Tocilizumab in COVID-19 interstitial pneumonia.

BACKGROUND: Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. METHODS: This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. RESULTS: Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. CONCLUSIONS: Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.

[Peripheral vascular damage in hypertension]. / Danno vascolare periferico nell'ipertensione.

The authors relate the pathophysiologic, hemodynamic and pharmacologic aspects of peripheral vascular damage in arterial hypertension. Particular attention is paid to the role of structural and functional changes both large elastic and muscular arteries (macroangiopathy) and small resistance vessels (microangiopathy) in the determinism and maintenance of arterial hypertension. These changes include impaired arterial wall compliance, vascular hyperactivity to agonists due to both hypertrophy and hyperplasia of smooth muscle cells, and endothelial dysfunction seen as an increase in endothelial permeability as well as an impaired release of relaxing and contracting factors. In the second part, personal observations are related. The aim of the research was to individuate hemodynamic non invasive patterns of peripheral vascular damage in essential, mild or moderate, hypertensives and to evaluate the hemodynamic peripheral effect of hypotensive drugs. The hemodynamic evaluation has been carried out by means of epiaortic vessels and lower limbs echo-Doppler, strain gauge plethysmography of lower limbs, and echocardiography. The following parameters have been considered: Trevis index, rest flow, peak flow, total time, resistance index of Pourcelot, left ventricular mass and ejection fraction. The first study involved 100 subjects (60 males and 40 females) with mild or moderate hypertension and a control group of 60 healthy subjects (35 males and 25 females). The hypertensives, compared to normotensives, showed an increase of Trevis index, reduction of peak flow, increase of total time and increase of resistance index. The second study was performed on 60 hypertensive subjects, 28 (17 diabetics) treated with nicardipine slow-release (40 mg twice a day) and 32 treated with terazosine (2-4 mg once a day). The treatment with nicardipine slow-release showed an increase of Trevis index, increase of rest flow and reduction of resistance index; the left ventricular mass resulted reduced. The treatment with terazosine showed a significant increase of rest flow and peak flow, reduction of total time, increase of Trevis index, reduction of resistance index, reduction of left ventricular mass. These data, concordantly with what known in literature, showed in hypertension an hemodynamic situation characterized by high resistance circulations, expression of arteriolar involvement. Nicardipine and terazosine can be placed as first choice hypotensive drugs adding at the hypotensive efficacy and tolerability a positive effect on peripheral vascular damage.

Diuresis and intensive saluresis.

Intensive saluresis, intended as an exceptional though real and practicable therapeutic approach, has made unimaginable progress possible in different sectors of Internal Medicine relating to hydrosaline balance alterations such as chronic and acute renal failure, nephrosic syndrome, refractory heart failure, acute pulmonary edema and ascites. We are proud to be the first who followed a path that assured patients compensation beyond "classic" therapeutic possibilities, and undoubtedly better quality of life, as well.

[The treatment of refractory hyperlipoproteinemias]. / Il trattamento delle iperlipoproteinemie resistenti.

The authors have studied a group of 25 patients treated with an HMG-CoA reductase inhibitor associated with DEAE-dextran, a safe and useful drug for the treatment of dyslipidemia. The patients were selected from a group of subjects previously submitted to long-term treatment with an HMG-CoA reductase inhibitor only who had failed to achieve normal cholesterol blood levels. The combined treatment with DEAE-dextran (1.5 g 3 times daily) and simvastatin (20 mg once daily) for 90 days lead to a further significant decrease in cholesterol and triglyceride blood levels. These findings confirm the validity of the association of an ion exchange resin with an HMG-CoA reductase inhibitor in the treatment of refractory dyslipidemias.

[A large case load of patients with dyslipidemia: effects of treatment with deae-dextran]. / Studio su un'ampia casistica di soggetti dislipidemici: effetti del trattamento con il deae-destrano.

The authors report the results of an open trial in 859 dyslipidemic patients, performed with the cooperation of general practitioners, treated with isocaloric diet and daily doses of 3 g deae-dextran for 3 months. Deae-dextran was effective in reducing cholesterol and triglyceride blood levels and in controlling body weight. The drug was very well tolerated and no significant side effects were registered during treatment with deae-dextran.