Post-COVID-19 syndrome, inflammation and insulin resistance: a retrospective cohort study.

BACKGROUND: COVID-19-induced diabetes is a novel and enigmatic disease. Our aim was to evaluate a possible relationship between post-COVID-19 syndrome (PCS) and increased insulin resistance (IR) in non-diabetic outpatients after mild COVID-19. METHODS: Repeated measures design. Three evaluations [1E (pre-COVID, baseline), 2E (3 months post-COVID) and 3E (21 months post-COVID)] were performed, directed to PCS+ and PCS- subjects. Triglyceride-glucose (TyG) index ≥8.74 was considered IR, and albumin-to-globulin ratio (AGR) <1.50, inflammation. RESULTS: We analyzed 112 individuals (median [IQR] age=44 [20] years, 58% women, 36 PCS+, 76 PCS-). PCS+ with very low basal IR (TyG <7.78, lowest quartile) showed a reduced inflammatory burden (basal AGR=1.81 [0.4] vs. 1.68 [0.2] in 2E; P=0.23), and increased TyG across evaluations (from basal 7.62 [0.2] to 8.29 [0.5]; P=0.018]. Conversely, PCS+ subjects with high basal TyG (TyG ≥8.65, highest quartile) did not show significant variations in TyG, but a greater inflammatory load (basal AGR=1.69 [0.3] vs. 1.44 [0.3] in 2E; P=0.10). In multivariable models addressing groups with reduced basal IR (TyG <8.01), PCS has been a consistent predictor for TyG, after adjusting for confounders. Partial correlation and multivariable analyses showed similarities involving acute polysymptomatic COVID-19 and PCS regarding IR. CONCLUSIONS: PCS was associated with increased IR, being more evident when the baseline degree of IR was very low. PCS and increased IR were separately associated with inflammation. Acute polysymptomatic COVID-19 and PCS could be clinical expressions of underlying inflammatory state, which in turn may also trigger IR.

Diffuse idiopathic skeletal hyperostosis (DISH) and trabecular bone score (TBS) in postmenopausal women: The Camargo cohort.

OBJECTIVES: The potential relationship between diffuse idiopathic skeletal hyperostosis (DISH) and bone microstructure has not been studied in women. We aimed to assess the association between the trabecular bone score (TBS) and DISH in postmenopausal women, as well as the role of other parameters related to bone metabolism, such as bone mineral density (BMD), calciotropic hormones, and bone remodeling markers. METHODS: Cross-sectional study, nested in a prospective population-based cohort (Camargo cohort). Clinical covariates, DISH, TBS, vitamin D, parathormone, BMD and serum bone turnover markers, were analyzed. RESULTS: We have included 1545 postmenopausal women (mean age, 62±9 years). Those with DISH (n = 152; 8.2%) were older and had a significantly higher prevalence of obesity, metabolic syndrome, hypertension, and type 2 diabetes mellitus (p<0.05). Moreover, they had lower TBS values (p = 0.0001) despite having a higher lumbar spine BMD (p<0.0001) and a higher prevalence of vertebral fractures than women without DISH (28.6% vs. 15.1%; p = 0.002). When analyzing DISH through Schlapbach grades, women without DISH had a median TBS value consistent with a normal trabecular structure while the values for women with DISH from grades 1 to 3 were consistent with a partially degraded trabecular structure. Women with vertebral fractures and DISH had a mean TBS corresponding to a degraded trabecular structure (1.219±0.1). After adjusting for confounders, the estimated TBS means were 1.272 (1.253-1.290) in the DISH group, and 1.334 (1.328-1.339) in the NDISH group (p<0.0001). CONCLUSION: An association between DISH and TBS has been shown in postmenopausal women, in which hyperostosis has been significantly and consistently related to trabecular degradation and, therefore, to deterioration in bone quality after adjusting for confounding variables.

Early stages of diffuse idiopathic skeletal hyperostosis (DISH) and chronic inflammation: the Camargo Cohort Study.

INTRODUCTION/OBJECTIVES: DISH has traditionally been considered a non-inflammatory rheumatic disorder. Currently, an inflammatory component has been theorized in the early phases of this condition (EDISH). The study is aimed at investigating a possible relationship between EDISH and chronic inflammation. METHOD: Analytical-observational study: participants from the Camargo Cohort Study were enrolled. We collected clinical, radiological, and laboratory data. C-reactive protein (CRP), albumin-to-globulin ratio (AGR), and triglyceride-glucose (TyG) index were assessed. EDISH was defined by Schlapbach's scale grades I or II. A fuzzy matching with tolerance factor = 0.2 was performed. Subjects without ossification (NDISH), sex- and age-matched with cases (1:4), acted as controls. Definite DISH was an exclusion criterion. Multivariable analyses were performed. RESULTS: We evaluated 987 persons (mean age 64 ± 8 years; 191 cases with 63.9% women). EDISH subjects presented more frequently obesity, T2DM, MetS, and the lipid pattern [↑TG ↓TC]. TyG index and alkaline phosphatase (ALP) were higher. Trabecular bone score (TBS) was significantly lower (1.310 [0.2] vs. 1.342 [0.1]; p = 0.025). CRP and ALP showed the highest correlation (r = 0.510; p = 0.0001) at lowest TBS level. AGR was lower, and its correlations with ALP (r = - 0.219; p = 0.0001) and CTX (r = - 0.153; p = 0.022), were weaker or non-significant in NDISH. After adjustment for potential confounders, estimated CRP means for EDISH and NDISH were 0.52 (95% CI: 0.43-0.62) and 0.41 (95% CI: 0.36-0.46), respectively (p = 0.038). CONCLUSIONS: EDISH was associated with chronic inflammation. Findings revealed an interplay between inflammation, trabecular impairment, and the onset of ossification. Lipid alterations were similar to those observed in chronic-inflammatory diseases. Key Points • An inflammatory component has been theorized in early stages of DISH (EDISH) • In EDISH group compared to non-DISH, we observed significantly higher correlations between biomarkers and some relevant variables. In particular, with alkaline phosphatase (ALP) and with trabecular bone score (TBS) • EDISH has shown to be associated with chronic inflammation • The lipid alterations observed in the EDISH group were similar to those observed in chronic-inflammatory diseases.

Blood group O is associated with post-COVID-19 syndrome in outpatients with a low comorbidity index.

BACKGROUND: ABO blood group system modulates the inflammatory response and has been implicated in COVID-19. Group O protects against SARS-CoV-2 infection, but there are no data regarding post-COVID-19 syndrome (PCS). Our aim was to assess this possible association. METHODS: Case-control study in a community setting, with subjects who had experienced mild COVID-19. Cases were PCS+, controls were PCS-, and the exposure variable, group O. We collected age, sex, BMI, smoking, comorbidities, inflammatory markers, anti-SARS-CoV-2 IgG antibodies, blood type and clinical data. Five composite inflammatory indices were developed. Multivariate analyses were performed. RESULTS: We analysed 121 subjects (56.2% women), mean age 45.7 ± 16 years. Blood group frequencies were 41.5%, 7.9%, 5.9%, and 44.5% for A, B, AB and O, respectively. Thirty-six patients were PCS+, without significant differences between cases and controls. Compared to non-O, a higher prevalence of PCS (p = .036), and number of symptoms of PCS (p = .017) were noted in group O. Concerning biomarkers, PCS + and PCS- showed no differences in A, B, and AB groups. In contrast, group O PCS + patients had significantly lower albumin-to-globulin ratio and higher lymphocyte count, fibrinogen, CRP levels, and higher percentages of 3 composite indices, than PCS- subjects. Group O showed a 6-fold increased risk of PCS, compared to non-O (adjusted OR = 6.25 [95%CI, 1.6-23]; p = .007). CONCLUSIONS: Group O has shown a consistent relationship with PCS, characterised by a more intense inflammatory burden than the other blood groups. Blood group O could be part of the immunological link between acute COVID-19 and PCS.

Trabecular bone score and bone turnover markers in men with DISH: Data from the Camargo Cohort study.

OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with an increased risk of vertebral fracture. To date, no studies have investigated the relationship between DISH and bone microstructure assessed by the trabecular bone score (TBS). METHODS: Cross-sectional study, nested in a prospective population-based cohort. All men (968) aged≥50 years were included. Clinical covariates, DISH, TBS, serum bone turnover markers and bone mineral density (BMD) were analyzed. RESULTS: Mean age of participants was 65 ± 9 years. 207 (21.6%) had DISH. DISH subjects were older, had higher body mass index (BMI) and abdominal perimeter, lower glomerular filtration rate (GFR), and higher prevalence of metabolic syndrome (MetS) than non-DISH (NDISH) subjects. Bone mineral density at the lumbar spine (LS-BMD) was significantly higher in the DISH group. TBS values were 1.317 [1.303-1.331] for DISH and 1.334 [1.327-1.341] for NDISH subjects, after adjusting by age, BMI, abdominal perimeter, arterial hypertension, diabetes mellitus, MetS, GFR, serum alkaline phosphatase (ALP), LS and femoral neck BMD (p = 0.03). Serum ALP levels were higher in DISH subjects, showing an inverse correlation with TBS that remained significant after adjusting by age and BMI. CONCLUSIONS: TBS values were significantly lower in men with DISH irrespective of age, BMI and BMD, suggesting that the presence of DISH might be related to a worse trabecular microstructure.

Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria / Factors associated to Clostridium difficile infection in a hospital-based home care service

Antecedentes y objetivo: No hay datos relativos a los factores de riesgo asociados a la infección por Clostridium difficile (ICD) en los servicios de hospitalización domiciliaria (SHD) del sistema sanitario español. Pacientes y métodos: Estudio casos-controles. Los casos fueron pacientes ingresados en un SHD entre 1 de enero de 2011 y el 31 de diciembre de 2016, que desarrollaron ICD. Los controles procedían de la misma población, con sospecha clínica de ICD y toxina CD(-). Se analizaron 82 variables. Resultados: Fueron evaluados 17 casos y 95 controles, sin diferencias por sexo, edad o comorbilidad. Se registró diarrea en el 94% y 92%, y un porcentaje de exitus del 18% y 1%, respectivamente (p=0,001). La hemiplejia/paraplejia se asoció significativamente con la ICD (odds ratio [OR] ajustada=26,4; IC 95%: 2,9-235,6; p=0,003), mientras que la enfermedad respiratoria crónica y el uso de cefalosporinas presentaron una significación marginal (OR ajustadas de 2,9 [0,8-10,3] y 3,1 [0,8-11,3], ambas p=0,08). Conclusiones: Las acciones en el SHD frente a la ICD deberían incluir una reducción en el uso de antibióticos de riesgo -según lo observado, las cefalosporinas- especialmente ante ciertas comorbilidades, como una hemiplejia/tetraplejia o una enfermedad respiratoria crónica

Background and objective: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. Patients and methods: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. Results: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). Conclusions: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease

Factors associated to Clostridium difficile infection in a hospital-based home care service. / Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria.

BACKGROUND AND OBJECTIVE: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. PATIENTS AND METHODS: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. RESULTS: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). CONCLUSIONS: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease.

Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection?

Resnick-Niwayama criteria for diagnosing DISH depict an advanced stage, and a new reduced cut-off point with three contiguous vertebrae affected (two bone bridges) has been proposed. The aim has been to know the interobserver agreement by using a graded scale of DISH in which grade II matches with the new proposed cut-off point and grade III matches with the first criterion of Resnick-Niwayama. Males ≥ 50 years and postmenopausal women included in a population-based prospective study (the Camargo Cohort) were analyzed. Sample size was obtained according to an expected kappa of 0.95 and an accuracy of ± 8%. Three physicians applied independently Schlapbach graded scale (ranged from grade 0, no ossification, to grade III, ≥ 3 consecutive bone bridges) on the lateral radiographs of thoracic and lumbar spine of participants. We calculated inter- and intra-observer agreement and correlation. One hundred and fifty eight radiographs (79 patients, 68 ± 9 years) were assessed. Kappa values (95% confidence interval) for grades 0, I, II, and III were 0.63 (0.50-0.77), 0.49 (0.37-0.62), 0.32 (0.17-0.47), and 0.69 (0.60-0.77), respectively. Weighted kappa for the three pairs of raters were 0.87 (0.82-0.93), 0.84 (0.77-0.91), and 0.81 (0.72-0.90). Grade III was the image that generated greater agreement, while a significant decrease was noted in grade II, the new proposed criterion. The simultaneous presence of an incomplete DISH and osteoarthritis, in a thoracic spinal segment with peculiar anatomical characteristics (reduced disk spaces, kyphotic curve), is thought to be a major cause of variability in the results.

Importancia y grado de conocimiento percibido por las enfermeras de Cantabria sobre farmacología, reacciones adversas medicamentosas e interacciones farmacológicas / Importance and level of knowledge perceived by nurses from Cantabria about pharmacology, adverse reactions to drugs, and drug-drug interactions

OBJETIVO: conocer la importancia y el grado percibido de conocimientos de las enfermeras de Cantabria sobre farmacología, reacciones adversas a medicamentos (RAM) e interacciones farmacológicas (IF); y determinar si existen diferencias en relación con sus características profesionales. MÉTODO: estudio descriptivo transversal. Se diseñó un cuestionario en papel autocumplimentado y anónimo de seis preguntas, tras revisión de la literatura, consenso y pilotaje de la herramienta. Mediante una muestra de conveniencia fueron encuestados profesionales enfermeros de hospitales, Atención Primaria (AP) y Atención Sociosanitaria (AS) de Cantabria. Se realizó estadística descriptiva y prueba de contraste de hipótesis con Chi cuadrado de Pearson. RESULTADOS: se recogieron 132 cuestionarios. El 72% y el 90,9% de los encuestados consideraban insuficiente la formación pregrado y postgrado en Farmacología, respectivamente. Se consideraba capacitado para reconocer RAM el 60% con una antigüedad < 6 años frente al 84,3% en >15 años (p= 0,01), y el 59,7% de eventuales frente al 77,1% de los fijos (p= 0,03). El 41,9% de los eventuales conocía las principales IF frente al 62,9% de los fijos (p= 0,02). La Enfermería hospitalaria fue el ámbito con mayor percepción de recibir una formación continuada adecuada en farmacología (p= 0,001). CONCLUSIONES: hay un importante déficit percibido de formación en farmacología. Existen ciertas características profesionales diferenciales: las enfermeras de hospitales, con contratos fijos y con una mayor experiencia, manifiestan mejores resultados respecto a los colectivos de enfermeras de AP, AS, eventuales y con menor experiencia laboral

OBJECTIVE: to understand the importance and perceived level of knowledge by nurses from Cantabria about pharmacology, adverse reactions to drugs (ARDs) and drug-drug interactions (DDIs); and to determine if there are differences according to their professional characteristics. METHOD: a cross-sectional descriptive study. A printed self-completion questionnaire was designed, anonymous and including six questions, after a literature review, consensus and pilot trial of the tool. Through convenience sampling, a survey was conducted on nursing professionals from hospitals, Primary Care (PC) and Healthcare and Social Work (HSW) from Cantabria. Descriptive statistics was conducted, as well as Hypothesis Contrast Test through Pearson's Chi Square. RESULTS: in total, 132 questionnaires were collected; 72% and 90.9% of participants considered insufficient the undergraduate and post-graduate training on Pharmacology, respectively. Sixty per cent (60%) with < 6-year seniority considered they were qualified to identify ARDs vs. 84.3% with >15 years (p= 0.01), and 59.7% of temporary workers vs. 77.1% of permanent workers (p= 0.03); 41.9% of temporary workers were aware of the main DDIs vs. 62.9% of permanent workers (p= 0.02). Hospital nursing was the setting with a higher perception of receiving an adequate continuous training on Pharmacology (p= 0.001). CONCLUSIONS: there is an important deficit perceived in terms of Pharmacology training. There are certain differentiating professional characteristics: hospital nurses with permanent contracts and higher experience show better results vs. the nurses in PC and HSW, temporary and with lower work experience