PRM51 From Clinical Trial to Real-World Evidence: A Systematic Approach to Identifying Data Sources for Observational Research

Edifici industrial de dos cossos de planta baixa i tres plantes pis acabades amb mansarda. Destaca el nombre i dimensions de les obertures que permeten una gran entrada de llum a l'interior i l'amplitud de les plantes diàfanes.Digitalitzat per Tecnodo

Antibiotic prescribing and outcomes of lower respiratory tract infection in UK primary care

BackgroundLower respiratory tract infection (LRTI) is common in the community, and may result in hospitalization or death. This observational study aimed to investigate the role of antibiotics in the management of LRTI in UK primary care.MethodsPatients receiving a first diagnosis of LRTI during 2004 and satisfying inclusion and data quality criteria were identified in the General Practice Research Database. Factors associated with respiratory infection-related admissions and death in the 3 months following initial diagnosis were identified using Cox proportional hazards regression.ResultsAntibiotic prescribing on the day of diagnosis was associated with a decreased rate of respiratory infection-related admission (hazard ratio: 0.73; 95% confidence interval: 0.58–0.92), while antibiotic prescribing in the previous 7 days (1.92; 1.24–2.96) and prior referral or hospitalization (1.48; 1.20–1.83) were associated with an increased risk of admission. Female sex (0.73; 0.64–0.84), allergic rhinitis (0.48; 0.27–0.83), influenza vaccination (0.75; 0.65–0.87), prior inhaled corticosteroid use (0.63; 0.52–0.76) and antibiotic prescription on the day of diagnosis (0.31; 0.26–0.37) were associated with decreased respiratory infection-related mortality, while a Charlson comorbidity index of &gt; 2 (2.24; 1.72–2.92), antibiotic prescription in the previous 7 days (1.56; 1.20–2.03) and frequent consultation (1.62; 1.09–2.40) were associated with increased mortality.ConclusionsAntibiotic prescribing on the day of LRTI diagnosis was associated with reductions in admissions and mortality related to respiratory infection. Antibiotics may help to prevent adverse outcomes for some patients with LRTI. <br/

Granzyme A-immunoreactive cells in synovial fluid in reactive and rheumatoid arthritis

Perforin and granzyme A co-localize in the cytotoxic granules of killer cells like cytotoxic T lymphocytes (CTL). Perforin is the cytolytic pore-forming protein, whereas the function of the homodimeric serine protease granzyme A and other members of the granzyme family is still unclear. Granzyme A-immunoreactive cells formed 8 +/- 2% of the resting peripheral blood lymphocytes of healthy individuals. In contrast, granzyme A-positive cells formed 15% of peripheral blood mononuclear cells in patients with reactive or rheumatoid arthritis. However, 29 +/- 4% (p &lt; 0.05 compared to normal peripheral blood) and 25 +/- 4% (p &lt; 0.05) of all lymphocytes in synovial fluid in reactive and rheumatoid arthritis, respectively, were granzyme A-positive. This suggests involvement of cell-mediated cytolytic mechanisms in the articular pathogenic mechanisms. This involvement, however, does not differentiate between reactive and rheumatoid arthritis