Pathogen reduction with methylene blue does not have an impact on the clinical effectiveness of COVID-19 convalescent plasma.

BACKGROUND AND OBJECTIVES: There is a concern about a possible deleterious effect of pathogen reduction (PR) with methylene blue (MB) on the function of immunoglobulins of COVID-19 convalescent plasma (CCP). We have evaluated whether MB-treated CCP is associated with a poorer clinical response compared to other inactivation systems at the ConPlas-19 clinical trial. MATERIALS AND METHODS: This was an ad hoc sub-study of the ConPlas-19 clinical trial comparing the proportion of patients transfused with MB-treated CCP who had a worsening of respiration versus those treated with amotosalen (AM) or riboflavin (RB). RESULTS: One-hundred and seventy-five inpatients with SARS-CoV-2 pneumonia were transfused with a single CCP unit. The inactivation system of the CCP units transfused was MB in 90 patients (51.4%), RB in 60 (34.3%) and AM in 25 (14.3%). Five out of 90 patients (5.6%) transfused with MB-treated CCP had worsening respiration compared to 9 out of 85 patients (10.6%) treated with alternative PR methods (p = 0.220). Of note, MB showed a trend towards a lower rate of respiratory progressions at 28 days (risk ratio, 0.52; 95% confidence interval, 0.18-1.50). CONCLUSION: Our data suggest that MB-treated CCP does not provide a worse clinical outcome compared to the other PR methods for the treatment of COVID-19.

Adult-onset Diamond-Blackfan anemia with a novel mutation in the exon 5 of RPL11: too late and too rare.

Diamond-Blackfan anemia (DBA) is a congenital erythroid aplasia usually diagnosed in the early infancy and associated with mutations or large deletions in 11 ribosomal protein (RP) genes. Adult patients with severe, transfusion dependence, aregenerative anemia might have a genetic-in-origin disease with an atypical presentation. Late onset nonclassical DBA should be ruled out and mutations of RP genes studied.

[Are intravenous immunoglobulins useful in severe episodes of autoimmune hemolytic anemia?: Comparative results in 21 episodes from a single centre]. / Inmunoglobulinas intravenosas en los episodios graves de anemia hemolítica autoinmune: resultados comparativos en 21 episodios de un único centro.

BACKGROUND AND OBJECTIVE: To analyze haemolytic episodes in patients with warm antibody autoimmune haemolytic anemia (AIHA) and compare corticosteroids treatment with intravenous immunoglobulins (IVIG) (group A) or without IVIG (group B). PATIENTS AND METHODS: Observational study that includes 21 haemolytic episodes occurred in 17 patients (9 males and 12 females), with a median age of 59 years (26-82). In group A, 8 episodes received IGIV + corticosteroids and in group B, 12 episodes received only corticosteroids and one rituximab. RESULTS: Hemoglobin (Hb) value at diagnosis was 1.8 g/dl lower (95% confidence interval: 0.6 to 3.1; P = .007) in group A, with a median Hb of 6.3g/dl in this group vs 7.9 g/dl in group B. There were non-significant differences in red blood cells transfusion (50 vs 23%; P > .20) and global increase of Hb values (7.3 vs 5.6; P > .20). Overall hematological responses were similar: 88 vs 92% (P > .20). CONCLUSIONS: Hematological response achieved in more severe episodes with the use of IVIG was similar to non-severe episodes treated without IVIG.

[Bisphosphonate related osteonecrosis of the jaw and infection with Actinomyces]. / Osteonecrosis maxilar asociada a bisfosfonatos e infección por Actinomyces.

BACKGROUND AND OBJECTIVE: Bisphosphonate related osteonecrosis of the jaw (BRONJ) has raised considerable interest since its recent description. Its pathogenesis is not yet clarified; formerly it has been considered a non-infectious complication, but recent studies seem to implicate bacteria of the genus Actinomyces. The objective of this study is to analyze the cases of BRONJ in our institution. PATIENTS AND METHODS: Review of medical records of patients diagnosed of BRONJ in the Maxillofacial Surgery Unit of our hospital. RESULTS: We have found 11 cases of BRONJ in our hospital: 4 women taking oral alendronate or risendronate for osteoporosis and 7 cancer patients treated with intravenous zolendronic acid. All of them showed bone invasion by bacteria of the genus Actinomyces. Nine patients underwent prolonged treatment with amoxicillin with favourable clinical outcome in all of them, but 3 died of their malignancy. By contrast, one patient with beta-lactamic allergy and irregular treatment with erythromycin and tetracycline had a chronic evolution of the lesions. There was no information for other patient. CONCLUSIONS: Actinomyces play an important role in the development of BRONJ and specific antibiotic treatment improves the prognosis of this process.

Inmunoglobulinas intravenosas en los episodios graves de anemia hemolítica autoinmune: resultados comparativos en 21 episodios de un único centro / Are intravenous immunoglobulins useful in severe episodes of autoimmune hemolytic anemia?: comparative results in 21 episodes from a single centre

Fundamento y objetivo: Analizar los episodios de anemia hemolítica autoinmune (AHAI) por anticuerpo caliente y comparar el tratamiento corticoideo con inmunoglobulinas intravenosas (IGIV) (grupo A) o sin IGIV (grupo B). Pacientes y método: Estudio observacional que incluye 21 episodios hemolíticos ocurridos en 17 pacientes (9 varones y 12 mujeres), con una mediana de edad de 59 años (extremos 26 a 82 años). En el grupo A, 8 episodios recibieron IGIV + corticosteroides, y en el grupo B, 12 episodios solo corticosteroides y uno rituximab. Resultados: La cifra de hemoglobina (Hb) al diagnóstico fue 1,8 g/dl inferior (intervalo de confianza del 95% 0,6-3,1; p = 0,007) en el grupo A, con una mediana de Hb de 6,3 g/dl en este grupo frente a 7,9 g/dl en el grupo B. Existieron diferencias no significativas en la necesidad de transfusión de hematíes (50 frente a 23%; p > 0,20) y en el incremento global del valor de la Hb (7,3 frente a 5,6 g/dl; p > 0,20). El índice global de respuestas hematológicas fue similar: 88 frente a 92% (p > 0,20). Conclusiones: El empleo de IGIV en los episodios más graves de AHAI logró una respuesta hematológica similar a la de los episodios más leves tratados sin IGIV (AU)

Background and objective: To analyze haemolytic episodes in patients with warm antibody autoimmune haemolytic anemia (AIHA) and compare corticosteroids treatment with intravenous immunoglobulins (IVIG) (group A) or without IVIG (group B). Patients and methods: Observational study that includes 21 haemolytic episodes occurred in 17 patients (9 males and 12 females), with a median age of 59 years (26-82). In group A, 8 episodes received IGIV + corticosteroids and in group B, 12 episodes received only corticosteroids and one rituximab. Results: Hemoglobin (Hb) value at diagnosis was 1.8 g/dl lower (95% confidence interval: 0.6 to 3.1; P = .007) in group A, with a median Hb of 6.3 g/dl in this group vs 7.9 g/dl in group B. There were non-significant differences in red blood cells transfusion (50 vs 23%; P > .20) and global increase of Hb values (7.3 vs 5.6; P > .20). Overall hematological responses were similar: 88 vs 92% (P > .20). Conclusions: Hematological response achieved in more severe episodes with the use of IVIG was similar to non-severe episodes treated without IVIG (AU)

Osteonecrosis maxilar asociada a bisfosfonatos e infección por Actinomyces / Bisphosphonate related osteonecrosis of the jaw and infection with Actinomyces

Fundamento y objetivo: La osteonecrosis maxilar asociada a bisfosfonatos (OMAB) ha centrado mucho interés desde su reciente descripción. Su patogenia aún no está aclarada; hasta hace poco tiempo se la consideraba una complicación no infecciosa, pero estudios recientes parecen implicar a bacterias del género Actinomyces. El objetivo del trabajo es analizar los casos de OMAB de nuestra institución. Pacientes y método: Revisión de historias clínicas de los pacientes con diagnóstico de OMAB en la consulta de Cirugía Maxilofacial de nuestro hospital. Resultados: Hemos encontrado 11 casos de OMAB: 4 mujeres en tratamiento con alendronato o risedronato oral por osteoporosis y 7 pacientes oncológicos en tratamiento con ácido zoledrónico intravenoso. En todos ellos se demostró invasión ósea por bacterias del género Actinomyces. En 9 casos se realizó tratamiento prolongado con amoxicilina con evolución clínica favorable en todos ellos, si bien 3 han fallecido por su neoplasia. Por el contrario, una paciente con alergia a betalactámicos y tratamiento irregular con eritromicina y tetraciclinas mantiene una evolución crónica de las lesiones. En otro paciente no hay información. Conclusiones: Actinomyces desempeña un papel importante en el desarrollo de OMAB y el tratamiento antibiótico específico mejora el pronóstico de este proceso(AU)

Background and objective: Bisphosphonate related osteonecrosis of the jaw (BRONJ) has raised considerable interest since its recent description. Its pathogenesis is not yet clarified; formerly it has been considered a non-infectious complication, but recent studies seem to implicate bacteria of the genus Actinomyces. The objective of this study is to analyze the cases of BRONJ in our institution. Patients and methods: Review of medical records of patients diagnosed of BRONJ in the Maxillofacial Surgery Unit of our hospital. Results: We have found 11 cases of BRONJ in our hospital: 4 women taking oral alendronate or risendronate for osteoporosis and 7 cancer patients treated with intravenous zolendronic acid. All of them showed bone invasion by bacteria of the genus Actinomyces. Nine patients underwent prolonged treatment with amoxicillin with favourable clinical outcome in all of them, but 3 died of their malignancy. By contrast, one patient with beta-lactamic allergy and irregular treatment with erythromycin and tetracycline had a chronic evolution of the lesions. There was no information for other patient. Conclusions: Actinomyces play an important role in the development of BRONJ and specific antibiotic treatment improves the prognosis of this process(AU)