To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia.
...Comparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125-250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation.
We included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31, 95% CI 0.08 to 1.12, p = 0.073 and HR 0.34, 95%CI 0.12 to 0.94, p = 0.038, respectively) but not in patients with higher SpO2/FiO2. Patients receiving out-of-week-2-MP, non-pulse glucocorticoids or no glucocorticoids had an increased adjusted risk for both outcomes compared with week-2-MP group: HR 5.04 (95% CI 0.91-27.86), HR 10.09 (95% CI 2.14-47.50), HR 4.14 (95% CI 0.81-21.23), respectively, for death; HR 7.38 (95% CI 1.86-29.29), HR 13.71 (95% CI 3.76-50.07), HR 3.58 (95% CI 0.89-14.32), respectively, for death or intubation. These differences were significant only in the subgroup with low SpO2/FiO2.
Week-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia with features of inflammatory activity and respiratory deterioration entering the second week of disease. The recognition of this high-risk population should prompt early use of MP at this point.
To study whether adding repeated 125 mg methyl-prednisolone pulses (MP) to Eurolupus fortnightly intravenous cyclophosphamide (CYC) improves remission of lupus nephritis (LN) compared with ...recommended schedules.
Observational comparative study of patients with biopsy-confirmed class III, IV or V LN: 30 in the mycophenolate (MMF) group, 25 in the CYC group and 38 in the CYC-MP group. The main efficacy outcome was complete response at 12 months.
Patients in the CYC-MP group received lower doses of prednisone within 6 months (mean 8.5 mg/d, vs. 15 mg/d in the MMF group vs. 24 mg/d in the CYC group, respectively). The complete response rates at 12 months were: CYC-MP 86%; CYC 56%; MMF 47% (p = 0.002) at Pr/Cr <0.5; CYC-MP 86%; CYC 65%; MMF 63% (p = 0.07) at Pr/Cr ≤0.7. The cumulative 12-month response rates for the CYC-MP, CYC and MMF groups were, respectively, 0.90, 0.58 and 0.63 (p = 0.004). In the adjusted Cox model, patients receiving CYC-MP were more likely to achieve complete response at Pr/Cr <0.5 than those in the MMF (HR vs. CYC-MP 0.33, 95%CI 0.16-0.65) and the CYC groups (HR vs. CYC-MP 0.47, 95%CI 0.21-1.04). Glucocorticoid-related toxicity was seen in 2.6% of the CYC-MP group, 24% of the CYC group and 20% of the MMF group (p = 0.029).
The addition MP of 125 mg to each fortnightly dose of 500 mg of CYC improves response rates and reduces the need for oral glucocorticoids in patients with class III, IV and V LN.
•Cyclophosphamide (CYC) and mycophenolate-based therapies fail to achieve complete response in 25% lupus nephritis patients.•The combination of repeated pulses of methyl-prednisolone and CYC increases 6 and 12-month complete response rates.•This combination also allows a reduction of prednisone doses and glucocorticoid-related side effects.
Symptomatic congenital pulmonary malformations (CPMs) are a group of anomalies involving the lungs. The long-term outcomes of these patients are not well known. The present research aimed to study ...the pulmonary function, respiratory morbidity, and health-related quality of life (QoL) of patients treated for CPMs. All children (<16 years of age) treated for CPMs in 2002−2012 (in Oulu University Hospital) were invited to the follow-up visit. Altogether, there were 22 patients, out of which 17 (77%) participated. The mean follow-up time was 6.6 (ranged from 3 to 16) years. Pulmonary function tests, diffusing capacity, respiratory morbidity, and QoL were determined as the primary outcomes. Potential residual malformations and lung anatomy were investigated using computer tomography (CT) imaging. The outcomes were compared to the age- and sex-matched healthy controls. The forced expiratory volume at 1 s (FEV1, Z-score) remained lower in operated patients compared to the healthy controls (−1.57 ± SD 1.35 vs. −0.39 ± SD −0.86, p-value 0.005). There were no differences in respiratory morbidity or QoL between the patients and the controls. The surgical approach (lobectomy vs. partial resection) did not affect lung function. A younger age (<1 year of age) at the time of the surgery seemed to result in a higher lung capacity, but the finding was not statistically significant. Patients with CPMs treated with surgery were satisfied with their wellbeing in the long-term. A lower lung function did not have an impact on their wellbeing. However, there was a slight decrease in lung function compared to the healthy controls, and a clinical follow-up of the patients was recommended.
Bakgrund: Fotboll är en av världens största idrotter och står för en stor del av alla sportrelaterade skador. Skadorna kan leda till nedsatt hälsa, kostnader för samhället samt slutet av en ...spelarkarriär. Hittills har forskningen främst fokuserats på träning när det gäller skadeförebyggande åtgärder. Det finns även andra faktorer som kan minska skaderisken men som i dagsläget inte utforskats i samma utsträckning. Syfte: Syftet var att undersöka uppfattningar och erfarenheter, hos fysioterapeuter till elitfotbollslag, rörande orsaker till skador samt viktiga komponenter för skadeförebyggande arbete inom elitfotboll. Metod: Studien har en kvalitativ ansats med deskriptiv design. Fem semistrukturerade intervjuer genomfördes och bearbetades genom en kvalitativ innehållsanalys. Resultat: Inom ”Orsaker till skador” identifierades fem kategorier; ”Fysisk belastning”, ”Psykisk- och social press”, ”Tränartyp”, ”Spelsituation” och ”Social situation”. ”Komponenter för skadeförebyggande arbete” genererade sex kategorier; ”Lagets resurser”, ”Planera belastning”, ”Kommunikation mellan medicinska teamet, tränarna och spelarna”, ”Utbildning av medicinska teamet, tränarna och spelarna”, ”Hitta balans i spelarnas vardag” och ”Hur spelarna mår fysiskt och psykiskt”. Konklusion: Flera aspekter påverkar uppkomsten av skador och därav behöver flera komponenter tas i beaktning vid förebyggandet av dessa. Vidare studier behövs för att täcka in ytterligare områden och för att kunna dra slutsatser om vilka av de möjliga komponenterna som bör prioriteras.
Background: Soccer is the world´s biggest sport and is responsible for a lot of all the sports related injuries. These injuries can result in impaired health, expenses for the society and the end of a career. The main focus of today´s research regarding injury preventions are different types of training. There may also be other components that might reduce the risk of getting injured that hasn´t been explored as much. Purpose: The aim was to investigate the perceptions and experiences of physiotherapists working for elite soccer clubs, regarding causes of injuries and important injury preventive methods. Method: A qualitative descriptive design was used in this study. Five semi structured interviews were performed and a qualitative content analysis was used. Result: Based on ”Causes of injuries”, five categories were identified; "Physical load", "Psychological and social pressure", "Type of trainer", "Game situation" and "Social situation". ”Injury prevention methods” generated six categories; "The team´s resources", "Planning Load", "Communication between the medical team, coaches and players", "Education of the medical team, coaches and players", "Finding balance in players' everyday life," and "How the players feel physically and psyochologically." Conclusion: Several aspects affect the occurrence of injuries, and therefore several components need to be taken into account in the prevention of these. Further studies are needed to cover additional areas and to draw conclusions about which of the possible components that should be prioritized.
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