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Background:Non- attendance to medical appointments and poor adherence to treatment negatively impact the control of rheumatic diseases (RD), increasing the risk of complications and healthcare costs[1].Objectives:This study aims to assess reasons for non-adherence to disease-modifying drugs (DMARDs) and non-attendance in appointments and to identify underlying causes before and after the pandemic.Methods:An observational cross-sectional study was conducted. We included patients ≥18 years old with a diagnosis of RD who attended both follow-up and initial assessments at the “Dr. José Eleuterio González” University Hospital during the period May to September 2023 and agreed to participate in the study. Those who missed their appointments were contacted to evaluate the reason for non-attendance. A questionnaire evaluated DMARDs taken, adherence to them, and reasons for non-adherence. Adherence was categorized based on intake frequency: Good >75% of the time (>21 days), regular 50-74% (15-21 days), poor 25-49% (8-14 days), null <25% (7 days or less). To compare adherence during the COVID-19 pandemic, we used a database covering rheumatology patients from 2021 to 2022.Results:A total of 4,289 patients were scheduled for assessment and 2,078 (48.44%) did not attend. Of this group, 354 patients had a first appointment scheduled, and 1,724 had a follow-up. During this same period, 78 patients were hospitalized, 73% attended follow-up, 23% did not attend and 4% died. Economic factors were the main cause of non-attendance (70%), followed by transportation (14%), forgetting (9%), and personal reasons (2%). Of the 161 patients evaluated for adherence to DMARDs, 135 (83.8%) considered adherence to be good. Hydroxychloroquine was the most common DMARD used by 34% of the patients, followed by methotrexate 29%, prednisone 16%, leflunomide 8%, mycophenolate mofetil 8%, azathioprine 3% with, and sulfasalazine 2%. The non-adherence reasons during 2021 and 2023 are shown in Table 1.Table 1.Non-adherence factors during the pandemic in 2021 vs. post-pandemic 2023COVID-19 pandemic 2021N=52Post-pandemic 2023N= 161Availability48.1%Economic44%Fear of getting sick from COVID-1925%Availability28%Indication from their rheumatologist7.7%Side effects8%Indication from another physician5.8%Forgetting13%Economic3.8%Unwillingness6%Other9.6%Family or friends referral1%Conclusion:Non-attendance and adherence to DMARDs depend on economic and social circumstances. Probably because the study was conducted in a developing country, it is worthwhile to rethink the cost/benefit ratio of the drugs prescribed at the assessment. New strategies are needed to recover patients who stopped attending our service.REFERENCES:[1] Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-159.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Non-attendance occurs when a patient neglects to attend a scheduled appointment without providing prior notice, presenting a notable challenge that can detrimentally impact patient health and well-being [1]. Patients who miss their appointments may face potential disruptions in their care, unnecessary emergency room admissions, and extended waiting times for future appointments. Rheumatic diseases contribute significantly to morbidity, potentially triggering psychological disorders such as anxiety and depression. This, in turn, can escalate morbidity, disability, and mortality rates [2]. Information on the influence of depression and anxiety on the non-attendance of rheumatic patients is limited.Objectives:To examine the prevalence of depression and anxiety among patients with autoimmune rheumatic diseases and their association with non-attendance at consultations.Methods:We conducted an observational retrospective study, encompassing patients with autoimmune rheumatic diseases (ARD) who missed at least one appointment between March and December 2023. These individuals had previously undergone assessment using the Hospital Anxiety and Depression Scale (HADS), with a score of 0 indicating no risk, 1-7 points signifying low risk, 8-10 points suggesting intermediate risk, and scores exceeding 11 indicating high risk. We categorized them into two groups: patients with regular attendance and those with non-attendance, matching them based on diagnoses. For statistical analysis, qualitative variables are depicted as frequencies and percentages, while quantitative variables are represented by distributions, including median and interquartile range (IQR). Chi-square was employed to compare differences between groups.Results:A total of 394 patients were included.The baseline patient characteristics are outlined in Table 1. The most common ARD was RA in 278 (70.6%) patients, followed by SLE 65 (16.5%), SS 12 (3%), SSC 10 (2.5%), RA+SLE 8 (2%), MCTD 7 (1.8%), APS (1.5%), IIM 4(1%), and SPA 4 (1%).The median HADS-A score was 3 (IQR 0-7) and HADS-D 0 (IQR 0.1) for anxiety and depression, respectively. The median age of the non-attendance group was 51 years (IQR 39-60) and the attendance group was 51 years (IQR 46-42). There was a significant difference between these groups (p=0.037). The median years of education in the non-attendance group was 9 years (IQR 6-12) and in the attendance group was 9 years (IQR 6-11). There was a significant difference between these groups (p=0.042) Among patients with rheumatoid arthritis, an intermediate-to-high risk for depression was observed in 9 (81.8%) patients in the non-attendance group compared to 2 (18.2%) patients in the attendance group. A significant difference was noted between the two groups (p=0.030).Conclusion:Our study found no significant association between non-attendance in patients with ARD and the risk of anxiety and depression. However, it is noteworthy that 59.4% of the non-attendance group showed a risk of anxiety, and 28.9% were at risk of depression.Interestingly, younger patients and those with higher education levels were more likely to miss appointments, highlighting the complex interplay of clinical and psychological factors in patient engagement.REFERENCES:[1] Leibner, G. et al. ‘To charge or not to charge: Reducing patient no-show’, Israel Journal of Health Policy Research, 2023;12(1). doi:10.1186/s13584-023-00575-8.[2] Jeffrey A, Aveka IA, Bashir AY, Umar A. Depression among patients with rheumatic musculoskeletal disorders attending tertiary hospital in northern nigeria. West Afr J Med. 2023; 10;40. PMID: 37976241.Table 1. Baseline Characteristics of Patients with Autoimmune Rheumatic Diseases (ARD) Based on Appointment Attendance and HADS ScoresAcknowledgements:NIL.Disclosure of Interests:None declared.

Background:Previous research has demonstrated that, from the patient’s perspective, the costs associated with rheumatic diseases significantly affect a considerable portion of their income. This is particularly noteworthy given that the monthly income of northeastern Mexican families has been reported to be $708.71 USD [1]. The degree of medication adherence is intricately connected to overall health outcomes. Various socioeconomic risk factors have been identified as contributing to poor adherence, with elevated medication costs being a significant factor. The affordability of medication depends on whether it is covered by each specific healthcare system [2].Objectives:To provide insights into medication utilization and associated costs, contributing to a better understanding of the economic aspects of rheumatic disease management.Methods:We conducted an observational retrospective analysis, focusing on the review of prescriptions provided to patients hospitalized for rheumatic diseases at the time of their discharge from our institution, Dr. José Eleuterio González University Hospital, located in Monterrey, Nuevo León, México. It is the only tertiary care facility in the northeastern region of the country for the population without social medical coverage. The study covered the period from March to December 2023. Medications prescribed at discharge were systematically categorized, as outlined in Table 1. Additionally, the average monthly expenses for DMARDs, immunosuppressants, biologics, and bisphosphonates were calculated using pricing data obtained from our institution’s internal pharmacy. The total cost was reported in US dollars (USD), considering an equivalence of USD 1 = 16.89 Mexican pesos (MXN).Results:During the period from March to December 2023, there were 143 hospitalized patients. Prescriptions were obtained from 71 patients, with an average of 7 medications per prescription. Patients, on average, take 6 tablets a day. The most frequently prescribed category of medications was supplements in 68 prescriptions (95.77%), specifically Caltrate 600D+ (calcium carbonate/cholecalciferol). The second most frequently prescribed category of medications was steroids in 55 prescriptions (77.46%), mainly prednisone in its 5 mg presentation. The third most frequently prescribed category of medications was the conventional synthetic DMARD category in 54 prescriptions (76.05%), primarily hydroxychloroquine followed by methotrexate, leflunomide, sulfasalazine, and chloroquine. Nine prescriptions included >2 synthetic DMARDs. The average expenditure for this category was $ 110.69 USD monthly. The average expenditure for immunosuppressants was $ 395.29 USD.The average expenditure for bisphosphonates was $ 118.36 USD.Table 1. Categories and Frequency of Medications Prescribed at Discharge for Hospitalized Patients with Rheumatic Diseases(*) Denotes the most frequently prescribed medication in each group.Conclusion:The high average number of medications per prescription indicates the complexity of the treatment regimens. The economic aspects highlight potential challenges faced by patients in accessing and affording necessary medications, pointing towards areas where healthcare support or interventions may be beneficial.REFERENCES:[1] Skinner-Taylor C, Perez-Barbosa L, et al. The economic burden of prenatal care for women with rheumatic diseases: a cross-selectional study from a university hospital. Clin Rheumatol. 2023 Sep;42(9):2521-2523. doi: 10.1007/s10067-023-06713-6.[2] Gil-Guillen, V.F.; Balsa, A.; Bernárdez, B. et al. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. Int. J. Environ. Res. Public Health 2022, 19, 12036. https://doi.org/10.3390/ ijerph191912036Acknowledgements:NIL.Disclosure of Interests:None declared.

Background: The notion that hepatic expression of genes involved in lipid metabolism is altered in obese patients is relatively new and its relationship with hepatic steatosis and cardiometabolic alterations remains unclear. Objective: We assessed the impact of Roux-en-Y gastric bypass surgery (RYGB) on the expression profile of genes related to metabolic syndrome in liver biopsies from morbidly obese individuals using a custom-made, focused cDNA microarray, and assessed the relationship between the expression profile and hepatic steatosis regression. Materials and methods: Plasma and liver samples were obtained from patients at baseline and 12 months after surgery. Samples were assayed for chemical and gene expression analyses, as appropriate. Gene expression profiles were assessed using custom-made, focused TaqMan low-density array cards. Results: RYGB-induced weight loss produced a favorable reduction in fat deposits, insulin resistance (estimated by homeostasis model assessment of insulin resistance (HOMA-IR)), and plasma and hepatic lipid levels. Compared with the baseline values, the gene expression levels of key targets of lipid metabolism were significantly altered: CD36 was significantly downregulated (−40%; P =0.001), whereas APOB (+27%; P =0.032) and SCARB1 (+37%; P =0.040) were upregulated in response to surgery-induced weight reduction. We also observed a favorable reduction in the expression of the PAI1 gene (−80%; P =0.007) and a significant increase in the expression of the PPARA (+60%; P =0.014) and PPARGC1 genes (+36%; P =0.015). Notably, the relative fold decrease in the expression of the CD36 gene was directly associated with a concomitant reduction in the cholesterol (Spearman’s r =0.92; P =0.001) and phospholipid (Spearman’s r =0.76; P =0.04) contents in this tissue. Conclusions: For the first time, RYGB-induced weight loss was shown to promote a favorable downregulation of CD36 expression, which was proportional to a favorable reduction in the hepatic cholesterol and phospholipid contents in our morbidly obese subjects following surgery.

The antinociceptive effects of the carbon monoxide-releasing molecule tricarbonyldichlororuthenium (II) dimer (CORM-2) during chronic pain are well documented, but most of its possible side-effects remain poorly understood. In this work, we examine the impact of CORM-2 treatment on the lipoprotein profile and two main atheroprotective functions attributed to high-density lipoprotein (HDL) in a mouse model of type 1 diabetes while analyzing the effect of this drug on diabetic neuropathy. Streptozotocin (Stz)-induced diabetic mice treated with CORM-2 (Stz-CORM-2) or vehicle (Stz-vehicle) were used to evaluate the effect of this drug on the modulation of painful diabetic neuropathy using nociceptive behavioral tests. Plasma and tissue samples were used for chemical and functional analyses, as appropriate. Two main antiatherogenic properties of HDL, i.e., the ability of HDL to protect low-density lipoprotein (LDL) from oxidation and to promote reverse cholesterol transport from macrophages to the liver and feces in vivo (m-RCT), were also assessed. Stz-induced diabetic mice displayed hyperglycemia, dyslipidemia and pain hypersensitivity. The administration of 10 mg/kg CORM-2 during five consecutive days inhibited allodynia and hyperalgesia and significantly ameliorated spinal cord markers (Cybb and Bdkrb1expression) of neuropathic pain in Stz mice, but it did not reduce the combined dyslipidemia shown in Stz-treated mice. Its administration to Stz-treated mice led to a significant increase in the plasma levels of cholesterol (∼ 1.4-fold vs. Ctrl, ∼ 1.3- fold vs. Stz-vehicle; p < 0.05) and was attributed to significant elevations in both non-HDL (∼ 1.8-fold vs. Ctrl; ∼ 1.6-fold vs. Stz-vehicle; p < 0.05) and HDL cholesterol (∼ 1.3-fold vs. Ctrl, ∼ 1.2-fold vs. Stz-vehicle; p < 0.05). The increased HDL in plasma was not accompanied by a commensurate elevation in m-RCT in Stz-CORM-2 compared to Stz-vehicle mice; instead, it was worsened as revealed by decreased [3H]-tracer trafficking into the feces in vivo. Furthermore, the HDL-mediated protection against LDL oxidation ex vivo shown by the HDL isolated from Stz-CORM-2 mice did not differ from that obtained in Stz-vehicle mice. In conclusion, the antinociceptive effects produced by a high dose of CORM-2 were accompanied by antioxidative effects but were without favorable effects on the dyslipidemia manifested in diabetic mice.

Sphingolipids are key signaling molecules involved in the regulation of cell physiology. These species are found in tissues and in circulation. Although they only constitute a small fraction in lipid composition of circulating lipoproteins, their concentration in plasma and distribution among plasma lipoproteins appears distorted under adverse cardiometabolic conditions such as diabetes mellitus. Sphingosine-1-phosphate (S1P), one of their main representatives, is involved in regulating cardiomyocyte homeostasis in different models of experimental cardiomyopathy. Cardiomyopathy is a common complication of diabetes mellitus and represents a main risk factor for heart failure. Notably, plasma concentration of S1P, particularly high-density lipoprotein (HDL)-bound S1P, may be decreased in patients with diabetes mellitus, and hence, inversely related to cardiac alterations. Despite this, little attention has been given to the circulating levels of either total S1P or HDL-bound S1P as potential biomarkers of diabetic cardiomyopathy. Thus, this review will focus on the potential role of HDL-bound S1P as a circulating biomarker in the diagnosis of main cardiometabolic complications frequently associated with systemic metabolic syndromes with impaired insulin signaling. Given the bioactive nature of these molecules, we also evaluated its potential of HDL-bound S1P-raising strategies for the treatment of cardiometabolic disease.

The potential of nicotinamide (NAM) to prevent atherosclerosis has not yet been examined. This study investigated the effect of NAM supplementation on the development of atherosclerosis in a mouse model of the disease. The development of aortic atherosclerosis was significantly reduced (NAM low dose: 45%; NAM high dose: 55%) in NAM-treated, apolipoprotein (Apo)E-deficient mice challenged with a Western diet for 4 weeks. NAM administration significantly increased (1.8-fold) the plasma concentration of proatherogenic ApoB-containing lipoproteins in NAM high-dose (HD)-treated mice compared with untreated mice. However, isolated ApoB-containing lipoproteins from NAM HD mice were less prone to oxidation than those of untreated mice. This result was consistent with the decreased (1.5-fold) concentration of oxidized low-density lipoproteins in this group. Immunohistochemical staining of aortas from NAM-treated mice showed significantly increased levels of IL-10 (NAM low-dose (LD): 1.3-fold; NAM HD: 1.2-fold), concomitant with a significant decrease in the relative expression of TNFα (NAM LD: −44%; NAM HD: −57%). An improved anti-inflammatory pattern was reproduced in macrophages cultured in the presence of NAM. Thus, dietary NAM supplementation in ApoE-deficient mice prevented the development of atherosclerosis and improved protection against ApoB-containing lipoprotein oxidation and aortic inflammation.

The intake of olive oil (OO) enriched with phenolic compounds (PCs) promotes ex vivo HDL-mediated macrophage cholesterol efflux in humans. We aimed to determine the effects of PC-enriched virgin OO on reverse cholesterol transport (RevCT) from macrophages to feces in vivo. Female C57BL/6 mice were given intragastric doses of refined OO (ROO) and a functional unrefined virgin OO enriched with its own PC (FVOO) for 14 days. Our experiments included two independent groups of mice that received intragastric doses of the phenolic extract (PE) used to prepare the FVOO and the vehicle solution (saline), as control, for 14 days. FVOO intake led to a significant increase in serum HDL cholesterol and its ability to induce macrophage cholesterol efflux in vitro when compared with ROO group. This was concomitant with the enhanced macrophage-derived [3H]cholesterol transport to feces in vivo. PE intake per se also increased HDL cholesterol levels and significantly promoted in vivo macrophage-to-feces RevCT rate when compared with saline group. PE upregulated the expression of the main macrophage transporter involved in macrophage cholesterol efflux, the ATP binding cassettea1. Our data provide direct evidence of the crucial role of OO PCs in the induction of macrophage-specific RevCT in vivo.