Efficacy of early transfusion of convalescent plasma with high-titer SARS-CoV-2 neutralizing antibodies in hospitalized patients with COVID-19

BACKGROUND

Despite most controlled trials have shown no measurable benefit of COVID-19 convalescent plasma (CCP) in patients with COVID-19, some studies suggest that early administration of CCP with high-titer anti-SARS-CoV-2 can be beneficial in selected patients. We investigated the efficacy of early administration of high-titer CCP to patients with COVID-19 who required hospitalization, STUDY DESIGN AND METHODS: Observational, propensity score (PS) matched case-control study of COVID-19 patients treated with CCP within 72 h of hospital admission and untreated controls from August 2020 to February 2021. All CCP donations had a Euroimmun anti-SARS-CoV-2 sample-to-cutoff ratio ≥3. PS matching was based on prognostic factors and presented features with high-standardized differences between the treated and control groups. The primary endpoint was mortality within 30 days of diagnosis.

RESULTS

A total of 1604 patients were analyzed, 261 of whom received CCP, most (82%) within 24 h after admission. Median age was 67 years (interquartile range: 56-79), and 953 (60%) were men. Presenting factors independently associated with higher 30-day mortality were increased age, cardiac disease, hypoxemic respiratory failure, renal failure, and plasma d-dimer >700 ng/ml. After PS matching, transfusion of CCP was associated with a significant reduction in the 30-day mortality rate (odds ratio [OR]; 0.94, 95% confidence interval [CI]: 0.91-0.98; p = .001) that extended to the 60th day after COVID-19 diagnosis (OR: 0.95; 95% CI: 0.92-0.99; p = .01).

CONCLUSION

Our results suggest that CCP can still be helpful in selected patients with COVID-19 and call for further studies before withdrawing CCP from the COVID-19 therapeutic armamentarium.

Convalescent plasma for SARS-CoV-2 infection: Win or Learn

At the end of the 19th century, Emil von Behring (figure 1) demonstrated that serum from horses infected with diphtheria or tetanus was useful in treating people affected by these diseases, inaugurating passive immunisation as a new therapeutic strategy. He received the Nobel Prize in Physiology or Medicine in 1901. This finding opened the door to the use of plasma from convalescent patients to treat infectious diseases; and throughout history, convalescent plasma has been used to treat many diseases, such as Spanish influenza, poliomyelitis, Korean haemorrhagic fever and, more recently, Ebola virus disease and influenza A (influenza H1N1 virus).

Current evidence does not support the use of convalescent plasma in the standard therapy for COVID-19https://bit.ly/3DGyz6t

Distonía focal de mano

La distonía focal de mano es un síndrome clínico neurológico caracterizado por la existencia de contracciones musculares involuntarias, sostenidas y persistentes, que provocan movimientos y posturas anormales. Su etiología, aunque controvertida, parece estar desencadenada por la actividad repetitiva, permanente y constante de la misma. Su diagnóstico es difícil, pues no existe ningún “test” o “pruebas diagnósticas” que la confirmen. De hecho, el diagnóstico de certeza de una distonía de mano puede demorarse entre 5 y 8 años, no siendo extraño que estos pacientes hayan pasado por varias cirugías previas innecesarias antes de su diagnóstico definitivo, el cual es básicamente clínico. Es por ello, que consideramos fundamental llegar a un diagnóstico precoz, con el fin evitar pérdidas innecesarias de tiempo y dinero, e iniciar el tratamiento más adecuado. En este sentido, la interacción entre cirujanos de mano, neurólogos y fisioterapeutas se hace imprescindible.

Crystal morphology and texture in calcium oxalate monohydrate renal calculi

The morphology of calcium oxalate monohydrate crystals in renal calculi has been studied. Morphology modifications with respect to equilibrium morphology have been explained from the structure of (1 0 0) crystal faces and the effect of polyelectrolytes present in urine. The texture of the stones has been considered as the result of both primary aggregation and crystal aggregation produced by anionic macromolecules. The arrangement in concentric layers of crystals with a radial disposition has been related to a process of intense nucleation induced by anionic macromolecules and typical polycrystalline growth on films.

Detection of hepatitis GB virus type C RNA in serum and liver from children with chronic viral hepatitis B and C

The aim of this work was to study the presence of the hepatitis GB virus type C (HGBV-C) in liver and serum samples of children with chronic viral hepatitis, the time course of changes in viral RNA, and the possible acquisition routes of infection. Frozen serum and liver samples from 58 children with chronic hepatitis B (n = 33) or C (n = 25) were analyzed using polymerase chain reaction. Twenty-seven children had been included in different interferon trials. Two additional serum samples from the HGBV-C-positive children as well as serum samples from 29 of their relatives were also analyzed. HGBV-C RNA was detected in serum and liver samples from 9 of 58 (15%) of children as well as in serum samples from 3 of 29 of the relatives of the HGBV-C-infected children: the mother and the brother of one child (index case A) and the mother of another child (index case B). The homologies of the HGBV-C RNA sequences were 93% between index case A and his mother, 88% between index case A and his brother, and 94% between index case B and his mother. In the 3 children receiving alpha-interferon, HGBV-C RNA became undetectable during treatment although it reappeared in 2 of them after therapy. In conclusion, we found that 15% of children with chronic viral hepatitis were coinfected with HGBV-C. HGBV-C RNA was simultaneously present in serum and liver samples and tended to remain detectable even after alpha-interferon therapy. Our results suggest that vertical transmission of HGBV-C may occur.

Mitochondrial glutathione oxidation correlates with age-associated oxidative damage to mitochondrial DNA

Mitochondria may be primary targets of free radical damage associated with aging. We have found that mitochondrial glutathione is markedly oxidized with aging in rats and mice. The oxidized to reduced glutathione ratio rises with aging in the liver, kidney, and brain. The magnitude of these changes is much higher than that previously found in whole cells of any species previously studied. In the liver, this ratio (expressing GSSG as a percent of GSH) changed from 0.77 +/- 0.19% (n=5) in young rats to 2.47 +/- 1.25% (n=5) in old ones, i.e., 320% of the controls. In the brain and kidney, values for old rats were, respectively, 600 and 540% higher than those of young rats. A marked oxidation of mitochondrial glutathione also occurred in mice. Aging also caused an increase in 8-oxo-7,8-dihydro-2'-deoxyguanosine levels in mtDNA in rats and mice. Oral antioxidant administration protected against both glutathione oxidation and mtDNA damage in rats and mice. Finally, we have found a direct relationship between mtDNA damage and mitochondrial glutathione oxidation. This occurs both in rats (r=0.95) and in mice (r=0.98). This relationship, which has been observed for the first time in these studies, underscores the role of glutathione in the protection against free radical damage that occurs upon aging.

Role of agglomeration in calcium oxalate monohydrate urolith development

Formation of agglomerates of calcium oxalate monohydrate (COM) crystals on semi-batch precipitation performed at conditions relevant to urolithiasis (37 degrees C, pH = 6, initial ratio [Ca]/[Ox] = 10), but without any specific admixture, was followed by both optical and electron microscopy. COM crystals formed on precipitation developed into large agglomerates consisting of intergrown crystals by a mechanism of primary agglomeration. Primary agglomeration of COM crystals represents an important mechanism of COM renal calculi growth.

Production of calcium oxalate monohydrate, dihydrate or trihydrate. A comparative study

Procedures to obtain calcium oxalate monohydrate, dihydrate and trihydrate are presented and discussed. The influence of several additives and conditions in the formation of calcium oxalate dihydrate crystals are comparatively evaluated. It seems that the presence of colloidal phosphate favours the formation of calcium oxalate dihydrate crystals through heterogeneous nucleation.

Pupil responsiveness in diabetes mellitus

The authors compared pupil responsiveness to light, convergence, and the effects of topical cocaine 4%, epinephrine 1%, phenylephrine 1%, homatropine 10%, and pilocarpine 1% in a group of 62 diabetics with a sex- and age-matched group of normal subjects. The duration of disease, metabolic control, and type of diabetes mellitus, the presence and severity of diabetic retinopathy, and evidence of systemic vegetative neuropathy were considered. It was found that sympathetic denervation was related significantly to the duration of disease and to the development of systemic autonomic neuropathy. There were also signs of iris myopathy in the pupil alterations of long-standing diabetics, explaining the poor pupil responsiveness to mydriatics occasionally found in these patients. Pupillary autonomic diabetic neuropathy should be considered an early and major sign of the development of systemic vegetative diabetic disease.

Ultrastructural study of a retinoma by intraocular fine-needle aspiration biopsy

The authors present the results of a transmission electron-microscopic study performed on a tissue sample obtained by an intraocular fine-needle aspiration biopsy in a case of retinoma. The ultrastructural study showed that the tumor was composed mainly of granular osmiophilic material which contained some tumor cells. These cells showed peculiar ultrastructural characteristics, which demonstrated their neural character, and appeared in different degenerative stages. Apparently, this is the first case in whom ultrastructural technique have been applied to study an intraocular tumor sample obtained by intraocular fine-needle aspiration biopsy, and the first case of retinoma studied by such a diagnostic approach.

Retinal manifestations of Mediterranean spotted fever

The authors studied the incidence, type and systemic relationship of the retinal findings observed by ophthalmoscopy in Mediterranean spotted fever (MSF) in a consecutive series of 34 cases. It is found that retinal vasculitis either arterial and/or, more frequently, venous is present in 55.9% of the cases. Branch vein retinal thrombosis appeared as complication of such small vessel vasculitis in 1 case. Although frequent, the retinal findings were asymptomatic in all cases but the retinal vein thrombosis one, and were not significatively related to or were predicted by other systemic parameters of severity of the disease. Because of its frequency, retinal vasculitis might be considered as an important clinical sign of MSF in endemic areas.

Increased biosynthesis of glycosaminoglycans by scleroderma fibroblasts in culture

Fibroblasts from normal and scleroderma skin, grown in culture, were incubated with radioactive glucosamine to study the biosynthesis of glycosaminoglycans (GAG). Incorporation of 3H-glucosamine and GAG biosynthesis was increased in 6 of 9 scleroderma fibroblast cultures examined. This increase ranged from 26 to 96% over normal values and was reproducible. Over 70% of the 3H-glucosamine incorporated was found in the medium of the cultures, and this fraction was used to isolate GAG. Characterization of media GAG from normal and control cultures showed that about 80% of the radioactive GAG could be degraded by a specific fungal hyaluronidase; therefore, it represented hyaluronic acid. Our findings indicate that the majority of scleroderma dermal fibroblasts display increased biosynthesis of GAG in culture and that this increase is mostly in the hyaluronic acid fraction.

Scleroderma-like alterations in collagen metabolism occurring in the TSK (tight skin) mouse

Abnormalities in collagen metabolism similar to those occurring in the skin of patients with scleroderma have been demonstrated in the TSK (tight skin) mouse, a dominant mutant of the inbred B10.D2(58N)/SN mouse strain. These abnormalities, which consist of increased collagen content, accelerated biosynthesis, and increased extractibility of the newly synthesized molecules, suggest that the TSK mouse may be an excellent animal model for the study of the connective tissue alterations characteristic of scleroderma.