Association of oral bisphosphonates with cardioembolic ischemic stroke: a nested case-control study

Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. Therefore, it is conceivable that they may increase the risk of cardioembolic ischemic stroke (IS). However, most epidemiological studies carried out thus far have not shown an increased risk of IS, though none separated by the main pathophysiologic IS subtype (cardioembolic and noncardioembolic) which may be crucial. In this study, we tested the hypothesis that the use of oral bisphosphonates increases specifically the risk of cardioembolic IS, and explored the effect of treatment duration, as well as the potential interaction between oral bisphosphonates and calcium supplements and anticoagulants. Methods: We performed a case-control study nested in a cohort of patients aged 40?99 years, using the Spanish primary healthcare database BIFAP, over the period 2002-2015. Incident cases of IS were identified and classified as cardioembolic or non-cardioembolic. Five controls per case were randomly selected, matched for age, sex, and index date (first recording of IS) using an incidence-density sampling. The association of IS (overall and by subtype) with the use of oral bisphosphonates within the last year before index date was assessed by computing the adjusted odds ratios (AOR) and their 95% CI using a conditional logistic regression. Only initiators of oral bisphosphonates were considered. Results: A total of 13,781 incident cases of IS and 65,909 controls were included. The mean age was 74.5 (SD ± 12.4) years and 51.6% were male. Among cases, 3.15% were current users of oral bisphosphonates, while among controls they were 2.62%, yielding an AOR of 1.15 (95% CI:1.01?1.30). Of all cases, 4,568 (33.1%) were classified as cardioembolic IS (matched with 21,697 controls) and 9,213 (66.9%) as non-cardioembolic IS (matched with 44,212 controls) yielding an AOR of 1.35 (95% CI:1.10?1.66) and 1.03 (95% CI: 0.88?1.21), respectively. The association with cardioembolic IS was clearly duration-dependent (AOR?1 year = 1.10; 95% CI:0.82?1.49; AOR>1?3 years = 1.41; 95% CI: 1.01?1.97; AOR>3 years = 1.81; 95% CI:1.25?2.62; p for trend = 0.001) and completely blunted by anticoagulants, even in long-term users (AOR>1 year = 0.59; 0.30?1.16). An interaction between oral bisphosphonates and calcium supplements was suggested. Conclusion: The use of oral bisphosphonates increases specifically the odds of cardioembolic IS, in a duration-dependent manner, while leaves materially unaffected the odds of non-cardioembolic IS.Research Foundation of the University Hospital Príncipe de Asturia

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

Trends in hip fracture in patients with rheumatoid arthritis: Results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study

Purpose T o analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years). Methods T his observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends. Results Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The ageadjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001). Conclusion I n Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.This work has a help for the research provided by the Society of Rheumatology of the Community of Madrid (SORCOM)

Democracia y mortalidad por COVID-19 en Europa

Background: In Europe there is a great variability in mortality by Covid-19 among different countries. While some countries, such as Greece, Belarus or Ukraine, have a mortality rate of less than 5 cases/100,000 inhabitants, other countries such as Belgium, Spain or the United Kingdom have a mortality rate of well over 50 cases/100,000 inhabitants. It is generally considered that the reason for this variability is multifactorial (including political reasons), but there are few studies that associate factors related to this variability. The objective of this work was to analyse political risk factors/markers that could explain the variability in mortality due to Covid-19 among different European countries. Methods: This is a retrospective, multinational, ecological study based on the exploitation of the database provided by the European Centre for Disease Prevention and Control which collects daily information worldwide on new cases and deaths. The accumulated mortality of Covid-19 in European countries (with more than 100 deaths on 01/05/2020) was calculated up to 29/05/2020. Political variables were compiled from different sources in the countries included in the study. The variables analysed were: the democracy index and the different factors included in it, the country’s political system and the country’s corruption index. On the other hand, specific political measures implemented in the different countries were collected, such as the number of days elapsed from the notification of the first infected person to 100 infected persons, to lockdown, to the closure of schools or the cancelation of meetings. The number of people infected up to the date of lockdown was also registered. For the statistical analysis of the association between the dependent variable (mortality) and the factors studied, correlation index were calculated, and the association was studied through univariate and multivariate linear regression models. Results: At May 1 2020, 27 European countries had at least 100 deaths. The mean mortality was 19.83 cases/100,000 inhabitants (SD 22.4) and a median of 7.95. Mortality varied from a minimum of 1.49 cases/100,000 population in Ukraine to 82.19 cases/100,000 population in Belgium. About factors analyzed both the democracy index (as well as the factors included in it), the political system (full democracy vs. no) and the corruption index were statistically associated with mortality. Also, the time until the implementation of the political measures was associated with mortality. Conclusions: In Europe, there is a west to east (from highest to lowest) gradient in the mortality of Covid-19. Some of the observed mortality variability can be explained by political factors.Fundamentos: En Europa hay una gran variabilidad en la mortalidad por Covid-19 entre los diferentes países. Mientras que algunos países, como Grecia, Bielorrusia o Ucrania, la mortalidad no alcanza los 5 casos por cada 100.000 habitantes actualmente, otros países como Bélgica, España o Reino Unido sobrepasan marcadamente los 50 casos por cada 100.000 habitantes. En general, se especula en que el motivo de esta variabilidad es multifactorial (entre ellos, motivos de índole política), pero existen escasos estudios que asocien factores relacionados con esta variabilidad. El objetivo de este trabajo fue analizar los factores/marcadores de riesgo de índole político que pudieran explicar la variabilidad en la mortalidad por Covid-19 entre los diferentes países europeos. Métodos: Estudio ecológico, observacional retrospectivo, de ámbito multinacional, basado en la explotación de la base de datos proporcionada por el European Centre for Disease Prevention and Control que recoge la información diaria a nivel mundial de los nuevos casos y fallecidos. Se calculó la mortalidad acumulada de Covid-19 en países europeos (con más de 100 fallecidos a fecha de 1 de mayo de 2020), hasta el 29 de mayo de 2020. Se recogieron variables de carácter político de los países incluidos en el estudio de diferentes fuentes. Las variables analizadas fueron: índice de democracia y los diferentes factores incluidos en él, sistema político del país e índice de corrupción del país. Por otra parte, se recogieron medidas políticas específicas implementadas en los distintos países, como los días transcurridos desde la notificación del primer infectado hasta llegar a los 100 infectados, así como los días transcurridos hasta el confinamiento, hasta el cierre de colegios o hasta el cese de reuniones. También se recogió el número de infectados hasta la fecha de confinamiento. Para el análisis estadístico de la asociación entre la variable dependiente (mortalidad) y los factores estudiados se calcularon índices de correlación, y la asociación se estudió a través de modelos de regresión lineal univariante y multivariante. Resultados: A fecha de 1 de mayo de 2020, 27 países europeos contaban con al menos 100 fallecidos. La media de la mortalidad fue de 19,83 casos por cada 100.000 hab. (DE 22,4) y una mediana de 7,95. La mortalidad varió desde un mínimo de 1,49 casos por cada 100.000 hab. en Ucrania hasta 82,19 casos por cada 100.000 hab. en Bélgica. De los factores analizados, tanto el índice de democracia (como los factores incluidos en él) como el sistema político (democracia plena frente a no) y el índice de corrupción se asociaron estadísticamente con la mortalidad. También, el tiempo transcurrido hasta la implantación de las medidas políticas se asoció con mortalidad. Conclusiones: En Europa, existe un degradado de oeste a este (de mayor a menor) en la mortalidad por Covid-19. Parte de la variabilidad de la mortalidad observada puede explicarse por factores de índole política

Diseño de la actividad práctica “exploración de los pares craneales” para el desarrollo de competencias interprofesionales

La educación interprofesional ha sido objeto de atención en varios informes de la OMS que considera que la calidad de la atención al paciente requiere la colaboración entre distintos profesionales del área de la salud. Esto implica una necesidad de adaptar las actividades de aprendizaje para permitir que el estudiante desarrolle las competencias de Educación Interprofesional (IPE) que mejoren las actitudes hacia otros profesionales de la salud. Aprender juntos mejorará la colaboración futura y la calidad de atención al paciente. Presentamos una acción conjunta en tres asignaturas (Óptica y optometría, Anatomía General y Estructura y Función del Cuerpo Humano) de tres titulaciones diferentes (Grado en Óptica, Grado en Podología y Grado en Fisioterapia). Esta acción ha consistido en la exploración de los pares craneales. Los estudiantes han trabajado de forma colaborativa, explicando de forma razonada a sus compañeros de otras titulaciones los aspectos más importantes de la exploración, según su punto de vista. Esta interacción, realizada en el laboratorio, les ha permitido relacionar los fundamentos anatómicos con los hallazgos clínicos, consiguiendo así un aprendizaje significativo. Al finalizar la actividad se ha pasado una encuesta a los estudiantes para conocer en qué medida han desarrollado competencias de IPE.SIN FINANCIACIÓNNo data 2015UE

Influencia en el aprendizaje de anatomía de dos programas “web based” (Concept Master y Educaplay)

La enseñanza de la anatomía se ha desarrollado tradicionalmente mediante clases magistrales en las que se presentaba al estudiante una gran cantidad de información de manera aburrida; esto motiva que muchos estudiantes no entiendan ni aprecien por qué la anatomía es la formación básica de las ciencias de la salud. En este contexto hemos introducido en la docencia de Anatomía del Aparato Locomotor del 1er curso del Grado de Fisioterapia actividades interactivas, que proporcionan un feedback inmediato al estudiante, diseñadas mediante las plataformas on-line “Educaplay” y el innovador programa denominado “Concept Master”. Los resultados recogidos mediante una encuesta de satisfacción indican que esta metodología mejora el aprendizaje y la comprensión de la asignatura. El 100% de los estudiantes han manifestado que las imágenes interactivas realizadas con “Concept Master” ayudan mucho a comprender la materia.SIN FINANCIACIÓNNo data 2014UE

A case of de novo palmoplantar psoriasis with psoriatic arthritis and autoimmune hypothyroidism after receiving nivolumab therapy

Nivolumab, a monoclonal antibody against the programmed cell death protein 1 (PD-1), has shown promising results in patients with advanced malignancies, including melanoma, lung cancer, and renal cancer. Immune-related adverse events (irAEs) have been reported, including both organ-specific toxicities and skin toxicities. Herein, we report a case of predominantly palmoplantar psoriasis with severe nail involvement, psoriatic arthritis, and autoimmune hypothyroidism after receiving nivolumab treatment for lung cancer. We also summarize the case reports that have been published previously. The knowledge of these irAEs in patients undergoing anti-PD1 therapy is important since it will enable earlier recognition and appropriate management, with the aim of maintaining effective dose without disruption

High Reproducibility of an Automated Measurement of Mobility for Patients with Axial Spondyloarthritis.

Conventional measures of spinal mobility used in the assessment of patients with axial spondyloarthritis (axSpA), such as the Bath Ankylosing Spondylitis Metrology Index and its components, are subject to interobserver variability. The University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI) is a validated composite index based on a motion video-capture system, UCOTrack. Our objective was to assess its reproducibility in clinical practice settings. We carried out an observational study of repeated measures in 3 centers. Video-capture systems were installed and adapted to clinical rooms. Patients with axSpA and stable disease were selected by consecutive stratified sampling [disease duration, sex, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Intraobserver reliability of the UCOASMI and of conventional measures was tested 3-5 days apart. For interobserver reliability, 3 patients from each center were evaluated in the other centers, within 3-7 days. The intraclass correlation coefficients (ICC) were calculated. Thirty patients were included (73% men, mean age 53 yrs, mean BASDAI 3.0). Interobserver and intraobserver ICC of the UCOASMI was 0.98. Conventional measurements showed lower but adequate reproducibility as well, except for interobserver reliability of lateral flexion (0.41), cervical rotation (0.61), and Schöber test (0.07), and intraobserver reliability of tragus-to-wall distance (0.30). Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility

Risk of ischaemic stroke among new users of glucosamine and chondroitin sulphate: a nested case–control study

Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosamine may reduce the risk of acute myocardial infarction. Although it is thought that this potential benefit could be extended to ischaemic stroke (IS), the evidence is scarce. Objective: To test the hypothesis that the use of prescription glucosamine or CS reduces the risk of IS. Design: Case–control study nested in an open cohort. Methods: Patients aged 40–99 years registered in a Spanish primary healthcare database (BIFAP) during the 2002–2015 study period. From this cohort, we identified incident cases of IS, applying a case-finding algorithm and specific validation procedures, and randomly sampled five controls per case, individually matched with cases by exact age, gender and index date. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were computed through a conditional logistic regression. Only new users of glucosamine or CS were considered. Results: A total of 13,952 incident cases of IS and 69,199 controls were included. Of them, 106 cases (0.76%) and 803 controls (1.16%) were current users of glucosamine or CS at index date, yielding an AOR of 0.66 (95% CI: 0.54–0.82) (for glucosamine, AOR: 0.55; 95% CI: 0.39–0.77; and for CS, AOR: 0.77; 95% CI: 0.60–0.99). The reduced risk among current users was observed in both sexes (men, AOR: 0.69; 95% CI: 0.49–0.98; women, AOR: 0.65; 95% CI: 0.50–0.85), in individuals above and below 70 years of age (AOR: 0.69; 95% CI: 0.53–0.89 and AOR: 0.59; 95% CI: 0.41–0.85, respectively), in individuals with vascular risk factors (AOR: 0.53; 95% CI: 0.39–0.74) and among current/recent users of nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR: 0.71; 95% CI: 0.55–0.92). Regarding duration, the reduced risk was observed in short-term users (364 days AOR: 0.86; 95% CI: 0.57–1.31). Conclusions: Our results support a protective effect of prescription CS and glucosamine in IS, which was observed even in patients at vascular risk. Mini abstract Our aim was to analyse whether the use of glucosamine or chondroitin sulphate (CS) reduces the risk of ischaemic stroke (IS). We detected a significant decrease