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

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

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