Lupus Enteritis: A Case Report

Lupus enteritis is a rare presentation of systemic lupus erythematous, clinically manifested by abdominal pain, vomiting, and diarrhoea. Proper diagnosis and treatment are essential to avoid complications, including death. Here, the authors report a case of a 52-year-old White female who presented with abdominal pain and chronic diarrhoea, with diagnostic tests compatible with lupus enteritis. Such a condition is an uncommon manifestation of systemic lupus erythematosus, an autoimmune disease that affects young females, resulting from gastrointestinal involvement by small vessel vasculitis. Early detection and proper management of lupus enteritis are essential to improve long-term survival. The present case addresses the clinical characteristics of lupus enteritis, emphasising its pathophysiology, diagnosis, and treatment

Xanthine oxidase inhibitors for prevention of cardiovascular events: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Xanthine oxidase inhibitors (XOI), classified as purine-like (allopurinol and oxypurinol) and non-purine (febuxostat and topiroxostat) XOI, present antioxidant properties by reducing the production of reactive oxygen species derived from purine metabolism. Oxidative stress is an important factor related to endothelial dysfunction and ischemia-reperfusion injury, and may be implicated in the pathogenesis of heart failure, hypertension, and ischemic heart disease. However, there is contradictory evidence regarding the possible cardiovascular (CV) protective effect exerted by XOI. Our objective is to compare the incidence of major adverse cardiovascular events (MACE), mortality, total (TCE) and specific CV events in randomized controlled trials (RCTs) testing XOI against placebo or no treatment. Methods PubMed, EMBASE, Web of Science, Cochrane Central, Lilacs databases were searched from inception to Dec 30 2016, along with hand searching. RCTs including exclusively adult individuals, lasting ≥ 4 weeks, with no language restriction, were eligible. Independent paired researchers selected studies and extracted data. Considering the expected rarity of events, Peto and DerSimonian/Laird odds ratios (OR), the latter in case of heterogeneity, were used for analysis. Random-effects meta-regression was used to explore heterogeneity. Results The analysis of MACE included 81 articles (10,684 patients, 6434 patient-years). XOI did not significantly reduce risk of MACE (ORP = 0.71, 95% CI 0.46–1.09) and death (0.89, 0.59–1.33), but reduced risk of TCE (0.60, 0.44–0.82; serious TCE: 0.64, 0.46 to 0.89), and hypertension (0.54, 0.37 to 0.80). There was protection for MACE in patients with previous ischemic events (0.42, 0.23–0.76). Allopurinol protected for myocardial infarction (0.38, 0.17–0.83), hypertension (0.32, 0.18–0.58), TCE (0.48, 0.31 to 0.75, I2 = 55%) and serious TCE (0.56, 0.36 to 0.86, I2 = 44%). Meta-regression associated increasing dose of allopurinol with higher risk of TCE and serious TCE (P  300 mg/day) may be associated with loss of CV protection