Objective: Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in COVID-19 patients. Hypertension (HT) and age are the two principal determinants of arterial stiffness (AS). The objective of this study is to estimate AS in COVID-19 patients requiring hospital admission and analyze its association with all-cause mortality. Design and method: This cross-sectional, observational, retrospective multicenter study includes 122170 patients who required hospital admission in 150 Spanish centers, included in the nationwide SEMI-COVID-19 Network. We compared estimated AS as pulse pressure > 60 mmHg and compared clinical characteristics between survivors and nonsurvivors. Results: Mean age was 67.5 ± 16.1 years, 42.5% were women. Most patients were white (90.0%). Globally, 2606 (21.4%) subjects died. Blood pressure (BP) < 120 mmHg and BP > 140 at admission predicted higher all-cause mortality (23.5% and 22.8%, respectively, p < 0.001), compared to BP between 120–140 mmHg (18.6%). 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that even adjusting for gender (males, OR: 1.6, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), Charlson-Index (second and third tertiles, OR: 4.8 and 8.6, p = 0.0001), heart failure, previous and in-hospital antihypertensive treatment, AS and BP < 120 mmHg significantly and independently predicted all-cause mortality (OR: 1.27, p = 0.0001 and OR: 1.48, p = 0.0001, respectively). Conclusions: Our data show that arterial stiffness, defined as pulse pressure above 60 mmHg at hospital admission, and BP at admission < 120 mmHg were important determinants with independent prognostic value for all-cause mortality in COVID-19 patients requiring hospitalization.
BackgroundThe indication or use of zoledronic acid on the Paget's disease of bone was approved in 2005. Recent studies point out the administration of a single intravenous dose of this medicine as the first therapeutic option.ObjectivesThe aim of this study is to determine whether there is improvement in the ALP values among the patients with Paget's disease of bone after the administration of the zoledronic acid and to analyze whether this improvement is greater in the group previously treated with oral bisphosphonates or in the group who have not received prior treatment.MethodsThis is a retrospective study which included 49 patients with Paget's disease of bone that were examined by the rheumatology department and that have been registered in a retrospective database since 2010.The independent variables included were age, gender, smoking habits, presence of diabetes mellitus, date of first treatment, doses received, corticosteroid therapy, presence of concomitant inflammatory disease, complications after treatment, fractures after the administration of the drug and pretreatment with oral bisphosphonates.ResultsThe mean age of patients was 75±9,84 years [53–97]. 25 patients (51%) were male and 24 (49%) were female. 29 patients (59.2%) non-smokers, 10 (20.4%) former smokers, and 10 (20.4%) current smokers. 9 patients (18.4%) were diabetic. 26 patients had not received prior treatment with oral bisphosphonates, while 23 had been previously treated. 2 patients were treated with corticosteroids. 7 patients had active cancer, one patient had rheumatoid arthritis and one patient had another type of inflammatory disease. One patient developed fever as a post-infusion complication; however, this side effect did not require the discontinuation of therapy. Two patients required reinfusion due to the resurgence of the Paget and due to the high levels of ALP after the first dose. The mean dose received was 1.12± 0.389. One patient had a fracture after the administration of the drug.There is a statistically significant difference between the average ALP prior to the initiation of treatment with zoledronic acid and after the treatment in both groups of patients. Nevertheless, when comparing both subgroups of patients (treated or not previously with bisphosphonates), there is a greater difference in the subgroup of patients who had not received prior treatment compared to those that had been treated with oral bisphosphonates.Conclusions* Zoledronic acid treatment is effective in reducing the ALP levels in patients with Paget's disease of bone.* The difference in ALP levels after the zoledronic acid administration with respect to the previous ones is higher in the group of patients not previously treated with oral bisphosphonates.ReferencesTucci JR. Zoledronic acid therapy of patients with paget disease of bone resistant to or with unsustained remission following prior bisphosphonate therapy. Endocr Pract. 2015 Oct;21(10):1111–6. doi: 10.4158/EP15664.OR.Baykan EK, Saygılı LF, Erdogan M, Cetinkalp S, Ozgen AG, Yilmaz C. Efficacy...
BackgroundDifferent frequency of clinical and serological manifestations has been detected according to the age of onset of the patients with Systemic lupus erythematosus (SLE). According to the literature, senile SLE manifests between 6% and 18% of the patients with lupus.ObjectivesTo identify and analyse the clinical-serological and epidemiological features of senile SLE in our environment.To determine the average survival time and mortality in these patients, identifying its main cause.MethodsObservational retrospective study of 319 patients diagnosed with SLE (according to ACR 1992 and SLICC 2012 criteria) at the Hospital of León between 1997–2017 and with an age of onset ≥65 years, obtaining a total of 68 patients with senile SLE.ResultsThe mean age at diagnosis was 75.4±12.1 years, with a female/male ratio of 2.4. The most frequent manifestations were as joint (63.2%) and haematological manifestations in the form of leuco-lymphopenia (55.9%). The hemolytic anaemia only appeared in 2.9% of the cases and the thrombocytopenia in 25%. 36.8% of patients showed photosensitivity and 29% had other cutaneous manifestations, being the malar erythema the most prevalent type (60%), followed by the discoid lupus erythematosus (20%) and the subacute lupus (15%). Alopecia was only observed in 4.4%. Lupus nephritis was detected in the form of proteinuria in 4.4% of the patients, and only one patient had microscopic haematuria. Lung involvement was uncommon (8.8%), taking precedence the UIP (33.3%) over the rest of the pulmonary manifestations. Only 11.1% of the patients with senile SLE had serositis, being in the form of pleuritis in 75% of the cases, pericarditis in the 37.5% and ascites in the 12.5%. Regarding the neurological involvement, 5 patients showed polyneuropathy and 1 had chorea. Likewise, the frequency of Sjögren, Raynaud and secondary antiphospholipid syndrome was of 16.7%, respectively.The most important serological findings were: 97.3% ANA; 44.1% DNA and 20.6% hypocomplementemia, with 54.4% of the patients having serological activity. Only 5.9% had anti-Sm. Antiphospholipid antibodies were positive in 41.2% of the cases, with 4.4% of them showing triple positivity.The average survival time was of 13.7 years (SD: 10.9–16.5). Out of the total patients, 14 died (20.59%), mostly due to infectious etiology (35.7%) and 14.28% due to disease activity. Other less common causes were neoplasia or ischaemic heart disease (7.14% respectively).ConclusionsThe late–onset SLE prevails in our environment, one of every 5 patients diagnosed with SLE in our consulting room is older than 65 years.It is found most often in women and it is confirmed a lower male/female ratio than expected.Joint and haematology manifestations and cutaneous involvement in the form of malar erythema define the clinical profile of our patients with senile SLE, with the renal involvement or the presence of serositis being uncommon.Half of the patients had serological activity at the onset, having hypocomplementemia only in 1 out of 5 cases.Infections w...
BackgroundSystemic lupus erythematosus (SLE) is a systemic autoimmune disease with a wide range of clinical manifestations. The persistence of activity of the disease and the prolonged use of corticosteroids are amongst the main predictors of accumulated organ damage in patients with SLE. Therefore, we need new strategies to induce long-lasting remission and minimise the adverse effects of standard medications.Objectivesto assess the effectiveness and safety of Belimumab in actual clinical practice during the first year of treatment in patients with SLE.Methodsretrospective observational study of patients treated with Belimumab. This study involves 6 hospitals in Castilla y León (Spain). It collects clinical and analytical data before the start of Belimumab, and 6 and 12 months after the initiation of the therapy. The data collected include the daily dose of prednisone received at different time points and the activity of the disease was classified as mild, moderate and severe based on SELENA-SLEDAI index. A reduction from baseline of 3 points on the SELENA-SLEDAI indicates meaningful symptomatic improvement.ResultsAmong the twenty-five patients were included, with a mean age of 43.7+12.2 years, 72% were female and 96% caucasian. The average time from diagnosis of SLE to Belimumab infusion was 9.5+7.1 years; 32% were diagnosed with SLE <5 years ago. Up to 56% of the patients had moderate disease activity and only 8% patients had very high activity of the disease. All but one of the patients had previously received an immunosuppressant (azathioprine in 50% of the cases) and 16% of the sample had not responded to rituximab. The most frequent reasons for initiating Belimumab were an ineffective previous treatment regimen (60%), the intend to decrease steroid use (56%), and worsening patient condition (52%); whereas the most frequent manifestation of SLE in these patients were arthritis (44%), followed by mucocutaneous (20%) and immunologic findings (20%). As for immunologic markers of activity, DNA was elevated by 40% and 68% of the patients showed hypocomplementemia, that dropped to 24% in both cases at 12 months. The mean score of the SELENA-SLEDAI index decreased from 9.5 to 6 in the first 6 months and to 5.2 in the 12 months of follow-up. A reduction in the initial mean steroid dose was also observed from 20 mg/day to 8.9 mg/day and 6.4 mg/day at 6 and 12 months respectively. Hence, the dose of steroid was reduced by 68% during the first year (p=0,06). This reduction was clinically significant, but it did not reach statistical significance in our study. Two patients (8%) had discontinued Belimumab within the first 6 months of therapy (1 pregnancy and 1 worsening proteinuria); 34.7% had discontinued it within the first 12 months, mostly due to ineffectiveness (62.5%). Two patients with severe renal involvement (>1 gr proteinuria/24 hour) were treated with Belimumab, allowing to reduce the steroids to a low dosis (<7.5 mg/day) at 12 months.ConclusionsBelimumab appears to be effective, reducing disease activity as m...
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