On-time denosumab dosing recovered rapidly during the COVID-19 pandemic, yet remains suboptimal.

Timely administration of denosumab every 6 mo is critical in osteoporosis treatment to avoid multiple vertebral fracture risk upon denosumab discontinuation or delay. This study aimed to estimate the immediate and prolonged impact of the COVID-19 pandemic on the timing of denosumab doses. We identified older adults (≥66 yr) residing in the community who were due to receive denosumab between January 2016 and December 2020 using Ontario Drug Benefit data. We completed an interrupted time-series analysis to estimate the impact of the COVID-19 pandemic (March 2020) on the monthly proportion of on-time denosumab doses (183 +/-30 d). Analyses were stratified by user type: patients due for their second dose (novice users), third or fourth dose (intermediate users), or ≥5th dose (established users). In additional analyses, we considered patients living in nursing homes, switching to other osteoporosis drugs, and reported trends until February 2022. We studied 148 554 patients (90.9% female, mean [SD] age 79.6 [8.0] yr) receiving 648 221 denosumab doses. The average pre-pandemic proportion of on-time therapy was steady in the community, yet differed by user type: 64.9% novice users, 72.3% intermediate users, and 78.0% established users. We identified an immediate overall decline in the proportion of on-time doses across all user types at the start of the pandemic: -17.8% (95% CI, -19.6, -16.0). In nursing homes, the pre-pandemic proportion of on-time therapy was similar across user types (average 83.5%), with a small decline at the start of the pandemic: -3.2% (95% CI, -5.0, -1.2). On-time therapy returned to pre-pandemic levels by October 2020 and was not impacted by therapy switching. Although on-time dosing remains stable as of February 2022, approximately one-fourth of patients in the community do not receive denosumab on-time. In conclusion, although pandemic disruptions to denosumab dosing were temporary, levels of on-time therapy remain suboptimal.

Beyond Acute COVID-19: A Review of Long-term Cardiovascular Outcomes.

Statistics Canada estimated that approximately 1.4 million Canadians suffer from long COVID. Although cardiovascular changes during acute SARS-CoV-2 infection are well documented, long-term cardiovascular sequelae are less understood. In this review, we sought to characterize adult cardiovascular outcomes in the months after acute COVID-19 illness. In our search we identified reports of outcomes including cardiac dysautonomia, myocarditis, ischemic injuries, and ventricular dysfunction. Even in patients without overt cardiac outcomes, subclinical changes have been observed. Cardiovascular sequelae after SARS-CoV-2 infection can stem from exacerbation of preexisting conditions, ongoing inflammation, or as a result of damage that occurred during acute infection. For example, myocardial fibrosis has been reported months after hospital admission for COVID-19 illness, and might be a consequence of myocarditis and myocardial injury during acute disease. In turn, myocardial fibrosis can contribute to further outcomes including dysrhythmias and heart failure. Severity of acute infection might be a risk factor for long-term cardiovascular consequences, however, cardiovascular changes have also been reported in young, healthy individuals who had asymptomatic or mild acute disease. Although evolving evidence suggests that previous SARS-CoV-2 infection might be a risk factor for cardiovascular disease, there is heterogeneity in existing evidence, and some studies are marred by measured and unmeasured confounders. Many investigations have also been limited by relatively short follow-up. Future studies should focus on longer term outcomes (beyond 1 year) and identifying the prevalence of outcomes in different populations on the basis of acute and long COVID disease severity.

Familiar size affects perception differently in virtual reality and the real world.

The promise of virtual reality (VR) as a tool for perceptual and cognitive research rests on the assumption that perception in virtual environments generalizes to the real world. Here, we conducted two experiments to compare size and distance perception between VR and physical reality (Maltz et al. 2021 J. Vis. 21, 1-18). In experiment 1, we used VR to present dice and Rubik's cubes at their typical sizes or reversed sizes at distances that maintained a constant visual angle. After viewing the stimuli binocularly (to provide vergence and disparity information) or monocularly, participants manually estimated perceived size and distance. Unlike physical reality, where participants relied less on familiar size and more on presented size during binocular versus monocular viewing, in VR participants relied heavily on familiar size regardless of the availability of binocular cues. In experiment 2, we demonstrated that the effects in VR generalized to other stimuli and to a higher quality VR headset. These results suggest that the use of binocular cues and familiar size differs substantially between virtual and physical reality. A deeper understanding of perceptual differences is necessary before assuming that research outcomes from VR will generalize to the real world. This article is part of a discussion meeting issue 'New approaches to 3D vision'.

Does Aleutian Disease Occur among Domestic Ferrets in Poland? Results of Preliminary Studies Conducted in Two Regions of Poland.

Although ferrets are becoming increasingly popular as companion animals, their population in households is still far lower compared to cats or dogs. This results in a much smaller number of ferret specialists, and thus poorer diagnosis of various diseases, including the Aleutian disease. Aleutian disease is a slowly progressing viral disease which can cause different symptoms in these animals. The virus can also cause symptoms in different species of animals, but in the case of ferrets, there is relatively less information on about both the prevalence and symptoms of this disease. Therefore, the aim of this study was to determine the presence of antibodies and the virus itself in ferrets from two regions of Poland. Blood samples and rectal swabs were obtained from 61 domestic ferrets from Mazowieckie and Dolnoslaskie voivodships. The presence of antibodies was determined using serological methods and real-time PCR analysis was performed to determine presence of viral DNA. Serological analyses demonstrated that 49% (n = 30) of the ferrets had antibodies against Aleutian disease virus (ADV). No relationship was observed between the prevalence of antibodies and age, sex, habitual residence or origin of ferrets. The real-time PCR did not confirm DNA of the ADV in any of the blood and rectal swab samples. Obtained results suggest that ADV circulates in the analyzed population of ferrets, therefore further studies in this direction should be carried out.

Fracture outcome definitions in observational osteoporosis drug effects studies: a scoping review protocol.

OBJECTIVE: The objective of this review is to describe fracture outcome definitions in observational osteoporosis drug effects studies from Canada and the United States. INTRODUCTION: Health care administrative data are commonly utilized in pharmacoepidemiologic studies. These data are used to define outcomes, such as fractures, and are critical to determining real-world safety and effectiveness of medications. However, there is no current standard for fracture outcome definitions in observational studies. As a result, fractures are inconsistently defined. To inform future research, a synthesis of how fractures are defined in observational studies using health care administrative claims data is needed. Providing clarity on how fractures are defined will provide guidance for future research. INCLUSION CRITERIA: We will include observational studies from the United States and Canada that consider the impact of osteoporosis pharmacotherapies on fracture risk and leverage health care administrative data. METHODS: This review will follow the three-step JBI methodology for scoping reviews. We will search MEDLINE, Embase, and CINAHL for studies published in English from 2000 to the present. Following de-duplication, titles and abstracts will be screened independently by two reviewers. We will then conduct full-text screening for eligible studies. In addition, Canadian and US government pharmacovigilance websites will be searched to identify gray literature. Data extraction will be completed by two reviewers. Results will be presented in figures and in tabular format.

Familiar size affects the perceived size and distance of real objects even with binocular vision.

Although the familiar size of real-world objects affects size and distance perception, evidence is mixed about whether this is the case when oculomotor cues are available. We examined the familiar size effect (FSE) on both size and distance perception for real objects under two viewing conditions with full or restricted oculomotor cues (binocular viewing, which provides vergence and accommodation cues, and monocular viewing through a 1-mm pinhole, which removes those cues). Familiar objects (a playing die versus a Rubik's cube) were manufactured in their typical (1.6-cm die and 5.7-cm Rubik's cube) and reverse (5.7-cm die and 1.6-cm Rubik's cube) sizes and shown at two distances (25 cm versus 91 cm) in isolation. Small near and large far objects subtended equal retinal angles. Participants provided manual estimates of perceived size and distance. For every combination of size and distance, Rubik's cubes were perceived as larger and farther than the dice, even during binocular viewing at near distances (<1 meter), when oculomotor cues are particularly strong. For size perception but not distance perception, the familiar size effect was significantly stronger under monocular pinhole viewing than binocular viewing. These results suggest that (1) familiar size affects the accuracy of perception, not just the speed; (2) the effect occurs even when oculomotor cues are available; and (3) size and distance perception are not perfectly yoked.

Bicycle and helmet use of adolescents in Markham, Canada.

Bicycle crashes are the second most common sports- or recreation-associated cause of serious injury. While the literature suggests that wearing protective helmets can significantly decrease risks associated with bicycle-related injuries, overall helmet use remains sub-optimal. A recent study by Chow et al. suggested that helmet-wearing rates in adolescent boys are negatively correlated with age. The aim of this study was to determine if similar trends are observed in a co-educational high school setting. A questionnaire was circulated at Unionville High School, a co-ed public high school in Markham, Canada. Of the 144 participants, 27 of them were in Grade 9 or 10, and 117 of them were in Grade 11 or 12. While there was no statistical difference between helmet-wearing rates in Grade 9-10 and Grade 11-12 students, overall usage rates were low (41% and 38%, respectively, for recreational cyclists). This trend is interesting, considering that nearly 90% of all students were aware that wearing a helmet while cycling is required under Ontario law. Further studies should be conducted among the young adult population to determine whether the alarming trends discovered by this study and Chow et al. continue.

Therapeutic effects of CO2 laser therapy of linear nevus sebaceous in the course of the Schimmelpenning-Feuerstein-Mims syndrome.

The Schimmelpenning-Feuerstein-Mims (SFM) syndrome is a rare phakomatosis which comprises a nevus sebaceous of Jadassohn, seizures and developmental delay associated with a wide spectrum of extracutaneous abnormalities including neurological, skeletal, ocular, cardiovascular and urogenital defects. We are presenting a case of an 18-year-old patient with systemic features of the SFM syndrome and an extensive linear nevus sebaceous partially removed with a carbon dioxide (CO2) laser. The treatment options of skin lesions in patients with SFM are discussed.

[Analysis of the chosen parameters of metabolic status in patients with psoriasis]. / Analiza wybranych parametrów stanu metabolicznego u pacjentów z luszczyca.

INTRODUCTION: Psoriasis is a chronic inflammatory dermatosis leading to the development of systemic inflammatory reaction. Previous data indicated the coexistence of psoriasis and the occurrence of metabolic disorders, with the common background of both processes determined by a chronic inflammation. The coexisting disorders, including type 2 diabetes, hypertension, heart ischemic disease, dislipidemia and obesity may have an important impact on intensity of psoriasis activity. MATERIAL AND METHODS: The analysis comprised of 82 randomly matched patients with various clinical forms of psoriasis, aged 17 to 81 years. In patients PASI and BSA indexes, BMI value and laboratory parameters of metabolic status (glucose and ureic acid levels, lipid fractions and CRP level in the serum) were evaluated. RESULTS: An average age in examined group was 54,3 years, an average time of presence of psoriasis symptoms was approximately 20 years. An average PASI value was 21,4; an average BSA value was 39.7%. The coexistence of type 2 diabetes was found in 14.6% of patients, hypertension in 42.7% and heart ischemic disease in 17%. Particularly large group of examined patients comprised persons with overweight (34.1%) and obesity (30.5%). Positive correlation between BSA and body weight, BSA and BMI value, BSA and abdominal circumference as well as positive correlation between PASI and body weight, PASI and BMI value, PASI and abdominal circumference were observed. Abnormal serum glucose levels were observed in 19.5% persons, ureic acid level in 2.9%, total cholesterol in 37.8% LDL cholesterol in 48.8%, and HDL cholesterol in 46.3%. CRP level was elevated in 43.9% patients. Positive correlation between BSA and ureic acid level, as well as PASI and ureic acid level was estimated. No correlation between PASI and the other laboratory parameters was found. CONCLUSIONS: The occurrence of metabolic syndrome is more common in patients with psoriasis in comparison to the general population. The extent and severity of psoriatic lesions correlate with high body weight, BMI and the level of ureic acid.

[Pemphigoid nodularis--diagnostic and therapeutic difficulties. A case report]. / Pemfigoid guzkowy--trudnosci diagnostyczne i terapeutyczne. Studium przypadku.

The case of a 62-year-old female patient diagnosed with an extremely rare clinical variant of pemphigoid--nodular pemphigoid, imitating prurigo nodularis, is presented in the paper. In connection with the existence of the typical prurigo nodularis-like appearance in the patient, the diagnosis was maintained for several months. However, because of no response to the treatment and the remarkably chronic course of the disease, the patient was admitted to the Department in order to extend the diagnostics and verify the previous diagnosis. The direct and indirect immunofluorescence examinations performed on the patient enabled the final diagnosis of a rare variant of pemphigoid without typical blisters, and effective treatment was carried out.

[Vitiligo as an aesthetic problem. Noninvasive therapeutic methods in vitiligo]. / Bielactwo nabyte jako problem estetyczny. Nieinwazyjne metody leczenia bielactwa.

Vitiligo is an idiopathic chronic skin disease that is notable for depigmented macules forming by destruction of melanocytes mediated by cells of the immune system. Vitiligo occurs in 1-2% of the population irrespective of race and without predilection to gender or age. The dynamics and extent of the disease vary widely, ranging from stable cases with isolated minor foci to states showing rapid progression and occupying large areas of the skin. For many patients, the disease represents a serious cosmetic defect which limits their activities in various spheres of life. There are many noninvasive methods of treatment but none of them offers a guarantee of complete therapeutic success. PUVA- and UVB-therapy are recognized as the most effective and most commonly used methods. The management of vitiligo should also include education, cosmetic correction options, and psychotherapy in some cases.

[Antimalarial drugs in contemporary dermatologic therapy]. / Miejsce leków przeciwmalarycznych we wspólczesnej terapii dermatologicznej.

Antimalarial drugs--chloroquine, hydroxychloroquine and quinacrine, initially devised for the treatment of malaria, have been used in the therapy of diverse skin diseases, including lupus erythematosus, dermatomyositis, porphyria cutanea tarda, and sarcoidosis. The mechanism of action of these drugs involves stabilization of lysosomal enzymes, inhibition of antigen-presenting cells and T lymphocyte stimulation, blocking of the pro-inflammatory cytokine cascade and endosomal toll-like receptor signaling. The understanding of potential mechanisms of action of antimalarials may extend their use to new areas in dermatology. This work describes the pharmacologic properties of antimalarial drugs and indications for their use in clinical practice. Moreover, the most important limitations of therapy with antimalarials and their adverse side effects are discussed.

[Retrospective analysis of adverse cutaneous drug reactions in patients hospitalized in Department of Dermatology and Venereology of Pomeranian Medical University in 1996-2006]. / Retrospektywna analiza niepoizdanych skórnych reakcji polekowych u pacjentów hospitalizowanych w Klinice Chorób skórnych i Wenerycznych Pomorskiej Akademii Medycznej w Latach 1996-2006.

INTRODUCTION: Every adverse and undesirable event observed after administration of the therapeutic dose of the drug is defined as adverse drug reaction. The aim of the study was to evaluate the incidence frequency of cutaneous adverse drug reactions, to define the drugs inducing such reactions and to define the type of the most frequently found lesions in patients admitted to Department of Dermatology and Venereology of Pomeranian Medical University in Szczecin (PAM) in 1996-2006. MATERIAL AND METHODS: A retrospective analysis of medical files of the patients, who were hospitalized in the Department of Dermatology and Venereology of PAM in Szczecin in 1996-2006, was carried out. Due to cutaneous adverse drug reactions, 386 patients were hospitalized. They made 4.25% of all admitted to our Department. RESULTS: These reactions were found more frequently in females (65.5%) than in males (34.5%). Non-steroidal anti-inflammatory drugs induced adverse events most frequently (37.6%), followed by aminopenicillin antibiotics, particularly amoxycillin-containing agents, responsible for 25.8% of these reactions. Other antibiotics were responsible for undesirable events less frequently--9.6%. Macular and maculopapular rashes were the most frequently observed adverse cutaneous drug reactions (42.0% of the cases), followed by acute urticaria and Quincke's oedema (39.1% of all reactions), whereas contact dermatitis after topical drugs was found in 8.0% of the cases. CONCLUSIONS: Cutaneous adverse drug reactions were mainly induced by non-steroidal anti-inflammatory drugs and aminopenicillin antibiotics. The most frequent forms of cutaneous adverse drug reactions were maculopapular rashes, acute urticaria and Quincke's oedema.

[Dry skin as a dermatological and cosmetic problem]. / Sucha skóra jako problem dermatologiczny i kosmetyczny.

The paper presents current opinions on aetiopathogenesis of dry skin including its occurrence in the course of certain dermatological disorders. A meaning of natural moisturizing factor, lipid barrier as well as epidermal differentiation processes in the maintenance of the proper skin moisturization is described. The importance of topical treatment is emphasized. Moreover, a survey of moisturizing factors applied in dry skin care is included.

[Complications of primary hyperthyroidism as a consequence of subsitutional therapy interruption]. / Powiklania pierwotnej niedoczynnosci tarczycy jako nastepstwo przerwania terapii substytucyjnej.

The case of a 32-year old female patient with primary hypothyroidism suffering from severe myxoedema as a consequence of denying thyroxin taking is presented. Severe expression of pathological changes in circular-respiratory system and uncommon skin changes are discussed.