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.

Ascenso inadvertido de mdio de contraste no iónico al sistema nervioso central durante un estudio mielotomográfico / Inadverted rise of nonionic contrast medium to central nervous system during a myelotomographic study

Introducción. El uso de medios de contraste no iónicos tiene efectos colaterales. Objetivo. Reportar un caso de aracnoiditis química y neuritis óptica después del empleo de medio de contraste no iónico (MCNI). Reporte del caso. Una paciente de 28 años de edad con historia de paraperesia postraumática fue enviada a una UCI después de presentar súbitamente convulsiones tónico-clónicas, mientras se le efectuaban una mielotomografía con MCNI. A su ingreso se encontró: TA 70/40 mmHg, 4 puntos en la escala de coma de Glasgow, postura de descerebración, rigidez de nuca y papiledema. La TAC cerebral mostró la presencia de medio de contraste en el espacio subaracnoideo y en las cisternas. Al 5o. días de estancia se encontró estable y había buena recuperación neurológica, excepto que tenia amaurosis (se diagnosticó neuropatía óptica retrobulbar). Conclusión. La aracnoiditis química y la neuropatía óptica retrobulbar pueden ocurrir después del ascenso inadvertido de MCNI