS: The average age of 53 female patients who had breast surgery was 52.3 ± 10.5 years. In the group with limited shoulder range of motion, the median pain catastrophizing scale value was 27 (range 5-32) and the shoulder pain severity score was 4 (range 0-8), while in the group with normal shoulder range of motion these values were 11 (range 3-39) and 2 (range 0-6), respectively (p < 0.05). In addition, it was found that factors such as surgical treatment modality and postoperative radiotherapy did not significantly affect shoulder range of motion limitation. CONCLUSION: Determining the pain catastrophizing scale of patients and controlling pain in the early postoperative period could have positive effects on shoulder range of motion.

Evaluation of the Effectiveness of Treatment with Botulinum Toxin on Sleep Quality in Stroke-Related Spasticity.

BACKGROUND AND PURPOSE: Botulinum toxin (BoNT) is a commonly used agent in the treatment of stroke-related spasticity. Sleep disorders can often be seen as a comorbidity or complication in stroke patients. Based on the data that spasticity is associated with sleep disorders, in this study, we aimed to evaluate whether sleep quality has changed in patients with stroke treated with BoNT. METHODS: Thirty five (17 female / 18 male) stroke patients with gastrocnemius and / or soleus spasticity were included in this observational cross-sectional study. In clinical evaluation before and three months after BoNT injection; for spasticity evaluation modified Ashworth scale (MAS), pain assessment visual analog scale (VAS), functional evaluation; passive joint range of motion (ROM) measurement, functional independence measurement (FIM), lower limb Brunstrom staging, life quality assessment short form-36 (SF-36) quality of life scale, and sleep quality assessment Pittsburgh sleep quality index (PSQI) scales were used. RESULTS: After the BoNT injection, there was a statistically significant decrease in MAS and VAS scores, a significant increase in passive ROM measurements, FIM, lower limb Brunstrom staging, and SF-36 physical function sub parameter. There was also a significant decrease in PSQI scores. Before and after treatment, there was no correlation found between PSQI values with pain and spasticity. However, there was a weak negative correlation between post-treatment PSQI values, passive ROM, SF-36 physical function and SF-36 physical role sub parameters (respectively: r: -0.335 p: 0.049, r: -0.364, 0.032, r: -0.404, p: 0.016). Conlusion: The results of our study suggest that BoNT, which is frequently used in the treatment of spasticity in stroke patients, has positive effects on sleep quality.

Familial mediterranean fever: assessment of clinical manifestations, pregnancy, genetic mutational analyses, and disease severity in a national cohort.

The aims of this study were to investigate the main clinical and laboratory features, including pregnancy and genetic analysis, of Turkish Familial Mediterranean Fever (FMF) patients and to analyze the relationships between genotypic features, age of disease onset, clinical findings, and disease severity. A study was planned within a national network of 22 different centers. Demographics, clinical and laboratory findings, attack characteristics, drugs, pregnancy and birth history, disease severity, and gene mutation analyses were evaluated. Disease severity, assessed using a scoring system developed by Pras et al., was evaluated in relation to gene mutations and age of disease onset. A total of 979 patients (643 females and 336 males; mean age: 35.92 ± 11.97 years) with FMF were included in the study. Of a total of 585 pregnancies, 7% of them resulted in preterm birth and 18.1% resulted in abortions. During pregnancy, there was no FMF attack in 61.4% of patients. Of the MEditerranean FeVer (MEFV) mutations, 150 (24.3%) cases were homozygous, 292 (47.3%) cases were heterozygous, and 175 (28.4%) were compound heterozygous. Patients with homozygous gene mutations had more severe disease activity, earlier age of disease onset, higher rates of joint and skin involvement, sacroiliitis, and amyloidosis. Patients with compound heterozygous genotype displayed severe disease activity in close resemblance to patients with homozygous mutation. In addition, patients with compound heterozygous mutations had higher rates of protracted febrile myalgia and elevated fibrinogen levels. In 63.9% of compound heterozygous patients, age of onset was < 20 years, with greater disease severity, and high rates of attack frequency and colchicine resistance. Our results suggest that indicators for disease severity include early onset of disease and homozygous gene mutations. Furthermore, patients with compound heterozygous mutations displayed significant presentations of severe disease activity.

Serum Interleukin-23/17 Levels in Ankylosing Spondylitis Patients Treated with Nonsteroidal Anti-Inflammatory Drugs: A Prospective Cohort Study.

Etiopathogenesis of ankylosing spondylitis (AS), a major subtype of a group of chronic inflammatory diseases known as spondyloarthropathies, is not clearly understood yet. In this study, we aimed to investigate the interleukin 23 (IL-23)/interleukin-17 (IL-17) pathway, which is a new cytokine pathway in inflammatory diseases. We evaluated serum IL-17 and IL-23 levels after 1-year follow-up in AS patients using only nonsteroidal anti inflammatory drugs (at need or continue). Forty-four AS patients and 40 healthy controls were included in the study. Clinical evaluations of disease activity were performed. Serum tumor necrosis factor-α (TNF-α), IL-6, IL-17, and IL-23 levels were evaluated. IL-17 and IL-23 levels of the patient group at baseline and 12 months were lower than the control group. There was no significant difference between the baseline and 12th month evaluations of the patient group. TNF-α levels were similar in all groups (in the baseline and 12th month of the patient group and in the control group). Although our results are in contrast to the literature findings, the IL-23/IL-17 pathway is a newly discovered pathway, and there may still be unknowns. New studies involving larger patient groups are needed for the factors affecting serum IL-23/IL-17 levels in patients with AS. We also think that it will be useful to make more comprehensive and long-term studies about which patients will respond well to IL-23/IL-17 blockade.

Biological and genetic evaluation of IL-23/IL-17 pathway in ankylosing spondylitis patients.

Ankylosing spondylitis is the most common form of the chronic inflammatory disease group known as spondyloarthritides. Recent discoveries of the CD4+ Th17 cells and IL-23/IL-17 axis have changed the paradigms in many autoimmune diseases. In this study, we aimed to evaluate the importance of IL-23/IL-17 pathway and IL-23 receptor polymorphism in the pathogenesis of ankylosing spondylitis. Blood samples for this study were obtained from 109 ankylosing spondylitis patients and 40 healthy control subjects. Serum levels of TNF-α, IL-6, IL-17, and IL-23 were measured by the ELISA method. The IL-23R gene polymorphisms rs11209026 (Arg381Gln) and rs4131362 (Val362Ile) were performed by the Sanger Sequence method. IL-6 levels were higher in the active and inactive ankylosing spondylitis groups than in the control group. However, levels of IL-17 and IL-23 were lower in the patient group. The frequency of IL-23R gene rs11209026 and rs4131362 polymorphism were 3.7% and 8.3% in the patient, respectively. As a result, dysregulation of the IL-23 / IL-17 pathway, which is caused by reduced levels of IL-17 and IL-23 in systemic circulation in patients with ankylosing spondylitis, may contribute to the pathogenesis of the disease by systemically producing chronic autoimmune inflammation.

Analysis of kyphosis, vertebral fracture and bone mineral density measurement in women living in nursing homes.

OBJECTIVES: To analyze the relationship between vertebral fracture, degree of kyphosis, and BMD in women living in nursing homes. METHODS: This cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation, Hitit University Hospital, Corum, Turkey, betweenJanuary 2014 and January 2015. Of the 126 female patients who participated in the study, 48 lived in nursing homes (nursing-home-group [NHG]), 78 lived in non-nursing home settings (control-group [CG]). Vertebral fractures were evaluated via the semi-quantitative Genant method. Cases in which a Cobb angle measured 40 degrees or more resulted in a diagnosis of kyphosis. RESULTS: The mean age of participants in the NHG was 77.2±7.6 years and 76.8±6.2 years in the CG (p greater than 0.05). The kyphosis rate in the NHG was found to be higher at 52.1% compared to 27.7% for the CG (p less than 0.001). In the NHG, 68.7% had osteoporosis, 31.3% had osteopenia; in the CG, 55.2% had osteoporosis, 32% had osteopenia, 12.8% had normal values (p less than 0.05).The vertebral fracture rate was 37.5% in the NHG and 24.3% in the CG (p greater than 0.05). The Cobb angle had correlation with the number of fractures in both groups (p less than 0.05). CONCLUSIONS: The osteoporosis and kyphosis rates of women living in NHG were higher than those of women living in CG. As kyphosis and the number of fractures are correlated, it is important to analyze kyphosis in women residing in NHG.

The efficacy of topical 0.05 % cyclosporine A in patients with dry eye disease associated with Sjögren's syndrome.

Sjögren's syndrome (SS) is an autoimmune epithelitis which usually presents with mouth and eye dryness. Although the place of systemic drugs in keratoconjunctivitis sicca treatment has been discussed, the efficacy of some topical drugs has also been demonstrated; however, there are contradictory results related to topical cyclosporine A. We aimed to investigate the efficacy of 0.05 % topical cyclosporine A in patients with keratoconjunctivitis sicca due to primary and secondary SS. This prospective study included 26 patients with a diagnosis of primary and secondary SS who visited our rheumatology outpatient clinic. Keratoconjunctivitis sicca was diagnosed in all patients after they were examined at the outpatient clinic. Patients were given topical 0.05 % cyclosporine A emulsions for both eyes. We used another 20 patients with SS who were treated with saline solution as a control group. Subjective symptoms reported after 1-week and 1-month follow-up were complaints of burning and pricking sensation, light sensitivity and pain. Objective signs included redness, Schirmer test and tear break-up time. A total of 26 patients (19 female) were enrolled in the study with a mean age of 47.5 years and mean disease duration of 5.2 years. In the first physical examination of patients, 23 patients had burning and pricking sensation, 24 had pain, 23 had light sensitivity, and 24 had red eyes. All subjective symptoms (burning and pricking sensation, light sensitivity and pain) were statistically significantly improved after 1-week and 1-month follow-up examinations (p = 0.0001). All objective signs (Schirmer test, tear break-up time, and redness) were statistically significantly improved after 1-week and 1-month follow-up examinations (p = 0.0001). Compared with the control group, there was significant improvement in all parameters. It is concluded that topical 0.05 % cyclosporine A is an effective treatment option for keratoconjunctivitis sicca due to SS after a 1-month follow-up period.

Do neutrophil gelatinase-associated lipocalin and interleukin-18 predict renal dysfunction in patients with familial Mediterranean fever and amyloidosis?

BACKGROUND: The aim of this study was to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) predict renal disfunction in patients with familial Mediterranean fever (FMF). METHODS: This prospective study consisted of 102 patients with FMF in attack-free period, and 40 matched healthy controls. Of the patients, nine were diagnosed as amyloidosis. The patients were divided into two groups according to eGFR as below 120 mL per minute and above 120 mL per minute. Also, patients were divided into three groups according to the degree of urinary albumin excretion as normoalbuminuric, microalbuminuric, and macroalbuminuric. The serum levels of IL-18 (sIL-18) and NGAL (sNGAL), and urinary levels of IL-18 (uIL-18) and NGAL (uNGAL) were measured by using ELISA kits. RESULTS: The levels of sIL-18, sNGAL, uIL-18, and uNGAL were detected significantly higher in FMF patients, particularly in patients with amyloidosis, when compared to controls. sNGAL, uIL-18, and uNGAL were significantly higher in patients with eGFR < 120 mL per minute than in patients with eGFR ≥ 120 mL per minute. sNGAL, uIL-18, and uNGAL were correlated significantly with urinary albumin excretion, additionally, were inverse correlated with eGFR. The most remarkable findings of this study are of the higher values of sIL-18, sNGAL, uIL-18, and uNGAL in both normoalbuminuric FMF patients and patients with eGFR ≥ 120 mL per minute. CONCLUSIONS: The results of this study suggest that sIL-18, uIL-18, sNGAL, and uNGAL are reliable markers of early renal disfunction in FMF patients, and may let us take measures from the early stage of renal involvement.

[Toxoplasma uveitis in a patient with ankylosing spondylitis]. / Ankilozan Spondilitli Olguda Toxoplasma Üveiti.

In this paper, a posterior uveitis case was reported in a patient who was being followed and under treatment for Ankylosing Spondylitis. Toxoplasma antibodies were investigated and anti-toxoplasma IgG was positive. Systematic treatment (Sulfamethoxazole/Trimethoprim and Clindamycin) was started. Despite medical treatment, reduction in visual acuity and development of dense membranous condensation in vitreous occurred. Surgical vitrectomy was performed. When posterior uveitis develops in patients who undergo immunosuppressive treatment, toxoplasma is among the first infectious agents that we should consider. A delay in diagnosis and treatment may result in failure in obtaining the desired outcome from medical treatment and a shift to surgical treatment.

Evaluation of metabolic syndrome in patients with chronic low back pain.

The aim of our study was to investigate the frequency of the metabolic syndrome in chronic low back pain and evaluate the differences in clinical and functional parameters in chronic low back pain patients with and without metabolic syndrome. Patients complaining of low back pain complaint lasting for at least 2 months were included in the study. In order to establish functional deficiency, Roland-Morris Disability Questionnaire, Istanbul Low Back Pain Disability Index and Oswestry Disability Index were used. To evaluate depression, Beck's depression scale was used. The diagnosis of metabolic syndrome was made according to the criteria of National Cholesterol Education Program (NCEP) defined in 2001. For this; lumbar circumference around anterior iliac spine, arterial blood pressure, fasting blood glucose, plasma triglyceride levels and HDL cholesterol levels were noted down. Sixty patients (51 women) were included in the study. There was significant difference in terms of BMI (P = 0.034), age (P = 0.001), waist circumference (P = 0.048) and disease duration (P = 0.005) between chronic low back pain patients with and without metabolic syndrome. There was no significant difference in other parameters. Low back pain is a frequent complaint amongst people with obesity in the abdominal area. According to our results, elderly people, people with chronic low back pain and patients with high BMI are under risk for metabolic syndrome. For this reason this group of patients can be screened for metabolic syndrome and preventive measures can be taken.

Retinopathy due to antimalarial drugs in patients with connective tissue diseases: are they so innocent? A single center retrospective study.

INTRODUCTION: Antimalarial medications are basal active drugs used for the treatment of various rheumatological conditions. Their common side-effects include eye damage. AIM: The aim of this study is to determine the safety of antimalarial medications used for rheumatological conditions and the incidence of retinopathy. MATERIAL AND METHODS: Eighty-five patients with rheumatological conditions, who were followed in our rheumatology clinics between 2005 and 2009 while under chloroquine (CQ) and/or hydroxychloroquine (HQ) treatment were included in the study. Indirect ophthalmoscopic examination with 90 dioptry lens, frontal segment examination and macular visual area test were applied to all patients. Severity of retinopathy was evaluated as mild initial defect in the macula, or severe visual area loss. RESULTS: Retinopathy findings were detected in 21 out of 85 patients (24.7%). Of these patients, 12 had mild initial defects while nine had severe visual area loss. Of 21 patients, eight were on HQ and 13 were on CQ treatment. Of the patients seen with findings of retinopathy, 17 had comorbid hypertension (HT) and six had diabetes mellitus (DM). Patients receiving CQ are under higher risk compared to those on HQ treatment (P = 0.001). Patient age, disease duration, HT and DM presence had no statistically significant effect on retinopathy development (P = 0.144, P = 0.305, P = 0.258, P = 0.395, respectively). CONCLUSION: The incidence of retinopathy among patients using antimalarial medications as observed in this study was relatively high. Based on these results, it is essential to emphasize the importance of close monitoring in patients receiving antimalarial medications and evaluation of visual findings before treatment initiation.

Effects of latanoprost and betaxolol on cardiovascular and respiratory status of newly diagnosed glaucoma patients.

AIMS: To investigate the cardiovascular and respiratory effects of topical latanoprost 0.005% and topical betaxolol 0.25% monotherapy in newly diagnosed glaucoma patients. METHODS: Fortynewly diagnosed glaucoma patients were enrolled in this prospective, observer-masked, randomized, parallel study. Patients received either latanoprost 0.005% or betaxolol 0.25% for a duration of 3 months. Baseline evaluation included intraocular pressure (IOP) measurement and cardiorespiratory examinations including pulse rate, systolic and diastolic blood pressure measurements and spirometry. These measurements were repeated after 3 months. RESULTS: Both latanoprost and betaxolol reduced IOP significantly (p = 0.001). After 3 months of therapy, the mean pulse rate, systolic and diastolic blood pressure values of the betaxolol group were reduced (p = 0.027, p = 0.07 and p = 0.016, respectively). No significant changes occurred in the cardiovascular measurements of the latanoprost group (p > 0.05). There were no significant changes in any of the spirometric measurements tested for both groups (p > 0.05). CONCLUSION: Both latanoprost and betaxolol are safe concerning respiratory functions. Betaxolol may cause small changes in the cardiovascular system, suggesting that blood pressure and pulse rates should be checked before and in regular intervals after prescribing it for the elderly. Latanoprost seems to be a safe medication in view of absence of systemic cardiovascular and respiratory side effects.