Andreas Sandgren and colleagues describe a new comprehensive resource on drug resistance mutations inM. tuberculosis.

The combined effects of multiple oral infections were significantly associated with preterm birth.

P rolonged use of hydroxychloroquine (HCQ) has been implicated in the development of conduction disturbances and myocardial dysfunction. 1 We report a case of cardiomyopathy after 10 years of HCQ therapy in a 66-yearold woman with systemic lupus erythematosus (SLE). Case PresentationA 66-year-old white woman with a 24-year history of SLE presented to our institution with decompensated heart failure. She had no cardiac history until 8 weeks before admission, when she presented to an outside hospital for new-onset heart failure. Other significant medical history included gout, dyslipidemia, hypertension, and SLE first diagnosed in 1986 complicated by World Health Organization class 4 lupus nephritis, diagnosed in 2001. She was taking HCQ (400 mg daily), prednisone (Ͻ5 mg/d), and azathioprine for treatment of SLE. The evaluation for new-onset heart failure at the outside facility consisted of an echocardiogram, which showed a left ventricular ejection fraction of 35% and coronary angiogram that revealed mild, nonobstructive coronary artery disease. The ECG showed new-onset, 3rd-degree atrioventricular block. She underwent placement of a biven-

Previous studies examined the serum immunoglobulin levels in relation to coronary artery disease (CAD). We hypothesized that the salivary immunoglobulins might better estimate oral infections in this relationship. Multivariate logistic regression analyses utilizing the data from 256 angiographically confirmed CAD patients and 250 non-CAD individuals that controlled for age, sex, smoking, diabetes, total/HDL cholesterol ratio, hypertension, and education revealed the trends that salivary IgA was positively and salivary IgG was inversely associated with CAD. The odds ratios (OR) of each increasing quartile of salivary IgA were 1.00 (first and second quartiles combined), 1.97, and 1.37 (p-value for trend = 0.06), while those for salivary IgG were 1.00, 0.77, 0.60, and 0.51 (p-value for trend = 0.02). Additionally, salivary IgA correlated positively with C-reactive protein and Asymptotic Dental Score (dental infection score), while IgG was inversely associated with these inflammation markers. Salivary IgA warrants further studies to confirm its role in the risk assessment of CAD.