“
“Background

and objective: Although the benefits of systemic corticosteroids in community-acquired pneumonia (CAP) are not clear, their use is frequent in clinical practice. We described the frequency of this practice, patients’ characteristics and its clinical impact.

Methods: We investigated all adult CAP patients visited between June 1997 and January 2008 (n = 3257).

Results: Two hundred and sixty patients received systemic corticosteroids (8%) with a mean daily dose of 45 (33) mg (median, 36 mg/day). Patients receiving corticosteroids were older (74 (13) vs 65 (19) years), had more comorbidities (respiratory, 59% vs 38%, cardiac, 29% vs 16%, etc.), higher IACS-10759 Pneumonia Severity Index (Fine IV-V, 76% vs 50%) and had received inhaled corticosteroids (36% vs 15%) and previous antibiotics (31% vs 23%) more frequently (P < 0.01, each). Significant predictors of corticosteroid administration were: chronic obstructive pulmonary disease (odds ratio (OR), 1.91), fever (OR, 0.59), expectoration (OR, 1.59), creatinine (+ 1 mg/dL, OR, 0.92), SaO(2) >= 92% (OR, 0.46), C-reactive protein (+ 5 mg/dL; OR, 0.92)

and cardiac failure (OR, 1.76). Mortality (6% vs 7%; P = 0.43) and time to clinical stability (4 (3-6) vs 5 (3-7) days; P = 0.11) did not differ between the two groups, selleck products while length of hospital stay was longer for the steroid group (9 (6-14) vs 6 (3-9) days; P this website < 0.01).

Conclusions: The main reasons for administering systemic steroids were the presence of chronic respiratory comorbidity or severe clinical presentation, but therapy did not influence mortality or clinical stability; by contrast,

steroid administration was associated with prolonged length of stay. Nevertheless the steroid group did not show an increased mortality as it was expected according to the initial Pneumonia Severity Index score. Influence of steroids on outcomes of CAP need to be further investigated through randomized clinical trial.”
“Renal intercalated cells mediate the secretion or the absorption of OH-/H+ equivalents and Cl- in the distal convoluted tubule (DCT), the connecting tubule (CNT) and the cortical collecting duct (CCD). In so doing, they regulate acid-base balance, vascular volume and blood pressure. In type B and non-A, non-B intercalated cells, Cl- absorption and HCO3- secretion are accomplished through the apical Na+-independent Cl-/HCO3- exchanger, pendrin. With increased circulating aldosterone or angiotensin II, pendrin abundance and function are up-regulated. In the absence of pendrin (Slc26a4 (-/-) or pendrin null mice), aldosterone- and angiotensin II-stimulated Cl- absorption are reduced, which attenuates the blood pressure response to these hormones. Pendrin also modulates aldosterone-induced changes in ENaC abundance and function through a kidney-specific mechanism that does not involve changes in the concentration of a circulating hormone.