Tocilizumab demonstrates superiority in decreasing C-reactive protein levels in hospitalized COVID-19 patients, compared to standard care treatment alone.

Severe acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crisis. The virus triggers the activation of inflammatory reactants including interleukin-6 (IL-6), ferritin, and C-reactive protein (CRP), causing multiorgan damage, particularly affecting the lungs. Tocilizumab, an IL-6 receptor blocker, has the potential to diminish the progression of the disease and reduce organ damage and long-term complications. The aim of this observational retrospective cohort study was to evaluate the efficacy of tocilizumab in decreasing CRP levels in hospitalized coronavirus disease 2019 (COVID-19) patients compared to standard care without the drug. The study included 141 patients during their Hospital Stay (HS), with 100 in the Tocilizumab group and 41 in the non-Tocilizumab group. Clinical information was collected from the electronic clinical record, analyzed using statistical software, and homogenized the CRP levels from the severe group to the levels of the less complicated group at 48 h of hospitalization. The results showed a statistically significant greater decrease in CRP levels in the Tocilizumab group at 48 h after the use of the treatment, with no differences in mortality or length of stay between the groups. In conclusion, tocilizumab accelerates the diminishing of CRP levels compared to standard treatment alone, and its use may have potential benefits in the management of severe COVID-19 patients when used alongside with follow-up quantification of CRP levels reduction.IMPORTANCESevere acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crises. International guidelines for managing coronavirus disease 2019 (COVID-19) give recommendations according to the severity of the disease and the level of oxygen therapy needed. Tocilizumab is an option for the therapeutic management of hospitalized patients with any level of oxygen therapy; IL-6 serum level is the parameter for the follow-up on the efficacy, but it is not available at many hospitals. In this study, we demonstrate that C-reactive protein determination can predict the response to tocilizumab in severe COVID-19, the target patients for treatment with this drug. The use of this affordable and extensively available biomarker supports clinical decisions for the early escalation of the therapy and for the rational use of this drug on those prone to improve with the use of it.

Ruxolitinib as a treatment strategy for SARS-CoV-2 pneumonia: clinical experience in a real-world setting.

INTRODUCTION: Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) infection is characterised by a viral phase and a severe pro-inflammatory phase. The inhibition of the JAK/STAT pathway limits the pro-inflammatory state in moderate to severe COVID-19. METHODOLOGY: We analysed the data obtained by an observational cohort of patients with SARS-CoV-2 pneumonia treated with ruxolitinib in 22 hospitals of Mexico. The applied dose was determined based on physician's criteria. The benefit of ruxolitinib was evaluated using the 8-points ordinal scale developed by the NIH in the ACTT1 trial. Duration of hospital stay, changes in pro-inflammatory laboratory values, mortality, and toxicity were also measured. RESULTS: A total of 287 patients were reported at 22 sites in Mexico from March to June 2020; 80.8% received ruxolitinib 5 mg BID and 19.16% received ruxolitinib 10 mg BID plus standard of care. At beginning of treatment, 223 patients were on oxygen support and 59 on invasive ventilation. The percentage of patients on invasive ventilation was 53% in the 10 mg and 13% in the 5 mg cohort. A statistically significant improvement measured as a reduction by 2 points on the 8-point ordinal scale was described (baseline 5.39 ± 0.93, final 3.67± 2.98, p = 0.0001). There were 74 deaths. Serious adverse events were presented in 6.9% of the patients. CONCLUSIONS: Ruxolitinib appears to be safe in COVID-19 patients, with clinical benefits observed in terms of decrease in the 8-point ordinal scale and pro-inflammatory state. Further studies must be done to ensure efficacy against mortality.

Multirresistencia, resistencia extendida y panresistencia a antibacterianos en el norte de México.

OBJETIVO: Describir el perfil de multirresistencia (MDR), resistencia extendida (XDR) y panresistencia (PDR) a antibacterianos en aislados de muestras de pacientes de un hospital privado de tercer nivel en el norte de México. MÉTODO: Se realizó un estudio retrospectivo durante el periodo comprendido de febrero de 2016 a abril de 2019. A partir de 156 muestras clínicas de orina, heridas, sangre, expectoración y otros fluidos se aislaron 166 bacterias; 10 de las muestras incluyeron dos microorganismos. Los microrganismos aislados se clasificaron en MDR, XDR o PDR. RESULTADOS: El 78% de los aislados gramnegativos y el 69% de los aislados grampositivos mostraron MDR, XDR o PDR. Staphylococcus epidermidis fue la bacteria grampositiva con multirresistencia más frecuentemente aislada. Escherichia coli y Klebsiella sp. se encontraron entre los gramnegativos MDR más frecuentes. En dos casos, los aislados clínicos de Pseudomonas aeruginosa procedentes de la unidad de cuidados intensivos neonatales mostraron PDR. CONCLUSIÓN: Los servicios de terapia intensiva, cirugía y unidad de cuidados intensivos neonatales merecen especial atención por la alta proporción de aislados MDR y la presencia de PDR a causa de P. aeruginosa. OBJECTIVE: To describe the profile of multidrug-resistance (MDR), extensively resistance (XDR) and pandrug-resistance (PDR) to antibacterial drugs in isolates from patient samples from a third level private hospital in the North of Mexico. METHOD: A retrospective study was carried out during the period from February 2016 to April 2019. From 156 clinical samples of urine, wounds, blood, expectoration and other fluids, 166 bacteria were isolated; 10 samples included two microorganisms. Isolated microorganisms were classified into MDR, XDR or PDR. RESULTS: 78% of the Gram negative and 69% of the Gram positive isolates showed MDR, XDR or PDR. Staphylococcus epidermidis was the most frequently isolated MDR Gram positive bacteria. Escherichia coli and Klebsiella sp. were among the most frequent MDR Gram negative. In two cases, the clinical isolates of Pseudomonas aeruginosa from the neonatal intensive care unit showed PDR. CONCLUSIONS: The intensive care, surgery and neonatal intensive care unit services deserve special attention due to the high proportion of MDR isolates and the presence of PDR due to P. aeruginosa.

Blood safety in Mexico and a perspective on Latin America.

Blood safety has been of paramount concern worldwide over the last decades, and Latin America and Mexico are no exception. Factors of utmost importance include the use of highly efficient screening tests and the encouragement of voluntary donation. This review summarizes the current situation in Latin America and particularly in Mexico with respect to these key issues. Except for some specific regions, there is a lack of progress of voluntary donation in Mexico compared with other Latin American countries. A more efficient voluntary donation system could provide donors with lower prevalence of infectious agents such as human immunodeficiency, hepatitis B, and hepatitis C viruses. In Latin America, and specifically in countries such as Argentina, Brazil and Nicaragua, voluntary donation and blood safety are strongly encouraged. However, to date, in Mexico there has not been a specific blood safety project because of fragmentation of the health system model with structural differences among organisations. Although national policies are established to grant health coverages in Mexico, blood safety is still limited and outdated because of oversights in technical fields and regulations. Individual molecular biological tests for donor screening have recently been incorporated into the Mexican national regulations. Although the routine use of these tests as part of effective donor screening is still not compulsory, it is enabling a progressive improvement of blood safety.

Comparison of the prevalence of metabolic syndrome and risk factors in urban and rural Mexican Tarahumara-foot runners.

OBJECTIVES: To determine and compare the prevalence and risk factors of metabolic syndrome (MS) among Tarahumara Indians living in rural and urban communities. METHODS: Conducted in 2010, this cross-sectional study included 204 Tarahumara (100 urban and 104 rural individuals 18-75 years old [yo]). Data obtained includes: Anthropometric, lifestyle, blood pressure (BP) and fasting blood tests. Analyses were stratified by gender and age. RESULTS: The total prevalence of MS in rural and urban Tarahumara were 41% and 28% (p = 0.04), respectively. In urban cohorts, the prevalence of MS increased linearly with age. Women presented with a higher MS prevalence than men in urban (44.6% vs. 34.3%, p = 0.4) and rural (50% vs. 12.5%, p = 0.0001) cohorts. In men, urban residents presented with a higher MS prevalence vs. rural subjects; The same was not true for women. Age-related increment in waist circumference was linear and significantly higher in urban men compared to their rural counterpart (urban 6.5 [95% CI 4.24-8.79] vs. rural 2.7 [95% CI 1.19-4.24] centimeters/decade, p < 0.05). Multivariate analysis showed a significant relationship between urban residency and MS in men, but not in women. CONCLUSION: The overall prevalence of MS is higher in women than men, but the latter are more susceptible to the urbanization-associated worsening of cardiometabolic health.

Immunoadjuvant Therapy and Noninvasive Ventilation for Acute Respiratory Failure in Lung Tuberculosis: A Case Study.

Acute respiratory failure caused by pulmonary tuberculosis is a rare event but with a high mortality even while receiving mechanical ventilatory support. We report the case of a young man with severe pulmonary tuberculosis refractory to conventional therapy who successfully overcame the critical period of his condition using noninvasive ventilation and immunoadjuvant therapy that included three doses of etanercept 25 mg subcutaneously. We conclude that the use of etanercept along with antituberculosis treatment appears to be safe and effective in patients with pulmonary tuberculosis presenting with acute respiratory failure.