Azithromycin and hydroxychloroquine in hospitalised patients with confirmed COVID-19: a randomised double-blinded placebo-controlled trial.

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 ≥18 years, admitted to hospital for ≤48 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 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice-daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 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 30 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.

[Electrical stimulation against loss of muscles and function in a patient admitted with COVID-19].

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.

Mortality associated with cardiovascular drugs in patients with chronic obstructive pulmonary disease and right-sided heart failure - A danish nationwide registry-based study.

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 10 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 2.2 years (±standard deviation 2.8, min-max 0-19.6 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.

[Palliative care of patients with terminal obstructive pulmonary disease]. / Palliativ behandling af patienter med terminal kronisk obstruktiv lungesygdom.

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.

[Endobronchial mediastinal ultrasound with biopsy]. / Endobronkial ultralydsskanning af mediastinum med biopsi.

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.

[The importance of physical activity and body mass index for body satisfaction]. / Betydningen af fysisk aktivitet og body mass index for tilfredshed med kropsbygningen.

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.