Higher mortality risk from gynaecological neoplasms and non-Hodgkin's lymphoma in patients with systemic lupus erythematosus: an observational study from the Spanish National Registry.

OBJECTIVE: To evaluate the impact of the different types of neoplasms and lineages on mortality of patients with SLE. METHODS: Retrospective and observational comparison of the neoplasm-related deaths in patients with SLE and the general Spanish population reported in the Spanish Hospital Discharge Database. To determine the impact of SLE on the risk of dying from each neoplasm lineage, a binary logistic regression considering age, female sex, tobacco and alcohol consumption, was performed. RESULTS: During 2016-2019, 139 531 in-hospital deaths from neoplasms were certified in Spain (91 in patients with SLE). Patients with SLE presented a lower mortality rate from solid organ neoplasms, (80.2% vs 91.1%, OR 0.393), linked to their lower risk of colorectal carcinoma (1.1% vs 10.8%, OR 0.110). By contrast, gynaecological neoplasms presented a higher risk (8.8% vs 3%, OR 3.039) in the deceased patients with SLE, associated with the higher frequency of vulvar neoplasms (2% vs 0.2%, OR 14.767) and cervical carcinomas (3.3% vs 0.5%, OR 3.809). Haematological neoplasm-related deaths were also more prevalent in patients with SLE (19.8% vs 8.9%, OR 2.546), mostly attributable to the higher proportion of deaths due to non-Hodgkin's lymphoma (11% vs 2.9%, OR 4.060) of B cell lineage (9.9% vs 2.5%, OR 4.133). CONCLUSIONS: Patients with SLE present a higher risk of death from vulvar neoplasms, cervical carcinomas and B-cell non-Hodgkin's lymphoma in comparison with the general Spanish population. In addition to developing strategies that might help to attenuate their occurrence and impact, such as decreasing the immunosuppressive burden, specific early detection programmes for these conditions should be investigated and considered carefully.

Sarcoidosis and lymphoma mortality risk: An observational study from the Spanish National Registry.

Introduction: Patients with sarcoidosis have a lower survival rate than the general population, in part due to cardiovascular disease, infections and neoplasms. Our objective was to evaluate the impact of haematological neoplasms (HN) and lymphomas on sarcoidosis patient mortality in a nation-wide analysis conducted in Spain, a country with a population of 47 million. Methods: Retrospective and observational comparison of the HN related deaths in sarcoidosis patients and the general Spanish population reported in the Spanish Hospital Discharge Database. To determine the impact of sarcoidosis on the risk of dying from each HN lineage, a binary logistic regression considering age, female sex, tobacco and alcohol consumption, was performed. Results: In the period 2016 and 2019, 139,531 in-hospital deaths from neoplasms were certified in Spain (77 in patients with sarcoidosis). Patients with sarcoidosis died at younger age than the general Spanish population (72.9 vs 77.6, p<0.001). Sarcoidosis patients presented a higher mortality risk from HN (20.8% vs 8.9%, p=0.001, OR=2.64, 95% CI 1.52-4.59), attributable to the higher proportion of deaths from non-Hodgkin lymphoma (NHL), (9.2% vs 2.9%, p=0.006, OR= 3.33, 95% CI 1.53-7.25) from both B cell (6.6% vs 2.5%, p=0.044, OR= 2.62, 95% 1.06-6.5) and T/NK cell lineages (2.6% vs 0.3%, p=0.024, OR= 7.88, 95% CI 1.92-32.29) as well as HN with uncertain behavior and myeloproliferative disorders (2.6% vs 0.3%, p=0.018, OR= 11.88, 95% CI 2.88-49.02). The mean age of sarcoidosis patients who died from HN (63.6 vs 71.9, p=0.032) and non-Hodgkin lymphoma (56.9 vs 71, p=0.009) was lower than that of the general population. Conclusion: Patients with sarcoidosis present a higher risk of premature death from HN, including NHL from B, T/NK cell lineage and myeloproliferative disorders in comparison with the general Spanish population. In addition to developing strategies that might help to attenuate their occurrence and impact, such as decreasing the immunosuppressive burden, specific early-detection programs for these conditions should be investigated and considered carefully.

[Telerehabilitación: evolución de la capacidad funcional, calidad de vida y salud mental en pacientes con covid-19 tras un programa de rehabilitación respiratoria.] / Telerehabilitation: Evolution of functional capacity, quality of life and mental health in COVID-19 patients after a Respiratory Rehabilitation program.

OBJECTIVE: The healthcare approach to rehabilitation has undergone important changes due to the COVID-19 pandemic. The objective of the study was to assess the role of a home respiratory telerehabilitation program based on exercises and education in patients admitted to COVID-19. METHODS: An observational cohort study of COVID-19 patients admitted to General Hospital La Mancha Centro from March to June 2020 was carried out, who were assessed and treated by the rehabilitation, physiotherapy and occupational therapy service. After hospital discharge, the functional capacity, quality of life, mental health and happiness of the patients were assessed by telephone consultation at two, fifteen and thirty days. A descriptive analysis was carried out and for follow-up the McNemar test was used for qualitative variables and Student's t or Wilcoxon paired samples test for quantitative variables. RESULTS: Thirty patients were included in the study. The mean age was 60.9 years, with 50% male and 50% female. 80% of the patients were admitted to the ICU, with a mean of thirty four days. 73.3% of the patients developed ICU-acquired weakness. There are statistically significant changes in functional capacity (Barthel from 57.5 to 90), quality of life (EQ-VAS from 60 to 70), mental health (MHI-5 from 23 to 27) and happiness (Lyubomirsky from 4 to 4.5) of patients at thirty days after discharge. CONCLUSIONS: Patients admitted for COVID-19 and included in the home respiratory rehabilitation program through telerehabilitation significantly improve their functional capacity, quality of life, mental health, and happiness during follow-up.

OBJECTIVE: El abordaje asistencial de la rehabilitación ha sufrido cambios importantes con motivo de la pandemia de la COVID-19. El objetivo del estudio fue valorar el papel de un programa de telerehabilitación respiratoria domiciliaria basada en ejercicios y educación en pacientes ingresados con COVID-19. METHODS: Se realizó un estudio observacional de una cohorte de pacientes con COVID-19 ingresados en el Hospital General La Mancha Centro desde marzo a junio de 2020, que fueron valorados y tratados por el servicio de rehabilitación, fisioterapia y terapia ocupacional. Tras el alta hospitalaria, se valoró mediante consulta telefónica a los dos, quince y treinta días, la capacidad funcional, la calidad de vida, la salud mental y la felicidad de los pacientes. Se realizó un análisis descriptivo y para el seguimiento se utilizó los test de McNemar para variables cualitativas y t de student o Wilcoxon de muestras apareados para las cuantitativas. RESULTS: Treinta pacientes fueron incluidos en el estudio. La edad media fue de 60,9 años, siendo un 50% hombres y un 50% mujeres. El 80% de los pacientes ingresaron en UCI, con una media de treinta y cuatro días. El 73,3% de los pacientes desarrollaron debilidad adquirida en UCI. Existen cambios estadísticamente significativos sobre capacidad funcional (Barthel de 57,5 a 90), calidad de vida (EVA de 60 a 70), salud mental (MHI5 de 23 a 27) y felicidad (Lyubomirsky de 4 a 4,5) de los pacientes a los treinta días tras el alta hospitalaria. CONCLUSIONS: Los pacientes ingresados por COVID-19 e incluidos en el programa de rehabilitación respiratoria domiciliaria mediante telerehabilitación mejoran de forma significativa su capacidad funcional, calidad de vida, salud mental y felicidad durante su seguimiento.

Telerehabilitación: evolución de la capacidad funcional, calidad de vida y salud mental en pacientes con COVID-19 tras un programa de rehabilitación respiratoria / Telerehabilitation: Evolution of functional capacity, quality of life and mental health in COVID-19 patients after a Respiratory Rehabilitation program

Fundamentos: El abordaje asistencial de la rehabilitación ha sufrido cambios importantes con motivo de la pandemia de la COVID-19. El objetivo del estudio fue valorar el papel de un programa de telerehabilitación respiratoria domiciliaria basada en ejercicios y educación en pacientes ingresados con COVID-19. Métodos: Se realizó un estudio observacional de una cohorte de pacientes con COVID-19 ingresados en el Hospital General La Mancha Centro desde marzo a junio de 2020, que fueron valorados y tratados por el servicio de rehabilitación, fisioterapia y terapia ocupacional. Tras el alta hospitalaria, se valoró mediante consulta telefónica a los dos, quince y treinta días, la capacidad funcional, la calidad de vida, la salud mental y la felicidad de los pacientes. Se realizó un análisis descriptivo y para el seguimiento se utilizó los test de McNemar para variables cualitativas y t de student o Wilcoxon de muestras apareados para las cuantitativas. Resultados: Treinta pacientes fueron incluidos en el estudio. La edad media fue de 60,9 años, siendo un 50% hombres y un 50% mujeres. El 80% de los pacientes ingresaron en UCI, con una media de treinta y cuatro días. El 73,3% de los pacientes desarrollaron debilidad adquirida en UCI. Existen cambios estadísticamente significativos sobre capacidad funcional (Barthel de 57,5 a 90), calidad de vida (EVA de 60 a 70), salud mental (MHI5 de 23 a 27) y felicidad (Lyubomirsky de 4 a 4,5) de los pacientes a los treinta días tras el alta hospitalaria. Conclusiones: Los pacientes ingresados por COVID-19 e incluidos en el programa de rehabilitación respiratoria domiciliaria mediante telerehabilitación mejoran de forma significativa su capacidad funcional, calidad de vida, salud mental y felicidad durante su seguimiento.(AU)

Background: The healthcare approach to rehabilitation has undergone important changes due to the COVID-19 pandemic. The objective of the study was to assess the role of a home respiratory telerehabilitation program based on exercises and education in patients admitted to COVID-19. Methods: An observational cohort study of COVID-19 patients admitted to General Hospital La Mancha Centro from March to June 2020 was carried out, who were assessed and treated by the rehabilitation, physiotherapy and occupational therapy service. After hospital discharge, the functional capacity, quality of life, mental health and happiness of the patients were assessed by telephone consultation at two, fifteen and thirty days. A descriptive analysis was carried out and for follow-up the McNemar test was used for qualitative variables and Student’s t or Wilcoxon paired samples test for quantitative variables.Results: Thirty patients were included in the study. The mean age was 60.9 years, with 50% male and 50% female. 80% of the patients were admitted to the ICU, with a mean of thirty four days. 73.3% of the patients developed ICU-acquired weakness. There are statistically significant changes in functional capacity (Barthel from 57.5 to 90), quality of life (EQ-VAS from 60 to 70), mental health (MHI-5 from 23 to 27) and happiness (Lyubomirsky from 4 to 4.5) of patients at thirty days after discharge. Conclusions: Patients admitted for COVID-19 and included in the home respiratory rehabilitation program through telerehabilitation significantly improve their functional capacity, quality of life, mental health, and happiness during follow-up.(AU)

Arquitectura de información para indicaciones médicas de signos vitales y ventilación

Introducción: La Historia Clínica es el documento principal en el sistema de información hospitalaria, imprescindible en sus vertientes asistencial y administrativa. Las nuevas tecnologías de la Informática y las comunicaciones han permitido informatizar todos los procesos del sistema de salud. Desde el punto de vista técnico, la informatización de los registros médicos, debe tener en cuenta la correcta descripción de las indicaciones médicas, más aún en los pacientes hospitalizados en las unidades de cuidados intensivos, por su estado de gravedad. Objetivo: desarrollar el prototipo de la aplicación informática que permitirá la gestión de la información del registro de las indicaciones médicas de signos vitales y ventilación de las historias clínicas en el Hospital Clínico-Quirúrgico Docente León Cuervo Rubio de la provincia de Pinar del Río. Métodos: la investigación que se describe obedeció a un estudio de desarrollo tecnológico, para su desarrollo se emplearon métodos teóricos y empíricos. Resultados: la investigación permite a los programadores desarrollar la aplicación informática para el registro de las indicaciones médicas de signos vitales y ventilación en la historia clínica tradicional, por una solución informatizada, a partir de la descripción del negocio, sus requisitos e interacciones. Conclusiones: se alcanzó un gran impacto social en nuestro sistema de salud tanto a nivel provincial como nacional, ya que no existe este sitema y beneficiaria tanto al paciente, como a los profesionales y a la misma institución al abaratar los costos.

Introduction: The Clinical History is the main document in the hospital information system, essential in its care and administrative aspects. The new information technology and communications have made it possible to computerize all the processes of the health system. From a technical point of view, the computerization of medical records must take into account the correct description of medical indications, especially in patients hospitalized in intensive care units, due to their state of seriousness. Objective: to develop the prototype of the computer application that will allow the management of the information of the registry of the medical indications of vital signs and ventilation of the medical records at the León Cuervo Rubio Teaching Clinical-Surgical Hospital in the province of Pinar del Río. Methods: the research that is described obeyed a study of technological development, for its development theoretical and empirical methods were used. Results: the research allows the programmers to develop the computer application for the registration of the medical indications of vital signs and ventilation in the traditional clinical history, by a computerized solution, based on the description of the business, its requirements and interactions. Conclusions: a great social impact was achieved in our health system both at the provincial and national level, since this system does not exist and it would benefit patient, professional and the institution itself by reducing costs.

Impact of severe infections in SLE: an observational study from the Spanish national registry.

OBJECTIVE: Infections are a common complication of SLE. Our objective was to evaluate their causes and impact on the survival of patients with SLE. METHODS: Analysis of the admissions and death causes in patients diagnosed with SLE from the Spanish Hospital Discharge Database and the infection-related deaths of the Spanish population from the National Statistical Institute, between 2016 and 2018.Only infections recorded as the main diagnosis were analysed (severe or clinically relevant infection). RESULTS: Among 18 430 admissions in patients with SLE, disease activity was the cause of admission in 19% of all patients and infection in 15%. However, infection was the main cause of death (25%) while SLE activity was responsible for only 6% of deaths (p<0.001). Severe infection exceeded SLE as a cause of death for patients dying at ages between 40-59 (23% vs 4%, p<0.001), 60-79 (26% vs 6%, p<0.001) and older than 80 years (25% vs 6%, p<0.001). Infection was the cause of death in 8% of the Spanish population, a significantly lower rate when compared with patients with SLE (p<0.001). Compared with the general population, infections were the highest relative cause of death in patients with SLE, particularly at younger ages: 40% vs 3% for those below 20 years old (p<0.01), 33% vs 4% between 20 and 39 (p<0.001), 23% vs 5% between 40 and 59 (p<0.001), 26% vs 5% between 60 and 79 (p<0.001) and 25% vs 9% for those older than 80 years (p<0.001). CONCLUSION: Our nationwide study confirms that infections are the leading cause of death in SLE in Spain, with the highest proportion occurring in young patients with lupus compared with the general population of the same age range.

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study.

We aimed to evaluate the clinical outcome of Systemic Autoimmune Diseases (SADs) patients hospitalized with COVID-19 in Spain, before the introduction of SARS-CoV-2 vaccines. A nationwide, retrospective and observational analysis of the patients admitted during 2020, based on the ICD10 codes in the National Registry of Hospital Discharges, was performed. Among 117,694 patients, only 892 (0.8%) presented any type of SAD before COVID-19-related admission: Sjogren's Syndrome constituted 25%, Systemic Vasculitides 21%, Systemic Lupus Erythematosus 19%, Sarcoidosis 17%, Systemic Sclerosis 11%, Mixed and Undifferentiated Connective Tissue Disease 4%, Behçet's Disease 4% and Inflammatory Myopathies 2%. The in-hospital mortality rate was higher in SAD individuals (20% vs. 16%, p < 0.001). After adjustment by baseline conditions, SADs were not associated with a higher mortality risk (OR = 0.93, 95% CI 0.78−1.11). Mortality in the SADs patients was determined by age (OR = 1.05, 95% CI 1.04−1.07), heart failure (OR = 1.67, 95% CI 1.10−2.49), chronic kidney disease (OR = 1.29, 95% CI 1.05−1.59) and liver disease (OR = 1.97, 95% CI 1.13−3.44). In conclusion, the higher COVID-19 mortality rate seen in SADs patients hospitalized in Spain in 2020 was related to the higher burden of comorbidities, secondary to direct organ damage and sequelae of their condition. Whilst further studies should evaluate the impact of baseline immunosuppression on COVID-19 outcomes in this population, efforts should be focused on the optimal management of SAD to minimize the impact of the organ damage that has been shown to determine COVID-19 prognosis.

Usefulness of the hemogram as a measure of clinical and serological activity in systemic lupus erythematosus.

Background and objectives: Systemic Lupus Erythematosus (SLE) follow-up is based on clinical, and analytical parameters. We aimed to determine the differences between the Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR) and Red blood cell distribution width (RDW) between SLE patients and healthy controls and to assess their association with anemia status, classical inflammatory biomarkers and cytokines, disease activity, SLE related factors and treatment received for SLE. Methods: Seventy-seven patients with SLE according to 2012 SLICC criteria and 80 healthy controls were included. Patients with SLE were classified in SLE with anemia (SLE-a) and SLE without anemia (SLE-na). Statistical analysis between SLE patients and controls and the association of serological and clinical activity markers with proposed hematological indices among SLE patients were performed. Results: RDW, NLR and PLR, were significantly higher in SLE patients than in healthy control group (p < 0.001), in SLE-a patients as compared to SLE-na (p < 0.0001) and were significantly associated with hypocomplementemia (p < 0.05). PLR was higher in active patients measured by SLEDAI-2K score and with longer disease duration (p < 0.05). RDW was associated with serological activity of the patients (p < 0.05) and was correlated with SLEDAI-2K and SLICC/ACR scores, hsCRP, D-dimer, fibrinogen, IL-6 and TNF as well as with corticosteroids intake (p = 0.05). A logistic regression analysis confirmed that after adjustment by age and hemoglobin values, RDW presented linear correlation with IL-6 levels (Beta-coefficient = 0.369, p = 0.003). Conclusion: NLR, PLR and RDW values suggest SLE serological and clinical activity. Given their availability, these markers not only could be useful tools to identify and monitor active SLE patients but whose application should be considered in inflammatory pathologies orchestrated by IL-6 and TNF.

Serum cytokines to predict systemic lupus erythematosus clinical and serological activity.

We aimed to explore the role of interleukin (IL)-6, interferon-gamma (IFNγ), IL-10, and tumor necrosis factor (TNF) as predictors of systemic lupus erythematosus (SLE) clinical and serological activity, and their correlation with the treatment received. We performed a retrospective analysis of 77 patients with SLE according to the 2012 Systemic Lupus International Collaborative Clinics (SLICC) criteria. The outcomes were serological activity (SA), active disease (AD), complete remission (CR), the low-disease activity state (LDAS), and immunosuppressive treatment. SA was present in 17.1%, AD in 17.3%, CR in 13%, and LDAS in 64.9% of patients. IL-6 values were higher in patients in SA, in AD, in those receiving steroids alone, and in patients without CR or LDAS (p < 0.05). IFNγ was associated with anti-double stranded DNA (dsDNA) antibodies positivity and immunosuppression, whereas IL-10 values were higher in patients with CR (p < 0.05). The IL6-IFN product was able to predict anti-double stranded DNA (anti-dsDNA) antibodies positivity (area under the receiver operating characteristic curve [AUC-ROC] = 0.705, 95% confidence interval [CI] 0.563-0.847), SA (AUC-ROC = 0.720, 95% CI 0.542-0.899), AD (AUC-ROC = 0.701, 95% CI 0.520-0.882), steroid treatment (AUC-ROC = 0.751, 95% CI 0.622-0.879), and the absence of LDAS (AUC-ROC = 0.700, 95% CI 0.558-0.834). The IL6-IFN/IL10 ratio predicted AD (AUC-ROC = 0.742, 955 CI 0.540-0.944), steroid treatment (AUC-ROC = 0.721, 95% CI 0.572-0.870), and the absence of LDAS (AUC-ROC = 0.694, 95% CI 0.536-0.853). In conclusion, IL-6, IL-10, and IFNγ might help to assess SLE serological and clinical activity. Their combination in the IL-6-IFN product and the IL-6xIFN to IL-10 ratio results in novel tools to determine and predict SA, AD, and LDAS. Prompt detection of SLE activity might allow a rapid intervention to avoid established or chronic damage.

Impact of cardiovascular risk factors in antiphospholipid syndrome: an observational study from the Spanish national registry.

OBJECTIVES: To determine the burden and impact of cardiovascular risk factors (CRF) in antiphospholipid syndrome (APS) patients. METHODS: Analysis of the patients diagnosed with APS identified in the Spanish Hospital Discharge Database between 2016 and 2017. We analysed the admissions due to arterial (ATE) and venous thromboembolic events (VTE) and evaluated the incidence and the attributed risk of each CRF. RESULTS: 5424 admissions in patients diagnosed with APS were identified. 64.6% were women and the mean age was 54.6. The mortality rate was 3.1%. Overall, 35.8% of patients had hypertension, 14% were diabetic, 21.7% hypercholesterolaemic, 9.9% obese and 26.7% smokers. Thromboembolic events (67.9% arterial and 32.1% venous) accounted for 11.9% of admissions and 7.1% of deaths. Male sex (OR 1.83, 95% CI 1.41-2.21), cholesterol (OR 1.25, 95% CI 1.01-1.54) and smoking (OR 1.49, 95% CI 1.22-1.81) were independently associated with thromboembolic events. Meanwhile, patients with ATE were older (57 vs. 54.1 years p=0.033), and presented more secondary APS (17.1% vs. 10.6%, p=0.034), hypertension (47.7% vs. 33.5%, p=0.001), diabetes (16.9% vs. 9.6%, p=0.017), cholesterol (34.3% vs. 17.8%, p<0.001) and smoking habit (41.2% vs. 24%, p<0.001) when compared with VTE. Risk factors independently associated with ATE events were male sex (OR=1.61, 95% CI=1.30-2.03), hypertension (OR=1.30, 95% CI=1.03-1.64), cholesterol (OR=1.51, 95% CI=1.18-1.94) and smoking habit (OR=1.84, 95% CI=1.47-2.32), while VTE events were determined by male sex (OR=2.06, 95% CI=1.53-2.77) and obesity (OR=1.61, CI=1.02-2.52). CONCLUSIONS: Thromboembolic events in APS were in part determined by a high prevalence of CRF. The identification of distinct profiles may allow us to undertake a more personalised approach to reduce thromboembolic events and to individualise anticoagulant and antiplatelet therapy.

Sperm mRNAs as potential markers of male fertility.

Advances in transcriptomic technologies are contributing to an increased understanding of the role of spermatozoal RNA in sperm physiology. Although sperm transcriptomic studies have delivered large amounts of valuable information, no new male fertility biomarkers have emerged from such studies to date. This review summarizes current knowledge about the potential relevance of certain mRNA as biomarkers, focusing on comparative studies of human spermatozoa transcriptomic profiles from fertile and pathological semen samples. Asthenozoospermia is the semen aberrant condition that has been most exhaustively investigated to date. We cross-analyzed findings from three different studies on the transcriptome of asthenozoospermic semen samples and identified 100 transcripts that were consistently differentially expressed and that consequently are candidates for characterizing the molecular source of this sperm anomaly. The potential use of sperm mRNAs as predictors of outcomes of assisted reproductive technologies (ART) is also reviewed. Improving the understanding of the human spermatozoa mRNA content is expected to improve the evaluation and diagnosis of infertile men, and ultimately facilitate the selection of the best treatment to overcome infertility.

Does admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry.

Acetylsalicylic acid (ASA) is widely used in the treatment and prevention of cardiovascular disorders. Our objective is to evaluate its possible protective role, not only in mortality but also in other aspects such as inflammation, symptomatic thrombosis, and intensive care unit (ICU) admission in hospitalized COVID-19 patients. We realized an observational retrospective cohort study of 20,641 patients with COVID-19 pneumonia collected and followed-up from Mar 1st, 2020 to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Propensity score matching (PSM) was performed to determine whether treatment with ASA affected outcomes in COVID-19 patients. On hospital admission, 3291 (15.9%) patients were receiving ASA. After PSM, 3291 patients exposed to ASA and 2885 not-exposed patients were analyzed. In-hospital mortality was higher in the ASA group (30.4 vs. 16.9%, p < 0.001) in the global sample. After PSM, no differences were found between groups (30.4 vs. 30.3%, p = 0.938). There were no differences in inflammation, symptomatic thrombosis, or ICU admission. In conclusion, ASA intake is not associated with in-hospital mortality or any other health outcome evaluated after applying PSM analysis in a real-world large sample of hospitalized COVID-19 patients.

Trends in Hospital Admissions and Death Causes in Patients with Systemic Lupus Erythematosus: Spanish National Registry.

BACKGROUND: the admission and death causes of SLE patients might have changed over the last years. METHODS: Analysis of the Spanish National Hospital Discharge database. All individuals admitted with SLE, according to ICD-9, were selected. The following five admission categories were considered: SLE, cardiovascular disease (CVD), neoplasm, infection, and venous-thromboembolic disease (VTED), along four periods of time (1997-2000, 2001-2005, 2006-2010, and 2011-2015). RESULTS: The admissions (99,859) from 43.432 patients with SLE were included. The absolute number of admissions increased from 15,807 in 1997-2000 to 31,977 in 2011-2015. SLE decreased as a cause of admission (from 47.1% to 20.8%, p < 0.001), while other categories increased over the time, as follows: 5% to 8.6% for CVD, 8.2% to 13% for infection, and 1.4% to 5.5% for neoplasm (p < 0.001 for all). The admission mortality rate rose from 2.22% to 3.06% (p < 0.001) and the causes of death evolved in parallel with the admission categories. A significant trend to older age was observed over time in the overall population and deceased patients (p < 0.001). CONCLUSIONS: Better control of SLE over the past two decades has led to a decrease in early admissions, and disease chronification. As a counterpart, CVD, infections, and neoplasm have become the main causes of admissions and mortality.

Efficacy and Safety of Sarilumab in patients with COVID19 Pneumonia: A Randomized, Phase III Clinical Trial (SARTRE Study).

INTRODUCTION: SARS-CoV-2 pneumonia is often associated with hyper-inflammation. The cytokine-storm-like is one of the targets of current therapies for coronavirus disease 2019 (COVID-19). High Interleukin-6 (IL6) blood levels have been identified in severe COVID-19 disease, but there are still uncertainties regarding the actual role of anti-IL6 antagonists in COVID-19 management. Our hypothesis was that the use of sarilumab plus corticosteroids at an early stage of the hyper-inflammatory syndrome would be beneficial and prevent progression to acute respiratory distress syndrome (ARDS). METHODS: We randomly assigned (in a 1:1 ratio) COVID-19 pneumonia hospitalized patients under standard oxygen therapy and laboratory evidence of hyper-inflammation to receive sarilumab plus usual care (experimental group) or usual care alone (control group). Corticosteroids were given to all patients at a 1 mg/kg/day of methylprednisolone for at least 3 days. The primary outcome was the proportion of patients progressing to severe respiratory failure (defined as a score in the Brescia-COVID19 scale ≥ 3) up to day 15. RESULTS: A total of 201 patients underwent randomization: 99 patients in the sarilumab group and 102 patients in the control group. The rate of patients progressing to severe respiratory failure (Brescia-COVID scale score ≥ 3) up to day 15 was 16.16% in the Sarilumab group versus 15.69% in the control group (RR 1.03; 95% CI 0.48-2.20). No relevant safety issues were identified. CONCLUSIONS: In hospitalized patients with Covid-19 pneumonia, who were under standard oxygen therapy and who presented analytical inflammatory parameters, an early therapeutic intervention with sarilumab plus standard of care (including corticosteroids) was not shown to be more effective than current standard of care alone. The study was registered at EudraCT with number: 2020-002037-15.

Arteritis de la temporal en paciente joven. A propósito de un caso clínico / Temporal Arteritis in a Young Patient. A Clinical Case

IntroducciónLa arteritis de la temporal es un proceso infrecuente en paciente jóvenes. Se presenta el caso de una paciente de 39 años con arteritis de la temporal con revisión de casos descritos hasta el momento.Presentación del casoMujer de 39 años sin antecedentes de interés que consulta por un nódulo subcutáneo temporal derecho, sin otros síntomas ni hallazgos a la exploración. En las pruebas realizadas destacaba la presencia de signo del halo ecográfico alrededor de la arteria temporal en la localización del nódulo. Se realizó escisión con curación de la paciente y la histopatología mostró hallazgos de arteritis temporal juvenil. ConclusionesLa arteritis temporal en pacientes jóvenes es una entidad infrecuente, ante la cual siempre hay que descartar manifestaciones sistémicas mediante una anamnesis, exploración física reglada y pruebas complementarias. La anatomía patológica establecerá el diagnóstico definitivo. El tratamiento suele ser quirúrgico. Tras dicho tratamiento, se deberá seguir a la paciente por el posible desarrollo posterior de otras enfermedades.(AU)

IntroductionTemporal arteritis is an uncommon disorder in young people. A 39-year-old woman with juvenile temporal arteritis is described and we performed a literature review of all cases of juvenile temporal arteritis described to date.Case presentationA 39-year-old woman presented with a subcutaneous temporal nodule in the right temple with no other associated symptoms or background and unremarkable physical examination. Ultrasonography of the nodule revealed an anechoic perivascular halo surrounding the temporal artery. The nodule was excised resulting in the patient's recovery. The results of the histopathological study showed features of juvenile temporal arteritis.ConclusionsJuvenile temporal arteritis is a very uncommon disorder. Systemic manifestations should be ruled out by physical examination and complementary tests. Histopathology establishes the definitive diagnosis. Treatment is surgical excision and a follow-up should be conducted to rule out complications.(AU)

Temporal Arteritis in a Young Patient. A Clinical Case. / Arteritis de la temporal en paciente joven. A propósito de un caso clínico.

INTRODUCTION: Temporal arteritis is an uncommon disorder in young people. A 39-year-old woman with juvenile temporal arteritis is described and we performed a literature review of all cases of juvenile temporal arteritis described to date. CASE PRESENTATION: A 39-year-old woman presented with a subcutaneous temporal nodule in the right temple with no other associated symptoms or background and unremarkable physical examination. Ultrasonography of the nodule revealed an anechoic perivascular halo surrounding the temporal artery. The nodule was excised resulting in the patient's recovery. The results of the histopathological study showed features of juvenile temporal arteritis. CONCLUSIONS: Juvenile temporal arteritis is a very uncommon disorder. Systemic manifestations should be ruled out by physical examination and complementary tests. Histopathology establishes the definitive diagnosis. Treatment is surgical excision and a follow-up should be conducted to rule out complications.

Morfea lineal asociada al uso de golimumab en paciente con espondiloartropatía / Linear localized morphea associated with golimumab in a patient with spondyloarthritis

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Gene transcription profiling of astheno- and normo-zoospermic sperm subpopulations.

Spermatozoa contain a repertoire of RNAs considered to be potential functional fertility biomarkers. In this study, the gene expression of human sperm subpopulations with high (F1) and low (F2) motility from healthy normozoospermic (N) and asthenozoospermic (A) individuals was evaluated using RNA microarray followed by functional genomic analysis of differentially expressed genes. Results from A-F1 versus N-F1, A-F2 versus N-F2, N-F1 versus N-F2, and A-F1 versus A-F2 comparisons showed a considerably larger set of downregulated genes in tests versus controls. Gene ontology (GO) analysis of A-F1 versus N-F1 identified 507 overrepresented biological processes (BPs), several of which are associated with sperm physiology. In addition, gene set enrichment analysis of the same contrast showed 110 BPs, 36 cellular components, and 31 molecular functions, several of which are involved in sperm motility. A leading-edge analysis of selected GO terms resulted in several downregulated genes encoding to dyneins and kinesins, both related to sperm physiology. Furthermore, the predicted activation state of asthenozoospermia was increased, while fertility, cell movement of sperm, and gametogenesis were decreased. Interestingly, several downregulated genes characteristic of the canonical pathway protein ubiquitination were involved in asthenozoospermia activation. Conversely, GO analysis of A-F2 versus N-F2 did not identify overrepresented BPs, although the gene set enrichment analysis detected six enriched BPs, one cellular component, and two molecular functions. Overall, the results show differences in gene transcription between sperm subpopulations from asthenozoospermic and normozoospermic semen samples and allowed the identification of gene sets relevant to sperm physiology and reproduction.

Advanced Paternal Age Affects Sperm Count and Anogenital Distance in Mouse Offspring.

In Western society, couples increasingly delay parenthood until later in life. Overall, studies have focused on the reproductive performance of older parents or the impact of advanced maternal age on pregnancy outcomes, but few studies have examined how advanced paternal age (APA) affects offspring health. The aim of this study was to investigate the impact of increasing paternal age on offspring reproductive performance and long-term metabolic health in a mouse model. Here, the same adult B6D2F1/J male mice were mated at 4, 12, and 18 months of age with 6- to 10-week-old naturally cycling CF1 females to generate 3 offspring cohorts conceived at increasing paternal ages PA4, PA12, and PA18. The offspring resulting from mating the same fathers at different ages (n = 20 per age; 10 males and 10 females) were maintained up to 20 weeks of age and morphometric parameters, growth curve, and glucose tolerance were measured. We found that increasing paternal age was associated with a trend toward longer time to conception. Litter sizes were not significantly different. Reassuringly, metabolic parameters and growth curve were not different in the 3 cohorts of offspring. Most importantly, increased paternal age (PA4 vs PA18) was associated with a statistically significant decrease in sperm concentration, sperm motility, and anogenital distance in offspring. These changes raise concerns about the potential impact of APA on the reproductive fitness in males of the next generation.