RESUMEN
The efficacy of tocilizumab (TOC), monoclonal antibody against interleukin-6 (IL-6) receptor, in patients with coronavirus disease-2019 (COVID-19) patients has led to conflicting results. We performed a systematic review and meta-analysis to compare the efficacy of addition of TOC to standard of care (SOC) versus SOC in patients with COVID-19. We performed a comprehensive literature search of PubMed, Embase, Web of Science, WHO COVID, LitCOVID, and Cochrane databases. Pooled outcomes (overall mortality, need for mechanical ventilation, intensive care unit admission, and secondary infections) were compared using DerSimonian-Laird/Random-effects approach. Risk difference (RD), confidence interval (CI), and p values were generated. A total of 23 studies with 6279 patients (1897 in TOC and 4382 in SOC group, respectively) were included. The overall mortality was lower in TOC group compared to SOC group (RD: -0.06; CI: -0.12 to -0.01; p = .03). Subgroup analysis including studies with only severe cases revealed lower mortality (RD: -0.12; CI: -0.18 to -0.06; p < .01) and need for mechanical ventilation (RD: -0.11; CI: -0.19 to -0.02; p = .01) in TOC group compared to SOC group. The addition of TOC to SOC has the potential to reduce mortality and need for mechanical ventilation in patients with severe COVID-19. Randomized controlled trials are needed to validate this.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Tratamiento Farmacológico de COVID-19 , COVID-19/mortalidad , Hospitalización , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Receptores de Interleucina-6/antagonistas & inhibidoresRESUMEN
Human herpesvirus 6 (HHV-6) infection is the cause of roseola infantum in children. The reactivation of HHV-6 is associated with multiple clinical syndromes including encephalitis and myelitis, especially in haematopoietic stem cell transplant recipients. However, the virus can cause encephalitis in other immunosuppressed as well as immunocompetent individuals. We report a case of a 70-year-old woman who was immunocompromised secondary to treatment of rheumatoid arthritis with leflunomide and methotrexate. The patient presented with acute ataxia, diplopia and dysarthria. MRI brain showed an enhancing lesion in the midbrain. The diagnosis of HHV-6 encephalitis was made after HHV-6 A DNA was detected in both serum and cerebrospinal fluid. Treatment consisted of a 3-week course of intravenous ganciclovir along with physiotherapy. At a 3-month follow-up, repeat MRI brain showed a decrease in size and oedema of the lesion and the patient's neurological function was improved.
Asunto(s)
Ataxia Cerebelosa/diagnóstico , Encefalitis Viral/diagnóstico , Herpesvirus Humano 6/aislamiento & purificación , Huésped Inmunocomprometido , Infecciones por Roseolovirus/diagnóstico , Anciano , Antivirales/uso terapéutico , Ataxia Cerebelosa/complicaciones , Ataxia Cerebelosa/diagnóstico por imagen , Ataxia Cerebelosa/tratamiento farmacológico , Diagnóstico Diferencial , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico por imagen , Encefalitis Viral/tratamiento farmacológico , Femenino , Ganciclovir/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Infecciones por Roseolovirus/complicaciones , Infecciones por Roseolovirus/diagnóstico por imagen , Infecciones por Roseolovirus/tratamiento farmacológicoAsunto(s)
Carcinoma de Células Escamosas/complicaciones , Fungemia/microbiología , Aspergilosis Pulmonar/microbiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Neoplasias de la Tiroides/complicaciones , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Aspergillus niger/efectos de los fármacos , Fungemia/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Combinación Piperacilina y Tazobactam/uso terapéutico , Aspergilosis Pulmonar/tratamiento farmacológico , Vancomicina/uso terapéutico , Voriconazol/uso terapéuticoAsunto(s)
Antibacterianos/administración & dosificación , Nocardiosis/diagnóstico , Nocardia/aislamiento & purificación , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Antibacterianos/uso terapéutico , Drenaje , Femenino , Jardinería , Humanos , Persona de Mediana Edad , Nocardiosis/terapia , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Neumonía por Pneumocystis/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/patología , Antibacterianos/uso terapéutico , Antirretrovirales/uso terapéutico , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Humanos , Biopsia Guiada por Imagen , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/patología , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/patología , Tomografía Computarizada por Rayos X , Carga ViralRESUMEN
Renal collecting system rupture is a rare manifestation of obstructive uropathy. The majority of cases are attributed to ureteric calculi and extrinsic ureteric compression. The optimal diagnostic image is contrast-enhanced CT scan with delayed phase protocol. Management is usually conservative and generally depends on the etiology, urinomas size, and the presence or absence of kidney failure or infections.
RESUMEN
Nivolumab is a monoclonal antibody against the programmed death protein 1 and is used for patients with advanced melanoma. It is associated with potentially immune-related adverse events, including disorders of the skin, GI tract, and the thyroid; these disorders were successfully treated with prednisone and infliximab. Other immunotherapeutic agents were observed to induce the formation of antiphospholipid antibody (APA) including α-interferon and interleukin-2. We present a case of APA development after the third dose of nivolumab in a 71-year-old male with advanced melanoma. The APA was detected after finding a prolonged aPTT; the lupus anticoagulant assay tested positive. The patient was treated with prednisone but, unfortunately, he expired a few days later.
RESUMEN
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disorder of the central nervous system and can present following influenza A infections as multifocal neurological deficits. ADEM remains a challenging diagnosis, and high clinical suspicious coupled with laboratory investigations and neuroimaging is required to exclude other primary and secondary demyelinating disorders.
RESUMEN
A 60-year-old African-American man with a medical history significant for heavy alcohol abuse, hypertension, delirium tremens, nephrolithiasis and seizure disorder was brought to the hospital with altered mental status. He was found to have high anion gap metabolic acidosis with significantly elevated lactate along with an elevated osmolal gap and calcium oxalate crystals in his urine. With this combination of findings, ethylene glycol poisoning was high in the differential. This case report describes why ethylene glycol poisoning was not the diagnosis in this patient despite the presence of these three classic laboratory findings, therefore emphasising the fact that these findings should not be taken at face value because they can be seen collectively in a patient yet each have a different cause.
Asunto(s)
Equilibrio Ácido-Base , Disfunción Cognitiva/diagnóstico , Glicol de Etileno/envenenamiento , Cumplimiento de la Medicación/psicología , Urolitiasis/diagnóstico , Acidosis/diagnóstico , Anticonvulsivantes/uso terapéutico , Encefalopatías/tratamiento farmacológico , Encefalopatías/psicología , Oxalato de Calcio/orina , Disfunción Cognitiva/etiología , Diagnóstico Diferencial , Epilepsia/tratamiento farmacológico , Epilepsia/psicología , Humanos , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Concentración Osmolar , Urolitiasis/etiología , Ácido Valproico/uso terapéuticoAsunto(s)
Empiema Subdural/diagnóstico , Empiema Subdural/patología , Anciano , Antibacterianos/uso terapéutico , Biopsia , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Ceftriaxona/uso terapéutico , Diagnóstico Diferencial , Drenaje , Empiema Subdural/terapia , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Metronidazol/uso terapéutico , Vancomicina/uso terapéuticoRESUMEN
Epstein-Barr virus mucocutaneous ulcer (EBVMCU) is a rare form of EBV lymphoproliferative disorder. The disease was recently described in 2010 for the first time in a case series and it was recently identified by the WHO classification of haematological malignancies as a separate category among the EBV lymphoproliferative disorders. We present a case of EBVMCU of the colon presenting as an ulcerating inflammatory mass in a female in her mid-60s who presented initially with abdominal pain and diarrhoea. The patient had extensive workup for her disease and due to progression of her symptoms, she was taken for an exploratory laparotomy. During the procedure, there was an inflammatory mass at the caecum and severe inflammation of the caecum and the terminal ileum and right hemicolectomy was performed. Diagnosis was confirmed by histopathology as EBV-positive lymphoproliferative disorder best classified as EBV-positive mucocutaneous ulcer.