The Contribution of Transpiration to Precipitation Over African Watersheds

The redistribution of biological (transpiration) and non-biological (interception loss, soil evaporation) fluxes of terrestrial evaporation via atmospheric circulation and precipitation is an important Earth system process. In vegetated ecosystems, transpiration dominates terrestrial evaporation and is thought to be crucial for regional moisture recycling and ecosystem functioning. However, the spatial and temporal variability in the dependency of precipitation on transpiration remains understudied, particularly in sparsely sampled regions like Africa. Here, we investigate how biological and non-biological sources of evaporation in Africa contribute to rainfall over the major watersheds in the continent. Our study is based on simulated atmospheric moisture trajectories derived from the Lagrangian model FLEXPART, driven by 1° resolution reanalysis data over 1981-2016. Using daily satellite-based fractions of transpiration over terrestrial evaporation, we isolate the contribution of vegetation to monthly rainfall. Furthermore, we highlight two watersheds (Congo and Senegal) for which we explore intra- and interannual variability of different precipitation sources, and where we find contrasting patterns of vegetation-sourced precipitation within and between years. Overall, our results show that almost 50% of the annual rainfall in Africa originates from transpiration, although the variability between watersheds is large (5%-68%). We conclude that, considering the current and projected patterns of land use change in Africa, a better understanding of the implications for continental-scale water availability is needed.

AB1094 SAFETY AND EFFICACY OF VACCINES FOR SARS-CoV-2 IN PATIENTS WITH RHEUMATIC AND IMMUNE-MEDIATED INFLAMMATORY DISEASES: DATA FROM THE ARGENTINEAN REGISTRY SAR-CoVAC

Background

Currently there is little information on the efficacy and safety of SARS-CoV-2 vaccination in patients with immune-mediated diseases and/or under immunosuppressive treatment in our country, where different types of vaccines and mix regimens are used. For this reason, the Argentine Society of Rheumatology (SAR) with the Argentine Society of Psoriasis (SOARPSO) set out to develop a national register of patients with rheumatic and immune-mediated inflammatory diseases (IMIDs) who have received a SARS-CoV-2 vaccine in order to assess their efficacy and safety in this population.

Objectives

To assess SARS-CoV-2 vaccine efficacy and safety in patients with rheumatic and IMIDs.

Methods

SAR-CoVAC is a national, multicenter and observational registry. Adult patients with a diagnosis of rheumatic or IMIDs who have been vaccinated for SARS-CoV-2 were consecutively included between June 1st and September 17th, 2021. Sociodemographic data, comorbidities, underlying rheumatic or IMIDs, treatments received and their modification prior to vaccination and history of SARS-CoV-2 infection were recorded. In addition, the date and place of vaccination, type of vaccine applied, scheme and indication will be registered. Finally, adverse events (AE), as well as SARS-CoV-2 infection after the application of the vaccine were documented

Results

A total of 1234 patients were included, 79% were female, with a mean age of 57.8 (SD 14.1) years. The most frequent diseases were rheumatoid arthritis (41.2%), osteoarthritis (14.5%), psoriasis (12.7%) and spondyloarthritis (12.3%). Most of them were in remission (28.5%) and low disease activity (41.4%). At the time of vaccination, 21% were receiving glucocorticoid treatment, 35.7% methotrexate, 29.7% biological (b) Disease Modifying Anti-Rheumatic Drugs (DMARDs) and 5.4% JAK inhibitors. Before vaccine application 16.9% had had a SARS-CoV-2 infection.

Regarding the first dose of the vaccine, the most of the patients (51.1%) received Gam-COVID-Vac, followed by ChAdOx1 nCoV-19 (32.8%) and BBIBP-CorV (14.5%). In a lesser proportion, BNT162b2 (0.6%), Ad26.COV2.S (0.2%) and CoronaVac (0.2%) vaccines were used. Almost half of them (48.8%) completed the scheme, 12.5% were mix regimenes, the most frequent being Gam-COVID-Vac / mRNA-1273. The median time between doses was 51days (IQR 53).

More than a quarter (25.9%) of the patients reported at least one AE after the first dose and 15.9% after the second. The flu-like syndrome and local hypersensitivity were the most frequent manifestations. There was one case of mild anaphylaxis. No patient was hospitalized. Altogether, the incidence of AE was 246.5 events/1000 doses. BBIBP-CorV presented significantly lower incidence of AE in comparison with the other types of vaccines. (118.5 events/1000 doses, p<0.002 in all cases)

Regarding efficacy, 63 events of SARS-CoV-2 infection were reported after vaccination, 19% occurred before 14 days post-vaccination, 57.1% after the first dose (>14 days) and 23.8% after the second. In most cases (85.9%) the infection was asymptomatic or had an outpatient course and 2 died due to COVID-19.

Conclusion

In this national cohort of patients with rheumatic and IMIDs vaccinated for SARS-CoV-2, the most widely used vaccines were Gam-COVID-Vac and ChAdOx1 nCoV-19, approximately half completed the schedule and in most cases homologously. A quarter of the patients presented some AE, while 5.1% presented SARS-CoV-2 infection after vaccination, in most cases mild.

Disclosure of Interests

None declared

POS1199 IS PSORIATIC ARTHRITIS A RISK FACTOR FOR SEVERE COVID -19 INFECTION? DATA FROM THE ARGENTINIAN REGISTRY SAR-COVID

Background

Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained.

Objectives

To describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confirmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA).

Methods

Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR / EULAR 2010 criteria), who had confirmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher’s test, Student’s test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed.

Results

A total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%; p=0.976). (Figure 1).

Table 1.

Characteristics of patients with PsA and RA who presented COVID-19 in the SAR-COVID registry.

Psoriatic arthritis (n=129)Rheumatoid arthritis (n=808)P valueTotal (n=937)Age (years), mean (SD)51.7 (12.7)53.1 (12.9)0.23952.9 (12.9)Female72 (55.8)684 (84.7)<0.001756 (80.7)Comorbidities65 (50.4)355 (43.9)0.203420 (44.8) Obesity (BMI ≥30)19 (15.2)102 (13.4)0.692121 (13.7) Morbid obesity (BMI ≥40)1 (0.8)10 (1.3)111 (1.25) Hypertension35 (28.5)205 (26.8)0.783240 (27.0) Diabetes16 (13.0)67 (8.8)0.18883 (9.39) Dyslipidemia24 (19.5)102 (13.5)0.106126 (14.4) Cardiovascular or cerebrovascular disease5 (11.4)32 (3.9)0.03337 (4.2)Two or more comorbidities55 (42.6)219 (27.1)<0.001274 (29.2)Current smoking4 (3.6)60 (8.4)0.7964 (7.7)High disease activity0 (0)29 (3.8)0.02729 (3.23)Glucocorticoids treatment5 (20.0)95 (60.1)<0.001100 (54.6)Conventional DMARDs47 (36.4)443 (54.8)<0.001490 (52.3)Biologic DMARDs60 (46.5)193 (23.9)<0.001253 (27.0)JAK inhibitors4 (3.10)72 (8.9)0.03876 (8.1)Full recovery of COVID-19105 (84.0)644 (81.7)0.127749 (82.0)COVID-19 complications16 (12.5)68 (8.7)0.22784 (9.2)Death due to COVID-191 (0.8)34 (4.3)0.07435 (3.8)

Notes=values n (%) unless otherwise indicated; BMI: Body Mass Index; DMARDs: disease-modifying antirheumatic drugs; JAK inhibitors: Janus kinase inhibitors.

PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5; p=0.002), had more frequently hypertension (52.2% vs 23%; p=0.011) and dyslipidemia (39.1% vs 15%; p=0.017). In the multivariate analysis, age (OR 1.06; 95% CI 1.02–1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34; 95% CI 0.11–0.92) and biological DMARDs (OR 0.28; 95% CI 0.09–0.78) had a better outcome.

Conclusion

Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.

References

[1]Beigel JH, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826.

Disclosure of Interests

None declared

POS1270 COVID19 VACCINATION IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS: ADVERSE EVENTS AND IMPACT ON DISEASE ACTIVITY

Background

There is scarce evidence on the rate of adverse events and the consequences on disease activity after vaccination against covid19

Objectives

To evaluate adverse events to vaccination and disease flares after vaccination in patients with axial spondyloarthritis (axSpA), peripheral spondyloarthritis (pSpA) and psoriatic arthritis (PsA) and to evaluate factors associated with adverse event.

Methods

Cross-sectional, observational, descriptive study. Consecutive patients with diagnosis of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) according to ASAS 2009 criteria; pSpA according to ASAS 2011 criteria and PsA according to CASPAR criteria were included. Demographic data, disease clinimetry, treatments, vaccination received and post-vaccination adverse events were recorded. We evaluated, according to medical criteria, whether the patient presented a flare disease after vaccination and whether it was mild, moderate or severe. We also evaluated the factors associated with the presence of at least one mild adverse event. Statistical analysis: descriptive statistics were performed, qualitative variables were expressed as frequency and percentage (%), numerical variables as mean and standard deviation (SD) or median and percentile25-75. Binary logistic regression was performed using the presence of at least one mild adverse event to vaccination as the dependent variable.

Results

210 patients were included with a mean age of 45 (SD 15) years. The diagnoses were: AS 50 (23.8%), nr-axSpA 10 (4.8), pSpA 9 (4.3%), PsA 141 (67%) and time of disease evolution in months 109 (SD 96). Regarding comorbidities, the following frequencies were reported: arterial hypertension 60 (30%), diabetes mellitus 25 (12%), heart failure 4 (2%), asthma/EPOC 15 (7%), inflammatory bowel disease 2 (1%), acute anterior uveitis 20 (9.5%), psoriasis 128 (61%). Sixteen percent (n=33) of the patients had SARS-CoV-2 infection prior to vaccination. Regarding treatments, those used were: antiTNF 88 (42%), Tofacitinib 6 (2.9%), Ustekinumab 2 (1%), Secukinumab 35 (17%), Ixekizumab 2 (1%), methotrexate 98 (47%), leflunomide 7 (3. 3), sulfasalazine 7 (3.3), apremilast 1 (0.5%), continuous NSAIDs 26 (12.4%) and NSAIDs on demand 103 (49%). Vaccines received were: Sputnik V 109 (51.9%), Oxford Vaccine, AstraZeneca 63 (30%), Janssen 1 (0.5%), BioNTech Vaccine, Pfizer 1 (0.5%), Sinopharm 33 (15.7%), Moderna 0%, Novavax 0% and others; 3 (1.4%). Thirty-eight percent (n=80) of patients reported having mild post-vaccination symptoms, of which 3.75% did not resolve, 41% resolved with medication and 39% resolved ad integrum without medication. The presence of mild adverse event to the vaccine was associated with lower use of methotrexate (31% vs 56 %, p<0.001), and lower age (54 (SD 14) vs 47 (SD 12), p<0.001), and lower BMI (25 (24-30.5) vs 28 (25-31), p<0.001); while no association was found with sex, diagnosis, comorbidities, treatments, desease activity or vaccines. In the logistic regression analysis all the variables remained independently associated with a lower probability of presenting a mild adverse event: methotrexate: OR: 0.30, 95%CI 0.15-0.58, p<0.001, age: OR: 0.97, 95%CI 0.95-0.99, p: 0.03, BMI: OR: 0.92, 95%CI 0.95-0.99, p: 0.02. Sixty-one percent (n=129) of patients received the 2nd dose of vaccination, which 27% (n=35) presented mild adverse event and only 1 (0.8%) patient suffered post vaccination disease flare.

Conclusion

Vaccination against COVID19 appears to be safe in this population, with only mild adverse events and low frequency of flare disease. Mild adverse events were associated with less use of methotrexate, younger age and lower BMI.

Disclosure of Interests

None declared

POS1204 SARS-CoV-2 INFECTION AFTER VACCINATION IN PATIENTS WITH RHEUMATIC DISEASES FROM ARGENTINA

Background

Patients with rheumatic diseases (RD) have been excluded from SARS-CoV-2 vaccine trials. Though data appear to show safety and efficacy, mostly evidence remains in mRNA vaccines. However in our country, adenovirus and inactivated vaccines, as well as heterologous schemes are frequently used.

Objectives

To describe clinical characteristics and outcomes of SARS-CoV-2 infection after vaccination in patients with RD from de the SAR-CoVAC registry and to compare them with patients who got infected before vaccination. Additionally, factors associated with COVID-19 unfavorable outcome were assessed.

Methods

Adult patients with RD who have been vaccinated for SARS-CoV-2 were consecutively included between June 1st and December 21st, 2021. Confirmed SARS-CoV-2 infection (RT-PCR o serology) was reported by the treated physician. Infection after an incomplete scheme was defined when the event was diagnosed at least 14 days after first dose; and after a complete scheme when it occurred > 14 days after second dose. Homologous scheme is defined by two same doses of vaccine and heterologous by two different doses. Patients with previous SARS-CoV-2 infection were excluded. To compare SARS-CoV-2 infection characteristics in not vaccinated patients, subjects from the SAR-COVID registry, which includes patients with RD and SARS-CoV-2 infection, were matched 2:1 by gender, age and RD.

WHO-Ordinal Scale ≥5 was used to define unfavorable infection outcome. Descriptive statics, Chi2 test, Fischer test, T test and ANOVA were used.

Results

A total of 1350 patients from the SAR COVAC registry were included, 67 (5%) presented SARS-CoV-2 infection after vaccination. The later were mostly (72%) females with a mean age of 57 (SD 15) years old. The most frequent RD were rheumatoid arthritis (41%), psoriatic arthritis (12%) and systemic lupus erythematosus (10%). At vaccination, most of them (75%) had low disease activity or remission, 19% were taking steroids, 39% methotrexate, 27% bDMARDs and 6% JAK inhibitors.

A total of 11 (16%) patients had SARS-CoV-2 infection <14 days after the first vaccine dose, 39 (58%) after an incomplete scheme and 17 (25 %) following a complete one. In the incomplete scheme group, 59% received Gam-COVID-Vac, 31% ChAdOx1 nCov-19 and 10% BBIBP-CorV; and in patients with complete scheme 47%, 24% and 29%, respectively. No event was reported after a complete heterologous scheme. No significant differences regarding sociodemoghraphic characteristics, RD, disease treatment, type of vaccine and regimen was found between in those with infection and those without it.

After vaccination only 8 (12%) of the patients who got infected had an unfavorable course, 88% of them following an incomplete scheme (5 received Gam-COVID-Vac, 1 ChAdOx1 nCov-19 and 1 BBIBP-CorV) and one subject after a complete homologous Gam-COVID-Vac scheme. Having an unfavorable outcome of SARS-CoV-2 infection was associated to: male gender [63% vs 24%, p=0.036], older age [mean 70 years (SD 7) vs 55 years (SD 15), p=0.005], being Caucasian [100% vs 54%, p=0.018], higher education [mean 17 years (SD 4) vs 12 years (SD 4), p=0.010], the presence of comorbidities [100% vs 39%, p=0.001, having pulmonary disease [37% vs 5%, p=0.019], dyslipidemia [63% vs 17%, p=0.011] and arterial hypertension [63% vs 24%, p=0.036], RD, treatments, disease activity and types of vaccines received were comparable between groups.

When comparing patients with and without vaccination prior SARS-CoV-2 infection, those who received at least one dose of vaccine had less frequently severe COVID-19 (12% vs 24%, p=0.067) and presented lower mortality due to COVID-19 (3% vs 6%, p=0.498). However these differences did not reach statistical significance.

Conclusion

In the SAR-CoVAC registry 5% of the patients had SARS-CoV-2 infection after vaccination, most of them mild and 25% after a complete scheme. Any vaccine was associated with severe COVID-19. When comparing with non-vaccinated patients, those with at least one dose, had less frequently severe disease and died due COVID-19.

Disclosure of Interests

None declared

POS1200 DIFFERENCES BETWEEN THE FIRST AND THE SECOND WAVE OF SARS-COV-2 INFECTION IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES IN ARGENTINA: DATA FROM THE SAR-COVID REGISTRY

Background

In Argentina we have witnessed two COVID 19 waves between 2020 and 2021. The first wave occurred during the spring of 2020 and it was related to the wild type of the virus, the second occurred during the fall/winter of 2021 when the gamma variant showed a clear predominance. During the first wave, patient with rheumatic diseases showed a higher frequency of hospitalization and mortality (4% vs 0.26%) when compared to the general population1; at that time, however, vaccination was not yet available.

Objectives

To compare sociodemographic and disease characteristics, course and outcomes of SARS-CoV-2 infection in patients with immune-mediated/autoinflammatory diseases (IMADs) during the first and second waves in Argentina.

Methods

SAR-COVID is a national, multicenter, longitudinal and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had confirmed SARS-CoV-2 infection (RT-PCR or positive serology) were consecutively included since August 2020. For the purpose of this report, only patients with IMADs who had SARS-CoV-2 infection during the first wave (defined as cases occurred between March 2020 and March 2021) and the second wave (cases occurred between April and August 2021) were examined. Sociodemographic characteristics, disease diagnosis and activity, comorbidities, immunosuppressive treatment and COVID 19 clinical characteristics, complications and outcomes: hospitalization, intensive care unit (ICU) admission, use of mechanical ventilation and death were compared among groups. Descriptive statistical analysis was performed. Variables were compared with Chi squared test and Student T test or Mann Whitney test. Multivariable logistic regression models with forward and backward selection method, using hospitalization, ICU admission and death as dependent variables were carried out.

Results

A total of 1777 patients were included, 1342 from the first wave and 435 of the second one. Patients had a mean (SD) age of 50.7 (14.2) years and 81% were female. Both groups of patients were similar in terms of socio-demographic features, disease diagnosis, disease activity, the use of glucocorticoids ≥ 10 mg/day and the immunosuppressive drugs (Table 1 below). Patients infected during the first wave have higher frequency of comorbidities (49% vs 41%; p= 0.004). Hospitalizations due to COVID 19 (31% vs 20%; p <0.001) and ICU admissions (9% vs 5%; p= 0.009) were higher during the first wave. No differences in the use of mechanical ventilation (16% vs 16%; p= 0.97) nor in the mortality rate (5% vs 4%; p= 0.41) were observed. In the multivariable analysis, after adjusting for demographics, clinical features and immunosuppressive treatment, patients infected during the second wave were 40% less likely to be hospitalized (OR= 0.6, IC95% 0.4-0.8) and to be admitted to the ICU (OR= 0.6, IC95% 0.3-0.9).

Table 1.Variable (% or Mean – SD)First wave(n=1342)Second wave(n=435)p ValueFemale gender81800.7Age (years)51.0 (14.5)50.0 (13.3)0.2Disease diagnosis Rheumatoid arthritis46461 Ankylosing spondylitis10110.8 Systemic lupus erythematosus171850.9 Systemic Scleroderma551 Sjögren´s syndrome650.7 Inflammatory myopathies330.5 Vasculitis430.4Disease activity High430.5Use of immune modulatorsDMARDcs53560.2DMARDts460.1DMARDb82821Use of glucocorticoids ≥10 mg12120.9Comorbidities49410.004

Conclusion

The impact of COVID 19 in Argentina, in terms of mortality in patients with IMADs was still higher compared to the general population during the second wave. However, the frequency of hospitalizations and ICU admissions was lower. These findings could be explained by the introduction of the SARS COV 2 vaccination and, probably, by the cumulative knowledge and management improvement of this infection among physicians.

References

[1]Isnardi CA et al. Epidemiology and outcomes of patients with rheumatic diseases and SARS-COV-2 infection: data from the argentinean SAR-COVID Registry. Ann Rheum Dis, 2021, suppl 1, 887.

Disclosure of Interests

None declared

POS0707 POTENTIAL USE OF BELIMUMAB IN LUPUS PATIENTS FROM ARGENTINE COHORT ACCORDING DISEASE ACTIVITY STATE

Background

The goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.

Objectives

To describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).

Methods

We evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.

Results

Overall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.

Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p <0.001) and higher use of immunosuppressant therapy (p <0.001). There was no difference regarding biologic treatment (RTX p= 0.547 and Belimumab p= 0.08). This group had higher proportion of hospital admissions and severe infections (p<0.001, respectively).

Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).

Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).

Conclusion

A high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.

References

[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).

[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.

[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.

[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.

[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032

Disclosure of Interests

Rosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant

African Swine Fever Virus (ASFV) Indirect ELISA Test Based on the Use of the Soluble Cytoplasmic Semi- purified Antigen (ASFV CP-Ag)

The present chapter describes a simple and economic indirect enzyme immunoassay (ELISA ) for African swine fever virus (ASFV) antibody detection based on the use of the soluble cytoplasmic fraction of ASFV-infected monkey stable cells (MS). The soluble antigen proteins of ASFV-infected cells are separated by sucrose precipitation centrifugation, and the supernatant above the sucrose layer is used as an ELISA antigen. The test serum sample reacts with the cytoplasmic soluble fraction, and antibodies are detected using a protein A-peroxidase conjugate. This crude antigen is currently recommended as a test reagent in screening and diagnostic tests by the World Organization for Animal Health (OIE).

Effects of Drought on Mortality in Macro Urban Areas of Brazil Between 2000 and 2019

A significant fraction of Brazil's population has been exposed to drought in recent years, a situation that is expected to worsen in frequency and intensity due to climate change. This constitutes a current key environmental health concern, especially in densely urban areas such as several big cities and suburbs. For the first time, a comprehensive assessment of the short-term drought effects on weekly non-external, circulatory, and respiratory mortality was conducted in 13 major Brazilian macro-urban areas across 2000-2019. We applied quasi-Poisson regression models adjusted by temperature to explore the association between drought (defined by the Standardized Precipitation-Evapotranspiration Index) and the different mortality causes by location, sex, and age groups. We next conducted multivariate meta-analytical models separated by cause and population groups to pool individual estimates. Impact measures were expressed as the attributable fractions among the exposed population, from the relative risks (RRs). Overall, a positive association between drought exposure and mortality was evidenced in the total population, with RRs varying from 1.003 [95% CI: 0.999-1.007] to 1.010 [0.996-1.025] for non-external mortality related to moderate and extreme drought conditions, from 1.002 [0.997-1.007] to 1.008 [0.991-1.026] for circulatory mortality, and from 1.004 [0.995-1.013] to 1.013 [0.983-1.044] for respiratory mortality. Females, children, and the elderly population were the most affected groups, for whom a robust positive association was found. The study also revealed high heterogeneity between locations. We suggest that policies and action plans should pay special attention to vulnerable populations to promote efficient measures to reduce vulnerability and risks associated with droughts.

Indirect Immunoperoxidase Test (IPT) for Detection of Antibodies Against African Swine Fever Virus (ASFV) on African Green Monkey Cell Lines (Vero, MS)

The immunoperoxidase technique (IPT) is an immunocytochemistry technique on fixed infected cells to determine the antibody-antigen complex formation through the action of the peroxidase enzyme. In this procedure, African green monkey established cell lines, such as Vero or MS, are infected with African swine fever virus (ASFV)-adapted isolates to these cell cultures. The infected cells are fixed and then used as antigens to determine the presence of the specific antibodies against ASFV in samples of swine origin. IPT has many advantages for the serological diagnosis of ASF. Firstly, IPT has a higher sensitivity than ELISA or immunoblot assay (IB) for the detection of antibodies against ASFV. Secondly, it has greater versatility to analyze any type of clinical sample of porcine origin and to conduct research studies on the epidemiological situation, through the presence of antibody titers in exudates from organs and tissues. Thirdly, the preparation of IPT plates with cells infected with ASFV is simple, although laborious, that can be stored for a long time and allow the analysis of a large number of samples.

POS1188 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES: COMPARISON OF DATA FROM THE ARGENTINE REGISTRY (SAR-COVID), WITH THE LATIN AMERICAN AND GLOBAL REGISTRY (GLOBAL RHEUMATOLOGY ALLIANCE)

Background:

SARS CoV-2 infection has recently burst onto the global scene, and the knowledge of the course of this infection in patients with rheumatic diseases receiving immunomodulatory treatment is still insufficient. The Argentine Society of Rheumatology (SAR) designed a national registry called SAR-COVID in order to get to assess our reality.

Objectives:

To identify the particular characteristics of patients with rheumatic diseases and COVID-19 in Argentina (SAR-COVID Registry), and to compare them with the data reported at the Latin American and Global level (Global International Alliance Rheum-COVID Registry).

Methods:

A national, multicenter, prospective and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or serology, were included between August 13, 2020 and January 17, 2021. Demographic data, underlying rheumatic disease (activity of the disease, current treatment), comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as received treatments (pharmacological, oxygen therapy / ventilatory support) and outcomes (hospitalization, mortality) were recorded. The characteristics of the included patients were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher’s test, according to the type of variable.

Results:

Four hundred sixty-five patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women (79.6%, 73% and 71% respectively), with a mean age of 50.2 (SD 15.3), 53.5 (DE 15.6) and 55.8 (15.5), years respectively. The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (43.9%, 35%, and 39%) and systemic lupus erythematosus (16.1%, 22%, and 14%) (Table 1).

In Argentina, fewer patients received specific pharmacological treatment for COVID-19 (40.9%, 68% and 43% respectively, p <0.0001), and there was a lower requirement of NIMV / IMV (Non-Invasive Mechanical Ventilation/Invasive Mechanical Ventilation) than in the rest of Latin America and the world (10.5% vs 31% vs 13%, p <0.0001).

Hospitalization was lower in Argentina than in the rest of Latin America (37.4% vs 61% p 0.0002) and of the world (37.4% vs 45% p 0.0123), and mortality was numerically lower in Argentina, but without statistically significant differences between the three groups (6.9%, 12% and 11%; p 0.6311). Most of the patients, (86.9%) did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, p <0.0001) (Graph 1).

Conclusion:

The patients with rheumatic diseases and SARS-CoV-2 infection reported in this argentinian registry received less specific pharmacological treatment for COVID-19, presented fewer complications and required less ventilatory support, than those reported in the Latinoamerican and Global registry. However, no statistically significant differences were observed in terms of mortality.

Graph 1.

Main outcomes and evolution of patients with rheumatic disease and COVID-19.

References:

[1]Stokes, Erin K, Zambrano, Laura D, Anderson, Kayla N, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep; 69(24): 759-765, 2020 Jun 19.

[2]Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm síndromes and immunosuppression. Lancet 2020;395:1033–4.

[3]Gianfrancesco M, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866.

[4]Manuel F. Ugarte-Gil, et al. Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America. Global Rheumatology. Septiembre 2020.

Disclosure of Interests:

Alvaro Andres Reyes Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Gelsomina Alle Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Tanten Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Marina Scolnik Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Enrique Soriano Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Berbotto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Maria Haye Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, María Julieta Gamba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Nieto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Mercedes García Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Veronica Savio Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana Gonzalez Lucero Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Paula Alba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Lorena Takashima Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, FABIAN RISUEÑO Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana CASALLA Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Natalia Cucchiaro Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Ana Bertoli Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Sabrina POrta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carla Maldini Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Gallo Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Cecilia Goizueta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Eugenia Picco Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Quintana Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Karen Roberts Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carolina Ayelen Isnardi Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Pons-Estel Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”

POS0933 TREATMENT ACCESS AND ADHERENCE DURING SOCIAL PREVENTIVE AND MANDATORY ISOLATION IN ARGENTINIAN PATIENTS WITH SPONDYLARTHRITIS

Background:

Access to high-cost treatments is especially limited in low-resource countries. This issue is becoming stronger today given the health and economic crisis caused by the SARS-CoV2 pandemic. There are no reports in our country on limitations to access and adherence to treatment in patients with Spondyloarthritis (SpA) during social preventive and mandatory isolation.

Objectives:

Evaluate access and adherence to treatment in patients with Spondyloarthritis during social preventive and mandatory isolation.

Methods:

Patients with axial spondyloarthritis (axSpA) radiological (r-axSpA), non-radiological (nr-axSpA) and peripheral spondyloarthritis (pSpA), according to ASAS criteria and psoriatic arthritis (PsA) according to CASPAR criteria, were included. Sociodemographic data, comorbidities, disease activity and treatments were collected at baseline. Data on treatment discontinuation, medical attention for suspected COVID-19 disease, RT-qPCR for SARS-CoV-2 detection and outcome of COVID-19 disease were collected from April to September 2020. Numerical variables were summarized as means and standard deviations (SD) or as medians and interquartiles 25-75 (IQ 25-75).

Results:

320 patients were included, 55% were male, with a mean age of 50 years (SD 13), 21.6% had diagnosis of r-axSpA, 6.9% nr-axSpA, 6.9% pSpA, and 64.7% PsA. Disease duration was 11 (IQ 5-16) years and activity parameters were as follow: BASDAI 3.65 (SD 3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). 14 (4.4%) patients with COVID-19 disease were reported, 10 were confirmed by positive RT-qPCR and 4 by symptoms and history of close contact with SARS patients. 4 (28.6%) received anti TNF (3 adalimumab, 1 certolizumab), 4 (28.6%) anti IL17 (3 secukinumab and 1 ixekizumab), 8 (57%) methotrexate (MTX) and 2 (14%) leflunomide (LF). Among the 320 patients included, 59 (18.4%) discontinued at least one treatment during follow-up. The discontinued medications were: adalimumab (16), MTX (15), secukinumab (9), etanercept (6), certolizumab(4), ustekinumab (3), NSAIDs (2), apremilast (1), golimumab (1), ixekuzumab (1), LF (1), MTX plus LF (1). The main reason for treatment discontinuation was drug shortage: 36 (62%), followed by patient’s decision: 12 (21%) and medical indication: 11 (17%). Of the 36 patients who discontinued due to shortage, 11 received adalimumab, 8 secukinumab, 5 MTX, 3 etanercept, 3 certolizumab, 3 ustekinumab, 2 NSAIDs and 1 golimumab.

Conclusion:

In our Argentinian cohort of patients with SpA, drug shortage was the main reason for treatment discontinuation. The SARS-CoV2 pandemic exposed limitations to access to treatment for patients with SpA.

Disclosure of Interests:

None declared

AB0342 OBSTETRIC AND THROMBOTIC ANTIPHOSPHOLIPID SYNDROME: ARE THEY DIFFERENT ENTITIES?

Background:

Several studies showed two main clinical phenotypes of antiphospholipid syndrome (APS): thrombotic (TAPS) and obstetric APS (OAPS). Although they have the same autoantibody profile, one of them developed thrombosis and other one obstetric morbidity.

Objectives:

To study clinical, demographic and antibody profile in patients with TAPS and OAPS.

Methods:

we retrospectively evaluated TAPS and OAPS patients who were included in Argentine Antiphospholipid antibodies registry. We studied clinical, demographic and antibody profile in both groups.

Results:

238 patients were included in the registry. 201 (84.81%) of them were female. 122 (60.69 %) of them fullfilled APS Sydney classification criteria, 47 (38.52%) TAPS and 52 (42.62%) OAPS. 23 (18.85%) patients had both thrombotic and obstetric events so they were excluded in this analysis.

Arterial Hypertension (HBP) and Hyperlipidemia were more frequent in TAPS versus OAPS. Older age was found in TAPS as well as in association with Systemic lupus erythematosus (SLE). There was no difference in antibody profile between the 2 groups, and the Global Antiphospholipid Syndrome Score (aGAPSS) was higher in TAPS than OAPS.

18 (38.3%) of TAPS patients had at least 1 pregnancy. Mean number of pregnancies of TAPS was 2.5 (1.10) and 3.84 (1.86) in OAPS. Thrombotic events were not found in TAPS during pregnancy and puerperium. HBP and gestational diabetes (GD) and other pregnancy related comorbidities were found in TAPS.

OAPS (n=52)TAPS (n=47)POAPS(n=52)TAPS(n=18)SLE, n (%)11 (21.2)28 (59.6)0.0002N% (DE)N % (DE)aGAPSS, mean (RIQ)4 (5)8 (5)<0.0001Abortions (<10 weeks)3338.4 (36.2)826.5 (35.3)Age, mean (DE)39.3 (6.24)43.1 (13.5)<0.0001Live Birth3633.5 (28.1)1672.2 (34.7)HBP, n (%)5 (9.6)15 (31.9)0.0121 >37 weeks2116.4 (2.38)1661.1 (31.7)Hyperlipidemia, n (%)4 (7.7)12(25.5)0.0267Prematurity <37 >34 weeks118.76 (1.97)0-GD, n (%)3(5.8)2(4.3)0.9999Prematurity <34 weeks96.37 (1.49)11.39 (5.89)Obesity, n (%)8 (15.4)4 (8.5)0.2912Pre eclampsia >34-<37 weeks10.490 (0.0350)24.63 (0.138)Smoking, n (%)11 (21.1)13 (27.6)0.4019Placental Hematoma31.86 (8.18)12.78 (11.8)Sedentary lifestyle, n (%)16 (30.8)17 (36.2)0.8486Abruptio Placentae21.96 (9.80)24.17 (12.9)Triple Positivity59.648.50.8323 Normal delivery2017.8 (27.9)1447.7 (33.9)Double Positivity11.936.4Cesarean section2217.2 (21.6)211.1 (32.3)Simple Positivity2938.51940.4Urgent Cesarean section139.80 (20.3)412.5 (24.6)GD21.37 (7.49)12.78 (11.8)HBP63.46 (10.3)310.2 (26.3)

Conclusion:

Antibody profile was similar in TAPS and OAPS. However, clinical manifestations and cardiovascular risk were different. These results should be evaluated in prospective studies.

Disclosure of Interests:

None declared

AB0689 INCIDENCE AND SEVERITY OF COVID-19 IN PATIENTS WITH SPONDYLOARTHRITIS IN ARGENTINA: EXPERIENCE IN A COUNTRY WITH STRICT ISOLATION

Background:

There are limited data worldwide on the behavior of SARSCOV2 in patients with Spondyloarthritis (SpA).

Objectives:

To describe the incidence and severity of COVID-19 disease in patients with SpA in Argentina.

Methods:

Patients with axial spondyloarthritis (AxSpA) radiological (EA) and non-radiological (AxSpA-nr) and peripheral spondyloarthritis (according to ASAS criteria) and psoriatic arthritis (PsA) (according to CASPAR criteria) were included. Sociodemographic data, comorbidities, disease activity and treatments were collected at baseline. The patients were followed up by phone or in person monthly. Data were collected from 1/4/2020 to 9/20/2020. Descriptive statistics were performed with mean and standard deviation (SD) and median and quartile 25-75 according to distribution, and the cumulative incidence (AI) of the disease was calculated.

Results:

320 patients were included, of which 55% were male, with a mean age of 50 SD 13, 21.6% had a diagnosis of AS, 6.9% SpAax-nr, 6.9% SpAp, and 64.7% PsA, BASDAI 3.65 (3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). Fourteen patients with a diagnosis of COVID-19 (4.4%) were reported, of which 10 diagnoses were by positive PCR and 4 by positive symptoms and close contact. 93% (13) of the cases were patients from the Province of Buenos and CABA and 1 patient from Santiago del Estero. The total IA for the country was 0.04. Of the 14 patients with COVID-19, 7 (50%) were men, 4 had a diagnosis of AS, 1 of SpAax-nr, 9 (64.3%) PsA. 100% live in urban areas, 2 (14%) have hypertension, 1 (7%) DBT, 1 (7%) COPD, 2 (14%) depression or anxiety, 11(97%) had received influenza vaccine 2020, 13 (93%), Antineumoccic 23, 14 (100%) Antineumoccic 13. Regarding the treatments: 4 (28.6%) were in treatment with anti TNF (3 with Adalimumab, 1 with certolizumab pegol), 4 (28.6%) with Anti IL17 (3 with Secukinumab, 1 with Ixekizumab), 8 (57%) with methotrexate and 2 (14%) with Leflunomide. Place of follow-up of the disease: 10 (71.4%) at home, 3 (21.4%) in the common room and 1 (7) in the intensive care unit. Treatments received for COVID-19: 1 (7%) antiretroviral, 1 (7%) antibiotic and 1 (7%) steroids. None of the patients died from COVID-19.

Conclusion:

An incidence of 4.4% of COVID-19 was found in this population with SpA and most of the patiend had mild symptoms and no deaths were reported.

Disclosure of Interests:

Victoria Martire: None declared, Carla Airoldi: None declared, María Soledad Gálvez Elkin: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Noel Callahuara: None declared, Vanesa Duarte Employee of: Novartis, José Alcivar Navarrete: None declared, Emilio Buschiazzo: None declared, Etel Saturansky: None declared, María Julieta Gamba: None declared, Paula Girard Bosch: None declared, David Zelaya: None declared, Rodrigo Garcia Salinas: None declared, María Alejandra Medina: None declared, Micaela Cosatti Employee of: Jannsen, SANTIAGO SCARAFIA: None declared, Maria Laura Acosta Felquer: None declared, Vanesa Cosentino: None declared, Fernando Sommerfleck: None declared, Ramiro Luis: None declared, Gisela Paola Pendon: None declared, Rodrigo Águila Maldonado: None declared, Silvina Nasi: None declared, Romina Nieto: None declared, Leila Abbas: None declared, Diego Vila: None declared, Eduardo Kerzberg: None declared, Mariana Benegas: None declared

Protein retention, growth performance and carcass traits of individually housed immunocastrated male- and female- and surgically castrated male Iberian pigs fed diets of increasing amino acid concentration

Immunocastration (IC, vaccination against gonadotropin releasing hormone (GnRH)) is one alternative to surgical castration (SC) for preventing sexual development and boar taint in male pigs. A temporal increase in performance has been described for IC pigs before the second vaccination against GnRH. The objective of this work was to assess the effects of IC on Iberian male and female pigs (fed diets of increasing CP content) on performance, nitrogen retention (NR) and digestibility, and carcass traits. Fifty-four pure Iberian pigs individually housed were allocated to a 3 × 3 factorial arrangement with three sex groups (IC males, IC females and SC males), three diets (153, 137 and 119 g CP/kg DM; 14 MJ metabolisable energy/kg DM) and six pigs per treatment combination. Pigs were vaccinated at 18 weeks of age (40 kg BW) and seven weeks later (70-80 kg BW) and fed at 0.9 × ad libitum on BW basis. Two digestibility and nitrogen balance assays were performed before and after the second vaccination, respectively. Pigs were slaughtered at 105 kg BW. Before the second vaccination, Iberian IC males showed higher growth rate (g/day), feed efficiency, NR (g/day) and efficiency of NR than the other groups (P < 0.001). The NR and efficiency of NR was 40% greater in IC v. SC males (P < 0.001). After the second vaccination, no differences in performance between sex groups were detected (P > 0.05). Growth rate and feed efficiency were higher in IC males than in the other groups for the whole experimental period (from the first vaccination to slaughter; P < 0.001). After the second vaccination, differences among sex groups in NR and the efficiency of NR disappeared (P > 0.05). NR efficiency was 0.177 on average. No significant effects of dietary CP were detected on performance. The NR was greater in pigs fed the 153 CP diet (17 to 37%; P > 0.05). Lean components of carcass (sirloin, loin and butt lean) were greater in IC males than in the other groups (0.001 < P < 0.05). There were no significant sex group×dietary CP interactions. Iberian IC males grew at higher rate, deposited more protein, and more efficiently, than Iberian SC males before the second vaccination against GnRH. Iberian IC females showed similar growth performance to SC males and intermediate protein deposition efficiency between IC and SC males. Despite the higher growth performance, protein deposition rate, and efficiency of protein deposition of IC males v. SC males, no significant differences in amino acid requirements were detected between them.

Drought effects on specific-cause mortality in Lisbon from 1983 to 2016: Risks assessment by gender and age groups

Portugal (Southwestern Europe) experiences a high incidence of dry hazards such as drought, a phenomenon that entails a notable burden of morbidity and mortality worldwide. For the first time in the Lisbon district, a time-series study was conducted to evaluate the impact of drought measured by the Standardised Precipitation Index (SPI) and Standardised Precipitation-Evapotranspiration Index (SPEI) on the daily natural, circulatory, and respiratory mortality from 1983 to 2016. An assessment by gender and adult age population groups (45-64, 65-74, ≥75 years old) was included. To estimate the relative risks and attributable risks, generalised linear models with a Poisson link were used. Additionally, the influence of heatwaves and atmospheric pollution for the period from 2007 to 2016 (available period for pollution data) was considered. The main findings indicate statistically significant associations between drought conditions and all analysed causes of mortality. Moreover, SPEI shows an improved capability to reflect the different risks. People in the 45-64 year-old group did not indicate any significant influence in any of the cases, whereas the oldest groups had the highest risk. The drought effects on mortality among the population varied across the different study periods, and in general, the men population was affected more than the women population (except for the SPEI and circulatory mortality during the long study period). The short-term influence of droughts on mortality could be explained primarily by the effect of heatwaves and pollution; however, when both gender and age were considered in the Poisson models, the effect of drought also remained statistically significant when all climatic phenomena were included for specific groups of the total population and men. This type of study facilitates a better understanding of the population at risk and allows the development of more effective measures to mitigate the drought effects on the population.

AB0646 IS IT FEASIBLE TO ACHIEVE RECOMMENDED THERAPEUTICAL TARGET IN PATIENTS WITH AXIAL SPONDYLARTHRITIS IN CLINICAL PRACTICE? DATA FROM THE SpA-Paz COHORT

Background:

Current ASAS/EULAR recommendations for the management of patients with axial spondylarthritis (axSpA) establish that the therapeutic goal to achieve in clinical practice is remission, defined as the absence of both clinical and laboratory disease activity evaluated by BASDAI&CRP or preferably ASDAS and if this is not possible, low disease activity may be an alternative. Recently, ASDAS nomenclature has been modified, calling now low disease activity to what was previously called moderate activity. To this day we do not know if this target is feasible in clinical practice.

Objectives:

To analyze the frequency of patients with axSpA achieving maintained remission (R) or low disease activity (LDA) after receiving biological therapy. Secondary objectives included: i) to assess if the activity index used influences the frequency of maintained R/LDA, ii) analyze the prognostic factors for achieving maintained R/LDA.

Methods:

An observational, longitudinal study of a prospective cohort (SpA-Paz) including all patients with axSpA who initiated their first biological treatment between the years 2003-2017. Demographic, clinical and analytical data were collected at the beginning of treatment and clinical disease activity measured by BASDAI&CRP and ASDAS every 6 months for 2 years. Maintained R was defined as (BASDAI<2 & normal CRP and/or ASDAS <1.3) and maintained LDA (BASDAI <4 & normal CRP and/or ASDAS <2.1) on at least 3 consecutive visits. Statistical analysis: i) measures of central tendency and dispersion for quantitative variables and frequencies for qualitative variables; ii) univariate and multivariate analysis of binomial logistic regression model and calculation of OR and 95% CI.

Results:

Out of 186 patients with axSpA who started treatment during the study period, 63% were men with a mean age of 54 ± 14.1 years. 75.3% of the patients had radiographic axSpA and 74.7% were HLA-B27 positive. Other baseline characteristics (not shown due to space restrictions). Overall, 80% of the patients achieved ASDAS R/LDA (R36%/LDA44%) in at least one of the visits after 2 years of follow-up, but only 40% (R27%/LDA13%) fulfilled the maintained ASDAS R/LDA state. On the other hand, 73% of patients were classified as BASDAI&CRP R/LDA (R31%/LDA42%) in at least one of the visits, but only 31% (R21%/LDA10%) obtained the maintained BASDAI&CRP R/LDA state. In the multivariate analysis, we observed an independent statistically significant association with male sex (OR=3.19; 95% CI=1.46-6.99), younger age at the beginning of the biological treatment (OR=0.97; 95% CI=0.95-0.99) and the use of methotrexate (OR=3.07; 95% CI=1.39-6.78) in patients who achieved maintained BASDAI&CRP R/LDA and with male sex (OR=4.01; 95% CI=1.83-8.77), younger age at the beginning of the biological therapy (OR=0.96; 95% CI=0.94-0.99) and HLA B27 presence (OR=4.30; 95% CI=1.68-11.01) in patients who achieved maintained ASDAS R/LDA.

Conclusion:

Although the majority of patients with axSpA who initiate biological therapy achieve the recommended therapeutic goal in the first two years of treatment, the percentage of patients who manage to maintain the R/LDA status is limited. In our study, maintained R was more frequent than maintained LDA, being somewhat higher when measured by ASDAS. This fact may suggest that patients who achieve maintained R have a greater inhibition of their inflammatory activity and, therefore, it remains in time. Male sex and younger age at the beginning of the biological therapy were the main baseline predictors for achieving maintained R/LDA.

Graphics:

Disclosure of Interests:

Karen Nathalie Franco Gomez: None declared, Chamaida Plasencia: None declared, Marta Novella-Navarro: None declared, Diego Benavent: None declared, Patricia Bogas: None declared, Romina Nieto: None declared, Irene Monjo: None declared, Laura Nuño: None declared, Alejandro Villalva: None declared, Diana Peiteado Grant/research support from: AbbVie, Lilly, MSD, and Roche, Speakers bureau: AbbVie, Roche, and MSD, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

OP0266-HPR WORK PRODUCTIVITY IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS

Background:

Work disability is an important outcome in the treatment of Spondyloarthritis (SpA) since this disease affects people in the most productive stage of life.

Objectives:

The aim of this study is to investigate the working status and the factors associated with work productivity loss (WPL) in patients with axial (axSpA) and peripheral SpA (pSpA).

Methods:

Patients with SpA according to ASAS criteria were included consecutively in this multicentric cross-sectional study. Evaluation of activity through a visual analogue scale (0-100), enthesitis (LEI), functional capacity (HAQ and BASFI), disease activity (DAS28 and BASDAI), health status (ASAS Health Index) and quality of life (ASQoL) were calculated. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was recorded. The Work Productivity and Activity Impairment Spondyloarthritis (WPAI SpA) questionnaire was used to assess work productivity.

Spearman’s correlation coefficient (ρ) was used to assess the correlation with the percentage of WPL.

Results:

274 patients with SpA were recruited, 129 (47.1%) with axSpA and 145 (52.9%) with pSpA. 56.6% were women and 33.2% stopped working due to the underlying disease.

Among axSpA patients, 70% were radiographic and 30% non radiographic, mean age 45.5 (SD14) yrs, median disease duration 72 (IQR 36-144) months and diagnosis delay 20 (IQR 11-70) months. 45.7% were employed, median hours worked in the last week was 40 (IQR 25-45), median scores for absenteeism was 0% (IQR 0-2), presenteeism 30% (IQR 5-40), WPL 30% (IQR 10-52.5) and activity impairment 30% (IQR 10-50). A positive correlation was found between WPL and the following variables: HAQ (ρ:0.40, p<0.001), BASDAI (ρ:0.48, p<0.001), ASDAS (ρ:0.46, p<0.001), BASFI (ρ:0.59, p<0.001), ASQoL (ρ:0.60, p<0.0001), LEI (ρ:0.31, p:0.02) and ASAS health index (ρ:0.54, p<0.001).

Among pSpA patients, mean age was 52.3 (SD13) yrs, median disease duration 60 (IQR 14-120) months and diagnosis delay 12 (IQR 3-24) months. 46.9% were employed, median hrs worked in the last week was 30 (IQR 14-40), absenteeism 0% (IQR 0-7), presenteeism 30% (IQR 2.5-58), WPL 30% (IQR 5-52) and activity impairment 20% (IQR 0-40). A positive correlation was found between WPL and: HAQ (ρ:0.49, p<0.001), ASDAS (ρ:0.58, p<0.001), ASQoL (ρ:0.57, p<0.0001), DAS28 (ρ:0.50, p<0.001), LEI (ρ:0.36, p:0.04) and ASAS health index (ρ:0.52, p<0.001). No statistically significant differences were found in absenteeism, presenteeism, WPL and activity impairment between axSpA and pSpA.

Conclusion:

Our study showed that WPL in this national cohort was 30% in both groups of patients and is associated with disease activity, enthesitis, health status, quality of life and functional ability.

Disclosure of Interests:

None declared

FRI0318 REAL-LIFE EVALUATION OF HEALTH STATUS USING ASAS HEALTH INDEX ON PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS IN ARGENTINA

Background:

The questionnaire “Assessment of Spondyloarthritis international Society Health Index” (ASAS HI) was developed to measure functionality and health status in patients with spondyloarthritis (SpA)1.

Objectives:

To describe the state of health measured by ASAS HI in Argentinian patients with SpA and to evaluate factors associated with poor health.

Methods:

Analytical, cross sectional, multicenter study. Patients with SpA according to ASAS criteria were consecutively included from 15 Argentinian centers. Statistical analysis: frequencies and percentages (%), mean and standard deviation (SD) or median and interquartile range (IQR). Bivariate analysis and logistic regression were performed to evaluate the factors associated with poor health status (ASAS HI > or equal to 12). Correlation with other parameters was evaluated by Spearman correlation.

Results:

We included 274 patients with a mean age 49 (SD 14) years, median disease duration 60 month (IQR 24-135), 155 (56.6%) of patients are male, 47% (n:129) axial SpA and 52.9 (n:145) peripheral SpA. One hundred and nine patients (43.4%) presented good health status, 117 (42.7%) had moderate state of health and 38 (13.9%) had poor health. In the bivariate analyses patients with ASAS health index greater than or equal to 12 (poor status), were older [54 (11) vs 48 (14), p: 0.01], had higher disease duration [11(IQR 57-192) vs 60 (IQR 24-120), p: 0.02], more hypertension [20 (52.6%) vs 67 (28.4%), p:0.004], more diabetes mellitus [10 (26.3%) vs 22(9.3%), p: 0.006], depression [6 (15.8%) vs 10 (4.2%), p:0.013], anxiety [8 (21%) vs (22 (9.3%),p:0.046], less years of education [9.8 (SD 3.5) vs 13 (SD 10), p:0.001], higher ASQol [12.6 (SD 4.6) vs 5.7 (SD4), p < 0.001], BASFI [7(SD2) vs 4(SD6), p: 0.001], DAS28 [4.71 (SD3.2) vs 2.8 (SD1),p: <0.001]. In the multivariate analyses the following variables were independently associated with poor health status: duration of disease, ASQol and DAS28. ASAS HI showed positive correlation with the following parameters: BASDAI (r:0.67, p< 0.001), HAQ (r:0.54, p< 0.001), ASDAS (r:0.67, p< 0.001), ASQol (r:0.80, p< 0.001), BASFI (r:0.72, p< 0.001) and DAS28 (0.56, p< 0.001).

Conclusion:

Poor health status is associated with disease activity, poor quality of life and functional activity. ASAS HI has a good correlation with other parameters to evaluate SpA, reinforcing the construct validity of this new tool.

References:

[1]Kiltz U,et al.Ann Rheum Dis2018;0:1–7.

Disclosure of Interests:

None declared

Short-term effects of drought on daily mortality in Spain from 2000 to 2009

Spain is a country of southern Europe that is prone to drought, and it is likely that this type of hydrological extreme will become substantially more frequent and intense in the 21st century, which could lead to greater health risks if adequate adaptive measures are not taken. For the first time, we calculated the relative risks (RRs) of daily natural (ICD10: A00-R99), circulatory (ICD10: I00-I99), and respiratory (ICD: J00-J99) mortality associated with drought events in each province of Spain from 2000 to 2009. For this purpose, we compared the performance of the Standardized Precipitation Index (SPI) and Standardized Precipitation- Evapotranspiration Index (SPEI) obtained at 1 month of accumulation (denoted as SPI-1/SPEI-1) to estimate the short-term risks of droughts on daily mortality using generalised linear models. Attributable risks were calculated from the RR data. The main findings of this study revealed statistically significant associations between the different causes of daily mortality and drought events for the different provinces of Spain, and clear spatial heterogeneity was observed across the country. Western Spain (northwest to southwest) was the region most affected, in contrast to northern and eastern Spain, and daily respiratory mortality was the group most strongly linked to the incidence of drought conditions. Moreover, for a considerable number of provinces, the effect of SPI-1 and SPEI-1 largely reflected the impact of atmospheric pollution and/or heatwaves; however, for other regions, the effect of drought conditions on daily mortality remained when these different climatic events were controlled in Poisson models. When the performances of the SPEI and SPI were compared to identify and estimate the risks of drought on daily mortality, the results were very similar, although there were slight differences in the specific causes of daily mortality.

Effects on daily mortality of droughts in Galicia (NW Spain) from 1983 to 2013

Climate change scenarios indicate an increase in the intensity and frequency of droughts in several regions of the world in the 21st century, especially in Southern Europe, highlighting the threat to global health. For the first time, a time-series diagnostic study has been conducted regarding the impact of droughts in Galicia, a region in north-western Spain, on daily natural-cause mortality, daily circulatory-cause mortality, and daily respiratory-cause mortality, from 1983 to 2013. We analysed the drought periods over the area of interest using the daily Standardized Evapotranspiration-Precipitation Index (SPEI) and the daily Standardized Precipitation Index (SPI), obtained at various timescales (1, 3, 6, 9 months), to identify and classify the intensity of drought and non-drought periods. Generalized linear models with the Poisson regression link were used to calculate the Relative Risks (RRs) of different causes of mortality, and the percentage of Attributable Risk Mortality (%AR) was calculated based on RRs data. According to our findings, there were statistically significant (p < 0.05) associations between drought periods, measured by both the daily SPEI and SPI, and daily mortality in all provinces of Galicia (except Pontevedra) for different timescales. Furthermore, drought periods had a greater influence on daily mortality in the interior provinces of Galicia than in the coastal regions, with Lugo being the most affected. In short term, the effect of droughts (along with heatwaves) on daily mortality was observed in interior regions and was mainly explained by atmospheric pollution effect throughout 2000 to 2009 period in Ourense, being respiratory causes of mortality the group most strongly associated. The fact that droughts are likely to become increasingly frequent and intense in the context of climate change and the lack of studies that have considered the impact of droughts on specific causes of mortality make this type of analysis necessary.

Índices productivos y características de la canal de cerdos Ibéricos inmunocastrados o castrados quirúrgicamente y alimentados con dietas de diferente concentración proteica. Resultados preliminares

La inmunocastración ha resultado una estrategia útil en el cerdo para prevenir el olor sexual en la carne. En trabajos previos se indica que los cerdos inmunocastrados (IC) pueden presentar mejores índices productivos que los castrados quirúrgicamente (SC). Además de las ventajas en bienestar animal que conlleva esta práctica, la mejora en producción puede tener interés en razas como la Ibérica, con capacidad de crecimiento limitada. El objetivo de este estudio ha sido examinar los efectos de la inmunocastración sobre los índices productivos del cerdo Ibérico, el uso de la proteína en la dieta y las características de la canal, en animales alimentados con dietas de diferente concentración proteica. Se utilizaron 27 animales de tres sexos (machos IC, machos SC, y hembras IC) alimentados con 3 dietas isoenergéticas (160, 140 y 120 g PB/kg materia seca), con tres animales por cada combinación de tratamientos. Los animales se vacunaron contra la hormona liberadora de gonadotropina a los 4,3 (40 kg) y 6 meses de edad (70-80 kg). Los tratamientos se ofrecieron a los animales, que permanecieron alojados individualmente, desde los 40 a los 100 kg de peso. Se realizaron ensayos de digestibilidad y balance de N a los 50 y 90 kg de peso. A los 100 kg se sacrificaron los animales. Los resultados preliminares indican que los machos IC tuvieron un ritmo de crecimiento superior (803 vs 706 and 696 g/d, para machos IC, machos SC y hembras IC, respectivamente; P < 0.001) y mejores índices productivos que el resto de grupos (P < 0.01). Los machos IC presentaron mayor longitud de la canal y pesos relativos en la mayoría de los componentes magros de la canal, así como menor peso relativo de canal y panceta que el resto de grupos. No se apreciaron diferencias en los parámetros estudiados debidas a la concentración proteica de la dieta. Necesitamos profundizar en el posible papel que pueda jugar la inmunocastación en el crecimiento magro del cerdo Ibérico en futuros trabajos.

Bases nutricionales para la alimentación proteica del cerdo Ibérico puro

En este trabajo de revisión describimos los resultados obtenidos en una serie de experimentos realizados con el objetivo de evaluar la utilización de la proteína dietética por el cerdo Ibérico en distintas fases de su ciclo productivo. Se describen ensayos nutricionales basados en diseños dosis/respuesta, en los que se han empleado tratamientos isoenergéticos con distinta concentración de proteína –con idéntica composición en aminoácidos siguiendo el concepto de proteína ideal-, así como ensayos ensayos metabólicos comparativos con razas porcinas magras. Los resultados obtenidos indican que la capacidad de la raza Ibérica para depositar proteína corporal es limitada en comparación con la descrita para razas porcinas convencionales en etapas similares de crecimiento. Asimismo, sugieren la necesidad de utilizar dietas con concentración de proteína sensiblemente inferior a la utilizada para razas convencionales, de acuerdo a esta limitación metabólica del animal. Estudios de carácter básico han puesto de manifiesto algunas peculiaridades metabólicas que dan lugar a un crecimiento limitado en proteína y tejido magro. Resumimos la información obtenida en varios experimentos y aportamos recomendaciones sobre la concentración y composición de la proteína en las dietas destinadas a la alimentación del cerdo Ibérico puro, en distintas fases de su ciclo productivo. Un adecuado manejo nutricional, particularmente el aporte proteico, mejora la eficiencia de utilización de este nutriente y da lugar a beneficios de carácter ambiental, económico y de bienestar animal.

Similar effects of lysine deficiency in muscle biochemical characteristics of fatty and lean piglets

The main objective of this work was to investigate the effects of feeding Lys-deficient diets on muscle biochemical characteristics, particularly intramuscular fat concentration and fatty acid profile, in a fatty (Iberian) and a conventional pig genotype (Landrace × Large White [LDW]) maintained in identical experimental conditions. Performance and plasma metabolite changes were also monitored. Twenty-eight barrows of 10 kg initial BW, 14 of Iberian and 14 of LDW breed, were randomly assigned to each of 2 experimental diets in a 2 × 2 factorial arrangement (2 breeds × 2 diets). Seven pigs were allocated to each treatment combination. Diets (isonitrogenous and isoenergetic; 200 g CP/kg DM and 14.7 MJ ME) based on barley, corn, corn gluten meal, and soybean meal, with identical composition, except for their Lys content (10.9 g/kg for the diet adequate in Lys and 5.2 g/kg for the diet deficient in Lys), were assayed. Pigs were housed in individual 2 m pens and fed at 85% of ad libitum intake of the Iberian genotype, of greater intake capacity. Daily feed allowance was based on BW individually measured each week. At 25 kg BW, pigs were slaughtered by exsanguination after electrical stunning. Blood samples were taken and longissimus dorsi and biceps femoris muscles were rapidly dissected and stored frozen prior to analysis. Performance was reduced in both pig breeds when fed Lys-deficient diets, particularly in LDW pigs (breed × diet interaction, < 0.05). Intramuscular fat content increased in longissimus dorsi of Iberian ( < 0.05) and in biceps femoris of both pig genotypes ( < 0.01) when fed Lys-deficient diets. Oleic acid increased ( < 0.05) and PUFA acid decreased ( < 0.01) in longissiumus dorsi and biceps femoris of pigs of both genotypes fed Lys-deficient diets. The proportion of oxidative fibers ( < 0.001) and free carnitine content ( < 0.05) increased in longissimus dorsi of both pigs types fed Lys-deficient diets. Plasma creatinine was greater in LDW pigs compared with Iberian pigs ( < 0.01). Urea and total cholesterol increased in pigs consuming Lys-deficient diets ( < 0.01). The plasma free carnitine concentration was higher in Iberian pigs than in LDW pigs ( < 0.059). No changes in plasma carnitine status due to dietary Lys supply were detected. Feeding Lys-deficient diets could be a suitable strategy for increasing intramuscular fat content in fatty and lean pigs.

Effects of dietary protein-to-energy ratio on rate of growth, protein deposition and tissue composition of pure Iberian boars prior to extensive production

Thirty entire male Iberian (IB) pigs of 12 kg initial BW were used to study the effects of dietary protein-to-energy ratio on performance, body protein accretion, and tissue composition. Two nutritional regimes were supplied at 3 stages of growth (Phase I, from 12 to 30 kg BW; Phase II, from 30 to 45 kg BW; and Phase III, from 45 to 100 kg BW): the first regime (RefP/E) was formulated to provide optimum protein-to-energy ratios for castrated IB pigs at several stages of growth from 10 to 100 kg BW; the second (IncP/E), for which an overall increase of 2.5 g digestible protein/MJ ME was provided, would allow an increased potential for lean tissue growth presumably well above that expected for the entire male of an obese pig breed. The pigs were surgically castrated at 45 kg BW and slaughtered at about 100 kg BW. In Phases I and II, in which feed was provided ad libitum, no significant differences between dietary treatments in ADG (580 ± 10 and 740 ± 11 g, on average, respectively), G:F (0.475 ± 0.004 and 0.362 ± 0.005, on average, respectively), and gain:ME intake ratio (37.8 ± 0.4 and 26.1 ± 0.4 g/MJ, on average, respectively) were found ( > 0.05). After surgical castration, for the entire fattening period (Phase III), ADFI was fixed and highly restricted. A lower gain:ME intake ratio (14.0 vs. 15.1 g/MJ; < 0.01) was obtained when the diet with the highest digestible protein:ME ratio was offered (IncP/E). With this regime, body protein accretion significantly improved in the IB boar growing from 12 to 45 kg BW, irrespective of the stage of growth, although the amount of protein accreted was notably enhanced at the later stage (75 vs. 85 g/d in Phase I [ < 0.05] and 110.5 vs. 151 g/d in Phase II [ < 0.001]). However, the efficiency of utilization of dietary N remained unchanged irrespective of the diet fed ( > 0.05). In contrast, in the fattening stage, similar daily rates of N retention ( > 0.05) were found, in spite of the observed differences in digestible N intake ( < 0.001). We concluded that the protein (lysine) requirements of the IB boar growing from 12 to 30 kg BW and from 30 to 45 kg BW are met with the supply of 11.5 and 10.2 g digestible protein of ideal AA pattern/MJ ME (0.80 and 0.71 g digestible lysine/MJ ME), respectively. As surgical castration is programmed to be abandoned in European Union by 1 January 2018, this information will be important for the efficient production of the immunologically castrated IB pig, at the earlier stages of growth.

Prevalence and factors associated with nontuberculous mycobacteria in non-cystic fibrosis bronchiectasis: a multicenter observational study

Background

Data on the prevalence of and factors associated with nontuberculous mycobacteria (NTM) in patients with non–cystic fibrosis (CF) bronchiectasis are limited. Our aim was to determine the prevalence and factors associated with isolation of NTM in this population.

Methods

We performed a multicenter observational study of historical cohorts comprising consecutive patients with non-CF bronchiectasis and at least 2 sputum samples cultured for mycobacteria over a period of 5 years.

Results

The study population included 218 adult patients (61.9 % women) with a mean (SD) age of 55.7 (16) years and a mean (SD) of 5.1 (3.3) cultures/patient. NTM was isolated from sputum in 18 patients (8.3 %). Of these, 5 patients (28 %) met the American Thoracic Society criteria for NTM disease. Mycobacterium avium complex was the most frequently isolated microorganism (9 patients, 4.1 %). The variables independently associated with isolation of NTM were FVC ≥ 75 % predicted (OR, 4.84; 95 % CI 1.47 to 15.9; p < 0.05), age ≥ 50 years (OR, 4.74; 95 % CI 1.25 to 17.97; p < 0.05), and body mass index (BMI) ≤ 23 kg/m² (OR, 2.97; 95 % CI 1.03-8.58; p < 0.05). Patients with these three characteristics had a 40 % probability of having at least one isolation of NMT.

Conclusions

A significant number of patients with non-CF bronchiectasis are positive for the isolation of NTM. M. avium complex is the most frequently isolated mycobacteria. FVC ≥ 75 % predicted, age ≥ 50 years, and a BMI ≤ 23 kg/m² were independently associated with the presence of NTM in patients with non-CF bronchiectasis.

A Lagrangian approach for investigating anomalies in the moisture transport during drought episodes

The present work proposes a Lagrangian diagnostic scheme to investigate the anomalous moisture transport before, during, and after the occurrence of drought episodes. The Lagrangian approach proposed here uses the model FLEXPART integrated with the ERA-Interim data set and it has been successfully applied in previous studies concerning the climatological characterization of the sources and sinks of moisture in several regions around the world. The drought episodes will be identified and characterized through the SPEI index. The anomalies of the moisture sources for the area affected will be analyzed, as well as the impact of the droughts on the moisture transport from the area affected towards its climatological sinks (previous studies suggest that some heat wave episodes can be associated with anomalies in moisture transport). In other words, the methodology proposes to investigate the role of the area affected as a receptor/source of moisture during the drought episodes. As an example of applicability of the methodology, the severe drought episode over central U.S. in 2012 is analyzed. An analysis of the 2012 anomalies suggests that there was some reduction in the contribution from the local and continental climatological moisture sources for the central U.S. mainly from June to October. The period from July to October 2012 was also characterized by the reduction of the moisture transport from the drought area towards its climatological sinks located over northeastern North America. A better understanding not only of the transport of humidity, but also of the relationship between sources/sinks of moisture and of possible impacts generated by variations in the sources is crucial for a more accurate weather forecast, helping to minimize the consequences of the natural hazards.

Appropriateness of colonoscopy requests according to EPAGE-II in the Spanish region of Catalonia

BACKGROUND

In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia.

METHODS

Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy).

RESULTS

The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women.

CONCLUSIONS

Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC.

Experimental Transmission of African Swine Fever (ASF) Low Virulent Isolate NH/P68 by Surviving Pigs

African swine fever (ASF) has persisted in Eastern Europe since 2007, and two endemic zones have been identified in the central and southern parts of the Russian Federation. Moderate- to low-virulent ASF virus isolates are known to circulate in endemic ASF-affected regions. To improve our knowledge of virus transmission in animals recovered from ASF virus infection, an experimental in vivo study was carried out. Four domestic pigs were inoculated with the NH/P68 ASF virus, previously characterized to develop a chronic form of ASF. Two additional in-contact pigs were introduced at 72 days post-inoculation (dpi) in the same box for virus exposure. The inoculated pigs developed a mild form of the disease, and the virus was isolated from tissues in the inoculated pigs up to 99 dpi (pigs were euthanized at 36, 65, 99 and 134 dpi). In-contact pigs showed mild or no clinical signs, but did become seropositive, and a transient viraemia was detected at 28 days post-exposure (dpe), thereby confirming late virus transmission from the inoculated pigs. Virus transmission to in-contact pigs occurred at four weeks post-exposure, over three months after the primary infection. These results highlight the potential role of survivor pigs in disease maintenance and dissemination in areas where moderate- to low-virulent viruses may be circulating undetected. This study will help design better and more effective control programmes to fight against this disease.

Assessment of African Swine Fever Diagnostic Techniques as a Response to the Epidemic Outbreaks in Eastern European Union Countries: How To Improve Surveillance and Control Programs

This study represents a complete comparative analysis of the most widely used African swine fever (ASF) diagnostic techniques in the European Union (EU) using field and experimental samples from animals infected with genotype II ASF virus (ASFV) isolates circulating in Europe. To detect ASFV, three different PCRs were evaluated in parallel using 785 field and experimental samples. The results showed almost perfect agreement between the Universal ProbeLibrary (UPL-PCR) and the real-time (κ = 0.94 [95% confidence interval {CI}, 0.91 to 0.97]) and conventional (κ = 0.88 [95% CI, 0.83 to 0.92]) World Organisation for Animal Health (OIE)-prescribed PCRs. The UPL-PCR had greater diagnostic sensitivity for detecting survivors and allows earlier detection of the disease. Compared to the commercial antigen enzyme-linked immunosorbent assay (ELISA), good-to-moderate agreement (κ = 0.67 [95% CI, 0.58 to 0.76]) was obtained, with a sensitivity of 77.2% in the commercial test. For ASF antibody detection, five serological methods were tested, including three commercial ELISAs, the OIE-ELISA, and the confirmatory immunoperoxidase test (IPT). Greater sensitivity was obtained with the IPT than with the ELISAs, since the IPT was able to detect ASF antibodies at an earlier point in the serological response, when few antibodies are present. The analysis of the exudate tissues from dead wild boars showed that IPT might be a useful serological tool for determining whether or not animals had been exposed to virus infection, regardless of whether antibodies were present. In conclusion, the UPL-PCR in combination with the IPT was the most trustworthy method for detecting ASF during the epidemic outbreaks affecting EU countries in 2014. The use of the most appropriate diagnostic tools is critical when implementing effective control programs.

Experimental Infection of Domestic Pigs with African Swine Fever Virus Lithuania 2014 Genotype II Field Isolate

An experimental infection was conducted to evaluate horizontal transmission, clinical, virological and humoral response induced in domestic pigs infected with African swine fever (ASF) genotype II virus circulating in 2014 into the European Union (EU). Ten naive pigs were placed in contact with eight pigs experimentally inoculated with the Lithuanian LT14/1490 ASF virus (ASFV) responsible for the first ASF case detected in wild boar in Lithuania in January 2014. Clinical examination and rectal temperature were recorded each day. Blood sampling from every animal was carried out twice weekly. Blood samples were examined for presence of ASF virus-specific antibodies and for determining the ASFV viral load. From the obtained results, it was concluded that the Lithuanian ASFV induced an acute disease which resulted in 94, 5% mortality. The disease was easily detected by real-time PCR prior to the onset of clinical signs and 33% of the animals seroconverted. All findings were in accordance with observations previously made in domestic pigs and wild boar when infected with ASF genotype II viruses characterized by a high virulence. One in-contact pig remained asymptomatic and survived the infection. The role of such animals in virus transmission would need further investigation.

An estimation of the protein requirements of Iberian x Duroc 50:50 crossbred growing pigs

The effects of dietary protein content on the rates of gain and protein deposition were studied in Iberian (IB) × Duroc (DU) 50:50 barrows at 2 stages of growth [10.6 ± 0.2 (n = 28) and 60.0 ± 0.4 (n = 24) kg initial BW]. Two feeding, digestibility, and N-balance trials were performed. At each stage of growth, they were allocated in individual pens and given restrictedly (at 0.9 × ad libitum intake) one of 4 pelleted diets of similar energy concentration (13.8 to 14.5 MJ ME/kg DM), formulated to provide 4 different (ideal) CP contents (236, 223, 208, and 184 g CP/kg DM in the first trial, and 204, 180, 143, and 114 g CP/kg DM in the second trial). Feed allowance was offered in 2 daily equal meals. The average concentration of Lys was 6.59 ± 0.13 g /100 g CP for all diets. Whatever the stage of growth, average daily BW gain and gain to feed ratio were unchanged by increases in dietary CP content (477 ± 7 and 1,088 ± 20 g, and 0.475 ± 0.027 and 0.340 ± 0.113, respectively, in the first and second trial). In pigs growing from 10 to 27 kg BW, the average rate of N retention increased linearly (P < 0.01) on increasing the protein content in the diet up to a break point, so a linear-plateau dose response was observed. Pigs fed diets providing 208 to 236 g/kg DM did not differ in rate of protein deposition (PD). A maximum value of 87 (13.93 g N retained × 6.25) g PD/d was obtained when the diet supplied at least 208 g CP/kg DM. The broken-line regression analysis estimated dietary CP requirements at 211 g ideal CP (15.2 g total Lys)/kg DM. In the fattening pigs, there was a quadratic response (P < 0.01) in the rate of N retention as dietary CP content increased. Maximum N retention (18.7 g/d) was estimated from the first derivative of the function that relates the observed N retained (g/d) and dietary CP content (g/kg DM). This maximum value would be obtained by feeding a diet containing 185 g ideal CP (13.3 g total Lys)/kg DM and represents the maximum capacity of the IB × DU 50:50 pigs for protein accretion (i.e., 117 g PD/d). Consequently, cross breeding of IB dams with Duroc sires alters the metabolic response to dietary CP supply by increasing the potential of the crossbred to accrete protein and by modifying the pattern of PD response with BW.

Dietary protein excess does not influence calcium and phosphorus absorption and retention in Iberian pigs growing from 50 to 100 kg body weight

Effects of apparent total tract digestible dietary protein [expressed as apparent ileal digestible (AID) Lys in parentheses] from excessive to marginally deficient [110 (7.9), 92 (6.6), 73 (5.3) and 54 (3.8) g/kg DM] and feeding level (FL; 0.80 and 0.95 × ad libitum) upon fractional absorption and retention of Ca and P was studied in 48 purebred Iberian barrows from 50 to 100 kg BW to investigate possible detrimental effects of protein over supply on Ca and P metabolism. The diets were prepared by diluting a high-protein diet, formulated according to the ideal protein concept, with a protein-free mixture. The diets provided (per kg DM) 11.6 to 10.7 g Ca, 6.67 to 6.25 g total P, and 13.9 to 14.8 MJ ME. Intake levels with free access to feed were calculated according to individual BW and were adjusted weekly. A digestibility and balance trial was performed at 75 kg BW. The ADFI was 3104 and 2643 g for 0.95 and 0.80 × ad libitum FL. The ADG reached a maximum at 854 g (18.87 g/MJ ME intake) with the diet containing 5.3 g AID Lys/kg DM. Dietary AID Lys content did not alter Ca and P fractional apparent absorption, which attained average values of 0.417 ± 0.0109 and 0.545 ± 0.0106. The Ca and P retention as a fraction of intake remained unaffected at 0.403 ± 0.0114 and 0.403 ± 0.0120. The Ca urinary losses were not elevated by excess of dietary protein supply, remaining at 0.260 ± 0.0212 g/d. High feeding level increased (P < 0.05) the flow of absorbed Ca and P. In conclusion, long-term, high-protein (Lys) intake did not affect Ca intestinal absorption and renal excretion in the pig.

Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort

OBJECTIVES

The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients.

METHODS

Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses.

RESULTS

Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99).

CONCLUSIONS

Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.

BDNF and schizophrenia: from neurodevelopment to neuronal plasticity, learning, and memory

Brain-Derived Neurotrophic Factor (BDNF) is a neurotrophin that has been related not only to neurodevelopment and neuroprotection, but also to synapse regulation, learning, and memory. Research focused on the neurobiology of schizophrenia has emphasized the relevance of neurodevelopmental and neurotoxicity-related elements in the pathogenesis of this disease. Research focused on the clinical features of schizophrenia in the past decades has emphasized the relevance of cognitive deficits of this illness, considered a core manifestation and an important predictor for functional outcome. Variations in neurotrophins such as BDNF may have a role as part of the molecular mechanisms underlying these processes, from the neurodevelopmental alterations to the molecular mechanisms of cognitive dysfunction in schizophrenia patients.