The effects of combination-therapy of tocilizumab and baricitinib on the management of severe COVID-19 cases: a randomized open-label clinical trial.

Background: Tocilizumab and baricitinib are considered standard treatments for hospitalized COVID-19 patients with an inflammatory status. However, the effects of co-administering these medications aiming for more rapid patient recovery are controversial among practitioners. The potential benefits include the rapid improvement of patients and regulation of the immune system, and the potential risks include the increased chance of serious adverse events, including infections. This study aimed to investigate the effects of co-administering these two medications on the 28-day mortality rate, other efficacy parameters, and safety issues. Methods: In this randomized open-label trial, 68 patients were recruited. The study was conducted at Dr. Masih Daneshvari Hospital during 6 months (from 21 March 2022 to 23 August 2022). Severely ill patients aged between 18 and 100 years old with confirmed COVID-19 were enrolled. The primary outcomes included the need for invasive mechanical ventilation and a 28-day mortality rate. Secondary outcomes included the need for non-invasive mechanical ventilation, the need for admission to the intensive care unit (ICU), the length of hospital stay, and the need for a second dose of tocilizumab. Safety assessments were also performed for 28 days. The data were collected from the patients' medical records, which included age, gender, and comorbidities. Results: The 28-day mortality rate or the need for mechanical ventilation was not statistically different among the two groups (p-value = 0.49 for both outcomes). The need for non-invasive mechanical ventilation, the need for admission to the ICU, or the need for a second dose of tocilizumab and the length of hospital stay was not affected either (p-value = 1; 0.1; 0.49 and 0.9, respectively). One patient developed thrombosis in the combination group. No adverse events related to infectious complications were recorded in any groups. Conclusion: This study showed no beneficial effects of combining tocilizumab and baricitinib in managing severe COVID-19 cases. However, the need for ICU admission was meaningfully lower in the combination group. Studies with larger sample sizes are needed to confirm these results. Clinical Trial Registration: Identifier: RCT20151227025726N30M.

Topical sucralfate for treatment of mucocutaneous conditions: A systematic review on clinical evidences.

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA-approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post-radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction/infection); ulcers; burns, and also pain relief.

Protective Effect of Vitis vinifera (Black Grape) Seed Extract and Oil on Acetic Acid-Induced Colitis in Rats.

BACKGROUND: Vitis vinifera (black grape) is cultivated worldwide and has numerous oral and therapeutic applications. It has proven anti-inflammatory, antioxidant, antimicrobial, and wound healing properties. The aim of this study was to investigate the effect of black grape seed (hydroalcoholic) extract (BGSE) and black grape seed oil (BGSO) on experimental colitis. METHODS: BGSE (50, 100, and 200 mg/kg) and BGSO (2, 4, and 8 mL/kg) were administered orally (p.o.) in groups of six male Wistar rats, 2 h before induction of colitis and continued further for 4 days. Prednisolone (4 mg/kg) and mesalamine (100 mg/kg) were used as reference drugs. Weight/length of colons, macroscopic and histopathologic indices, and biochemical parameters including myeloperoxidase (MPO) and malondialdehyde (MDA) were evaluated. RESULTS: All doses of BGSE and BGSO significantly decreased the colon weight, ulcer index, and total colitis index in comparison with the control group, although greater doses of both fractions had more significant protection. Data of MPO activity revealed that all treated groups with the exception of BGSE (50 mg/kg) and BGSO (2 mL/kg) showed a meaningful decline in comparison with the control group. Concerning the MDA values in colonic tissue, it was demonstrated that BGSE (100, 200 mg/kg) and BGSO (8 mL/kg) caused a significant dip in this oxidative stress parameter. CONCLUSIONS: Oral administration of BGSE and BGSO had an appropriate anti-inflammatory effect and so could be considered as a suitable candidate for treating or preventing ulcerative colitis. Furthermore, detailed studies are warranted to explore the exact mechanism of action and clinical preference of these compounds.

Multiple pigmented macules as a sequel of cosmetic lip micro-pigmentation: New clinical presentation of tattoo reactions.

Cosmetic tattooing using micro-pigmentation has gained popularity in recent years. Tattoos can cause a broad range of clinical and psychosocial problems. Several medical complications may arise after tattooing. A 35-year-old female was referred with an 8-week history of grey-to-smoky hyperpigmentation of permanent makeup of lips and lip lines. Histopathological examination revealed lichenoid lymphocytic infiltrations in the dermis. Clinical and histopathological findings were compatible with the diagnosis of multiple pigmented macules as a sequel of cosmetic lip micro-pigmentation. Here, we report the first case of lichenoid-type tattoo reactions with new presentation as multiple asymptomatic pigmented macules after lip tattooing. The current report emphasises the requirement of a skin biopsy of all tattoo reactions. Considering the new component in the tattoo material, a dermatologist should be aware of the new clinical presentation of tattoo reactions that may occur.