Background. We aimed to determine whether a 6-day course of intravenous methylprednisolone (MP) improves outcome in patients with SARS CoV-2 infection at risk of developing Acute Respiratory Distress Syndrome (ARDS). Methods. Multicentric, partially randomized, preference, open-label trial, including adults with COVID-19 pneumonia, impaired gas exchange and biochemical evidence of hyper-inflammation. Patients were assigned to standard of care (SOC), or SOC plus intravenous MP [40mg/12h 3 days, then 20mg/12h 3 days]. The primary endpoint was a composite of death, admission to the intensive care unit (ICU) or requirement of non-invasive ventilation (NIV). Results. We analyzed 85 patients (34, randomized to MP; 22, assigned to MP by clinician preference; 29, control group). Patient age (mean 68±yr) was related to outcome. The use of MP was associated with a reduced risk of the composite endpoint in the intention-to-treat, age-stratified analysis (combined risk ratio -RR- 0.55 [95% CI 0.33-0.91]; p=0.024). In the per-protocol analysis, RR was 0.11 (0.01-0.83) in patients aged 72 yr or less, 0.61 (0.32-1.17) in those over 72 yr, and 0.37 (0.19-0.74, p=0.0037) in the whole group after age-adjustment by stratification. The decrease in C-reactive protein levels was more pronounced in the MP group (p=0.0003). Hyperglycemia was more frequent in the MP group. Conclusions A short course of MP had a beneficial effect on the clinical outcome of severe COVID-19 pneumonia, decreasing the risk of the composite end point of admission to ICU, NIV or death.

Summary Introduction:The relationship between osteoporosis and arterial hypertension has not been clearly established, with alterations in calcium metabolism having been reported in the latter which may explain their association. Our objective was to establish the relationship between the A986S polymorphism of the calcium-sensing receptor (CaSR) and the presence of osteoporotic clinical fractures in a group of patients with hypertension. Material: Prospective observational cohort study in 71 patients with hypertension, from 2001 to June 2014. We obtained socio-demographic and clinical data, including osteoporotic clinical fractures. The CaSR polymorphism was analysed using molecular techniques. The data was analysed using SPSS 15.0 (p<0.5) Results: 43.77% of the patients were men and 56.3% women. Genotype AA was found in 67.6% of patients, genotype SS in 2.8% and genotype AS in 29.6%. Those with genotype AA did not have higher comorbidity (27% vs 26%, p=0.9) or more pathological fractures (14.6% vs 21.7%, p=0.4) than the others. In the subgroup of women, 11 osteoporotic clinical fractures were recorded, without there being any differences between those with the AA genotype and the others (28% vs 27%, p=0.9). Conclusions: We found no association between the A986S polymorphism and the presence of osteoporotic clinical fractures in our cohort.

Abstract:Metastasis to breast from extra-mammary sites is much less common as compared to primary ones and only few cases are reported in the literature. Furthermore, very little is known about prognosis and treatment of patients with solid neoplasms metastatic to the breast. If a breast lump is found, it is recommended to perform a bilateral mammogram specially when there is a rapidly enlargement. Here, we describe a case of a young woman with synchronic breast metastasis from asymptomatic, widely spread, renal cell carcinoma, Furhman grade 4. RCC is one of the most aggressive urologic tumors and rarely metastasizes to the breast. This phenomenon takes place in less than 3% of all metastatic renal cell carcinoma and the appearance as first sign of renal disease is exceptional. This case illustrates the importance of histopathological investigation in a breast mass and the potential for rare sites of metastasis in order to prevent unnecessary radical procedures. Also, this report contributes to importance of a proper diagnosis when rare sites of metastatic deposit, like breast, are detected, especially if there is no previous history of neoplasm.

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