Risk of Myocardial Infarction among new users of calcium supplements alone or combined with vitamin D: a population-based case-control study

A population-based case-control study was conducted to evaluate the risk of acute myocardial infarction among new users of calcium supplements either in monotherapy (CaM) or in combination with vitamin D (CaD). A total of 23,025 cases and 114,851 controls randomly sampled from the underlying cohort and matched with cases by age, sex, and index date were included. New users of CaM and CaD were categorized as current users, recent users, past users, and nonusers. We computed adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) among current users as compared with nonusers through a conditional logistic regression. No increased risk was associated with CaM overall (59 cases (0.26%) and 273 controls (0.24%); AOR = 0.80; 95% CI 0.59?1.09), nor was it found in any of the conditions examined. Instead, the use of CaD was associated with a decreased risk (275 cases (1.19%) and 1,160 controls (1.45%); AOR = 0.78; 95% CI 0.67?0.90), dose and duration-dependent, and particularly evident in patients with a high cardiovascular risk (AOR = 0.59; 95% CI 0.43?0.81).Instituto de Salud Carlos IIIMinisterio de Ciencia e Innovació

Risk of Acute Myocardial Infarction Among New Users of Allopurinol According to Serum Urate Level: A Nested Case-Control Study

Abstract: Objectives: To test the hypothesis that allopurinol reduces the risk of acute myocardial infarction (AMI) in hyperuricemic patients and to assess whether the effect is dependent on dose, duration and serum uric acid (SUA) level attained after treatment. Methods: Nested case-control study over the period 2002?2015. From a cohort of patients aged 40?99 years old, we identified incident AMI cases and randomly selected five controls per case, matched for exact age, sex and index date. Adjusted odds ratios (AOR) and 95% CI were computed through unconditional logistic regression. Only new users of allopurinol were considered. Results: A total of 4697 AMI cases and 18,919 controls were included. Allopurinol use was associated with a reduced risk of AMI mainly driven by duration of treatment (AOR ?180 days = 0.71; 95% CI: 0.60?0.84). Among long-term users (>180 days), the reduced risk was only observed when the SUA level attained was below 7 mg/dL (AOR7mg/dL = 1.04; 95% CI: 0.75?1.46; p for trend = 0.001). A dose-effect was observed but faded out once adjusted for the SUA level attained. The reduced risk of AMI occurred in both patients with gout and patients with asymptomatic hyperuricemia. Conclusions: The results confirm a cardioprotective effect of allopurinol which is strongly dependent on duration and SUA level attained after treatment

Selective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study

BACKGROUND: Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias. METHODS: A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered. RESULTS: A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97?1.34) as compared with nonusers, 0.94 (95% CI, 0.77?1.13) as compared with past-users and 0.74 (95% CI, 0.58?0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (?1, >1 year), sex, age (<70, ?70 years old) and background vascular risk. CONCLUSIONS: The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.Instituto de Salud Carlos IIIMinisterio de Ciencia e InnovaciónFondo Europeo de Desarrollo Regiona

Risk factors for non-diabetic renal disease in diabetic patients

Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 6 12.8 years, creatinine was 2.8 6 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n ¼ 329) of patients had DN, 49.6% (n ¼ 413) NDRD and 10.8% (n ¼ 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n ¼ 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) ¼ 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR ¼ 1.51, 95% CI: 1.03–2.21, P ¼ 0.033) and absence of diabetic retinopathy (DR) (OR ¼ 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P ¼ 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P ¼ 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P ¼ 0.002), higher creatinine (P ¼ 0.01) and DN (P ¼ 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis

Cardiovascular and renal outcomes of renin-angiotensin system blockade in adult patients with diabetes mellitus: a systematic review with network meta-analyses

Medications aimed at inhibiting the renin-angiotensin system (RAS) have been used extensively for preventing cardiovascular and renal complications in patients with diabetes, but data that compare their clinical effectiveness are limited. We aimed to compare the effects of classes of RAS blockers on cardiovascular and renal outcomes in adults with diabetes

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Lipofuscinosis ceroidea neuronal 6 (enfermedad Kufs tipo A): Reporte de caso en Colombia

INTRODUCCIÓN: Las lipofuscinosis ceroideas neuronales (CLN) son un grupo de enfermedades neurodegenerativas de inicio generalmente en la infancia, caracterizadas por acumulación intracelular de material de almacenamiento autofluorescente. En la última década se han identificado 14 formas de CLN con mutaciones en 13 genes (CLN1-CLN14), en la CLN9 no se ha identificado aún el gen. Los pacientes con mutaciones en el gen CLN6 localizado en el cromosoma 15q21-23 presentan tres tipos de variantes clínicas: CLN6 infantil tardía, con presentación entre 18 meses a 8 años, las variantes Kufs tipo A y Kufs tipo B de inicio en adolescentes y adultos. REPORTE DE CASO: Se presenta el caso de un paciente con epilepsia generalizada de inicio en la edad adulta, que ingresa a valoración en primera ocasión, con resonancia magnética cerebral con atrofia cortical leve; la enfermedad se inició a los 14 años con déficit cognitivo lentamente progresivo, sin compromiso visual; con posterior identificación genética de una variante patogénica en el gen CLN6, con un conjunto de la variante clínica Kufs tipo A de lipofuscinosis ceroidea neuronal 6 (CLN6). DISCUSIÓN: Este es el primer reporte de CLN6 con variante clínica Kufs tipo A en Colombia. Con el advenimiento de técnicas genéticas se pueden hacer diagnósticos específicos de CLN6, a partir de la clínica y sospecha diagnóstica; utilizando métodos no invasivos

Coberturas financieras con derivados y su incidencia en el valor de mercado en empresas colombianas que cotizan en Bolsa

The financial theory (Modigliani&Miller, 1958)risesthatriskmanagement was not an issue for companies because shareholders could make their own hedging management through portfolio diversification; however, further studies conflict with that statement and show that corporate financial hedging improves performance and increases the value thereof (Ahmed, Azevedo, & Guney, 2014; Allayannis & Weston, 2001; Allayannis & Ofek, 1998). Efficient management of market risks, which is based on the use of financial derivatives, demands strategic and efficient managers in hedging that adds value to the firm, especially in against shocks and imbalances from a macroeconomic and financial nature. Empirical evidence analyzes the performance of the Q-Tobin as an indicator of the effect of hedging strategies of exchange rate associated to the market value. This paper aims to find evidence in Colombia on the effect of using derivatives in the market value of the firm. Its added value lies in the analysis made by economic sectors, identified by CIIU codes and grouped into 5 sectors (Agricultural, Commercial, Industrial or Manufacturing, Services and Construction). The methodology includes several models estimating regression panel data, using a Pooled regression with estimators of fixed and random effects by maximum likelihood estimator. In general, it wasfound a premium due to hedging, statistically and financially significant, for companies exposed to exchange rate risks that use derivatives by an average of 6.3% on the market value. Moreover, mixed results were found regarding the analyzed variables in the model.La teoría financiera (Modigliani & Miller, 1958) plantea la gestión del riesgo como un asunto sin importancia debido a que los mismos accionistas hacían su gestión de cobertura diversificando sus portafolios; sin embargo, estudios posteriores entran en conflicto con dicha premisa y evidencian que la cobertura financiera empresarial mejora el desempeno˜ e incrementa el valor de las mismas (Ahmed, Azevedo y Guney, 2014; Allayannis y Ofek, 1998; Allayannis y Weston, 2001). La gestión eficiente de riesgos de mercado se apoya en los derivados financieros y exige administradores estratégicos y eficientes en cobertura que agreguen valor, especialmente frente a choques y desequilibrios macroeconómicos y financieros. Evidencia empírica analiza el comportamiento de la Q-Tobin como indicador del efecto de las estrategias de cobertura de tipo de cambio asociado al valor de mercado. Este trabajo pretende encontrar evidencia en Colombia sobre el efecto del uso de derivados en el valor de mercado de la empresa. Su valor agregado radica en el análisis que se hace por sectores económicos, identificados por códigos CIIU y agrupados en 5 sectores macro (agropecuario, comercial, industrial o manufactura, servicios y construcción). La metodología empleada incluye la estimación de varios modelos de regresión en panel de datos, utilizando una regresión Pooled con estimadores de efectos fijos y aleatorios mediante el estimador de máxima verosimilitud. En general, se encontró una prima por cobertura estadística y financieramente significativa para empresas expuestas a riesgos de tipo de cambio que usan derivados de un 6.3% de promedio sobre el valor de mercado. Adicionalmente, se encontraron resultados mixtos con relación a las variables analizadas en el modelo

Financial hedging with derivatives and its impact on the Colombian market value for listed companies

The financial theory (Modigliani & Miller, 1958) presentsrisk management as a matter without importance in companies, given that the shareholders themselves managed their hedges, diversifying their portfolios. However, subsequent studies dispute said premise and present evidence that business financial hedging improves performance and increases the value of the same (Ahmed, Azevedo, & Guney, 2014; Allayannis & Weston, 2001; Kapitsinas, 2008). The efficient market risk management is supported in the financial derivatives, and demands strategic and efficient administrators in hedges that add value, especially in the face of clashes and macroeconomic and financial imbalances. The empirical evidence analyzes the behavior of the Q-Tobin as an indicator of the effect of the hedge strategies for the exchange rate associated to the market value. The aim of this work is to find evidence in Colombia on the effect of the use of derivatives in the market value of the company. Its added value lies in the analysis that is done by economic sectors, identified by ISIC codes and grouped into five (5) macro sectors (Agriculture and livestock, Commercial, Industrial or Manufacture, Services, and Construction). The methodology used includes the estimation of several regression models in data panels, using a Pooled regression model with fixed and random effect estimators through the maximum likelihood estimator. In general, a statistical and financially significant premium for hedges was found for companies exposed to exchange rate risks that se derivatives of a 6.3% average on the market value. Additionally, mixed results were found in relation to the variables analyzed in the modelLa teoría financiera (Modigliani y Miller, 1958) plantea la gestión del riesgo como un asunto sin importancia en las empresas debido a que los mismos accionistas hacían su gestión de cobertura diversificando sus portafolios; sin embargo, estudios posteriores entran en conflicto con dicha premisa y evidencian que la cobertura financiera empresarial mejora el desempeño˜ e incrementa el valor de las mismas (Ahmed, Azevedo y Guney, 2014; Allayannis y Weston, 2001; Kapitsinas, 2008). La gestión eficiente de riesgos de mercado se apoya en los derivados financieros y exige administradores estratégicos y eficientes en cobertura que agregue valor, especialmente frente a choques y desequilibrios macroeconómicos y financieros. Evidencia empírica analiza el comportamiento de la Q-Tobin como indicador del efecto de las estrategias de cobertura de tipo de cambio asociado al valor de mercado. Este trabajo pretende encontrar evidencia en Colombia sobre el efecto del uso de derivados en el valor de mercado de la empresa. Su valor agregado radica en el análisis que se hace por sectores económicos, identificados por códigos CIIU y agrupados en cinco (5) sectores macro (Agropecuario, Comercial, Industrial o Manufactura, Servicios y Construcción). La metodología empleada incluye la estimación de varios modelos de regresión en panel de datos, utilizando una regresión Pooled con estimadores de efectos fijos y aleatorios mediante el estimador de máxima verosimilitud. En general, se encontró una prima por cobertura estadística y financieramente significativa para empresas expuestas a riesgos te tipo de cambio que usan derivados de un 6.3% promedio sobre el valor de mercado. Adicionalmente, se encontraron resultados mixtos en relación a las variables analizadas en el model