RESUMEN
BACKGROUND: Hydroxychloroquine (HCQ) nonadherence is associated with a 3-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported: 1) risk of acute care utilization by HCQ blood levels; 2) cost of HCQ monitoring vs. acute care visits. METHODS: HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as: a) subtherapeutic (<750 ng/ml), b) therapeutic (750-1200 ng/ml), or c) supratherapeutic (>1200 ng/ml). All lupus-related acute care visits (ER visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher acute care utilization. RESULTS: A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower acute care utilization. In our cohort, two groups, people of Black race or Hispanic ethnicity and those with public insurance, faced 3-4x higher acute care utilization. Levels within 750-1200 ng/ml were associated with 95% lower acute care utilization in subgroups with higher acute care utilization. CONCLUSION: HCQ blood levels within 750-1200 ng/ml are associated with lower acute care utilization in all patients with lupus, including groups with higher acute care utilization. Future clinical trials should establish the causal association between HCQ level monitoring and acute care utilization in lupus.
RESUMEN
The larynx undergoes significant age and sex-related changes in structure and function across the lifespan. Emerging evidence suggests that laryngeal microbiota influences immunological processes. Thus, there is a critical need to delineate microbial mechanisms that may underlie laryngeal physiological and immunological changes. As a first step, the present study explored potential age and sex-related changes in the laryngeal microbiota across the lifespan in a murine model. We compared laryngeal microbial profiles of mice across the lifespan (adolescents, young adults, older adults and elderly) to determine age and sex-related microbial variation on 16s rRNA gene sequencing. Measures of alpha diversity and beta diversity were obtained, along with differentially abundant taxa across age groups and biological sexes. There was relative stability of the laryngeal microbiota within each age group and no significant bacterial compositional shift in the laryngeal microbiome across the lifespan. There was an abundance of short-chain fatty acid producing bacteria in the adolescent group, unique to the laryngeal microbiota; taxonomic changes in the elderly resembled that of the aged gut microbiome. There were no significant changes in the laryngeal microbiota relating to biological sex. This is the first study to report age and sex-related variation in laryngeal microbiota. This data lays the groundwork for defining how age-related microbial mechanisms may govern laryngeal health and disease. Bacterial compositional changes, as a result of environmental or systemic stimuli, may not only be indicative of laryngeal-specific metabolic and immunoregulatory processes, but may precede structural and functional age-related changes in laryngeal physiology.