The use of alpha 1 thymosin as an immunomodulator of the response against SARS-Cov2.

BACKGROUND: Since the beginning of SARS-CoV2 pandemic, the mortality rate among elderly patients (60-90 years) has been around 50%, so age has been a determining factor of a worse COVID-19 prognosis. Associated with age, the thymic function involution and depletion plays an important role, that could be related to a dysregulated and ineffective innate and adaptive immune response against SARS-CoV2. Our study aims to further in vitro effect of human Thymosin-alpha-1 (α1Thy) treatment on the immune system in population groups with different thymic function levels in the scenario of SARS-CoV2 infection. RESULTS: Activation markers such as CD40, CD80 and TIM-3 were upregulated in α1Thy presence, especially in plasmacytoid dendritic cells (pDCs) and, with increased TNFα production was observed compared to untreated condition. Co-cultures of CD4 + and CD8 + T cells with DCs treated with α1Thy in response to SARS-CoV2 peptides showed a decrease in the cytokine production compared to the condition without α1Thy pre-treated. A decrease in CD40L activation co-receptor expression in CD8 + LTs was also observed, as well as an increase in PD1 in CD4 + TLs expression in both age groups. In fact, there are no age-related differences in the immunomodulatory effect of the hormone, and it seems that effector memory and terminally differentiated memory T lymphocyte subsets were the most actively influenced by the immunomodulatory α1Thy effect. Finally, the polyfunctionality measured in SARS-CoV2 Specific-T cells response was maintained in α1Thy presence in total and memory subpopulations CD4 + and CD8 + T-cells, despite decreased proinflammatory cytokines production. CONCLUSION: The hormone α1Thy could reduce, through the modulation of DCs, the amount of proinflammatory cytokines produced by T cells. Moreover, α1Thy improve lymphocyte functionality and could become a beneficial therapeutic alternative as an adjuvant in SARS-CoV2 treatment either in the acute phase after infection or reinfection. In addition, the effect on the T immune response means that α1Thy can be incorporated into the vaccination regimen, especially in the most immunologically vulnerable individuals such as the elderly. SUBJECTS: Thymosin alpha 1, Dendritic cells, SARS-CoV2-specific T cells response, Immunomodulation.

Utilidad del sulfato cálcico e hidroxiapatita con antibióticos en las osteomielitis de la mano, a propósito de 2 casos clínicos / Use of calcium sulfate and hydroxyapatite with antibiotics in osteomyelitis of the hand: Two clinical cases

Las osteomielitis representan entre el 1-6% de las infecciones de la mano, cuya etiología fundamental es el Staphilococcus aureus. Presentamos 2 casos tratados eficazmente mediante legrado de la lesión y relleno con sulfato cálcico e hidroxiapatita (PerOssal®) impregnado con antibióticos, valorando el tipo de lesión, aspectos analíticos, y radiológicos. Nuestro objetivo es la revisión de esta patología, así como subrayar la utilidad de este nuevo biomaterial en la cirugía de la mano (AU)

Osteomyelitis accounts for 1-6% of all infections of the hand, the main causal agent being Staphylococcus aureus. We present two cases successfully treated with lesion curettage and filling with calcium sulfate and hydroxyapatite (PerOssal®) impregnated with antibiotics, evaluating the type of lesion, laboratory test parameters and radiological data. Our aim is to offer a review of this condition, and to underscore the usefulness of this new biomaterial in surgery of the hand (AU)

Tratamiento con linezolid oral en osteomielitis postraumáticas / Treatment of posttraumatic osteomyelitis with oral linezolid

Objetivo. Valorar la eficacia y seguridad de linezolid oral asociado a cirugía en el tratamiento de las osteomielitis postraumáticas. Material y método. Estudio prospectivo monitorizado de todos los pacientes ingresados en la unidad de infecciones óseas y articulares del hospital con osteomielitis postraumática por cocos grampositivos meticilín resistentes tratados con cirugía programada y linezolid, 600 mg cada doce horas, desde junio de 2002 hasta diciembre de 2004. Resultados. Hemos tratado con linezolid a nueve pacientes con osteomielitis postraumática. Los microorganismos aislados han sido: un Staphylococcus aureus meticilín resistente, un estafilococo coagulasa negativo meticilín resistente, siete Staphylococcus epidermidis meticilín resistentes. Dos pacientes han tenido infección asociada con Pseudomonas aeruginosa. La duración media del tratamiento ha sido de 9,5 semanas (rango 6-12). En el seguimiento realizado ocho pacientes están clínicamente curados con estabilización de la fractura y sin signos de infección. Un paciente está en situación de pseudoartrosis infectada. El linezolid ha sido tolerado de manera excelente y no ha habido necesidad de suspender la medicación por toxicidad en ningún caso. Conclusiones. En nuestra experiencia, linezolid oral asociado a cirugía puede ser una excelente opción de tratamiento en osteomielitis postraumática causada por bacterias grampositivas resistentes a meticilina que no respondan a la administración de otros antimicrobianos o que no toleren éstos

Purpose. To assess the efficacy and safety of oral linezolid associated with surgery in the treatment of posttraumatic osteomyelitis. Materials and methods. Monitored prospective study of all patients suffering from posttraumatic osteomyelitis caused by Methicillin-resistant Gram positive cocci treated with elective surgery and linezolid 600 mg every 12 hours from June 2002 to December 2004. Results. We have used linezolid to treat 9 patients with posttraumatic osteomyelitis. The microorganisms isolated were: Methicillin-resistant Staphylococcus aureus, 1; Methicillin-resistant Staphylococcus epidermidis, 7. Two patients had an associated infection caused by Pseudomonas aeruginosa. Mean duration of treatment was 9.5 weeks (range 6-12). During follow-up 8 patients were found to be clinically cured with fracture stabilization and with no sign of infection. One patient had an infected mal-union. Linezolid was excellently tolerated and in none of the cases it was necessary to discontinue administration due to toxicity. Conclusions. In our experience oral linezolid associated with surgery can be an excellent option for the treatment of posttraumatic osteomyelitis caused by Methicillin-resistant Gram positive bacteria that do not respond to other antimicrobials or if these are not well tolerated (AU)

Pseudoartrosis de tibia infectada por Staphylococcus aureus meticilin resistente: Tratamiento con Linezolid oral / Infected Pseudoarthrosis of the tibia by methicillinresistant Stapyhlococcus aureus: Treatment with oral Linezolid

La pseudoartrosis de tibia infectada por Staphylococcusaureus meticilin resistente (SARM) constituye una de lasinfecciones óseas de más dificil tratamiento. Presentamosun caso clínico de un paciente de 30 años en situación depseudoartrosis infectada de tibia por SARM que fue tratadopor nuestro equipo multidisciplinar, Unidad de InfeccionesÓseas y Articulares, y tras una nueva intervenciónquirúrgica y seis semanas de tratamiento antibiótico conLinezolid oral, se consigue la estabilización de la fractura,la esterilización del hueso y curación de la infección

Infected pseudoarthrosis of the tibia by methicillin-resistantStapyhlococcus aureus (MRSA) is one of the boneinfections more difficult to treat. We report one case of apatient thirty-years-old male with an infected pseudoarthrosisof tibia by MRSA who was treated by our interdisciplinaryteam, Unit of Bone and Joints Infections and aftera new surgical procedure and six weeks of antibiotic therapywih oral Linezolid we obtained stabilitation the fracture,sterilitation the bone and resolution the infection

Paciente con hipercalcemia y tumor de células de los islotes pancreáticos (paratirinoma) / Patient with hypercalcemia and islet cell carcinoma of the pancreas (parathyrimoma)

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