Tocilizumab use in COVID-19-associated pneumonia.

BACKGROUND: We sought to evaluate the effect of tocilizumab (TCB), a recombinant humanized monoclonal antibody against soluble interleukin-6 receptors, in patients hospitalized for coronavirus disease 2019 (COVID-19). METHODS: We included all patients with laboratory-confirmed COVID-19 who had completed hospitalization between March 10, 2020 and April 10, 2020 with follow-up through April 20, 2020. Patients who received TCB in addition to standard of care within 48 h of admission were matched in a 1:2 fashion to a similar cohort who received standard of care alone. Clinical outcomes were compared between matched groups. The primary outcome was de-escalation in oxygen therapy. Secondary outcomes were in-hospital death, septic shock, and acute kidney injury (AKI) requiring hemodialysis. RESULTS: Out of 77 patients who received TCB in addition to standard of care, 34% (n = 26) received TCB within 48 h of admission. One-to-two propensity matching identified 20 versus 40 patients in the TCB and no-TCB treatment arms. In the TCB group, an improvement in oxygenation was observed in 80% (n = 16) of the patients by 7 days post TCB administration. After matching, there was no difference in clinical outcomes between TCB and no-TCB patients. In-hospital death: 10% versus 8%; p = .823, septic shock: 10% versus 11%, p = .912, AKI requiring hemodialysis (10% vs. 13%; p = .734). CONCLUSIONS: Early treatment with TCB in patients admitted for COVID-19 led to an improvement in their oxygen status during hospitalization. This change however did not translate into improved survival when compared to a matched cohort with a similar clinical profile.

Clinical outcomes of patients with COVID-19 and HIV coinfection.

BACKGROUND: Patients with human immunodeficiency virus (HIV) infection may be at an increased risk for morbidity and mortality from the coronavirus disease 2019 (COVID-19). We present the clinical outcomes of HIV patients hospitalized for COVID-19 in a matched comparison with historical controls. METHODS: We conducted a retrospective cohort study of HIV patients admitted for COVID-19 between March 2020 and April 2020 to Newark Beth Israel Medical Center. Data on baseline clinical characteristics and hospital course were documented and compared with that of a matched control group of COVID-19 patients who had no history of HIV. Kaplan-Meier survival curves and the log-rank tests were used to estimate and compare in-hospital survival between both unmatched and matched groups. RESULTS: Twenty-three patients with HIV were hospitalized with COVID-19. The median age was 59 years. The rates of in-hospital death, the need for mechanical ventilation, and intensive care unit (ICU) admission were 13% (n = 3), 9% (n = 2), and 9% (n = 2), respectively. The HIV infection was well-controlled in all patients except for three patients presented with acquired immune deficiency syndrome (AIDS). All AIDS patients were discharged home uneventfully. A one-to-one propensity matching identified 23 COVID-19 patients who served as a control group. In both pre- and post-match cohorts, survival between HIV and control groups were comparable. CONCLUSIONS: In our cohort of HIV-infected patients hospitalized for COVID-19, there was no difference in mortality, ICU admission, and the need for mechanical ventilation when compared with a matched control of COVID-19 patients with HIV.

Embolic serratia aortic valve endocarditis.

Infective endocarditis secondary to Serratia marcescens is very rare, noted in patients with severe immunosuppresion. The disease is associated with high mortality. Therefore early diagnosis and aggressive treatment is recommended.

Sousse, Tunisia: tumultuous history and high Y-STR diversity.

In the present study, 17 Y-chromosomal STR (Y-STR) loci were typed in 218 unrelated males from Sousse, Central-East Tunisia, to evaluate forensic and population genetic applications of the data. A total of 154 different haplotypes were identified, 127 (82.5%) of which were unique, with the most frequent haplotype occurring in 14 individuals (6.4%). The locus diversity ranged from 0.2050 at DYS392 to 0.8760 at DYS385. The haplotype diversity at the 17-loci resolution was calculated to be 0.9916, while the corresponding values for the extended (11 loci) and minimal (9 loci) haplotypes were estimated at 0.9735 and 0.9710, respectively. Comparison with 29 regional and global populations using correspondence analysis, neighbor joining (NJ) tree, and Rst genetic distance revealed that the Sousse population is highly diverse. This finding is consistent with historical data. Furthermore, the results of this study indicate a distinct genetic substructure among Tunisian populations. In conclusion, the present study demonstrated that the 17 Y-STRs analyzed are highly informative for individual identification, parentage analysis, and population genetic studies.