A randomized clinical trial of lipid metabolism modulation with fenofibrate for acute coronavirus disease 2019.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cytotoxicity may involve inhibition of peroxisome proliferator-activated receptor alpha. Fenofibrate activates peroxisome proliferator-activated receptor alpha and inhibits SARS-CoV-2 replication in vitro. Whether fenofibrate can be used to treat coronavirus disease 2019 (COVID-19) infection in humans remains unknown. Here, we randomly assigned inpatients and outpatients with COVID-19 within 14 d of symptom onset to 145 mg of oral fenofibrate nanocrystal formulation versus placebo for 10 d, in a double-blinded fashion. The primary endpoint was a severity score whereby participants were ranked across hierarchical tiers incorporating time to death, mechanical ventilation duration, oxygenation, hospitalization and symptom severity and duration. In total, 701 participants were randomized to fenofibrate (n = 351) or placebo (n = 350). The mean age of participants was 49 ± 16 years, 330 (47%) were female, mean body mass index was 28 ± 6 kg/m2 and 102 (15%) had diabetes. Death occurred in 41 participants. Compared with placebo, fenofibrate had no effect on the primary endpoint. The median (interquartile range) rank in the placebo arm was 347 (172, 453) versus 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in secondary and exploratory endpoints, including all-cause death, across arms. There were 61 (17%) adverse events in the placebo arm compared with 46 (13%) in the fenofibrate arm, with slightly higher incidence of gastrointestinal side effects in the fenofibrate group. Overall, among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes ( NCT04517396 ).

Resultado de la quimioprofilaxis con Isoniazida en la prevención de tuberculosis en pacientes con lupus eritematoso sistémico / Results of chemoprophylaxis isoniazid on tuberculosis prevention in patients with systemic Lupus Erythematosus, Systemic

Objetivos: Evaluación de la quimioprofilaxis con Isoniazida (INH) en la prevención de tuberculosis en pacientes con Lupus Eritematoso Sistémico (LES). Material y Métodos: Estudio retrospectivo analítico caso control, se incluyen a todos los pacientes con LES atendidos entre enero 1993 a diciembre 2002. Exclusiones: Diagnóstico de LES inducido, Enfermedad Mixta de Tejido Conectivo o síndrome de sobreposición, Lupus Discoide. Se definieron dos grupos: A) pacientes que recibieron regularmente INH profiláctica B) pacientes que no recibieron INH profiláctica en forma regular o no la recibieron. Se evaluaron las características clínicas, dosis de prednisona al diagnóstico de tuberculosis (TBC), periodo de tiempo entre el diagnostico de LES y el diagnostico de tuberculosis, criterios diagnósticos, SLEDAI, biopsia renal, IMC. Resultados: Se incluyeron 184 pacientes, 96 (52.2%) pacientes recibieron regularmente INH profiláctica y 88 (47.8%) pacientes la recibieron en forma irregular o no la recibieron, esta diferencia fue estadísticamente significativa (p=0.028), OR fue 8.21 (IC 95% 1.22-188.21). Ocho (4.4%) casos desarrollaron TBC asociada al LES. Todos fueron de sexo femenino, edad promedio fue 29.625, tiempo promedio entre el diagnóstico de LES y TBC fue; 83.5 semanas, al diagnóstico de TBC recibían prednisona en dosis promedio de 40.6 mg/día. En 3 casos el diagnóstico de LES y TBC fue en la misma hospitalización, en los 5 restantes el tiempo entre el diagnóstico de LES y el de TBC fue 32.9 meses. El diagnóstico fue baciloscópico en 7 pacientes; en una paciente el diagnóstico de meringoencefalitis TBC se realizó por ADA en liquido cefalorraquídeo, dos casos fueron sólo TBC pulmonar, dos casos: pulmonar y extrapulmonar (ganglionar y renal) y 4 casos extrapulmonar: ganglionar, peritoneal, meníngea y osteoarticular. Conclusiones: La INH profiláctica protege al paciente con LES para el desarrollo de TBC.

Objetives: Assessment of quimioprofilaxis with isoniazida (INH) in tuberculosis prevention in patients with Systemic Lupus Erythematosus (SLE). Material and Methods: We conducted a retrospective, analytic, case control study; it included all the patients with assisted SLE among January 1993 to December 2002. Exclusions: Diagnostic of induced SLE, Mixed connective tissue disease or overlap syndrome, Discoid Lupus. We defined two groups: A) patients that received INH prophylaxis regularly and B) patient that INH prophylaxis didn’t receive in regular form or they didn’t receive it. We evaluated the clinical characteristics, prednisona dose to the diagnosis of TBC, period of time between the diagnostic of SLE and the one diagnoses of tuberculosis, diagnostic approaches, SLEDAI, renal biopsy, IMC. Results: 184 patients were included: 96 (52.2%) patients received INH prophylaxis and (47.8%) received INH in irregular form or they didn’t receive it, this difference was statistically significant (p=0.028), OR was 8.21 (IC 95% 1.22-188.21). Eight (4.4%) cases developed TBC to the associated SLE. All were of feminine sex, age average was 29.625, time average between the diagnosis of SLE and TBC was 83.5 weeks and to the diagnosis of TBC they received prednisona in dose average of 40.6 mg /day. In 3 cases the diagnosis of SLE and TBC were in the same hospitalization, in the 5 remaining the time between the diagnosis of SLE and that of TBC was 32.9 months. The diagnosis was by bacilloscopy in 7 patients; in a patient the diagnosis of Meningoencephalitis TBC was carried out for ADA in cerebrospinal fluid, two cases were only lung TBC, two cases: lung and extrapulmonary (lymphatic and renal) and 4 cases extrapulmonary: ganglionary, peritoneal, meningea , bone and joint.

Adenocarcinoma gástrico y síndrome sweet como manifestación paraneoplásica / Gastric adenocarcinoma and sweet sindrome as paraneoplastic manifestation

We present a rare asociation between Sweet Syndrome and Gastric Cancer in 72 year old woman, who came to the hospital with a painful skin lesion, bone pain and polyarthralgia. Initially the skin lesion was studied and it showed Neutrophilic Dermatitis/Paniculitis. An abdominal CT Scan showed Retroperitoneal limphadenopathy, 2 weeks after admission developed Acute Emetic Syndrome, that did not improve with standard therapy, a upper endoscopy was done showing Gastric Ulcer and duodenal Infiltrative lesion, pathologic study showd Gastric Adenocarcinoma that went lymphathic and Liver metastases. This is the fourth case with this association reported in international bibliography.