Temporary changes in the menstrual cycle have recently been reported following SARS-CoV-2 vaccination. In the current study, we aimed to screen menstrual cycle changes following SARS-CoV-2 infection ...in Saudi Arabia. The type and duration of these changes have been screened in relation to the severity of coronavirus disease symptoms and vaccination status. In total, 956 individuals responded: sixty-nine did not get the COVID-19 vaccine, while the remaining were vaccinated with either a single dose of ChAdOx1 vaccine (n:45) or BNT162b2 vaccine (n: 142) or two doses of the vaccine (n:700) using BNT162b2 (n:477), ChAdOx1 (n:89) or ChAdOx1/ BNT162b2 (n:134). Approximately 26.1% (18/69) of the subjects who did not receive the SARS-CoV-2 vaccine and 15.3% (29/188) and 26.4% (185/700) of the subjects who received single and double doses of the vaccines, respectively, reported menstrual cycle changes. The persistence of menstrual cycle changes for more than six months was reported by 6.4% (61/956) of the participants. These changes were significantly correlated with the severity of COVID-19 infection. We concluded that menstrual cycle changes, associated with COVID-19 infection, increase due to the severity of COVID-19 infection. Thus, menstrual cycle changes are among the long-term effects associated with COVID-19 infection.
BackgroundFragility fractures are a consequence of poor bone health, this is especially seen in patients on corticosteroids. Polymyalgia rheumatica (PMR) is usually treated with corticosteroids for a ...median of two years (1). The predictors of fragility fractures in this cohort have not been explored in a large observational cohort. Furthermore it is unknown which other risk factors for Osteoporosis contribute to the risk of fractures in this cohort The FRAX™ tool uses the BMD in the femoral neck as a predictor for fracture, the ability of the lumbar spine bone mineral density (BMD) to increase prediction of fragility fracture has not been explored.ObjectivesTo explore the further predictors of fragility fractures in patients with PMR on corticosteroids and to explore the added predictive value of lumbar spine BMD.MethodsPatients referred for BMD estimation using a dual X-ray absorptiometry (DEXA) machine to a scanner in the North West of England between 2004 and 2014 were included in the study. Patients with a history of PMR on steroids were extracted. Initially those that sustained a fracture were compared to those that had not sustained a fracture using the chi squared test for categorical variables and Students T test for continuous variables. The predictors of fracture in that cohort were explored using a logistic model, initially in a univariate manner, and subsequently in a stepwise logistic model. Predictors included age at scan in years, gender, smoking, excess alcohol consumption, the presence of rheumatoid arthritis, body mass index (BMI) and family history of fragility fracture in addition to BMD in the lumbar spine and femoral neck.Results703 patients were included in the analysis, 525 (74.7%) were female. Mean age was 70.4 years (SD 8.9 years). 154 (21.9%) had sustained a fracture. Comparing the patients who had and who had not sustained a fracture showed that they were more likely to be female 138/525 (26%) vs 16/178 (9%) (p<0.001), older 72.5 years (SD9.0) vs 70.0 (SD8.8) p=0.002 and have a lower BMD in the lumbar spine and the femoral neck. The results of the logistic models unadjusted and adjusted for age are shown in table 1 below with significant values denoted with an asterisk (*)Table 1VariableUnadjusted OR (95%CI)Adjusted OR (95%CI)Age at scan in decades1.39 (1.131.71)*–Female gender3.61 (2.08,6.25)*3.90 (2.24,6.80)*Smoking1.07 (0.74,1.55)1.09 (0.75,1.59)Alcohol excess0.40 (0.14,1.16)0.44 (0.15,1.28)Rheumatoid arthritis0.37 (0.08,1.59)0.38 (0.09,1.65)Body mass index (kg/m2)1.00 (0.97,1.03)1.01 (0.98,1.05)Family history of fracture1.32 (0.67,2.62)1.57 (0.78,3.15)L1-L4 BMD0.07 (0.03,0.19)*0.08 (0.03,0.21)*Femoral neck BMD0.03 (0.01,0.11)*0.04 (0.01,0.15)*In the multivariate model aside from age, female gender (OR 2.010 95%CI 1.11,3.99) and femoral neck but not lumbar spine BMD remained in the model (OR 0.07 95%CI 0.01,0.59), surprisingly family history of fracture (OR 2.21 95%CI 1.01,4.84) and a higher BMI (OR 1.06 95%CI 1.01,1.10) also were significant predictors.ConclusionsIn this cohort of patients the females, older patients and low BMD in the femoral neck were all associated with fractures, which is not unexpected, however added risks were identified which are not necessarily clinically obvious. BMD in the lumbar spine did not add to the predictive value of sustaining a fracture. Further prospective work is needed to validate these findings.Referencesdoi:10.1093/rheumatology/kep303bDisclosure of InterestNone declared
Summary
We undertook cluster analysis in 11,003 patients who had sustained ≥ 1 fragility fracture, to find associations between fracture sites and comorbidities. We identified three distinct groups ...of fracture sites and four clusters of fractures and comorbidities. Knowledge of factors associated with fracture sites will aid prophylaxis in at-risk patients.
Introduction
Fragility fracture (FF) prevalence is increasing. Subsequent fractures lead to greater morbidity and mortality. Few data are available on the association between FF sites and comorbidities.
Objectives:
Establish the most common sites of FF and clusters within patients.
Identify patterns of co-existing FF and associated comorbidities.
Methods
We retrospectively reviewed clinical records of patients undergoing bone mineral density estimation at a district hospital in North-West England, 2004–2016, identifying those who had sustained ≥ 1 FF. Demographics, FF site(s), comorbidities, and medications were recorded. Cluster analysis was performed on fracture sites alone, and sites and comorbidities, using Jaccard similarity coefficient. Results were plotted on a dendrogram and divided into clusters.
Results
Of 28,868 patients, 11,003 had sustained ≥ 1 FF, 84.6% female, with overall mean age 67.5 years and median T-score − 1.12 SD. FF of the forearm was more frequent (
n
= 5045), most commonly co-existing with tibia/fibula fractures. Three FF site clusters were identified: ankle and elbow; forearm, tibia/fibula, ribs and spine; and pelvis, femur and humerus. When including comorbidities, four clusters were identified: forearm, tibia/fibula, spine, associated with family history of FF, smoking, corticosteroids and bisphosphonates; pelvis associated with hyperparathyroidism, PMR, coeliac disease and HRT; femur and humerus associated with IBD and RA; and ribs associated with alcohol and hyperthyroidism.
Conclusion
Cluster analysis demonstrated three fracture site clusters, and four subgroups of FF sites and comorbidities. Cluster analysis is a novel method to evaluate comorbidities associated with FF sites. Knowledge of factors associated with FF sites will aid prophylaxis in at-risk patients.
•Improved nutrient uptake and wheat yield.•Increased production of osmoprotectants, activities of peroxidase (POX), catalase (CAT) and ascorbate peroxidase (APX).•Foliar spray and fertigation with Se ...were effective.
The paper mainly reported the effects of exogenous selenium (Se) supply (Se seed priming, Se fertigation and Se foliar spray) on physiological and antioxidant system of wheat aiming to clarify its effect on yield and nutritional quality of wheat under both normal and water deficit conditions. Water stress markedly decreased the grain Se, iron (Fe), phosphorous (P), zinc (Zn) and magnesium (Mg) contents. Supplemental Se (Na2SeO4) improved the yield and quality of water stressed plants due to enhancement in the production of osmoprotectants and increased activity of antioxidant enzymes. The foliar spray of Se was more effective than Se fertigation and Se seed treatment. To the best of our knowledge, this is the first elaborate study that involved various Se application methods to evaluate the efficiency of Se supply to plants that would be crucial to develop better understanding of Se translocation and accumulation within crop plants under drought stress.
To evaluate effect of dental caries experience and untreated dental decay on Oral Health-Related Quality of Life (OHRQoL) in working adults.
The clinical records of 160 patients were reviewed. Dental ...health indicators were derived from individual tooth- and surface-level data allowing for calculating the number of decayed surfaces (D), number of decayed missed filled surfaces (DMFS), and significant caries (SiC) indices. A questionnaire was administered to verify demographic factors and OHRQoL. The questionnaire was administered via face-to-face interview, for patients in the hospital; or via telephone interview, for those who could not complete it during their hospital visit. Models were developed using multivariable linear regression to predict total OHIP-14 scores and examine the simultaneous association of independent and outcome variables. The model was adjusted for age, gender, and nationality..
Physical limitation and psychological discomfort were the most frequent impacted domains, affecting 17.1% and 7.5% of subjects, respectively. Painful aching was the most frequent item to have any impact, affecting 64.4% of the subjects. The results of multivariable analysis indicated that the SiC score could statistically significantly predict the Oral Health Impact Profile (OHIP) score, P=0.0003. In the linear regression model, for participants with DMFS equal to or higher than the SiC, on average, OHIP scores were almost 10 points higher than for participants with DMFS below the SiC.
The more the dental decay the higher the impact on OHRQoL. From a dental public health perspective, using OHRQoL as a need assessment tool, along with dental clinical indicator, can be helpful in planning and targeting public health programs for the most in-need adult populations.
This study identified that patients with severe dental caries report poorer OHRQoL. Clinicians should be aware of impacts that dental decay may have on OHRQoL, including physical, psychological concerns, and pain.
Objectives
Bone loss in systemic lupus erythematosus is multifactorial. Recent studies demonstrate corticosteroids, previous fractures and increasing age decrease bone mineral density. The effect of ...body mass index and fat mass are less well characterized. We sought to determine fracture risk factors in patients undergoing dual-energy X-ray absorptiometry scanning at a district hospital in 2004–2015.
Methods
Standard dual-energy X-ray absorptiometry parameters were recorded, plus rheumatoid arthritis diagnosis, smoking status, alcohol consumption, family history of fractures, history of secondary operation and corticosteroid use. Data were analyzed using Fisher's exact test for categorical data and logistic regression for continuous data.
Results
One hundred and fifty patients (141 women, nine men) with SLE were included; 52 (34.6%) had sustained at least one fracture. Fracture risk increased with increased age, body mass index, fat mass and average tissue thickness, and decreased lean mass (adjusted for steroid use), as well as with smoking and rheumatoid arthritis. Increased femoral and vertebral bone mineral density conversely decreased fracture risk.
Conclusion
Our study suggests increased age, body mass index, fat mass, smoking and/or rheumatoid arthritis increase fracture risk in SLE patients. To our knowledge, this is the first demonstration of a correlation between increased fat mass, adjusted for steroid use and fracture risk, in adults, potentially indicating a differential effect of fat on bone metabolism and lessening of lean body mass.
BackgroundMany different elements and variations of diet in the management of rheumatoid arthritis (RA) have been studied over the years such as vegan or Mediterranean diets.ObjectivesThis systematic ...literature review covers one food stuff, omega-3 polyunsaturated fats efficacy in the management of RA alongside or independent of conventional DMARD therapy.MethodsA systematic review of the literature between 1966–2017 was conducted using MEDLINE, CINAHL and EMBASE databases, with key words ”RA” and ”omega-3” for English-language articles producing 209 hits. We then refined to publications within the last 10 years, giving 96 results. Only including clinical trials gave 12 hits pertaining to 8 trials.ResultsThe table above shows a summary of the evidence found. In total, 751 were exposed to omega-3 versus 1733 controls with the smallest study being an RCT involving 13 people and the largest a case-control study with 1569 participants. A notable difference between these studies was the use of DMARD therapy as part of the inclusion or exclusion criteria. Another difference noted was the RA stage eligible for a trial. Some studies required a diagnosis of RA of <12 months whereas most required stable RA ongoing for >12 months.ConclusionsThis review concludes that omega-3 leads to clinical and statistically significant improvements in RA. There was a significant heterogeneity in the trials published with different inclusion criteria especially regarding disease duration and concomitant DMARD therapy. It would seem prudent to include dietary advice in our advice to patients when treating RA. Possible reasons for this evidence would include altering the microbiome.References1 The British Journal of Nutrition2015;114(6):885–90.2 Epidemiology1996;7(3):256–63.3 Archives of Medical Research2012;43(5):356–62.4 Journal of Parenteral and Enteral Nutrition2010;34(2):151–5.5 Global Journal of Health Science2015;8(7):18.6 Arthritis Care & Research2017.7 Rheumatology (Oxford, England)2008;47(5):665–9.8 Nutrients2017;9(4).Disclosure of InterestNone declaredAbstract AB0375 – Table 1Reference:Study typeParticipants in intervention groupParticipants in control groupOmega-3 doseDurationDid it show efficacy?How did they assess response? Proudman et al1RCT86533.7 g/day1 yearYesSuccess/failure of DMARDsShapiro et al2Case-control3241245>2 servings boiled/baked fish per weekDiet from a 1 year periodYesRA riskLee et al3Meta-analysis183187>2.7 g/day>3 monthsClinical not statistical significanceNSAID consumption, tender/swollen joint count, physical functionBahadori et al4RCT850.2 g/kg– fish oil emulsion22 weeksYesDecrease in swollen and tender joint countsRajaei et al5RCT30303.9 g/day12 weeksYesDAS28Tedeschi et al6Cross sectional analysis31145Eat fish>2 x per week(<5.5 g/day)Diet from past yrYesDAS28Galarraga et al7RCT49482.2 g/day9 monthsYes in reducing NSAID intake but not in DAS28Daily NSAID requirementVeselinovic et al8RCT4020600 mg/day12 weeksYesDAS28
BackgroundPredictors of fragility fracture (FF) risk and low bone mineral density (BMD) in the general population are well-documented. Previous studies have shown strong familial association between ...parental and offspring BMD and hip fracture, varying according to factors including body mass index and corticosteroids. Little data exists on predictors of FF and BMD in patients with a family history of fracture, despite this increasing fracture risk.ObjectivesWe aimed to evaluate predictors of FF and low BMD in patients attending for dual energy X-ray absorptiometry scanning.MethodsPatients referred for BMD estimation, between 2004 and 2016, with a history of parental fracture, were included. Parameters recorded: femoral and vertebral BMD, height, weight, fat mass, age, smoking, alcohol, corticosteroids, aromatase inhibitors, Depo-Provera, hormone replacement therapy (HRT), rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), breast or prostate cancer, and coeliac disease.Logistic regression was used to model fracture risk, and linear regression was used to model the impact of each factor on vertebral and femoral BMD.Results6053 patients (5513 female) were included. 2094 patients (34.6%) had sustained at least one fracture. Smoking, alcoholism, corticosteroid, increased age, height, and fat mass significantly increased fracture risk. Coeliac disease, HRT, and aromatase inhibitors were protective. Cancer, aromatase inhibitor use, and female gender significantly decreased vertebral BMD. Corticosteroids, RA, and PMR significantly decreased L1–2 BMD. Increased age and height, and decreased weight, fat mass, and tissue thickness decreased vertebral and right femoral BMD; this significantly increased FF risk. Corticosteroids, RA, PMR, Depo-Provera, female gender, and aromatase inhibitors decreased BMD; in the left femur, alcohol, corticosteroid use, increased age, height, and decreased weight decreased BMD.ConclusionsSimilar to studies in the general population, smoking, alcohol, and corticosteroid therapy increase fracture risk, while HRT decreases it. Chronic aromatase inhibitor use increases fracture risk, suggesting a dose-dependent effect. Coeliac disease was found to be protective; previous studies have shown coeliac disease to decrease BMD, with a variable impact on fracture. Concurrent with previous studies, a differential effect of BMD in the dominant and non-dominant hip was found, with decreased right femoral BMD significant for fracture risk. Limitations of this study include lack of dose and duration of medications and lack of comparative data before and after fracture in a single patient.Our study confirms the effect of the above factors on spinal BMD, but suggests a differential effect of smoking and alcohol on L1–2, with corticosteroids, RA and PMR affecting the lower lumbar spine. Our results also suggests a differential effect of the studied factors on the right femur compared to the left, suggesting the dominant femur is more susceptible to factors decreasing BMD. Limitations of this study include the large proportion of female subjects and lack of data on dose and duration of medications studied.Disclosure of InterestNone declared
BackgroundFragility fractures (FF) are fractures due to low energy force. Factors predisposing to FF in the general population include reduced bone mineral density (BMD), and family history of ...osteoporosis. FF most commonly occur in the vertebrae, proximal femur, and distal radius. Studies have demonstrated increased risk of FF in patients with decreased BMD and parental history of FF, particularly hip fracture.1,2 Few data exist on the association between sites of fracture in patients with a history of parental fracture, especially whether they co-exist at several sites and if particular factors are associated with discrete sites.ObjectivesWe aimed to find the correlation between sites of FF in patients with a history of parental fracture, and identify and examine the clinical association with any clusters of fractures.Methods2094 patients with a history of parental FF and personal history of at least one FF, presenting for BMD estimation from their primary or secondary care practitioner, from 2006–2016, were included. Parameters recorded: height, weight, age at scan, average fat mass, site of fracture(s), smoking, alcohol, corticosteroid use, aromatase inhibitor use, Depo-Provera use, hormone replacement therapy (HRT), rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), breast or prostate cancer, and coeliac disease.Factor analyses with polychoric correlation matrices were applied to determine association between fracture sites. Any associations with Eigenvalues of more than one were then examined using a logistic model to analyse the effect of the above risk factors.ResultsFracture sites with Eigenvalue of more than one (tibia/fibula, spine, ribs, pelvis) were compared to sites with least co-variability (humerus, forearm, femur). The two cohorts were significantly different in age; therefore, an age-adjusted model is reported below (table 1). Smoking, HRT, and increased age significantly impacted clustering of fractures in the tibia/fibula, spine, ribs, and pelvis, compared with clustering at the humerus, forearm, and femur.Abstract SAT0705 – Table 1Age-adjusted predictors of fracture for tibia/fibula/spine/ribs/pelvis vs. humerus/forearm/femur (* denotes significance)Variable/Fracture clusterOR (95% CI) Corticosteroid0.878 0.748–1.031Smoking0.879 0.779, 0.992 *Alcohol0.954 0.808–1.127Rheumatoid arthritis1.393 0.928–2.092Polymyalgia rheumatica0.907 0.465–1.769HRT0.635 0.420, 0.961 *Aromatase inhibitors 0.950 0.772, 1.170Breast/prostate cancer1.489 0.610–3.636Gender0.804 0.589–1.096Age at scan (years)1.011 1.003, 1.019 *Height (cm)0.989 0.978–1.000Weight (kg)0.995 0.989–1.000ConclusionsIn this cohort of patients, there was overlap between all fracture sites, with significant clustering seen in fractures of the tibia/fibula, spine, ribs, and pelvis. After adjusting for age, predictors of fracture in this cluster were smoking, HRT and increased age. This indicates that risk factors for FF are different at different sites, and affects the association of fracture between sites. Further work validating this finding is currently underway.References1 A family history of fracture and fracture risk: a meta-analysis. Bone Internet. Elsevier 2004Nov 1 cited 2017 Oct 27;35(5):1029–37.2 Strong familial association of bone mineral density between parents and offspring: KNHANES 2008–2011. Osteoporos Int2017.Disclosure of InterestNone declared
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