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The Evolut R/Pro and the Sapien 3 are the most commonly valve systems used today for transcatheter aortic valve implantation (TAVI). However, there is a still uncertainty regarding the efficacy and safety comparison of these two valves.We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing the Evolut R/Pro versus the Sapien 3. The primary outcome was all-cause mortality (short and long-term). The secondary outcomes were stroke, bleeding, permanent pacemaker implantation (PPI), acute kidney injury (AKI), major vascular complication, device success, moderate- severe aortic regurgitation (AR), and pressure gradients.Twenty-one publications totaling 35,248 patients were included in the analysis. Evolut R/Pro was associated with higher risk of short-term all-cause mortality (OR = 1.31;95% CI 1.15-1.49, p 0.001) and a trend of higher long-term mortality (OR = 1.07;95% CI 1.00-1.16, p = 0.06). The Evolut R/Pro was associated with higher risk of PPI and AR and lower risk for bleeding, major vascular complication, and pressure gradients. There was no significant difference between the groups regarding the risk of stroke, AKI and device success.The Evolut R/Pro valve system compared to the Sapien 3 is associated with higher risk of short-term mortality, significant AR and PPI while providing the advantage of lower risk of bleeding, major vascular complication, and lower residual transvalvular gradients.

Metamizole is commonly used as analgesic and antipyretic drug. The use of metamizole is prohibited in several countries due to its rare side effect of neutropenia and even agranulocytosis. Among the many symptoms of COVID-19, fever and diffuse pain predominant and therefore it can be assumed that metamizole may be widely used in the current epidemic period. So far, there have been no reports on the safety of metamizole in COVID-19 patients. We describe a series of 3 patients who developed severe neutropenia under metamizole treatment, raising a concern of a possible increased risk of this side effect among COVID-19 patients.

To elucidate the association between adolescent microscopic hematuria and early onset urothelial carcinoma and renal cell carcinoma.Nationwide, population-based, retrospective cohort study using medical data of 970,366 adolescents aged 16 through 19 years (58.6% male) examined for fitness for military service between 1980 and 1997. Diagnoses of persistent isolated microscopic hematuria were given after thorough work up process excluding any other renal abnormalities. Incident cases of urothelial carcinoma and renal cell carcinoma diagnosed during the years of 1982-2012 were retrieved from the Israeli National Cancer Registry. Cox proportional hazards models were used to estimate the hazard ratio (HR) separately for urothelial carcinoma and renal cell carcinoma.During a cumulative follow-up of 22,115,629 person-years (median follow-up, 22.8), persistent isolated microscopic hematuria was diagnosed among 5509 (0.6%) adolescents. Urothelial carcinoma and renal cell carcinoma developed in 332 (3 among those with persistent isolated microscopic hematuria) and 292 (2) individuals, respectively. The adjusted HR for incident urothelial carcinoma among adolescents with isolated microscopic hematuria was 1.17 (95% CI, 0.38-3.66) and the adjusted HR for renal cell carcinoma was 1.02 (95% CI, 0.25-4.12).Persistent asymptomatic isolated microscopic hematuria at adolescence was not associated with increased risk for urothelial carcinoma nor renal cell carcinoma.

(1) Background: The use of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis is expanding significantly. We aimed to perform a meta-analysis comparing the safety and efficacy of TAVI versus surgical aortic valve replacement (SAVR) during the early and mid-term follow-up period. (2) Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing 1- to 2-year outcomes between TAVI and SAVR. The study protocol was preregistered in PROSPERO and the results were reported according to PRISMA guidelines. (3) Results: The pooled analysis included data from eight RCTs totaling 8780 patients. TAVI was associated with a lower risk of all-cause mortality or disabling stroke (OR 0.87, 95%CI 0.77–0.99), significant bleeding (OR 0.38, 95%CI 0.25–0.59), acute kidney injury (AKI; OR 0.53, 95%CI 0.40–0.69) and atrial fibrillation (OR 0.28, 95%CI 0.19–0.43). SAVR was associated with a lower risk of major vascular complication (MVC; OR 1.99, 95%CI 1.29–3.07) as well as permanent pacemaker implantation (PPI; OR 2.28, 95%CI 1.45–3.57). (3) Conclusions: TAVI compared with SAVR during early and mid-term follow-up was associated with a lower risk of all-cause mortality or disabling stroke, significant bleeding, AKI and atrial fibrillation; however, it was associated with a higher risk of MVC and PPI.

Previous studies have demonstrated an association between proton pump inhibitors (PPI) use and vitamin B12 deficiency. However, data regarding PPI use and elevated serum homocysteine level, an important marker of vitamin B12 deficiency, are scant.Data were collected from medical records of subjects examined at a screening center in Israel. Cross sectional analysis was conducted on 25,953 subjects. Levels of vitamin B12 and homocysteine were compared between subjects who consumed PPI medications and those who did not.The mean age of the study population was 45 years and 33% were females. Subjects who received PPI medications had a minor higher vitamin B12 levels (320 pmol/L vs 300 pmol/L, p=0.024). Levels of vitamin B12 remained higher in females receiving PPI medications after performing a stratified analysis according to subjects' gender. Homocysteine levels were higher in subjects receiving PPI medications as compared to those who did not (12.0 μmol/L vs 11.6 0 μmol/L, p0.001). Levels remained higher in female subjects after performing a stratified analysis according to subjects' sex. There was no statistically significant difference in the prevalence of vitamin B12 deficiency (according to two cutoffs: vitamin B12≤200 or ≤140 pmol/L) as well as the prevalence of hyperhomocysteinemia (defined as homocysteine15.0 μmol/L) between the two groups.According to our study, no association was found between PPI medication use and vitamin B12 deficiency or hyperhomocysteinemia. Patients receiving PPI medications had slightly higher levels of vitamin B12 and homocysteine, however these differences were too small to have any clinical relevance.

BACKGROUND The purpose of this study was to examine the correlation between research productivity in the field of rheumatology and various updated economic indicators of Countries of the Organisation for Economic Co-operation and Development (OECD). METHODS The number of documents published, number of citable documents, number of citations, citations per document, and the H-index for the 36 OECD countries in the field of rheumatology between 1996 and 2017 were obtained from the The Scimago Journal and Country rank source. The recent data regarding gross domestic product (GDP) per capita, total health spending as percent of GDP, and the gross domestic expenditure on research and development as percent of GDP were collected from the World Bank, OECD, and United Nations Educational, Scientific, and Cultural Organization Web sites, accordingly. The relationship between economic indicators and scientific productivity for each of the OECD countries was analyzed. RESULTS A total of 132,314 documents were analyzed. A moderate to strong significance correlation was found between health expenditure and the number of documents published (r = 0.67, p < 0.001), number of citable documents (r = 0.68, p < 0.001), number of citation (r = 0.76, p < 0.001), and H-index (r = 0.77, p < 0.001). CONCLUSIONS This study provides a current highlight on the relationship between academic productivity in rheumatology and economic indicators of OECD countries. We showed a positive moderate to strong significant correlation between total health expenditure as percent of GDP and different bibliometric indicators, implying another possible advantage of national investment in this filed.

BACKGROUND The optimal treatment for patients suffering from stable obstructive coronary artery disease (SOCAD) is controversial. Many studies have examined the value of performing percutaneous coronary intervention (PCI) in these patients but so far no study has been able to demonstrate an improvement in outcomes by performing PCI in addition to optimal medical therapy (OMT). This study aimed to examine the added value of performing PCI plus OMT vs. OMT alone regarding cardiovascular outcomes. METHODS AND RESULTS We performed a systematic search and a meta-analysis for randomized controlled trials comparing PCI plus OMT vs. OMT in SOCAD patients. We included six trials (N = 11 144) with follow-up ranges 2.2-11.4 years. The pooled analysis showed no significant difference between PCI + OMT vs. OMT group regarding all-cause mortality, odds ratio (OR) = 0.98 [confidence interval (CI) 0.86-1.12, P = 0.79, I2 = 0%]. In addition, we have found no difference between the two groups regarding cardiovascular mortality, OR = 0.91 (CI 0.76-1.08, P = 0.27, I2 = 24%). Moreover, there was no difference in the incidence of myocardial infarction, OR = 0.92 (CI 0.81-1.04, P = 0.18, I2 = 49%). CONCLUSION Our results suggest that there is no improvement in cardiovascular outcomes of patients with SOCAD by performing PCI plus OMT vs. OMT alone. This study provides an insight that should be taken under consideration in the management of SOCAD patients.

Previous studies have demonstrated a correlation between national economic indicators and academic productivity. However, such a relationship has not been studied in the field of internal medicine (IM).The number of documents published, number of citable documents, number of citations, citations per document and the h index between 1996 and 2019 in the field of IM among the Organisation for Economic Co-operation and Development (OECD) countries were analysed. Data were derived from the The Scimago Journal and Country rank source. We analysed the correlation between these indicators to the gross domestic product (GDP) per capita, health spending as percent of GDP and gross domestic expenditure on research and development as percent of GDP (GERD). Economic data were collected from the OECD websites.A significant correlation was found between health expenditure and h index (r = 0.75, P0.001), number of citations (r = 0.72, P0.001), number of documents (r = 0.62, P0.001) and number of citable documents (r = 0.61, P0.001); between GERD and number of citations (r = 0.6, P0.001), h index (r = 0.6, P0.001), number of documents published (r = 0.53, P = 0.001) and citable documents (r = 0.51, P = 0.001); between the GDP per capita and number of citations (r = 0.46, P = 0.005), citations per document (r = 0.54, P = 0.001) and h index (r = 0.5, P = 0.002).This study demonstrated a positive correlation between academic productivity in the field of IM and economic indicators of the OECD countries, mainly health expenditure, implying the advantage of domestic investment in health.

Background: The relation between health investment and research has been portrayed previously in several medical fields, showing a positive relation between economic resources and academic yield. Purpose: To assess the relations between various economic and bibliometric parameters in otolaryngology - head and neck surgery (ORL-HNS) of the OECD countries. Methods: Data regarding bibliometric parameters in ORL-HNS; number of publications, citations, citations per document and H index, between the years 1996 and 2019, were gathered from the Scimago Journal and Country Rank source. These data were then analysed in several breakdowns – seldom county, regional and language comparisons, in order to assess variations in ORL-HNS scholar activity. Economic data regarding each OECD country; GDP per capita, total health expenditure as percent of the GDP and GERD as percent of the GDP were gathered from the OECD and World Bank websites. The correlation between economic and bibliometric indicators was analysed. Results: Among 209,949 documents analysed, a strong correlation was found between H index and health expenditure (r=0.734, p=0.000), and a moderate connection was found between H index and both GDP per capita (r=0.459, p=0.005) and GERD as percent of GDP (r=0.579, p=0.000). Health expenditure showed the strongest correlations to bibliometric parameters. Nonetheless, most data showed some degree of positive correlations between economics and scholar productivity. Conclusion: This study emphasizes the positive relation between scholar productivity and economic indicators, mostly health expenditure, in the OECD countries in the field of ORL-HNS, implying the importance of health investment to ORL-HNS research.

The standard approach for urgent trans-venous temporary cardiac pacemaker (TVTP) implantation is fluoroscopy guidance. The delay in activation of the fluoroscopy-room and the transfer of unstable patients may be life-threatening. Echocardiography-guided TP implantation may increase the safety of the patients by obviating the need for in-hospital transfer. We examined the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TVTP implantation. From January 2015 to September 2017 data for consecutive patients who needed emergent TVTP implantation were retrospectively reviewed. Ultrasound-guided TVTP protocol that was introduced in our center in January 2015 involved ultrasound guidance for both central venous access and pacing lead positioning. Access sites included femoral, subclavian, or jugular veins. Electrodes were placed in the right ventricular apex by means of echocardiographic monitoring in intensive care unit or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications. Sixty-six patients (17 echocardiography-guided and 49 fluoroscopy-guided) were included. There were no differences in pacing threshold between the echocardiography-guided group and the fluoroscopy-guided group (0.75 ± 0.58 mA vs. 0.57 ± 0.35 mA, p = 0.24). The access site for implantation was femoral vein in 27% for the fluoroscopy-guided vs. none for the echocardiography-guided approach (p = 0.015). One hematoma and one related infection occurred in the fluoroscopy-guided group. The need for electrode repositioning was observed in 1 patient in each group. There were no procedural-related deaths in either group. Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly lowers the need for in-hospital transfer.

To compare the accuracy of intraocular lens power prediction for eyes with average keratometry (K) readings greater than 46.00 diopters (D) and lower than 42.00 D.Ein-Tal Eye Center, Tel-Aviv, Israel.Retrospective case series.Eyes having cataract extraction surgery with steep and flat preoperative corneal curvatures determined with the Lenstar-LS900 device were enrolled. Refractive prediction errors for the Barrett Universal II, Haigis, Hill-RBF, Hoffer-Q, Holladay 1, Holladay 2, Olsen, and SRK/T formulas were compared. Optimized K values for the SRK/T formula were back-calculated for each group. Validation was performed using an additional dataset.The study comprised 171 eyes (79, K reading46.00 D; 92, K reading42.00 D). For K readings greater than 46.00 D, myopic errors were noted using the SRK/T and Hill-RBF formulas and hyperopic errors using the Olsen C-constant and Haigis (-0.31 D, -0.17 D, 0.18 D, and 0.17 D, respectively). The percentage of eyes with an absolute error within ±0.50 D from target refraction ranged from 60.8% (SRK/T) to 83.0% (Hill-RBF). For K readings lower than 42.00 D, myopic errors were seen using the Haigis, Hill-RBF, Hoffer-Q, and Olsen-C formulas (-0.31 D, -0.14 D, -0.22 D, and -0.17 D, respectively) and a hyperopic error using the SRK/T formula (0.16 D). The refractive prediction within ±0.50 D ranged between 75.0% (Haigis) and 96.7% (Barrett Universal II).Power calculation for eyes with flat corneas and steep corneas requires the use of specific formulas for accurate postoperative results. An adjustment method of the SRK/T formula is proposed.

OBJECTIVE The aim of this study was to compare the effect of biologic agents and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) on the psychologic status of patients with psoriatic arthritis (PsA) in remission or with low disease activity. METHODS This is a case-control study of PsA patients in remission or with low disease activity treated at a single-center combined rheumatologic-dermatologic clinic between 2015 and 2017. Patients were assigned to 2 comparison groups according to their treatment (1) biologic drugs and (2) csDMARDs therapy. Psoriatic arthritis disease activity was evaluated by disease activity score-28. Anxiety, somatization, and depression were evaluated by patient health questionnaires (PHQ): generalized anxiety disorder-7, PHQ-15, and PHQ-9, respectively. Disability was assessed by the health assessment questionnaire disability index (HAQ-DI). RESULTS Thirty PsA patients on biologic treatment (BT) and 14 PsA patients in csDMARDs were enrolled. No significant differences in disease duration and treatment duration between the 2 groups were found. Disease activity score-28 was significantly better in the BT group compared with the csDMARDs group (1.8 ± 0.4 vs 2.1 ± 0.4, respectively, p = 0.028). A nonsignificant tendency toward higher scores in psychologic questionnaires was seen among the non-BT group. Moderate to high correlations between all mental questionnaires and HAQ-DI were found in both groups (0.567 ≤ r ≤ 0.850, p < 0.05). Patients with mental disturbance (generalized anxiety disorder-7/PHQ-15/PHQ-9 ≥ 5) showed significant poorer performance in their HAQ-DI in comparison with patient without physiological comorbidities in both groups. CONCLUSIONS Tight disease control in PsA patients, achieved with BT, may offer an improvement in psychological outcomes in addition to relieving clinical symptoms.

Background Noninvasive or minimally invasive cosmetic dermatologic procedures are considered safe with low parentage of reported adverse events. However, reliable prevalence data regarding adverse event of such cosmetic procedures among patients with systemic autoimmune diseases are insufficient. Objectives To assess the occurrence of adverse events and disease exacerbation associated with noninvasive or minimally invasive cosmetic dermatologic procedures, including those involving hyaluronic acid fillers, botulinum toxins and laser application among patients with systemic autoimmune diseases. Methods Consecutive cases of patients suffering from autoimmune diseases and attending the rheumatology clinic for regular follow-ups, were asked about receiving cosmetic procedures during the last two years. Medical history, including clinical and laboratory signs of disease exacerbation after the date of the procedure, was retrospectively obtained from medical files of the patients included in the study. Patients were also asked about subjective disease exacerbation and local adverse events after the procedure. Results During the three months of study period, 148 patients were inquired. Nineteen patients (89% females) underwent 23 cosmetic procedures in total. Thirty-nine percent had Rheumatoid arthritis (RA), 39% had Ankylosing spondylitis (AS) and 22% had other systemic connective tissue disease. Sixty seven percent were treated by Disease-modifying antirheumatic drugs (DMARDs), 28% by Biologic treatment and 5% did not receive any specific treatment. All patients were in remission during the cosmetic procedures. Forty three and a half percent of patients underwent hyaluronic acid injection, 21.7% botulinum toxin injection, 21.7% laser application, 8.7% mesotherapy and 4.3% silicon injection. None of the patients suffered from subjective disease exacerbation after the procedure. No changes in antibody titer and level of acute phase reactants (C-reactive protein and erythrocyte sedimentation rate) were noticed. Two patients (10.5%) experienced local oedema after filler injections. Both patients received Hydroxychloroquine treatment (one patient with RA and one with AS). Conclusions Our results suggest that noninvasive or minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, may be safe among rheumatological patients, and do not cause autoimmune systemic disease exacerbation when performed in periods of remission. Hydroxychloroquine may predispose to a higher occurrence rate of local site injection adverse events. Further studied are desired to investigate this phenomena. Disclosure of Interest None declared

Prasugrel has proved its superiority over clopidogrel for reducing ischemic events among patients with ST elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). Data on switching of antiplatelet therapy in acute coronary syndrome patients in clinical practice are very limited. Importantly, the safety of in-hospital switching from clopidogrel to prasugrel following thrombolysis has not been addressed.We reviewed consecutive STEMI patients from February 2011 to April 2014 who were transferred to a tertiary center after receiving thrombolysis and a loading dose of clopidogrel in a non-PCI-capable center. If not contraindicated, these patients were reloaded and treated with prasugrel. A control group, three times larger, was selected from patients who underwent primary PCI and were initially treated with prasugrel. In-hospital outcomes were examined.Cases (n=45, 13% female, mean age 56 years) and controls (n=135, 11% female, mean age 54 years) did not differ significantly with respect to MI location, left ventricular systolic function, and extent of coronary artery disease. Mean time from thrombolysis to prasugrel loading was 32±19 hours. No significant differences were found between cases and controls in TIMI major or minor bleeding (0% vs. 3%), overall mortality (0% vs. 1.5%), and hospitalization length (4.8 vs. 5.5 days).In-hospital reloading and subsequent maintenance therapy with prasugrel in patients who received thrombolysis and a loading dose of clopidogrel appears to be as safe as in STEMI patients managed by primary PCI; however, larger studies are needed to verify these results.

Background: Combined therapy of weight loss and exercise provide today the best treatment for Knee Osteoarthritis. Most studies evaluating the effect of this therapy focus on the active intervention phase or immediately after the end of the treatment. Objectives: To describe the of long term effectiveness of weight loss and exercise treatment on Knee Osteoarthritis. Methods: Medical charts of 10 overweight women who suffered from Knee Osteoarthritis and had been treated for six months with a combined treatment of weight loss with Orlistat in the recommended dose, aerobic exercise and muscle mass strengthening, were retrospectively reviewed. Knee Osteoarthritis symptoms were assessed before treatment, at the end of treatment and following 6 months using the Western Ontario and McMaster Universities Osteoarthritis Index. Results: In comparison to baseline, we documented a statistically significant improvement in pain, stiffness, and function at the end of the treatment (37.0 vs. 21.0, P=0.007, 44.5 vs. 28.3, P=0.037 and 45.5 vs. 27.1, P=0.005, respectively) together with reduction in BMI (32.9 vs. 29.5, P=0.007). Six months later, although the mean BMI had returned to its baseline (31.1, P=0.126), the improvement in all parameters still existed (23.9, P=0.028, 27.1, P=0.028 and 32.9, P=0.037, respectively). Conclusions: Weight reduction together with muscle strengthening can improve function, stiffness, and pain symptoms in women with knee Osteoarthritis. Our case series suggest that this combined intervention may potentially maintain clinical improvement even when patients return to their baseline weight.

Background Reactivation of latent tuberculosis (TB) is a major complication of tumor necrosis factor alpha inhibitors (TNF-i). Therefore, screening for latent TB is recommended before initiation of this treatment. Currently, the cut-off size of a positive Tuberculosis skin test (TST) among immunosuppressed patients is 5 mm. It is vastly described in the literature that Prednisone treatment along with chronic inflammatory disease depresses TST reaction. Nevertheless, few studies reject this hypothesis. Objectives To assess the correlation between Prednisone treatment duration and dosing with the size of a TST reaction among Rheumatoid Arthritis (RA) patients. To compare the size of a TST reaction among RA patients with and without Prednisone therapy. Methods Consecutive cases of RA patients candidate for TNF-i therapy were retrospectively reviewed. TST measurements, Prednisone and Methotrexate doses and treatment durations were recorded. Active tuberculosis (TB) was excluded by chest X-ray and patient9s history. A control group, was randomly selected from healthy patients who had a TST at the pulmonology clinic in our institution. We compared the results of the mean TST reaction size between the following three groups: RA patients with current prednisone treatment, RA patients without history of prednisone treatment and healthy individuals. Oneway ANOVA test was used to compare the differences between the groups. We then calculated a score of Prednisone and Methotrexate unit-years (u-y) by multiplying the dosage of the medication divided by it9s minimal unit (5 mg/day and 2.5 mg/week, respectively) by the number of treatment years. A correlation between this score and the size of the TST reaction was assessed using Pearson9s correlation coefficient (r). A value of p Results 43 (mean age 57.8±13.1 years, 86% female) RA patients with prednisone treatment, 20 (mean age 59.0±10.5 years, 70% female) prednisone naive patients and 137 (mean age 32.7±13.0 years, 62% female) healthy subjects were enrolled in the study. There was no significant difference in mean TST between these three groups (5.3±6.8, 7.4±6.3, 4.2±6.0, respectively, p=.079). No correlation was noted between TST size and Prednisone u-y (mean u-y =5.2±5.7, r=.235, p=.130), and Methotrexate u-y in patients with and without Prednisone therapy (mean u-y =14.4±28.5, r=.220, p=.156; mean=32.3±34.4, r=-.351, p=.130 respectively). Conclusions Our results showed that TST reaction distribution among RA patients isn9t affect by Prednisone therapy. In addition, RA patients may present TST reaction similar to healthy individuals. Therefore, we conclude that the criterion of 5 mm TST reaction defining latent TB infection in our population should be re-evaluated. It may be more appropriate to substitute the traditional TST for newer diagnostic tools as the QuantiFERON assay. Larger studies are needed to verify our results. Disclosure of Interest None declared