Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program.

INTRODUCTION: Sodium ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects, with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients. METHODS: NaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care (SOC) to hospitalized COVID-19 patients until oxygen saturation levels of > 94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 4 and October 31, 2020, are summarized. Results were compared with a retrospective contemporaneous control (CC) group of hospitalized COVID-19 patients with SOC alone during the same time frame from a subset of participating hospitals from Córdoba and Buenos Aires. RESULTS: The evolution of 383 patients treated with SOC + NaIHS [56 on mechanical ventilation (MV) at baseline] and 195 CC (21 on MV at baseline) are summarized. At baseline, NaIHS-treated patients had basal oxygen saturation of 90.7 ± 0.2% (74.3% were on supplemental oxygen at baseline) and a basal respiratory rate of 22.7 ± 0.3 breath/min. In the CC group, basal oxygen saturation was 92.6 ± 0.4% (52.1% were on oxygen supplementation at baseline) and respiratory rate was 19.3 ± 0.3 breath/min. Despite greater pulmonary compromise at baseline in the NaIHS-treated group, the length of treatment (LOT) was 9.1 ± 0.2 gs with an average length of stay (ALOS) of 11.5 ± 0.3 days, in comparison with an ALOS of 13.3 ± 0.9 days in the CC group. In patients on MV who received NaIHS, the ALOS was lower than in the CC group. In both NaIHS-treated groups, a rapid reversal of deterioration in oxygenation and NEWS2 scores was observed acutely after initiation of NaIHS therapy. No serious adverse events were considered related to ibuprofen therapy. Mortality was lower in both NaIHS groups compared with CC groups. CONCLUSIONS: Treatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS s worthy of further study in randomized, placebo-controlled trials (ClinicalTrials.gov: NCT04382768).

Hidatidosis maxilofacial / Maxillofacial hydatidosis

Se presenta un caso de hidatidosis ósea con localización Maxilofacial. Se trataría del cuatro caso descripto en la literatura mundial en los últimos 20 años y el primero en Latinoamérica. Se revisa el cuadro clínico, los hallazgos del laboratorio, radiología y estudios de mayor complejidad. Se destaca el valor de la Anatomía Patológica como medio certero de diagnóstico etiológico y como terapéutica de elección la extirpación quirúrgica

Tuberculosis extrapulmonar / Extrapulmonary tuberculosis

Las localizaciones extrapulmonares de la tuberculosis (TBC) presentan frecuentemente dificultades en su reconocimiento clínico, lo que determina retraso en el tratamiento. En este trabajo se revisó nuestra experiencia en TBC extrapulmonar en el período 1974-1983. En base a criterios bien definidos en cuanto al diagnóstico se efectuó la selección del material clínico a estudiar, reuniéndose 31 casos, distribuidos de la siguiente forma: TBC ganglionar, 10 casos (32,4%); osteoarticular, 11 (35,4%); miliar, 3 (9,7%); peritoneal, 3 (9,7%); renal, 2 (6,4%); endometrial, 2 (6,4%). En los 31 casos se constataron situaciones equívocas en cuanto al diagnóstico de TBC extrapulmonar, en 24 de los cuales sin consecuencias indeseables. La anatomía patológica fue diagnóstica en 28 casos; la bacteriología, en 13; la radiología, en 13, y la intradermorreacción, en 6. El seguimiento evolutivo fue insuficiente, pues en 18 pacientes la evolución ulterior fue desconocida. El diagnóstico de TBC extrapulmonar se fundamenta en un alto grado de sospecha clínica, especialmente ante adenopatías, artritis crónicas, ascitis, hepatitis granulomatosas y fiebre prolongada de causa oscura