Safety and efficacy of convalescent plasma for severe COVID-19: a randomized, single blinded, parallel, controlled clinical study.

BACKGROUND: Convalescent plasma (CP) has been widely used to treat COVID-19 and is under study. However, the variability in the current clinical trials has averted its wide use in the current pandemic. We aimed to evaluate the safety and efficacy of CP in severe coronavirus disease 2019 (COVID-19) in the early stages of the disease. METHODS: A randomized controlled clinical study was conducted on 101 patients admitted to the hospital with confirmed severe COVID-19. Most participants had less than 14 days from symptoms onset and less than seven days from hospitalization. Fifty patients were assigned to receive CP plus standard therapy (ST), and 51 were assigned to receive ST alone. Participants in the CP arm received two doses of 250 mL each, transfused 24 h apart. All transfused plasma was obtained from "super donors" that fulfilled the following criteria: titers of anti-SARS-CoV-2 S1 IgG ≥ 1:3200 and IgA ≥ 1:800 antibodies. The effect of transfused anti-IFN antibodies and the SARS-CoV-2 variants at the entry of the study on the overall CP efficacy was evaluated. The primary outcomes were the reduction in viral load and the increase in IgG and IgA antibodies at 28 days of follow-up. The per-protocol analysis included 91 patients. RESULTS: An early but transient increase in IgG anti-S1-SARS-CoV-2 antibody levels at day 4 post-transfusion was observed (Estimated difference [ED], - 1.36; 95% CI, - 2.33 to - 0.39; P = 0.04). However, CP was not associated with viral load reduction in any of the points evaluated. Analysis of secondary outcomes revealed that those patients in the CP arm disclosed a shorter time to discharge (ED adjusted for mortality, 3.1 days; 95% CI, 0.20 to 5.94; P = 0.0361) or a reduction of 2 points on the WHO scale when compared with the ST group (HR adjusted for mortality, 1.6; 95% CI, 1.03 to 2.5; P = 0.0376). There were no benefits from CP on the rates of intensive care unit admission (HR, 0.82; 95% CI, 0.35 to 1.9; P = 0.6399), mechanical ventilation (HR, 0.66; 95% CI, 0.25 to 1.7; P = 0.4039), or mortality (HR, 3.2; 95% CI, 0.64 to 16; P = 0.1584). Anti-IFN antibodies and SARS-CoV-2 variants did not influence these results. CONCLUSION: CP was not associated with viral load reduction, despite the early increase in IgG anti-SARS-CoV-2 antibodies. However, CP is safe and could be a therapeutic option to reduce the hospital length of stay. Trial registration NCT04332835.

Physiological and biochemical insights into the basal level of resistance of two maize hybrids in response to Fusarium verticillioides infection.

Fusarium stalk rot (FSR), caused by Fusarium verticillioides, is one of the most destructive diseases impacting maize yield worldwide. In this study, net carbon assimilation rate (A), stomatal conductance to water vapor (gs), transpiration rate (E), and internal CO2 concentration (Ci) were evaluated on leaves and the activities of enzymes (chitinase (CHI), ß-1-3-glucanase (GLU), phenylalanine ammonia-lyase (PAL), polyphenoloxidase (PPO), catalase (CAT), ascorbate peroxidase (APX), peroxidase (POX)) as well the concentrations of total soluble phenolics (TSP), lignin-thioglycolic acid (LTGA) derivatives, and malondialdehyde (MDA) were evaluated in the internodes and nodes of plants from maize hybrids moderately resistant (BRS 1035) and susceptible (30F35Y) to FSR. The upward relative lesion length (URLL) and radial fungal colonization (RFC) were 46 and 29% lower for the BRS 1035 hybrid in comparison to 30F35Y hybrid, respectively, at 30 after inoculation (dai). For both hybrids, A, gs, and E values significantly decreased while the Ci values increased on infected leaves compared to noninoculated plants. Inoculated plants from BRS 1035 hybrid showed an increase in A compared to inoculated plants from 30F35Y hybrid, and the increase in Ci values was greater for plants from 30F35Y hybrid at 30 dai compared to plants from BRS 1035 hybrid. The CHI, GLU, PPO, CAT, APX, and POX activities increased for inoculated plants from both hybrids compared to the noninoculated plants. In the internodes region, the increase in the activities of CHI (during the infection process of F. verticillioides) and GLU (at earlier stages of F. verticillioides infection) was more pronounced for plants from BRS 1035 hybrid than for plants from 30F35Y hybrid. In the region of the nodes, activities of CHI (during the infection process of F. verticillioides), PAL (at 20 dai), PPO (at 30 dai), and CAT and POX (both at three dai) were more pronounced for plants from BRS 1035 hybrid than for plants from 30F35Y hybrid. In the internodes region, the lower TSP concentration at 30 dai was linked to a high concentration of LTGA derivatives for inoculated plants from BRS 1035 hybrid compared to inoculated plants from 30F35Y hybrid. Taking together, the results of the present study allowed to conclude that the infection by F. verticillioides triggered physiological and biochemical changes on the stalk of maize plants influencing photosynthesis on leaves. A more robust antioxidative metabolism for reactive oxygen species removal in association with an efficient and strong activity of defense enzymes helped to minimize the cellular damage caused by F. verticillioides infection resulting, therefore, in an increase in maize resistance to FSR.

Pielonefritis enfisematosa en paciente con infección por virus de inmunodeficiencia humana: reporte de caso / Emphysematous pyelonephritis in patient with human immunodeficiency virus infection: A case report

La pielonefritis enfisematosa es una infección necrosante del parénquima renal que puede afectar los tejidos perirrenales y cuyo espectro de presentación clínica, por esa razón, es variable (choque séptico, acidosis metabólica, hiperglucemia, hipoglucemia, falla renal, delirio, entre otros); la mayoría de los casos se han informado en pacientes con diabetes mellitus o presencia de uropatía obstructiva. Reportamos el caso de una paciente joven no diabética quien presentó pielonefritis enfisematosa como condición clínica que lleva al diagnóstico inicial de infección por VIH, sin otras comorbilidades relacionadas, exitosamente tratada con manejo quirúrgico y antibioticoterapia. Se realizó una búsqueda sistemática de la literatura, en la cual no se ha informado esta enfermedad como manifestación clínica que lleve al diagnóstico inicial de la infección por VIH.

Emphysematous pyelonephritis is a necrotising infection of the renal parenchyma that may affect the perirenal tissue. Thus, the spectrum of clinical presentation is variable (septic shock, metabolic acidosis, hyperglycaemia, hypoglycaemia, renal failure, delirium); most cases have been reported in patients with diabetes mellitus or obstructive uropathy. We report the case of a young female patient without diabetes who presented emphysematous pyelonephritis as the condition that led to the diagnosis of HIV infection, without related comorbidities, and who was successfully treated with surgical and antibiotical therapy. A systematic search of the literature revealed that this disease as a condition leading to an initial diagnosis of HIV infection has not been previously reported.

A 30-year-old male with corneal opacity and a rapidly progressing ulcer / Hombre de 30 años con opacidad y úlcera corneal de rápida progresión

Gonococcal keratoconjunctivitis is a rapidly progressing and aggressive infection caused by Neisseria gonorrhoeae . We report a case of a patient who presented keratoconjunctivitis with an opacity in the left cornea that progressed into an ulcerative lesion despite initial treatment with antibiotic eye drops. Gram stains from the purulent discharge of the left eye showed gram-negative diplococci, and the culture from the ocular discharge was positive for Neisseria gonorrhoeae . Resolution was achieved with the administration of 2 g of intramuscular ceftriaxone in a single dose, and the patient had no sequelae.

La queratoconjuntivitis gonocócica es un infección agresiva y de rápida progresión causada por Neisseria gonorrhoeae . Reportamos el caso de un paciente quien presentó queratoconjuntivitis con opacidad corneal izquierda, la cual progresó a lesión ulcerativa a pesar del tratamiento inicial con antibiótico en gotas oftálmicas. La tinción de Gram y el cultivo a partir de la secreción purulenta del ojo izquierdo mostró diplococos gramnegativos y crecimiento de Neisseria gonorrhoeae , respectivamente. La curación del paciente se logró tras la administración de 2 g de ceftriaxona intramuscular en dosis única; el paciente no presentó secuelas.

Síndrome de falla multiorgánica secundario a hematoma esplénico por Plasmodium vivax / Mulitorgan dysfunction syndrome due to splenic hematoma secondary to Plasmodium vivax infection

Los cuadros de falla orgánica múltiple y mortalidad secundarios a Plasmodium vivax son escasos. Generalmente esta infección es considerada un enfermedad de curso benigno. El compromiso esplénico con la formación de hematoma es una complicación poco frecuente por este parásito pero, al presentarse, puede asociarse a un compromiso mayor de los sistemas cardiovascular, respiratorio, hematológico, renal y nervioso central; en algunos casos puede ser fatal. Para el diagnóstico de esta complicación se debe tener una alta sospecha clínica y descartar otras enfermedades, por lo cual presentamos el caso de un paciente quien cursó con un cuadro de hematoma esplénico con falla orgánica múltiple con desenlace fatal por Plasmodium vivax .

Cases of multiple organ failure and mortality secondary to Plasmodium vivax are scarce, and the infection produced by this parasite is generally considered of a benign nature. Splenic compromise with formation of a haematoma is a complication not usually seen; however, when present, it can be associated with a greater compromise of the cardiovascular, respiratory, hematologic, renal and central nervous systems, leading to death in some reports. To diagnose this type of complication, physicians must have a high clinical suspicion and exclude other associated pathologies. We present the case of a patient who developed splenic haematoma associated with multiple organ failure and death secondary to infection with Plasmodium vivax .

Uso de sistemas de seguridad vial en vehículos en los que viajan niños y adolescentes uruguayos. Estudio observacional en tres ciudades uruguayas / Using road safety systems in vehicles traveling Uruguayan children and adolescents. Observational study in three cities in Uruguay

Introducción: los traumatismos o injurias causadaspor siniestros de tránsito constituyen un serio problema de salud en Uruguay y en el mundo. El uso de cinturón de seguridad y sistemas de retención infantil constituyen medidas fundamentales para prevenir estos traumatismos o disminuir sus consecuencias. En Uruguay la Ley de Tránsito y Seguridad Vial Nº 18.191, decreta obligatoriedad en el uso de cinturón por el conductor y los pasajeros. No hace referencia a sistemas de seguridad específicos para niños. Objetivo: describir características vinculadas a la seguridad intravehicular de niños uruguayos que viajan en vehículos particulares motorizados de cuatro ruedas y la prevalencia del uso de cinturón de seguridad de los mayoresde14 añosqueviajanconellos. Método: estudio descriptivo, observacional, transversal realizado en Montevideo, Salto y Paysandú, en mayo y junio de 2008. Resultados: vehículos observados 909. Total de ocupantes 2.523. 47 % eran menores de 14 años.Viajaban en filas delanteras: 25% de los menores de 5 años y 32% de los menores de un año. No utilizabansistema de seguridad intravehicular 83 % de los menores de 14 años. No utilizaban cinturón de seguridad 45 % de los mayores de 14 años. Conclusiones: es imperativa la elaboración y aprobación de leyes sobre el uso de sistemas de retención infantil adecuados así como el desarrollo de acciones de fiscalización del cumplimiento de éstas. Es tarea de todos promover la responsabilidad social apelando a modificar la conducta en la vía pública con el fin de disminuir los factores de riesgo que inciden en la enfermedad traumática.

Tuberculoma intramedular en paciente inmunocompetente / Intramedullary tuberculoma in an immunocompetent patient

Presentamos el caso de un paciente de sexo masculino, de 26 años de edad, con compromiso subagudo de la fuerza muscular de los miembros inferiores y retención urinaria. Se documentó la presencia de un tuberculoma intramedular para el que recibió tratamiento antituberculoso y corticosteroides, obteniéndose resolución total de los síntomas. Al final se hace una corta revisión de la literatura científica.

We present the case of a 26 year old male patient, with a subacute compromise of muscle strength in his lower limbs and urinary retention. The presence of an intramedullary tuberculoma was documented. The patient received corticosteroids and anti-tuberculous therapy, with a total resolution of the symptoms. A short a literature review is also included.

Pancreatic islet amyloidosis, beta-cell apoptosis, and alpha-cell proliferation are determinants of islet remodeling in type-2 diabetic baboons.

beta-Cell dysfunction is an important factor in the development of hyperglycemia of type-2 diabetes mellitus, and pancreatic islet amyloidosis (IA) has been postulated to be one of the main contributors to impaired insulin secretion. The aim of this study was to evaluate the correlation of IA with metabolic parameters and its effect on islets of Langerhans remodeling and relative endocrine-cell volume in baboons. We sequenced the amylin peptide, determined the fibrillogenic propensities, and evaluated pancreatic histology, clinical and biochemical characteristics, and endocrine cell proliferation and apoptosis in 150 baboons with different metabolic status. Amylin sequence in the baboon was 92% similar to humans and showed superimposable fibrillogenic propensities. IA severity correlated with fasting plasma glucose (FPG) (r = 0.662, P < 0.001) and HbA1c (r = 0.726, P < 0.001), as well as with free fatty acid, glucagon values, decreased homeostasis model assessment (HOMA) insulin resistance, and HOMA-B. IA severity was associated with a decreased relative beta-cell volume, and increased relative alpha-cell volume and hyperglucagonemia. These results strongly support the concept that IA and beta-cell apoptosis in concert with alpha-cell proliferation and hypertrophy are key determinants of islets of Langerhans "dysfunctional remodeling" and hyperglycemia in the baboon, a nonhuman primate model of type-2 diabetes mellitus. The most important determinants of IA were age and FPG (R(2) = 0.519, P < 0.0001), and different FPG levels were sensitive and specific to predict IA severity. Finally, a predictive model for islet amyloid severity was generated with age and FPG as required variables.

Miasis cavitaria: reporte de un caso / Miasis cavitaria: reporte de caso / Cavitary myiasis: case report

La miasis es una enfermedad producida en tejidos o en cavidades corporales por la infestación de larvas de algunas especies de dípteros; su clasificación se hace según el sitio anatómico de infestación o de acuerdo al ciclo vital de la especie. En Colombia, la mayoría de los casos reportados de miasis cavitaria son debidos a Cochiliomyia hominivorax. Se reporta el caso de una paciente desnutrida con perforación del septo nasal, a quien al realizarle endoscopia nasal se le extraen once larvas vivas que posteriormente se envían al Laboratorio de Entomología del Instituto Nacional de Salud, en donde después de 22 días se obtienen moscas adultas de la familia Calliphoridae, género Cochliomyia, especie hominivorax...

Myiasis is an animal or human disease caused by parasitic dipterous fly larvae feeding on the host's necrotic or living tissue. Different classifications of myiasis can be adopted: description of myiasis by the infected area of the host, or accordingly with the biology of the fly species causing the myiasis and its likely effect. In Colombia most of the reported cases of cavity miasis are caused by Cochiliomyia hominivorax. A malnourished female patient is described with perforations in the nasal septo. A nasal endoscopy was performed to this patient and eleven alive larvae extracted and sent to the Laboratory of Entomology at the National Institute of Health. There, the larvea were given the appropriate development conditions for 22 days to finally obtained adult flies, which were identified in the Calliphoridae family, the Cochiliomyia gender and the hominivorax species...

A Miasis é uma doença produzida nos tecidos ou cavidades corporais pela infestação de larvas de algumas espécies de dípteros, sua classificação se faz segundo o lugar anatômico da infestação ou por o ciclo vital da espécie. Na Colômbia, A maioria dos casos reportados de miasis cavitaria são devidos à Cochiliomyia hominivorax. Reporta-se o caso de uma paciente desnutrida com perfuração do septo nasal, a quém ao realizar-lhe endoscopia nasal de llhe extraem onze larvas vivas que posteriormente se enviam ao laboratório de Entolologia do Instituto Nacional de Saúde, em onde depois de 22 dias de obtêm moscas adultas da família Calliphoridae, gênero Cochlomyia, espécie hominivorax...

Interpretación de la PPD, fundamentos fisiopatologicos y enfoque práctico / PPD interpretation: physiopathology background and practice assessment

La Tuberculosis (TB) es un problema de salud pública, y la PPD (Tuberculina) se constituye en una herramienta para la detección de la TB latente. La interpretación de la PPD a través de un modelo que involucre el componente fisiopatológico, el sistema inmune del paciente y sus factores de riesgo permite una decisión correcta sobre tratar o no una TB latente de alta prevalencia de TB. En esta revisión se introduce un modelo racional de interpretación de la Tuberculina.

Medicamentos en un servicio de cirugia hospitalaria / Drugs in a hospital surgery ward

Se presenta un estudio de las irregularidades en la utilizacion de medicamentos en un servicio hospitalario y se recomiendan algunas medidas de control que incluyen el empleo de un formulario especial para realizar pedidos a la farmacia del hospital