***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Statins have anti-inflammatory properties that are independent of their lipid-lowering abilities . We hypothesized that statin therapy before the onset of an acute bacterial infection may have a protective effect against severe sepsis . The aim of this study was to determine whether patients treated with statins  develop severe sepsis less frequently . Methods and Results —In this prospect i ve observational cohort study , consecutive patients admitted with presumed or documented acute bacterial infection were enrolled . The primary outcomes were the rate of severe sepsis and intensive care unit ( ICU ) admission . Of the 361 patients enrolled , 82 ( 22.7 % ) were treated with statins before their admission . Both groups had a similar severity of illness on admission .  Severe sepsis developed in 19 % of patients in the no-statin group and in only 2.4 % of the statin group ( P<0.001 ) . Statin treatment was associated with a relative risk of developing severe sepsis of 0.13 ( 95 % CI , 0.03 to 0.52 ) and an absolute risk reduction of 16.6 % . The overall ICU admission rate was 10.2 % ( 37/361 ) : 12.2 % of the no-statin group required ICU admission , whereas in the statin group only 3.7 % were admitted to the ICU ( P=0.025 ) , reflecting a relative risk of ICU admission of 0.30 ( 95 % CI , 0.1 to 0.95 ) . Conclusions —Prior therapy with statins may be associated with a reduced rate of severe sepsis and ICU admission . If supported by prospect i ve controlled trials , statins may have a role in the primary prevention of sepsis Recent studies suggest that statins and angiotensin-converting enzyme ( ACE ) inhibitors may have beneficial effects for some types of infections . The present study aim ed to examine the association of outpatient use of these medications on 30-day mortality for subjects aged > 65 yrs and hospitalised with community-acquired pneumonia . A retrospective national cohort study was conducted using the Department of Veterans Affairs administrative data including subjects aged ≥65 yrs hospitalised with community-acquired pneumonia , and having ≥1 yr of prior Veterans Affairs outpatient care . In total , 8,652 subjects were identified with a mean age of 75 yrs , 98.6 % were male , and 9.9 % of subjects died within 30 days of presentation . In this cohort , 18.1 % of subjects were using statins and 33.9 % were using ACE inhibitors . After adjusting for potential confounders , current statin use ( odds ratio ( OR ) 0.54 , 95 % confidence interval ( CI ) 0.42–0.70 ) and ACE inhibitor use ( OR 0.80 , 95 % CI 0.68–0.89 ) were significantly associated with decreased 30-day mortality .  Use of statins and angiotensin-converting enzyme inhibitors prior to admission is associated with decreased mortality in subjects hospitalised with community-acquired pneumonia . R and omised controlled trials are needed to examine whether the use of these medications in patients hospitalised with community-acquired pneumonia may be beneficial Background Recent studies suggested that administration of corticosteroids may improve clinical outcomes in patients with severe pneumonia . Objectives The aim of this study was to assess the effectiveness of corticosteroids as an adjunctive therapy in community-acquired pneumonia ( CAP ) requiring hospitalization . Design and Setting An open label , prospect i ve , r and omized control study was conducted from September 2003 to February 2004 in a community general hospital in Japan . Patients Thirty-one adult CAP patients who required hospitalization were enrolled . Measurements and Results Fifteen patients received 40 mg of prednisolone intravenously for 3 days ( steroid group ) . Sixteen patients did not receive prednisolone ( control group ) . Both groups were also evaluated for their adrenal function . The primary endpoint was length of hospital stay . Secondary endpoints were duration of intravenous ( IV ) antibiotics and time required to stabilize vital signs . Both groups demonstrated similar baseline characteristics and length of hospital stay , and yet a shorter duration of IV antibiotics was observed in the steroid group ( p < 0.05 ) . In addition , vital signs were stabilized earlier in the steroid group ( p < 0.05 ) . These differences were more prominent in the moderate – severe subgroup but not as significant in the mild – moderate subgroup . The prevalence of relative adrenal insufficiency ( RAI ) in both groups was high ( 43 % ) , yet there was no difference in baseline characteristics between patients , with or without RAI . In multiple regression models , RAI seemed to have no influence on clinical courses . Conclusions In moderate – severe CAP , administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy A r and omised double-blind trial involving vitamin C/placebo supplementation was conducted on 57 elderly patients admitted to hospital with acute respiratory infections ( bronchitis and bronchopneumonia ) . Patients were assessed clinical ly and biochemically on admission and again at 2 and 4 weeks after admission having received either 200 mg vitamin C per day , or placebo . This relatively modest oral dose led to a significant increase in plasma and white cell vitamin C concentration even in the presence of acute respiratory infection . Using a clinical scoring system based on major symptoms of the respiratory condition , patients supplemented with the vitamin fared significantly better than those on placebo . This was particularly the case for those commencing the trial most severely ill , many of whom had very low plasma and white cell vitamin C concentrations on admission . Various mechanisms by which vitamin C could assist this type of patient are discussed STUDY OBJECTIVE To determine if the use of statins affects pneumonia-related outpatient visits , hospitalizations with survival , and deaths . DESIGN Population -based , retrospective , nested case-control analysis . DATA SOURCE United Kingdom-based General Practice Research Data base . PARTICIPANTS The study population ( 134,262 patients aged > or = 30 yrs ) consisted of 55,118 patients who took statins and /or fibrates , 29,144 patients with hyperlipidemia not taking lipid-lowering agents , and 50,000 r and omly selected patients without hyperlipidemia and without lipid-lowering treatment .  MEASUREMENTS AND MAIN RESULTS We identified 1253 patients with pneumonia and matched them with 4838 control subjects based on age , sex , general practice , and index date . After adjusting for comorbidity and frequency of visits to general practitioners , we calculated the risks ( odds ratios with 95 % confidence intervals ) of uncomplicated pneumonia , hospitalization for pneumonia with survival , and fatal pneumonia in participants who used  statins compared with those who did not . Current statin users had a significantly reduced risk of fatal pneumonia ( adjusted odds ratio 0.47 , 95 % confidence interval 0.25 - 0.88 ) and slightly but not significantly reduced risks of uncomplicated pneumonia and pneumonia hospitalization with survival . Recent or past statin use and fibrate use at any time were not associated with a reduced risk of pneumonia . CONCLUSION Current use of statins was associated with a reduced risk of pneumonia . The risk reduction was particularly strong in the subgroup of patients with fatal pneumonias Because of the critical role of neutrophils in host defenses , it was hypothesized that stimulation of neutrophil production and function with Filgrastim would improve the outcome of hospitalized patients with community-acquired pneumonia . To test this hypothesis , a r and omized , placebo-controlled , multicenter trial of Filgrastim ( 300 micrograms/day up to 10 days ) as an adjunct to antibiotics was conducted for these patients . Outcome measures included time to resolution of morbidity ( TRM , a composite measure of temperature , respiratory rate , blood oxygenation , and chest radiograph ) , 28-day mortality , length of stay , and adverse events . Filgrastim increased blood neutrophils 3-fold , but TRM , mortality , and length of hospitalization were not affected . Treatment , however , accelerated radiologic improvement and appeared to reduce serious complications ( e.g. , empyema , adult respiratory distress syndrome , and disseminated intravascular coagulation ) .  Filgrastim administration was safe and well tolerated in these patients . Additional trials are needed to establish the value of this approach to treatment of infectious diseases A r and omised trial was undertaken in one hundred patients with heart failure and /or chest infection to determine whether low-dose subcutaneous heparin reduced the frequency of deep vein thrombosis ( DVT )  in the legs . Heparin , ( 5000 units 8 hourly ) significantly reduced the frequency of DVT , diagnosed by the125I-fibrinogen scan technique , from 26 to 4 per cent ( p < 0.01 ) . Heparin was started within 12 hours of admission to hospital and continued until the patient was fully mobile . Heparin did not cause bleeding problems except for a 20 per cent incidence of injection site bruising . We therefore recommend prophylaxis with low-dose subcutaneous heparin in patients with heart failure or chest infection who require more than three days bed rest Two hundred and seventy patients over 65 years were included in a placebo-controlled r and omized double-blind trial to determine whether a small dose of a low molecular weight ( LMW ) heparin prevents the occurrence of deep vein leg thrombosis ( DVT ) diagnosed by 125I fibrinogen scanning . LMW heparin ( 60 mg daily ) significantly reduced the frequency of DVT from 9 to 3 percent ( p = 0.03 ) . Adverse drug reactions did not differ significantly between the 2 groups , except for the injection site hematomas that were more frequent in the LMW heparin group . In conclusion , LMW heparin appears of value in preventing the occurrence of DVT in an unselected elderly in-patient population BACKGROUND The efficacy and safety of thromboprophylaxis in patients with acute medical illnesses who may be at risk for venous thromboembolism have not been determined in adequately design ed trials . METHODS In a double-blind study , we r and omly assigned 1102 hospitalized patients older than 40 years to receive 40 mg of enoxaparin , 20 mg of enoxaparin , or placebo subcutaneously once daily for 6 to 14 days . Most patients were not in an intensive care unit . The primary outcome was venous thromboembolism between days 1 and 14 , defined as deep-vein thrombosis detected by bilateral venography ( or duplex ultrasonography ) between days 6 and 14 ( or earlier if clinical ly indicated ) or documented pulmonary embolism . The duration of follow-up was three months . RESULTS The primary outcome could be assessed in 866 patients . The incidence of venous thromboembolism was significantly lower in the group that received 40 mg of enoxaparin ( 5.5 percent [ 16 of 291 patients ] ) than in the group that received placebo ( 14.9 percent [ 43 of 288 patients ] ) ( relative risk , 0.37 ; 97.6 percent confidence interval , 0.22 to 0.63 ; P < 0.001 ) . The benefit observed with 40 mg of enoxaparin was maintained at three months . There was no significant difference in the incidence of venous thromboembolism between the group that received 20 mg of enoxaparin ( 43 of 287 patients [ 15.0 percent ] ) and the placebo group . The incidence of adverse effects did not differ significantly between the placebo group and either enoxaparin group . By day 110 , 50 patients had died in the placebo group ( 13.9 percent ) , 51 had died in the 20-mg group ( 14.7 percent ) , and 41 had died in the 40-mg group ( 11.4 percent ) ; the differences were not significant . CONCLUSIONS Prophylactic treatment with 40 mg of enoxaparin subcutaneously per day safely and effectively reduces the risk of venous thromboembolism in patients with acute medical illnesses BACKGROUND Community-acquired pneumonia is a major cause of death in third world countries . Antimicrobial therapy may have little impact on the natural history of patients with severe pneumonia . We hypothesized that the intrapulmonary production of tumor necrosis factor-alpha ( TNF-alpha ) may be responsible for the progressive lung injury and shock commonly seen in patients with severe pneumonia after commencing antibiotic therapy . AIM To investigate the effects of a single bolus of hydrocortisone on the clinical course and serum TNF-alpha levels of patients with severe community-acquired pneumonia . DESIGN R and omized placebo-controlled study . SETTING Multidisciplinary ICU of a tertiary care teaching hospital . PATIENTS AND METHODS Patients with three or more British Thoracic Society criteria of severe pneumonia were studied . Patients were r and omized to receive either a single dose of hydrocortisone ( 10 mg/kg ) or placebo 30 min prior to commencing antibiotic therapy . Patients were treated with cefotaxime and other antibiotics as clinical ly indicated . Blood for TNF-alpha was taken at the time of hospital admission and repeated 2 , 6 , and 12 h after starting antibiotic therapy . RESULTS Thirty patients were studied : 16 received placebo 
    Output:
    
There was no evidence suggesting a survival benefit by the administration of activated protein C , non-invasive mechanical ventilation , anticoagulants , immunoglobulin , granulocyte-colony-stimulating factor , statins , probiotics , chest physiotherapy , antiplatelet drugs , over-the-counter cough medications , beta(2)-agonists , inhaled nitric oxide and angiotensin-converting enzyme inhibitors  in patients with CAP .