Acute limb ischemia and aortic mural thrombosis as primary manifestations of severe acute respiratory syndrome coronavirus 2.

A variable clinical presentation is emerging as a hallmark of the novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). In addition to hypoxic respiratory failure, multiorgan dysfunction, and septic shock, significant thromboembolic complications posited to result from diffuse coagulopathy have been associated with this viral infection. We report on a unique primary manifestation of SARS-CoV-2 infection presenting as acute limb ischemia and aortic mural thrombosis without clinical evidence of pulmonary disease. Despite our best attempts at limb salvage with therapeutic anticoagulation, emergent aortoiliac and distal embolectomy, the patient developed bilateral dry gangrene and ultimately required lower extremity amputations.

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID-19: A systematic review.

BACKGROUND: The manifestations of COVID-19 as outlined by imaging modalities such as echocardiography, lung ultrasound (LUS), and cardiac magnetic resonance (CMR) imaging are not fully described. METHODS: We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, CMR, and pulmonary manifestations using LUS. We queried PubMed, EMBASE, and Web of Science for relevant articles. Original studies and case series were included. RESULTS: This review describes the most common abnormalities encountered on echocardiography, LUS, and CMR in patients infected with COVID-19.

Prospective Observational Study to Determine Kinetics of Procalcitonin in Hospitalized Children Receiving Antibiotic Therapy for Non-Critical Acute Bacterial Infections.

INTRODUCTION: The kinetics of procalcitonin in pediatric patients with non-critical acute bacterial infections receiving appropriate antibiotic therapy are not well described. METHODS: We performed a single-center, prospective observational pilot study of children admitted to a tertiary care children's hospital who were receiving antibiotics for treatment of a non-critical acute bacterial infection, and we prospectively measured serial procalcitonin levels daily for 4 days during hospitalization. RESULTS: Among the 46 children with baseline procalcitonin levels enrolled in the study, procalcitonin kinetics followed a half-life of approximately 24 h in most patients. Procalcitonin declined faster than C-reactive protein over the first 48 h of appropriate antibiotic treatment. There was variation in biomarker levels among participants with the same infection type, especially in participants with bacteremia, musculoskeletal infection and skin/soft tissue infection. CONCLUSION: Utility of procalcitonin as a biomarker to follow every 24-48 h in non-critically ill children receiving antibiotic therapy for bacterial infections as an objective measure of clinical improvement is promising.

Agreement Between Two Procalcitonin Assays in Hospitalized Children.

INTRODUCTION: Agreement between available procalcitonin (PCT) assays is unclear. We sought to compare concordance between Roche and bioMérieux PCT assays using pediatric samples. METHODS: We evaluated 213 plasma samples from 208 children. We tested each sample on both the Roche and bioMérieux PCT platforms. RESULTS: At ranges < 2 µg/L, the Roche platform had a mean negative bias of 0.13 µg/L versus the bioMérieux platform. This bias resulted in PCT levels that crossed accepted cut points in 12.7% of patients. CONCLUSIONS: PCT levels measured on either platform are similar, especially at PCT ranges used for antibiotic decision-making algorithms. FUNDING: This work was supported by an investigator-initiated research agreement through bioMérieux and by the National Institute of Allergy and Infectious Diseases Childhood Infection Research Program (ChIRP), National Institute of Health and the National Center for Advancing Translational Sciences of the National Institute of Health.

Advances in immunotherapy for acute myeloid leukemia.

Evasion of the host immune system is a key mechanism to promote malignant progression. Therapeutically targeting immune pathways has radically changed the treatment paradigm for solid and lymphoid tumors but has yet to be approved for myeloid malignancies. Here, we summarize the most recent advances in immunotherapy for acute myeloid leukemia. Topics reviewed here include adoptive cellular approaches (chimeric antigen receptor-T cells, natural killer and other immune cells), checkpoint inhibitors (anti-PD-1/PD-L1, anti-CTLA-4 and TIM-3) and vaccines (WT-1, HLA-A2 and hTERT). Emphasis is placed on agents with clear evidence of tumor-specific immune responses and/or clinical activity in early-phase trials. Despite concerns regarding heterogeneous antigen expression and cytokine release syndrome, immunotherapy remains a highly promising strategy for acute myeloid leukemia, particularly transplant-ineligible patients and minimal residual disease states.