Use of risk chart algorithms for the identification of psoriatic arthritis patients at high risk for cardiovascular disease: findings derived from the project CARMA cohort after a 7.5-year follow-up period.

OBJECTIVE: To assess the predictive value of four cardiovascular (CV) risk algorithms for identifying high-risk psoriatic arthritis (PsA) patients. METHODS: Evaluation of patients with PsA enrolled in the Spanish prospective project CARdiovascular in RheuMAtology. Baseline data of 669 PsA patients with no history of CV events at the baseline visit, who were followed in rheumatology outpatient clinics at tertiary centres for 7.5 years, were retrospectively analysed to test the performance of the Systematic Coronary Risk Assessment (SCORE), the modified version (mSCORE) European Alliance of Rheumatology Associations (EULAR) 2015/2016, the SCORE2 algorithm (the updated and improved version of SCORE) and the QRESEARCH risk estimator version 3 (QRISK3). RESULTS: Over 4790 years of follow-up, there were 34 CV events, resulting in a linearised rate of 7.10 per 1000 person-years (95% CI 4.92 to 9.92). The four CV risk scales showed strong correlations and all showed significant associations with CV events (p<0.001). SCORE, mSCORE EULAR 2015/2016 and QRISK3 effectively differentiated between low and high CV risk patients, although the cumulative rate of CV events observed over 7.5 years was lower than expected based on the frequency predicted by these risk scales. Additionally, model improvement was observed when combining QRISK3 with any other scale, particularly the combination of QRISK3 and SCORE2, which yielded the lowest Akaike information criterion (411.15) and Bayesian information criterion (420.10), making it the best predictive model. CONCLUSIONS: Risk chart algorithms are very useful for discriminating PsA at low and high CV risk. An integrated model featuring QRISK3 and SCORE2 yielded the optimal synergy of QRISK3's discrimination ability and SCORE2's calibration accuracy.

Effect of antifibrotic agents on postoperative complications after lung transplantation for idiopathic pulmonary fibrosis.

BACKGROUND: Antifibrotic agents (AFAs) are now standard-of-care for idiopathic pulmonary fibrosis (IPF). Concerns have arisen about the safety of these drugs in patients undergoing lung transplantation (LTx). METHODS: We performed a multi-centre, nationwide, retrospective, observational study of French IPF patients undergoing LTx between 2011 and 2018 to determine whether maintaining AFAs in the peri-operative period leads to increased bronchial anastomoses issues, delay in skin healing and haemorrhagic complications. We compared the incidence of post-operative complications and the survival of patients according to AFA exposure. RESULTS: Among 205 patients who underwent LTx for IPF during the study period, 58 (28%) had received AFAs within 4 weeks before LTx (AFA group): pirfenidone in 37 (18.0%) and nintedanib in 21 (10.2%). The median duration of AFA treatment before LTx was 13.8 (5.6-24) months. The AFA and control groups did not significantly differ in airway, bleeding or skin healing complications (p = 0.91, p = 0.12 and p = 0.70, respectively). Primary graft dysfunction was less frequent in the AFA than control group (26% vs. 43%, p = 0.02), and the 90-day mortality was lower (7% vs. 18%, p = 0.046). CONCLUSIONS: AFA therapy did not increase airway, bleeding or wound post-operative complications after LTx and could be associated with reduced rates of primary graft dysfunction and 90-day mortality.

Cyclophosphamide added to glucocorticoids in acute exacerbation of idiopathic pulmonary fibrosis (EXAFIP): a randomised, double-blind, placebo-controlled, phase 3 trial.

BACKGROUND: The use of cyclophosphamide in patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF) is unknown. Our study was designed to evaluate the efficacy and safety of four cyclophosphamide pulses in addition to high-dose methylprednisolone in this population. METHODS: In this double-blind, placebo-controlled trial done in 35 departments across 31 hospitals in France, adult patients (≥18 years) with acute exacerbation of IPF and those with suspected acute exacerbation of IPF were randomly assigned in a 1:1 ratio using a web-based system to receive either intravenous pulses of cyclophosphamide (600 mg/m2) plus uromitexan as haemorrhagic cystitis prophylaxis (200 mg/m2) at the time of cyclophosphamide administration and then again, 4 h later, or placebo at days 0, 15, 30, and 60. Random assignment was stratified according to the severity of IPF and was block-balanced with variable block sizes of four or six patients. Patients receiving mechanical ventilation, with active infection, with active cancer, or who were registered on the lung transplant waiting list were excluded. All patients received standardised high-dose glucocorticoids. The investigators, patients, and the sponsor were masked to the treatment assignments. The primary endpoint was 3-month all-cause mortality, analysed by a χ2 test adhering to an intention-to-treat principle. The trial is now complete and registered with ClinicalTrials.gov, NCT02460588. FINDINGS: Between Jan 22, 2016, and July 19, 2018, 183 patients were assessed for eligibility, of whom 120 patients were randomly assigned and 119 patients (62 [52%] with severe IPF) received at least one dose of cyclophosphamide (n=60) or placebo (n=59), all of whom were included in the intention-to-treat analysis. The 3-month all-cause mortality was 45% (27/60) in patients given cyclophosphamide compared with 31% (18/59) in the placebo group (difference 14·5% [95% CI -3·1 to 31·6]; p=0·10). Similar results were found after adjustment by IPF severity (odds ratio [OR] 1·89 [95% CI 0·89-4·04]). The risk of death at 3 months, independent of the treatment received, was higher with severe than non-severe IPF (OR 2·62 [1·12-6·12]) and was lower with the use of antifibrotic therapy (OR 0·33 [0·13-0·82]). Adverse events were similar between groups by 6 months (25 [42%] in the cyclophosphamide group vs 30 [51%] in the placebo group) and their proportion, including infections, did not differ. Overall infection was the main adverse event and occurred in 20 (33%) of 60 patients in the cyclophosphamide group versus 21 (36%) of 59 patients in the placebo group. INTERPRETATION: In patients with acute exacerbation of IPF, adding intravenous cyclophosphamide pulses to glucocorticoids increased 3-month mortality. These findings provide evidence against the use of intravenous cyclophosphamide in such patients. FUNDING: Programme Hospitalier de Recherche Clinique of the French Ministry of Health (PHRC 2014-502), Roche Pharmaceuticals.

Balance disorders as potential confounders associated with an increased risk of acute cerebrovascular accidents.

PURPOSE: There is a higher risk of stroke after suffering from balance disorders (BDs) such as vertigo or dizziness. The causal relationship remains unclear due to the limited scope of the existing studies and the high prevalence of cardiovascular risk factors (CVRFs) in BD patients. The objective of this study is to clarify the role that BDs seem to have in the development of acute cerebrovascular accidents (ACAs). METHODS: This is an observational prospective study. The CVRFs and demographic factors of a sample of our population were noted. Five clusters of patients were tracked over the course of 2 years to detect and diagnose BDs and ACAs. The causal relationships between the CVRFs, BDs and ACAs were analyzed in a univariate analysis. A logistic regression multivariant analysis was performed on those variables that reached statistical significance. RESULTS: The sample included 7886 participants and 31 ACAs were recorded. CVRFs that reached statistical significance included age ≥ 60, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, atrial fibrillation and previous ACAs. The relationship between BDs and ACAs always reached statistical significance, regardless of how the BD variable was defined. Five different multivariate analyses were performed, but in none of them did the BD variables significantly reduce the deviance and thus, they were not taken into account when building the final model. CONCLUSION: This study shows that BDs are probably confounders that are closely linked to other CVRFs and they are also useful red flags to identify patients at a higher risk of suffering from ACAs.

Comparison of three sampling procedures for evaluating intestinal villi: A swine model / Comparación de tres procedimientos de muestreo para evaluar vellosidades intestinales: Modelo porcino / Comparação de três métodos de amostragem para a avaliação das vilosidades intestinais: Modelo suíno

Abstract Background: Villi morphology and function affect the absorption capacity of the small intestine. Most tissues are fragile and their morphology may change with excessive manipulation and inadequate sampling techniques. Intestinal sampling includes methodologies such as cutting longitudinally or transversely, keeping the intestinal content in it and preserving all in a 10% formalin solution; washing the intestinal sample in saline solution while emptying it by pressing downwards with two fingers, conserving the sample in a 10% formalin solution and knotting both ends of the sample, introducing 10% formalin into it and preserving it in the same solution. Objective: To compare height, area and desquamation caused by washing, pressing, and knotting used in sampling and conservation techniques of small intestine villi of pigs. Methods: Samples (n = 270) from duodenum, jejunum and ileum of 30 Landrace × Yorkshire crossed pigs, aged 7 to 8 months were randomly subjected to washing, soft pressing or knotting procedures, fixed in 10% formalin solution, embedded in paraffin, and stained with eosin and hematoxylin. Intestinal villi in each slide were observed to determine height, surface area and cellular desquamation of each villus. Results: Villi height from duodenum and ileum knotted samples was higher (p<0.05) compared with samples from the other procedures in the same anatomical portion, which were similar to each other (p>0.05). Villi from knotted jejunum samples were the shortest (p<0.05) compared to the other two procedures, which were similar to each other (p>0.05). Knotted samples from ileum had larger villi area compared with the rest of the procedures and intestinal portions (p<0.05). Villi desquamation was similar among procedures and portions of the intestine (p>0.05). Conclusion: Knotting is the recommended procedure for intestinal cell morphometry evaluation, as values of villi height and area are higher. Desquamation in the three procedures may be related to epithelial restoration processes.

Resumen Antecedentes: La morfología y función de las vellosidades afectan la capacidad de absorción del intestino delgado. La mayoría de los tejidos son frágiles y su morfología puede cambiar con una manipulación excesiva y técnicas de muestreo inadecuadas. El muestreo intestinal incluye metodologías tales como el corte longitudinal o transversal, conservando el contenido intestinal y conservando todo en una solución de formol al 10%; lavado de la muestra de intestino en solución salina mientras se vacía, presionándola hacia abajo con dos dedos, conservando la muestra en solución de formol al 10% y anudando ambos extremos de la muestra, introduciendo en ella formol al 10% y preservándola en la misma solución. Objetivo: Comparar la altura, área y descamación causada por el lavado, presión y anudamiento utilizados en la toma de muestras y técnicas de conservación utilizadas en vellosidades intestinales en cerdos. Métodos: Se obtuvieron 270 muestras de duodeno, yeyuno e íleon de 30 cerdos cruzados Landrace × Yorkshire de 7 a 8 meses de edad, y se sometieron aleatoriamente a procedimientos de lavado, prensado suave o anudado y fueron fijados en solución de formol al 10%, procesados por inclusión en parafina y teñidos con eosina y hematoxilina. Se observaron las vellosidades intestinales de cada muestra para determinar su altura, la superficie de cada vellosidad y la descamación celular. Resultados: La altura de las vellosidades de las muestras anudadas de duodeno e íleon fue mayor (p<0,05) que las muestras de los otros procedimientos en la misma porción anatómica, las cuales fueron similares entre sí (p>0,05). Las vellosidades procedentes de muestras de nudos de yeyuno fueron las más cortas (p<0,05) en comparación con los otros dos procedimientos, que fueron similares entre sí (p>0,05). Las muestras anudadas del íleon presentaron mayor área de vellosidades que el resto de los procedimientos y porciones intestinales (p<0,05). La descamación de las vellosidades fue similar en todos los procedimientos y porciones del intestino (p>0,05). Conclusión: El procedimiento de anudamiento es el recomendado para la evaluación morfométrica de células intestinales, considerando que los valores de altura y área de las vellosidades son mayores. La observación de la descamación en los tres procedimientos puede estar relacionada con un proceso de restauración epitelial.

Resumo Antecedentes: A morfologia e função das vilosidades afeta a capacidade de absorção no intestino delgado. A maioria dos tecidos são frágeis e podem mudar sua morfologia com um manuseio excessivo e técnicas de amostragem inadequada. A amostragem de intestino inclui metodologias tais como corte longitudinal ou transversal, conservando o conteúdo intestinal e mantendo tudo em uma solução de formalina a 10%. A amostra do intestino é lavada em solução salina enquanto se esvazia pressionando para baixo com dois dedos, após isso a amostra é submergida em uma solução de formalina a 10% e atam-se as duas extremidades do intestino, mais formalina 10% é introduzida no mesmo e é preservado na mesma solução. Objetivo: Comparar a altura, área e descamação nas vilosidades do intestino delgado em porcos, causada pela lavagem, pressão e colocação do nó y pelas técnicas de conservação. Métodos: Duzentos e setentaa mostras de duodeno, jejuno e íleo de 30 porcos de cruzamento de raças Landrace e Yorkshire de sete a oito meses de idade foram submetidos aleatoriamente a procedimentos de lavagem, prensagem suave ou colocação de nós e foram fixados em solução de formalina a 10%, processados para inclusão em parafina e corados com hematoxilina e eosina. Foram observadas as vilosidades de cada amostra para determinar a sua altura, a superfície de cada célula vilosidade e descamação celular. Resultados: A altura das vilosidades nas amostras de duodeno e íleo com nó foi maior (p<0,05) do que as amostras de outros procedimentos na mesma parte anatómica, as quais foram semelhantes entre si (p>0,05). Amostras de jejunos com nó apresentaram vilosidades menores (p<0,05) em comparação com os outros dois procedimentos, que foram semelhantes entre si (p>0,05). Amostras de íleo com nó apresentaram maior área nas vilosidades do que outros procedimentos e outras porções do intestino (p<0,05). A descamação das vilosidades foi semelhante em todos os procedimentos e porções do intestino (p>0,05). Conclusão: O procedimento de colocação do nó é o recomendado para a avaliação morfométrica das células intestinais, já que os valores de altura e área das vilosidades são mais elevados. A observação da descamação nos três procedimentos poderia estar relacionada com um processo de restauração epitelial.

The effects of truncal adiposity in forced spirometry: Sex differences.

The aim of the current paper is to establish the influence of truncal fat accumulation on the spirometric results of a group of healthy individuals. A cross-sectional study of 305 healthy, non-smoking adult subjects (144 males, 161 females) was conducted. Forced spirometry and dual-energy X-ray absorptiometry to quantify body fat were performed. Partial correlation and multiple linear regression analyses were performed. In females, abdominal fat was negatively correlated with forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). In males, thoracic fat was negatively correlated with respiratory variables, as was abdominal fat. In the multiple linear regression, FEV1 was the spirometric parameter that showed higher R2 values in both sexes. Truncal fat had a greater influence on FEV1 than on FVC. In males, no significant differences between the influence of thoracic and abdominal fat on spirometric results were found, and total body fat was shown to have more influence than regional. In females, the influence of abdominal fat was higher.

Women and Minorities Are at Risk of Developing Unexpected Reduction of Preoperative Flexion After Total Knee Arthroplasty.

BACKGROUND: Reduced flexion after total knee arthroplasty (TKA) compared to the preoperative values can affect patient's activities of daily living and lead to patient dissatisfaction. The aim of this study was to determine preoperative risk factors for developing a decrease in knee flexion after a primary TKA. METHODS: We identified 37 knees diagnosed with osteoarthritis with a preoperative knee flexion ≥120° but a 12-month postoperative range of motion (ROM) ≤110°. A random sample of 111 patients (1:3) from the same database, whose knees had a preoperative and 12-month postoperative ROM ≥120°, based on a diagnosis of primary osteoarthritis and no previous open knee surgery, were selected as the controls. RESULTS: We found female gender, black ethnicity, and the low preoperative knee-specific Knee Society Score to be significant risk factors for developing a reduction of knee flexion after TKA with odds ratios of 3.48, 5.11, and 0.95, respectively. CONCLUSION: In the absence of the well-recognized preoperative risk factors for a limited postoperative ROM, female patients, minorities, and those with lower knee-specific Knee Society Scores are at an increased risk of developing a decrease in flexion after an elective primary TKA.

Nivel de satisfacción del usuario externo sobre la calidad de atención de enfermería en centro quirúrgico en el Hospital de Apoyo "Víctor Ramos Guardia". Huaraz-2009 / Level of satisfaction of the external user on the quality of attention of infirmary in surgical center in the Hospital of Support

Los objetivos del estudio fueron: Determinar el nivel de satisfacción del usuario externo sobre "la calidad de atención de enfermería en Centro Quirúrgico en el Hospital de Apoyo "Víctor Ramos Guardia"- Huaraz-2009. El material y método: Nivel aplicativo, tipo cuantitativo, método descriptivo, de corte transversal. La Técnica fue la entrevista y el instrumento la Escala de Lickert modificado. Resultados, Del 100 por ciento (30), el 53.3 por ciento (16) tienen una baja satisfacción, 36.7 por ciento (11) media y 10 por ciento (3) alta. En relación a la dimensión humana, 47 por ciento (14) presentan una baja satisfacción, 43 por ciento (13) media y 10 por ciento (3) alta, referidos a que no se identifica cuando le va atender, muestra indiferencia ante sus temores y preocupaciones y al llamado para una atención, falta de cortesía. Acerca de la dimensión técnica, 37 por ciento (11) tienen baja satisfacción, 33 por ciento (9) media y 33 por ciento (10) alta, relacionados a que no brinda educación sobre los cuidados que debe tener frente a la recuperación, no informa sobre la medicación que le administra. En cuanto a la dimensión entorno, 23 por ciento (7) es de satisfacción baja, 33 por ciento (10) media y 43 por ciento (13) alta, referido a que muestra preocupación ante el ambiente de la unidad, cuidado en la privacidad y seguridad en las camillas. Conclusiones. La mayoría de los usuarios externos tienen una opinión de satisfacción baja con relación a la calidad de atención que brinda la enfermera al usuario externo, relacionado a que la enfermera no le brinda educación sobre los cuidados que debe tener frente a su recuperación, ni le explica sobre la sala de operaciones, no le muestra interés frente a sus temores y preocupaciones, que no le explica sobre el medicamento que le administraban, ni le llama por su nombre, etc

The study objectives were to determine the level of external customer satisfaction on the quality of nursing care at the Hospital Surgery Center Support ôVictor Ramos Guardia"-Huaraz-2009. Material and Methods: Applied level, quantitative, descriptive method, cross-sectional. Technique was the interview and the Lickert Scale instrument as amended. Results. 100 per cent (30), 53.3 per cent (16) have low satisfaction, 36.7 per cent (11) average and 10 per cent (3) high. In relation to the user's opinion on the satisfaction of care of the nurse in the human dimension of 100 per cent (30), 47 per cent (14) have a low satisfaction, 43 per cent (13) average and 10 per cent (3) high, related to low satisfaction are given when the user reports that the nurse is not identified as the professional who will attend, indifferent to their fears and concerns, indifference to the call for attention, lack of courtesy. About the family's opinion on the technical dimension of 100 per cent (30), 37 per cent (11) have a low opinion of satisfaction, 33 per cent (9) middle and 33 per cent (10) high, related to the categories of satisfaction low and medium are referred to the user shows no concern that the nurse provides care education to the recovery of the user, no information about the medication you're giving. As for the opinion on the dimension of 100 per cent (30), 23 per cent (7) have a low opinion of satisfaction, 33 per cent (10) middle and 43 per cent (13) high related satisfaction at medium and high categories are referred to the nurse shows concern about the environment of the unit, care in the privacy and security on stretchers. Conclusions. Most external users have a low opinion of satisfaction regarding the quality of care provided by the nurse to the external user, related to nurse education does not provide the care that must be compared to recovery is not identified as the professional who will attend, as it does not explain the operating room, no interest was shown in front of their fears and concerns, did not explain about the medication he was given, did not call him by name, etc

Phenotypes of asthma revisited upon the presence of atopy.

Immunological studies claimed that atopic and non-atopic asthma share more similarities than differences. However, these two phenotypes of asthma are considered to be distinguishable upon distinct clinical patterns, which were not systematically assessed before in a large population. We studied characteristics discriminating atopic from non-atopic asthma among 751 asthmatic patients and 80 factors were analysed in univariate and multivariate analysis. Age, age of onset of asthma, female/male ratio were higher in non-atopic (n=200) than in atopic (n=551) asthmatics. Familial asthma, seasonal symptoms, rhinitis, conjunctivitis, allergen-triggered symptoms, improvement in altitude, exercise-induced asthma were associated with atopy. Non-atopic asthmatics displayed lower FEV(1) and FVC. Smoking was more frequent and asthma was more severe in these patients. Younger age, early onset, male sex, rhinitis and smoking were independent factors discriminating atopic from non-atopic asthma. This study establishes in a large population of asthmatics that although similarities exist between atopic and non-atopic asthma, two clinical phenotypes can still distinguish both kinds of asthma.