Experts document about an adequate utilization of SYSADOAs in controversial clinical situations

BACKGROUND AND OBJECTIVE

SYSADOAs (Symptomatic Slow-Acting Drugs for Osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations.

MATERIALS AND METHODS

Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy.

RESULTS

The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding Diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease.

CONCLUSIONS

There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use. This work may contribute towards improving the management protocols of SYSADOAs in the treatment of OA and offer a useful approach in uncertain situations.

Experts Document About an Adequate Utilization of SYSADOAs in Controversial Clinical Situations

BACKGROUND AND OBJECTIVE

SYSADOAs (symptomatic slow-acting drugs for osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations.

MATERIALS AND METHODS

Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy.

RESULTS

The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease.

CONCLUSIONS

There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use. This work may contribute towards improving the management protocols of SYSADOAs in the treatment of OA and offer a useful approach in uncertain situations.

OP0002 INCIDENCE OF FIRST CARDIOVASCULAR EVENT IN SPANISH PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: PROSPECTIVE DATA FROM THE CARMA PROJECT AFTER 5 YEARS OF FOLLOW-UP

Objectives:

To determine the incidence and risk factors implicated in the development of first cardiovascular (CV) event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) attending Spanish rheumatology clinics after 5 years of follow-up

Methods:

Analysis of data of patients included in an observational prospective study [CARdiovascular in rheuMAtology (CARMA) project] after 5 years of follow-up. The study includes a cohort of 2234 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA), and another cohort of matched individuals (n=677) without CIRD from 67 hospitals in Spain. Cumulative incidence per 1000 patients of CVE was estimated in both cohorts at 5 years from the start. Weibull proportional hazard model was used to calculate the Hazard Ratio (HR) and 95% confidence intervals (CI) of the risk factors involved in the development of CV events. Losses to follow-up and their causes were also analyzed.

Results:

The total number patient who completed the follow-up visit at 5 years was 2.382 (81.9%). Fifteen patients died due to CVE and sixty due to non-CVE. The patients with CIRD showed higher cardiovascular cumulative incidence (40.5; 95% CI: 36.2-44.8) than controls (28.3; 95% CI: 21.8-34.8). The higher risk of developing a first CVE during the 5 years of follow-up was seen in patients with AS (HR: 4.60; 95% CI: 1.32-15.99; p=0.02), those with older age (HR:1.09; 95% CI: 1.05-1.13; p<0.001), higher systolic blood pressure (HR: 2.64; 95% CI: 1.32-5.25; p=0.006), and those with longer duration of the rheumatic disease (HR: 1.07; 95% CI: 1.03-1.12; p=0.002). In contrast, woman gender was a protective factor (HR: 0.45; 95% CI: 0.21-0.99; p=0.047).

Conclusion:

Patients with AS prospectively followed-up at rheumatology outpatient clinics showed higher risk of developing a first CVE than those without CIRD. Besides traditional CV disease risk factors, a longer time course of the disease is a risk factor for the development of CV disease in patients with CIRD.

Acknowledgments:

This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results and preparation of the manuscript has been done independently of Abbvie.

Disclosure of Interests:

Maria Auxiliadora Martin-Martinez: None declared, Santos Castañeda: None declared, Fernando Sánchez-Alonso: None declared, Carmen García Gomez: None declared, Carlos Gonzalez Juanatey: None declared, Maria Angeles Belmonte: None declared, Jesús Tornero: None declared, José Santos Rey: None declared, CARMEN OLGA SANCHEZ GONZALEZ: None declared, Estefanía Quesada-Masachs: None declared, MARIA DELPUERTO MORENO GIL: None declared, Tatiana Cobo-Ibáñez: None declared, Jose Antonio Pinto Tasende: None declared, Jesús Babío: None declared, Gemma Bonilla: None declared, Antonio Juan Mas: None declared, Javier Manero: None declared, Montserrat Romera: None declared, Javier Bachiller-Corral: None declared, Eugenio Chamizo Carmona: None declared, Javier Calvo: None declared, Raimon Sanmarti: None declared, Maria Celia Erausquin: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Carmen Barbadillo: None declared, Sergio Ros Exposito: None declared, Javier del Pino Grant/research support from: Roche, Bristol, Consultant of: Gedeon, MARIA JOSE GONZALEZ: None declared, José Manuel Pina Salvador: None declared, Javier Llorca: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

AB0594 EFFECTIVENESS OF RITUXIMAB IN CSDMARDS-RESISTANT ACTIVE MIXED CONNECTIVE TISSUE DISEASE

Background:

Objectives:

To evaluate rituximab (RTX) effectiveness and safety in treating patients with refractory mixed connective tissue disease (MCTD).

Methods:

Open observational study including patients with refractory MCTD (active disease despite treatment with glucocorticoids and csDMARDs) from two third-level hospitals who had been treated with RTX (off-label use) from January 2001 to December 2019.

Results:

Thirteen patients (all women) were included, with a mean age of 32 years (SD: 10, range 17-50) and a median time of evolution of the disease of 55 months (SD: 34.3; range 5-98 months). The main indication for initiating treatment with RTX was refractory arthritis (100%), most of the times accompanied by other features of the disease including shrinking lung syndrome (2), fibrosing progressive non-specific interstitial pneumonia (FP-NSIP) (1), recurrent serositis (2), glomerulonephritis (GMN) (2), lymphadenitis (1) and immune thrombocytopenic purpura (ITP) (1). All patients were treated with RTX at rheumatoid arthritis dosage while the baseline immunosuppressive treatment (methotrexate, azathioprine, mycophenolate, leflunomide or tacrolimus) remained unchanged. Hydroxychloroquine was also associated in 8 of the patients. The follow-up time (median) after starting RTX was 118 months (range, 65-177 months, with a total of 132.6 patient-years of follow-up) and the mean number of cycles of treatment was 4.2 (range, 1-15), with a variable interval (from 6 to 12 months). After the first RTX cycle, a partial or complete response was achieved in 92% of the patients. A significant improvement in the mean DAS28-ESR was observed (initial: 4.56 ± 1.6 / final: 2.21 ± 0.85; p=0.008). In all but one patient, who had previously failed to 2 anti-TNFα DAS28-ESR clinical remission or low activity was achieved, generally from week 16 to 20, although relapses were frequent and all cases need retreatment after 6-9 months. In 4 patients, RTX retreatment dosage was optimized to 1 g/cycle. The 3 patients with pulmonary involvement showed stabilization (2 cases) or improvement (1) of the lung function(as defined by the American Thoracic Society). In patients with GMN, renal response to RTX treatment was complete in a patient and partial in the other. The patient with ITP entered remission after the first RTX cycle and no more cycles were needed. Response in patients with serositis and lymphadenitis was also complete and maintained. Moreover, the glucocorticoid doses were reduced to less than half of the initial dose in all cases. At the end of the follow-up, 7 out of the 13 patients (54%) were still being treated with RTX. For the remaining 6 patients, RTX was withdrawn because of primary failure (1), recurrent bacterial infections (2), gestational desire (2) sustained remission (1).

Conclusion:

According to our preliminary results, RTX seems to be effective and relatively safe in patients with csDMARDs-resistant active MCTD.

Disclosure of Interests:

L Montolio-Chiva: None declared, J. Narváez: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, J Lluch Pons: None declared, Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, Maribel Mora: None declared, Xavier González: None declared, Carla Marco: None declared, Jesús Rodriguez: None declared, Montserrat Romera: None declared, Joan Miquel Nolla: None declared

Improved prediction of knee osteoarthritis progression by genetic polymorphisms: the Arthrotest Study

OBJECTIVE

The aim of this study was to develop a genetic prognostic tool to predict radiographic progression towards severe disease in primary knee OA (KOA) patients.

METHODS

This investigation was a cross-sectional, retrospective, multicentric association study in 595 Spanish KOA patients. Caucasian patients aged ≥40 years at the time of diagnosis of primary KOA of Kellgren-Lawrence grade 2 or 3 were included. Patients who progressed to Kellgren-Lawrence score 4 or who were referred for total knee replacement within 8 years after diagnosis were classified as progressors to severe disease. Clinical variables of the initial stages of the disease (gender, BMI, age at diagnosis, OA in the contralateral knee, and OA in other joints) were registered as potential predictors. Single nucleotide polymorphisms and clinical variables with an association of P < 0.05 were included in the multivariate analysis using forward logistic regression.

RESULTS

A total of 23 single nucleotide polymorphisms and the time of primary KOA diagnosis were significantly associated with KOA severe progression in the exploratory cohort (n = 220; P < 0.05). The predictive accuracy of the clinical variables was limited: area under the curve (AUC) = 0.66. When genetic variables were added to the clinical model (full model), the prediction of KOA progression was significantly improved (AUC = 0.82). Combining only genetic variables (rs2073508, rs10845493, rs2206593, rs10519263, rs874692, rs7342880, rs780094 and rs12009), a predictive model with good accuracy was also obtained (AUC = 0.78). The predictive ability for KOA progression of the full model was confirmed on the replication cohort (two-sample Z-test; n = 62; P = 0.190).

CONCLUSION

An accurate prognostic tool to predict primary KOA progression has been developed based on genetic and clinical information from OA patients.

High sensitivity cardiac troponin T and interleukin-6 predict adverse cardiovascular events and mortality in anticoagulated patients with atrial fibrillation

There are limited data on the prognostic role of biomarkers in anticoagulated patients with atrial fibrillation (AF). We evaluated the prognostic value of high sensitivity TnT (hsTnT) and high-sensitivity interleukin-6 (hsIL6) in a large cohort of AF patients taking oral anticoagulant therapy (OAC) as both biomarkers have been associated with adverse cardiovascular events.

METHODS

We studied 930 patients (51% male; median age 76) with permanent/ paroxysmal AF who were stabilized (for at least 6 months) on OAC (INRs 2.0-3.0). Plasma hsTnT and hsIL6 levels were quantified by electrochemiluminescense immunoassay at baseline. Patients were followed-up for up to 2 years, and adverse events (thrombotic and vascular events, mortality and major bleeding) were recorded.

RESULTS

At follow-up, 96 patients (3.97%/year) died whilst 107 had an adverse cardiovascular event (3.14%/year). On multivariate analysis, high hsTnT and high hsIL6 remained significantly associated with prognosis even after adjusting for CHADS2 score: HR 2.21 (1.46-3.35, P<0.001) for high hsTnT and 1.97 (1.29-3.02, P=0.002) for high hsIL6, for adverse cardiovascular events. For all-cause mortality, the HRs were 1.79 (1.13-2.83, P=0.013) and 2.48 (1.60-3.85, P<0.001), respectively. The integrated discrimination index (IDI) values of clinical scores (CHADS2 and CHA2 DS2-VASc) were improved by the addition of hsTnT and/or hsIL6 (all P<0.05).

CONCLUSION

In a large 'real world' cohort of anticoagulated AF patients, both hsTnT and hsIL6 levels provided prognostic information that was complementary to clinical risk scores for prediction of long-term cardiovascular events and death, suggesting that these biomarkers may potentially be used to refine clinical risk stratification in AF.

[Differences in the frequency of osteoporosis according to the skeletal site evaluated. Analysis in 987 Spanish postmenopausal women referred to a bone densitometry unit]

OBJECTIVE

To analyze the differences in the frequency of osteoporosis according to the skeletal site evaluated in a group of Spanish postmenopausal women.

METHODS

We reviewed the data of 987 postmenopausal women (mean age, 53.8±5.5 years). BMD status was evaluated by DXA. We used the WHO thresholds to classify the patients. T-score was obtained from the single evaluation of each lumbar vertebra (L2, L3 and L4), the mean value of lumbar spine (L2-L4), femoral neck and total hip.

RESULTS

In 144 (14.7%) women, discrepancies were observed when we considered the single vertebral analysis versus the L2-L4 analysis; 62 (6%) women who presented osteoporosis in at least one vertebra would have been due to the osteopenia category when L2-L4 value was selected. In 271 (27.8%) women, discrepancies were observed when we considered the total hip analysis versus the femoral neck analysis. The frequency of osteoporosis ranged from 3% when only the analysis of the total hip was considered to 16% when the results of L2-L4 and proximal femur (total hip or femoral neck) measurements were selected.

CONCLUSIONS

Frequency of osteoporosis varies notably according to the skeletal zone considered.

Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit

OBJECTIVE

Although several decision rules have been developed to identify postmenopausal women who may be selected for dual-energy x-ray absorptiometry measurements, information on their utility in a clinical setting is scarce. We evaluated the utility of 4 previously validated decision rules in a large group of Spanish postmenopausal women referred to a bone densitometry unit.

METHODS

We reviewed the data on 665 postmenopausal women (mean age 54.2 +/- 5.4 yrs). We selected the 4 decision rules that could be applied with the information that was available: the Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST), Osteoporosis Index of Risk (OSIRIS), and Body Weight Criterion (BWC). The sensitivity, specificity, and predictive values of each decision rule were determined.

RESULTS

The ORAI would recommend 45% of women for bone mineral density (BMD) testing, OST 46%, OSIRIS 37%, and BWC 70%. Sensitivity values obtained in the overall series were 64.1% for the ORAI, 69.2% for OST, 58.1% for OSIRIS, and 83.8% for BWC. The sensitivity increased progressively with age. The negative predictive value in the overall series was 88.5% for ORAI, 89.9% for OST, 88.4% for OSIRIS, and 90.6% for BWC.

CONCLUSION

In a complementary way with previous studies in older women, where decision rules were valuable to identify the majority of women likely to have osteoporosis, our data indicate that in younger postmenopausal women, decision rules are useful as a screening method to rule out the presence of osteoporosis and the need for BMD scanning.

[Evaluation of two proposals based on clinical factors for selecting what male patients with rheumatoid arthritis should undergo a bone densitometry]

Criteria based on age, inflammation, and immobility have been proposed to identify which patients with rheumatoid arthritis (RA) should be examined by dual energy X-ray absorptiometry (DXA) to diagnose osteoporosis. Recently, a modified version of the criteria by including weight and the use of corticosteroids has been proposed. These two set of criteria have not been tested in male patients in a clinical setting.

OBJECTIVE

To analyse, in a group of patients followed in a teaching hospital, the value of two proposals to select men with RA for bone densitometry.

PATIENTS AND METHOD

Clinical and demographic data were collected from the charts of a total of 65 men with RA, submitted to the bone densitometry unit during a fouryear period. Bone mineral density (BMD) was measured in spine and femoral neck by DXA. Two set of criteria were tested: a) three item criteria (age, inflammation and immobility), and b) five item criteria (age, inflammation, immobility, weight, and ever use of corticosteroids). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

RESULTS

Thirty five (54%) patients fulfilled the three item criteria and 38 (59%) the five item criteria. For the diagnosis of osteoporosis using the three item criteria, the sensitivity was 62%, specificity 48%, PPV 23% and NPV 83%; using the 5 item criteria the sensitivity was 90%, specificity 47%, PPV 23%, and NPV 96%.

CONCLUSIONS

The five item criteria are a more accurate tool to identify, in clinical practice, male patients with RA and osteoporosis than the three item criteria. It seems a good screening method for the selection of those patients with RA whose BMD should be assessed, as the sensitivity and NPV seem acceptable.

Insulin resistance as a non-invasive method for the assessment of fibrosis in patients with hepatitis C: a comparative study of biochemical methods

INTRODUCTION

Insulin resistance (IR) promotes the progression of fibrosis and diminishes response to treatment in patients with hepatitis C. Recently, Sydney's index (includes IR) has been proposed as a non-invasive method for the prediction of fibrosis.

OBJECTIVE

To assess the usefulness of Sydney's index for the prediction of advanced fibrosis (F3-F4) or absence of significant fibrosis (F0-F1) in patients with chronic hepatitis C.

PATIENTS AND METHODS

We included 131 patients suffering from chronic hepatitis C. Mean age was 40 +/- 11, 78 men and 53 women. Fibrosis stage was (F0-F1) 69 patients, F2: 40, and advanced (F3-F4) in 22 patients. We measured baseline AST, ALT, GGT, platelet, cholesterol, alcohol, and IR (HOMA - IR) levels. Sydney, Forns' and APRI indexes were calculated.

RESULTS

The area under the curve for the diagnosis of absence of significant fibrosis in each method was: Sydney: 0.80, Forns: 0.71, APRI: 0.70; p = ns. Moreover, the diagnostic capacity of advanced fibrosis was: Sydney: 0.88, Forns: 0.83, APRI: 0.82; p = ns. The predictive negative value of significant fibrosis was 74, 72, and 67%, respectively. Due to the presence of intermediate values, the indexes were not applicable to 36, 44 and 43% of patients respectively.

CONCLUSIONS

The incorporation of insulin resistance among biochemical non-invasive methods slightly improves the yield of other indexes. Nevertheless, results are suboptimal, and more than one third of patients might not be correctly classified.

Localization of monoamine oxidase A and B and semicarbazide-sensitive amine oxidase in human peripheral tissues

Monoamine oxidase (MAO) A and B and semicarbazide-sensitive amine oxidase (SSAO) localizations in peripheral human tissues were compared by immunohistochemistry. The primary antibodies used were mouse monoclonal anti-human MAO-A (6G11/E1) and anti-human MAO-B (3F12/G10/2E3) and a rabbit polyclonal anti-bovine SSAO antibody. Immunoreactivities of the samples, obtained from 6 routine autopsy cases, showed different distributions in the tissues studied (heart, lung, duodenum, liver, pancreas, spleen, thyroid gland, adrenal gland and kidney). The relative MAO-A, MAO-B and SSAO distributions indicated a widespread distribution of these enzymes in the human body that is characterized by a matching cellular pattern in only few tissues. These differences suggest that each amine oxidase may play a specific function in, at least some, peripheral tissues.

Breaking a secure communication scheme based on the phase synchronization of chaotic systems

A security analysis of a recently proposed secure communication scheme based on the phase synchronization of chaotic systems is presented. It is shown that the system parameters directly determine the cipher text waveform, hence it can be readily broken by system parameter estimation from the cipher text signal.

[Anterior uveitis and juvenile idiopathic arthritis]

PURPOSE

Anterior uveitis is one of the most important extraarticular manifestations of juvenile idiopathic arthritis (JIA). The aim of this study was to describe the frequency of uveitis, complications and ocular surgical procedures, to corroborate risk factors for the development of uveitis and to analyze its evolutive characteristics.

METHODS

Retrospective review of 132 children diagnosed with JIA in our hospital from 1985 to 2000. Patients presenting anterior uveitis (Tyndall + or recent keratic precipitates) were studied.

RESULTS

Uveitis was detected in 26 of 132 children (19%). All of them presented pauciarticular JIA. The patients received corticosteroid therapy for a mean time of 19.2 months, developing a mean of 4.5 episodes of uveitis. Patients diagnosed with uveitis before or within 1 year from the onset of arthritis required longer treatment (295 months versus 206) and suffered more episodes (73 versus 44) than those with uveitis found later on. Complications (cataract, band keratopathy, glaucoma, macular edema) developed in 27.9% of the affected eyes. Surgery was required in 10 eyes.

CONCLUSIONS

The incidence of uveitis in our study is similar to recently reported rates. Female sex, pauciarticular onset, serum antinuclear antibodies (ANA) and early onset of uveitis seem to increase the development of chronic uveitis. Periodic slit-lamp ophthalmologic screenings in high risk patients are recommended (Arch Soc Esp Oftalmol 2003; 78: 561-566).

Protective effect of N-(2-propynyl)-2-(5-benzyloxyindolyl) methylamine (PF 9601N), a novel MAO-B inhibitor, on dopamine-lesioned PC12 cultured cells

Oxidative stress may play a role in the pathogenesis of Parkinson's disease. We have standardised a new model of dopaminergic-cell toxicity that uses dopamine, which is able to generate free radicals, as a toxin. The effect of this catecholamine on cell viability (MTT staining) was dose-dependent, reaching 65% of cell loss at a dopamine concentration of 300 microM. In this model, the protective effect of a novel MAO-B inhibitor, N-(2-propynyl)-2-(5-benzyloxy-indolyl) methylamine (PF 9601N), was studied and compared with the effect of L-deprenyl assayed under the same experimental conditions. Whereas PF 9601N (50 microM and 100 microM) showed a significant protective effect, this was not the case with L-deprenyl. This different behaviour could be explained in terms of difference in antioxidant capacity. The toxicity induced in PC12 cells by 300 microM dopamine was partially reversed by incubating it in the presence of GBR-12909, a dopamine-transporter blocker. The results indicated that, besides the intracellular toxicity effect of dopamine, another non-specific extracellular mechanism could be involved.

Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures

OBJECTIVE

To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture.

METHODS

Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified.

RESULTS

The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm(2) and the T score was -2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm(2) and the T score was -2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60-70, and 60% in patients over 70.

CONCLUSION

These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD.

Inefficacy of burst-suppression anesthesia in medication-resistant major depression: a controlled trial

Burst-suppression anesthesia (BSA) has been previously compared with electroconvulsive therapy (ECT) in drug-resistant depression, with promising results. We have carried out a double-blind randomized clinical trial comparing BSA with sham-BSA in 20 patients meeting DSM-IV criteria for major depression with inadequate response to antidepressant drugs and who chose BSA as an alternative to ECT. After withdrawing antidepressant drugs, patients were randomized to receive four sessions of either BSA (induction with propofol followed by the anesthetic agent sevoflurane, achieving BSA for 1 hour) or sham-BSA (induction with propofol until loss of consciousness, followed by spontaneous awakening in 5-10 minutes). Decrease in the Hamilton Rating Depression Scale was larger with BSA (-6.0 +/- 7.3) than with sham-BSA (-2.5 +/- 4.5), but differences did not reach statistical significance ( t = -1.08, p = 0.3). In our sample, we have not found BSA to be superior to sham-BSA and therefore cannot consider BSA as an alternative to ECT.

Prefrontal repetitive transcranial magnetic stimulation as add on treatment in depression

A growing number of studies report antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) in patients with major depression. The hypothesis that high frequency (20 Hz) rTMS (HF-rTMS) may speed up and strengthen the therapeutic response to sertraline in MD was tested. Twenty eight patients who had not yet received medication for the present depressive episode (n=12) or had failed a single trial of an antidepressant medication (n=16) were started on sertraline and randomised to receive either real of sham HF-rTMS. HF-rTMS was applied to the left dorsolateral prefrontal area in daily sessions (30 trains of 2 s, 20-40 s intertrain interval, at 90% motor threshold) on 10 consecutive working days. The results suggest that in this patient population, HF-rTMS does not add efficacy over the use of standard antidepressant medication.

Osteoporotic vertebral fracture in clinical practice. 669 Patients diagnosed over a 10 year period

OBJECTIVE

Few data are available on clinically diagnosed vertebral fracture. Information about osteoporotic vertebral fracture has mainly been obtained via inferences from epidemiological studies of vertebral deformity. We evaluated the characteristics of patients with osteoporotic vertebral fracture diagnosed in a rheumatology department over a 10 year period.

METHODS

Patients with back pain and vertebral fracture diagnosed between January 1990 and December 1999 were recruited from our data base. Patients with high energy trauma, malignancies, and metabolic bone diseases other than osteoporosis were excluded. These variables were analyzed: sex, age at diagnosis, type of osteoporosis (primary vs secondary), number of fractures at diagnosis (single vs multiple), and percentage of admissions and length of stay.

RESULTS

Of the 669 patients, 534 (80%) were women and 135 (20%) were men. Age at diagnosis ranged from 30 to 91 yrs, mean 67.1 +/- 9.1. Secondary osteoporosis was diagnosed in 177 (26%) patients and the frequency was significantly higher in men than women (55% vs 19%; p < 0.001); the most common associations for secondary osteoporosis were oral corticosteroids, chronic obstructive airway disease, and rheumatoid arthritis. At diagnosis, half of the patients presented with multiple fractures. One hundred twenty (18%) patients were admitted; length of stay ranged from 5 to 56 days, mean 15.9 +/- 7.7. The frequency of admissions was higher in men than women (27% vs 16%; p < 0.001), higher in patients with secondary osteoporosis than in those with primary osteoporosis (33% vs 12%; p < 0.001), and higher in patients with multiple fractures than in those with single fractures (27% vs 8%; p < 0.001).

CONCLUSION

Characteristics of patients recruited from a clinical setting differ significantly from those of subjects included in the epidemiological studies. In a rheumatology practice, frequency of secondary osteoporosis, mainly associated with corticosteroid treatment, is notably high. Admission is by no means a rare event.

Tissue activity and cellular localization of human semicarbazide-sensitive amine oxidase

Semicarbazide-sensitive amine oxidase (SSAO), widely distributed in highly vascularized mammalian tissues, metabolizes endogenous and xenobiotic aromatic and aliphatic monoamines. To assess whether its physiological role in humans is restricted to oxidation, we used an immunohistochemical approach to examine the cellular localization of SSAO in human peripheral tissues (adrenal gland, duodenum, heart, kidney, lung, liver, pancreas, spleen, thyroid gland, and blood vessels) and also analyzed its subcellular localization. The results are in agreement with the specific activities also determined in the same samples and are discussed with reference to the tissue distribution of monoamine oxidase A and B. Together with the oxidative deamination of monoamines, SSAO cellular localization indicates that, in most human peripheral tissues, it might participate in the regulation of physiological processes via H(2)O(2) generation. (J Histochem Cytochem 49:209-217, 2001)

Visual search in complex displays: factors affecting conflict detection by air traffic controllers

Recent free flight proposals to relax airspace constraints and give greater autonomy to aircraft have raised concerns about their impact on controller performance. Relaxing route and altitude restrictions would reduce the regularity of traffic through individual sectors, possibly impairing controller situation awareness. We examined the impact of this reduced regularity in four visual search experiments that tested controllers' detection of traffic conflicts in the four conditions created by factorial manipulation of fixed routes (present vs. absent) and altitude restrictions (present vs. absent). These four conditions were tested under varying levels of traffic load and conflict geometry (conflict time and conflict angle). Traffic load and conflict geometry showed strong and consistent effects in all experiments. Color coding altitude also substantially improved detection times. In contrast, removing altitude restrictions had only a small negative impact, and removing route restrictions had virtually no negative impact. In some cases conflict detection was actually better without fixed routes. The implications and limitations of these results for the feasibility of free flight are discussed. Actual or potential applications include providing guidance in the selection of free flight operational concepts.

Ordering of the Mandelbrot-like set of the exponential map

We graphically study the Mandelbrot-like set of the complex exponential family of maps E(lambda)(z)=lambdae(z), which we call the Baker-Rippon-Devaney (BRD) set. We observe that the period of every hyperbolic component can be deduced with the naked eye by using two simple rules. (c) 1998 American Institute of Physics.

[Dietary habits of 2 populations of the province of Barcelona (III): energy consumption and macronutrients]

BACKGROUND

The identification of an association between alimentary and nutritional factors and different diseases has led to the study of alimentary habits in different populations. The consumption of energy and macronutrients was analyzed in two urban populations in the province of Barcelona (Spain).

METHODS

One thousand thirty-four randomly selected individuals from primary care centers (PCC) were studied by a systematic sampling of all the out patient consultations over one year and to those to whom a semiquantitative questionnaire of frequency foodstuffs was given to estimate their normal diet. The subjects included all those residents in the two towns studied from 13 to 80 years of age who attended the PCC during the study period.

RESULTS

The percentage of subjects from Vilanova i la Geltrú who were found to be high consumers of milk and derivatives, fish and vegetables was significantly higher in comparison with subjects from Gavá. The males of both towns presented a higher mean consumption of carbohydrates and energy than the females. On comparison of the consumption between the 2 populations, the mean carbohydrate diet ingested was significantly greater in the population from Gavá in both sexes as was the consumption of energy and total lipids between women and men, respectively.

CONCLUSIONS

The population studied presented a clear pattern of Mediterranean diet consumption with elevated ingestion of carbohydrates and monounsaturated fats.

[Dietary habits of 2 populations of the province of Barcelona (II): comparative study of the frequency of consumption in both populations and its relationship to recommended diet in diabetes]

BACKGROUND

The aim of the present study was to compare the eating habits of two urban populations (Vilanova i la Geltrú and Gavá) of the province of Barcelona, Spain, and determine the relation with the diet recommended in diabetes since this diet does not differ from what is considered "equilibrated diet".

METHODS

One thousand thirty-four individuals randomly selected from Primary Health Care Centers (PHCC) by a systematic sampling of all the outpatient consultations over one year to whom a questionnaire on semiquantitative frequencies were studied with the aim of determining their everyday diet. All those between 13 and 80 years of age, residing in the two municipalities studied and who attended the PHCC over the period of the study were included in the study.

RESULTS

On comparison of both populations a statistically higher consumption (p < 0.01) of milk products, fish, vegetables, fruits and oils was observed in Vilanova i la Geltrú than in Gavá. Both groups presented a lower intake than recommended of fish, vegetables, and fruits. In contrast a high intake of sugar, ice cream and sugared beverages and foods were observed in the two populations studied and in the younger are groups.

CONCLUSIONS

The population of Vilanova i la Geltrú have dietary habits which are closer to those recommended in the diet of diabetics than the population of Gavá.

[Dietary habits of 2 populations of the province of Barcelona (I): design and validation of a semiquantitative questionnaire of frequency of food consumption]

BACKGROUND

The identification of associations between alimentary factors and specific chronic diseases has led to the development of valid diet measurement methods. In the present article the design and validation of a questionnaire on the frequency of food consumption is reported.

METHODS

From an initial sample of 1,034 inhabitants of two populations in the province of Barcelona, Spain, a sample stratified by age, sex and population of 64 individuals between 13-70 years of age was randomly selected. A semiquantitative questionnaire was initially given to 58 of the 64 subjects including 39 foods or groups of food and these were instructed as to how to follow a registry of food for 7 days in two different periods. The intakes of energy products, macronutrients, fiber, cholesterol and vitamins C, A and E were estimated by the two methods were compared.

RESULTS

The means of nutrients estimated were lower in the questionnaire than those obtained by the reports of foods with the exception of the intake of carbohydrates. The range of the correlation coefficients for the values obtained by both methods was of 0.17 for vitamin E and 0.54 for the monounsaturated fatty acids which, after correction for the alternation factor, were found to be 0.20 and 0.67, respectively. Thirty-nine percent of the individuals were classified within the quintile of low consumption with 33% being within the quintile of greatest consumption.

CONCLUSIONS

The use of a semiquantitative questionnaire may be useful to describe the dietary habits in a given population and fundamentally when the population studied is to be classified according to the normal consumption of energy and macronutrients.

[Evaluation of a tuberculosis prevention and control program (1987-1989)]

Tuberculosis continues to be an important health problem. A tuberculosis prevention and control program was begun in 1989 in Ciutat Badia, introducing the inclusion of those who had been in close contact with infected subjects. In the two years of the study, a total of 1,548 tuberculin tests was performed, 518 of which were positive 33%). Prevalence of tubercular infection in the study population, was 13.95%. Ages ranged from 14 to 20 years. We detected 20 cases of pulmonary tuberculosis and were able to study 91% of those who had been in close contact with the subjects in question. Three of these were detected in the latter study, and two by contact with tubercular infection. We prescribed a total of 180 chemoprophylaxes (47 primary and 133 secondary) with compliance of 60% and 71% respectively. We believe that chemoprophylaxis plays an important role in the prevention and control of tuberculosis in primary care.