Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study

by Kueiyu Joshua Lin, Evan Dvorin, Aaron S. Kesselheim BackgroundEvidence and guidelines do not support use of systemic steroids for acute respiratory tract infections (ARTIs), but such practice appears common. We aim to quantify such use and determine its predictors. Methods and findingsWe conducted a cohort study based on a large United States national commercial claims database, the IBM MarketScan, to identify patients aged 18 –64 years with an ARTI diagnosis (acute bronchitis, sinusitis, pharyngitis, otitis media, allergic rhinitis, influenza, pneumonia, and unspecified upper respiratory infections) recorded in ambulatory visits from 2007 to 2016. We excluded those with systemic steroid use in the prior year and an ext ensive list of steroid-indicated conditions, including asthma, chronic obstructive pulmonary disease, and various autoimmune diseases. We calculated the proportion receiving systemic steroids within 7 days of the ARTI diagnosis and determined its significant predictors. We identified 9,763,710 patie nts with an eligible ARTI encounter (mean age 39.6, female 56.0%) and found 11.8% were prescribed systemic steroids (46.1% parenteral, 47.3% oral, 6.6% both). All ARTI diagnoses but influenza predicted receiving systemic steroids. There was high geographical variability: the adjusted odds ratio (aOR ) of receiving parenteral steroids was 14.48 (95% confidence interval [CI] 14.23–14.72,p
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research

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Authors: Rombauts A, Abelenda-Alonso G, Cuervo G, Gudiol C, Carratalà J Abstract INTRODUCTION: Despite adequate antibiotic coverage, community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality worldwide. It induces both a local pulmonary and a systemic inflammatory response, particularly significant in severe cases. The intensity of the dysregulated host response varies from patient to patient and has a negative impact on survival and other outcomes. AREAS COVERED: This comprehensive review summarizes the pathophysiological aspects of the inflammatory response in CAP, brie...
Source: Expert Review of Anti-Infective Therapy - Category: Infectious Diseases Tags: Expert Rev Anti Infect Ther Source Type: research
Abstract Trace metals concentrations of 25 elements were determined for 22 subcomponents of biodegradable and non-biodegradable waste samples representing the United States municipal solid waste (MSW) stream collected during three separate waste sorts. The subcomponent trace metal concentrations and estimated composition results were used to predict trace metal concentrations present in the overall MSW stream along with MSW compost and waste to energy (WTE) ash, which were compared to health-based standards (i.e., US EPA regional screening levels) and to values previously reported in the literature. These estimate...
Source: Chemosphere - Category: Chemistry Authors: Tags: Chemosphere Source Type: research
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Xiaoqin Liu, Trine Munk-Olsen, Clara Albiñana, Bjarni J. Vilhjálmsson, Emil M. Pedersen, Vivi Schlünssen, Marie Bækvad-Hansen, Jonas Bybjerg-Grauholm, Merete Nordentoft, Anders D. Børglum, Thomas Werge, David M. Hougaard, Preben B. Mortensen, Esben Agerbo
Source: Brain, Behavior, and Immunity - Category: Neurology Source Type: research
ConclusionThe COMQ-12 could be a useful tool to differentiate chronic otitis media with or without cholesteatoma.
Source: European Archives of Oto-Rhino-Laryngology - Category: ENT & OMF Source Type: research
AbstractPurposeTo investigate the efficacy and safety of bencycloquidium bromide nasal spray (BCQB) in patients with persistent allergic rhinitis (PAR).MethodsWe enrolled 720 patients from 15 hospitals across China and randomly assigned them into BCQB group or placebo group (90  μg per nostril qid) to receive a 4-week treatment. Visual analog scale (VAS) for rhinorrhea, sneezing, nasal congestion, itching and overall symptoms were recorded by patients every day. Anterior rhinoscopy scoring was completed by doctors on every visit. Adverse events were recorded in detail.ResultsA total of 354 and 351 patients were inc...
Source: European Archives of Oto-Rhino-Laryngology - Category: ENT & OMF Source Type: research
Secretary Azar testified before Congress that “herd immunity is not the strategy of the U.S. government.” Yet, frequently the Trump Administration’s rhetoric tells a different story. The Administration’s recent actions on the ground belie its claims of not advancing a herd immunity policy.
Source: Forbes.com Healthcare News - Category: Pharmaceuticals Authors: Tags: Healthcare /healthcare Innovation /innovation business pharma & Source Type: news
The researchers urge Australian leaders to safeguard the nation's political system "from these very insidious and ongoing threats."
Source: Reuters: Health - Category: Consumer Health News Source Type: news
Authors: Tamai H, Shingaki N, Ida Y, Shimizu R, Maeshima S, Okamura J, Kawashima A, Nakao T, Hara T, Matsutani H, Nishikawa I, Higashi K Abstract BACKGROUND: Although clinical use of sofosbuvir plus ribavirin has been approved for patients infected with genotype 2 hepatitis C virus, patients ≥ 75-years-old have not been included in previous clinical trials. AIM: To evaluate the real-world safety and efficacy of sofosbuvir plus ribavirin for elderly patients (≥ 75-years-old) compared to nonelderly patients, we conducted a post-marketing prospective cohort study. METHODS: We treated 265 patients with ge...
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
CONCLUSION: Our study showed that transaminitis on admission was associated with severe clinical outcomes such as admission to the intensive care unit, need for mechanical ventilation, and mortality. PMID: 33033568 [PubMed]
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Publication date: Available online 9 October 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Manuel Jorge Rial, Marcela Valverde, Victoria del Pozo, Francisco Javier González-Barcala, Carlos Martínez-Rivera, Xavier Muñoz, José María Olaguibel, Vicente Plaza, Elena Curto, Santiago Quirce, Pilar Barranco, Javier Domínguez-Ortega, Joaquin Mullol, César Picado, Antonio Valero, Irina Bobolea, Ebymar Arismendi, Paula Ribó, Joaquín Sastre
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
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