Antimalarials have shown beneficial effects on systemic lupus erythematosus (SLE) activity. Our aim was to investigate whether antimalarials protect against thrombosis and influence survival in SLE patients. A prospective cohort including 232 patients with SLE were included in the study at the time of lupus diagnosis. End points were documented thrombosis and death due to any cause. A Cox regression-multiple-failure time survival analysis model was fitted to establish the effect of antimalarials on the development of thrombosis. Kaplan-Meier survival curves and propensity score adjusted-Cox regression analysis were performed to investigate the effect of antimalarials use on survival. Of our subjects, 204 patients (88%) were women. 230 patients (99%) were white. 150 patients (64%) had ever received antimalarials. Median time on antimalarials was 52 months (range three to 228 months). The Cox multiple-failure time survival analysis showed that taking antimalarials was protective against thrombosis (HR 0.28, 95% CI 0.08-0.90), while aPL-positivity (HR 3.16, 95% CI 1.45-6.88) and previous thrombosis (HR 3.85, 95% CI 1.50-9.91) increased the risk of thrombotic events. Twenty-three patients died, 19 of whom (83%) had never received antimalarials. No patient treated with antimalarials died of cardiovascular complications. Cumulative 15-year survival rates were 0.68 for never versus 0.95 for ever treated patients (P < 0.001). Age at diagnosis and propensity score-adjusted HR for antimalarials ever versus never users was 0.14 (95% CI 0.04-0.48). Our study shows a protective effect of antimalarials against thrombosis and an increased survival of SLE patients taking these drugs. These data support the routine use of antimalarials in all patients with SLE.

The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD).Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off $10 3 colony-forming units (CFU . mL -1 ). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis.Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45±17.9) and current smoking (OR 3.17, 95% CI 2.5±8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19±39.3) being the only variable independently associated with positive bacterial cultures.Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking. Eur Respir J 1999; 13: 343±348. Despite intensive investigation, the precise role of bacterial infection in the production and recurrent aspects of chronic obstructive pulmonary disease (COPD) has yet to be elucidated [1,2]. It has been estimated that the lower respiratory tract of stable COPD patients is colonized in 50±100% of cases [3,4]. In most studies, however, the tracheobronchial microflora was characterized by unreliable diagnostic techniques (e.g. expectorated sputum, transtracheal aspiration) owing to the lack of specificity and the absence of quantitative cultures [5±8]. Fibreoptic bronchoscopy using a protected specimen brush (PSB) catheter is a highly sensitive and specific technique used to obtain uncontaminated specimens for culture from the lower respiratory tract [9]. In patients with stable COPD, the prevalence of lower airway bacterial colonization using the PSB varies between 25 and 55.5% [10±12]. However, predisposing factors to bacterial colonization in patients with stable COPD have not been well defined.To determine precisely the influence of different factors, such as age, degree of airflow obstruction, smoking habit, pack-yrs of smoking and chest radiographic findings, on the detection of bacteria in COPD patients, a prospective study was conducted using the PSB and quantitative cultures. Materials and methods Study populationThe study was carried out in a 1,000-bed te...

Background: Recent studies suggest that antimalarials have antineoplastic properties. Objective: To investigate whether antimalarials decrease the risk of cancer in systemic lupus erythematosus (SLE). Methods: An observational prospective cohort study was carried out. 235 patients were included in the study at the time of diagnosis (American College of Rheumatology criteria). The end point was the diagnosis of cancer. Kaplan-Meier cancer-free survival curves for patients treated and not treated with antimalarials were compared. A Cox proportional hazards model was fitted, with cancer as the dependent variable. Age at diagnosis, gender, treatment with azathioprine, cyclophosphamide and methotrexate, smoking, Systemic Lupus International Collaborating Clinics (SLICC) Damage Index 6 months after diagnosis, year of diagnosis and treatment with antimalarials were entered as independent variables. Results: 209 (89%) patients were women. 233 (99%) patients were white. Mean (SD) age at diagnosis was 37 (16) years. Median (range) follow-up was 10 (1-31) years. 156 (66%) patients had ever received antimalarials. 2/156 (1.3%) evertreated patients compared with 11/79 (13%) never-treated patients had cancer (p,0.001). Cumulative cancer-free survival in treated and not treated patients was 0.98 and 0.73, respectively (p,0.001). Adjusted hazard ratio for cancer among malaria drug users compared with non-users was 0.15 (95% CI 0.02 to 0.99). Conclusions: This study launches the hypothesis of a protective action of antimalarials against cancer in patients with SLE. This effect should be confirmed in larger multicentre studies.

Objective 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. Methods 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. Results 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,

The pretreatment nodal SUV in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUV and nodal SUV were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.

OBJECTIVE: To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) on the clinical course of patients with severe coronavirus disease 2019 (COVID-19) pneumonia. DESIGN: Comparative observational study using data collected from routine care. SETTING: Hospital Universitario Cruces, a tertiary level University hospital at Barakaldo, Bizkaia, Spain. PARTICIPANTS: All patients with COVID-19 pneumonia admitted between 1st March and 30th April 2020 to the services of Infectious Diseases and Internal Medicine. INTERVENTIONS: Treatment with week-2-MP (125-250 mg/d for 3 consecutive days with no subsequent tapering) vs. standard of care. MAIN OUTCOMES MEASURES: Time to death and time to death or endotracheal intubation. RESULTS: Two hundred and forty-two patients with confirmed COVID-19 pneumonia and elevated inflammatory markers at admission were included in the study. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died during the study period. Thirty-one patients (12.8%) suffered death or intubation. The adjusted HR for death was 0.35 (95%CI 0.11 to 1.06, p= 0.064) for patients in the week-2-MP group. The adjusted HR for death or intubation week-2-MP was 0.33 (95%CI 0.13 to 0.84, p=0.020) for patients in the week-2-MP group. These differences were seen in the subcohort of patients with a SaO2/FiO2 at day 7 lower than the median of the whole population: 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 SaO2/FiO2. Other predictors of the final outcomes were arterial hypertension, SaO2/FiO2, high-risk CURB65 scores and the use of non-pulse glucocorticoids. Non-pulse glucocorticoids were a predictor of infections (OR 4.72, 95%CI 1.90 to 11.80, p<0.001), while week-2-MP were not (OR 1.04, 95%CI 0.40 to 2.70, p=0.938). CONCLUSIONS: 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. REGISTRATION: This study has been registered in the EU PAS Register with the number EUPAS36287.

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