COVID-19 prophylaxis with doxycycline and zinc in health care workers: a prospective, randomized, double-blind clinical trial

OBJECTIVES

This study aims to assess the efficacy of a combination treatment of doxycycline and zinc in the primary prevention of COVID-19 infection in Tunisian health care workers compared with two control groups.

METHODS

We conducted a prospective, randomized, double-blind clinical trial over 5 months to determine the efficacy of a preventive combination treatment dose of doxycycline (100 mg/day) and zinc (15 mg/day), compared with a single-dose treatment with doxycycline versus placebo. The effectiveness of preventive treatment was measured by the significant decline in the number of cases of COVID-19 infection and/or a decrease in the viral load as determined by SARS-CoV-2 cycle threshold value using reverse transcription polymerase chain reaction tests.

RESULTS

We detected a significant decrease of SARS-CoV-2 infection in the group that received both doxycycline and zinc compared with other participants. We also demonstrated that COVID-19 infection was neither associated with diabetes (P = 0.51) nor associated with hypertension (P = 0.99), asthma (P = 0.52), and chronic obstructive pulmonary disease (P = 0.27).

CONCLUSION

Our findings indicated that preventive therapy reduced the risk of SARS-CoV-2. These results suggest that the combination of doxycycline and zinc has a protective effect in patients with SARS-CoV-2 infection.

La place du dosage de l'interleukine 6 chez les patients hospitalisés dans une unité COVID (en dehors du milieu de la réanimation)

Introduction

Le développement d'une forme grave de COVID-19 pourrait être causé par la survenue d'un syndrome de libération de cytokines pro-inflammatoires. L‘interleukine 6 (IL-6) est une cytokine qui joue un rôle clé dans la mobilisation et la coordination de la réponse immunitaire pour contenir l'infection par le SARS-CoV-2. L'objectif de notre étude est d'évaluer les niveaux d'IL-6 chez les patients atteints de COVID-19 admis en dehors du milieu de réanimation et leur corrélation avec la forme clinique.

Matériels et méthodes

Il s'agit d'une étude rétrospective descriptive analytique mené à l'unité COVID-19 durant 12 mois [2020-2021]. Tous les patients ayant eu un dosage de l'IL-6 à l'admission.

Résultats

Ils s'agissaient de 81 patients, 53 hommes et 28 femmes (sex-ratio H/F=1,9), âgés en moyenne de 58,4 ans [20-93 ans]. Le délai moyen d'hospitalisation était de 8 jours [2-21 jours]. La forme clinique à l'admission était sévère dans 91 % et modérée dans 9 % des cas. La symptomatologie était dominée par l'asthénie (79 %), la toux (74,1 %), la dyspnée (63 %), l'arthromyalgie (59,3 %) et la fièvre (58 %). Au moins une comorbidité était présente chez 88 % des patients. Les plus fréquentes étaient l'hypertension artérielle (40 %), le diabète (30,9 %), les pathologies cardio-vasculaires (13,6 %) et les maladies respiratoires chroniques (7,5 %). une TDM thoracique réalisée chez 80 patients avait objectivé des lésions évocatrices avec une étendue entre 50 et 75 % (34,6 %), 25 et 50 % (28,4 %) et 10 et 25 % (18,5 %). La valeur moyenne des globules blancs est de 7122 ± 3564 éléments/mm³, celle de CRP de 104,6 ± 59,6 mg/l, de la ferritinémie de 412 pg/l [188 -643pg/L] et des D-dimères de 743 µg/l (481 – 1729µg/l). Le taux de l'IL6 était augmenté chez tous les patients avec une valeur moyenne de 42pg/ml +/- 54 pg/ml [2 et 580 pg/ml]. Le taux d'IL-6 était significativement plus élevée dans les formes sévères que dans les formes modérées (p=0,01). La valeur moyenne de l'IL-6 était de 20,2pg/ml et de 58,6 pg/ml respectivement dans la forme modérée et la forme sévère. L'évolution était favorable dans 92,6 % des cas. Six patients (7,4 %) sont décédés. Le modèle multivarié de Cox a montré que le taux d'IL-6 pouvait être utilisé comme facteur indépendant pour prédire la gravité de la COVID-19 (p <0,001).

Conclusion

Les taux sériques d'IL-6 sont significativement plus élevés dans les formes sévères que dans les formes modérées de COVID-19 et peuvent être considérés comme critère de gravité. Son taux sanguin est un bon marqueur de l'évolution.

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Toxocariasis and nephrotic syndrome

We describe a case of toxocariasis as a rare cause of nephrotic syndrome in an adult woman. This rare association was confirmed by elevated Toxocara-specific immunoglobulin M titers. Renal biopsy was not done because of prolonged activated partial thromboplastin time. Our patient was treated with prednisone and albendazole. These treatments resulted in partial remission of renal symptoms as well as the abatement of the Toxocariasis infection. The relationship between toxocariasis infection and glomerular disease is still unclear. In the literature, exceptional renal impairment secondary to toxocariasis have been described, especially in children. To the best of our knowledge, this is the second case of nephrotic syndrome associated with toxocariasis in adults.

Sarcoidosis with heart involvement: a rare association of terrible prognosis, a report of two cases

Sarcoidosis is a multisystemic disorder of unknown etiology which is characterized by the formation of non-caseating granulomas in involved tissues. Cardiac involvement is one of the least common manifestations and it can occur at any point of time during the course of sarcoidosis. Here we present the case of 2 patients with known sarcoidosis who develop cardiac abnormalities in the absence of known primary cardiac cause. In our report, we would like to draw attention to the importance of considering heart involvement in any case with systemic sarcoidosis especially in young age.

Estimating genetic potential of biofuel forest hardwoods to withstand metal toxicity in industrial effluent under dry tropical conditions

Biofuel tree species are recognized as a promising alternative source of fuel to conventional forms. Additionally, these tree species are also effective in accumulating toxic heavy metals present in some industrial effluents. In developing countries such as Pakistan, the use of biofuel tree species is gaining popularity not only for harvesting economical and environmentally friendly biofuel, but also to sequester poisonous heavy metals from industrial wastewater. This study was aimed at evaluating the genetic potential of two biofuel species, namely, Jatropha curcas and Pongamia pinnata, to grow when irrigated with industrial effluent from the Pak-Arab Fertilizer Factory Multan, Southern Punjab, Pakistan. The growth performances of one-year-old seedlings of both species were compared in soil with adverse physiochemical properties. It was found that J. curcas was better able to withstand the toxicity of the heavy metals present in the fertilizer factory effluent. J. curcas showed maximum gain in height, diameter, and biomass production in soil irrigated with 75% concentrated industrial effluent. In contrast, P. pinnata showed a significant reduction in growth in soil irrigated with more than 50% concentrated industrial effluent, indicating that this species is less tolerant to higher toxicity levels of industrial effluent. This study identifies J. curcas as a promising biofuel tree species that can be grown using industrial wastewater.

[Thrust of Kaposi sarcoma and elevated CA 19-9: think tubersulosis!]

La maladie de Kaposi (MK) est une entité pathologique qui peut survenir chez les patients VIH positifs et dans le cadre d'une immunodépression, d'origine tuberculeuse très rarement. On décrit le cas d'une MK chez un patient VIH négatif au décours d'une tuberculose. Nous rapportons le cas d'un patient âgé de 81 ans, VIH négatif, ayant présenté deux nodules angiomateux de l'avant bras gauche dont la biopsie cutanée était en faveur d'une MK. L’évolution était marquée 2 mois plus tard, par l'apparition de placards angiomateux extensifs des deux membres supérieurs et d'adénopathies cervicales jugulo-carotidiennes bilatérales. La biopsie ganglionnaire était en faveur d'une tuberculose ganglionnaire. Par ailleurs, il avait un taux sérique élevé des CA 19-9. La régression de l’étendue des lésions au niveau des membres supérieurs et la normalisation du taux sérique des CA 19-9 ont été obtenues sous traitement anti-tuberculeux. Chez les patients atteints d'une MK avec une élévation des CA 19-9, il faut penser à la tuberculose.

[Antibiotic resistant furuncles: think myiasis]

Les myiases sont des infections parasitaires par des larves de mouches. La localisation cutanée doit être évoquée de retour d'un pays tropical devant une évolution inhabituelle de lésions cutanées. Nous rapportons une observation d'un militaire tunisien, ayant séjourné en République Démocratique du Congo. Il était atteint de myiase cutanée simulatrice d'une furonculose résistante aux antibiotiques. L'intérêt de cette observation est de souligner l'importance d’évoquer la myiase dont le traitement est simple et rapide chez un patient de retour de zone d'endémie.

A biochemical and histopathologic study showing protection and treatment of gentamicin-induced nephrotoxicity in rabbits using vitamin C

Gentamicin and vitamin C have been proposed as nephrotoxic and antioxidant, respectively. This study involved biochemical and histopathologic investigation showing protection and treatment of gentamicin-induced nephrotoxicity in rabbits using vitamin C for 26 days hypothesizing that whether vitamin C would inhibit or decrease the raised serum urea and creatinine levels. This study was conducted on 25 healthy male albino rabbits (average weight 1.5±0.2 kg), classified into 5 groups: group A, B, C, D and E for nephrocurative (study-I) and nephroprotective (study-II) studies. Control group of rabbits (group A) received only the vehicle of gentamicin ampoule. In study-I, gentamicin sulphate (GS 80 mg/kg, i.m.) was administered to group B and C rabbits for ten days, then group C rabbits received vitamin C 250 mg/Kg for remaining 16 days. Group D and E received GS 80 mg/kg and GS 80 mg/kg i.m.-vitamin C 250 mg/kg orally, respectively during whole period (26 days) of study-II. After 26 days, various biochemical parameters, i.e. serum creatinine, blood urea nitrogen (BUN), and serum antioxidant activity, and histopathologic investigations were made. Nephrotoxicity was observed in rabbit groups B, C and D as evident from significant (p<0.05) high levels of serum creatinine and BUN and low serum antioxidant levels as compared to the levels of control group. Decrease in the levels of serum creatinine and BUN along with the increase in serum antioxidant activity was observed after vitamin C treatment in group C. While, renal-protective role of vitamin C was seen in group E as compared to the control. In conclusion, Gentamicin induced nephrotoxicity can be attenuated or treated using vitamin C.

Prevalence of rheumatic heart disease in school children of urban Lahore

OBJECTIVE

To determine the prevalence of rheumatic heart disease (RHD) among school children in urban and semiurban areas of Lahore, Pakistan.

METHODS

A cross-sectional survey of school children aged 5-15 years from 70 schools of urban and semiurban Lahore was carried out by a team of cardiologists. Children were screened by clinical examination and diagnosis confirmed by echocardiography. Sociodemographic data were also collected.

RESULTS

Of 24 980 children screened, 986 (3.9%) had a confirmed cardiac lesion; 546 had RHD, 440 had congenital heart disease. The prevalence of RHD was 21.9/1000 children screened (95% CI 20.1 to 23.7). Their mean (SD) age was 10.7 (2.6) years and the female:male ratio was 1.6:1. Most (92.5%) were unaware of the diagnosis and less than 2% were taking rheumatic prophylaxis. All children belonged to a low socioeconomic group and 67% were undernourished.

CONCLUSION

The prevalence of RHD in the urban school population of Lahore is among the highest in the world. The younger age of onset is a special feature and most are unaware of the diagnosis, and hence not receiving life-saving secondary prophylaxis.

PR-39 and PR-11 peptides inhibit ischemia-reperfusion injury by blocking proteasome-mediated I kappa B alpha degradation

PR-39 inhibits proteasome-mediated I kappa B alpha degradation and might protect against ischemia-reperfusion injury. We studied PR-39, its truncated form PR-11, and a mutant PR-11AAA, which lacks the ability to prevent I kappa B alpha degradation, in a rat heart ischemia-reperfusion model. After 30 min of ischemia and 24 h of reperfusion, cardiac function, infarct size, neutrophil infiltration, and myeloperoxidase activity were measured. Intramyocardial injection of 10 nmol/kg PR-39 or PR-11 at the time of reperfusion reduced infarct size by 65% and 57%, respectively, which improved blood pressure, left ventricular systolic pressure, and relaxation and contractility (+/-dP/dt) compared with vehicle controls 24 h later. Neutrophil infiltration, myeloperoxidase activity, and the expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule 1 were reduced. Thus PR-39 and PR-11 effectively inhibit myocardial ischemia-reperfusion injury in the rat in vivo. This effect is mediated by inhibition of I kappa B alpha degradation and subsequent inhibition of nuclear factor-kappa B-dependent adhesion molecules. The active sequence is located in the first 11 amino acids, suggesting a potential for oligopeptide therapy as an adjunct to revascularization.

[GAPO syndrome]

INTRODUCTION

The GAPO syndrome is a rare but distinct genetic disorder. GAPO is an acronym for the manifestation of Growth retardation, Alopecia, Pseudoanodontia and Optic atrophy. The syndrome was first reported in 1947; to date, 24 cases have been reported. We report the first Tunisian case.

OBSERVATION

We studied a 12 year-old boy with GAPO syndrome which was associated with peculiar facial appearance, umbilical hernia, hemangiomatous plaques of the neck, depigmented maculae arranged in a splashed pattern located in the trunk and the right upper limb. He had a pulsated mass in the right mastoid area and a bruit was audible, he had a second flaccid mass of the vertex. These tumefactions correspond to very developed commissure veins.

DISCUSSION

In addition to the classical manifestations of the GAPO syndrome, the patients have a strikingly characteristic facial appearance and may also have umbilical hernia, skin redundance and prominent dilatation of scalp veins. Our case had depigmented maculae suggestive of incontinentia pigmenti achromians. This has never been reported previously. The pathogenesis of this syndrome is unknown and inheritance is considered to be autosomal recessive.

Novel features of the functional site and expression of the yeast deoxyhypusine synthase

A unique amino acid, hypusine, is formed posttranslationally in the precursor of eukaryotic translation initiation factor 5A (eIF-5A). Deoxyhypusine synthase catalyzes the first of two steps in the biosynthesis of hypusine. We reported earlier that the DYS1 gene encoding deoxyhypusine synthase is essential for cell viability and proliferation in yeast. Here, we show by deletion studies that both N- and C-terminal regions, which are not so well conserved, are necessary for the activity of the yeast enzyme. Of the seven cysteine residues present in the yeast enzyme, only one cysteine (position 252; C252) appeared to be essential for its activity. Moderate overexpression of DYS1 showed very little effects on cell growth and no obvious effects on the intracellular level of eIF-5A. However, repression of the expression of DYS1 resulted in near-complete depletion of eIF-5A 24 h after the initiation of repression and was followed by cell growth arrest after another 24 h. This novel finding suggests that the major role of deoxyhypusine synthase in cell proliferation is mediated not only through its modification of the eIF-5A precursor, but also through its regulation of intracellular eIF-5A levels.

[Superior caval syndrome caused by chronic mediastinitis in Behçet's disease]

We report a case of Behçet disease complicated by superior vena cava syndrome secondary to extrinsic compression by mediastinal fibrosis. This association is not reported in literature. The habituel etiology of vena cava syndrome in Behçet disease is venous thrombosis. Radiological investigations of this syndrome are necessary to avoid an useless anticoagulant therapy.

[Rare causes of ossification of the posterior common vertebral ligament causing cervical compression. Apropos of 2 cases]

The ossification of the posterior longitudinal is always responsible of cervical myelopathy. Radiological study and the CT scan, are able to precise the level, the morphologic and associated abnormalities of this lesion. Two cases of ossification of the posterior longitudinal ligamentum with cervical myelopathy are reported. The radiologic studies determined the etiology, in the first case, it was fluorosis and the second DISH disease.

[Uncommon etiology of cruralgia]

A 58 year old man suffered from low back pain. Physical examination showed asymmetry of the quadriceps and slight motor deficiency of right leg. Plain radiography of the pelvis revealed a large osteophyte, developed anteriorly at the low part of the right sacro iliac joint. CT exam of lumbar spin was normal. But, it confirmed osteophyte of right sacro iliac. Percutaneous injection of a small quantity of xylocaine under CT guidance in the site of the osteophyte behind crural muscle was marked by immediate disappearance of the pain, confirming the site of conflict between the crural nerve and the osteophyte. The patient was treated by injection of corticosteroid at the same location. Recovery was good.

[Brain and spinal cord cavernoma. Value of MRI and review of the literature. Apropos of a case]

MRI has transformed the diagnosis of cavernous hemangioma, a hamartoma that is most often located in the central nervous system. The appearance of this lesion is fairly characteristic with MRI. This technique has allowed distinguishing multiple forms. Encephalic sites are most frequent, with rare medullary sites, and double brain and cord locations are exceptional. Many cases of single or multiple brain involvement have now been reported. Series of medullary involvement are much less frequent and include few cases. Double sites in the brain and cord are exceptional. The authors present a case of cavernous hemangiomas of the central nervous system with multiple encephalic sites associated with a single medullary site confirmed by surgery.