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The clinical picture of SARS-CoV-2 infection is variable, ranging from moderate to severe and critical forms. Various studies have shown that disturbances in certain biochemical parameters are correlated with the severity of the disease. They can be used to predict the risk of complications, allowing early and appropriate care of these patients. The aim of our study is to evaluate the correlation between admission ferritin levels and mortality in COVID-19 patients. We used data from the records of patients with positive RT-PCR admitted to the Mohamed V Military Training Hospital in Rabat between april 2020 and december 2021. Demographic and biologic data were exctracted from DxLab LIS of Dedalus. 1.310 patients are included; the average age is 56 years and 72% of patients are male. The all-cause mortality of seriously ill hospitalized patients in the intensive care units are 23%. 73% of patients who died were over 60 years. The mean ferritinemia at admission was 2040 ng/ml for patients who died versus 521 ng/ml for the survivors (p

Correction to: American Journal of Cardiovascular Drugs (2020) 20:81–103 https://doi.org/10.1007/s40256-019-00359-z

Background Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders affecting females in their reproductive age. In PCOS, an imbalance between androgens, anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH), cause a halt of follicular growth. Insulin resistance (IR) is another important component of PCOS. There is increasing evidence that vitamin D affects insulin and glucose metabolism, Vitamin D plays a vital role in the regulation of glucose-insulin homeostasis. Objectives to assess the efficacy of vitamin D supplementation in improving ovulation induction in PCOS women (1ry outcome) and increasing pregnancy rate (secondary outcome). Patients and Methods 120 women diagnosed PCOS according to Rotterdam criteria and were resistant to CC treatment were randomly allocated into equal two groups: Group V: number of 60 patients received cholecalciferol + Metformin for 2 months. Group C: 60 patients received Metformin 2 months. After two months from the start:Both study groups started induction with Clomiphene Citrate added every month starting from the 3rd month to the 5th month (3 cycles of ovulation induction) in addition to previous drugs mentioned. Results In our study results, regulation of menstrual cycle occured in 63.6% of women who recieved vitamin D + metformin (group V) and ovulation was confirmed in 34.5% of the total number (55 women). Later, 18% of them got pregnant after 3 months of treatment. Added to that 16 women out of 39 (41%) got pregnant by the end of the follow up period with cumulative pregnancy rate (53%). On the other hand menstrual regularity in (group C: metformin) recorded 61% with ovulation percentage of 26.9% (n = 54). Followed by 14.8% pregnancy rate at the 3rd month., which increased to 27.5% by the end of the study out of 47.5% ovulated women (n = 40). Cumulative pregnancy rate 40%. Conclusion From the current study we can conclude that there is no significant difference of adding vitamin D to CC resistant PCOS regarding ovulation and pregnancy rates. However, it can augment metformin action and improves its outcome.

Summary Background Quadruple therapy using a single capsule formulation of bismuth, metronidazole and tetracycline (BMT; Pylera®), associated with omeprazole for the eradication of Helicobacter pylori, represents the reintroduction of bismuth in France after 40 years. Objective To describe the real-life patterns of use of BMT following a request from the French health authorities. Methods Patients with a first BMT dispensing (index date, ID), with one year of data before and after ID, were identified in the French nationwide claims database 1/97 sample. Misuse of BMT was defined as dispensing >1 pack of BMT at ID or absence of a diagnostic test in the preceding year. Results In total, 540 patients were included. Prescribers were gastroenterologists (n = 243; 45%) and general practitioners (n = 160; 30%). A proton pump inhibitor was co-dispensed to 504 patients (96%). Ten patients (2%) had contraindications to BMT. Fifty-nine patients (11%) met the misuse criteria: ten (2%) were dispensed > 1 pack of BMT and 49 (9%) had not had a diagnostic test for H. pylori in the previous year. During follow-up, 27 patients (5%) required retreatment (treatment failure). Conclusion In this real-life study, most patients were dispensed only one pack of BMT, consistent with recommendations. Misuse related principally to the absence of prior diagnostic test for H. pylori.

Background Diagnosis performances of case-identifying algorithms developed in healthcare database are usually assessed by comparing identified cases with an external data source. When this is not feasible, intra-database validation can present an appropriate alternative. Objectives To illustrate through two practical examples how to perform intra-database validations of case-identifying algorithms using reconstituted Electronic Health Records (rEHRs). Methods Patients with 1) multiple sclerosis (MS) relapses and 2) metastatic castration-resistant prostate cancer (mCRPC) were identified in the French nationwide healthcare database (SNDS) using two case-identifying algorithms. A validation study was then conducted to estimate diagnostic performances of these algorithms through the calculation of their positive predictive value (PPV) and negative predictive value (NPV). To that end, anonymized rEHRs were generated based on the overall information captured in the SNDS over time (e.g. procedure, hospital stays, drug dispensing, medical visits) for a random selection of patients identified as cases or non-cases according to the predefined algorithms. For each disease, an independent validation committee reviewed the rEHRs of 100 cases and 100 non-cases in order to adjudicate on the status of the selected patients (true case/ true non-case), blinded with respect to the result of the corresponding algorithm. Results Algorithm for relapses identification in MS showed a 95% PPV and 100% NPV. Algorithm for mCRPC identification showed a 97% PPV and 99% NPV. Conclusion The use of rEHRs to conduct an intra-database validation appears to be a valuable tool to estimate the performances of a case-identifying algorithm and assess its validity, in the absence of alternative.

Introduction Bien que les medicaments indiques dans l’osteoporose aient deja fait preuve de leur efficacite dans les essais cliniques contre placebo, les donnees sur leur efficacite en situation reelle de soins sont a ce jour limitees. Patients et methodes Une etude de cohorte a ete realisee a partir des donnees de l’Assurance maladie francaise, le SNDS, incluant toute femme de 55 ans et plus initiant un traitement pour l’osteoporose (i.e., denosumab, acide zoledronique (AZ), bisphosphonates oraux (BPO), estrogenes, teriparatide et raloxifene) entre le 1er janvier 2014 et le 31 decembre 2016 selon une approche hierarchique qui suit l’ordre de commercialisation de ces medicaments en France. Les patientes incluses etaient traitees pendant au moins 6 mois par le traitement index et etaient suivies au moins 2 ans. L’incidence des fractures etait comparee au sein d’un meme groupe de traitement, en comparant le taux d’incidence des 3 mois suivant la date d’initiation (risque fracturaire de reference), avec celui des 12, 18 et 24 mois suivants. Les resultats des analyses autocontrolees « sous traitement » ont ete presentes en termes d’Incidence Rate Ratio (IRR) et de son intervalle de confiance a 95 % (IC95 %). Resultats Parmi les 200 496 patientes inclues, 33 % avaient initie du denosumab, 26 % des BPO, 21 % de l’AZ, 10 % des estrogenes, 6 % du raloxifene et 4 % du teriparatide. Les patientes avaient en moyenne entre 63 ans (SD ± 8 ans) dans le groupe estrogene et 76 ans (±9 ans) dans le groupe teriparatide. Un traitement prealable par un medicament anti-osteoporotique etait plus frequemment retrouve dans le groupe denosumab (55 %). Le risque fracturaire de reference etait variable entre les groupes de traitement ; il etait le plus eleve dans les groupes AZ (fracture de la hanche) et teriparatide (fractures vertebrales) et le plus bas dans le groupe estrogene. En comparaison avec les 3 mois suivant l’initiation, les fractures vertebrales faisant l’objet d’une hospitalisation etaient significativement reduites dans les 12, 18 et 24 mois suivants avec le denosumab (IRRs : 0,7 [0,5 ; 0,8], 0,6 [0,5 ; 0,7] et 0,6 [0,5 ; 0,7]), l’AZ (IRR : 0,4 [0,3 ; 0,4] pour les 3 periodes), le teriparatide (IRRs : 0,4 [0,3 ; 0,6], 0,4 [0,2 ; 0,5] et 0,3 [0,2 ; 0,5]) et les BPO (IRRs : 0,6 [0,4 ; 0,8] pour les 3 periodes). Comparativement aux 3 premiers mois suivant la date index, l’incidence de fracture de la hanche etait significativement plus faible avec le denosumab dans les 18 et 24 mois suivants (IRRs : 0,8 [0,6 ; 0,9]) mais significativement plus elevee pour les BPO pour l’ensemble des 3 periodes (IRRs : 1,6 [1,1 ; 2,2] dans les 12 mois suivants, et 1,7 [1,2 ; 2,3] dans les 18 et les 24 mois suivants), alors qu’aucune difference significative n’etait observee avec l’AZ et le teriparatide. Une diminution significative de l’incidence des fractures peripheriques etait observee uniquement dans le groupe denosumab pour les 3 periodes (IRRs : 0,85 [0,75 ; 0,96] dans les 12 mois suivants, 0,83 [0,73 ; 0,94] dans les 18 mois suivants et 0,82 [0,73 ; 0,92] dans les 24 mois suivants). Discussion L’incidence des fractures vertebrales a ete reduite par le traitement avec des therapies contre l’osteoporose. Une diminution significative des fractures de hanche et peripheriques a ete observee uniquement avec le denosumab. Conclusion Le traitement avec des medicaments contre l’osteoporose est efficace dans en situation reelle.

Objectives: To assess the effectiveness of dimethyl fumarate (DMF) on annual rate of relapse (ARR) and disability progression in multiple sclerosis (MS) compared to injectable immunomodulators (IMM), teriflunomide (TERI) and fingolimob (FTY), in real life setting. Methods: A population-based cohort study was conducted using data of the French nationwide claims database, SNDS. All patients initiating IMM, TERI, FTY or DMF between July 1, 2015 and December 12, 2017, with 4.5 years of database history and 1 to 3.5 years of follow-up were included in this study. DMF patients were 1:1 matched to IMM, TERI or FTY using a high dimensional Propensity Score. Negative binomial regression and a logistic regression models were used to estimate the relative risk (RR ± [95% CI]) of ARR and the Odds Ratio (OR ± [95% CI]) of disability progression, respectively. Results: Overall, 9 304 subjects were identified: 29.0% initiated DMF, 33.2% TERI, 5.6% FTY and 32.2% an IMM. The matched cohorts consisted of 1779 DMF- IMM, patients, 1679 DMF-TERI patients, and 376 DMF-FTY patients. DMF significantly reduced ARR compared to IMM (RR 0.72 [0.61 - 0.86]) and TERI (0.81 [0.68 - 0.96]) and did not show any significant difference when compared with FTY The risk of the progression of MS specific disability was not significantly different for any matched cohorts. Interpretation: DMF is associated with lower risk of relapse for patients with RRMS than other first-line RRMS agents (TERI and IIM).

Objectives: To assess the effectiveness of dimethyl fumarate (DMF) on annual rate of relapse (ARR) and disability progression in multiple sclerosis (MS) compared to injectable immunomodulators (IMM), teriflunomide (TERI) and fingolimob (FTY), in real life setting. Methods: A population-based cohort study was conducted using data of the French nationwide claims database, SNDS. All patients initiating IMM, TERI, FTY or DMF between July 1, 2015 and December 12, 2017, with 4.5 years of database history and 1 to 3.5 years of follow-up were included in this study. DMF patients were 1:1 matched to IMM, TERI or FTY using a high dimensional Propensity Score. Negative binomial regression and a regression logistic models were used to estimate the relative risk (RR ± [95% CI]) of ARR and the Odds Ratio (OR ± [95% CI]) of disability progression, respectively. Results: Overall, 9 304 subjects were identified: 29.0% initiated DMF, 33.2% TERI, 5.6% FTY and 32.2% an IMM. The matched cohorts consisted of 1779 DMF- IMM, patients, 1679 DMF-TERI patients, and 376 DMF-FTY patients. DMF significantly reduced ARR compared to IMM (RR 0.72 [0.61 - 0.86]) and TERI (0.81 [0.68 - 0.96]). The risk of the progression of MS specific disability was not significantly different for any matched cohorts.Interpretation: DMF is associated with lower risk of relapse for patients with RRMS than other first-line RRMS agents (TERI and IIM).

Additional file 1: Algorithm for the identification of multiple sclerosis relapses.

Additional file 2: Algorithm performance indicators before setting adjustment resulting from expert inputs.

BACKGROUND: Quadruple therapy using a single capsule formulation of bismuth, metronidazole and tetracycline (BMT; Pylera®), associated with omeprazole for the eradication of Helicobacter pylori, represents the reintroduction of bismuth in France after 40 years. OBJECTIVE: To describe the real-life patterns of use of BMT following a request from the French health authorities. METHODS: Patients with a first BMT dispensing (index date, ID), with one year of data before and after ID, were identified in the French nationwide claims database 1/97 sample. Misuse of BMT was defined as dispensing>1 pack of BMT at ID or absence of a diagnostic test in the preceding year. RESULTS: In total, 540 patients were included. Prescribers were gastroenterologists (n=243; 45%) and general practitioners (n=160; 30%). A proton pump inhibitor was co-dispensed to 504 patients (96%). Ten patients (2%) had contraindications to BMT. Fifty-nine patients (11%) met the misuse criteria: ten (2%) were dispensed>1 pack of BMT and 49 (9%) had not had a diagnostic test for H. pylori in the previous year. During follow-up, 27 patients (5%) required retreatment (treatment failure). CONCLUSION: In this real-life study, most patients were dispensed only one pack of BMT, consistent with recommendations. Misuse related principally to the absence of prior diagnostic test for H. pylori.

BackgroundDabigatran (D) and rivaroxaban (R) showed better benefit-risk than vitamin K antagonists for stroke prevention in nonvalvular atrial fibrillation (NVAF), but there is no direct face-to-face randomized trial comparing D to R. However, our previous results and other studies conducted in real-life settings found similar or better results with D at either dose than R after 1 or 2 years of follow-up. This analysis aimed to estimate the real-life comparative benefit-risk of standard (D150 vs. R20) and reduced doses (D110 vs. R15) on major events over 3 years of follow-up.MethodsNew D or R users for NVAF in 2013 were identified and followed for 3 years in the SNDS French nationwide claims database. NVAF was defined from long-term disease registration, hospital diagnoses or procedures for atrial fibrillation without valvular disease (3-year database history). D and R patients were 1:1 matched according to dose, gender, age, drug start date and high-dimensional propensity scores (hdPS) including individual stroke and bleeding risk factors (CHA2DS2-VASc and HAS-BLED). Hazard ratios (HR) [95% confidence interval] were estimated on treatment using Cox proportional hazards or Fine and Gray models.ResultsOf the 10,847 D150, 15,532 D110, 18,829 R20 and 11,195 R15 new users for NVAF in 2013, 8,195 D150/R20 per arm, and 7,651 D110/R15 per arm were matched, i.e. 76% and 68% of patients of the smallest group (D150 and R15), respectively; with very good overlap of hdPS distributions, and most standardized differences < 0.02. The 3-year D vs. R HR for clinically relevant bleeding was 0.53 [0.42-0.66] for standard dose and 0.70 [0.58-0.83] for reduced dose, and respectively 0.78 [0.58-1.05] and 0.80 [0.63-1.02] for stroke and systemic embolism, 1.00 [0.73-1.36] and 0.85 [0.65-1.12] for acute coronary syndrome, 0.83 [0.65-1.07] and 0.91 [0.80-1.03] for death, 0.73 [0.64-0.84] and 0.84 [0.77-0.92] for the composite of the 4 major events.ConclusionThis real-life nationwide study with long-term follow-up shows that dabigatran standard and reduced doses have similar or better effectiveness than rivaroxaban with lower bleeding risk.

Clinical trials have indicated that the direct-acting oral anticoagulants dabigatran and rivaroxaban have better risk/benefit profiles than do vitamin K antagonists (VKAs) for stroke prevention in non-valvular atrial fibrillation (NVAF). Our objective was to compare the 1-year real-life risk of major clinical events with dabigatran or rivaroxaban versus VKAs for NVAF. This was a high-dimensional propensity score (hdPS)-matched cohort study of new users of dabigatran, rivaroxaban or VKAs for NVAF in the French national healthcare systems database in 2013 followed-up for 1 year [22]. Hazard ratios (HRs) with 95% confidence intervals (CIs) for clinical events and death were determined during exposure. In 2013, a total of 103,101 new anticoagulant users had definite NVAF: 44,653 VKA, 27,060 dabigatran, and 31,388 rivaroxaban. In matched populations, HRs were as follows for dabigatran versus VKAs (20,489 per group): stroke and systemic embolism (SSE) 0.75 (95% CI 0.63–0.88), clinically relevant bleeding (CRB) 0.58 (95% CI 0.51–0.66), hemorrhagic stroke (HS) 0.22 (95% CI 0.14–0.36), gastrointestinal bleeding (GIB) 0.98 (95% CI 0.80–1.19), acute coronary syndrome (ACS) 0.79 (95% CI 0.65–0.95), death 0.74 (95% CI 0.67–0.82), composite (any of the above) 0.71 (95% CI 0.66–0.76). For matched rivaroxaban versus VKA (23,053 per group) HRs were as follows: SSE 0.98 (95% CI 0.85–1.14), CRB 0.83 (95% CI 0.75–0.92), HS 0.65 (95% CI 0.49–0.87), GIB 1.08 (95% CI 0.90–1.30), ACS 0.84 (95% CI 0.71–1.00), death 0.77 (95% CI 0.71–0.84), composite 0.84 (95% CI 0.79–0.89). Numbers needed to treat to observe one fewer death were 49 ± 0.05 with dabigatran or rivaroxaban versus VKAs. Consistent with results from clinical trials and other observational studies, dabigatran and rivaroxaban were at least as effective and safer than VKAs for the prevention of thromboembolic events in NVAF over 1 year in the French population. European Medicines Agency EUPAS 13017 (www.encepp.eu) Clinicaltrials.gov id NCT02785354.

Background Hypertension is a multifactorial disease involving both environmental and genetic Factros. G894 T eNOS polymorphism has been suggested to be responsible for reduced NO synthesis, and EH development. The objective of our case-control study is to evaluate the potential association of G894 T eNOS polymorphism with Essential Hypertension (EH) susceptibility, among a sample of Moroccan patients. Methods One hundred forty five hypertensive patients were recruited from the department of Cardiology, University Hospital Center Ibn Rochd, Casablanca, Morocco, and compared to 184 apparently healthy subjects. DNA samples were genotype by PCR-RFLP method using MboI restriction enzyme. Results Our results showed a positive correlation between G894 T eNOS distribution and Alcohol and Obesity rik factors (P = 0.009 and 0.02 respectively). Patients with elevated Cardio Vascular Risk (CVR) carried out the higher frequency of homozygous mutant genotype TT (62.2%) and T mutant allele (77.8%), compared to median and low CVR groups. G894 T eNOS distribution was significantly associated to a high risk of EH occurrence under the GT and TT genotypes (OR [95% CI] = 20.2 [7.7–52.4], P

Objective The aim of the present study was to investigate the association of I/D polymorphisms of ACE gene is associated with resistant hypertension and essential controlled hypertension. Results Our results show that the homozygous mutant genotype DD was more represented among resistant than controlled (58.1% vs 41.9% respectively), however the homozygote wild was more represented among controlled than resistant (70.6% vs 29.4% respectively). But more heterozygous ID among controlled than resistant patients (63.6% vs 36.4% respectively). The difference was statistically significant (p = 0.04). Analysis of clinical parameters indicated that physical activity contributes to resistant hypertension (P Based on our findings, the homozygous mutant for DD of ACE gene is associated with resistant hypertension in our population. Further studies with larger sample sizes are needed to confirm the results of this study.