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Background There is an urgent need to reduce mortality of COVID-19. We examined if corticosteroids and tocilizumab reduce risk for death in patients with severe pneumonia caused by SARS-CoV-2. Methods A retrospective cohort study was performed in a single university hospital. All adult patients admitted with confirmed severe COVID-19 pneumonia from 9 March to 9 April 2020 were included. Severe pneumonia was defined as multi-lobar or bilateral pneumonia and a ratio of oxygen saturation by pulse oximetry to the fraction of inspired oxygen (SpFi)

Introduction: The aetiological agent of erythema infectiosum is Erythrovirus B19 (also known as parvovirus B19), frequently found in children and adolescents, but also associated with arthropathy, aplastic crisis, and abortion in adults. Material and methods: A retrospective study of Erythrovirus B19 cases in the years 2010–2015. Results: Of the 56 cases of Erythrovirus B19 diagnosed, 34 were adults (32 women and 2 men) and 22 younger than 18 years (12 girls and 10 boys). Six cases were in pregnant women. Infections mainly occurred between spring and summer. In childhood, fever (64%), rash (50%), and anaemia (55%) were the most frequent symptoms. However, arthralgia (59%) was the most frequent symptom in adults, and less frequent were anaemia (41%), fever (32%), and rash (29%). Conclusions: The characteristic clinical presentation in childhood was rash and fever, whereas in adults it was arthralgia. Anaemia is also frequent, but only severe in previous haematological disease. It should be pointed out that Erythrovirus B19 infection during pregnancy could severely affect the foetus. Resumen: Introducción: El Erythrovirus B19 (anteriormente denominado parvovirus B19) es el agente etiológico del eritema infeccioso que afecta mayoritariamente durante la infancia y la adolescencia, pero también está relacionado con artropatías, crisis aplásicas y abortos en adultos. El propósito de esta revisión es estudiar las características de las infecciones causadas por Erythrovirus B19 diagnosticadas en nuestro hospital en los últimos 6 años y las diferencias entre la población adulta y la pediátrica. Material y métodos: Estudio retrospectivo de los casos diagnosticados de Erythrovirus B19 mediante serología, entre enero de 2010 y diciembre de 2015. Resultados: Fueron diagnosticados 56 casos, 34 adultos (32 mujeres y 2 varones) y 22 menores de 18 años (12 niñas y 10 niños). El 75% de los casos se dieron entre primavera y verano. Seis fueron en gestantes y en 2 hubo complicaciones graves que conllevaron la muerte fetal. En la población pediátrica los síntomas más frecuentes fueron fiebre (64%), exantema (50%) y anemia (55%). En adultos las artralgias (59%) y menos frecuentemente la anemia (41%), la fiebre (32%) y el exantema (29%). Conclusiones: En pediatría la clínica más frecuente es el exantema y la fiebre, y en adultos las artralgias. También es frecuente la anemia, los casos más graves en presencia de enfermedad hematológica previa. Hay que destacar la grave afectación que pueden sufrir los fetos en las gestantes.

We compared the bacterial microbiomes lodged in the bronchial tree, oropharynx and nose of patients with early stage cystic fibrosis (CF) not using chronic antibiotics, determining their relationships with lung function and exacerbation frequency. CF patients were enrolled in a cohort study during stability and were checked regularly over the following 9 months. Upper respiratory samples (sputum [S], oropharyngeal swab [OP] and nasal washing [N]) were collected at the first visit and every 3 months. 16S rRNA gene amplification and sequencing was performed and analyzed with QIIME. Seventeen CF patients were enrolled (16.6 SD 9.6 years). Alpha-diversity of bacterial communities between samples was significantly higher in S than in OP (Shannon index median 4.6 [IQR: 4.1–4.9] vs. 3.7 [IQR: 3-1-4.1], p = 0.003/Chao 1 richness estimator median 97.75 [IQR: 85.1–110.9] vs. 43.9 [IQR: 31.7–59.9], p = 0.003) and beta-diversity analysis also showed significant differences in the microbial composition of both respiratory compartments (Adonis test of Bray Curtis dissimilarity matrix, p = 0.001). Dominant taxa were found at baseline in five patients (29.4%), who showed lower forced expiratory volume in the first second (FEV1%, mean 74.8 [SD 19] vs. 97.2 [SD 17.8], p = 0.035, Student t test). The Staphylococcus genus had low RAs in most samples (median 0.26% [IQR 0.01–0.69%]), but patients with RA > 0.26% of Staphylococcus in bronchial secretions suffered more exacerbations during follow-up (median 2 [IQR 1–2.25] vs. 0 [0–1], p = 0.026. Mann–Whitney U test), due to S. aureus in more than a half of the cases, microorganism that often persists as bronchial colonized in these patients (9/10 [90%] vs. 2/7 [28.6%], p = 0.034, Fisher’s exact test). In conclusion, the bronchial microbiome had significantly higher diversity than the microbial flora lodged in the oropharynx in early stage CF. Although the RA of the Staphylococcus genus was low in bronchial secretions and did not reach a dominance pattern, slight overrepresentations of this genus was associated with higher exacerbation frequencies in these patients.

BackgroundThe respiratory microbiome is altered in COPD patients but its relationship with core components of the disease, such as the severity of airflow limitation, the frequency of exacerbations or the circulating levels of eosinophils, is unclear.MethodsCross-sectional study comprising 72 clinically stable COPD patients (mean age 68 [SD 7.9] years; FEV1 48.7 [SD 20.1]% of reference) who provided spontaneous sputum samples for 16S rRNA gene amplification and sequencing. The microbiome composition was analysed with QIIME.ResultsWe observed that: (1) more severe airflow limitation was associated with reduced relative abundance (RA) of Treponema and an increase in Pseudomonas; (2) patients with 2 exacerbations the previous year showed a significantly different bacterial community with respect to non-exacerbators (p=0.014), with changes in 13 genera, including an increase of Pseudomonas, and finally, (3) peripheral eosinophils levels 2% were associated with more diverse microbiome [Chao1 224.51 (74.88) vs 277.39 (78.92) p=0.006; Shannon 3.94 (1.05) vs 4.54 (1.06) p=0.020], and a significant increase in the RAs of 20 genera.ConclusionThe respiratory microbiome in clinically stable COPD patients varies significantly according to the severity of airflow limitation, previous history of exacerbations and circulating eosinophils levels., This study was funded by FIS PI15/00167 and PI15/02042 from Instituto de Salud Carlos III (ISCIII), SAF 2014-54371 (FEDER) from Ministerio de Economia y Competitividad, Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR), Laboratorios Menarini S. A, Fundacio Pla Armengol and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES). CIBERES is an initiative of the ISCIII.; This work was also supported by grants from Agencia de Gestio d'Ajuts Universitaris i de Recerca-Generalitat de Catalunya (2017 GRC-716).

Introduction:While preoperative urinary tract infection (UTI) has the potential to cause bacteremia and postsurgical acute prosthetic joint infections (APJIs), the influence of asymptomatic bacteriuria (AB) in these infections remains unclear. So the majority of guidelines not recommend the treatment of AB prior to the surgery. However, as patients with dementia usually cannot explain the symptoms of dysuria, the differential diagnosis between AB and UTI may be very difficult in this group of patients. The principal aim of the study was to compare the rate of positive urine culture at admission in patients with femoral neck fracture with and without dementia and secondarily try to assess the connection of positive urinoculture and postoperative acute gram-negative PJI.Methods:All patients with a femoral neck fracture underwent a urine culture on hospital admission and were prospectively recorded. Variables such as sex, age, institutionalization, dementia and other comorbidities, PJI rate, and in-hospital death were collected. The results of cultures were retrospectively revised. Patients who received postoperative antibiotics or had been diagnosed with UTI during hospital stay were excluded. Statistical comparisons between patients with and without dementia were performed using SPSS software version 17.Results:A total of 148 patients were included (52 with dementia). The rate of positive urine culture was 32% (n = 16) in patients with dementia and 11.5% in patients without dementia ( P = .003). Of these 16 patients with dementia and positive urine culture, 2 (12.5%) developed an acute gram-negative PJI, whereas there were no cases in the group without dementia ( P = .011).Discussion:The only difference between UTI and AB is the expression of symptoms by the patient. However, as patients with dementia have difficulties to explain UTI symptoms, some UTI may be underdiagnosed.Conclusion:Patients with dementia have a statistically higher rate of presurgical positive urine culture compared with patients without dementia.

Objective: To evaluate the relationships between respiratory microbiome and main COPD phenotyes Methods: Sputum samples from COPD patients were obtained during stability and 16S rRNA gene was analyzed. Taxonomic and diversity information were correlated with frequent exacerbator (FE) and eosinophilic COPD (EC) phenotypes Results: 78 subjects were analyzed, mean age 67 (SD 9) years. Patients with ≥2 exacerbations the previous year were considered FE (n=23). Their bacterial community was significantly different (p=0.014) from patients with no exacerbations (n=31), with changes in RA of 3 phyla and 13 genera, which included an increase in Pseudomonas. Patients with 1 exacerbation (n=18) showed borderline differences in their bacterial community (p=0.081) compared to no exacerbations patients, with a loss of RA of 2 phyla and 13 genera. Patients with 1 or ≥2 exacerbations showed similar borderline differences (p=0.087) with changes in RA of 4 genera. EC patients, identified by a systemic eosinophil level ≥2%, showed a significantly more diverse respiratory microbiome [Chao1 224.5 (74.9) vs 280.5 (79.6) p=0.003; Shannon 3.9 (1.1) vs 4.6 (1.1) p= 0.010] and a different community structure (p=0.037), mediated by a significant increment of 4 phyla and 26 genera Conclusion: A specific bacterial composition was shown in stability samples of FE and EC phenotypes. The presence of 1 exacerbation the previous year produces significant changes in the RA of specific OTUs and in patients with ≥2 exacerbations these changes lead to significant differences in their bacterial community. The respiratory microbiome was more diverse in EC patients and with a specific bacterial community Funded by FIS 15/00167, SEPAR and BRN-Pla Armengol