Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors

Identification of risk factors influencing the duration of carriage of multidrug-resistant Gram-negative bacilli (MDR-GNB) may be useful for infection control. The aim of this study is to estimate the impact of several factors collected for routine hospital surveillance on the duration of carriage of selected MDR-GNB. From January 2015 to July 2021, patients with at least two clinical/surveillance samples positive for MDR-GNB different from ESBL-producing E. coli or AmpC - exclusively producing Enterobacterales were assessed. Microorganisms, age, number of admissions, clinical or rectal sample, sex, and admission service were evaluated as risk factors. Multivariate analysis was performed by a Cox proportional hazard model. A total of 1981 episodes of colonization were included. Involved microorganisms were ESBL-Klebsiella pneumoniae (KP) in 1057 cases (53.4%), other ESBL-non-E. coli Enterobacterales in 91 (4.6%), OXA-48-KP in 263 (13.3%), KPC-KP in 90 (4.5%), VIM-KP in 29 (1.5%), carbapenemase-producing non-KP Enterobacterales (CP-non-KP) in 124 (6.3%), and MDR Pseudomonas aeruginosa (MDR-PAER) in 327 (16.5%). No differences in duration of colonization were observed among ESBL-KP (median colonization time 320 days), ESBL-non-E. coli Enterobacterales (226 days), OXA48-KP (305 days), and MDR-PAER (321 days). For each group, duration of colonization was significantly longer than that of KPC-KP (median colonization time 60 days), VIM-KP (138 days), and CP-non-KP (71 days). Male sex (HR = 0.88; 95% CI 0.78-0.99), detection in Hepatology-Gastroenterology (HR = 0.71; 95% CI 0.54-0.93), clinical sample (HR = 0.61; 95% CI 0.53-0.69), and > 2 admissions after first detection (HR = 0.47; 95% CI 0.42-0.52) were independent predictors of longer carriage, whereas VIM-KP (HR = 1.61; 95% CI 1.04-2.48), KPC-KP (HR = 1.85; 95% CI 1.49-2.3), and CP-non-KP (HR = 1.92; 95% CI 1.49-2.47) were associated with shorter colonization time. Duration of colonization was significantly longer for ESBL-KP, other ESBL-non-E. coli Enterobacterales, OXA-48-KP, and MDR-PAER. For these microorganisms, prolonging surveillance up to 2.5-3 years should be considered. Male sex, clinical sample, multiple readmissions, admission service, and type of microorganism are independent predictors of the duration of carriage.

Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE

OBJECTIVES

This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress.

METHOD

Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared.

RESULTS

A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424).

CONCLUSION

The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.

POS0749 ASSOCIATION BETWEEN IMMUNE-SEROLOGICAL PROFILE AND PULMONARY MANIFESTATIONS IN COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (LES)

Background:

Pulmonary involvement is common in Systemic Lupus Erythematosus (SLE) patients with varying degrees of parenchymal, vascular, and pleural compromise. In GLADEL, pulmonary involvement was reported in 28.4% of the cohort, but its occurrence ranges between 30-90% due to diversity in populations and the methods used to define it.

Objectives:

To describe the immune-serological profile of a Colombian cohort of SLE patients and to establish its association with pulmonary manifestations.

Methods:

Retrospective analysis of observational data from the follow-up of a cohort of adult patients with SLE. We included 559 patients that fulfilled the SLICC 2012 classification criteria with at least 6 months of disease history and being treated in a rheumatology specialized medical center between 2015 and 2018. The immuno-serological profile was characterized, and pulmonary involvement was monitored for 1 year. Diagnosis of pulmonary involvement was performed with the rheumatologist report in the clinical chart. Prevalence of pulmonary manifestations and immune-serological profile was determined, and logistic regression was performed afterward adjusted by age, sex, and level of education to establish the association between pulmonary manifestations and a positive auto-antibodies profile.

Results:

The median age of the cohort was 45 years, 96.5% were female. Pulmonary involvement was documented in 113 patients (20.5%) at the beginning of the study. Their frequency was: pleuritis (14.3%), lupus pneumonitis (3.6%), pulmonary hypertension (3.2%), interstitial lung disease (ILD) (2.3%), pulmonary embolism (2.3%), lung fibrosis (2.14%), alveolar hemorrhage (1.4%), shrinking lung (0.2%). At 1 year of follow up. there were no statistically significant differences in the frequency of pulmonary manifestations. As for the immune-serological profile, there were positive ANA in 92%, anti-dsDNA in 53.1%, anti-B2GP IgM 15.2%, anti- B2GP IgG in 17.2%, and ENA in 97.2%; as for the ENA 41.7% had positive anti-RNP, 40.2% anti-Ro, 36.4% anti-SM and 16.5% anti-La. Low complement levels was characterized as follows: C3 53.1% and C4 29.2%. In the logistic regression adjusted by age, sex and level of education, there was an association between anti-SM and pulmonary manifestations with an adjusted OR of 1.85; 95% CI 1.13-3.01.

Conclusion:

An association between anti-SM positivity and pleuro-pulmonary manifestations was found. In other cohorts with a greater size, anti-La and anti-RNP have been associated with pulmonary involvement (OR 2.51; 95% CI 1.39-4.57 and OR 1.32; 95% CI 1-1.75 respectively). Anti-RNP positivity has been associated in particular with ILD, pulmonary hypertension and shrinking lung. Although these manifestations prevalence was similar in our cohort, an association with this antibody was not found (OR 1.01, 95% CI: 0.2-4.9). This could be explained by the smaller sample size. As for anti-La positivity, its prevalence in our cohort was less than what was found in the GLADEL cohort (16.5% vs 24.3% respectively). It is possible that this could explain the poor association between anti-La positivity with the presence of pulmonary manifestations in our study compared with those of the GLADEL cohort. There are data that indicates that anti-SM and anti-RNP simultaneous positivity is related mainly to pleuritis OR 1.98 (95% CI: 1.31-3); and this kind of involvement was found to be more frequent in our study. Our results suggest an association between positive anti-SM and pulmonary manifestations in Colombian patients with SLE, pleuritis in particular.

References:

[1]Haye Salinas MJ, Caeiro F, Saurit V et al. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus. 2017;26(13):1368–77.

[2]Emad Y, Gheita T, Darweesh H, Klooster P, et al. Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: Correlations with clinical manifestations and disease activity. Reumatismo. 2018;70(2):85–91.

Disclosure of Interests:

None declared

AB0336 PULMONARY MANIFESTATIONS IN A COLOMBIAN COHORT OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Pulmonary manifestations are frequent in systemic lupus erythematosus (SLE) with a frequency of 30-90% that depends on the cohort and the methods used for their identification. The association of this compromise with mortality highlights its importance and the need for biomarkers to adequately predict this complication. We describe the prevalence of pulmonary manifestations, and the clinic and immunoserological characteristics of 551 Colombian patients with SLE

Objectives:

We performed an observational and analytic study of a retrospective cohort with adult SLE patients who fulfilled the 2012 SLICC classification criteria and that had a history of at least 6 months of the disease. These patients were treated in a specialized center of rheumatology with presence in six cities of Colombia between 2015 and 2018. We excluded pregnant patients and those with incomplete data for our survey. The first clinic consult occurred between 2015 and 2018, being defined as moment one. The follow up one year later was defined as moment two. We obtained 710 registries that were potentially eligible and analyzed 465 patients at moment two after applying the exclusion criteria

Methods:

In 465 eligible patients, 20,5% had pulmonary compromise (93.8% female) with a median age of 42,4 years. The average SLICC Damage Index of 551 patients with SLE was 0,9 in women and 1.05 in men, while the average SDI of patients with pulmonary compromise was 1. The most frequent manifestation was pleural (14.3%), followed by Lupus pneumonitis (3.6%) and pulmonary hypertension (3.2%). Other manifestations and serological characteristics are recorded in Table 1. Of note, ANA homogeneous pattern was the most common (34.5%), anti-RNP positivity was 41.7%, anti-dsDNA positivity was 53.1% and 53.1% had hypocomplementemia.

Results:

The prevalence of pulmonary manifestations in our cohort was 20,5%, which is lower that in the previous described GLADEL cohort (28,4%). This could be explained by the regional differences of ethnicities in Latin America and in immune-serological profiles. Anti-RNP positivity was frequent (41.7%) and new pulmonary compromise for one year follow-up was rare. Of not, the mean damage index for our patients with pulmonary manifestations was 1, this could highlight the importance of this organ as a causa of higher damage accrual and mortality, which we will explore in the future

Conclusion:

The prevalence of pulmonary manifestations in our cohort was 20,5%, which is lower that in the previous described GLADEL cohort (28,4%). This could be explained by the regional differences of ethnicities in Latin America and in immune-serological profiles. Anti-RNP positivity was frequent (41.7%) and new pulmonary compromise for one year follow-up was rare. Of not, the mean damage index for our patients with pulmonary manifestations was 1, this could highlight the importance of this organ as a causa of higher damage accrual and mortality, which we will explore in the future

References:

[1]G. Aguilera-Pickens, C. Abud-Mendoza. Pulmonary Manifestations in Systemic Lupus Erythematosus: Pleural Involvement, Acute Pneumonitis, Chronic Interstitial Lung Disease and Diffuse Alveolar Hemorrhage. Reumatol Clin. 2018;14(5):294–300.

[2]Haye Salinas MJ, Caeiro F, Saurit V. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus (2017) 0, 1–10.

[3]Santamaria-Alza Y, Sanchez-Bautista J, Fajardo-Rivero J. Acute respiratory involvement in Colombian patients with systemic lupus erythematosus undergoing chest computed tomography. Int J Rheum Dis. 2019;00:1–7.

Table 1.

clinical and immunoserological characteristics

n%Women10693,8Global mortality468,3Pulmonary compromise mortality87,1ANA10492Anti-DNA6053,1ENAS97,2Ro35/8740,2La14/8516,5SM32/8836,4RNP35/8441,7Follow up 1 %Follow up 2 %P Value *Pulmonary hypertension3,22,80,28Pulmonary fibrosis2,142,61Shrunken lung0,20,21Pleuritis14,315,050,42Lupus pneumonitis3,63,010,85Alveolar hemorrhage1,41,30,76Pulmonary embolism2,31,930,72

Disclosure of Interests:

None declared

AB0351 PROGRESSION TO SEVERE LUPUS NEPHRITIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOUS: UPDATE FROM A COLOMBIAN COHORT

Background:

Continuous monitoring of patients with Systemic lupus erythematosus (SLE) provides relevant information

Objectives:

To update the analysis of clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed from January 2015 to October 2020

Methods:

A retrospective follow-up study based on clinical records. Patients with SLE diagnosis fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with the diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The primary outcome was defined as the time from diagnosis to severe renal involvement defined as creatinine clearance ≤50ml/min, 24-hour proteinuria ≥3.5 grams o end-stage renal disease. Updated age and sex-adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values <0.05 were considered statistically significant. Descriptive statistics were previously reported in EULAR 2020 (1)

Results:

548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 25 were interval censored as outcome occurred between study visits (19 new events), and 456 were right-censored as involvement was not registered during follow-up. In this cohort update Age and sex-adjusted Hazard Ratios for high blood pressure were HR = 3.1 (95%CI 1.5-6.3; p-value = 0.003) and Anti-RO (per unit increase) HR = 1.003 (95%CI 1.001-1.005; p-value = 0.029). Figure 1 shows the updated age and sex-adjusted survival function

Conclusion:

In this cohort update, we found similar clinical and immunological characteristics associated with time to severe renal involvement in SLE patients to those reported in (1). However, continuous follow-up allows us to deepen our understanding of the progression to severe renal involvement in SLE patients

References:

[1]Herrera S, Diaz-Coronado JC, Rojas-Gualdrón D, Betancur-Vasquez L, Gonzalez-Hurtado D, Gonzalez-Arango J, et al. SAT0210 factors associated with time to severe lupus nephritis in a cohort of colombian patients. Ann Rheum Dis. junio de 2020;79(Suppl 1):1048.2-1048

Disclosure of Interests:

None declared

AB0335 SURVIVAL ASSESSMENT IN PATIENTS WITH SLE AND PULMONARY MANIFESTATIONS IN A COLOMBIAN COHORT WITH 2-YEAR FOLLOW-UP

Background:

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with heterogenous and variable behavior. The frequency of pulmonary involvement ranges from 10-90%, with this variability in occurrence attributed to differences in populations and heterogeneity in detection methods and study designs.

Objectives:

To analyze survival in patients with SLE and the presence of pulmonary manifestations according to clinical and demographic characteristics in a cohort of patients in Colombia

Methods:

Observational-analytical, retrospective, follow-up study of a cohort of adult patients with SLE. We included 559 adult patients who fulfilled the 2012 SLICC SLE classification criteria and with at least 6 months of disease evolution, treated in a medical center specialized in rheumatology with locations in 6 cities in Colombia between 2015 and 2018. Pregnant patients and those who had incomplete data or visits were excluded. Immunoserological profile was characterized and pulmonary involvement was followed for 1 year. The diagnosis of pulmonary involvement was obtained from the rheumatology report in the clinical chart. The prevalence of pulmonary manifestations and the immunoserological profile were determined and subsequently a logistic regression adjusted for age, sex and level of education was performed to establish the association between pulmonary manifestations and a positive autoantibody profile

Results:

Median age was 44.5 ± 14 years, 96.6% were women. In patients with pulmonary compromise 9.7% were smokers, 12.4% had an active alcohol intake, 58.4% had a low socioeconomic status, 38.1% medium and 4.7% high. Pulmonary involvement was present in 20% of patients, the most common manifestations were pleuritis (14.3%), lupus pneumonitis (3.6%), pulmonary hypertension (3.2%), interstitial lung disease (2.3%), pulmonary embolism (2.3%), pulmonary fibrosis (2.14%), alveolar hemorrhage (1.4%), shrinking lung (0.2%). there was no significant difference in the follow up at one year. Immunoserological characteristics shows ANA positivity in 92%, anti-DNA in 53%, ENAS in 97%, with anti-RNP being the most common (41.7%), and low complement levels in 53%. Mortality for pulmonary compromise was 1.4%, and survival at 2 years did not have a statistically significant difference (p=0.155)

Conclusion:

Survival was not found to be lower in patients with SLE and pulmonary involvement (p=0.155) when compared to SLE patients without pulmonary involvement after 2-year follow-up. This finding was independent of age, gender, and educational level. Previous large cohorts like GLADEL and RELESSER describe an association between pulmonary involvement and lower survival HR 2,79 (95% CI: 1,80-4,31), p <0,001 and HR 3.13, (95% IC: 1.56– 6.28, P = 0.00 respectively. In the RELESSER cohort pleural involvement and pulmonary embolism was found to have low to minimal impact on survival.

In our cohort pleuritis was the most common finding whereas the other pulmonary manifestations were reported in less than 4% of patients. This difference could explain our differences with other cohorts. Other causes for this difference are a smaller sample size and a short follow-up.

The results of our study do not suggest that there is an association between pulmonary involvement and mortality in Colombian patients with SLE during a 2-year follow-up. We will continue to monitor and report in this regard

References:

[1]Narváez J, Borrell H, Sánchez-Alonso F, Rúa-Figueroa I, López-Longo FJ, Galindo-Izquierdo M, et al. Primary respiratory disease in patients with systemic lupus erythematosus. (RELESSER) cohort. Arthritis Res Ther. 2018;20(1):1–10.

[2]Keane MP, Lynch JP. Pleuropulmonary manifestations of systemic lupus erythematosus. Vol. 55, Thorax. Thorax; 2000. p. 159–66.

[3]Haye Salinas MJ, Caeiro F, Saurit V, Alvarellos A, Wojdyla D, Scherbarth HR, et al. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus. 2017;26(13):1368–77

Disclosure of Interests:

None declared

SAT0210 FACTORS ASSOCIATED WITH TIME TO SEVERE LUPUS NEPHRITIS IN A COHORT OF COLOMBIAN PATIENTS

Background:

Systemic lupus erythematosus (SLE) clinical manifestations, and their severity, vary according to age, ethnicity and socioeconomic status. Both Hispanic and Afro-Americans have a higher incidence and more sever presentation when compared to Caucasian patients with SLE

Objectives:

To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018

Methods:

Retrospective follow-up study based in clinical records. Patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The main outcome was defined as time from diagnosis to sever renal involvement defined as creatinine clearance ≤50 ml/min, 24-hour proteinuria ≥3.5 grams o end stage renal disease.

We analyzed clinical and immunological characteristics. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges (IQR) for quantitative variables. Age and sex adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models por interval-censored data. P values < 0.05 were considered statistically significant

Results:

548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 6 were interval censored as outcome occurred between study visits, and 475 were right-censored as involvement was not registered during follow-up. 529 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.5 (IQR = 20.6). 67% were mestizo, 13% Caucasian and 0.3% Afro-Colombian. Age and sex adjusted variables associated with time to severe lupus nephritis were high blood pressure HR = 3.5 (95%CI 2.2-5.6; p-value <0.001) and Anti-RO (per unit increase) HR = 1.002 (95%CI 1.001-1.004; p-value = 0.04). Figure 1 shows age and sex adjusted survival function.

Conclusion:

In our cohort the appearance of severe lupus nephritis occurs in less than 15% of patients at 10 years. Both high blood pressure and elevated anti-Ro titers were associated with a higher rate of onset in the presentation of severe lupus nephritis, as seen in some polymorphs of anti Ro.

References:

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Lopez: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ana Sierra: None declared, Deicy Hernandez-Parra: None declared, Ricardo Pineda.Tamayo: None declared

THU0269 CLINICAL COMPARISON OF NEW CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A COLOMBIAN COHORT

Background:

Due to heterogeneity of the disease, there has been several classification criteria for Systemic Lupus Erythematosus (SLE). These have considered the knowledge obtained through the years and have strived for increased sensibility and specificity. Recently, both EULAR and ACR have proposed new criteria for disease classification that mandate a positive ANA result to apply the criteria.

Objectives:

To compare the 2019 EULAR/ACR classification criteria (1) with the Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria (2) and the American College of Rheumatology (ACR) 1997 classification criteria in a Colombian cohort (3).

Methods:

A cross-section retrospective study was done with data collected between 2014 and 2018 from a population diagnosed with SLE by a group of rheumatology in an autoimmunity referral centre and followed for one year. The new 2019 EULAR/ACR classification criteria were applied to the information collected from the clinical records. Three sets of criteria were compared using Cohen´s kappa coefficient and concordance was evaluated

Results:

We obtained information for 480 patients, in this analysis were mostly females (96%). Anti-nuclear antibody (ANA) results were available for 95% of the patients. According to SLICC classification criteria the diagnosis of SLE was definite in 92% of patients, 81% by ACR 1997 and 89% using ACR/EULAR 2019. The sensibility was 93% and 97% for ACR/EULAR 2019 and SLICC 2012, and the specificity was 67% and 48% respectively. The concordance analysis between the two sets of criteria showed agreement of 92% (kappa 0.52 p <0.001) in the whole group.

Conclusion:

We found good agreement between SLICC 2012 criteria and EULAR/ACR 2019 classification criteria. In contrast with previous studies, where the new criteria had a sensitivity of 96.1% and specificity of 93.4%, in our cohort the sensitivity was maintained in 93% but the specificity decreased to 67%. A possible explanation could be the ANA negativity that was seen in 5% of the patients and would force to discard patients with false negative results. Despite this, the agreement of the criteria is good and should continue to be applied in our population, without abandoning the expert’s clinical criteria.

References:

[1]Aringer M, Costenbader K, Daikh D, et al. 2019 European League against Rheumatism/American College of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis2019;78:1151–9

[2]Petri M, Orbai A-M, Alarcón GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum2012;64:2677–86.

[3]Hochberg MC. Updating the American College of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997;40:1725.

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Yecenia Durango-Durango: None declared, Carolina Perez-Rios: None declared, Marcela Posada-Velásquez: None declared, Jennifer Rojas-Londoño: None declared, Manuela Vallejo-Patiño: None declared, Katherine Marín: None declared, Carlos Guerrero-Calderón: None declared, Sara jaramillo: None declared, Veronica Usuga-Graciano: None declared, Martha Isabel López-Flórez: None declared, Camilo Restrepo-Raigosa: None declared, Juan Pablo Restrepo-Hincapié: None declared, Catalina Carvajal-Naranjo: None declared, Sarita Restrepo-Upegui: None declared, Ricardo Pineda.Tamayo: None declared

AB0997 IS HEIGHT ADJUSTMENT NECESSARY IN PEDIATRIC DENSITOMETRY IN ALL CHILDREN?

Background:

The current guidelines of the International Society for Clinical Densitometry (1) recommend that in children with linear growth or maturational delay, Z score results should be adjusted. Height for age Z score (HAZ) adjustment is valid and can be calculated using the formula the formula proposed by Zemmel et al(2).

It is possible that pediatric populations without linear growth or maturational delay, also benefit from HAZ, to prevent bone size from influencing the final Z score.

Objectives:

To evaluate Z score variability adjusted and without adjusting for height for age.

Methods:

We analysed data from densitometry performed on patients 2-20 years of age, from 2016 to 2018, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for low bone mass/osteoporosis. The HAZ was calculated according to Zemel’s formula.

Results:

Data from 103 patients are presented. Its characteristics are summarized in Table 1

Table 1.Mean age9,8 yearsFemale52,4%Height Percentil ≤ 36,8%Height Percentil ≥ 974,9%LBM (Z score ≤ -2) spine8,2%LBM HAZ spine6,4%LBM whole body10,5%LBM HAZ whole body7,2%

The table shows that the proportion of patients with BMD decreases in both the spine region and the whole body when adjusting for HAZ.

When evaluating the relationship between densitometric measurements we found that spine Z score (ZsS) and whole body Z score (ZsWB) had a correlation coefficient of 0,73 (p<0,001). There were no differences between their averages (p=0,170).

At the LBM cut-off point (Z score ≤ -2) there were discrepancies in 7%, where 5% presented LBM in ZsWB but not in ZsS. The concordance index at this point was 0,557.

When comparing these measures with their HAZ adjusted equivalents, we observe:

Conclusion:

There are discrepancies at the LBM cut-off point depending on the HAZ adjustment.

The pediatric population without linear growth or maturational delay, can also benefit from HAZ adjustment, especially those with high height percentiles in which their size can hide a diagnosis of LBM.

References:

[1]Weber DR, Boyce A, Gordon C, Hogler W, Kecskemethy HH, Misra M, et al. The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2019;22(4):567-89.

[2]Zemel BS, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield S, et al. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. The Journal of clinical endocrinology and metabolism. 2010;95(3):1265-73.

Disclosure of Interests:

None declared

SAT0463 SEVERE OSTEOPOROSIS IN COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Osteoporosis predominantly affects post-menopausal women. There is an important percentage of the population that have additional risk factors that decrease bone mineral density. Patients with Systemic Lupus Erythematosus (SLE) have an increased risk for osteoporosis due to corticosteroid use and chronic inflammation. This population could have a higher prevalence of osteoporosis when compared to post-menopausal women of equal or older age. There is a paucity of information regarding bone mineral density and SLE in Latin America.

Objectives:

To describe the prevalence and incidence of osteoporosis and osteoporotic fractures in a Colombian population with Systemic Lupus Erythematosus

Methods:

We collected 464 clinical records of patients who met either the American College of Rheumatology 1997 or Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria for systemic lupus erythematosus between January 2015 and June 2019. The clinical and immunoserological characteristics, and damage accrual were monitored for one year. The diagnosis of osteoporosis was confirmed with densitometry by energy x-ray absorptiometry (DXA) and the presence of fragility fractures according to the rheumatologist’s report in the clinical history. The description of proportions and incidence rate of osteoporosis and fragility fracture is performed.

Results:

The mean age was 45 years, 96.5% were women and the mean disease duration was 12 years. Others clinical characteristics in table 1. The prevalence of osteoporosis was 13.8% with an incidence of 1.1 fractures / 100 person-months in the general population with SLE. In postmenopausal women, over 50 years the prevalence of osteoporosis was 28.4% with an incidence of 0.8 fractures / 100 months person. In the densitometric characteristics, the mean bone mineral density was 0.772 gr / cm2, T-score spine -2.9 and T-score femoral -2.6. SLEDAI mean 1.5 (SD 2.92) and SLICC mean 1.

Table 1.

clinical characteristics

n%Active Smoking8317.9Premature gonadal failure81.7Lupic Nephritis17838.4Proteinuria >2.5grams/24hours347.3End Stage Renal Disease163.4Anti-dsDNA14631.4Anti-Sm11023.7Anti-Ro13829.7Prednisone Cumulative Dose2.8grAntimalarial5712

Conclusion:

Low bone mineral density and severe osteoporosis are prevalent in our cohort with SLE. We have found a fracture rate of 1080 per 100.000 people, which is well over what has been reported in the general population (53-443 per 100.000 people in women). Osteoporotic fractures are part of damage accrual and thus have an association with morbidity and mortality. Data regarding osteoporotic fractures are necessary in order to develop guidance and health policy in the region. SLE is an important risk factor for severe osteoporosis and must be kept in mind when developing guidance and health policy

References:

[1]Jumei Xia, Ran Luo, Shuiming Guo, et al. Prevalence and Risk Factors of Reduced Bone Mineral Density in Systemic Lupus Erythematosus Patients: A Meta-Analysis. BioMed Research International. Volume 2019, Article ID 3731648, 10 pages.

[2]Irene E.M. Bultinka, Willem F. Lemsa. Lupus and fractures. Curr Opin Rheumatol 2016, 28:426–432.

Disclosure of Interests:

Juan camilo Diaz-Coronado: None declared, Sebastian Herrera Speakers bureau: academic conference, Deicy Hernandez-Parra: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Sebastian Guerra-Zarama: None declared, Santiago Monsalve: None declared, Jose David Serna Giraldo: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ricardo Pineda.Tamayo: None declared

AB0998 TRABECULAR BONE SCORE IN PEDIATRICS, IS IT USEFUL?

Background:

Bone fragility depends not only on bone mineral density (BMD), but also on bone microarchitecture. In adults, Trabecular Bone Score (TBS) is being used as an indirect marker of bone microarchitecture

It is a software that applicated to the vertebral image obtained by conventional densitometry, informs about the thickness of the trabeculae, the trabecular connectivity and the space between them. A high score indicates a better bone microstructure. In adults, a TBS equal to or greater than 1,350 is considered to represent a normal microarchitecture

Objectives:

To evaluate the usefulness of TBS in pediatric population with risk factors for Low Bone Mass (LBM)

Methods:

TBS was assessed by analyzing vertebral densitometries performed on patients from 4 to 20 years of age, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for LBM, consecutively from 2016 until 2018

Data were compared with normal pediatric population

Results:

Data from 83 patients are shown, with an average age of 11.2 years, 62% female, 80% Caucasian

The main risk factors for LBM were (%): Insufficient calcium intake (84,5), medications with osteopenizing potential (31), corticosteroids (39), sedentary lifestyle (13,6), fractures of long or vertebral bones (12,6) and hypovitaminosis D (8,1)

Table 1.

TBS por age groups and in patients with and without LBM

Age groupsnMeanSDMinimum-MaximumScholars (4-9a)221,3210,0931,119-1,502Adolescence (10-17a)541,3090,0881,073-1,493Youth (18-20a)61,3590,0851,258-1,460Spine Z scorenMean (SD)pMinimum-Maximum ≤-281,270 (0,075)0,1261,419-1,162 >-2741,321 (0,090)1,502-1,073Whole Body Z score ≤-291,246 (0,060)0,0121,323-1,145 >-2731,324 (0,089)1,502-1,073Table 2.

TBS in healthy population and study population for age

Healthy girls (n=2535)Healthy boys (n=1459)Study girls (n=47)Study boys (n=36)Age (y)Spine BMDTBSSpine BMDTBSTBSTBS1-20,401,3250,371,2722-30,511,3630,461,2671,1273-40,521,3460,511,2641,2044-50,601,3460,601,2671,2371,2435-60,601,2880,561,2691,3301,3686-70,651,2800,601,2321,3181,4227-80,671,2680,641,2441,3391,3458-90,711,2660,681,2281,2449-100,751,2780,701,2081,2531,34110-110,81,2850,731,2311,2291,29211-120,841,3370,761,2501,3031,31512-130,991,3550,811,2481,3811,36813-141,061,3860,891,2731,3941,33814-151,101,3980,991,3031,4741,28515-161,141,4051,081,3111,3681,40616-171,171,4051,151,3341,3321,37117-181,171,4041,201,3281,3741,28518-191,171,4041,161,314

Conclusion:

TBS was lower in the patients with LBM by whole body Z score, but not in those with LBM by spine Z score. We observed a decrease in TBS in adolescence, not corresponding with a decrease in BMD, and that should not be interpreted as a pathological finding

Similar results have been described in other pediatric populations (1, 2), but larger studies are needed to evaluate this phenomenon. We hypothesize that it may be due to a higher rate of growth in adolescence, with a lower rate of calcium apposition into the osteoid material

References:

[1]Del Rio DS, Winthenrieth R. BONE MICROARCHITECTURE (TBS) AND BONE MASS DEVELOPMENT DURING CHILDHOOD AND ADOLESCENCE IN A SPANISH POPULATION GROUP. . WCO-IOF-ESCEO; Seville2014.

[2]Shawwa K, Arabi A, Nabulsi M, et al. Predictors of trabecular bone score in school children. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(2):703-10.

Disclosure of Interests:

None declared

AB0246 FACTORS ASSOCIATED WITH THE TIME OF PRESENTATION OF CARDIOVASCULAR EVENTS IN A COHORT OF COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus is a systemic disease characterized by a compromise of vital organs. The autoimmune activity has been linked to accelerated endothelial damage and increased cardiovascular risk and its outcomes such as heart attack, stroke, and peripheral arterial disease(1). Patients with Lupic nephritis have been characterized by requiring aggressive immunosuppressive therapies apart from prolonged and progressive use of corticosteroids, what you have shown can accelerate these outcomes(2). Other factors such as secondary arterial hypertension, dyslipidemia among others are factors to consider (3).

Objectives:

To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018.

Methods:

Retrospective follow-up study based on clinical records of patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Patients with cardiovascular disease outcomes such as angina, acute myocardial infarction, stroke, transient cerebral ischemia and chronic arterial occlusive disease were included. Patients who did not have at least two follow-up measurements or had structural heart disease, valvulopathies, arrhythmias, myocarditis, pericarditis were excluded. The main outcome was defined as the time from diagnosis to cardiovascular diseases.

Clinical and immunological characteristics were analyzed. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges for quantitative variables. Age and sex adjusted survival functions and Hazard Ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values < 0.05 were considered statistically significant

Results:

547 patients were analyzed: 29 were left-censored as they presented renal involvement at entry, 22 were interval censored as outcome occurred between study visits, and 496 were right-censored as involvement was not registered during follow-up. 528 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.4 (IQR = 20.9). Statistically significant age and sex adjusted variables were High Blood Pressure (HBP) HR = 2.0 (95%CI 1.1-3.6; p-value <0.018) and cumulative prednisolone dose (>10 gr vs <2 gr) HR = 2.4 (95%CI 1. 1-5.1; p-value = 0.023). Figure 1 shows the age and sex adjusted survival function for HBP

Conclusion:

HBP and cumulative steroid doses accelerate the onset of cardiovascular diseases in patients with lupus more than two times. Maintaining blood pressure in goals and performing early clearance of glucocorticoids could improve outcomes in these patients who are already considered a high cardiovascular risk

References:

[1]Hans-Joachim Anders, Ramesh Saxena, Ming-Hui Zhao. Lupus Nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.

[2]Shanthini Kasturi, Lisa R Sammaritano. Corticosteroids in Lupus. Rheum Dis Clin North Am, 42 (1), 47-62, viii

[3]César Magro-Checa, Juan Salvatierra, José Luis Rosales-Alexander, et al. Cardiovascular risk in systemic lupus erythematosus: implicated factors and assessment methods. Semin Fund Esp Reumatol. 2012;13(3):95–102

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Deicy Hernandez-Parra: None declared, Ana Sierra: None declared, Ricardo Pineda.Tamayo: None declared

AB0245 RHEUMATOID ARTHRITIS DISEASE ACTIVITY AND VITAMIN D LEVELS IN A COLOMBIAN COHORT

Background:

There seems to be a relationship between 25-hydroxyvitamin D [25(OH)D] level and rheumatoid arthritis (RA)(1). It has been proposed that susceptibility for RA exists in selected patients with low 25(OH) with conflicting results (2,3) Regarding disease activity, most of the evidence suggests an inverse relationship of disease activity with 25(OH)D levels(4). To our knowledge, there is only a small study that suggests low 25(oh) D levels as a predictor of disease activity (5) in our region

Objectives:

We aimed to evaluate the possible association of low 25(OH) D levels and disease activity in a large cohort of patients with Rheumatoid Arthritis in Colombia

Methods:

We evaluated the clinical records of 3576 patients with RA that fulfilled the 2010 EULAR Classification Criteria for Rheumatoid Arthritis and that were managed in our autoimmunity center between 2014 and 2017. Registries that contained both the measurement of 25(OH)D levels and DAS28 VSG with no more than 6 months apart and that also had at least a mean 12-month follow-up were included. We classified 25(OH) D insufficiency as levels ≤ 20ng/ml. We evaluated differences in achieving disease control depending on the 25(OH) D levels with McNemar’s test. Disease control was defined as DAS28VSG≤3.2

Results:

A total of 880 patients were included, 90% were female and their mean age was 63 years and 24.3% had 25(OH) D insufficiency. The vast majority were seropositive and only 13% were on biologics (Table 1). A 25% of patients who 25(OH)D insufficiency had DAS28 3.2 and a year of follow-up decreased to 24% with medical intervention (p=0,1), while patients without 25(OH)D insufficiency at the beginning of follow-up, 27% had DAS28 3.2 and after one year follow-up decreased to 17% (p=0.001)

Table 1Mean (SD)Age (years)63.3 (10.6)Disease Duration14.7 (10.8)Age at diagnosis48.6(13.5)N%Sex (Feminine)79390.1Rheumatoid Factor (Positive)N=81769985.6ACPA (Positive)N=36632.377.6Actual Steroid use61169.4Actual Biologic Therapy12313.9DMARD Methotrexate57064.8 Leflunomide68277.5 Sulfasalazine21824.8 Azathioprine50.6 Antimalarials14716.7

Conclusion:

In Colombian patients with rheumatoid arthritis low 25(OH) D status has an inverse correlation with disease control. Even in an equatorial country, up to 24% of RA patients had low vitamin levels. A strategy of active detection of 25(OH) D insufficiency could have an impact on disease activity and health status

References:

[1]Ishikawa LLW, Colavite PM, Fraga-Silva TF de C, Mimura LAN, França TGD, Zorzella-Pezavento SFG, et al. Vitamin D Deficiency and Rheumatoid Arthritis. Vol. 52, Clinical Reviews in Allergy and Immunology. Humana Press Inc.; 2017. p. 373–88.

[2]Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, et al. Vitamin D and rheumatoid arthritis: An ongoing mystery. Vol. 29, Current Opinion in Rheumatology. Lippincott Williams and Wilkins; 2017. p. 378–88.

[3]Bae SC, Lee YH. Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis: a Mendelian randomization. Clin Rheumatol. 2018 Sep 1;37(9):2415–21.

[4]Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis. Clin Exp Rheumatol. 2016;34(5):827–33.

[5]Quintana-Duque MA, Caminos JE, Varela-Nariño A, Calvo-Paramo E, Yunis JJ, Iglesias-Gamarra A. The role of 25-hydroxyvitamin D as a predictor of clinical and radiological outcomes in early onset rheumatoid arthritis. J Clin Rheumatol. 2017;23(1):33–9.

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Carolina Perez-Rios: None declared, Yecenia Durango-Durango: None declared, Ricardo Pineda.Tamayo: None declared

The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients

Diabetes mellitus is associated with a higher risk of fracture. In this study, we analysed the bone quality of premenopausal women with type 1 diabetes mellitus by microindentation. No differences in bone quality were identified between patients and healthy controls, suggesting that intensive insulin therapy can preserve bone health.

PURPOSE

To compare the bone quality of women with type 1 diabetes mellitus (T1DM) and healthy controls, and to determine the relationship with bone mineral density (BMD).

METHODS

This was a cross-sectional study of 45 premenopausal women with T1DM and 21 healthy controls, matched according to age and BMI. Clinical parameters, BMD and bone tissue mechanical properties (assessed using the bone material strength index [BMSi]) were evaluated in each group using microindentation. In T1DM patients, glycosylated haemoglobin (HbA_1c), the number of hypoglycaemic events and the status of chronic complications were also analysed.

RESULTS

No differences in BMSi or BMD between T1DM patients and healthy controls were identified. In the T1DM patients, the mean HbA_1c was 7.52% ± 1.00% and the mean time elapsed since diagnosis was 22.6 ± 12.2 years. Eight patients (17.7%) met the criteria for metabolic syndrome (MetS), and microvascular complications were present in 12 patients (26.7%). Neither the number of features of MetS present nor the presence of microangiopathy was found to be associated with BMSi.

CONCLUSIONS

T1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results.

What's the risk? The frequency of false positives in psychosis risk screening instruments

One way to facilitate early intervention in psychosis is by improving early identification of individuals with psychosis risk through screening. However, screening instruments for psychosis risk have not incorporated the low base rates of psychosis risk and psychosis into their psychometric properties, resulting in an overestimation of the instruments' utility. This study evaluated the false positives of psychosis risk screening instruments using methods that incorporate base rates. Five psychosis risk screening instruments were selected: the Prodromal Questionnaire (PQ), the Prodromal Questionnaire-Brief Version, the Prodromal Questionnaire-16-item version, the Abbreviated Youth Psychosis at Risk Questionnaire, and the PRIME screen. We calculated the long-run probability of false positives for the author-recommended cutoff scores of each instrument. The incorporation of base rates revealed high frequencies of false positives for all psychosis risk screening instruments despite all selected instruments demonstrating acceptable sensitivity and specificity. Using base rates that reflect psychosis risk in a help-seeking population and in the general population, all instruments resulted in ≥ 95% false positives for individuals scoring at the author-recommended cutoff score and ≥ 81% false positives for individuals scoring at or above the author-recommended cutoff score. The PQ had the highest predictive power for a help-seeking sample, demonstrating that the instrument provides 17% additional diagnostic information beyond chance. Screening instruments for psychosis risk should incorporate base rates into instrument validation and cutoff score determination in order to improve identification of psychosis risk in United States mental health settings where these individuals are likely to present. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A combinatorial biomarker predicts pathologic complete response to neoadjuvant lapatinib and trastuzumab without chemotherapy in patients with HER2+ breast cancer

BACKGROUND

HER2-positive (+) breast cancers, defined by HER2 overexpression and/or amplification, are often addicted to HER2 to maintain their malignant phenotype. Yet, some HER2+ tumors do not benefit from anti-HER2 therapy. We hypothesize that HER2 amplification levels and PI3K pathway activation are key determinants of response to HER2-targeted treatments without chemotherapy.

PATIENTS AND METHODS

Baseline HER2+ tumors from patients treated with neoadjuvant lapatinib plus trastuzumab [with endocrine therapy for estrogen receptor (ER)+ tumors] in TBCRC006 (NCT00548184) were evaluated in a central laboratory for HER2 amplification by fluorescence in situ hybridization (FISH) (n = 56). HER2 copy number (CN) and FISH ratios, and PI3K pathway status, defined by PIK3CA mutations or PTEN levels by immunohistochemistry were available for 41 tumors. Results were correlated with pathologic complete response (pCR; no residual invasive tumor in breast).

RESULTS

Thirteen of the 56 patients (23%) achieved pCR. None of the 11 patients with HER2 ratio <4 and/or CN <10 achieved pCR, whereas 13/45 patients (29%) with HER2 ratio ≥4 and/or CN ≥10 attained pCR (P = 0.0513). Of the 18 patients with tumors expressing high PTEN or wild-type (WT) PIK3CA (intact PI3K pathway), 7 (39%) achieved pCR, compared with 1/23 (4%) with PI3K pathway alterations (P = 0.0133). Seven of the 16 patients (44%) with HER2 ratio ≥4 and intact PI3K pathway achieved pCR, whereas only 1/25 (4%) patients not meeting these criteria achieved pCR (P = 0.0031).

CONCLUSIONS

Our findings suggest that there is a clinical subtype in breast cancer with high HER2 amplification and intact PI3K pathway that is especially sensitive to HER2-targeted therapies without chemotherapy. A combination of HER2 FISH ratio and PI3K pathway status warrants validation to identify patients who may be treated with HER2-targeted therapy without chemotherapy.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

[Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat]

This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event.

Discrepancy between bone density and bone material strength index in three siblings with Camurati-Engelmann disease

Camurati-Engelmann (CE) is a very rare disease affecting one in every million persons worldwide. It is characterized by an enlargement of long bones. We aimed to assess bone characteristics in three siblings with different tools. Even if there was an excess of bone density, quality seemed to be deteriorated.

INTRODUCTION

CE disease is a rare monogenic disorder affecting approximately one in every million persons worldwide. It is mainly characterized by a progressive hyperostosis of the periosteum and endosteum of the diaphysis of long bones. Limited data are available about bone characteristics in these patients. In three siblings with CE disease, we aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) by dual-energy X-ray absorptiometry (DXA) and material characteristics at tissue level using bone impact reference point indentation.

METHODS

Clinical data were collected and a general laboratory workup was performed. At the lumbar spine and hip, BMD and TBS were measured using DXA imaging. Bone material strength index (BMSi) was measured by bone impact microindentation using an Osteoprobe instrument.

RESULTS

All three cases had densitometric values consistent with high bone mass (sum of Z-score at the lumbar spine and hip > 4). Hip BMD was extremely high in all three siblings at both total hip and femoral neck, while at the lumbar spine, two of them had normal values but the third again had very high BMD. TBS values were in the normal range. In contrast, BMSi measurements were at low or very low levels, compared with normal controls.

CONCLUSION

Despite strikingly increased BMD and normal microarchitecture, BMSi is affected in patients with CE. Microindentation could be an appropriate tool for assessing bone fragility in these patients. Bone disease in this group of patients requires further study to better understand the underlying regulatory mechanisms and their alterations.

Bone density, microarchitecture, and material strength in chronic kidney disease patients at the time of kidney transplantation

Bone health is assessed by bone mineral density (BMD). Other techniques such as trabecular bone score and microindentation could improve the risk of fracture's estimation. Our chronic kidney disease (CKD) patients presented worse bone health (density, microarchitecture, mechanical properties) than controls. More than BMD should be done to evaluate patients at risk of fracture.

INTRODUCTION

BMD measured by dual-energy X-ray absorptiometry (DXA) is used to assess bone health in end-stage renal disease (ESRD) patients. Recently, trabecular bone score (TBS) and microindentation that can measure microarchitectural and mechanical properties of bone have demonstrated better correlation with fractures than DXA in different populations. We aimed to characterize bone health (BMD, TBS, and strength) and calcium/phosphate metabolism in a cohort of 53 ESRD patients undergoing kidney transplantation (KT) and 94 controls with normal renal function.

METHODS

Laboratory workout, lumbar spine/hip BMD measurements (using DXA), lumbar spine TBS, and bone strength were carried out. The latter was assessed with an impact microindentation device, standardized as percentage of a reference value, and expressed as bone material strength index (BMSi) units. Multivariable linear regression was used to study differences between cases and controls adjusted by age, gender, and body mass index.

RESULTS

Among cases, serum calcium was 9.6 ± 0.7 mg/dl, phosphorus 4.4 ± 1.2 mg/dl, and intact parathyroid hormone 214 pg/ml [102-390]. Fourteen patients (26.4%) had prevalent asymptomatic fractures in spinal X-ray. BMD was significantly lower among ESRD patients compared to controls: lumbar 0.966 ± 0.15 vs 0.982 ± 0.15 (adjusted p = 0.037), total hip 0.852 ± 0.15 vs 0.902 ± 0.13 (adjusted p < 0.001), and femoral neck 0.733 ± 0.15 vs 0.775 ± 0.12 (adjusted p < 0.001), as were TBS (1.20 [1.11-1.30] vs 1.31 [1.19-1.43] (adjusted p < 0.001)) and BMSi (79 [71.8-84.2] vs 82. [77.5-88.9] (adjusted p = 0.005)).

CONCLUSIONS

ESRD patients undergoing transplant surgery have damaged bone health parameters (density, microarchitecture, and mechanical properties) despite acceptably controlled hyperparathyroidism. Detecting these abnormalities may assist in identifying patients at high risk of post-transplantation fractures.

Impact of cognitive impairment, depression, disease activity, and disease damage on quality of life in women with systemic lupus erythematosus

OBJECTIVES

To define the relative role of cognitive impairment, depression, disease activity, and disease damage in the decreased health-related quality of life (HRQoL) frequently observed in systemic lupus erythematosus (SLE) patients.

METHOD

We studied 101 Chilean female SLE patients and applied the 12-item Medical Outcomes Study (MOS) Short Form Health Survey version 2 (SF-12v2) to assess HRQoL and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive function. Analysis of covariance (ANCOVA) models included demographic and disease-related factors and cognitive function tests of sustained attention, memory, and executive function.

RESULTS

All measures of HRQoL were lower in the 101 female SLE patients compared to the women from the Chilean general population. HRQoL was associated with the following factors: (i) depression symptoms, which were detrimental to all components of the physical and mental HRQoL scores; (ii) executive dysfunction (spatial planning), which was associated with lower scores on role limitations due to physical health problems and emotional problems, and general health perceptions; (iii) higher activity and organ damage were deleterious to role physical, bodily pain, and physical summary scores; and (iv) higher damage also impacted physical function. Impairments in sustained attention and memory did not decrease the HRQoL.

CONCLUSIONS

Our results highlight the relevance of executive dysfunction to poor physical and mental health components of HRQoL in SLE together with depression, while disease activity and disease damage are associated with lower HRQoL physical components. The need for cognitive function evaluation and rehabilitation in SLE is indicated.

POCIS passive samplers as a monitoring tool for pharmaceutical residues and their transformation products in marine environment

In the last years, several scientific studies have shown that carbamazepine (CBZ) is one of the most frequently detected pharmaceutical in aquatic environment. However, little data is available on its detection and its transformation products (TPs) in marine water. The use of polar organic chemical integrative sampling (POCIS) passive samplers as a semi-quantitative and qualitative tool for screening of pharmaceuticals and TPs in seawater has been studied. Furthermore, the uptake rates of the target compounds were also determined under laboratory experiments to characterize the levels accumulated in devices. The results confirmed the presence of residues of anticonvulsant CBZ as well as some of its main metabolites, over a 1-year monitoring campaign carried out in French coast on the Mediterranean Sea. The work reports for the first time the presence of two TPs (10,11-dihydro-10,11-trans-dihydroxycarbamazepine (TRANS) and 10-hydroxy-10,11-dihydrocarbamazepine (10OH)) in marine water. The results contribute in assessing the environmental and human health risk of pharmaceuticals on coastal areas.

BackCLIP: a tool to identify common background presence in PAR-CLIP datasets

MOTIVATION

PAR-CLIP, a CLIP-seq protocol, derives a transcriptome wide set of binding sites for RNA-binding proteins. Even though the protocol uses stringent washing to remove experimental noise, some of it remains. A recent study measured three sets of non-specific RNA backgrounds which are present in several PAR-CLIP datasets. However, a tool to identify the presence of common background in PAR-CLIP datasets is not yet available.

RESULTS

We used the measured sets of non-specific RNA backgrounds to build a common background set. Each element from the common background set has a score that reflects its presence in several PAR-CLIP datasets. We present a tool that uses this score to identify the amount of common backgrounds present in a PAR-CLIP dataset, and we provide the user the option to use or remove it. We used the proposed strategy in 30 PAR-CLIP datasets from nine proteins. It is possible to identify the presence of common backgrounds in a dataset and identify differences in datasets for the same protein. This method is the first step in the process of completely removing such backgrounds.

AVAILABILITY

The tool was implemented in python. The common background set and the supplementary data are available at https://github.com/phrh/BackCLIP.

CONTACT

phreyes@gmail.com

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Hostile attributions in bipolar disorder and schizophrenia contribute to poor social functioning

OBJECTIVE

To compare the profile of attributional style of a group of out-patients with bipolar disorder (BD) and schizophrenia (SZ), and a group of healthy controls - along with other social cognition domains - such as emotion recognition and theory of mind (ToM).

METHOD

A total of 46 out-patients diagnosed with BD, 49 with SZ, and 50 healthy controls were assessed in attributional style (Ambiguous Intentions Hostility Questionnaire), facial emotion recognition (FEIT, FEDT, ER-40), and ToM (Hinting Task). Symptomatology, clinical variables and global functioning were also collected.

RESULTS

Both groups with SZ and BD showed hostile social cognitive biases, compared with the control group. Patients with BD also showed a capacity for emotional recognition similar to those with SZ and worse than control subjects. In contrast, patients with SZ showed poorer ToM. Subthreshold depressive symptoms and an attributional style toward hostility appeared as the factors with a strongest association to global functioning in BD. In SZ, PANSS score and a tendency to aggressiveness were the most relevant factors.

CONCLUSION

Attributional style (along with other domains of social cognition) is altered in out-patients with BD and SZ. The presence of residual symptoms and a hostile social cognitive bias may contribute to the functional impairment of both groups.

Bio-inspired impact-resistant composites

Through evolutionary processes, biological composites have been optimized to fulfil specific functions. This optimization is exemplified in the mineralized dactyl club of the smashing predator stomatopod (specifically, Odontodactylus scyllarus). This crustacean's club has been designed to withstand the thousands of high-velocity blows that it delivers to its prey. The endocuticle of this multiregional structure is characterized by a helicoidal arrangement of mineralized fiber layers, an architecture which results in impact resistance and energy absorbance. Here, we apply the helicoidal design strategy observed in the stomatopod club to the fabrication of high-performance carbon fiber-epoxy composites. Through experimental and computational methods, a helicoidal architecture is shown to reduce through-thickness damage propagation in a composite panel during an impact event and result in an increase in toughness. These findings have implications in the design of composite parts for aerospace, automotive and armor applications.

Untersuchungen zum chemischen Transport von YX3 mit AlX3 und zur Existenz von gasförmigen und festen Komplexen YAl3 X12 (X = Br, I) / Investigations on the Chemical Transport Reaction of YX3 with AlX3 and on the Existence of Gaseous and Solid Complexes YAl3 X12 (X = Br, I) H

The dominant gaseous complexes YAl3Br12 and YAl3I12 were generated in the chemical trans­port reactions of YBr3 with AlBr3 and YI3 with AlI3. The enthalpy of formation

ΔH0 B(YAl3Br12,g,298) = -484,5 ± 6 kcal/mol

and the standard entropy

S°(YA13B12,g,298) = 290,0 ± 7,5 cal/K·mol

have been calculated. It follows from total pressure measurements of mixtures of YBr3,s with AlBr3,1 and YI3,s with AlI3,1 respectively, that complexes YAl3Br12,s and YAl3I12,s do not exist up to the boiling points of the aluminium trihalides.

Abstract PD1-2: PIK3CA mutations and/or low PTEN predict resistance to combined anti-HER2 therapy with lapatinib and trastuzumab and without chemotherapy in TBCRC006, a neoadjuvant trial of HER2-positive breast cancer patients

We have recently reported that in patients with HER2-positive breast cancer, neoadjuvant targeted therapy with lapatinib and trastuzumab to more completely block the HER receptor layer, combined with endocrine therapy (in ER-positive tumors) and without chemotherapy led to a substantial 27% pathologic complete response (pCR) rate in the breast. Activation of downstream signaling pathways may lead to resistance to therapies targeting the HER pathway receptors. Aberrant activation of the PI3K pathway via decreased levels of PTEN and/or the presence of activating PIK3CA mutations has been implicated in resistance to targeted anti-HER2 therapy, but results of clinical trials are all confounded by the co-administration of chemotherapy and are inconsistent. We sought to clarify the role of these variables in predicting pCR, a surrogate for long-term outcome, in patients treated with potent targeted therapy alone in a prospective Phase II neoadjuvant trial in patients with HER2-positive breast cancer.

Patients with large tumors (median 6 cm) were given 12 weeks of lapatinib plus trastuzumab followed by surgery (Rimawi et al. JCO, 2013). Serial tissue biopsies were obtained from study participants. For this study, we focused on baseline pre-treatment characteristics. PTEN protein levels were measured by IHC and scored using the H-score. PIK3CA mutations were identified on extracted DNA using multiplex PCR with targeted next generation sequencing (the Ion Torrent 50-gene cancer mutation panel).

Of 64 evaluable patients, tissue was available on 59 for PTEN IHC, and sufficient DNA was available on 33 for the mutation panel. PTEN median H-score was 100 (range 0-300). PTEN status when dichotomized by the median was correlated with pCR (32% in high PTEN vs. 9% in low PTEN, p = 0.04). Activating PIK3CA mutations were identified in 12 out of 33 tumors (36%; 3 mutations in the helical and 9 in the catalytic domain) and were independent of ER status. None of the patients whose tumors harbored a PIK3CA mutation achieved pCR (p = 0.06). There was no association between PTEN status and PIK3CA mutation suggesting they are independent variables (p = 0.44). When PIK3CA mutations were considered together with PTEN status, there were 31 cases with data on both. The overall pCR rate in this cohort was 16% (lower than pCR rate observed in the overall trial). However, 0/17 cases (0%) with a mutation and/or PTEN low expression (&lt;100 H score) had a pCR compared to 5/14 cases (36%) with PI3KCA wild type and high PTEN levels (p = 0.01).

We conclude that PI3K pathway activation downstream of HER2 as a result of either low PTEN or activating PIK3CA mutation results in resistance to the combination of lapatinib and trastuzumab. This is the first report on patient tissue samples from a neoadjuvant trial using the combination of lapatinib and trastuzumab without chemotherapy. If validated in a larger cohort, our findings suggest that patients with HER2 positive tumors and who also harbor aberrant downstream PI3K pathway activation may benefit from the addition of PI3K/Akt/mTOR inhibitors to potent HER2 blockade.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD1-2.