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Schöbi N, Sanchez C, Welzel T, Bamford A, Webb K, Rojo P, Tremoulet A, Atkinson A, Schlapbach LJ, Bielicki JA. Swissped-RECOVERY: masked independent adjudication for the interpretation of non-randomised treatment in a two-arm open-label randomised controlled trial (methylprednisolone vs immunoglobulins) in Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) involving 10 secondary and tertiary paediatric hospitals in Switzerland. BMJ Open 2024; 14:e078137. [PMID: 38670610 DOI: 10.1136/bmjopen-2023-078137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES In trials of acute severe infections or inflammations frequent administration of non-randomised treatment (ie, intercurrent event) in response to clinical events is expected. These events may affect the interpretation of trial findings. Swissped-RECOVERY was set up as one of the first randomised controlled trials worldwide, investigating the comparative effectiveness of anti-inflammatory treatment with intravenous methylprednisolone or intravenous immunoglobulins in children and adolescents with Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS). We present one approach towards improving the interpretation of non-randomised treatment in a randomised controlled trial. DESIGN This is a pre-planned ancillary analysis of the Swissped-RECOVERY trial, a randomised multicentre open-label two-arm trial. SETTING 10 Swiss paediatric hospitals (secondary and tertiary care) participated. PARTICIPANTS Paediatric patients hospitalised with PIMS-TS. INTERVENTIONS All patient-first intercurrent events, if applicable, were presented to an independent adjudication committee consisting of four international paediatric COVID-19 experts to provide independent clinical adjudication to a set of standardised questions relating to whether additional non-randomised treatments were clinically indicated and disease classification at the time of the intercurrent event. RESULTS Of 41 treatments in 75 participants (24/41 (59%) and 17/41 (41%) in the intravenous methylprednisolone and immunoglobulin arms of the trial, respectively), two-thirds were considered indicated. The most common treatment (oral glucocorticoids, 14/41, 35%) was mostly considered not indicated (11/14, 79%), although in line with local guidelines. Intercurrent events among patients with Shock-like PIMS-TS at baseline were mostly considered indicated. A significant proportion of patients with undifferentiated PIMS-TS at baseline were not attributed to the same group at the time of the intercurrent event (6/12 unchanged, 4/12 Kawasaki disease-like, 2/12 Shock-like). CONCLUSION The masked adjudication of intercurrent events contributes to the interpretation of results in open-label trials and should be incorporated in the future. TRIAL REGISTRATION NUMBERS SNCTP000004720 and NCT04826588.
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Affiliation(s)
- Nina Schöbi
- Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlos Sanchez
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Tatjana Welzel
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Alasdair Bamford
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Webb
- Division of Paediatric Rheumatology, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Pablo Rojo
- Pediatrics, Hospital Universitario Doce de Octubre. Universidad Complutense. Instituto de Investigación 12 Octubre, Madrid, Spain
| | - Adriana Tremoulet
- Paediatrics, University of California San Diego, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Andrew Atkinson
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, St Louis, Missouri, USA
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatalogy, and Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, and Paediatric Intensive Care Unit, Queensland Children's Hospital, Saint Lucia, Queensland, Australia
| | - Julia Anna Bielicki
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
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Izzy S. Traumatic Spinal Cord Injury. Continuum (Minneap Minn) 2024; 30:53-72. [PMID: 38330472 PMCID: PMC10869103 DOI: 10.1212/con.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article provides a review of the initial clinical and radiologic evaluation and treatment of patients with traumatic spinal cord injuries. It specifically highlights essential knowledge for neurologists who encounter patients with these complex injuries. LATEST DEVELOPMENTS There has been improvement in the care of patients with traumatic spinal cord injuries, particularly in the prehospital evaluation, approach for immediate immobilization, standardized spinal clearance, efficient triage, and transportation of appropriate patients to traumatic spinal cord injury specialized centers. Advancements in spinal instrumentation have improved the surgical management of spinal fractures and the ability to manage patients with spinal mechanical instability. The clinical evidence favors performing early surgical decompression and spine stabilization within 24 hours of traumatic spinal cord injuries, regardless of the severity or location of the injury. There is no evidence that supports the use of neuroprotective treatments to improve outcomes in patients with traumatic spinal cord injuries. The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged. Early and delayed mortality rates continue to be high in patients with traumatic spinal cord injuries, and survivors often confront substantial long-term physical and functional impairments. Whereas the exploration of neuroregenerative approaches, such as stem cell transplantation, is underway, these methods remain largely investigational. Further research is still necessary to advance the functional recovery of patients with traumatic spinal cord injuries. ESSENTIAL POINTS Traumatic spinal cord injury is a complex and devastating condition that leads to long-term neurologic deficits with profound physical, social, and vocational implications, resulting in a diminished quality of life, particularly for severely affected patients. The initial management of traumatic spinal cord injuries demands comprehensive interdisciplinary care to address the potentially catastrophic multisystem effects. Ongoing endeavors are focused on optimizing and customizing initial management approaches and developing effective therapies for neuroprotection and neuroregeneration to enhance long-term functional recovery.
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Lv J, Wong MG, Hladunewich MA, Jha V, Hooi LS, Monaghan H, Zhao M, Barbour S, Jardine MJ, Reich HN, Cattran D, Glassock R, Levin A, Wheeler DC, Woodward M, Billot L, Stepien S, Rogers K, Chan TM, Liu ZH, Johnson DW, Cass A, Feehally J, Floege J, Remuzzi G, Wu Y, Agarwal R, Zhang H, Perkovic V. Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial. JAMA 2022; 327:1888-1898. [PMID: 35579642 PMCID: PMC9115617 DOI: 10.1001/jama.2022.5368] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE The effect of glucocorticoids on major kidney outcomes and adverse events in IgA nephropathy has been uncertain. OBJECTIVE To evaluate the efficacy and adverse effects of methylprednisolone in patients with IgA nephropathy at high risk of kidney function decline. DESIGN, SETTING, AND PARTICIPANTS An international, multicenter, double-blind, randomized clinical trial that enrolled 503 participants with IgA nephropathy, proteinuria greater than or equal to 1 g per day, and estimated glomerular filtration rate (eGFR) of 20 to 120 mL/min/1.73 m2 after at least 3 months of optimized background care from 67 centers in Australia, Canada, China, India, and Malaysia between May 2012 and November 2019, with follow-up until June 2021. INTERVENTIONS Participants were randomized in a 1:1 ratio to receive oral methylprednisolone (initially 0.6-0.8 mg/kg/d, maximum 48 mg/d, weaning by 8 mg/d/mo; n = 136) or placebo (n = 126). After 262 participants were randomized, an excess of serious infections was identified, leading to dose reduction (0.4 mg/kg/d, maximum 32 mg/d, weaning by 4 mg/d/mo) and addition of antibiotic prophylaxis for pneumocystis pneumonia for subsequent participants (121 in the oral methylprednisolone group and 120 in the placebo group). MAIN OUTCOMES AND MEASURES The primary end point was a composite of 40% decline in eGFR, kidney failure (dialysis, transplant), or death due to kidney disease. There were 11 secondary outcomes, including kidney failure. RESULTS Among 503 randomized patients (mean age, 38 years; 198 [39%] women; mean eGFR, 61.5 mL/min/1.73 m2; mean proteinuria, 2.46 g/d), 493 (98%) completed the trial. Over a mean of 4.2 years of follow-up, the primary outcome occurred in 74 participants (28.8%) in the methylprednisolone group compared with 106 (43.1%) in the placebo group (hazard ratio [HR], 0.53 [95% CI, 0.39-0.72]; P < .001; absolute annual event rate difference, -4.8% per year [95% CI, -8.0% to -1.6%]). The effect on the primary outcome was seen across each dose compared with the relevant participants in the placebo group recruited to each regimen (P for heterogeneity = .11): full-dose HR, 0.58 (95% CI, 0.41-0.81); reduced-dose HR, 0.27 (95% CI, 0.11-0.65). Of the 11 prespecified secondary end points, 9 showed significant differences in favor of the intervention, including kidney failure (50 [19.5%] vs 67 [27.2%]; HR, 0.59 [95% CI, 0.40-0.87]; P = .008; annual event rate difference, -2.9% per year [95% CI, -5.4% to -0.3%]). Serious adverse events were more frequent with methylprednisolone vs placebo (28 [10.9%] vs 7 [2.8%] patients with serious adverse events), primarily with full-dose therapy compared with its matching placebo (22 [16.2%] vs 4 [3.2%]). CONCLUSIONS AND RELEVANCE Among patients with IgA nephropathy at high risk of progression, treatment with oral methylprednisolone for 6 to 9 months, compared with placebo, significantly reduced the risk of the composite outcome of kidney function decline, kidney failure, or death due to kidney disease. However, the incidence of serious adverse events was increased with oral methylprednisolone, mainly with high-dose therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01560052.
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Affiliation(s)
- Jicheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Muh Geot Wong
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Australia
| | | | - Vivekanand Jha
- The George Institute for Global Health India, UNSW, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom
| | | | - Helen Monaghan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Sean Barbour
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Meg J. Jardine
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | | | | | - Richard Glassock
- David Geffen School of Medicine, University of California, Los Angeles
| | - Adeera Levin
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - David C. Wheeler
- Department of Renal Medicine, University College London, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sandrine Stepien
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kris Rogers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Tak Mao Chan
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR of China
| | - Zhi-Hong Liu
- Research Institute of Nephrology, Jinling Hospital, Nanjing, China
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Alan Cass
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | | | - Hong Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Park E, You J. A Case Report for Using Methylprednisolone for Severe ARDS Caused by SARS-CoV-2 Delta Variant in a Pediatric Patient With Lennox-Gastaut Syndrome. J Korean Med Sci 2022; 37:e82. [PMID: 35289141 PMCID: PMC8921209 DOI: 10.3346/jkms.2022.37.e82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/14/2022] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 can result in fatal comorbidities, including acute respiratory distress syndrome (ARDS). Several reports suggest that children have milder illness, though severe cases have still been reported. We report a 9-year-old boy with ARDS caused by the SARS-CoV-2 delta (B.1.617.2) variant. He was admitted to our hospital and carefully observed due to underlying Lennox-Gastaut syndrome. He developed intractable seizures with a high fever. Although the seizures were controlled, his respiratory condition deteriorated to severe ARDS. High-dose methylprednisolone was administered with high positive end-expiratory pressure and low tidal volume. After ARDS treatment, oxygenation improved sufficiently to permit extubation. This case suggests that close observation is required in pediatric patients with neurologic comorbidities because of an increased risk for severe COVID-19.
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Affiliation(s)
- Esther Park
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
| | - Jihye You
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
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Bressan AK, Isherwood S, Bathe OF, Dixon E, Sutherland FR, Ball CG. Preoperative Single-dose Methylprednisolone Prevents Surgical Site Infections After Major Liver Resection: A Randomized Controlled Trial. Ann Surg 2022; 275:281-287. [PMID: 33351452 DOI: 10.1097/sla.0000000000004720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The primary aim of this study was to evaluate the efficacy of a single preoperative dose of methylprednisolone for preventing postoperative complications after major liver resections. SUMMARY BACKGROUND DATA Hepatic resections are associated with a significant acute systemic inflammatory response. This effect subsequently correlates with postoperative morbidity, mortality, and length of recovery. Multiple small trials have proposed that the administration of glucocorticoids may modulate this effect. METHODS This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients undergoing elective major hepatic resection (≥3 segments) at a quaternary care institution were included (2013-2019). Patients were randomly assigned to receive a single preoperative 500 mg dose of methylprednisolone versus placebo. The main outcome measure was postoperative complications after liver resection, within 90 days of the index operation. Standard statistical methodology was employed (P < 0.05 = significant). RESULTS A total of 151 patients who underwent a major hepatic resection were randomized (mean age = 62.8 years; 57% male; body-mass-index = 27.9). No significant differences were identified between the intervention and control groups (age, sex, body-mass-index, preoperative comorbidities, hepatic function, ASA class, portal vein embolization rate) (P > 0.05). Underlying hepatic diagnoses included colorectal liver metastases (69%), hepatocellular carcinoma (18%), noncolorectal liver metastases (7%), and intrahepatic cholangiocarcinoma (6%). There was a significant reduction in the overall incidence of postoperative complications in the methylprednisolone group (31.2% vs 47.3%; P = 0.042). Patients in the glucocorticoid group also displayed less frequent organ space surgical site infections (6.5% vs 17.6%; P = 0.036), as well as a shorter length of hospital stay (8.9 vs 12.5 days; P = 0.015). Postoperative serum bilirubin and prothrombin timeinternational normalized ratio (PT-INR) levels were also lower in the steroid group (P = 0.03 and 0.04, respectively). Multivariate analysis did not identify any additional significant modifying factor relationships (estimated blood loss, duration of surgery, hepatic vascular occlusion (rate or duration), portal vein embolization, drain use, etc) (P > 0.05). CONCLUSIONS A single preoperative dose of methylprednisolone significantly reduces the length of hospital stay, postoperative serum bilirubin, and PT-INR, as well as infectious and overall complications following major hepatectomy.
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Li L, Liu H, Wang H, Liu Z, Chen Y, Liu C, Zhao X, Li L, Wang H, Shao Z, Fu R. Clinical observation of low-dose combination chemotherapy in refractory/recurrent paroxysmal nocturnal hemoglobinuria patients: A single-center retrospective analysis. J Clin Lab Anal 2022; 36:e24239. [PMID: 35028973 PMCID: PMC8841174 DOI: 10.1002/jcla.24239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We performed a retrospective analysis to investigate the clinical characteristics and therapeutic strategies of 20 refractory/recurrent PNH patients, including the clinical efficacy of chemotherapy treatment, safety, and survival. METHODS The clinical data of 20 classic PNH patients who were refractory/recurrent or had glucocorticoid dependence in our hospital were analyzed, including clinical manifestations, laboratory examinations, treatment efficacy, and survival. RESULTS Seventeen patients had a marked improvement in anemia after chemotherapy, 14 patients acquired blood transfusion independence, and the Hb of 3 patients increased to normal levels. Although 6 patients still needed blood transfusion, the transfusion interval was significantly prolonged. The percentages of LDH, TBIL, and RET, which are indicators of hemolysis, were significantly lower than those before chemotherapy. The dosage of adrenal glucocorticoids was reduced by more than half compared with that before chemotherapy. CONCLUSIONS Chemotherapy can reduce PNH clones, promote normal hematopoiesis, and control hemolytic attack. It is a promising and widely used therapeutic method.
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Affiliation(s)
- Liyan Li
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Hui Liu
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Honglei Wang
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Zhaoyun Liu
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Yingying Chen
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Chunyan Liu
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Xiaoyu Zhao
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Lijuan Li
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Huaquan Wang
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Zonghong Shao
- Department of HematologyTianjin Medical University General HospitalTianjinChina
| | - Rong Fu
- Department of HematologyTianjin Medical University General HospitalTianjinChina
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Tay SH, Toh MMX, Thian YL, Vellayappan BA, Fairhurst AM, Chan YH, Aminkeng F, Bharwani LD, Huang Y, Mak A, Wong ASC. Cytokine Release Syndrome in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Case Series of 25 Patients and Review of the Literature. Front Immunol 2022; 13:807050. [PMID: 35154124 PMCID: PMC8831742 DOI: 10.3389/fimmu.2022.807050] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/11/2022] [Indexed: 12/23/2022] Open
Abstract
Cytokine release syndrome (CRS) is a phenomenon of immune hyperactivation described in the setting of immunotherapy. Unlike other immune-related adverse events, CRS triggered by immune checkpoint inhibitors (ICIs) is not well described. The clinical characteristics and course of 25 patients with ICI-induced CRS from 2 tertiary hospitals were abstracted retrospectively from the medical records and analyzed. CRS events were confirmed by 2 independent reviewers and graded using the Lee et al. scale. The median duration of CRS was 15.0 days (Q1; Q3 6.3; 29.8) and 10 (40.0%) had multiple episodes of CRS flares. Comparing the clinical factors and biomarkers in Grades 1-2 and 3-5 CRS, we found that patients with Grades 3-5 CRS had following: (i) had longer time to fever onset [25.0 days (Q1; Q3 13.0; 136.5) vs. 3.0 days (Q1; Q3 0.0; 18.0), p=0.027]; (ii) more cardiovascular (p=0.002), neurologic (p=0.001), pulmonary (p=0.044) and rheumatic (p=0.037) involvement; (iii) lower platelet count (p=0.041) and higher urea (p=0.041) at presentation compared to patients with Grades 1-2 CRS. 7 patients (28.0%) with Grades 1-2 CRS were rechallenged using ICIs without event. 9 patients (36.0%) were treated with pulse methylprednisolone and 6 patients (24.0%) were treated with tocilizumab. Despite this, 3 patients (50%) who received tocilizumab had fatal (Grade 5) outcomes from ICI-induced CRS. Longer time to fever onset, lower platelet count and higher urea at presentation were associated with Grade 3-5 CRS. These parameters may be used to predict which patients are likely to develop severe CRS.
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Affiliation(s)
- Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michelle Min Xuan Toh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee Liang Thian
- Division of Body Imaging, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Balamurugan A. Vellayappan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Anna-Marie Fairhurst
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Folefac Aminkeng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lavina D. Bharwani
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alvin Seng Cheong Wong
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Baldev K, Dai F, Barrett C, Zhou B, Shah M, Howie B, Boominathan P, Zhao X, Li J. Glucocorticoid minimizes local anesthetic infusion requirement through adductor canal block and improves perioperative prosthetic joint range of motion in total knee arthroplasty. PLoS One 2022; 17:e0261949. [PMID: 35081134 PMCID: PMC8791457 DOI: 10.1371/journal.pone.0261949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The use of glucocorticoid as local anesthetic adjuvant in single-injection adductor canal block (ACB) is well-documented but its effects in the presence of an indwelling catheter is unclear. The purpose of this study was to determine the impacts of one-time perineural glucocorticoid injection on continuous adductor canal block in patients undergoing total knee arthroplasty. Methods A single center retrospective study of 95 patients undergoing unilateral total knee arthroplasty (TKA) was performed. Patients were divided into three groups based on adjuvant received through ACB before continuous catheter placement: a control group with no adjuvant (N = 41), a treatment group with dexamethasone (DEX) as adjuvant (N = 33) and another treatment group with DEX/ Methylprednisolone acetate (MPA) as adjuvant (N = 21). The primary outcome was the amount of ropivacaine administered via patient controlled ACB catheter. Secondary outcomes included numeric pain score, perioperative opioid usage, immediately postoperative prosthetic knee joint active range of motion (AROM), opioid usage at 6 weeks and 3 months, length of stay and discharge disposition. Results Patients in both treatment groups demonstrated a statistically significant decrease in the requirement of self-administered ropivacaine than the control group on postoperative day (POD) 1 (p<0.001) and POD 2 (p<0.001). There was no significant difference in opioid consumption and pain scores between either treatment group vs. control. Compared to control (66%), more home disposition was observed in the DEX (88%, p = 0.028) and DEX/MPA group (95%, p = 0.011). Conclusion This study suggested that single dose perineural glucocorticoid injection with DEX or DEX/MPA significantly decreased the dose of local anesthetic ropivacaine infusion required through continuous ACB for TKA while maintaining comparable level of pain score and opioid consumption, and significantly more patients were discharged home.
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Affiliation(s)
- Khushboo Baldev
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, Connecticut, United States of America
| | - Feng Dai
- Yale Center for Analytical Sciences, Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Cassandra Barrett
- Department of Anesthesiology, Legacy Emanuel Medical Center, Portland, Oregon, United States of America
| | - Bin Zhou
- Yale Center for Analytical Sciences, Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Misty Shah
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, Connecticut, United States of America
| | - Benjamin Howie
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, Connecticut, United States of America
| | - Praba Boominathan
- Division of Pain Medicine, Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Xuechun Zhao
- Department of Anesthesiology, Temple University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Jinlei Li
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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Watanabe-Kusunoki K, Nakazawa D, Yamamoto J, Matsuoka N, Kaneshima N, Nakagaki T, Yamamoto R, Maoka T, Iwasaki S, Tsuji T, Fukasawa Y, Nishimoto N, Nishio S, Atsumi T. Comparison of administration of single- and triple-course steroid pulse therapy combined with tonsillectomy for immunoglobulin A nephropathy. Medicine (Baltimore) 2021; 100:e27778. [PMID: 34918629 PMCID: PMC8677957 DOI: 10.1097/md.0000000000027778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
Immunoglobulin A nephropathy (IgAN) is a form of chronic glomerulonephritis that can cause end-stage renal disease. Recently, tonsillectomy combined with corticosteroid pulse (TSP) has been shown to be effective for achieving clinical remission and favorable renal outcome in patients with IgAN. However, the standard regimen of corticosteroid use in TSP has not been established. Herein, we compared the effect of single- or triple-course steroid pulse therapy combined with tonsillectomy in patients with IgAN.This retrospective, observational cohort study included 122 patients with IgAN enrolled from January 2004 to December 2018 at 2 independent institutions. We divided the patients into 2 groups; single-course (TSP1: n = 70) and triple-course (TSP3: n = 52) of corticosteroid pulse therapy (1 course comprised 3 consecutive days' infusion of 0.5 g methylprednisolone) combined with tonsillectomy. The primary outcome for renal survival was defined as the first occurrence of ≧30% decrease in estimated glomerular filtration rate from baseline. Secondary outcomes included the incidence of clinical remission and recurrence of the disease.Regarding clinical parameters and findings at baseline, there were no significant differences between the 2 groups. The 8-years renal survival in the 2 groups was not significantly different according to Kaplan-Meier curves (TSP1; 82.5% vs TSP3; 69.2%, log-rank test P = .39). The cumulative incidence rates of remission of hematuria (94.4% vs 85.4%, P = .56) and clinical remission (85.0% vs 64.8%, P = .07) were comparable in both groups, while those of proteinuria showed higher rates in TSP1 than TSP3 (88.4% vs 65.4%, P = .02). The cumulative incidence of relapse of hematuria (5.6% vs 2.3%, P = .42) and proteinuria (7.1% vs 3.3%, P = .41) showed no significant differences in the 2 groups. Cox regression analyses showed that the number of courses of corticosteroid pulse therapy was not significantly associated with renal outcome (TSP1 vs TSP3; Hazard ratios 0.69, 95% confidence intervals 0.29-1.64, P = .39).The effect of single-course corticosteroid pulse therapy is not statistically, significantly different from triple-course in TSP protocol for improving renal outcome and preventing relapse in patients with IgAN. Single-course corticosteroid pulse therapy may become a treatment option for patients with IgAN.
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Affiliation(s)
- Kanako Watanabe-Kusunoki
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Junya Yamamoto
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoko Matsuoka
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Tasuku Nakagaki
- Department of Nephrology, NTT Medical Center Sapporo, Sapporo, Japan
| | - Rie Yamamoto
- Department of Nephrology, NTT Medical Center Sapporo, Sapporo, Japan
| | - Tomochika Maoka
- Department of Nephrology, NTT Medical Center Sapporo, Sapporo, Japan
| | - Sari Iwasaki
- Department of Pathology, Sapporo City General Hospital, Sapporo, Japan
| | - Takahiro Tsuji
- Department of Pathology, Sapporo City General Hospital, Sapporo, Japan
| | - Yuichiro Fukasawa
- Department of Pathology, Sapporo City General Hospital, Sapporo, Japan
| | - Naoki Nishimoto
- Division of Biostatistics, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Ye F, Liu J, Chen L, Zhu B, Yu L, Liang B, Xu L, Li S, Lu S, Fan L, Yang D, Zheng X. Time-course analysis reveals that corticosteroids resuscitate diminished CD8+ T cells in COVID-19: a retrospective cohort study. Ann Med 2021; 53:181-188. [PMID: 33183091 PMCID: PMC7877944 DOI: 10.1080/07853890.2020.1851394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To illustrate the effect of corticosteroids and heparin, respectively, on coronavirus disease 2019 (COVID-19) patients' CD8+ T cells and D-dimer. METHODS In this retrospective cohort study involving 866 participants diagnosed with COVID-19, patients were grouped by severity. Generalized additive models were established to explore the time-course association of representative parameters of coagulation, inflammation and immunity. Segmented regression was performed to examine the influence of corticosteroids and heparin upon CD8+ T cell and D-dimer, respectively. RESULTS There were 541 moderate, 169 severe and 156 critically ill patients involved in the study. Synchronous changes of levels of NLR, D-dimer and CD8+ T cell in critically ill patients were observed. Administration of methylprednisolone before 14 DFS compared with those after 14 DFS (β = 0.154%, 95% CI=(0, 0.302), p=.048) or a dose lower than 40 mg per day compared with those equals to 40 mg per day (β = 0.163%, 95% CI=(0.027, 0.295), p=.020) significantly increased the rising rate of CD8+ T cell in 14-56 DFS. CONCLUSIONS The parameters of coagulation, inflammation and immunity were longitudinally correlated, and an early low-dose corticosteroid treatment accelerated the regaining of CD8+ T cell to help battle against SARS-Cov-2 in critical cases of COVID-19.
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Affiliation(s)
- Fangzhou Ye
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Liangkai Chen
- School of Public Health, Ministry of Education Key Lab of Environment and Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Zhu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yu
- Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Boyun Liang
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Xu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Sumeng Li
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Sihong Lu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Fan
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Dongliang Yang
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zheng
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
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11
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Bui A, Butts EB, Aslam N. 47-Year-Old Woman With Bilateral Flank Pain. Mayo Clin Proc 2021; 96:3147-3152. [PMID: 34863400 DOI: 10.1016/j.mayocp.2021.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Albert Bui
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Emily Brooke Butts
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Nabeel Aslam
- Advisor to residents and Consultant in Nephrology, Mayo Clinic, Jacksonville, FL.
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12
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Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today 2021; 51:1897-1905. [PMID: 33590327 DOI: 10.1007/s00595-021-02234-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023]
Abstract
Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breasts with an unknown etiology. Corticosteroids are one the primary options for treating this disease, but the results of previous studies concerning their efficacy have been controversial. We, therefore, decided to assess the effectiveness of corticosteroids on IGM using a systematic review and meta-analysis. We conducted a systematic search using MeSH terms and all relevant keywords in PubMed, EMBASE, Cochrane Library and Web of Science until May 21, 2019. Data were analyzed using the Comprehensive Meta-Analysis (CMA) V.2 software program and presented as the event rate, risk ratio (RR) and risk difference (RD). Twelve studies including 559 IGM patients were entered into the meta-analysis. Our analysis showed that the RR and RD of recurrence in the steroid-only group compared with the surgery-only group were 2.99 (95% confidence interval [CI] 0.28-31.33) and 0.14 (95% CI - 0.01-0.30), respectively, showing no statistical significance. The meta-analysis of the steroid-only group and steroid + surgery group showed that the RR of recurrence was 6.13 (95% CI 0.41-81.62) with no significance. However, the meta-analysis of the RD showed that the risk of recurrence in the steroid group was significantly higher than that in the steroids + surgery group (RD: 0.28, 95% CI 0.11-0.44). This meta-analysis showed that managing IGM with only steroids may be less effective than the combination of steroids and surgery. This combination approach may result in a lower rate of recurrence and side effects in these patients.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leyla Shojaee
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Hessami
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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13
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Siomkajło M, Mizera Ł, Szymczak D, Kolačkov K, Grzegrzółka J, Bolanowski M, Daroszewski J. Effect of systemic steroid therapy in Graves' orbitopathy on regulatory T cells and Th17/Treg ratio. J Endocrinol Invest 2021; 44:2475-2484. [PMID: 33866536 DOI: 10.1007/s40618-021-01565-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/29/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Glucocorticoids are a mainstay treatment for Graves' orbitopathy, yet their exact mechanisms of action remain unclear. We aimed to determine whether the therapeutic effects of systemic steroid therapy in Graves' orbitopathy are mediated by changes in regulatory T lymphocytes (Tregs) and T helper 17 lymphocytes (Th17). METHODS We assessed Treg and Th17 levels in the peripheral blood of 32 patients with active, moderate-to-severe Graves' orbitopathy who received 12 weekly pulses of methylprednisolone, and determined their association with disease severity, disease activity, and treatment outcomes. The acute orbitopathy phase was confirmed based on clinical evaluation and magnetic resonance imaging, and assessed using the clinical activity score (CAS). The severity of the disease was classified according to ETA/EUGOGO guidelines, and quantified based on the total eye score. Treatment response was determined based on specific criteria (e.g., changes in CAS score, diplopia grade, visual acuity, etc.). Treg and Th17 cells were identified using flow cytometry. RESULTS Methylprednisolone treatment improved the activity of the disease and altered the Th17/Treg balance (i.e., the percentage of Tregs decreased while the number of Th17 cells remained unchanged). There was no association between the Treg/Th17 ratio and the activity and severity of the disease or the treatment response. CONCLUSIONS Therapeutic effects of steroid therapy in Graves' orbitopathy are not mediated by Treg and Th17 alterations in the peripheral blood. The decrease in peripheral Treg percentage is likely a consequence of the non-specific effects of steroids and does not impact clinical outcome.
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Affiliation(s)
- M Siomkajło
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland.
| | - Ł Mizera
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - D Szymczak
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - K Kolačkov
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - J Grzegrzółka
- Department of Human Morphology and Embryology, Wroclaw Medical University, T. Chalubinskiego 6a, 50-368, Wroclaw, Poland
| | - M Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - J Daroszewski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
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14
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Yang JX, Williamson KA, Duarte-García A. 75-Year-Old Man With Fever and Malaise. Mayo Clin Proc 2021; 96:2905-2910. [PMID: 34736613 DOI: 10.1016/j.mayocp.2021.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Jeffrey X Yang
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Katrina A Williamson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Alí Duarte-García
- Advisor to residents and Consultant in Rheumatology, Mayo Clinic, Rochester, MN.
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15
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Tanaka M, Taniguchi K, Miki S, Iwanari S, Ikeda M, Hasui M, Takeoka H. Rapidly progressive IgA vasculitis-associated nephritis successfully treated with immunosuppressive therapy in an adolescent with chronic granulomatous disease. CEN Case Rep 2021; 10:461-467. [PMID: 33683583 PMCID: PMC8494880 DOI: 10.1007/s13730-021-00586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a rare immunodeficiency disorder with genetic defects in the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex in phagocytes, leading to recurrent severe infections and granuloma formation. Genitourinary involvement, including obstructive granulomas, infections, nephrotoxicity of anti-infective agents, and amyloidosis, is frequently observed in patients with CGD, whereas the clinical and pathological details of the less commonly reported glomerular disease remain obscure. Here, we report the case of a patient with CGD who developed rapidly progressive IgA vasculitis-associated nephritis (IgAVN) and review the literature on biopsy-proven glomerular diseases in patients with CGD. A 22-year-old male patient with CGD developed rapidly progressive glomerulonephritis (RPGN) following peripheral purpura and was diagnosed with crescentic IgAVN based on the renal biopsy evaluation. There was no evidence of active infections, and he received pulse intravenous methylprednisolone followed by oral prednisolone. His renal function returned to normal within 4 weeks, and his proteinuria and microhematuria finally resolved. The present case and literature review indicate that IgAVN and IgA nephropathy with RPGN are the most common causes of glomerular disease in patients with CGD. Clinicians should be aware of the possibility of these diseases as causes of RPGN in CGD, because delays in diagnosis and appropriate treatment may affect renal outcomes.
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Affiliation(s)
- Mari Tanaka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Keisuke Taniguchi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Sho Miki
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Sachio Iwanari
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Masaki Ikeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | | | - Hiroya Takeoka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
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16
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Andersen LW, Isbye D, Kjærgaard J, Kristensen CM, Darling S, Zwisler ST, Fisker S, Schmidt JC, Kirkegaard H, Grejs AM, Rossau JRG, Larsen JM, Rasmussen BS, Riddersholm S, Iversen K, Schultz M, Nielsen JL, Løfgren B, Lauridsen KG, Sølling C, Pælestik K, Kjærgaard AG, Due-Rasmussen D, Folke F, Charlot MG, Jepsen RMHG, Wiberg S, Donnino M, Kurth T, Høybye M, Sindberg B, Holmberg MJ, Granfeldt A. Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2021; 326:1586-1594. [PMID: 34587236 PMCID: PMC8482303 DOI: 10.1001/jama.2021.16628] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Previous trials have suggested that vasopressin and methylprednisolone administered during in-hospital cardiac arrest might improve outcomes. OBJECTIVE To determine whether the combination of vasopressin and methylprednisolone administered during in-hospital cardiac arrest improves return of spontaneous circulation. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, placebo-controlled trial conducted at 10 hospitals in Denmark. A total of 512 adult patients with in-hospital cardiac arrest were included between October 15, 2018, and January 21, 2021. The last 90-day follow-up was on April 21, 2021. INTERVENTION Patients were randomized to receive a combination of vasopressin and methylprednisolone (n = 245) or placebo (n = 267). The first dose of vasopressin (20 IU) and methylprednisolone (40 mg), or corresponding placebo, was administered after the first dose of epinephrine. Additional doses of vasopressin or corresponding placebo were administered after each additional dose of epinephrine for a maximum of 4 doses. MAIN OUTCOMES AND MEASURES The primary outcome was return of spontaneous circulation. Secondary outcomes included survival and favorable neurologic outcome at 30 days (Cerebral Performance Category score of 1 or 2). RESULTS Among 512 patients who were randomized, 501 met all inclusion and no exclusion criteria and were included in the analysis (mean [SD] age, 71 [13] years; 322 men [64%]). One hundred of 237 patients (42%) in the vasopressin and methylprednisolone group and 86 of 264 patients (33%) in the placebo group achieved return of spontaneous circulation (risk ratio, 1.30 [95% CI, 1.03-1.63]; risk difference, 9.6% [95% CI, 1.1%-18.0%]; P = .03). At 30 days, 23 patients (9.7%) in the intervention group and 31 patients (12%) in the placebo group were alive (risk ratio, 0.83 [95% CI, 0.50-1.37]; risk difference: -2.0% [95% CI, -7.5% to 3.5%]; P = .48). A favorable neurologic outcome was observed in 18 patients (7.6%) in the intervention group and 20 patients (7.6%) in the placebo group at 30 days (risk ratio, 1.00 [95% CI, 0.55-1.83]; risk difference, 0.0% [95% CI, -4.7% to 4.9%]; P > .99). In patients with return of spontaneous circulation, hyperglycemia occurred in 77 (77%) in the intervention group and 63 (73%) in the placebo group. Hypernatremia occurred in 28 (28%) and 27 (31%), in the intervention and placebo groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone, compared with placebo, significantly increased the likelihood of return of spontaneous circulation. However, there is uncertainty whether this treatment results in benefit or harm for long-term survival. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03640949.
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Affiliation(s)
- Lars W. Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Dan Isbye
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Camilla M. Kristensen
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Darling
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Stine T. Zwisler
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Stine Fisker
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jens Christian Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Anders M. Grejs
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen R. G. Rossau
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob M. Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil S. Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Riddersholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Kasper Iversen
- Department of Emergency Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Schultz
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Jakob L. Nielsen
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Pennsylvania
| | - Bo Løfgren
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Medicine, Randers Regional Hospital, Randers, Denmark
- Unit of Clinical Simulation and Education, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Christoffer Sølling
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Kim Pælestik
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Anders G. Kjærgaard
- Department of Anesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark
| | - Dorte Due-Rasmussen
- Department of Anesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Mette G. Charlot
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | - Sebastian Wiberg
- Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Michael Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Høybye
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Birthe Sindberg
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mathias J. Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Tamaki K, Mera H, Takeshita S, Fujioka S, Goto M, Matsumoto T, Yamano Y, Takamatsu Y, Tsuboi Y. A refractory human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis patient with lymphoma-type adult T-cell leukemia/lymphoma: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e27450. [PMID: 34622865 PMCID: PMC8500642 DOI: 10.1097/md.0000000000027450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Adult T-cell leukemia/lymphoma (ATL) and human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are caused by HTLV-1, but the coexistence of both disorders is rare. The estimated incidence is approximately 3%. PATIENT CONCERNS A 54-year-old man was unable to stand up because of spastic paraparesis 1 month after the onset. He developed lymphadenopathy in the left supraclavicular fossa 5 months after the onset. The spastic paraplegia and sensory symptoms below the thoracic spinal cord level worsened. DIAGNOSES Both blood and cerebrospinal fluid (CSF) tests were positive for anti-HTLV-1 antibodies. The patient was diagnosed with rapidly progressive HAM/TSP. He was also diagnosed with lymphoma-type ATL by the biopsy specimen of the lymph node. CSF examination at the time of symptom exacerbation showed abnormal lymphocytes, suggesting central infiltration of the ATL in the central nervous system. INTERVENTIONS Methylprednisolone pulse therapy and oral prednisolone maintenance therapy were administered for rapidly progressive HAM/TSP. Intrathecal injection of methotrexate was administered for the suggested central infiltration of the ATL. OUTCOMES Methylprednisolone pulse therapy and intrathecal injection of methotrexate did not improve the patient's exacerbated symptoms. Five months later, clumsiness and mild muscle weakness of the fingers appeared, and magnetic resonance imaging showed swelling of the cervical spinal cord. Clonality analysis showed monoclonal proliferation only in the DNA of a lymph node lesion, but not in the CSF and peripheral blood cells. LESSONS This was a case of rapidly progressive HAM/TSP associated with lymphoma-type ATL that was refractory to steroids and chemotherapy. The pathogenesis was presumed to involve ATL cells in the brain and spinal cord because of the presence of abnormal lymphocytes in the CSF, but DNA analysis could not prove direct invasion. This case suggests that when we encounter cases with refractory HAM/TSP, it should be needed to suspect the presence of ATL in the background.
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Affiliation(s)
- Keiko Tamaki
- Department of Neurology, Fukuoka University, Japan
| | | | | | | | - Maki Goto
- Division of Medical Oncology, Hematology and Infectious Diseases, Fukuoka University, Japan
| | - Taichi Matsumoto
- Department of Drug Informatics and Translational Research, Faculty of Pharmaceutical Sciences, Fukuoka University, Japan
| | - Yoshihisa Yamano
- Division of Neurology, St. Marianna University School of Medicine, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Diseases, Fukuoka University, Japan
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Abstract
IMPORTANCE Local steroid injection is commonly used in treating patients with idiopathic carpal tunnel syndrome, but evidence regarding long-term efficacy is lacking. OBJECTIVE To assess the long-term treatment effects of local steroid injection for carpal tunnel syndrome. DESIGN, SETTING, AND PARTICIPANTS This exploratory 5-year extended follow-up of a double-blind, placebo-controlled randomized clinical trial was conducted from November 2008 to March 2012 at a university hospital orthopedic department. Participants included patients aged 22 to 69 years with primary idiopathic carpal tunnel syndrome and no prior treatment with local steroid injections. Data were analyzed from May 2018 to August 2018. INTERVENTIONS Patients were randomized to injection of 80 mg methylprednisolone, 40 mg methylprednisolone, or saline. MAIN OUTCOMES AND MEASURES The coprimary outcomes were the symptom severity score and rate of subsequent carpal tunnel release surgery on the study hand at 5 years. Secondary outcomes were time from injection to surgical treatment, SF-36 bodily pain score, and score on the 11-item disabilities of the arm, shoulder, and hand scale. RESULTS A total of 111 participants (mean [SD] age at follow-up, 52.9 [11.6] years; 81 [73.0%] women and 30 [27.0%] men) were randomized, with 37 in the 80 mg methylprednisolone group, 37 in the 40 mg methylprednisolone group, and 37 in the saline placebo group. Complete 5-year follow-up data were obtained from all 111 participants with no dropouts (100% follow-up). At baseline, mean (SD) symptom severity scores were 2.93 (0.85) in the 80 mg methylprednisolone group, 3.13 (0.70) in the 40 mg methylprednisolone group, and 3.18 (0.75) in the placebo group, and at the 5-year follow up, mean (SD) symptom severity scores were 1.51 (0.66) in the 80 mg methylprednisolone group, 1.59 (0.63) in the 40 mg methylprednisolone group, and 1.67 (0.74) in the placebo group. Compared with placebo, there was no significant difference in mean change in symptom severity score from baseline to 5 years for the 80 mg methylprednisolone group (0.14 [95%CI, -0.17 to 0.45]) or the 40 mg methylprednisolone group (0.12 [95%CI, -0.19 to 0.43]). After injection, subsequent surgical treatment on the study hand was performed in 31 participants (83.8%) in the 80 mg methylprednisolone group, 34 participants (91.9%) in the 40 mg methylprednisolone group, and 36 participants (97.3%) in the placebo group; the number of participants who underwent surgical treatment between the 1-year and 5-year follow-ups was 4 participants (10.8%) in the 80 mg methylprednisolone group, 4 participants (10.8%) in the 40 mg methylprednisolone group, and 2 participants (5.4%) in the placebo group. All surgical procedures were conducted while participants and investigators were blinded to type of injection received. The mean (SD) time from injection to surgery was 180 (121) days in the 80 mg methylprednisolone group, 185 (125) days in the 40 mg methylprednisolone group, and 121 (88) days in the placebo group. Kaplan-Meier survival curves showed statistically significant difference in time to surgical treatment (log-rank test: 80 mg methylprednisolone vs placebo, P = .002 ; 40 mg methylprednisolone vs placebo, P = .02; methylprednisolone 80 mg vs 40 mg, P = .37). CONCLUSIONS AND RELEVANCE These findings suggest that in idiopathic carpal tunnel syndrome, local methylprednisolone injection resulted in statistically significant reduction in surgery rates and delay in need for surgery. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT00806871 and NCT02652390.
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Affiliation(s)
- Manfred Hofer
- Department of Orthopedics, Kristianstad Hospital, Kristianstad, Sweden
| | - Jonas Ranstam
- Department of Clinical Sciences–Orthopedics, Lund University, Lund, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Kristianstad Hospital, Kristianstad, Sweden
- Department of Clinical Sciences–Orthopedics, Lund University, Lund, Sweden
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Lei J, Wang H. Neuromyelitis optica spectrum disorder with active replication of hepatitis B virus and seropositive anti-aquaporin-4 antibody: A case report. Medicine (Baltimore) 2021; 100:e27207. [PMID: 34559109 PMCID: PMC8462564 DOI: 10.1097/md.0000000000027207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Neuromyelitis optica spectrum disorder (NMOSD) associated with active replication of hepatitis B virus (HBV) is rare. High-dose corticosteroids are the mainstay treatment of NMOSD; however, these may cause reactivation of viral replication in patients with stable HBV which may lead to liver damage. Therefore, care should be placed in corticosteroid use in patients with NMOSD and HBV infection. PATIENT CONCERNS Herein, we report the case of a 31-year-old woman with NMOSD and HBV infection who was seropositive for anti-aquaporin-4 antibody. The stable and HBV carrier status of the patient led to the deferment of antiviral and hepatoprotective agents in early treatment. However, liver function impairment was detected during follow-up, with an improvement in the best-corrected visual acuity. DIAGNOSES The patient was diagnosed with NMOSD with active replication of HBV and seropositive anti-aquaporin-4 antibody considering the medical history and ancillary examinations. INTERVENTIONS To manage NMOSD, intravenous high-dose methylprednisolone (20 mg/kg d) was administered for 5 days which was gradually tapered to oral steroids. However, liver function impairment was observed during follow-up; therefore, anti-HBV drugs (entecavir) and hepatoprotective drugs (bicyclol or polyunsaturated phosphatidylcholine) were administered. OUTCOMES A marked improvement was observed in the patient's best-corrected visual acuity after 4 weeks of treatment. However, follow-up examinations revealed liver function damage which necessitated administration of antiviral and hepatoprotective drugs. Liver function normalized after 1 month. LESSON This case underscores the importance of preventive treatment of liver protection in patients with HBV infection prior to or simultaneous with glucocorticoid therapy and furthermore, there is an urgent need to develop authoritative guidelines regulating corticosteroid use in the treatment of patients with HBV infection.
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Zhang N, Lin J, Lin VPH, Milbreta U, Chin JS, Chew EGY, Lian MM, Foo JN, Zhang K, Wu W, Chew SY. A 3D Fiber-Hydrogel Based Non-Viral Gene Delivery Platform Reveals that microRNAs Promote Axon Regeneration and Enhance Functional Recovery Following Spinal Cord Injury. Adv Sci (Weinh) 2021; 8:e2100805. [PMID: 34050637 PMCID: PMC8336488 DOI: 10.1002/advs.202100805] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 05/05/2023]
Abstract
Current treatment approaches toward spinal cord injuries (SCI) have mainly focused on overcoming the inhibitory microenvironment that surrounds lesion sites. Unfortunately, the mere modulation of the cell/tissue microenvironment is often insufficient to achieve desired functional recovery. Therefore, stimulating the intrinsic growth ability of injured neurons becomes crucial. MicroRNAs (miRs) play significant roles during axon regeneration by regulating local protein synthesis at growth cones. However, one challenge of using miRs to treat SCI is the lack of efficient delivery approaches. Here, a 3D fiber-hydrogel scaffold is introduced which can be directly implanted into a spinal cord transected rat. This 3D scaffold consists of aligned electrospun fibers which provide topographical cues to direct axon regeneration, and collagen matrix which enables a sustained delivery of miRs. Correspondingly, treatment with Axon miRs (i.e., a cocktail of miR-132/miR-222/miR-431) significantly enhances axon regeneration. Moreover, administration of Axon miRs along with anti-inflammatory drug, methylprednisolone, synergistically enhances functional recovery. Additionally, this combined treatment also decreases the expression of pro-inflammatory genes and enhance gene expressions related to extracellular matrix deposition. Finally, increased Axon miRs dosage with methylprednisolone, significantly promotes functional recovery and remyelination. Altogether, scaffold-mediated Axon miR treatment with methylprednisolone is a promising therapeutic approach for SCI.
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Affiliation(s)
- Na Zhang
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Junquan Lin
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Vincent Po Hen Lin
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Ulla Milbreta
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Jiah Shin Chin
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
- Interdisciplinary Graduate SchoolNanyang Technological University61 Nanyang DriveSingapore637335Singapore
| | - Elaine Guo Yan Chew
- Human GeneticsGenome Institute of Singapore60 Biopolis StreetSingapore138672Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
| | - Michelle Mulan Lian
- Human GeneticsGenome Institute of Singapore60 Biopolis StreetSingapore138672Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
| | - Jia Nee Foo
- Human GeneticsGenome Institute of Singapore60 Biopolis StreetSingapore138672Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
| | - Kunyu Zhang
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Wutian Wu
- Guangdong‐Hongkong‐Macau Institute of CNS RegenerationMinistry of Education CNS Regeneration Collaborative Joint LaboratoryJinan University601 West Huangpu AvenueGuangzhou510632P. R. China
- Re‐Stem Biotechnology Co., Ltd.1463 Wuzhong AveSuzhou330520P. R. China
| | - Sing Yian Chew
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
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21
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Sioka C, Nikas D, Tsoumani A, Kiortsis DN, Fotopoulos A, Kostadima V. Transient myocardial ischemia due to corticosteroid use in a patient with multiple sclerosis diagnosed with myocardial perfusion imaging. J Nucl Cardiol 2021; 28:1805-1808. [PMID: 32394408 DOI: 10.1007/s12350-020-02185-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Chrissa Sioka
- Department of Nuclear Medicine, Medical School, University Hospital of Ioannina, 1 Stavrou Niarchou Street, 45110, Ioannina, Greece.
| | - Dimitrios Nikas
- First Cardiology Department, University Hospital of Ioannina, Ioannina, Greece
| | - Afroditi Tsoumani
- Department of Neurology, Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitris-Nikiforos Kiortsis
- Department of Nuclear Medicine, Medical School, University Hospital of Ioannina, 1 Stavrou Niarchou Street, 45110, Ioannina, Greece
| | - Andreas Fotopoulos
- Department of Nuclear Medicine, Medical School, University Hospital of Ioannina, 1 Stavrou Niarchou Street, 45110, Ioannina, Greece
| | - Vasiliki Kostadima
- Department of Neurology, Medical School, University Hospital of Ioannina, Ioannina, Greece
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22
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Piccica M, Lagi F, Trotta M, Spinicci M, Zammarchi L, Bartoloni A. High-dose steroids for the treatment of severe COVID-19. Intern Emerg Med 2021; 16:1395-1399. [PMID: 33856664 PMCID: PMC8047517 DOI: 10.1007/s11739-021-02707-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/08/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Matteo Piccica
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, SOD Malattie Infettive eTropicali, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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23
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Mahale R, Farsana MK, Mahadevan A, Mukherjee J, Lakshmi V, Sandeep M, Padmanabha H, Mailankody P, Pavagada M. Stroke-like episodes with cerebellar ataxia as presenting manifestation of adult-onset anti-N-methyl D-aspartate receptor encephalitis: an unusual presentation. Acta Neurol Belg 2021; 121:1093-1095. [PMID: 34216377 DOI: 10.1007/s13760-021-01735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | | | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Joydeep Mukherjee
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Vathsala Lakshmi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - M Sandeep
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Mathuranath Pavagada
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
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24
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Dravid A, Kashiva R, Khan Z, Memon D, Kodre A, Potdar P, Mane M, Borse R, Pawar V, Patil D, Banerjee D, Bhoite K, Pharande R, Kalyani S, Raut P, Bapte M, Mehta A, Reddy MS, Bhayani K, Laxmi SS, Vishnu PD, Srivastava S, Khandelwal S, More S, Shinde R, Pawar M, Harshe A, Kadam S, Mahajan U, Joshi G, Mane D. Combination therapy of Tocilizumab and steroid for management of COVID-19 associated cytokine release syndrome: A single center experience from Pune, Western India. Medicine (Baltimore) 2021; 100:e26705. [PMID: 34398044 PMCID: PMC8294888 DOI: 10.1097/md.0000000000026705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/19/2021] [Indexed: 01/08/2023] Open
Abstract
Cytokine release syndrome (CRS) or cytokine storm is thought to be the cause of inflammatory lung damage, worsening pneumonia and death in patients with COVID-19. Steroids (Methylprednislone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroid in COVID-19 associated CRS.This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India between April 2 and November 2, 2020. All patients administered TCZ and steroids during this period were included. The primary endpoint was incidence of all cause mortality. Secondary outcomes studied were need for mechanical ventilation and incidence of systemic and infectious complications. Baseline and time dependent risk factors significantly associated with death were identified by Relative risk estimation.Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. Thirty seven percent patients were managed in wards and did not need intensive care unit (ICU) admission. Infectious complications like hospital acquired pneumonia, blood stream bacterial and fungal infections were observed in 2.13%, 2.13% and 0.06% patients respectively. Age ≥ 60 years (P = .014), presence of co-morbidities like hypertension (P = .011), IL-6 ≥ 100 pg/ml (P = .002), D-dimer ≥ 1000 ng/ml (P < .0001), CT severity index ≥ 18 (P < .0001) and systemic complications like lung fibrosis (P = .019), cardiac arrhythmia (P < .0001), hypotension (P < .0001) and encephalopathy (P < .0001) were associated with increased risk of death.Combination therapy of TCZ and steroids is likely to be safe and effective in management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled trials.
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Affiliation(s)
- Ameet Dravid
- Department of Infectious Diseases and HIV/AIDS, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Reema Kashiva
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Zafer Khan
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Danish Memon
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Aparna Kodre
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Prashant Potdar
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Milind Mane
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Rakesh Borse
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Vishal Pawar
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Dattatraya Patil
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Debashis Banerjee
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Kailas Bhoite
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Reshma Pharande
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Suraj Kalyani
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Prathamesh Raut
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Madhura Bapte
- Department of Critical Care Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Anshul Mehta
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - M. Sateesh Reddy
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Krushnadas Bhayani
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - S. S. Laxmi
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - P. D. Vishnu
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Shipra Srivastava
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Shubham Khandelwal
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sailee More
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Rohit Shinde
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Mohit Pawar
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Amol Harshe
- Department of Pathology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Sagar Kadam
- Department of Radiology, Noble hospital and Research Centre, Pune, Maharashtra, India
| | - Uma Mahajan
- VMK Diagnostics Private Limited, Pune, Maharashtra, India
| | | | - Dilip Mane
- Department of Medicine, Noble hospital and Research Centre, Pune, Maharashtra, India
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25
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Stanescu N, Wood K, Greenberg T, Maklakovski M, Rubinov A, Dagan A. Hemi-central Retinal Artery Occlusion Associated with Giant Cell Arteritis. Isr Med Assoc J 2021; 23:454-455. [PMID: 34251132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Nir Stanescu
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Wood
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Tal Greenberg
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Marina Maklakovski
- Department of Pathology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Avi Rubinov
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Dagan
- Department of Rheumatology, Wolfson Medical Center, Holon, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
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Matsumoto H, Tokimura R, Fujita Y, Matsuoka N, Asano T, Sato S, Temmoku J, Yashiro-Furuya M, Yoshida K, Takahashi R, Tanaka S, Itagaki Y, Honma M, Matsuda N, Watanabe H, Migita K, Kanai K. Meningoencephalitis in relapsing polychondritis: A case report. Medicine (Baltimore) 2021; 100:e26315. [PMID: 34128872 PMCID: PMC8213297 DOI: 10.1097/md.0000000000026315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Aseptic meningoencephalitis is a rare central nervous system complication of relapsing polychondritis (RP). PATIENT We report a 61-year-old Japanese male patient with spiking fever and impaired consciousness. Neurological examination revealed meningealirritation, and cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with elevated protein (199 mg/dL) and interleukin-6 (3810 pg/mL). Serological analysis showed high levels of anti-type II collagen antibodies, and the result of auricular biopsy was consistent with the diagnosis of RP showing cartilage degeneration surrounded by inflammatory cell infiltrations. DIAGNOSIS A clinical diagnosis of RP was made according to the diagnostic criteria established by MacAdams et al. INTERVENTION Steroid pulse therapy (methylprednisolone 1000 mg, consecutive 3 days) followed by oral prednisolone (60 mg/day) resolved the patient's high fever and disturbance of consciousness. OUTCOMES The patient rapidly improved after steroid treatments and has a normal quality of life under the maintenance dose of steroid plus methotrexate (4 mg/week). LESSONS RP-associated meningoencephalitis is a rare complication with significant morbidity and mortality. It should be considered and differentiated in patients with RP with unexplained spiking fever and impaired consciousness. In addition, the assessment of cerebrospinal fluid interleukin-6 levels may be useful to investigate the disease activity of RP-related meningoencephalitis. Further prospective studies are required to confirm this result.
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Affiliation(s)
| | - Ryo Tokimura
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | | | | | | | | | | | | | - Kenji Yoshida
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Ryoma Takahashi
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Shoko Tanaka
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Yuya Itagaki
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Mari Honma
- Department of Neurology, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Nozomu Matsuda
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | | | | | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
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Aomar-Millán IF, Salvatierra J, Torres-Parejo Ú, Faro-Miguez N, Callejas-Rubio JL, Ceballos-Torres Á, Cruces-Moreno MT, Gómez-Jiménez FJ, Hernández-Quero J, Anguita-Santos F. Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study. Intern Emerg Med 2021; 16:843-852. [PMID: 33400157 PMCID: PMC7782569 DOI: 10.1007/s11739-020-02600-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265-0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis.
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Affiliation(s)
- Ismael Francisco Aomar-Millán
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain.
| | - Juan Salvatierra
- Department of Rheumatology, San Cecilio University Hospital, Granada, Spain
| | - Úrsula Torres-Parejo
- Department of Statistics and Operational Research, University of Granada, Granada, Spain
| | - Naya Faro-Miguez
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
| | - José Luis Callejas-Rubio
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | - Ángel Ceballos-Torres
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | | | - Francisco Javier Gómez-Jiménez
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | - José Hernández-Quero
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
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28
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Sakaguchi H, Mizuochi T, Haruta M, Takase R, Yoshida S, Yamashita Y, Nishikomori R. AIRE Gene Mutation Presenting at Age 2 Years With Autoimmune Retinopathy and Steroid-Responsive Acute Liver Failure: A Case Report and Literature Review. Front Immunol 2021; 12:687280. [PMID: 34122451 PMCID: PMC8194255 DOI: 10.3389/fimmu.2021.687280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare monogenic autosomal recessive disorder caused by mutation in the autoimmune regulator (AIRE) gene. Patients usually are diagnosed at ages between 5 and 15 years when they show 3 or more manifestations, most typically mucocutaneous candidiasis, Addison's disease, and hypoparathyroidism. APECED-associated hepatitis (APAH) develops in only 10% to 40% of patients, with severity varying from subclinical chronic active hepatitis to potentially fatal acute liver failure (ALF). Ocular abnormalities are fairly common, most often keratopathy but sometimes retinopathy. Here we report a 2-year-old Japanese girl with an AIRE gene mutation who developed APAH with ALF, preceded by autoimmune retinopathy associated with anti-recoverin antibody before major symptoms suggested a diagnosis of APECED. Intravenous pulse methylprednisolone therapy followed by a corticosteroid combined with azathioprine treatment resolved ALF and achieved control of APAH. To our knowledge, our patient is the youngest reported to have ALF resulting from an AIRE gene mutation. Pulse methylprednisolone induction therapy followed by treatment with corticosteroid plus azathioprine may well be effective in other children with APAH and AIRE gene mutations.
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MESH Headings
- Administration, Intravenous
- Adrenal Cortex Hormones/administration & dosage
- Autoantibodies/blood
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Azathioprine/administration & dosage
- Child, Preschool
- Drug Therapy, Combination
- Female
- Genetic Predisposition to Disease
- Humans
- Immunosuppressive Agents/administration & dosage
- Liver Failure, Acute/diagnosis
- Liver Failure, Acute/drug therapy
- Liver Failure, Acute/genetics
- Liver Failure, Acute/immunology
- Methylprednisolone/administration & dosage
- Mutation
- Phenotype
- Polyendocrinopathies, Autoimmune/diagnosis
- Polyendocrinopathies, Autoimmune/drug therapy
- Polyendocrinopathies, Autoimmune/genetics
- Polyendocrinopathies, Autoimmune/immunology
- Pulse Therapy, Drug
- Recoverin/immunology
- Retinal Diseases/diagnosis
- Retinal Diseases/drug therapy
- Retinal Diseases/genetics
- Retinal Diseases/immunology
- Transcription Factors/genetics
- Treatment Outcome
- AIRE Protein
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Affiliation(s)
- Hirotaka Sakaguchi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Masatoshi Haruta
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Ryuta Takase
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Ryuta Nishikomori
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
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29
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Festa S, Scribano ML, Pugliese D, Bezzio C, Principi M, Ribaldone DG, Allocca M, Mocci G, Bodini G, Spagnuolo R, Vernia P, Mazzuoli S, Costa F, Barberio B, Cosintino R, Zerboni G, Aratari A, Armuzzi A, Papi C. Long-term outcomes of acute severe ulcerative colitis in the rescue therapy era: A multicentre cohort study. United European Gastroenterol J 2021; 9:507-516. [PMID: 33259773 PMCID: PMC8259429 DOI: 10.1177/2050640620977405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/05/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The long-term course of ulcerative colitis after a severe attack is poorly understood. Second-line rescue therapy with cyclosporine or infliximab is effective for reducing short-term colectomy but the impact in the long-term is controversial. OBJECTIVE The purpose of this study was to evaluate the long-term course of acute severe ulcerative colitis patients who avoid early colectomy either because of response to steroids or rescue therapy. METHODS This was a multicentre retrospective cohort study of adult patients with acute severe ulcerative colitis admitted to Italian inflammatory bowel disease referral centres from 2005 to 2017. All patients received intravenous steroids, and those who did not respond received either rescue therapy or colectomy. For patients who avoided early colectomy (within 3 months from the index attack), we recorded the date of colectomy, last follow-up visit or death. The primary end-point was long-term colectomy rate in patients avoiding early colectomy. RESULTS From the included 372 patients with acute severe ulcerative colitis, 337 (90.6%) avoided early colectomy. From those, 60.5% were responsive to steroids and 39.5% to the rescue therapy. Median follow-up was 44 months (interquartile range, 21-85). Colectomy-free survival probability was 93.5%, 81.5% and 79.4% at 1, 3 and 5 years, respectively. Colectomy risk was higher among rescue therapy users than in steroid-responders (log-rank test, p = 0.02). At multivariate analysis response to steroids was independently associated with a lower risk of long-term colectomy (adjusted odds ratio = 0.5; 95% confidence interval, 0.2-0.8), while previous exposure to antitumour necrosis factor-α agents was associated with an increased risk (adjusted odds ratio = 3.0; 95% confidence interval, 1.5-5.7). Approximately 50% of patients required additional therapy or new hospitalisation within 5 years due to a recurrent flare. Death occurred in three patients (0.9%). CONCLUSIONS Patients with acute severe ulcerative colitis avoiding early colectomy are at risk of long-term colectomy, especially if previously exposed to antitumour necrosis factor-α agents or if rescue therapy during the acute attack was required because of steroid refractoriness.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giorgia Bodini
- Department of Internal MedicineUniversity of GenoaGenoaItaly
| | | | - Piero Vernia
- Division of GastroenterologySapienza University of RomeRomeItaly
| | - Silvia Mazzuoli
- Gastroenterology UnitMonsignor Raffaele Dimiccoli HospitalBarlettaItaly
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30
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Taniguchi Y, Kano Y, Kitamura T, Miura T, Yamada K. [Varicella-zoster meningoencephalitis and vasculitis after treatment with amenamevir to herpes zoster in the trigeminal nerve area]. Rinsho Shinkeigaku 2021; 61:239-242. [PMID: 33762495 DOI: 10.5692/clinicalneurol.cn-001531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 78-year-old woman was diagnosed with herpes zoster in the first branch of the trigeminal nerve and was treated with amenamevir. Subsequently, she was hospitalized for postherpetic neuralgia. Fever and unconsciousness were observed, and a diagnosis of varicella-zoster virus meningoencephalitis and vasculitis was made. In addition to the antithrombotic therapy, she was treated with intravenous acyclovir and steroid pulse therapy; however, her unconsciousness persisted. Amenamevir was not transferrable to the spinal fluid and resulted in an incomplete treatment of herpes zoster in the cerebral nerve region, suggesting that this case may be related to the severe course of the disease.
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Affiliation(s)
- Yoko Taniguchi
- Department of Neurology, Nagoya City East Medical Center
| | - Yuya Kano
- Department of Neurology, Nagoya City East Medical Center
| | - Taro Kitamura
- Department of Neurology, Nagoya City East Medical Center
| | | | - Kentaro Yamada
- Department of Neurology, Nagoya City East Medical Center
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31
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Batırel A, Demirhan R, Eser N, Körlü E, Tezcan ME. Pulse Steroid Treatment for Hospitalized Adults with COVID-19. Turk J Med Sci 2021; 51:2248-2255. [PMID: 33878858 DOI: 10.3906/sag-2101-243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND High-dose steroid has been shown to reduce the mortality rate in Corona virus disease 2019(COVID-19) patients who need oxygen support. Here, we evaluated the effectiveness of pulse-steroid in case of unresponsiveness to treatment with high dose steroid. MATERIAL AND METHODS The study is a retrospective controlled trial. We divided the patients in three groups: Standard-care therapy alone, high-dose steroid treatment and pulse-steroid treatment (250 mg/day methy-prednisolone). One hundred fifty patients were enrolled in each group. All patients were hospitalized and needed oxygen support. We matched the patients according to disease severity at the onset of hypoxia, weight of co-morbidities, age and gender. We then compared three groups in terms of mortality, length of hospitalization, need for intensive care unit (ICU) admission and mechanical ventilation (MV), length of stay in ICU and duration of MV. RESULTS The pulse-steroid group had shorter ICU stay. The median ICU stay was 9.0(CI 95% 6.0-12.0) days in standard ?care group, 8.0(CI 95% 5.0-13.0) days in high-dose steroid group and 4.5(CI %95 3.0-8.0) days in pulse-steroid group. Moreover, although they were initially unresponsive to steroid therapy, they achieved similar results compared to the high-dose steroid group in other outcomes except for length of hospital stay. CONCLUSIONS Pulse-steroid treatment would be an option for COVID-19 patients who do not respond to the initial high-dose steroid treatment.
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Affiliation(s)
- Ayşe Batırel
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Recep Demirhan
- Department of Thoracic Surgery, University of Health Sciences, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Nurullah Eser
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Ezgi Körlü
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Mehmet Engin Tezcan
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
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32
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Koziorowska-Gawron E, Koszewicz M, Bladowska J, Ejma M, Budrewicz S. Opsoclonus-myoclonus syndrome with severe clinical course and beneficial outcome: A case report. Medicine (Baltimore) 2021; 100:e25261. [PMID: 33832088 PMCID: PMC8036019 DOI: 10.1097/md.0000000000025261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Opsoclonus-myoclonus syndrome (OMS) is a rare immune-mediated movement disorder, mostly of paraneoplastic or idiopathic origin. The disease usually has an acute onset, serious course and leads rapidly to disability in adult patients. To the best of our knowledge, this is the fourth presented case of OMS with a severe course and complete reversibility of neurological symptoms in a pregnant woman. This report includes videos and a literature review. PATIENT CONCERNS A 30-year-old woman in the 12th week of pregnancy developed severe nausea and vomiting, after several days balance and gait disorders appeared. On admission to hospital, neurological examination revealed opsoclonus, dysarthria, myoclonic jerks with ataxia of the trunk and limbs with inability to sit, stand or walk. DIAGNOSIS Well-known causes of OMS were excluded. Although in our patient the idiopathic origin of the disorder was taken under consideration, diagnosis of opsoclonus-myoclonus related to the pregnancy was highly likely. INTERVENTIONS After administration of steroids and benzodiazepines the patient improved. OUTCOMES In the 6th month of pregnancy, after termination of immunotherapy, she recovered completely and was able to sit, stand and walk independently. In the 39th week of pregnancy, she delivered a healthy child. LESSONS We confirm that understanding of clinical symptoms and rare causes of OMS contributes to early diagnosis and therapy, which ensures an optimal outcome. One probable cause of OMS could be a physiological change to immune system regulation during pregnancy. The relationship between OMS and pregnancy remains uncertain and needs further investigation.
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Affiliation(s)
| | | | - Joanna Bladowska
- Department of General, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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33
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Du Plessis EM, Lalla U, Allwood BW, Louw EH, Nortje A, Parker A, Taljaard JJ, Ayele BT, Nyasulu PS, Koegelenberg CFN. Corticosteroids in critical COVID-19: Are all corticosteroids equal? S Afr Med J 2021; 111:550-553. [PMID: 34382564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 06/13/2023] Open
Abstract
The hyperinflammation seen as part of a dysregulated immune response to SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Corticosteroid therapy targets this hyperinflammation, otherwise known as a cytokine storm. It is the only therapeutic agent to date with a mortality benefit, with clear guidelines from national and international health authorities guiding its use. Objectives. To compare severity-of-illness indices, survival, length of intensive care unit (ICU) stay and potential ICU complications in patients treated with different corticosteroid regimens (high-dose hydrocortisone, high-dose methylprednisolone and lower-dose dexamethasone). Methods. In this single-centre descriptive retrospective observational study of a cohort of patients with severe COVID-19 admitted to a COVID-dedicated ICU, we compared patients treated with the three different corticosteroid regimens. Results. In 242 cases we could not demonstrate any statistically or clinically significant difference in the outcome of patients with critical COVID-19 treated with high-dose intravenous hydrocortisone (n=88) or methylprednisolone (n=46) compared with a relatively lower dose of dexamethasone (n=108). The survival rates were 38.6%, 39.1% and 33.3%, respectively (p=0.68). Patients treated with methylprednisolone tended to have a shorter length of ICU stay (median (interquartile range) 6 (4 - 10), 4 (2 - 8) and 5 (2 - 8) days; p=0.015) and fewer episodes of nosocomial sepsis (47.7%, 32.6% and 48.1%; p=0.01). Conclusions. Hydrocortisone or methylprednisolone can be given as an alternative to dexamethasone in the management of critical COVID-19, and this is a feasible alternative, especially in resource-constrained settings.
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Affiliation(s)
- E M Du Plessis
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
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34
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Shi JC, Yu ZJ, He GQ, Chen W, Ye XC, Wu ZX, Zhu XQ, Pan JZ, Jiang XG. Epidemiological Features of 105 Patients Infected with the COVID-19. J Natl Med Assoc 2021; 113:212-217. [PMID: 33268103 PMCID: PMC7581504 DOI: 10.1016/j.jnma.2020.09.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate and evaluate the clinical features of patients infected with the 2019 novel coronavirus (COVID-19) outside of Wuhan. METHODS 105 patients admitted to our hospital with clinical- and laboratory-confirmed COVID-19 infection were studied. Data were collected from January 17, 2020 to March 5, 2020. RESULTS 105 patients (57 male and 48 female) were confirmed to have COVID-19 infection. Among the 105 patients, 55 (52%) had made short trips to Wuhan during the two weeks before the onset of illness, and these were the first-generation confirmed cases. An exact date of close contact with someone in Wenzhou with confirmed or suspected COVID-19 infection from Wuhan (the second-generation confirmed cases) could be provided by 38 (36%) patients. Of the remaining patients, six (6%; the third-generation confirmed cases) were familial clusters of the second-generation confirmed cases, three (3%) had no definite epidemiological features, and 16 (15%) were from the same location as for the case report. CONCLUSION Due to the infectiousness of COVID-19, patients with infections should be diagnosed and treated as early as possible after developing fever symptoms or showing other clinical characteristics or imaging features. With respect to high-risk cases, we must focus on any complications that arise and take effective measures to treat them immediately. This will significantly improve the prognosis of patients with severe infections.
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Affiliation(s)
- Ji-Chan Shi
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Zhi-Jie Yu
- Department of Hematology, Wenzhou Key Laboratory of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Gui-Qing He
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Wei Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin-Chun Ye
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Zheng-Xing Wu
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Xiao-Qu Zhu
- Department of Infectious Disease, Wenzhou Hospital of Traditional Chinese Medicine, China
| | - Jiao-Zhi Pan
- Departments of Infectious Diseases, Yongjia People's Hospital, Wenzhou, Zhejiang, China
| | - Xian-Gao Jiang
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China.
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35
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Pontali E, Volpi S, Signori A, Antonucci G, Castellaneta M, Buzzi D, Montale A, Bustaffa M, Angelelli A, Caorsi R, Giambruno E, Bobbio N, Feasi M, Gueli I, Tricerri F, Calautti F, Castagnola E, Moscatelli A, Rollandi GA, Ravelli A, Cassola G, Sormani MP, Gattorno M. Efficacy of early anti-inflammatory treatment with high doses of intravenous anakinra with or without glucocorticoids in patients with severe COVID-19 pneumonia. J Allergy Clin Immunol 2021; 147:1217-1225. [PMID: 33556464 PMCID: PMC7865089 DOI: 10.1016/j.jaci.2021.01.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND IL-1 plays a pivotal role in the inflammatory response during cytokine storm syndromes. OBJECTIVE Our aim was to analyze the efficacy and safety of early anti-inflammatory treatment (AIT) with intravenous anakinra with or without glucocorticoids in coronavirus disease 2019 (COVID-19) pneumonia. METHODS We performed a retrospective single-center cohort study of patients admitted for COVID-19 pneumonia from February 26 to April 29, 2020, to assess the efficacy of early AIT with intravenous anakinra (100 mg every 8 hours for 3 days, with tapering) alone or in combination with a glucocorticoid (intravenous methylprednisolone, 1-2 mg/kg daily, with tapering). The standard of care (SOC) treatment was hydroxychloroquine and/or azithromycin with or without antivirals and anticoagulants. Late rescue AIT with anakinra or tocilizumab was also evaluated. Treatment effect on overall survival was assessed by a propensity score-adjusted Cox model. RESULTS A total of 128 patients were analyzed; 63 patients received early AIT (30 received anakinra alone and 33 received anakinra plus a glucocorticoid) at admission, and 65 patients did not receive early AIT and were used as controls; of the latter 65 patients, 44 received the SOC treatment alone and 21 received the SOC treatment plus late rescue AIT. After adjustment for all the unbalanced baseline covariates, early AIT reduced the hazard of mortality by 74% (adjusted hazard ratio [HR] = 0.26; P < .001). The effect was similar in patients receiving anakinra alone (adjusted HR = 0.28; P = .04) and anakinra plus a glucocorticoid (adjusted HR = 0.33; P = .07). Late rescue treatment did not show a significant advantage over SOC treatment alone (adjusted HR = 0.82; P = .70). CONCLUSIONS This study suggests, on a larger series of patients with COVID-19 pneumonia, the potential efficacy and safety of the early use of high doses of intravenous anakinra with or without glucocorticoids.
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Affiliation(s)
| | | | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Italy
| | | | | | - Davide Buzzi
- Ente Ospedaliero Ospedale Galliera, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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Huang Z, Xie J. Ruxolitinib in conjunction with the HLH-94 protocol for Epstein-Barr virus-related hemophagocytic lymphohistiocytosis in the intensive care unit: A case report. Medicine (Baltimore) 2021; 100:e25188. [PMID: 33726009 PMCID: PMC7982154 DOI: 10.1097/md.0000000000025188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The HLH-94 protocol is a standard induction treatment for hemophagocytic lymphohistiocytosis. However, about 30% of patients may not respond. Ruxolitinib has been clinically proven to be an effective treatment for hemophagocytic lymphohistiocytosis (HLH). PATIENT CONCERNS A previously healthy 14-year-old girl presented to the local hospital with a 4-day history of persistent fever and sore throat. DIAGNOSIS Clinical and laboratory tests revealed fever >38.5°C, hepatosplenomegaly, pancytopenia, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia, and an elevated interleukin-2 receptor level. INTERVENTION This patient was treated with ruxolitinib and the HLH-94 protocol. OUTCOMES The patient's clinical and some laboratory indices improved. Unfortunately, vital signs such as respiratory function and consciousness did not improve. LESSONS This case report highlights the effect of using ruxolitinib in conjunction with the HLH-94 protocol. However, safety evaluation of this regimen was not performed because critically ill patient died too fast.
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Affiliation(s)
| | - Jiangbo Xie
- Department of Intensive Care Unit, the First Affiliated Hospital of Gannan Medical University, Jiangxi, China
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Zhao B, Chen JY, Liao YB, Li YF, Jiang XM, Bi X, Yang MF, Li L, Cui JJ. Steroid-resistant nephrotic syndrome in infants caused by a novel compound heterozygous mutation of the NUP93: A CARE case report. Medicine (Baltimore) 2021; 100:e24627. [PMID: 33578576 PMCID: PMC7886470 DOI: 10.1097/md.0000000000024627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Steroid-resistant nephrotic syndrome (SRNS) is a special kidney disease. SRNS is characterized by steroid-resistant, clinical variability, and genetic heterogeneity. Patients with SRNS often may eventually need renal transplantation. PATIENT CONCERNS A 10-month-old Chinese male infant presented with oliguria, renal dysfunction, hypertension, and anemia. DIAGNOSES Combined with clinical manifestations, laboratory testing and sequencing results, the patient was diagnosed as SRNS. INTERVENTIONS Combined intravenous methylprednisolone and cefoperazone sulbactam did not improve the patient's condition. Thus, SRNS associated with hereditary nephrotic syndrome was strongly suspected. Genetic testing for hereditary renal disease of the patient revealed 2 novel heterozygous mutations in the Nucleoporin 93 (NUP93) gene, which were predicted pathogenic and harmful by bioinformatic softwares of SIFT, PolyPhen_2 and REVEL. OUTCOMES As general physical health deterioration and renal dysfunction, the patient died of a severe infection. LESSONS The novel NUP93 heterozygous mutations identified in the current study broadened the genetic spectrum of SRNS and further deepened our insight into pathogenic mutations of NUP93 to improve disease diagnosis.
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Affiliation(s)
- Bo Zhao
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
| | | | - Ya-Bin Liao
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
| | - Yan-Fang Li
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
| | - Xue-Mei Jiang
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
| | - Xin Bi
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
| | - Mi-Feng Yang
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
| | - Li Li
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Jing-Jing Cui
- Department of Nephrology and Rheumatology, Kunming Children's Hospital, Kunming
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Campi I, Currò N, Vannucchi G, Covelli D, Simonetta S, Fugazzola L, Dazzi D, Pignataro L, Guastella C, Lazzaroni E, Pirola G, Salvi M. Quantification of Global Ocular Motility Impairment in Graves' Orbitopathy by Measuring Eye Muscle Ductions. Thyroid 2021; 31:280-287. [PMID: 32940167 DOI: 10.1089/thy.2020.0165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The overall changes of ocular motility in Graves' orbitopathy (GO) are not easily quantifiable with the methods currently available, especially in clinical studies. The aim of the present study was to calculate parameters that quantify the changes of ocular motility in GO in relation to the Gorman score for diplopia. Methods: We studied 100 GO patients (Group 1) and 100 controls (Group 2). We also included 30 patients treated with intravenous methylprednisolone (iv-MP), assessed at baseline and after 12 and 24 weeks (Group 3), and 66 patients submitted to squint surgery, assessed at baseline and after 12 weeks (Group 4). Ocular ductions were measured in four gaze directions by a perimeter arc and were used to calculate a total motility score (TMS) as the sum of ductions in each direction; a biocular TMS (b-TMS) as the sum of the TMS of two eyes; and an asymmetry ratio (AR) as the sum of the differences of the corresponding ductions between the two fellow eyes divided by the mean difference found in controls. Quality of life was accessed by a specific questionnaire (Graves' orbitopathy quality of life [GO-QoL] questionnaire). Results: TMS and b-TMS were lower, while AR was higher, in Group 1 compared with controls (p < 0.001). In Group 1, TMS and b-TMS were inversely correlated with the Gorman score (p < 0.001) and AR was higher in patients with constant diplopia compared with the others (p < 0.001). In Group 3, TMS and b-TMS increased after treatment in responders to iv-MP (p < 0.001). In Group 4, TMS and b-TMS improved in all patients after surgery (p < 0.01), while AR and GO-QoL score improved only in those without residual constant diplopia (p < 0.001). Conclusion: We describe a quantitative method to assess eye motility dysfunction in any stage of GO to be used as an outcome measure in clinical studies.
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Affiliation(s)
- Irene Campi
- Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nicola Currò
- Ophthalmology Unit, Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Guia Vannucchi
- Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Danila Covelli
- Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Simonetta
- Ophthalmology Unit, Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Davide Dazzi
- Division of Internal Medicine, Ospedale Vaio, Fidenza, Italy
| | - Lorenzo Pignataro
- ENT Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Guastella
- ENT Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa Lazzaroni
- Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacinta Pirola
- Ophthalmology Unit, Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Salvi
- Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Yildirim E, Kayadibi Y, Bektas S, Ucar N, Oymak A, Er AM, Senturk A, Demir IA. Comparison of the efficiency of systemic therapy and intralesional steroid administration in the treatment of idiopathic granulomatous Mastitis. The novel treatment for Granulomatous Mastitis. Ann Ital Chir 2021; 92:234-241. [PMID: 34193647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis that has not had a clear consensus about its treatment since the day it was identified as a rare, benign inflammatory breast disease that mimics malignancy due to its appearance features. AIMS In our research, we intended to compare the efficiency of intralesional and systemic steroids administration in the treatment of idiopathic granulomatous mastitis. STUDY DESIGN Prospective randomized controlled study. METHODS A total of 36 female patients who had been histopathologically diagnosed with idiopathic granulomatous mastitis and whose other factors had been microbiologically excluded were included in the study. The patients were randomized into two sub-groups that would be treated with systemic and intralesional steroids. All patients were evaluated through physical examination one week after the completion of the treatment. Subsequently, the follow-up of the patients was performed thorough physical examination and ultrasonography and/or magnetic resonance imaging at the 1st, 3rd, and 6th months. RESULTS All patients adapted to treatment. Complete clinical regression occurred in 32 patients, while 30 of 36 patients responded to treatment both radiologically and clinically. A total of 4 patients had minor side effects. It was determined that there was no statistically significant difference between local and systemic steroid groups in terms of complete clinical regression, responded to treatment side effects, and recurrence rates. CONCLUSION Intralesional steroid administration was also considered just as a successful treatment method as the systemic steroid administration. KEY WORDS Idiopathic granulomatous mastitis, Intralesional steroid, Systemic steroid.
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You X, Wu CH, Fu YN, He Z, Huang PF, Chen GP, Lin CH, Ming WK, Lin RF. The use of methylprednisolone in COVID-19 patients: A propensity score matched retrospective cohort study. PLoS One 2020; 15:e0244128. [PMID: 33382734 PMCID: PMC7775059 DOI: 10.1371/journal.pone.0244128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of methylprednisolone in treating the coronavirus disease 2019 (COVID-19) patients. METHODS A retrospective cohort study was conducted, and all COVID-19 patients were recruited who were admitted to the Yichang Third People's Hospital from February 1st to March 31st, 2020. One-to-one propensity score matching (PSM) was used for minimizing confounding effects. The primary outcome was hospital mortality, with the secondary outcomes being the time needed for a positive SARS-CoV-2 nucleic acid test to turn negative and the length of hospital stay. RESULTS Totaling 367 patients with COVID-19 hospitalized at the Yichang Third People's Hospital were identified, of whom 276 were mild or stable COVID-19, and 67 were serious or critically ill. Among them, 255 patients were treated using methylprednisolone, and 188 did not receive any corticosteroid-related treatment. After PSM, no statistically significant difference was found in the baseline characteristics between the two groups. Regarding the outcomes, there also were no statistically significant difference between the two groups. Patients without the use of methylprednisolone were more quickly to obtain negative results of their nasopharyngeal swab tests of SARS-CoV-2 nucleic acid after treatment, compared to those receiving methylprednisolone. CONCLUSION Methylprednisolone could not improve the prognosis of patients with COVID-19, and the efficacy and safety of the use of methylprednisolone in patients with COVID-19 still remain uncertain, thus the use of corticosteroids clinically in patients with COVID-19 should be with cautions.
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Affiliation(s)
- Xiang You
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chao-hui Wu
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ya-nan Fu
- Department of Pharmacy, Yichang Third People’s Hospital, Yichang, China
| | - Zonglin He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Pin-fang Huang
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Gong-ping Chen
- Respiratory Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Cui-hong Lin
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wai-kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Rong-fang Lin
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Abstract
A 72-year-old man was admitted to our hospital because of right facial muscle weakness and diplopia. He had been treated for aplastic anemia with cyclosporin for 2 years. Thirteen days before admission, a diagnosis of herpes zoster was made and treated with amenamevir. On admission, neurological examination revealed mild cognitive disturbance, mydriasis, weakness of the inferior rectus muscle of the left eye, and right peripheral facial nerve palsy. Cerebrospinal fluid (CSF) analysis showed elevated leukocytes and increased protein levels. Antibody index to varicella-zoster virus (VZV) was elevated in CSF to 25.6, although VZV DNA was negative by PCR. Head CT revealed multiple intracerebral hemorrhages in the left dorsal pons, left ventral midbrain, left thalamus, and left front-parietal lobe. MR angiography detected cerebral artery stenosis. In addition to intravenous acyclovir, the patient was treated with steroid pulse therapy and steroid tapering therapy. One month after admission, his symptoms improved. We diagnosed him with VZV vasculopathy. We believe that multiple intracerebral hemorrhages due to VZV vasculopathy caused facial and oculomotor nerve palsy. Our findings suggest that cerebral hemorrhage induced by VZV vasculopathy must be considered when differentiating cranial nerve palsy after herpes zoster.
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Affiliation(s)
- Tatsuya Mukai
- Department of Neurology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
| | - Toru Saiga
- Department of Neurology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
| | - Takehisa Araki
- Department of Neurology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
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Mehta A, Rathod R, Virk RS, Bashyal B. Reversal of vision loss after traumatic optic neuropathy. BMJ Case Rep 2020; 13:e238461. [PMID: 33370994 PMCID: PMC7757461 DOI: 10.1136/bcr-2020-238461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/24/2022] Open
Abstract
Traumatic optic neuropathy is sinister sequelae of craniofacial trauma leading to vision loss. The decision between early medical or surgical intervention is usually individualised. Visual evoked potentials may guide the treatment plan. We describe a young male presenting 5 days after a road traffic accident with no perception of light vision in the right eye. He was managed medically with high dose of intravenous steroids. At the 3-month follow-up, he reported a reversal of vision loss with return of visual acuity to 3/60, which improved to 6/36 at 5 months and remained stable at 8 months.
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Affiliation(s)
- Aditi Mehta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramya Rathod
- Department of Otolaryngology and Head and Neck Surgery, PGIMER, Chandigarh, India
| | - Ramandeep S Virk
- Department of Otolaryngology and Head and Neck Surgery, PGIMER, Chandigarh, India
| | - Byanjana Bashyal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Corticosteroids are a nonspecific immune modulator used in the treatment of ulcerative colitis. Topical and systemic forms of corticosteroids have been shown to be effective in induction of clinical remission and remain first-line therapy for acute severe ulcerative colitis. A large proportion of patients experience adverse effects, however, including some serious adverse effects, including infection and increased mortality. Newer formulations of gut selective corticosteroids have reduced adverse effects associated with steroids.
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Affiliation(s)
- Lauren A George
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201, USA.
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Igasaki S, Suzuki Y, Sakai N, Takenouchi A, Shinohara K, Kanemoto T. [A case of surfer's myelopathy with serial imaging examination from early stage after onset]. Rinsho Shinkeigaku 2020; 60:752-757. [PMID: 33115989 DOI: 10.5692/clinicalneurol.cn-001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Surfer's myelopathy is non-traumatic spinal cord injury which develops in beginner surfers. The patient was a 17-year-old female who developed severe paraplegia with bilateral sensory dysfunction below the groin and bladder/rectal dysfunctions after her first surfing lesson. A spinal-cord MRI performed six hours after onset revealed an intramedullary hyperintensity area from T8 to the conus medullaris on the T2 weighted images. Expansion of this hyperintensity area was observed on Day 3 and showed a reduction on Day 8. After providing intravenous methylpredonisolone, intravenous glycerol and intravenous edaravone, motor function and bladder/rectal functions began to improve after approximately three weeks. In this study, the expansion of the lesion in the early stages of the disease course was observed by sequential spinal MRI. Furthermore, a time lag between improvement according to imaging and improvement in symptoms was also observed.
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Affiliation(s)
| | - Yoji Suzuki
- Department of Neurology, Yaizu City Hospital
| | - Naoki Sakai
- Department of Neurology, Yaizu City Hospital
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Ishibashi H, Neshige S, Aoki S, Ueno H, Iida K, Maruyama H. [Ictal electroencephalography (EEG) activity and cerebral blood flow dynamics as potential pathological indicators: a case of anti-leucine-rich glioma-inactivated 1 protein (LGI1) encephalitis]. Rinsho Shinkeigaku 2020; 60:778-785. [PMID: 33115994 DOI: 10.5692/clinicalneurol.cn-001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 29 year-old, right-handed woman was admitted to our hospital due to her headache with fever elevation lasting for two months followed by a prolonged loss of awareness with an involuntary movement in her left hand and mouth. This movement appeared very frequently, and the duration was very short, so called "faciobrachial dystonic seizures (FBDS)". Some of FBDS were followed by prolonged loss of awareness. Brain MRI fluid attenuated inversion recovery (FLAIR) image revealed high intensity lesion in the left mesial temporal lobe. Arterial spin labeling (ASL) image indicated hyper perfusion in this lesion and also the lateral temporal region. No ictal electroencephalography (EEG) change was observed before the onset of FBDS. FBDS was often followed by focal impaired awareness seizure (FIAS) in which ictal EEG showed rhythmic alpha activity arising from left mid-temporal region. This EEG seizure pattern was clearly visible in the time-frequency analysis. Given these clinical findings, along with an evidence of serum anti-leucine-rich glioma-inactivated 1 (LGI1) antibody positive, she was diagnosed with anti-LGI1 encephalitis. Immunotherapy (methylpredonisolone and intravenous immunoglobulin) with a multiple anti-epileptic drugs therapy (lacosamide, perampanel, and lamotrigine) was highly responsible to her symptoms. Although the high intensity lesion in FLAIR image still remained after the treatment, findings of ASL and EEG showed clear correlation to her cognitive function and seizures, respectively. Temporal change in ASL imaging suggested that the hyper perfusion in ASL during the acute stage could be provided by inflammation of the encephalitis its self and also the seizures activities (FBDS and FIAS). The pathophysiological indication of anti-LGI1 encephalitis was limited in terms of the therapeutic strategy, however, our findings collectively suggested that the combination analysis of EEG activity and cerebral blood flow dynamics (ASL) could be the potential candidate.
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Affiliation(s)
| | - Shuichiro Neshige
- Department of Neurology, Hiroshima University Hospital
- Epilepsy Center, Hiroshima University
| | - Shiro Aoki
- Department of Neurology, Hiroshima University Hospital
| | - Hiroki Ueno
- Department of Neurology, Hiroshima University Hospital
- Epilepsy Center, Hiroshima University
| | - Koji Iida
- Epilepsy Center, Hiroshima University
- Department of Neurosurgery, Hiroshima University Hospital
| | - Hirofumi Maruyama
- Department of Neurology, Hiroshima University Hospital
- Epilepsy Center, Hiroshima University
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Fadel R, Morrison AR, Vahia A, Smith ZR, Chaudhry Z, Bhargava P, Miller J, Kenney RM, Alangaden G, Ramesh MS. Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19. Clin Infect Dis 2020; 71:2114-2120. [PMID: 32427279 PMCID: PMC7314133 DOI: 10.1093/cid/ciaa601] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is no proven antiviral or immunomodulatory therapy for coronavirus disease 2019 (COVID-19). The disease progression associated with the proinflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. METHODS We conducted a single pretest, single posttest quasi-experiment in a multicenter health system in Michigan from 12 March to 27 March 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on 20 March 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to intensive care unit (ICU), new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up. RESULTS We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs 54.3%, P = .005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (5 vs 8 days, P < .001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (adjusted odds ratio: 0.41; 95% confidence interval, .22 - .77). CONCLUSIONS An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes. CLINICAL TRIALS REGISTRATION NCT04374071.
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Affiliation(s)
- Raef Fadel
- Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Amit Vahia
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Zohra Chaudhry
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pallavi Bhargava
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph Miller
- Emergency Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - George Alangaden
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mayur S Ramesh
- Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
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Wu C, Hou D, Du C, Cai Y, Zheng J, Xu J, Chen X, Chen C, Hu X, Zhang Y, Song J, Wang L, Chao YC, Feng Y, Xiong W, Chen D, Zhong M, Hu J, Jiang J, Bai C, Zhou X, Xu J, Song Y, Gong F. Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis. Crit Care 2020; 24:643. [PMID: 33172477 PMCID: PMC7655069 DOI: 10.1186/s13054-020-03340-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. METHODS In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. RESULTS A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. CONCLUSION In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
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Affiliation(s)
- Chaomin Wu
- Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dongni Hou
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunling Du
- Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanping Cai
- Infection Division, Wuhan Jin Yin-Tan Hospital, Wuhan, China
| | - Junhua Zheng
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Xu
- Department of Infectious Diseases, Fengxian Guhua Hospital, Shanghai, China
| | - Xiaoyan Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuicui Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianglin Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuye Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juan Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lu Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yen-Cheng Chao
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Feng
- Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinjun Jiang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Zhou
- Department of Pulmonary Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Respiratory Research Institute, Shanghai, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
- Jinshan Hospital of Fudan University, Shanghai, China.
| | - Fengyun Gong
- Infection Division, Wuhan Jin Yin-Tan Hospital, Wuhan, China.
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Mongardon N, Piagnerelli M, Grimaldi D, Perrot B, Lascarrou JB. Impact of late administration of corticosteroids in COVID-19 ARDS. Intensive Care Med 2020; 47:110-112. [PMID: 33156381 PMCID: PMC7645397 DOI: 10.1007/s00134-020-06311-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France
- Faculté de Santé, Univ Paris Est Créteil, 94010, Créteil, France
- U955-IMRB, Equipe 03 "Pharmacologie et Technologies Pour les Maladies Cardiovasculaires (PROTECT)", Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700, Maisons-Alfort, France
- AfterROSC Research Group, 75014, Paris, France
| | - Michael Piagnerelli
- Intensive Care, CHU-CharleroiMarie Curie, Université Libre de Bruxelles, 140, Chaussée de Bruxelles, 6042, Charleroi, Belgium
| | - David Grimaldi
- AfterROSC Research Group, 75014, Paris, France
- Soins Intensifs, Hôpital Erasme, ULB, Route de Lennik 808, 1070, Bruxelles, Belgium
| | - Bastien Perrot
- UMR_S 1246 Methods in Patient-Centered Outcomes and Health Research, Nantes University, 44000, Nantes, France
| | - Jean-Baptiste Lascarrou
- AfterROSC Research Group, 75014, Paris, France.
- Médecine Intensive Réanimation, University Hospital Center of Nantes, 30 Boulevard Jean Monnet, 44000, Nantes Cedex 9, France.
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49
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Cappellani D, Urbani C, Manetti L, Martino E, Bartalena L, Bogazzi F. Effect of high-dose intravenous glucocorticoid therapy on serum thyroid hormone concentrations in type 2 amiodarone-induced thyrotoxicosis: an exploratory study. J Endocrinol Invest 2020; 43:1637-1643. [PMID: 32300976 DOI: 10.1007/s40618-020-01252-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Type 2 amiodarone-induced thyrotoxicosis (AIT2) is a form of drug-induced destructive thyroiditis, usually treated with oral glucocorticoids (oGCs). Our objective was to investigate the short-term effects of intravenous glucocorticoids (ivGCs) on serum thyroid hormone concentrations in patients with AIT2. METHODS Exploratory study of three naive AIT2 patients treated with iv methylprednisolone (two pulses of 400 mg with no interpulse oGCs), followed by oGCs, matched 1:3 with AIT2 patients treated with oGCs alone. Changes in serum thyroid hormone concentrations were evaluated in the short-term period (24 h and 7 days) and after a cumulative dosage of 400 and 800 mg equivalents of methylprednisolone; in addition, healing time and duration of exposure to GCs were calculated. RESULTS During the first 24 h of treatment, serum FT4 concentrations increased in ivGCs patients, and decreased in oGCs patients (+ 3.3% vs - 10.7%, respectively, p = 0.025). After 7 days, serum FT4 and FT3 concentrations decreased significantly in both groups, with no statistical difference between them (p = 0.439 for FT4 and p = 0.071 for FT3), even though the cumulative GCs dose was higher in ivGCs than in oGCs patients (800 mg vs 280 mg, p = 0.008). Furthermore, the iv administration of single 400 mg pulses of methylprednisolone resulted in a less significant decrease in serum thyroid hormone concentrations when compared to equivalent GCs doses fractionated in several consecutive days (p = 0.021 for FT4 and p = 0.052 for FT3). There were no significant differences in the healing time (p = 0.239) and duration of exposure to GCs (p = 0.099). CONCLUSIONS High-dose ivGCs therapy does not offer advantages over standard oGCs therapy in the rapid, short-term control of AIT2.
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Affiliation(s)
- D Cappellani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - C Urbani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - L Manetti
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - E Martino
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - L Bartalena
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy.
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50
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Rahmani H, Davoudi-Monfared E, Nourian A, Khalili H, Hajizadeh N, Jalalabadi NZ, Fazeli MR, Ghazaeian M, Yekaninejad MS. Interferon β-1b in treatment of severe COVID-19: A randomized clinical trial. Int Immunopharmacol 2020; 88:106903. [PMID: 32862111 PMCID: PMC7445008 DOI: 10.1016/j.intimp.2020.106903] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022]
Abstract
In this study, efficacy and safety of interferon (IFN) β-1b in the treatment of patients with severe COVID-19 were evaluated. Among an open-label, randomized clinical trial, adult patients (≥18 years old) with severe COVID-19 were randomly assigned (1:1) to the IFN group or the control group. Patients in the IFN group received IFN β-1b (250 mcg subcutaneously every other day for two consecutive weeks) along with the national protocol medications while in the control group, patients received only the national protocol medications (lopinavir/ritonavir or atazanavir/ritonavir plus hydroxychloroquine for 7-10 days). The primary outcome of the study was time to clinical improvement. Secondary outcomes were in-hospital complications and 28-daymortality. Between April 20 and May 20, 2020, 80 patients were enrolled and finally 33 patients in each group completed the study. Time to clinical improvment in the IFN group was significantly shorter than the control group ([9(6-10) vs. 11(9-15) days respectively, p = 0.002, HR = 2.30; 95% CI: 1.33-3.39]). At day 14, the percentage of discharged patients was 78.79% and 54.55% in the IFN and control groups respectively (OR = 3.09; 95% CI: 1.05-9.11, p = 0.03). ICU admission rate in the control group was significantly higher than the IFN group (66.66% vs. 42.42%, p = 0.04). The duration of hospitalization and ICU stay were not significantly different between the groups All-cause 28-day mortality was 6.06% and 18.18% in the IFN and control groups respectively (p = 0.12). IFN β-1b was effective in shortening the time to clinical improvement without serious adverse events in patients with severe COVID-19. Furthermore, admission in ICU and need for invasive mechanical ventilation decreased following administration of IFN β-1b. Although 28-day mortality was lower in the IFN group, further randomized clinical trials with large sample size are needed for exact estimation of survival benefit of IFN β-1b.
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Affiliation(s)
- Hamid Rahmani
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Davoudi-Monfared
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahid Nourian
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nooshin Hajizadeh
- Department of Infectious Diseases, Shohadaye Gomnam Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narjes Zarei Jalalabadi
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Fazeli
- Department of Food and Drug Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Monireh Ghazaeian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran Univesity of Medical Sciences, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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