Treatment With Tocilizumab for Patients With COVID-19 Infections: A Case-Series Study.

Tocilizumab (TCZ), a humanized monoclonal antibody targeting the interleukin-6 receptor, holds the potential for treating coronavirus disease 2019 (COVID-19) patients, particularly those at high risk of cytokine storm syndrome. However, data regarding the clinical impact of treatment with TCZ in patients with COVID-19 are limited. This study was conducted to evaluate the safety and effectiveness of TCZ as an adjunct therapy for the treatment of severe COVID-19 infection. This was a retrospective observational chart review of confirmed COVID-19 patients who received TCZ, along with other COVID-19 therapies. The outcomes of interest included changes in vital signs such as temperature and laboratory biomarkers, duration of mechanical ventilation, adverse events possibly associated with TCZ, and intensive care unit and hospital lengths of stay. This study included 38 patients with an average age of 63 years (IQR, 48-70 years). The average dose of TCZ given was 519 ± 61 mg. Median C-reactive protein significantly decreased following TCZ administration (189.9 vs 54.8 mg/L, P = .003). Nineteen of all febrile patients before the initiation of TCZ (73%) became fever free on the fourth day of TCZ treatment. Following TCZ treatment, 11 patients developed infections because of multidrug-resistant bacteria, and elevated liver transaminases were observed in 6 patients. The preliminary findings of this study suggested TCZ appeared to ameliorate COVID-19-related cytokine storm syndrome. However, large randomized, controlled trials are needed to investigate whether treatment with TCZ is associated with better outcomes in COVID-19.

Acute Blood Loss Anemia in the Setting of Abdominal Aortic Aneurysm Rupture in a Jehovah's Witness.

Acute blood loss anemia occurs due to many variants. The standard of care in managing acute blood loss anemia is challenged in this case. Jehovah's Witnesses's (JW) management of blood loss anemia continues to remain a controversy in medicine since they do not allow the use of blood products. This case highlights the management of acute blood loss anemia, utilizing a multidisciplinary bloodless approach in a JW who underwent an endovascular aneurysmal repair (EVAR) of an impending rupture of abdominal aortic aneurysm (AAA). The severity of anemia with hemoglobin of 2.7 g/dL and survival outcome is unique; however, the minimal hemoglobin level required to sustain life is still unclear.

Anterior and posterior suprasellar extensions of a symmetrical trilobed nonfunctional giant pituitary adenoma in the sagittal plane: a case report and review of literature.

INTRODUCTION: To the best of our knowledge, the presence of a trilobed nonfunctional giant pituitary adenoma has never been described before in the literature. These tumors present unique diagnostic and therapeutic challenges. Tumors of this etiology can be managed with pharmacologic treatment or aggressive surgical intervention. The following case illustrates an unique visual presentation of a giant pituitary adenoma. CASE PRESENTATION: We report the case of a 40-year-old Hispanic man who presented with new onset seizures. Radiological imaging showed the presence of a trilobed giant pituitary adenoma extending anterior into the frontal lobe, posterior to the hypothalamus, and inferior. The patient underwent a right pteronial craniotomy to remove majority of his tumor. CONCLUSIONS: The large size of the tumor should be considered in the differential diagnosis of various other conditions leading to a pituitary region mass such as a craniopharyngioma, pituitary metastasis, pituitary carcinoma, and a meningioma. Careful planning and outlining of therapeutic interventions are needed to rectify this abnormality. Those patients who meet the qualifications of a combined transsphenoidal and transcranial procedure should opt for this method of tumor resection.