Hydroxychloroquine and the associated risk of arrhythmias

Hydroxychloroquine (HCQ), which was initially used as an antimalarial drug, is now being used to treat other illnesses, especially rheumatic autoimmune disorders  such as systemic lupus erythematosus, primary Sjögren's syndrome, and rheumatoid arthritis, because it is safe, effective, and cost efficient. This drug has shown high efficacy and has become the first-line treatment for many of these diseases. Although HCQ has many therapeutic effects, it has unfortunately shown some complications, especially with its long-term use. One of these side effects is arrhythmia through prolongation of the QT interval. This narrative literature review focuses on the effects of HCQ on the QT interval in patients with rheumatologic diseases who have been prescribed this drug. In particular, we will focus on the increased risk of arrhythmia when HCQ is administered with other drugs, such as azithromycin and many others, along with drug-drug interactions. In addition, we investigated the safety of this drug in pregnant women.

Evaluation of Efficacy of Bromocriptine as a Therapeutic Modality in the Treatment of Diabetes Mellitus: A Systematic Review

Diabetes mellitus (DM), one of the oldest diseases known to mankind has always been difficult to treat even with the availability of a variety of medications. In such a scenario, the Food and Drug Administration (FDA) has approved a novel therapeutic, bromocriptine, with a different mechanism of action than the traditional medications since 2009 but has not been used as either first-line therapy or add-on therapy. In this systematic review, we searched databases like PubMed, Medline, PubMed Central, Cochrane Library, Clinicaltrials.gov, and Wiley Online Library. The selected articles were screened using inclusion and exclusion criteria and quality appraised; finally, 11 studies including eight clinical trials and three narrative reviews were included. It was found that an increase in dopamine and serotonin levels were hypothesized to convert the insulin-resistant (IR) state to an insulin-sensitive (IS) state. Hence in DM, as there is an IR state, the administration of dopamine was hypothesized to increase insulin sensitivity. In our study based on included studies, it was found that bromocriptine was superior as an add-on therapy to metformin compared to metformin alone, also it was found beneficial in people failing treatment with any one oral hypoglycemic agent. On the contrary, bromocriptine was found inferior to teneligliptin in treating DM. Still, more studies are required to make an accurate and reliable assessment of the efficacy of bromocriptine in treating DM.

The Associations of Auto-Brewery Syndrome and Diabetes Mellitus: A Literature Review and Clinical Perspective

Endogenous production of alcohol without the external intake of alcohol is called auto-brewery syndrome (ABS), and to get its levels to rise to a level that it has physical symptoms of alcohol intake is rare. The most common cause of ABS is the metabolism of ingested carbohydrates by intestinal microflora. This occurrence does not happen in all normal individuals but only in some high-risk individuals. Patients with diabetes mellitus (DM) have been hypothesized to be at high risk for ABS. We searched databases, such as PubMed, Medline, and PubMed Central, to search for existing literature with relevant keywords. In the finalized review, we have included 30 relevant articles. Alcohol formed in the gut gets absorbed in the bloodstream and immediately gets metabolized, so usually it does not achieve a level in blood high enough to cause symptoms. In high-risk patients, there is an increase in the level of bloodstream alcohol above a certain level, so it shows symptoms. Because there is higher blood glucose in DM, the patients have been shown to be at increased risk for developing ABS. Similarly, obesity is also a risk factor for DM, making it a high-risk condition for ABS. The most involved pathogens are Candida and Saccharomyces.

Unmasking a Silent Killer and Understanding Sudden Cardiac Death in Brugada Syndrome: A Traditional Review

Brugada syndrome (BrS) is an intricate and heterogeneous genetic disorder that engenders a formidable risk of life-threatening ventricular arrhythmias (VAs). While initially regarded as an electrophysiological aberration, emergent studies have illuminated the presence of underlying structural anomalies in select BrS cases. Although mutations in the SCN5A gene encoding the α-subunit of the cardiac sodium channel were originally identified as a primary causative factor; they account for only a fraction of the syndrome's multifaceted complexity pointing at genetic heterogeneity as a contributing factor. Remarkably, BrS has been linked to a higher incidence of fatal arrhythmic incidents and sudden cardiac death (SCD) with about 4% of SCD cases thought to be caused by BrS. Patients who spontaneously exhibit type one Brugada ECGs are more likely to experience cardiac events, emphasizing the importance of early risk stratification. To aid in risk stratification, the Shanghai score; a multifactorial risk stratification scoring system that incorporates ECG, clinical history, family history, and genetic test results; is utilized to identify those most susceptible to SCD. Beyond single ECGs, evaluation of arrhythmic findings from 24-hour Holter monitoring, ECG variables, electrophysiologic study (EPS) status in the temporal domain, and EPS data collected over time are all critical factors in risk classification. Among management options avoidance of triggers, early risk stratification, and implantation of an Implantable Cardioverter-Defibrillator (ICD) are recommended for asymptomatic patients. For symptomatic patients, pharmacotherapy and ICD implantation are available, with the latter being a highly effective choice for treating and preventing lethal arrhythmias in BrS.

Spontaneous Cholesterol Embolism Leading to Small Bowel Obstruction and Perforation

A spontaneous occurrence of cholesterol embolization syndrome causing small bowel obstruction and perforation is a highly scarce event. In this article, we report a case of spontaneous cholesterol embolism resulting in small bowel obstruction and perforation in a 52-year-old male with multiple cardiovascular and medical comorbidities. In our patient, the source was an eccentric left lateral atherosclerotic plaque from the abdominal aorta that was identified using computed tomography. A distal occlusion in numerous small intestinal arteries due to cholesterol embolism was confirmed on biopsy after surgical resection. (Level of Difficulty: Intermediate.).

Understanding Auto-Brewery Syndrome in 2023: A Clinical and Comprehensive Review of a Rare Medical Condition

Auto-brewery syndrome (ABS) occurs when the gastrointestinal tract produces excessive endogenous ethanol. This article examines various aspects of ABS such as its epidemiology, underlying etiology, diagnostic difficulties, management strategies, and social implications. By synthesizing the existing medical literature, we hope to identify understanding gaps, pave the way for further research, and ultimately improve detection, treatment, and awareness. The databases we used are PubMed, PubMed Central, and Google Scholar. We carefully screened all published articles from inception till date and narrowed down 24 relevant articles. We at Richmond University Medical Center and Mount Sinai are one of the leading medical centers for diagnosing and treating this rare condition in the United States.

Ectopic Cushing Syndrome in Adenocarcinoma of the Lung: Case Report and Literature Review

Paraneoplastic syndromes are rare disorders that occur with many types of tumors. Ectopic cushing syndrome (ECS) is the second most common paraneoplastic syndrome that is only seen in 1-5% of all small cell lung cancers (SCLC), with limited papers reporting this syndrome since it was first described by Brown in 1928 or in carcinoid tumors. It is also found to be associated to a lesser extent with pheochromocytoma, thymic tumors, pancreatic carcinoma, and anaplastic thyroid carcinoma. While lung adenocarcinoma is the most common histological type of lung neoplasms, it is seldom associated with Cushing syndrome. In this article, we describe a patient who initially presented with Cushing syndrome and found to have adenocarcinoma of the lung.

Antacid-induced acute hypercalcemia: An increasingly common and potentially dangerous occurrence

Hypercalcemia is frequently encountered in both hospital wards and the primary care setting; 90% of cases can be attributed to primary hyperparathyroidism and malignancy. However, a minority are caused by medications, of which calcium supplements have been an increasingly common etiology. We are presenting a case of hypercalcemia resulted after acute oral intake of a moderate amount of antacids (calcium tablets) and normalized after supplement withdrawal.

Menopausal hormone treatment in postmenopausal women: risks and benefits

Our objectives in this review were to examine the relevant menopausal hormone treatment (MHT) trials in postmenopausal women during the past 3 decades, provide an insight analysis of these studies from a clinical point of view, determine the efficacy and applicability of hormone therapy in the prevention of cardiovascular diseases, and provide suggestions on the use of MHT as a cardiovascular disease prophylaxis based on the available data. MHT may have a more complicated role in cardiovascular protection, and there is a need for further research to elucidate the dose and type of estrogen, its route of administration, the time of MHT initiation, and the preventive role of MHT in women's health.