RESUMO
BACKGROUND: Combining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also having in vitro antiviral properties. This may improve outcomes in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: Placebo-controlled double-blind randomised multicentre trial. Patients aged ≥18â years, admitted to hospital for ≤48â h (not intensive care) with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription PCR test were recruited. The intervention was 500â mg daily azithromycin for 3â days followed by 250â mg daily azithromycin for 12â days combined with 200â mg twice-daily hydroxychloroquine for all 15â days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14â days (DAOH14). RESULTS: After randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due to futility, based on pre-specified criteria. Consequently, the trial was terminated on 1 February 2021. 61 patients received the combined intervention and 56 patients received placebo. In the intervention group, patients had a median (interquartile range) 9.0 (3-11) DAOH14 versus 9.0 (7-10) DAOH14 in the placebo group (p=0.90). The primary safety outcome, death from all causes on day 30, occurred for one patient in the intervention group versus two patients receiving placebo (p=0.52), and readmittance or death within 30â days occurred for nine patients in the intervention group versus six patients receiving placebo (p=0.57). CONCLUSIONS: The combination of azithromycin and hydroxychloroquine did not improve survival or length of hospitalisation in patients with COVID-19.
Assuntos
Tratamento Farmacológico da COVID-19 , Hidroxicloroquina , Adolescente , Adulto , Azitromicina , Método Duplo-Cego , Humanos , SARS-CoV-2 , Resultado do TratamentoRESUMO
This is a case report of a hospitalised 62-year-old male patient with COVID-19, who received unilateral neuromuscular electrical stimulation treatment with a customised anti-embolic compression stocking and maintained muscle mass as well as maximum voluntary quadriceps contraction and balance during six days of illness-induced immobilisation. This illustrates, that short durations of neuromuscular electrical stimulation can help maintaining muscle mass and physical function in patients with SARS-CoV-2.
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COVID-19 , Terapia por Estimulação Elétrica , Estimulação Elétrica , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Músculo Quadríceps , SARS-CoV-2RESUMO
BACKGROUND: The optimal medical treatment in patients with chronic obstructive pulmonary disease (COPD) and right-sided heart failure (RHF) is unknown. We aimed to estimate the risks of all-cause mortality associated with the current clinical use of various cardiovascular drugs in this patient-group. METHODS: We followed all patients with registered COPD and RHF (defined as a diagnosis of pulmonary hypertension plus use of loop-diuretics) for the risk of all-cause mortality (Jan 1, 1995 to Dec 31, 2015) using the Danish nationwide administrative registries. The association between mortality and claimed prescriptions for cardiovascular drugs was assessed by multivariable Cox regression models. RESULTS: 5991 patients (mean age 74⯱â¯standard deviation 10â¯years, 51% women) were included. Of these, 1440 (24%) used beta-blockers, 2149 (36%) renin-angiotensin system inhibitors [RASi], 1340 (22%) oral anticoagulants, 1376 (23%) calcium channel blockers, 1194 (20%) statins, 1824 (30%) spironolactone, and 2099 (35%) low-dose aspirin. During an average follow-up of 2.2â¯years (±standard deviation 2.8, min-max 0-19.6â¯years), 5071 (85%) died, corresponding to a mortality rate of 38 per 100 person-years (95% confidence interval 37-39). Compared to no use, beta-blockers were associated with adjusted hazards ratio 0.90 (95% confidence interval 0.84-0.98), RASi 0.92 (0.86-0.98), calcium channel blockers 0.86 (0.80-0.92), spironolactone 1.17 (1.10-1.24), statins 0.85 (0.78-0.92), oral anticoagulants 0.87 (0.79-0.95), and aspirin 0.99 (0.93-1.05). Propensity-score matched analyses and inverse-probability-weighted models yielded similar results. CONCLUSION: Several cardiovascular drugs may be associated with lowered mortality in COPD and RHF. Given the grave prognosis, randomized clinical trials are warranted to test this hypothesis.
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Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Mortalidade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Dinamarca/epidemiologia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pontuação de Propensão , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/complicações , Sistema de Registros , Espironolactona/uso terapêutico , Resultado do TratamentoRESUMO
Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative phase of the disease. Furthermore we discuss the prognostic and ethical challenges for patients, their families and their caregivers. Finally, we summarize the current evidence for palliative treatment of dyspnoea and ways to evaluate response to treatment.
Assuntos
Cuidados Paliativos , Doença Pulmonar Obstrutiva Crônica/terapia , Assistência Terminal , Cuidadores/psicologia , Dinamarca , Dispneia/tratamento farmacológico , Dispneia/enfermagem , Dispneia/terapia , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Relações Profissional-Família , Relações Profissional-Paciente , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/enfermagem , Assistência Terminal/métodos , Assistência Terminal/organização & administraçãoRESUMO
INTRODUCTION: Endobronchial ultrasound (EBUS) is a minimally invasive diagnostic modality, by which it is possible to visualize and do biopsy of structures adjacent to the trachea and the central bronchial system. EBUS is mostly used for staging of lung cancer patients, but EBUS is now used worldwide as a diagnostic tool in patients with mediastinal tumours or adenopathy. MATERIAL AND METHODS: In this paper, we report of the result of the first 100 EBUS patients referred for further investigation of mediastinal adenopathy or tumour found via CT. All 100 patients underwent EBUS in general anaesthesia, and 95 patients had transbronchial needle aspiration biopsy performed (TBNA). RESULTS: A total of 46 patients were known to have or have had cancer; in 20 of these patients we found cancer in the mediastinum by EBUS-TBNA, 24 patients had lymph node aspirates without cancer and in two patients the aspirate was inconclusive. The remaining 49 patients all had a record of non-malignant medical disease; 22 of these patients were found to have cancer in the mediastinum, one patient had cancer-suspect EBUS-TBNA, 24 had lymph node aspirates without malignancy and in two patients the aspirate was inconclusive. All patients were followed for 6-30 months. The sensitivity was roughly calculated to 94%. No patients suffered any complications. CONCLUSION: We conclude that EBUS-TBNA is a safe and accurate diagnostic tool in the evaluation of mediastinum in patients with cancer as well as in patients with non-malignant disease.
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Biópsia por Agulha Fina/métodos , Neoplasias do Mediastino/patologia , Mediastino/patologia , Ultrassonografia de Intervenção/métodos , Endossonografia/métodos , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Neoplasias do Mediastino/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Estadiamento de Neoplasias , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Body satisfaction has mostly been investigated among patients with psychiatric diseases. A few studies have found an association between physical activity, obesity and body satisfaction in the healthy population, but the focus has mostly been on the risk of developing diseases. The aim of the present study has been to study the association between body satisfaction, BMI, physical activity and chronic diseases. MATERIALS AND METHODS: A total of 15,252 women and 14,181 men born between 1953 and 1982 (both years included) and registered with The Danish Twin Registry answered a questionnaire which they were sent in 1994. We used the questions on chronic diseases, height and weight, physical activity and body satisfaction. Univariat analysis of body satisfaction and the other variables was carried out using chi2-tests and t-tests. Multivariat analysis was carried out with logistic regression. RESULTS: More men than women are satisfied with their bodies; BMI confers a negative association, while physical activity confers a positive association with body satisfaction. This satisfaction appears to some degree mediated by BMI. The presence of asthma and other lung symptoms and lower-back pain was negatively associated with body satisfaction. DISCUSSION: Thinness tends to be the ideal body image today and this may explain why more obese people are dissatisfied with their body. This ideal is more important for women s perception of their bodies. Physical activity and being healthy adds to body satisfaction.