Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study

INTRODUCTION

Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache.

SUBJECTS AND METHODS

A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed.

RESULTS

A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements.

CONCLUSION

Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

The MIGREX study: Prevalence and risk factors of sexual dysfunction among migraine patients

BACKGROUND

Migraine attacks have a high impact on daily activities. There is limited research on the burden of migraine on sexual functioning.

OBJECTIVE

To determine the prevalence of sexual dysfunction in patients with migraine and its relationship with migraine features and comorbidities.

METHOD

This is a cross-sectional study. We included migraine patients between 18 and 60 years-old from 8 Headache Clinics in Spain. We recorded demographic data and migraine features. Patients fulfilled a survey including comorbidities, Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale and a questionnaire about migraine impact on sexual activity. A K-nearest neighbor supervised learning algorithm was used to identify differences between migraine patients with and without sexual dysfunction.

RESULTS

We included 306 patients (85.6% women, mean age 42.3±11.1 years). A 41.8% of participants had sexual dysfunction. Sexual dysfunction was associated with being female (OR [95% CI]: 2.42 [1.17-5.00]; p<0.001), being older than 46.5 years (4.04 [2.48-6.59]; p<0.001), having chronic migraine (2.31 [1.41-3.77]; p=0.001), using preventive medication (2.45 [1.35-4.45]; p=0.004), analgesic overusing (3.51 [2.03-6.07]; p<0.001), menopause (4.18 [2.43-7.17]; p<0.001) and anxiety (2.90 [1.80-4.67]; p<0.001) and depression (6.14 [3.18-11.83]; p<0.001). However, only female gender, age, menopause and depression were the statistically significant variables selected in the model to classify migraine patients with or without sexual dysfunction (Accuracy [95% CI]: 0.75 (0.62-0.85), Kappa: 0.48, p=0.005).

CONCLUSIONS

Sexual dysfunction is frequent in migraine patients visited in a headache clinic. However, migraine characteristics or use of preventive medication are not directly associated with sexual dysfunction. Instead, risk factors for sexual dysfunction were female gender, higher age, menopause and depression.

Incidental maternal findings on fetal MRI

AIM

To evaluate the type and frequency of maternal findings incidentally identified during fetal magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A retrospective single-centre study was undertaken which included all consecutive fetal MRI studies performed between July 2017 and May 2021 at a tertiary institution. Two fellowship-trained radiologists reviewed the studies independently to determine the type and frequency of incidental maternal findings of both no clinical significance (requiring no further follow-up) and of clinical significance (requiring further follow-up, work-up, and/or management). Differences in acquisition were resolved by two-reader consensus. Non-diagnostic MRI examinations or abdominal MRI examinations indicated for maternal complications were excluded from review.

RESULTS

A total of 455 consecutive fetal MRI examinations performed in 429 women were included. Mean age was 30 years (SD 5.5 years). At least one incidental maternal finding was identified in 58% (265/455) of studies. Umbilical hernias (35%), maternal hydronephrosis (19%), and maternal hydro-ureter (15%) were the most common. Only two studies (0.5%) showed clinically significant incidental maternal findings (pancreatic pseudocyst and ovarian cyst).

CONCLUSIONS

Incidental maternal findings are common on fetal MRI but rarely require further follow-up, work-up, and/or management.

Monitoring storm evolution using a high-density seismic network

Data acquired by a dense seismic network deployed in the Cerdanya basin (Eastern Pyrenees) is used to track the temporal and spatial evolution of meteorological events such as rainfall episodes or thunderstorms. Comparing seismic and meteorological data, we show that for frequencies above 40 Hz, the dominant source of seismic noise is rainfall and hence the amplitude of the seismic data can be used as a proxy of rainfall. The interstation distance of 1.5 km provides an unprecedented spatial resolution of the evolution of rainfall episodes along the basin. Two specific episodes, one dominated by stratiform rain and the second one dominated by convective rain, are analyzed in detail, using high resolution disdrometer data from a meteorological site near one of the seismic instruments. Seismic amplitude variations follow a similar evolution to radar reflectivity values, but in some stratiform precipitation cases, it differs from the radar-derived precipitation estimates in this region of abrupt topography, where radar may suffer antenna beam blockage. Hence, we demonstrate the added value of seismic data to complement other sources of information such as rain-gauge or weather radar observations to describe the evolution of ground-level rainfall fields at high spatial and temporal resolution. The seismic power and the rainfall intensity have an exponential relationship and the periods with larger seismic power are coincident. The time intervals with rain drops diameters exceeding 3.5 mm do not result in increased seismic amplitudes, suggesting that there is a threshold value from which seismic data are no longer proportional to the size of the drops. Thunderstorms can be identified by the recording of the sonic waves generated by thunders, with. Single thunders detected to distances of a few tens of kilometers. As the propagation of these acoustic waves is expected to be strongly affected by parameters as air humidity, temperature variations or wind, the seismic data could provide an excellent tool to investigate atmospheric properties variations during thunderstorms.

Health protection among own account and platform workers during COVID19 in Chile. The PWR project

Background

In the last decades, non-standard employment has grown globally. Especially for own account workers (OAW), this implies the self-management of economic, health and other work-related risks. In the context of COVID19, this management was stressed by lockdowns and the novel health risks imposed by an unknown and highly contagious virus, demanding the incorporation of new knowledge and preventive actions. As part of a six-country multiple case qualitative study on non-standard workers (NSW), we explore their experiences and strategies deployed to protect their health while continuing to work.

Methods

We performed 40 in-depth interviews to NSWs between October 2020 and February 2021, identified through the PWR online-survey and selected through an intentional sampling strategy according to levels of precarity (high-low), gender (male/female) and age (18-39/40-55). Interviews were analysed through abductive thematic analysis.

Results

We observed a significant transfer to platform, Uber-like jobs in the delivery of goods during lockdown (n = 7). In the absence of institutional prevention programs and provision of protective equipment, OAWs (n = 13) refer the self-provision of COVID19 prevention to protect themselves and their families while continuing to work, deploying a series of strategies amidst limited understanding of both mode of transmission of the virus and actual effective preventive measures. This had serious consequences for them and their families, expressed in anguish, sense of lack of control, fear, and fragility in the face of a major health risk given their constant potential exposure to the virus, leading to both physical and mental health problems, as well as COVID19 infection.

Conclusions

The substantial growth worldwide of gig delivery work during lockdowns magnified a pressing public health problem, critically requiring social security for gig and OAWs and the development of more equitable and accessible occupational health for all.

Key messages

• Substantial growth worldwide of gig delivery work during lockdowns magnified a pressing public health problem.

• Social security for gig and OAWs are critically required as well as the development of more equitable and accessible occupational health for all.

Usefulness of telemedicine-based heart failure monitoring according to “eHealth literacy” domains: insights from the iCOR randomised controlled trial

Background/Introduction

The potential positive effect of electronic health (eHealth)-based heart failure (HF) monitoring remains uncertain, largely due to the heterogeneity of the studies published to date. A subgroup of patients in which its key role is particularly uncertain is in the “low literacy” or “computer or digital illiterate” patients mainly due to telemedicine (TM)-based strategies have been often discouraged on the basis of a foreseeable limited benefit in them.

Purpose

The aim of this study was to determine the effectiveness of a TM-based managed care solution across literacy levels and information and communications technology (ICT) skills.

Methods

We performed a sub-analysis on the basis of two literacy domains (traditional and computer literacy) encompassed in the definition of “eHealth literacy” to the HF-patients included in the “insuficiència Cardíaca Optimitzaciό Remota” (iCOR) randomised study comparing TM vs. usual care (UC) in HF-patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The event rates of primary (the occurrence of non-fatal HF event) and secondary (all-cause hospitalization, all cause death and the composite endpoint combining of allcause death or non-fatal HF events) study endpoints were calculated for each literacy domains and its combination. Cox proportional-hazards regression models were used to evaluate the effect of “eHealth literacy” dimensions, treatment group and the interaction term “eHealth literacy” domains by treatment group on study endpoints, and p-value was used to compare the different curves.

Results

178 patients were analysed (81 TM vs 90 UC). As far as the “traditional literacy” analyses, 65% of patients had only elementary education and the 6% had no literacy qualifications, defining the low-educated subgroup as “lower literacy” (126 patients, 71%). All the other patients were classified in the “middle or higher literacy” (52 patients, 29%) subgroup. Moreover, concerning new technological management, 128 patients (72%) referred presenting moderate to high difficulties in its handling, constituting the “lower ICT skills” subgroup. The remaining 28% (50 patients) were allocated into the “middle or higher ICT skills” subgroup due to their minor handicap in their ICT use.

The beneficial effect of TM compared to UC strategy was consistent across all literacy domains (pvalue for interaction 0.207 and 0.117 respectively). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC in both clustered in the “lower literacy” (p-value=0.001) (Picture 1) and those allocated to the “lower ICT skills” (p-value=0.001) (Picture 2) subgroup.

Conclusions

Non-invasive eHealth-based HF monitoring tools are effective compared to UC in preventing HF events in the early post-discharge period, regardless of two “eHealth literacy” domains (“traditional and computer literacy”).

Funding Acknowledgement

Type of funding sources: None.

P-134 The robustness of Gardner and Schoolcraft (GS) scoring prior vitrification for selecting a single vitrified blastocyst for transfer

Study question

Do changes in the GS score before vitrification and before transfer of a single vitrified-warmed blastocyst (SVBT) predict the chance of live birth?

Summary answer

There was no association between changes in GS score and the chance of live birth after SVBT.

What is known already

Morphological scoring of human blastocysts is commonly used for assessing the embryo potential for implantation and live birth. Blastocysts that are vitrified and subsequently warmed are usually observed for re-expansion, which is taken for the decision whether to transfer or if another blastocyst will be warmed. Re-scoring warmed embryos before SVBT may result in a lower, same or higher score and may be applied to select the embryo with the highest quality for transfer.

Study design, size, duration

The GS score was evaluated twice namely before vitrification and immediately before SVBT for 374 embryo transfers in 240 women participating in the RAINBOW trial (NCT03564509). Subjects were stimulated with a fixed individualized daily dose of follitropin delta in a long GnRH agonist protocol. Blastocyst transfer was performed on day 5; remaining blastocysts were cryopreserved on day 5/6.

Participants/materials, setting, methods

The association between changes in GS score from before vitrification to before SVBT was investigated using a mixed effect logistic regression model with factors for expansion and hatching status, inner cell mass, and trophectoderm (with decrease, no change, and increase as factor levels for each), and assuming that the log-odds of achieving a live birth was normally distributed in the trial population.

Main results and the role of chance

A total of 472 embryos were vitrified and scored with the GS grading system before vitrification and before SVBT. Of these 298 (63%) had identical scores before and after vitrification. Changes in expansion and hatching status were seen for 23%, inner cell mass for 21%, and trophectoderm for 21% of embryos. Of the 472 warmed embryos, 32 were discarded and 66 were used for double transfers. The remaining 374 blastocysts were used for single embryo transfers. Of these 374 embryos, 68% had identical GS scores at the two scorings, 12%/6% had increase/decrease in expansion and hatching score, 10%/6% had increase/decrease in inner cell mass grading, and 12%/4% had increase/decrease in trophectoderm grading. There was no statistically significant association between either of these changes and the chance of live birth (expansion and hatching: p = 0.94, inner cell mass: p = 0.71, trophectoderm: p = 0.60).

Limitations, reasons for caution

Only 68 (32%) of the 374 blastocysts had different scores before vitrification and before SVBT, indicating the consistency of the score regardless vitrification. Thus, there was only limited power to show an association with chance of live birth. Also, embryos with low quality after thawing were not used for transfer.

Wider implications of the findings

Selection of vitrified embryos for transfer can be based on the pre-vitrification score, as the post-vitrification quality correlates well with the pre-vitrification quality and potential changes may not affect the chance of live birth

Trial registration number

NCT03564509

Extracellular miR-6723-5p could serve as a biomarker of limbal epithelial stem/progenitor cell population

BACKGROUND

Dysfunction or loss of limbal stem cells can result in limbal stem cell deficiency (LSCD), a disease that cause corneal opacity, pain, and loss of vision. Cultivated limbal epithelial transplantation (CLET) can be used to restore stem cell niche homeostasis and replenish the progenitor pool. Transplantation has been reported with high success rate, but there is an unmet need of prognostic markers that correlate with clinical outcomes. To date, the progenitor content in the graft is the only parameter that has been retrospectively linked to success.

METHODS

In this study, we investigate extracellular micro RNAs (miRNAs) associated with stem/progenitor cells in cultivated limbal epithelial cells (cLECs). Using micro RNA sequencing and linear regression modelling, we identify a miRNA signature in cultures containing high proportion of stem/progenitor cells. We then develop a robust RNA extraction workflow from culture media to confirm a positive miRNA correlation with stem/progenitor cell proportion.

RESULTS

miR-6723-5p is associated with cultures containing high proportion of stem/progenitor cells, and is detected in the basal layer of corneal epithelium.

CONCLUSIONS

These results indicate that miR-6723-5p could potentially serve as a stem/progenitor cell marker in cLECs.

Identification of natural and anthropogenic signals in controlled source seismic experiments

The analysis of the background noise in seismic networks has proved to be a powerful tool not only to acquire new insights on the crustal structure, but also to monitor different natural and anthropogenic processes. We show that data acquired during controlled source experiments can also be a valuable tool to monitor such processes, in particular when using high-density deployments. Data from a wide-angle reflection and refraction seismic profile in the central-northwest part of Iberia is used to identify signals related to aircrafts, road traffic, quarry blasts, wind blow, rainfall or thunders. The most prominent observations are those generated by a helicopter and an airplane flying following trajectories subparallel to the profile, which are tracked along 200 km with a spatial resolution of 350 m, hence providing an exceptional dataset. Other highlights are the observation of the Doppler effect on signals generated by moving cars and the high-density recording of acoustic waves generated by thunders. In addition to the intrinsic interest of identifying such signals, this contribution proves that it is worth inspecting the data acquired during seismic experiments beyond the time interval including the arrival of the seismic waves generated by the controlled source.

Molecular detection of Rickettsia in ectoparasites (Siphonaptera and Phthiraptera) of domestic and feral pigs from Argentina

Rickettsioses are distributed among a variety of hematophagous arthropods, and represent an emergent threat. The presence of rickettsial bacteria in ectoparasites collected from pigs from Argentina is still unknown. This study investigated the presence and identity of Rickettsia spp. in fleas, Pulex irritans, and sucking lice, Haematopinus suis, of domestic and feral pigs, Sus scrofa, from Central-Northern Argentina, through the genes gltA and ompB. Rickettsial bacteria were detected in 50% of fleas and 24% of lice. The BLASTn analysis of the ompB gene fragments in P. irritans samples showed identities 99% and 100% with R. felis. Positive samples of H. suis were 99% similar with species from the spotted fever group, future amplifications of a more polymorphic fragment of the ompB gene will allow to corroborate the identity of the Rickettsia species present in these lice samples. The Rickettsia spp. reported in the present study are having eventually been associated with cases of human diseases, and the circulation of these agents in arthropods has already been reported in several countries. Therefore, the identification of circulating pathogenic agents, such as reported in this study, is crucial for development of preventive measures for the control of ectoparasite-borne rickettsiosis diseases. Further studies, using serology techniques, will be allow to explore the ability of pigs as a possible Rickettsia reservoir and its role as part of transmission cycle of Rickettsia spp. in the studied scenarios.

The MIGREX study: Prevalence and risk factors of sexual dysfunction among migraine patients

BACKGROUND

Migraine attacks have a high impact on daily activities. There is limited research on the burden of migraine on sexual functioning.

OBJECTIVE

To determine the prevalence of sexual dysfunction in patients with migraine and its relationship with migraine features and comorbidities.

METHOD

This is a cross-sectional study. We included migraine patients between 18 and 60 years-old from 8 Headache Clinics in Spain. We recorded demographic data and migraine features. Patients fulfilled a survey including comorbidities, Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale and a questionnaire about migraine impact on sexual activity. A K-nearest neighbor supervised learning algorithm was used to identify differences between migraine patients with and without sexual dysfunction.

RESULTS

We included 306 patients (85.6% women, mean age 42.3±11.1 years). A 41.8% of participants had sexual dysfunction. Sexual dysfunction was associated with being female (OR [95% CI]: 2.42 [1.17-5.00]; p<0.001), being older than 46.5 years (4.04 [2.48-6.59]; p<0.001), having chronic migraine (2.31 [1.41-3.77]; p=0.001), using preventive medication (2.45 [1.35-4.45]; p=0.004), analgesic overusing (3.51 [2.03-6.07]; p<0.001), menopause (4.18 [2.43-7.17]; p<0.001) and anxiety (2.90 [1.80-4.67]; p<0.001) and depression (6.14 [3.18-11.83]; p<0.001). However, only female gender, age, menopause and depression were the statistically significant variables selected in the model to classify migraine patients with or without sexual dysfunction (Accuracy [95% CI]: 0.75 (0.62-0.85), Kappa: 0.48, p=0.005).

CONCLUSIONS

Sexual dysfunction is frequent in migraine patients visited in a headache clinic. However, migraine characteristics or use of preventive medication are not directly associated with sexual dysfunction. Instead, risk factors for sexual dysfunction were female gender, higher age, menopause and depression.

Bioengineered Exosomal Extracellular Vesicles in Cancer Therapeutics

Liquid or blood-based biopsy is a less invasive and more efficient method in which to clinicians can identify diagnostic, prognostic, and therapeutic responsive biomarkers in cancer patients. Circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), RNAs, proteins, metabolites, and extracellular vesicles (EVs) are all potential biomarkers found in liquid biopsies. All nucleated cells including healthy, virally infected, and cancer cells release EVs. Since the early 1980s, evidence has mounted to support the pathophysiological role of EVs in cancer. Here we focus on the smallest of the EV, the exosome, and their clinical relevance as nanotherapeutics for cancers. Exosomes obtained from tumors have been reported to promote and/or facilitate malignancy of cancers especially in terms of metastatic potential. Exosomal EVs have also contributed to the development of therapeutic resistance. Recent studies demonstrate that intrinsic and bioengineered exosomes can serve as effective therapeutic agents that disrupt cancer progression. Here we review the current literature regarding the utilization of bioengineered exosomes for therapeutics to treat prevalent cancers such as melanoma, glioma, breast, pancreatic, hepatic, cervical, prostate, and colon cancers. Overall, studies reviewed show that bioengineered exosomes are effective and promising for targeted cancer therapy.

Chronic inflammatory demyelinating polyradiculoneuropathy: can a diagnosis be made in patients not fulfilling electrodiagnostic criteria?

BACKGROUND AND PURPOSE

The aim was to identify the clinical and diagnostic investigations that may help to support a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in patients not fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria.

METHODS

The data from patients with a clinical diagnosis of CIDP included in a national database were retrospectively reviewed.

RESULTS

In all, 535 patients with a diagnosis of CIDP were included. This diagnosis fulfilled the EFNS/PNS criteria in 468 patients (87.2%) (definite in 430, probable in 33, possible in three, while two had chronic immune sensory polyradiculopathy). Sixty-seven patients had a medical history and clinical signs compatible with CIDP but electrodiagnostic studies did not fulfill the EFNS/PNS criteria for CIDP. These patients had similar clinical features and frequency of abnormal supportive criteria for the diagnosis of CIDP compared to patients fulfilling EFNS/PNS criteria. Two or more abnormal supportive criteria were present in 40 (61.2%) patients rising to 54 (80.6%) if a history of a relapsing course as a possible supportive criterion was also included. Increased cerebrospinal fluid proteins and response to immune therapy most frequently helped in supporting the diagnosis of CIDP. Response to therapy was similarly frequent in patients fulfilling or not EFNS/PNS criteria (87.3% vs. 85.9%).

CONCLUSIONS

Patients with a clinical diagnosis of CIDP had similar clinical findings, frequency of abnormal supportive criteria and response to therapy compared to patients fulfilling EFNS/PNS criteria. The presence of abnormal supportive criteria may help in supporting the diagnosis of CIDP in patients with a medical history and clinical signs compatible with this diagnosis but non-diagnostic nerve conduction studies.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

AB0254 PATIENT CHARACTERISTICS, COMORBIDITIES, AND INFECTION OUTCOMES AMONG RHEUMATOID ARTHRITIS (RA) PATIENTS IN PUERTO RICO (PR)

Background:

Although the burden of comorbidities and infections in RA patients in the US is well established,1there is an evidence gap for RA patients in the US territory of PR.

Objectives:

To describe the patient demographics, clinical characteristics, and infection rates in patients with RA in PR

Methods:

A retrospective cohort of adults age ≥18 years from PR with ≥2 diagnosis of RA were identified using International Classification of disease codes (ICD-9 or ICD-10) on separate days from Jan 1, 2006 to June 30, 2018 using the Truven MarketScan™ database. Patients were divided into three treatment cohorts: no treatment, conventional disease-modifying anti-rheumatic drugs (csDMARD) user, and biologic DMARD (bDMARD) user. Patients in the no treatment group were followed from their first RA diagnosis date to the date of initiation of any DMARDs. The csDMARD users were followed from the initiation of csDMARD until the initiation of any bDMARD or targeted synthetic DMARDs (tsDMARDs). Patients were censored at the last observed medical claim if treatments were not initiated during follow-up. bDMARD users were followed from the date of initiation of bDMARD or tsDMARD until their last observed medical claim. Crude incidence rates /1000 person-years (PY) were reported for opportunistic infections (e.g. Mycobacterium, Cytomeglavirus, Candidiasis, and Chlamydial infections) and infections requiring hospitalisation.

Results:

Of the 623 patients in the cohort of RA patients from PR, majority were women (75.4%), aged 41-64 years (67.1%), employed full time (69.8%), with PPO health plan (89.4%), and with mean length of follow-up of 5.77 years from index RA diagnosis. Our results shows that cardiovascular conditions (CVD, hypertension, and hyperlipidemia) were the most prevalent comorbidities in PR patients with RA (Table 1), followed by diabetes (55.7%) in the total RA patient population. The crude IR/1000 PY for opportunistic infections was 23.35 for patients in the no treatment cohort, 48.52 for patients in csDMARD, and 28.31 for bDMARD users. For hospitalized infections, the crude IR/1000 PY was 26.00 for patients in the no treatment cohort, 22.08 for csDMARD users, and 41.90 for bDMARD users.

Table 1.

Patient Clinical Characteristics

Patient CharacteristicsTotal PatientsNo TreatmentcsDMARD userbDMARD userN%N%N%N%Total623100.060697.3168279415.1CCI ScoreMean (SD)2.31 (1.85)2.39 (1.82)1.85 (1.47)2.57 (2.41)ComorbiditiesTotal Patients57191.7%48680.2%13077.4%7680.9%Asthma17029.8%12525.7%3325.4%2532.9%Chronic Kidney Disease478.2%326.6%75.4%810.5%COPD13824.2%10822.2%2216.9%1621.1%Cardiovascular disease35762.5%27857.2%6146.9%5572.4%Hypertension44778.3%37176.3%8766.9%6382.9%Hyperlipidemia41873.2%35072.0%6650.8%4761.8%Malignancy12421.7%10120.8%1813.9%2026.3%Peripheral artery disease7413%5811.9%107.7%1114.5%T2DM31855.7%25151.7%5844.6%3748.7%

Note: Comorbidities and CCI was calculated for patients during follow-up in respective cohort

Conclusion:

Puerto Rican patients with RA have a significant burden of comorbidities, infections and hospitalisations. Trends indicate a variation in the burden by the type of treatment. Furthermore studies are warranted to better understand the potential healthcare implications of comorbidities in patients with RA.

References:

[1]Yun, Huifeng et al. “Comparative risk of hospitalised infection associated with biologic agents in rheumatoid arthritis patients enrolled in Medicare.” Arthritis & Rheumatology 68, no. 1 (2016): 56-66.

Disclosure of Interests:

Manasi Suryavanshi Consultant of: Bristol Myers Squibb, Sonick Suri Consultant of: Bristol Myers Squibb, Ying Bao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Maribelis Ruiz Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vardhaman PATEL Employee of: Bristol Myers Squibb, Eory Madera-Miranda Employee of: Bristol Myers Squibb

Phenotypic correlations in a large single-center cohort of patients with BSCL2 nerve disorders: a clinical, neurophysiological and muscle magnetic resonance imaging study

BACKGROUND AND PURPOSE

BSCL2 heterozygote mutations are a common cause of distal hereditary motor neuropathies (dHMNs). A series of BSCL2 patients is presented and clinical, neurophysiological and muscle magnetic resonance imaging (MRI) findings are correlated.

METHODS

Twenty-six patients from five families carrying the p.N88S mutation were identified. Age of onset, clinical phenotype (dHMN, Charcot-Marie-Tooth, spastic paraplegia), physical examination, disability measured as a modified Rankin Scale score and neurophysiological findings were collected. A whole body muscle MRI had been performed in 18 patients. The pattern of muscle involvement on T1-weighted and short time inversion recovery sequences was analysed. Hierarchical analysis using heatmaps and an MRI Composite Score were generated. Statistical analysis was carried out with STATA SE v.15 (TX, USA).

RESULTS

The mean age was 51.54 ± 19.94 years and 14 patients were men. dHMN was the most common phenotype (50%) and five patients (19.23%) showed no findings on examination. Disease onset was commonly in childhood and disability was low (modified Rankin Scale score 1.34 ± 1.13) although median time since onset of disease was 32 years (range 10-47). Charcot-Marie-Tooth-like patients were more disabled and disability correlated with age. On muscle MRI, thenar eminence, soleus and tibialis anterior were most frequently involved, irrespective of clinical phenotype. MRI Composite Score was strongly correlated with disability.

CONCLUSION

Patients with the p.N88S BSCL2 gene mutation are phenotypically variable, although dHMN is most frequent and generally slowly progressive. Muscle MRI pattern is consistent regardless of phenotype and correlates with disease severity, probably serving as a reliable outcome measure for future clinical trials.

Norway rat (Rattus norvegicus) ectoparasites in livestock production systems from central Argentina: Influencing factors on parasitism

Haematophagous ectoparasites are worldwide vectors of many zoonotic bacterial diseases, both emerging and re-emerging, whose incidences are rising. Livestock development alters different environmental characteristics such as the microclimate of a site, changing the availability, density and susceptibility of the hosts to pathogens and vectors, indirectly influencing the spread and persistence of a disease within an ecosystem. The Norway rat (Rattus norvegicus), the most abundant vertebrate pest species found on livestock farms from Argentina, is a reservoir for several important zoonotic bacteria and may harbor ectoparasite species, which act as their vectors. Even though the Norway rat is widely known for its role as an ectoparasite host, the ecological characteristics of their ectoparasite communities and the related factors with parasitism on livestock farms have never been described. In the present study, we describe the ectoparasite community in Norway rats from central Argentina livestock farms, while also depicting the influencing factors on both ectoparasite occurrence and abundance. Ectoparasites were collected from rats captured in 20 sites from Buenos Aires province, between the winter of 2016 and the summer of 2018. A total of 1441 ectoparasite individuals were collected from 159 Norway rat individuals [Total ectoparasite prevalence = 69.2%; Mean ectoparasite specimen abundance (± CI) = 9.06 ± 2.32 ectoparasite individuals per rat; Mean ectoparasite specimen intensity (±CI) = 13.10 ± 3.08 ectoparasite individuals per infested rat found]. Ectoparasite assemblage consisted of four cosmopolitan species, recognized for their sanitary relevance: mites (Laelapidae: Laelaps nuttalli and Laelaps echidninus), lice (Polyplacidae: Polyplax spinulosa) and fleas (Pulicidae: Xenopsylla cheopis). We observed higher Norway rat abundance in sites related to higher ectoparasite occurrence and abundance frequencies on the rats. Additionally, ectoparasites were more abundant on rats in warm seasons and on male individuals, over female rats. Moreover, the geographical location of the studied sites influenced the ectoparasite assemblage structure observed on the rats. This study broadens the knowledge on the role of Norway rats as zoonotic ectoparasites hosts and analyzes the drivers influencing ectoparasite occurrence and abundance on the most populated region of Argentina, which is also the region with the most intensive livestock farming. Therefore, this survey may assist in evaluating potential risks for humans and generate effective sanitary control strategies for ectoparasite-borne infectious diseases.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

P1948Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017

Purpose

To assess SEP inequalities in hypertension prevalence and management in Chilean adults.

Methods

Data came from the Chilean National Health Surveys (ENS) 2003, 2010 and 2017. Years of formal education was used as the SEP measure. Age-and gender-specific Slope and Relative Indices of Inequalities (SII and RII) were calculated for the prevalence of hypertension (mean SBP ≥140mmHg, DBP ≥90mmHg, or current medication use to lower blood pressure) and for each management outcome.

Results

Analytical sample comprised 3,426; 4,838 and 5,373 participants aged ≥17y with blood pressure measurements for years 2003, 2010 and 2017, respectively. Prevalence of hypertension was 32.4%, 32.2% and 30.8% for the years 2003, 2010 and 2017, respectively. According to the SII and RII, males and females aged <65y showed higher hypertension prevalence among those with fewer years of education in 2003, 2010 and 2017. Among those classed as hypertensive, levels of awareness increased from 59.4% in 2003 to 65.9% in 2017. Over the same time period, levels of treatment increased from 39.0% to 65.2%, and levels of control increased from 14.1% to 23.9%. SEP inequalities in hypertension management – with better outcomes for the most educated – were highest among females aged ≥65y.

Conclusion

Introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise of hypertension management levels since 2003. According to local and international strategies for the prevention and control of noncommunicable diseases, there is room for improvement. However, improvements should have a specific focus on SEP inequalities.

Acknowledgement/Funding

Chilean Ministry of Health

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

CALCA and TRPV1 genes polymorphisms are related to a good outcome in female chronic migraine patients treated with OnabotulinumtoxinA

Background

Some variables have been proposed as predictors of efficacy of OnabotulinumtoxinA in chronic migraine patients, but data available are inconclusive. We aimed to analyse the influence of single nucleotide polymorphisms in the response to OnabotulinumtoxinA.

Methods

We included 156 female patients treated with OnabotulinumtoxinA accordingly to PREEMPT paradigm in three headache units. OnabotulinumtoxinA was offered to patients that had not responded to topiramate and at least one other preventative. Age at first procedure was 43.7 ± 11.8 years (16–74). Patients with a reduction of at least 50% in the number of migraine days after two OnabotulinumtoxinA procedures were considered as responders. We analysed 25 polymorphisms selected for their relevance regarding migraine pathophysiology and their association with migraine according to previously published genome-wide association studies. Genotyping was performed using KASP probes and a LightCycler-480 (Roche-Diagnostics). Allelic, genotypic frequencies and dominance/recesivity hypothesis of the allelic variants were compared between responders and non-responders by Fisher’s exact test.

Results

Response to treatment with OnabotulinumtoxinA was achieved in 120 patients (76,9%). Two polymorphisms showed differences: CALCA rs3781719, where allele C represents 26.9% in responders and 40.9% in non-responders (p = 0.007, OR = 3.11 (1.33–7.26)); and TRPV1 rs222749, where allele A represents 4.17% in responders and 12.5% in non-responders (p = 0.013, OR = 3.29 (1.28–8.43)). No significant differences in rest of polymorphisms or clinical or demographic variables were found.

Conclusions

Polymorphic variations of CALCA and TRPV1 genes might play a role as prognostic markers of efficacy of OnabotulinumtoxinA in chronic migraine female patients in our population.

TGFβi is involved in the chondrogenic differentiation of mesenchymal stem cells and is dysregulated in osteoarthritis

OBJECTIVE

Transforming growth factor-β (TGFβ) is a major regulator of cartilage homeostasis and its deregulation has been associated with osteoarthritis (OA). Deregulation of the TGFβ pathway in mesenchymal stem cells (MSCs) has been proposed to be at the onset of OA. Using a secretome analysis, we identified a member of the TGFβ family, TGFβ-induced protein (TGFβi or βIGH3), expressed in MSCs and we investigated its function and regulation during OA.

DESIGN

Cartilage, bone, synovium, infrapatellar fat pad and bone marrow-MSCs were isolated from patients with OA or healthy subjects. Chondrogenesis of BM-MSCs was induced by TGFβ3 in micropellet culture. Expression of TGFβi was quantified by RT-qPCR, ELISA or immunohistochemistry. Role of TGFβi was investigated in gain and loss of function experiments in BM-MSCs and chondrocytes.

RESULTS

TGFβi was up-regulated in early stages of chondrogenesis and its knock-down in BM-MSCs resulted in the down-regulation of mature and hypertrophic chondrocyte markers. It likely occurred through the modulation of adhesion molecules including integrin (ITG)β1, ITGβ5 and N-cadherin. We also showed that TGFβi was upregulated in vitro in a model of OA chondrocytes, and its silencing enhanced the hypertrophic marker type X collagen. In addition, TGFβi was up-regulated in bone and cartilage from OA patients while its expression was reduced in BM-MSCs. Similar findings were observed in a murine model of OA.

CONCLUSIONS

Our results revealed a dual role of TGFβi during chondrogenesis and pointed its deregulation in OA joint tissues. Modulating TGFβi in BM-MSCs might be of interest in cartilage regenerative medicine.

Weaning practices in phenylketonuria vary between health professionals in Europe

Background

In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe.

Methods

A cross sectional questionnaire (survey monkey®) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis.

Results

Weaning started at 17–26 weeks in 85% (n = 81/95) of centres, >26 weeks in 12% (n = 11/95) and < 17 weeks in 3% (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51% (n = 48/95) of centres introduced Phe containing foods at 17–26 weeks and 48% (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59%, n = 56/95) and fruit (34%, n = 32/95).

A Phe exchange system to allocate dietary Phe was used by 52% (n = 49/95) of centres predominantly from Northern and Southern Europe and 48% (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods.

A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41% (n = 39/95) of centres at infant age 26–36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37% (n = 35/95) at infant age > 1y mainly from Southern Europe. 53% (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form.

Conclusions

Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Early feeding practices in infants with phenylketonuria across Europe

Background

In infants with phenylketonuria (PKU), dietary management is based on lowering and titrating phenylalanine (Phe) intake from breast milk or standard infant formula in combination with a Phe-free infant formula in order to maintain blood Phe levels within target range. Professionals use different methods to feed infants with PKU and our survey aimed to document practices across Europe.

Methods

We sent a cross sectional, survey monkey® questionnaire to European health professionals working in IMD. It contained 31 open and multiple-choice questions. The results were analysed according to different geographical regions.

Results

Ninety-five centres from 21 countries responded. Over 60% of centres commenced diet in infants by age 10 days, with 58% of centres implementing newborn screening by day 3 post birth. At diagnosis, infant hospital admission occurred in 61% of metabolic centres, mainly in Eastern, Western and Southern Europe. Breastfeeding fell sharply following diagnosis with only 30% of women still breast feeding at 6 months.

53% of centres gave pre-measured Phe-free infant formula before each breast feed and 23% alternated breast feeds with Phe-free infant formula. With standard infant formula feeds, measured amounts were followed by Phe-free infant formula to satiety in 37% of centres (n = 35/95), whereas 44% (n = 42/95) advised mixing both formulas together. Weaning commenced between 17 and 26 weeks in 85% centres, ≥26 weeks in 12% and < 17 weeks in 3%.

Discussion

This is the largest European survey completed on PKU infant feeding practices. It is evident that practices varied widely across Europe, and the practicalities of infant feeding in PKU received little focus in the PKU European Guidelines (2017). There are few reports comparing different feeding techniques with blood Phe control, Phe fluctuations and growth. Controlled prospective studies are necessary to assess how different infant feeding practices may influence longer term feeding development.

Old-Fashioned Responses in an Updating Memory Task

Errors in a running memory task are analysed. Participants were presented with a variable-length list of items and were asked to report the last four items. It has been proposed (Morris & Jones, 1990) that this task requires two mechanisms: the temporal storage of the target set by the articulatory loop and its updating by the central executive. Two implicit assumptions in this proposal are (a) the preservation of serial order, and (b) participants’ capacity to discard earlier items from the target subset as list presentation is running, and new items are appended. Order preservation within the updated target list and the inhibition of the outdated list items should imply a relatively higher rate of location errors for items from the medial positions of the target list and a lower rate of intrusion errors from the outdated and inhibited items from the pretarget positions. Contrary to these expectations, for both consonants (Experiment 1) and words (Experiment 2) we found recency effects and a relatively high rate of intrusions from the final pretarget positions, most of them from the very last. Similar effects were apparent with the embedded four-item lists for catch trials. These results are clearly at odds with the presumed updating by the central executive.

Differences in performance in CAMCOG-R domains between old and oldest old patients with Alzheimer's disease

The purpose of this study is to evaluate the neuropsychological performance in a ≥90-year-old population with Alzheimer disease (AD) in comparison with younger elderly patients. We retrospectively studied all patients with AD attended in a specialized clinic between 1999 and 2011. Age, sex, educational level, and sensory loss data were collected. Neuropsychological evaluation included Mini-Mental State Examination and Global Deterioration Scale. We used the eight Cambridge Cognitive Assessment (CAMCOG-R) domains to evaluate and compare the neuropsychological performance in the younger than 90 years old (<90) and older than 90 years old (≥90) groups. We selected 2931 patients, 2897 <90 (98.83%) and 34 ≥90 years old (1.17%). The ≥90 group had significant lower punctuations in memory, praxis, and abstract thinking CAMOCG-R domains with 1.49, 0.75, and 0.58 less points, respectively, (p < 0.05). Neuropsychological characteristics of cognitive decline seem to be different in ≥90 compared to <90 years old patients. According to age, the biggest differences in the CAMCOG-R performance are in the memory, praxis, and abstract thinking domains.