Background. We aimed to determine whether a 6-day course of intravenous methylprednisolone (MP) improves outcome in patients with SARS CoV-2 infection at risk of developing Acute Respiratory Distress Syndrome (ARDS). Methods. Multicentric, partially randomized, preference, open-label trial, including adults with COVID-19 pneumonia, impaired gas exchange and biochemical evidence of hyper-inflammation. Patients were assigned to standard of care (SOC), or SOC plus intravenous MP [40mg/12h 3 days, then 20mg/12h 3 days]. The primary endpoint was a composite of death, admission to the intensive care unit (ICU) or requirement of non-invasive ventilation (NIV). Results. We analyzed 85 patients (34, randomized to MP; 22, assigned to MP by clinician preference; 29, control group). Patient age (mean 68±yr) was related to outcome. The use of MP was associated with a reduced risk of the composite endpoint in the intention-to-treat, age-stratified analysis (combined risk ratio -RR- 0.55 [95% CI 0.33-0.91]; p=0.024). In the per-protocol analysis, RR was 0.11 (0.01-0.83) in patients aged 72 yr or less, 0.61 (0.32-1.17) in those over 72 yr, and 0.37 (0.19-0.74, p=0.0037) in the whole group after age-adjustment by stratification. The decrease in C-reactive protein levels was more pronounced in the MP group (p=0.0003). Hyperglycemia was more frequent in the MP group. Conclusions A short course of MP had a beneficial effect on the clinical outcome of severe COVID-19 pneumonia, decreasing the risk of the composite end point of admission to ICU, NIV or death.

The osteoporosis prevalence in our patients was greater than other studies (30%). Emphasis may be placed on screening osteoporosis with BUA in primary health care. We suggested that educational community programs should start at an earlier age to identify factors that contribute to maintaining bone mineral density among postmenopausal women.

Objectives: To assess serum concentrations of 25-hydroxyvitamin D, 25(OH)D, in osteoporotic patients treated for one year with calcifediol. Methods: We have studied 156 patients with osteoporosis (23 males and 133 females), aged 71,9±9,6 years who had received treatment with calcifediol for at least one year. Ninety-two of them received 0.266 mg of calcifediol every fifteen days and the remaining 64 the same dose once a month. Serum levels of 25(OH)D, intact PTH (iPTH), procollagen type 1 amino-terminal propeptide (PINP) and C-terminal crosslinked telopeptide of type I collagen (CTX) were determined before and one year after starting treatment. Results: A significant increase in the concentration of 25(OH)D was observed with both treatment regimens (p<0.001). The percentage of patients who reached levels of 25(OH)D higher than 20 and 30 ng/ml was similar with both guidelines, while the percentage of patients exceeding 60 ng/ml was higher with the biweekly dose (p<0.01). The concentration of iPTH decreased significantly after the administration of calcifediol, although on this occasion there were no differences between the two forms of treatment. Both bone remodeling markers, PINP and CTX, decreased similarly in patients treated with antiresorptives (p<0.0001), without these changes being related to the calcifediol regimen. Conclusions: The monthly administration of 0.266 mg of calcifediol is adequate to achieve effective levels of vitamin D, and it is also safe enough to avoid reaching potentially harmful levels of it, so it would be preferable to the biweekly schedule in the usual clinical practice.

BackgroundRheumatoid arthritis (RA) patients have higher levels of resistance to the action of insulin (IR) compared to healthy subjects.The “Incretin effect” consists in a greater release of insulin by the pancreas when there is a gastrointestinal glucose stimulation, compared to an intravenous stimulation. It is known that this effect is altered in patients with IR.ObjectivesTo determine if the incretins-insulin axis is altered in patients with RA and if this correlates to IR in patients with RA, as well as if it is explainable by certain features of the disease.MethodsCross-sectional study that includes 361 non-diabetic individuals, 151 patients with RA and 210 controls. Serum levels of insulin, C-peptide, Amylin, glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP) and dipeptidyl peptidase 4 (DPP-4) were analyzed in patients and controls. Indexes of resistance and sensitivity to insulin activity were determined by HOMA2.A “meal test” consisting on the intake of 500 kcal was performed to a subset of 10 patients and 10 controls, in order to determine the postprandial curves of glucose, insulin, C-peptide, GLP-1 and GIP. Differences between patients and controls as well as the relationship of selected characteristics of the disease with the baseline and postprandial levels of incretins were analyzed using multivariate regression. During the meal test, areas under the curve (AUC), maximum concentrations and the minutes of response were compared between patients and controls. This study was approved by the Clinical Trial Committee of the University Hospital of the Canary Islands.ResultsPatients with RA showed, at baseline and after multivariate adjustment, higher levels of insulin (9.8±6.5 vs 13.0±13.4 U/ml, p=0.05), C-peptide (1.53±0.77 vs. 3.37±2.94 ng/ml, p=0.00), GLP-1 (0.49±1.28 vs. 0.71±0.22, p=0.00) and GIP (0.37±0.40 vs. 1.78±0.51, p=0.00). Similarly, IR indexes such as HOMA2-IR and HOMA2%B, built with insulin or Cpeptide, were higher in patients with RA compared to controls. Patients with RA, showed significantly lower levels of DPP-4 (811±459 vs. 696±301 ng/ml,p=0.02) after multivariate analysis. Amylin levels did not differ between patients and controls. Both C-reactive protein (beta coefficient 0.54,95% CI 0.16–0.96, p=0.013) and Erythrocyte Sedimentation Rate (beta coef. 0.01,0.00–0.01, p=0.033) showed a positive relationship with HOMA2%B and GIP levels, respectively. The presence of anti-cyclic citrullinated peptide antibody (beta coef. 157 CI 58–256, p=0.002) and the levels of disease activity measured by DAS28 (beta coef. 46,CI 6–87, p=0.026) and CDAI (beta coef 1.27 (0.28–2.26), p=0.012) showed a positive relationship with the levels of DPP-4. Patients with RA showed Pearson correlation coefficient of incretines, DPP-4 with insulin, C peptide and IR lower compared to control group. After the meal test patients with RA exhibited an AUC of glucose and GIP greater than controls and a slower C-Peptide response time (75 vs. 30 minutes, p=0.029).ConclusionsIncretins-insulin axis is alter...