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Marín JS, Mazenett-Granados EA, Salazar-Uribe JC, Sarmiento M, Suárez JF, Rojas M, Munera M, Pérez R, Morales C, Dominguez JI, Anaya JM. Increased incidence of rheumatoid arthritis after COVID-19. Autoimmun Rev 2023; 22:103409. [PMID: 37597602 DOI: 10.1016/j.autrev.2023.103409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
An increase in the incidence of inflammatory arthritis after COVID-19 has been reported. Since many diseases exhibit population-specific causal effect sizes, we aimed to evaluate the incidence trends of inflammatory arthritis, including rheumatoid arthritis (RA), after COVID-19 in a large admixed Colombian population. Data analysis for this retrospective, population-based cohort study was carried out using the COOSALUD EPS registry. The following codes were selected for analyses: M059, seropositive RA, M069, unspecified RA, M060 seronegative RA, and other RA-related diagnoses: M064, M139, M068, M058, M130 and M053. The study period was limited to January 01, 2018, through December 31, 2022. Incidence rates (IRs) and incidence rate ratios (IRRs) were assessed. A Cox survival model was built to evaluate the influence of age, gender, and COVID-19 vaccination status on the development of inflammatory arthritis. A bioinformatic analysis was performed to evaluate the homology between SARS-CoV-2 and autoantigen peptides related to RA. The entire population study comprised 3,335,084 individuals. During the pandemic period (2020-2022) the total IIR for seropositive and unspecified RA were 1.60 (95% CI, 1.16-2.22) and 2.93 (95% CI, 2.04-4.19), respectively, and the IIR for overall RA-related diagnosis was 2.01 (95% CI 1.59-2.53). The age groups hazard ratios (HRs) were increased until the age group of 51-60 years (HR: 9.16; 95% CI, 7.24-11.59) and then decreased slightly in the age group 61 years or older (HR: 5.364; 95% CI, 4.24-6.78) compared to those within 18-30 years. Men were less at risk than women to develop inflammatory arthritis (HR: 0.21; 95% CI, 0.18-0.24). The greater time since COVID-19 diagnosis was associated with a lower likelihood of developing inflammatory arthritis (HR: 0.99; 95% CI:0.998-0.999). Vaccination (all types of COVID-19 vaccines included) did not prevent the development of inflammatory arthritis after COVID-19. Low identity was found between the SARS-CoV-2 ORF1ab antigen and the human antigens Poly ADP-ribose polymerase 14 and Protein mono-ADP-ribosyltransferase PARP9 isoform D (39% and 29%, respectively). In conclusion, our study confirms increased incidence of inflammatory arthritis, including RA, after COVID-19, with the greatest increase occurring before the first year post-covid. Women in their fifties were more susceptible. Further research is required to examine the effectiveness of vaccination in preventing post-COVID inflammatory arthritis and the mechanisms implicated in the development of RA after COVID-19.
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Affiliation(s)
- Juan Sebastian Marín
- Health Research and Innovation Center at Coosalud EPS, Cartagena 130001, Colombia; Population Health Management Group at Coosalud EPS, Cartagena 130001, Colombia
| | | | | | - Mauricio Sarmiento
- Health Research and Innovation Center at Coosalud EPS, Cartagena 130001, Colombia
| | - John Fredy Suárez
- Population Health Management Group at Coosalud EPS, Cartagena 130001, Colombia
| | - Manuel Rojas
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA 95616, USA; Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Marlon Munera
- Medical Research Group (GINUMED), University Corporation Rafael Núñez, Cartagena 130002, Colombia
| | - Rosalbina Pérez
- Health Research and Innovation Center at Coosalud EPS, Cartagena 130001, Colombia
| | - Claudia Morales
- Health Research and Innovation Center at Coosalud EPS, Cartagena 130001, Colombia
| | - Jorge I Dominguez
- Health Research and Innovation Center at Coosalud EPS, Cartagena 130001, Colombia
| | - Juan-Manuel Anaya
- Health Research and Innovation Center at Coosalud EPS, Cartagena 130001, Colombia.
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Correa-Álvarez CD, Salazar-Uribe JC, Pericchi-Guerra LR. Bayesian multilevel logistic regression models: a case study applied to the results of two questionnaires administered to university students. Comput Stat 2022. [DOI: 10.1007/s00180-022-01287-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractBayesian multilevel models—also known as hierarchical or mixed models—are used in situations in which the aim is to model the random effect of groups or levels. In this paper, we conduct a simulation study to compare the predictive ability of 1-level Bayesian multilevel logistic regression models with that of 2-level Bayesian multilevel logistic regression models by using the prior Scaled Beta2 and inverse-gamma distributions to model the standard deviation in the 2-level. Then, these models are employed to estimate the correct answers in two questionnaires administered to university students throughout the first academic semester of 2018. The results show that 2-level models have a better predictive ability and provide more precise probability intervals than 1-level models, particularly when the prior Scaled Beta2 distribution is used to model the standard deviation in the second level. Moreover, the probability intervals of 1-level Bayesian multilevel logistic regression models proved to be more precise when Scaled Beta2 distributions, rather than an inverse-gamma distribution, are employed to model the standard deviation or when 1-level Bayesian multilevel logistic regression models, are used.
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Acevedo L, Piñeres-Olave BE, Niño-Serna LF, Vega LM, Gomez IJA, Chacón S, Jaramillo-Bustamante JC, Mulett-Hoyos H, González-Pardo O, Zemanate E, Izquierdo L, Mejìa JP, González JLJ, Duran BG, Gonzalez CB, Preciado H, Marun RO, Alvarez-Olmos MI, Alzate CG, Rojas J, Salazar-Uribe JC, Anaya JM, Fernández-Sarmiento J. Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study). BMC Pediatr 2021; 21:516. [PMID: 34794410 PMCID: PMC8600488 DOI: 10.1186/s12887-021-02974-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. METHODS An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. RESULTS There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). CONCLUSIONS Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.
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Affiliation(s)
- Lorena Acevedo
- Department of Pediatrics and Intensive Care. Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia
| | | | | | - Liliana Mazzillo Vega
- Department of Pediatrics and Intensive Care, Hospital Infantil Los Ángeles, Pasto, Colombia
| | | | - Shayl Chacón
- Department of Pediatrics and Intensive Care, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan Camilo Jaramillo-Bustamante
- Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network, Medellín, Colombia
| | - Hernando Mulett-Hoyos
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia
| | - Otto González-Pardo
- Department of Pediatrics and Intensive Care, Fundación Clínica Shaio, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Eliana Zemanate
- Department of Pediatrics and Intensive Care, Hospital Susana Lopez de Valencia, Universidad del Cauca, Popayán, Colombia
| | - Ledys Izquierdo
- Department of Pediatrics and Intensive Care, Hospital Militar Central, Hospital Santa Clara, Bogotá, Colombia
| | - Jaime Piracoca Mejìa
- Department of Pediatrics and Intensive Care, Clínica Infantil de Colsubsidio, Bogotá, Colombia
| | | | - Beatriz Giraldo Duran
- Department of Pediatrics and Intensive Care, Hospital Infantil de la Cruz Roja Rafael Henao Toro, Manizales, Colombia
| | | | - Helen Preciado
- Department of Pediatrics and Intensive Care, Fundación Universitaria de Ciencias de la Salud. Hospital de San José, Bogotá, Colombia
| | - Rafael Orozco Marun
- Department of Pediatrics and Intensive Care, Clínica Portoazul, Puerto Colombia, Colombia
| | - Martha I Alvarez-Olmos
- Department of Pediatrics and Infectious Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia
| | | | - Jorge Rojas
- Department of Pediatrics and Intensive Care, Hospital Santa Clara, Bogotá, Colombia
| | | | - Juan-Manuel Anaya
- Center for Autoimmune Disease Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jaime Fernández-Sarmiento
- Department of Pediatrics and Intensive Care. Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia.
- Universidad CES Graduate School, Medellín, Colombia.
- Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Cundinamarca, Chía, Colombia.
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Gómez-Porro P, Cabal-Paz B, Valenzuela-Chamorro S, Desanvicente Z, Sabin-Muñoz J, Ochoa-López C, Flórez C, Enríquez-Calzada S, Martín-García R, Esain-González Í, García-Fleitas B, Silva-Hernández L, Ruiz-Molina Á, Gamo-González E, Durán-Lozano A, Velasco-Calvo R, Alba-Alcántara L, González-Santiago R, Callejas-Díaz A, Brea-Álvarez B, Salazar-Uribe JC, Escamilla-Crespo C, Carneado-Ruiz J. High frequency of endoluminal thrombus in patients with ischaemic stroke following SARS-CoV-2 infection. Neurologia 2021; 39:S0213-4853(21)00084-0. [PMID: 34103174 PMCID: PMC8112291 DOI: 10.1016/j.nrl.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS Data were collected retrospectively on consecutive patients with SARS-CoV-2 infection who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.
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Affiliation(s)
- P Gómez-Porro
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - B Cabal-Paz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - S Valenzuela-Chamorro
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Z Desanvicente
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sabin-Muñoz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - C Ochoa-López
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - C Flórez
- Universidad CES, Medellín, Colombia
| | - S Enríquez-Calzada
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R Martín-García
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Í Esain-González
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - B García-Fleitas
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - L Silva-Hernández
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Á Ruiz-Molina
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - E Gamo-González
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - A Durán-Lozano
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R Velasco-Calvo
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - L Alba-Alcántara
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R González-Santiago
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - A Callejas-Díaz
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - B Brea-Álvarez
- Servicio de Radiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - C Escamilla-Crespo
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Carneado-Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
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Jiménez I, Villegas L, Salazar-Uribe JC, Álvarez LG. Facial growth changes in a Colombian Mestizo population: An 18-year follow-up longitudinal study using linear mixed models. Am J Orthod Dentofacial Orthop 2020; 157:365-376. [DOI: 10.1016/j.ajodo.2019.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/15/2022]
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Salgado K, Salazar-Uribe JC, Gallo-Villegas J, Valencia Á, Espíndola-Fernández D, Mesa C, de la Calle J, Montoya Y, Aristizábal D. [Evaluation of the cost-effectiveness of an integral model of ambulatory treatment in patients with acute coronary syndrome: application of a probabilistic Markov modelAvaliação da relação custo-eficácia de um modelo integral de tratamento ambulatorial em pacientes com síndrome coronariana aguda: aplicação de um modelo probabilístico de Markov]. Rev Panam Salud Publica 2018; 42:e10. [PMID: 31093039 PMCID: PMC6385638 DOI: 10.26633/rpsp.2018.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of an integral model of ambulatory treatment in patients who presented an acute coronary syndrome. METHODS An economic evaluation was made from a quasi-experimental intervention study, which included 442 patients aged 30 to 70 years who presented an acute coronary syndrome. The intervention group (n = 165) received an integral model of ambulatory treatment based on managed care (disease management), while the control group (n = 277) received conventional cardiovascular rehabilitation. During one year of follow-up, the presentation of cardiovascular events and hospitalizations was evaluated. A probabilistic Markov model was developed. The study perspective was applied within the General System of Health Social Security in Colombia, including the direct health costs; the time horizon was 50 years with discounts of 3.42% for costs and effectiveness; and the measure of effectiveness was quality-adjusted life years (QALYs). A probabilistic and multivariate sensitivity analysis was performed using the Montecarlo simulation. RESULTS During the year of follow-up, the direct costs related to the value paid were, on average, USD 2 577 for the control group and USD 2 245 for the intervention group. In the probabilistic sensitivity analysis, 91.3% of the simulations were located in the quadrant corresponding to incremental negative costs and positive incremental effectiveness (evaluated intervention at a lower cost, more effective). In the simulations, an average annual savings per patient of USD 1 215 per QALY was observed. CONCLUSIONS The integral model of ambulatory treatment implemented in patients who suffered an acute coronary syndrome was found to be less expensive and more effective compared to conventional care. Considering it is a dominant alternative, it is recommended as a model of care in this population.
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Affiliation(s)
| | | | | | - Ángela Valencia
- Centro Clínico y de Investigación Soluciones Integrales de Conocimiento en Riesgo Cardiovascular, Medellín, Colombia
| | - Diego Espíndola-Fernández
- Centro Clínico y de Investigación Soluciones Integrales de Conocimiento en Riesgo Cardiovascular, Medellín, Colombia
| | - Cristina Mesa
- Centro Clínico y de Investigación Soluciones Integrales de Conocimiento en Riesgo Cardiovascular, Medellín, Colombia
| | | | | | - Dagnóvar Aristizábal
- Centro Clínico y de Investigación Soluciones Integrales de Conocimiento en Riesgo Cardiovascular, Medellín, Colombia
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