Results We identified 28 906 new episodes of medication use,

\n\nResults. We identified 28 906 new episodes of medication use, including TNF-alpha antagonists (8%), MTX alone (15%) and glucocorticoids alone (57%). Compared with MTX initiation, TNF-alpha antagonist initiation did not significantly increase the

risk of hospitalizations for pneumonia [adjusted hazard ratio (aHR) 1.61; 95% CI 0.85, 3.03] or any infection (aHR 1.31; 95% CI 0.78, 2.19). selleck screening library Initiation of LEF, SSZ or HCQ did not increase serious infections, compared with MTX. Both initiation and concurrent glucocorticoid use were associated with a dose-dependent increase in serious infections. Sensitivity analyses showed consistent results.\n\nConclusions. Compared with initiation of MTX alone, initiation of TNF-alpha antagonists was not associated with a large increase in the risk of serious infections. Glucocorticoid use was associated with a dose-dependent increase in the risk of these infections.”
“The aim of the report is to document

two cases of biopsy-proven temporal arteritis, resulting in major visual loss that recovered almost completely after treatment with intravenous methylprednisolone and intravenous heparin infusion. An 80-year-old Caucasian lady presented with vision of perception of light (PL) due to a central retinal artery occlusion. Following systematic treatment with anterior chamber paracentesis, intravenous heparin, and intravenous steroids, vision improved to 6/5. A definitive diagnosis was made following temporal artery biopsy. A 77-year-old Caucasian lady presented with treated polymyalgia rheumatica, which on further history and examination was confirmed to be temporal click here arteritis. Prompt treatment of her arteritic anterior ischaemic optic neuropathy with intravenous methylprednisolone and intravenous heparin infusion resulted in improvement of visual acuity from 6/12 to 6/5 with Rocilinostat a sustained improvement in visual fields and in the funduscopically visible optic nerve ischaemic changes. The authors conclude that near-complete resolution of major visual loss in these two patients with biopsy-proven temporal arteritis suggests

that the appropriate use of a therapeutic intravenous methylprednisolone and heparin protocol could represent a way forward in the management of this potentially blinding disease. This would need to be confirmed in large prospective, randomised controlled studies.”
“Climate change models for California’s Sierra Nevada predict greater inter-annual variability in precipitation over the next 50 years. These increases in precipitation variability coupled with increases in nitrogen deposition from fossil fuel consumption are likely to result in increased productivity levels and significant increases in forest understory fuel loads. Higher understory plant biomass contributes to fuel connectivity and may increase future fire size and severity in the Sierra Nevada.

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