Anakinra in hospitalized patients with severe COVID-19 pneumonia requiring oxygen therapy: Results of a prospective, open-label, interventional study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of anakinra in patients who were admitted to hospital for severe COVID-19 pneumonia requiring oxygen therapy. METHODS: A prospective, open-label, interventional study in adults hospitalized with severe COVID-19 pneumonia was conducted. Patients in the interventional arm received subcutaneous anakinra (100 mg twice daily for 3 days, followed by 100 mg daily for 7 days) in addition to standard treatment. Main outcomes were the need for mechanical ventilation and in-hospital death. Secondary outcomes included successful weaning from supplemental oxygen and change in inflammatory biomarkers. Outcomes were compared with those of historical controls who had received standard treatment and supportive care. RESULTS: A total of 69 patients were included: 45 treated with anakinra and 24 historical controls. A need for mechanical ventilation occurred in 14 (31%) of the anakinra-treated group and 18 (75%) of the historical cohort (p < 0.001). In-hospital death occurred in 13 (29%) of the anakinra-treated group and 11 (46%) of the historical cohort (p = 0.082). Successful weaning from supplemental oxygen to ambient air was attained in 25 (63%) of the anakinra-treated group compared with 6 (27%) of the historical cohort (p = 0.008). Patients who received anakinra showed a significant reduction in inflammatory biomarkers. CONCLUSION: In patients with severe COVID-19 pneumonia and high oxygen requirement, anakinra could represent an effective treatment option and may confer clinical benefit. TRIAL REGISTRATION NUMBER: ISRCTN74727214.

Impulse oscillometry: an alternative modality to the conventional pulmonary function test to categorise obstructive pulmonary disorders.

Impulse oscillometry (IOS) was introduced as an alternative modality to the conventional pulmonary function test (cPFT) to test lung mechanics. The objective of this study is to assess the use of IOS as an alternative, or in conjunction with cPFT, to categorise an obstructive respiratory disorder as chronic obstructive pulmonary disease (COPD) or asthma. Patients referred to the PFT laboratory, with different diagnoses of obstructive airways disorders, completed a standardised respiratory questionnaire prior to testing. All recruited subjects completed both modalities of PFT. A total of 146 patients were included. The overall mean age was 51+/-18.4 SD. The majority were non-smokers (68.7%). A standardised diagnosis of asthma was found for 51 subjects, while COPD was diagnosed in 36 subjects and 59 subjects were categorised as normal. The sensitivity of IOS in relation to asthma was 31.3% and 19.6% for cPFT. Among cases of COPD, the cPFT had better sensitivity (47.4%) than IOS (38.95%). The specificity was comparable for IOS and cPFT in relation to asthma and COPD. IOS had better sensitivity (45.8%) in detecting normal subjects than cPFT (28.8%), while specificity was comparable (80.5% and 86.2%, respectively). IOS may replace cPFT where the latter cannot be carried out due to feasibility or lack of cooperation. It can, however, discriminate between diseased and non-diseased subjects.

Extrahepatic biliary atresia in Saudi Arabia: the importance of early diagnosis and referral.

OBJECTIVE: A retrospective analysis of the medical records of children who were managed for extrahepatic biliary atresia (EHBA) over a 6-year period. MATERIALS AND METHODS: Twelve children were managed at King Fahad National Guard Hospital with a diagnosis of extrahepatic biliary atresia from January 1993 through December 1998. The data obtained included age, sex, clinical presentation, age at referral, investigations, management, complications and follow-up. RESULTS: There were 7 males and 5 females with age of onset of jaundice ranging from 3 days to 42 days (mean 10 days). The mean age at referral was 17 weeks (range 6-49 weeks). Kasai Portoenterostomy (PE) was performed in 7 infants and the mean age at surgery was 8 weeks (range 7 to 10.5 weeks). Four children could not undergo Kasai PE because they were more than 20 weeks old and 1 child although 10 weeks old had extensive liver cirrhosis and was considered not suitable for the procedure. One child who had primary liver transplant outside the Kingdom and 4 children who had Kasai PE are still alive. Seven children are lost to follow-up and are probably dead. CONCLUSION: The incidence of EHBA in Saudi Arabia is unknown and the disease is probably rare based on our review. Although jaundice, pale stools and dark urine were observed in early infancy, referral was always late. Public and health professional's awareness of the clinical features of EHBA is important in early identification of infants and early referral. Starting paediatric hepatobiliary centers in Saudi Arabia will improve the management of these cases.

Sporadic neonatal schizencephaly associated with brain calcification.

Schizencephaly rarely presents in the neonatal period. We present the case of a baby girl born with growth retardation and microcephaly who developed seizures on the 3rd day of life. There was no clinical or laboratory evidence of a congenital viral infection but brain imaging revealed widespread calcification and bilateral schizencephaly clefts. By the age of 11 months, she had developed gross psychomotor retardation.

Viscoelastic properties of pectin--co-solute mixtures at iso-free-volume states.

Small-deformation oscillatory measurements were performed on pectin-sucrose-glucose syrup systems at a total level of solids of 81%, with the polysaccharide content being fixed at levels of industrial use (1%). The experimental temperature range was between 50 and - 50 degrees C. Analysis of the temperature dependence of viscoelastic processes by the equation of Williams, Landel, and Ferry provides values of fractional free volume for the temperatures covering the glass transition region. The shift factors used in the conversion of mechanical spectra into master curves were normalised at suitably different temperatures so that their temperature dependence becomes coincident. The treatment implies an iso-free-volume state and relates to changes in the monomeric friction coefficient with increasing levels of intermolecular interactions in the mixture. A free-volume related glass transition temperature was defined and manipulated markedly by introducing pectin of variable degrees of esterification to the sucrose-glucose syrup system.