Clinical impact of COVID-19 on people with substance use disorders.

BACKGROUND: People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. METHODS: an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. RESULTS: Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. CONCLUSION: Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

Bone density, microarchitecture, and material strength in chronic kidney disease patients at the time of kidney transplantation.

Bone health is assessed by bone mineral density (BMD). Other techniques such as trabecular bone score and microindentation could improve the risk of fracture's estimation. Our chronic kidney disease (CKD) patients presented worse bone health (density, microarchitecture, mechanical properties) than controls. More than BMD should be done to evaluate patients at risk of fracture. INTRODUCTION: BMD measured by dual-energy X-ray absorptiometry (DXA) is used to assess bone health in end-stage renal disease (ESRD) patients. Recently, trabecular bone score (TBS) and microindentation that can measure microarchitectural and mechanical properties of bone have demonstrated better correlation with fractures than DXA in different populations. We aimed to characterize bone health (BMD, TBS, and strength) and calcium/phosphate metabolism in a cohort of 53 ESRD patients undergoing kidney transplantation (KT) and 94 controls with normal renal function. METHODS: Laboratory workout, lumbar spine/hip BMD measurements (using DXA), lumbar spine TBS, and bone strength were carried out. The latter was assessed with an impact microindentation device, standardized as percentage of a reference value, and expressed as bone material strength index (BMSi) units. Multivariable linear regression was used to study differences between cases and controls adjusted by age, gender, and body mass index. RESULTS: Among cases, serum calcium was 9.6 ± 0.7 mg/dl, phosphorus 4.4 ± 1.2 mg/dl, and intact parathyroid hormone 214 pg/ml [102-390]. Fourteen patients (26.4%) had prevalent asymptomatic fractures in spinal X-ray. BMD was significantly lower among ESRD patients compared to controls: lumbar 0.966 ± 0.15 vs 0.982 ± 0.15 (adjusted p = 0.037), total hip 0.852 ± 0.15 vs 0.902 ± 0.13 (adjusted p < 0.001), and femoral neck 0.733 ± 0.15 vs 0.775 ± 0.12 (adjusted p < 0.001), as were TBS (1.20 [1.11-1.30] vs 1.31 [1.19-1.43] (adjusted p < 0.001)) and BMSi (79 [71.8-84.2] vs 82. [77.5-88.9] (adjusted p = 0.005)). CONCLUSIONS: ESRD patients undergoing transplant surgery have damaged bone health parameters (density, microarchitecture, and mechanical properties) despite acceptably controlled hyperparathyroidism. Detecting these abnormalities may assist in identifying patients at high risk of post-transplantation fractures.

Frequency and severity of potential drug interactions in a cohort of HIV-infected patients Identified through a Multidisciplinary team.

OBJECTIVES: Interactions between antiretroviral treatment (ART) and comedications are a concern in HIV-infected patients. This study aimed to determine the frequency and severity of potential drug-drug interactions (PDDIs) with ART in our setting. METHODS: Observational study by a multidisciplinary team in 1259 consecutive HIV patients (March 2015-September 2016). Data on demographics, toxic habits, comorbidities, and current ART were collected. A structured questionnaire recorded concomitant medications (including occasional and over-the-counter drugs). PDDIs were classified into four categories: (1) no interactions, (2) mild (clinically non-significant), (3) moderate (requiring close monitoring or drug modification/dose adjustment), and (4) severe (contraindicated). STATISTICAL ANALYSIS: chi-square test, logistic regression analysis. RESULTS: In total, 881 (70%) patients took comedication, and 563 (44.7%) had ≥ PDDI. Forty-one comedicated patients (4.6%) had severe and 522 (59.2%) moderate PDDIs. Moderate PDDIs mainly involved cardiovascular (53.8%) and central nervous system (40.2%) drugs. Independent risk factors for PDDIs were ART containing a boosted protease inhibitor (odds ratio [OR]=9.11, 95% confidence interval [CI] 5.15-16.11; p = 0.0001) and/or non-nucleoside reverse transcriptase (NNRTI) (OR = 4.34, 95%CI 2.49-7.55; p = 0.0001), HCV co-infection (OR = 3.26, 95%CI 2.15-4.93; p = 0.0001), and use of two or more comedications (OR = 3.36, 95%CI 2.27-4.97; p = 0.0001). Adherence and effectiveness of ART were similar in patients with and without PDDIs. The team made 133 recommendations related to comedications (drug change or dose adjustment) or ART (drug switch or change in administration schedule). CONCLUSIONS: Systematic evaluation detected a significant percentage of PDDIs requiring an intervention in HIV patients on ART. Monitoring and advice about drug-drug interactions should be part of routine practice.

Clinical and economic impact of urinary tract infections caused by ESBL-producing Escherichia coli requiring hospitalization: A matched cohort study.

OBJECTIVE: To analyze the clinical and economic impact of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli requiring hospitalization. METHODS: Matched cohort study including adults with UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between August 2010 and July 2013. Demographic, clinical and economic data were analyzed. RESULTS: One hundred and twenty episodes of UTI were studied: 60 due to ESBL-producing E. coli and 60 due to non-ESBL-producing E. coli. Bivariate analysis showed that prior antimicrobial treatment (p = 0.007) and ESBL production (p < 0.001) were related to clinical failure during the first 7 days. Multivariate analysis selected ESBL as the sole risk factor for clinical failure (p = 0.002). Regarding the economic impact of infections caused by ESBL-producing E. coli, an ESBL-producing infection cost more than a non-ESBL-producing E. coli infection (mean €4980 vs. €2612). Looking at hospital expenses separately, the total pharmacy costs and antibiotic costs of ESBL infections were considerably higher than for non-ESBL infections (p < 0.001), as was the need for outpatient parenteral antibiotic therapy (OPAT) and its related costs. Multivariate analysis performed for the higher costs of UTI episodes found statistically significant differences for males (p = 0.004), chronic renal failure (p = 0.025), ESBL production (p = 0.008) and OPAT (p = 0.009). CONCLUSION: UTIs caused by EBSL-producing E. coli requiring hospital admission are associated with worse clinical and economic outcomes.

[Bone microindentation and pressure algometry applied to revision total knee replacement and tibial end-of-stem pain. Preliminary results in a group of twenty patients]. / Técnica de microindentación ósea y algometría de presión aplicada al recambio protésico de rodilla y dolor en punta de vástago tibial. Resultados preliminares en un grupo de 20 pacientes.

OBJECTIVES: To study the relationship between the appearance of end-of-stem pain with a preoperative decrease in local bone strength by using the bone microindentation technique. The potential usefulness of pressure algometry in the diagnosis and monitoring of this group of patients is also determined. MATERIAL AND METHOD: A preliminary intra- and inter-rater correlation study was performed in a group of 50 healthy volunteers in order to validate the algometry technique. A prospective study was then conducted on 20 patients with a mean age of 74 years (range 57-84) undergoing knee prosthetic surgery with use of a cementless tibial stem. Bone microindentation and pressure algometry measurements were made preoperatively, and after one year of follow-up. The statistical analysis was performed using the Intraclass correlation coefficient and the Student t test for paired data. RESULTS: The intra and inter-rater correlation values were excellent; 0.91 (0.84-0.95) and 0.86 (0.74-0.92), respectively. No significant variations were found in the microindentation (P=.11) or in the pressure algometry (P=.6) values after one year of follow-up. Nevertheless, a significant correlation was observed between the values for pressure algometry and the EVA (P=.002) and functional scale (P=.02) at the end of follow-up. CONCLUSIONS: Pressure Algometry is a useful tool to evaluate this group of patients. Bone microindentation does not seem to be useful in identifying patients with increased risk of developing tibial end-of-stem pain.

Estudio del patrón de expresión de microRNAs en el hueso osteoporótico / Study of miRNAs expression patterns in osteoporotic bone

Objetivos: Identificar microRNAs (miRNAs) diferencialmente expresados en muestras óseas con fractura osteoporótica respecto a huesos sanos. Material y métodos: Se extrajo RNA total a partir de hueso trabecular fresco del cuello femoral de mujeres sometidas a reemplazo de cadera, ya sea debido a fractura osteoporótica (n=6) o por artrosis en ausencia de osteoporosis (según la DMO) (n=6). Las muestras se hibridaron en un array de miRNAs y se realizaron diagramas de PCA y de mapa de calor. Para la comparación de los niveles de expresión, se fijó como significativo un umbral de cambio de >1,5 veces y un valor p <0,05 en la t de Student (corregido para múltiples pruebas). Resultados: Tanto los análisis de PCA como el mapa de calor mostraron una agrupación de las muestras según si eran de fractura o no. Se detectaron 790 miRNAs en las muestras de hueso, 82 de los cuales estaban alterados en las muestras osteoporóticas. Tras la validación en otro panel de 6 muestras osteoporóticas y 6 no osteoporóticas mediante PCR a tiempo real de los miRNAs más significativos, y para los que existía un ensayo disponible, se confirmaron los miRNAs miR-320a y miR-22-3p. Estos dos miRNAs se detectaron en cultivos de osteoblastos primarios, aunque no mantenían el mismo patrón de expresión que en las muestras de hueso total. Conclusiones: Hemos demostrado que existen diferencias en la expresión de miRNAs en muestras con fractura osteoporótica, lo que abre nuevas perspectivas para la investigación y diseño de nuevas terapias (AU)

Objectives: To identify microRNAs (miRNAs) differentially expressed in bone samples with osteoporotic fracture compared with healthy bones. Methods: Total RNA was extracted from fresh trabecular bone of the femoral neck of women undergoing hip replacement surgery, either because to osteoporotic fracture (n=6) or in the absence of osteoarthritis osteoporosis (based on BMD) (n=6). The samples were hybridized on an array of miRNAs and PCA diagrams and heat map were made. To compare expression levels, >1.5 times and a value p<0.05 Student's T test (corrected for multiple testing) was set as a threshold of significant change. Results: Both PCA analysis and the heat map showed a samples grouping whether there was fracture or not. 790 were detected miRNAs in bone samples, 82 of which were altered in the osteoporotic samples. After validation in another panel of 6 samples 6 osteoporotic and non-osteoporotic by PCR real time of the most significant miRNAs, and for which there was a test available, the miRNAs, miR-320a and miR-22-3p were confirmed. These two miRNAs were detected in cultures of primary osteoblasts, although they did not maintain the same pattern of expression in total bone samples. Conclusions: We have shown that there are differences in the expression of miRNAs in samples with osteoporotic fracture. This opens prospects for research and design of new therapies (AU)

Técnica de microindentación ósea y algometría de presión aplicada al recambio protésico de rodilla y dolor en punta de vástago tibial. Resultados preliminares en un grupo de 20 pacientes / Bone microindentation and pressure algometry applied to revision total knee replacement and tibial end-of-stem pain. Preliminary results in a group of twenty patients

Objetivos. Valorar la relación entre la aparición de dolor en punta de vástago tibial con una disminución de la resistencia ósea preoperatoria mediante microindentación ósea. En segundo lugar, conocer la utilidad potencial de la algometría de presión en el diagnóstico y seguimiento de este grupo de pacientes. Material y método. Se realizó un estudio de correlación intra- e interobservador preliminar, para validar el método de la algometría en un grupo de 50 voluntarios sanos. Posteriormente se realizó un estudio prospectivo en un grupo de 20 pacientes con una media de edad de 74 años (57-84), sometidos a cirugía protésica de rodilla con utilización de un vástago tibial no cementado. Se realizaron mediciones de microindentación y algometría preoperatoriamente y después de un año. Para el análisis estadístico se utilizó el coeficiente de correlación intraclase y la t de Student para datos apareados. Resultados. En el trabajo preliminar, los valores de correlación intra- e interobservador obtenidos fueron excelentes; 0,91 (0,84-0,95) y 0,86 (0,74-0,92), respectivamente. En el grupo prospectivo no se observaron modificaciones significativas en los valores de microindentación (p = 0,11) ni algometría (p = 0,6) después de un año. Se observó una correlación significativa entre los valores de la algometría y las escalas de EVA (p = 0,002) y funcional (p = 0,02) en el control anual. Conclusiones. La algometría de presión fue una herramienta útil en el seguimiento de estos pacientes. La microindentación no fue adecuada para identificar pacientes en situación de riesgo de presentar dolor en punta de vástago tibial (AU)

Objectives. To study the relationship between the appearance of end-of-stem pain with a preoperative decrease in local bone strength by using the bone microindentation technique. The potential usefulness of pressure algometry in the diagnosis and monitoring of this group of patients is also determined. Material and method. A preliminary intra- and inter-rater correlation study was performed in a group of 50 healthy volunteers in order to validate the algometry technique. A prospective study was then conducted on 20 patients with a mean age of 74 years (range 57-84) undergoing knee prosthetic surgery with use of a cementless tibial stem. Bone microindentation and pressure algometry measurements were made preoperatively, and after one year of follow-up. The statistical analysis was performed using the Intraclass correlation coefficient and the Student t test for paired data. Results. The intra and inter-rater correlation values were excellent; 0.91 (0.84-0.95) and 0.86 (0.74-0.92), respectively. No significant variations were found in the microindentation (P=.11) or in the pressure algometry (P=.6) values after one year of follow-up. Nevertheless, a significant correlation was observed between the values for pressure algometry and the EVA (P=.002) and functional scale (P=.02) at the end of follow-up. Conclusions. Pressure Algometry is a useful tool to evaluate this group of patients. Bone microindentation does not seem to be useful in identifying patients with increased risk of developing tibial end-of-stem pain (AU)