Objective We sought to determine the accuracy of the LOW‐HARM score (Lymphopenia, Oxygen saturation, White blood cells, Hypertension, Age, Renal injury, and Myocardial injury) for predicting death from coronavirus disease 2019) COVID‐19. Methods We derived the score as a concatenated Fagan's nomogram for Bayes theorem using data from published cohorts of patients with COVID‐19. We validated the score on 400 consecutive COVID‐19 hospital admissions (200 deaths and 200 survivors) from 12 hospitals in Mexico. We determined the sensitivity, specificity, and predictive values of LOW‐HARM for predicting hospital death. Results LOW‐HARM scores and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 5 (SD: 14) versus 70 (SD: 28). The overall area under the curve for the LOW‐HARM score was 0.96, (95% confidence interval: 0.94–0.98). A cutoff > 65 points had a specificity of 97.5% and a positive predictive value of 96%. Conclusions The LOW‐HARM score measured at hospital admission is highly specific and clinically useful for predicting mortality in patients with COVID‐19.

- Importance: Many COVID-19 prognostic factors for disease severity have been identified and many scores have already been proposed to predict death and other outcomes. However, hospitals in developing countries often cannot measure some of the variables that have been reported as useful. - Objective: To assess the sensitivity, specificity, and predictive values of the novel LOW-HARM score (Lymphopenia, Oxygen saturation, White blood cells, Hypertension, Age, Renal injury, and Myocardial injury). - Design: Demographic and clinical data from patients with known clinical outcomes (death or discharge) was obtained. Patients were grouped according to their outcome. The LOW-HARM score was calculated for each patient and its distribution, potential cut-off values and demographic data were compared. - Setting: Twelve hospitals in ten different cities in Mexico. - Participants: Data from 438 patients was collected. A total of 400 (200 per group) was included in the analysis. - Exposure: All patients had an infection with SARS-CoV-2 confirmed by PCR. - Main Outcome: The sensitivity, specificity, and predictive values of different cut-offs of the LOW-HARM score to predict death. - Results: Mean scores at admission and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 10 (SD: 17) vs 70 (SD: 28). The overall AUC of the model was 95%. A cut-off > 65 points had a specificity of 98% and a positive predictive value of 96%. More than a third of the cases (36%) in the sample had a LOW-HARM score > 65 points. - Conclusions and relevance: The LOW-HARM score measured at admission is highly specific and useful for predicting mortality. It is easy to calculate and can be updated with individual clinical progression.

Osteoartritis (OA) es una enfermedad de gran impacto que produce invalidez funcional a temprana edad en los caballos de carrera donde su diagnóstico generalmente se lleva a cabo en los estados avanzados de la enfermedad. El objetivo de esta investigación fue demostrar la presencia del ligando del receptor activador del factor nuclear kappa-β (RANKL) en líquido sinovial de equinos en training. Se evaluó clínica y radiográficamente a tres caballos sanos de dos años y cuatro caballos de 3-4 años con signos de inflamación articular. Se les extrajo líquido sinovial para cuantificar la expresión de RANKL en diferentes estados patológicos del carpo mediante una prueba de ELISA. El valor promedio de RANKL en los caballos sanos fue de 33.13 ± 8.30 pg/ml y en los caballos con signos de OA de 49.03 ± 5.95 pg/ml (p<0.05).

La osteoartritis (OA) es una de las principales afecciones que incide en el rendimiento de equinos de deporte. El diagnóstico temprano de la enfermedad es relevante en su manejo clínico y terapéutico. La evidencia demuestra que este proceso tiene una clara relación entre osteoclastos y células inmune compartiendo moléculas como citoquinas, receptores, moléculas de señalización, factores de transcripción que se influencian mutuamente donde juegan un rol crucial tanto en la resorción ósea patológica como fisiológica. Se describe el rol del ligando del activador del receptor nuclear-KB (RANKL) como una de las citoquinas más relevantes que inducen osteoclastogénesis.

Background Renal disease associated with antiphospholipid syndrome has been studied for many years and vascular thrombotic lesions have predominantly been described. However, an expanding spectrum of renal diseases associated with APS has also been encountered and although “non-thrombotic” nephropaties have been reported, they are infrequent and poorly characterized. Objectives To analyze the clinical and histological features of non-thrombotic kidney disease in a cohort of primary antiphospholipid syndrome (PAPS) patients and to propose treatment patterns besides anticoagulant therapy. Methods From a dynamic cohort of 60 PAPS patients we identified 20 patients with decreased creatinine clearance (<60 ml/min) at least 2 times. All patients were receiving oral anticoagulation with a target INR 2-3, they underwent a renal function protocol which included: bimonthly creatinine clearance measurement, serum creatinine levels, urinalysis and arterial hypertension surveillance. If any of these parameters was abnormal, renal doppler, functional kidney scintigraphy and if possible, ultrasound-guided kidney biopsy was performed. After diagnosis of kidney disease, antihypertensives, mainly felodipine or enalapril were started regardless arterial hypertension. Patients have underwent follow-up for at least 12 months (range 14-136 months) Results 20 patients (33%) from our cohort were identified. Demographic characteristics were: 5 male and15 female, mean age ± 38.6 years, mean disease duration 9.6 years. 8 patients had diastolic pressure >90 mmHg, the rest of them were normotensive. Median creatinine clearance was 46 ml/min ±8.3. Basal kidney scintigraphy reported diminished glomerular filtration rates in 16 patients. Renal Doppler was abnormal in 3 patients. Kidney biopsy was performed in 10 patients, histologic findings were: fibrous intimal thickening with luminal reduction in 9 cases, 18 patients had intimal hyperplasia, 18 biopsies reported mesangial hypercellularity, none of the renal specimens showed thrombosis or thrombotic mycroangiopathy. At follow up creatinine clearance raised to 79 ml/min ant month 4 and remains stable. Conclusions The spectrum of PAPS renal disease is expanding and in patients under anticoagulant therapy with optimum INR, a new class of kidney disease without thrombotic findings but with some degree of diminished renal function sensitive to vasodilator drugs seems to be quite prevalent. Therefore we advise to follow up renal function regularly and to start vasodilators such as calcium channel blockers and/or angiotensin inhibitors. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5982

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