OBJECTIVES: Liver enzyme elevation is an important and common adverse effect among patients with autoimmune diseases who receive biologic and/or diseasemodifying anti-rheumatic drugs (DMARDs), and has various causes. We undertook to control for potential confounding factors, including hepatotoxic drugs, to assess the relative risk of developing abnormal liver function in patients with different hepatitis B virus (HBV) infection status, which was hitherto uncertain. METHODS: From 472 patients with rheumatoid arthritis, ankylosing spondylitis, or psoriasis/psoriatic arthritis who received tumour necrosis factor-alpha inhibitors (anti-TNF-a) agents and DMARDs, this nested case-control analysis included 368: 30 with serum alanine aminotransferase >40 international units/L within 12 months after starting anti-TNF-a agents, and 338 controls. Conditional logistic regression analyses were used to evaluate associations between abnormal liver function and HBV serostatus, as well as other risk factors. RESULTS: Adjusted for potential confounders, HBV-surface-antigen positive serostatus (HBsAg+) was associated with almost eight-fold higher likelihood of developing liver enzyme elevation (OR 7.91, 95% CI 2.16e31.31) relative to patients without HBV infection; no such association was apparent among HBsAg negative/HBV-core-antibody positive (HBsAgÀ/HBcAb+) patients. Increased risk of abnormal liver function was associated with use of methotrexate alone without folic acid (OR 11.60, 95% CI 2.52e56.46), as well as history of liver enzyme elevation (OR 13.71, 95% CI 4.32e45.75). CONCLUSIONS: HBsAg+ patients with autoimmune diseases receiving anti-TNF-a agents had more than six-fold higher risk for liver enzyme elevation than those without HBV infection, whereas the risk among patients with HBsAgÀ/HBcAb+ serostatus was similar to that of uninfected patients.OBJECTIVES: Optimal use of prophylactic platelet transfusions requires knowledge of adverse event (AE) risks. Rates of several AEs were published in a consensus AABB guideline (Kaufmann et al., 2015); however, these estimates come from studies employing various data sources and study designs. The objective of this review was to help those considering prophylactic use of platelet transfusions better understand the risks summarized in consensus documents and uncertainty surrounding these estimates. METHODS: We reviewed the publications upon which the AE rates in the AABB guidelines were based and applied the hierarchical system for rating levels of evidence promoted by the Center for Evidence-based Medicine (CEBM). We also validated the rates presented in the guidelines against source documents cited. RESULTS: The AABB guideline cites 7 sources, 1 per AE, as evidence of AE rates associated with platelet transfusion. Two were randomized controlled trials assessing the frequency of acute AEs after alternative platelet preparation strategies; 2 were published surveillance reports; and 3 were cited as "personal communication," with no study characteristics provided (but apparently ba...

diseases related to overweight and obesity in Colombia, to generate information that allows decision makers to identify economic costs of this pathology. METHODS: Through a systematic review, diseases caused by excess weight were identified and the risk of becoming ill due to excess weight was determined in every disease. Burden of CID, CVD, cancer, hypertension, DM, CKD and low back pain in Colombia was determined. Proportion attributable to exposure (excess weight) of each disease was calculated and adjusted for sex or age. Average annual cost of healthcare of each NDC produced by excess weight was identified. Absolute frequency of patients with each disease caused by excess weight was calculated. Average healthcare costs for each disease caused by excess weight was calculated. RESULTS: Diseases caused by excess weight are: esophagus cancer, colon cancer, cancer of gallbladder and bile ducts, pancreatic cancer, breast cancer, uterine cancer, ovarian cancer, kidney cancer, thyroid cancer, leukemia in adults, CID, CVD, hypertension, DM, CKD and low back pain. In 2018, in Colombia there will be 1,824,041 people with excess weigh and any of these pathologies, who got ill because of their excess weight. Annual healthcare cost of these patients to Colombian health system is V1,739,017,779. CONCLUSIONS: Healthcare costs caused by excess weight in Colombia is 23.5% of annual health budget of the country. Actions of secondary prevention of these diseases should be developed in patients with excess weight.

OBJECTIVES: Liver enzyme elevation is an important and common adverse effect among patients with autoimmune diseases who receive biologic and/or diseasemodifying anti-rheumatic drugs (DMARDs), and has various causes. We undertook to control for potential confounding factors, including hepatotoxic drugs, to assess the relative risk of developing abnormal liver function in patients with different hepatitis B virus (HBV) infection status, which was hitherto uncertain. METHODS: From 472 patients with rheumatoid arthritis, ankylosing spondylitis, or psoriasis/psoriatic arthritis who received tumour necrosis factor-alpha inhibitors (anti-TNF-a) agents and DMARDs, this nested case-control analysis included 368: 30 with serum alanine aminotransferase >40 international units/L within 12 months after starting anti-TNF-a agents, and 338 controls. Conditional logistic regression analyses were used to evaluate associations between abnormal liver function and HBV serostatus, as well as other risk factors. RESULTS: Adjusted for potential confounders, HBV-surface-antigen positive serostatus (HBsAg+) was associated with almost eight-fold higher likelihood of developing liver enzyme elevation (OR 7.91, 95% CI 2.16e31.31) relative to patients without HBV infection; no such association was apparent among HBsAg negative/HBV-core-antibody positive (HBsAgÀ/HBcAb+) patients. Increased risk of abnormal liver function was associated with use of methotrexate alone without folic acid (OR 11.60, 95% CI 2.52e56.46), as well as history of liver enzyme elevation (OR 13.71, 95% CI 4.32e45.75). CONCLUSIONS: HBsAg+ patients with autoimmune diseases receiving anti-TNF-a agents had more than six-fold higher risk for liver enzyme elevation than those without HBV infection, whereas the risk among patients with HBsAgÀ/HBcAb+ serostatus was similar to that of uninfected patients.