Obstructive sleep apnoea (OSA) is a chronic pathology characterised by the presence of repetitive upper airway obstruction during the sleep, the prevalence of which increases with the age [1], and for which continuous positive airway pressure (CPAP) is the treatment of choice [2-4]. However, there have been few studies on diagnosis and management of OSA in elderly people. A qualitative systematic review of randomised clinical trials (RCTs) was conducted to evaluate the impact of CPAP therapy on health-related quality of life (HRQL) in OSA patients (aged >65 years), diagnosed by polysomnography or polygraphy and treated with CPAP for at least 3 months (>4 h•day −1). Studies whose primary outcome did not assess HRQL were excluded. Interventions were categorised according to whether or not they included CPAP treatment. The primary outcome was HRQL based on validated generic or specific questionnaires. Following quality guidelines for conducting systematic literature reviews [5], research was carried out in November and December 2015; trials were identified in the records of Trip, Scopus, the Cochrane Controlled Trials Register and Medline. Studies published since November 2000 were identified using Medical Subject Headings: "CPAP", "SAHS", "quality of life", "therapeutic effect" and "elderly". The search formula was: "CPAP [AND] OSA [AND] quality life; CPAP [AND] quality life; OSA [AND] quality life". Subsequently, two authors classified the studies independently, taking into account the summary, key words and title of the study. At a second level, two researchers independently determined the eligibility and quality of the studies, and the performed intervention. Disagreements were analysed and resolved by discussion. We found up to 896 potentially relevant articles; in the first evaluation, 868 of them were rejected, as they did not comply with some of the requirements. In the second evaluation, from these 28 studies, one was ruled out because it was not finished and nine because they were not RCTs with control groups. In the third evaluation, from 18 studies, 16 were ruled out because the average age was <65 years. Finally, only two RCTs were included in the review; the main results are shown in table 1.

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BackgroundBiobadasar is a registry that monitors adverse events in patients who use biological treatments in rheumatologic diseases conducted by the Argentine Society of Rheumatology. As in others international registries the community acquired pneumonia (CAP) has been detected as one of the most frequent infectological adverse events. Although all immunosuppressed patients should be vaccinated against streptococcus pneumoniae, there is a proportion of patients who are not.ObjectivesEvaluate the prevalence of pneumococcal vaccination in patients with CAP within the Biobadasar database. Assess factors associated with Severe CAP in these patients.MethodsA cross-sectional, multicentric study was made in BIOBADASAR database from 2010 to2016.In patients who reported CAP data of demographics, comorbidities and state of pneumococcal immunization was collected. Microbiological data, treatment and outcome of the event were considered. The severity of CAP was assessed according to the opinion of the attending physician, hospitalization, risk of life and/or death. Values are expressed as mean ± standard deviation, median (ranges) and frequencies (percentages), as appropriate. We performed bivariate and multivariate logistic regression analysis to identify variables associated with the event.ResultsOf the 4029 patients enrolled in the registry, the cumulative incidence of CAP was 4.2% (n 170), 72.4% (n 123) were women. The mean age was 57 (SD +/- 14.5). Biological treatment was found in 81.8% (n 139). Patient s that have received the pneumococcal vaccine were 40.6% (n=69). Severe CAP was detected in 7.1%. Streptococco Pneumoniae was the main pathogen isolated in 13% of the cases. Overall mortality was 4.1%. In the univariate analysis for severe CAP we found statistical significance for Smoking OR 3.88, CI95 1.063–14.22, p= 0.029 and chronic kidney disease (CKD) OR 31, CI95 2.6–376, p= 0.007. When performing a multiple logistic regression model, only renal failure OR 7.39 CI95 0.003–0.38 p= 0.007 was a predictor of severe CAP. Not significative association with immunosuppressive treatment (p: 0.09), age (p: 0.464), or vaccination (p: 0.937)ConclusionsThe annual incidence of CAP in Argentina varies between 0.5 -1.1% while in our cohort it was four times higher. The prevalence of pneumococcal vaccination was less than 50%, showing that, although the literature and guidelines establish the need for vaccination, this is not so in the real world. In the multivariate analysis, only CKD was related to severe CAP. Although in the univariate analysis the CKD and the smoking habit represented factors associated with severity. We must emphasize the medical education in following the international vaccination guidelines.Disclosure of InterestNone declared

BackgroundDermatomyositis represents one of the major forms among the inflammatory myopathies (IIM). Although the muscle biopsy remains the definitive test, MRI has been used to detect unique patterns of muscle involvement. To date, no studies have compared MRI with muscle pathology in naïve DM.ObjectivesTo compare the pattern of muscle MRI with muscle pathology.MethodsAll the patients enrolled in the Hospital Clínic de Barcelona (HCB) from January 2009 to December 2016 with an available MRI, performed just before muscle biopsy were included. The HCB ethics committee approved this study, and written informed consent was obtained from each participant.MRI data and the clinical and demographic features were prospectively collected. Patients were classified as having definite DM (ref 4). MRI was performed on a 1.5T with standardized protocol of whole body or scapular and pelvic girdle MRI, which include coronal and axial T1-weighted and STIR images. Image analysis was performed by two experienced musculoskeletal radiologists masked to the disease activity. The presence of oedema, fatty replacement and fascial oedema was evaluated in the biopsied muscle. Muscle and fascial inflammation was scored using a 0–3 point scale. The extent of muscle involvement was also evaluated by the analysis of 12 to 14 axial images and a percentage of muscle volume was calculated. Fatty replacement was scored using a 0–3 point scale. Muscle biopsies were evaluated by two trained pathologists at the HCB. Muscle biopsies were routinely processed. Quantification of fiber necrosis, regeneration and inflammation infiltrate were recorded. All statistical analyses were performed using “SPSS v22.0 ®”. In all statistical tests performed p value of 0.05 was considered significant.ResultsA total of 16 (13 female) patients were included. Except in one patient all of them had proximal muscle weakness, and all of them except one had typical DM skin lesions. In 12% of the patients a solid cancer was diagnosed. All patients had fascial edema at muscle MRI while no one had fatty replacement, and 65% had muscle oedema. Only one biopsy was normal. A significant correlation was found between muscle inflammation and MRI muscle edema (p=0,036) and the percentage of volume muscle involvement at MRI (p=0,027). Muscle necrosis was seen in those patients with moderate and severe fascial edema compared with those with mild fascial edema (p=0,032). More regenerating cells were seen in those patients with moderate and severe muscle edema compared with negative or mild muscle oedema (p=0,018).ConclusionsA strong and significant correlation between histological and imaging findings was found. Fascial and muscle edema were the predominant findings in DM patientsReferences Garcia J. MRI in inflammatory myopathies. Skeletal Radiol 2000;29:425–38.Connor A, Stebbings S, Hung N, et al. STIR MRI to Direct Muscle Biopsy in Suspected Idiopathic Inflammatory Myopathy. J Clin Rheumatol 2007;13: 341–45.Dalakas MC. Inflammatory muscle diseases. N Engl J Med 2015;373:393–4.Hoogendi...