A Phase II Safety and Efficacy Study on Prognosis of Moderate Pneumonia in Coronavirus Disease 2019 Patients With Regular Intravenous Immunoglobulin Therapy

BACKGROUND

Currently, there is no specific drug for the treatment of coronavirus disease 2019 (COVID-19). Therapeutic benefits of intravenous immunoglobulin (IVIG) have been demonstrated in wide range of diseases. The present study is conducted to evaluate the safety and efficacy of IVIG in the treatment of COVID-19 patients with moderate pneumonia.

METHODS

An open-label, multicenter, comparative, randomized study was conducted on COVID-19 patients with moderate pneumonia. One hundred eligible patients were randomized in 1:1 ratio either to receive IVIG + standard of care (SOC) or SOC.

RESULTS

Duration of hospital stay was significantly shorter in the IVIG group compared with that of SOC alone (7.7 vs 17.5 days). Duration for normalization of body temperature, oxygen saturation, and mechanical ventilation were significantly shorter in IVIG compared with SOC. Percentages of patients on mechanical ventilation in 2 groups were not significantly different (24% vs 38%). Median time to reverse-transcription polymerase chain reaction negativity was significantly shorter with IVIG than SOC (7 vs 18 days). There were only mild to moderate adverse events in both groups except for 1 patient (2%), who died in SOC.

CONCLUSIONS

Intravenous immunoglobulin was safe and efficacious as an adjuvant with other antiviral drugs in the treatment of COVID-19.

Comet assay of cumulus cell DNA status and the relationship to oocyte fertilization via intracytoplasmic sperm injection

This paper postulates that in the ovary, the close association between the cumulus cells and the oocytes permits the fertilizing ability of the oocytes to be determined indirectly through cumulus cell DNA status. The objective was to use a modified comet assay to analyse cumulus cell DNA and relate the data to oocyte fertilization after intracytoplasmic sperm injection (ICSI) procedures. Oocytes were retrieved (n = 15 cases) and free-floating cumulus cells were pooled and smeared on clear glass slides to dry. Meanwhile, the denuded oocytes were injected with spermatozoa and fertilization was assessed, followed by embryo transfer. The fixed cumulus cells were stained in acridine orange, coated with a mini-gel agarose layer, lysed in alkaline buffer and electrophoresis performed. Analyses of fluorescent cell images (n = 449) showed that the tail moment was positively correlated to the percentage of fertilization after ICSI (r = 0.567, P < 0.05). In contrast, there was no correlation between tail moment and number of oocytes retrieved, total ampoules used, endometrial thickness and age of patient. The results suggested that the competence of the oocytes was associated with the cumulus cell DNA status. A unique feature here was the comet assay for archived material with obvious advantages.

Disseminated malignant melanoma

A 25-year-old man had multiple asymptomatic, nodular lesions on the trunk, extremities and the face for 3 months. He also had left facial palsy with severe headache and vomiting. There were no other systemic or constitutional symptoms. Skin biopsy from a nodular lesion showed features of malignant melanoma, confirmed by Fontana Masson and S-100 protein staining. A diagnosis of disseminated malignant melanoma was made and the patient was treated symptomatically. The patient died in 4 months.

Effect of glucose on stress induced antinociception in normal mice

Stress induced analgesia has been shown to utilise both non-opioidergic and opioidergic mechanisms. Earlier studies indicate that opiodergic analgesics exhibit corollary changes in blood glucose level. In this study, the changes in blood glucose level by swim induced stress and the influence of exogenous glucose administration on the stress induced antinociception were studied. Stress per se (both 30 sec and 3 min) did not modify the blood glucose level. However, exogenous administration of glucose reversed the stress induced antinociception in both non-opioid and opioid segments. Our results favour a role for glucose in stress induced analgesic activity.

Collaboration Technology for Rural Health-care

Health-care is a collaborative endeavor involving a number of individuals and organizations with diverse perspectives. Computer-supported collaboration technologies have great potential to enable health-care providers to improve the quality of care provided to their patients. Such technologies have the potential to overcome barriers to quality health-care in the small, scattered populations of rural areas. Rapid changes in technology are making it more and more possible for collaborative telemedicine to be a part of the practice of medicine. The World Wide Web has amply demonstrated that the globe has shrunk and information from afar is a mere mouse click away. However, the ease with which information is accessed along with the potential disclosure and misuse of personal information has raised serious concerns about the ability to restrict such information to legitimate accesses by duly authorized health-care providers. The authors present their experience in developing a health-care collaboration facility, ARTEMIS, which enabled Web-based access to electronic medical records, and provide a vision of their experiment to provide secure telemedicine for rural health-care practitioners.

Collaboration Technology for Rural Health-care

Health-care is a collaborative endeavor involving a number of individuals and organizations with diverse perspectives. Computer-supported collaboration technologies have great potential to enable health-care providers to improve the quality of care provided to their patients. Such technologies have the potential to overcome barriers to quality health-care in the small, scattered populations of rural areas. Rapid changes in technology are making it more and more possible for collaborative telemedicine to be a part of the practice of medicine. The World Wide Web has amply demonstrated that the globe has shrunk and information from afar is a mere mouse click away. However, the ease with which information is accessed along with the potential disclosure and misuse of personal information has raised serious concerns about the ability to restrict such information to legitimate accesses by duly authorized health-care providers. The authors present their experience in developing a health-care collaboration facility, ARTEMIS, which enabled Web-based access to electronic medical records, and provide a vision of their experiment to provide secure telemedicine for rural health-care practitioners.

A strategy for the development of secure telemedicine applications

Healthcare applications based on computer-supported collaboration technologies have the potential to improve the quality of care delivered to patients. Such applications can help overcome barriers to quality healthcare in the small, scattered populations of rural areas enabling telemedicine to be a part of the practice of medicine. However the growing concern about the potential for abuse through disclosure of personal health information to unauthorized parties has restricted the deployment and adoption of these potentially valuable tools. The authors, who built ARTEMIS--an Intranet healthcare collaboration facility, now describe their approach to develop secure telemedicine applications for rural healthcare practitioners.

Dexamethasone-cyclophosphamide pulse therapy for pemphigus

BACKGROUND

During the last 12 years, we have used a different approach, arbitrarily designed by us, for treating pemphigus patients that has given us very different and encouraging results.

METHOD

The treatment schedule consists of giving 100 mg dexamethasone on 3 consecutive days and 500 mg cyclophosphamide on one day and repeating these pulses (DCPS) every 4 weeks. In between the DCPS, the patient receives only 50 mg cyclophosphamide orally daily and generally no corticosteroids. An essential component of the regimen is to administer a specified amount of the treatment for 1.5 years after achieving clinical remission.

RESULTS

Of the 300 patients enrolled for this treatment, 61 patients could not complete the treatment, whereas 12 patients have died, some of them due to unrelated causes. Of the remaining 227 patients, 190 patients (84%) have already completed the treatment and are free of the disease even after complete withdrawal of all treatment, the duration of posttreatment follow-up being more than 5 years in 48 patients, 2 to 5 years in 75 patients, and less than 2 years in 67 patients. The maximum duration of posttreatment follow-up is 9 years. The remaining patients are also showing the same trend. Twenty-four patients are in remission but have not yet completed the treatment schedule, whereas 13 patients are still having evidence of clinically active disease, although it has already become much milder. The blood levels of intercellular antibody also decrease as the treatment progresses. The side effects commonly observed during treatment with corticosteroids are generally absent or insignificant. The relapses of the disease, seen so far in 59 patients, have been observed mostly in those patients who defaulted during the treatment, but a further course of the DCP regimen led again to complete recovery.

CONCLUSIONS

If substantiated by further follow-up, this treatment schedule may prove curative in this potentially fatal disease.