scholarly journals P5‐97: High‐dose methylprednisolone in combination with tocilizumab in hospitalized patients with critical COVID‐19 pneumonia: A case series

Respirology ◽  
2021 ◽  
Vol 26 (S3) ◽  
pp. 196-196
Keyword(s):  
Case Series ◽  
Hospitalized Patients ◽  
High Dose ◽  
High Dose Methylprednisolone

scholarly journals Outcomes of COVID-19 in a cohort of pediatric patients with rheumatic diseases

2021 ◽  
Author(s):  
Diana Sofia Villacis-Nunez ◽  
Christina A. Rostad ◽  
Kelly Rouster-Stevens ◽  
Arezou Khosroshahi ◽  
Shanmuganathan Chandrakasan ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Case Series ◽  
Hospitalized Patients ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Severe Immunosuppression ◽  
Dose Corticosteroid

Abstract Background There are few reports of COVID-19 in pediatric patients with rheumatic diseases. This study describes the clinical presentation and outcomes of COVID-19 in this population. Methods We analyzed a single-center case series of pediatric patients with rheumatic diseases and laboratory-confirmed COVID-19. Demographic, baseline and COVID-19 associated clinical features were compared between ambulatory and hospitalized patients using univariate analysis. Results Forty cases were identified: 32 (80%) in the ambulatory group and 8 (20%) hospitalized. Older age (median age 18 years vs 16 years; p = 0.01) and African American race (OR 8.42; 95% CI [1.20-101.69]; p = 0.01) predominated in hospitalized patients. Systemic lupus erythematosus (OR 6.77; 95% CI [1.01–56.71]; p = 0.02), medium/high-dose corticosteroid use (OR 10.62; 95% CI [1.46–99.57]; p = 0.008), mycophenolate use (OR 11.91; 95% CI [1.64-149.35]; p = 0.005), and severe immunosuppression (OR 16.83; 95% CI [1.74-861.43]; p = 0.004) were associated with increased odds of hospitalization. Patients with fever (OR 11.91; 95% CI [1.64-149.35]; p = 0.004), dyspnea (OR 16.51; CI [1.10-998.37]; p = 0.02), and myalgias (OR 13.40; 95% CI [1.43-194.56)]; p = 0.009) were more commonly encountered in the hospitalized group. Rheumatic disease flares were almost exclusive to hospitalized patients (OR 42.13; 95% CI [3.40-2463.87]; p < 0.001).. All patients recovered. Conclusions Medium/high-dose corticosteroid use, mycophenolate use, and severe immunosuppression were risk factors for hospitalization. Fever, dyspnea and myalgias were high-risk symptoms. The type of rheumatic disease, as well as disease flare could be contributing factors to the need for hospitalization.

Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series

2020 ◽  
Vol 3 (3) ◽  
pp. 297-310 ◽  
Author(s):  
Rafael Ricafranca Castillo ◽  
Gino Rei A. Quizon ◽  
Mario Joselito M. Juco ◽  
Arthur Dessi E. Roman ◽  
Donnah G De Leon ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Clinical Improvement ◽  
Case Series ◽  
High Dose ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Rt Pcr ◽  
Average Hospital ◽  
Sleeping Problems

 Treatment for coronavirus disease 2019 (COVID19) pneumonia remains empirical and the search for therapies that can improve outcomes continues. Melatonin has been shown to have anti-inflammatory, antioxidant, and immune-modulating effects that may address key pathophysiologic mechanisms in the development and progression of acute respiratory distress syndrome (ARDS), which has been implicated as the likely cause of death in COVID19. We aimed to describe the observable clinical outcomes and tolerability of high-dose melatonin (hdM) given as adjuvant therapy in patients admitted with COVID19 pneumonia. We conducted a retrospective descriptive case series of patients who: 1) were admitted to the Manila Doctors Hospital in Manila, Philippines, between March 5, 2020 and April 4, 2020; 2) presented with history of typical symptoms (fever, cough, sore throat, loss of smell and/or taste, myalgia, fatigue); 3) had admitting impression of atypical pneumonia; 4) had history and chest imaging findings highly suggestive of COVID19 pneumonia, and, 5) were given hdM as adjuvant therapy, in addition to standard and/or empirical therapy. One patient admitted to another hospital, who one of the authors helped co-manage, was included. He was the lone patient given hdM in that hospital during the treatment period. Main outcomes described were: time to clinical improvement, duration of hospital stay from hdM initiation, need for mechanical ventilation (MV) prior to cardiopulmonary resuscitation, and final outcome (death or recovery/discharge). Of 10 patients given hdM at doses of 36-72mg/day per os (p.o.) in 4 divided doses as adjuvant therapy, 7 were confirmed COVID19 positive (+) by reverse transcription polymerase chain reaction (RT-PCR) and 3 tested negative  (-), which was deemed to be false (-) considering the patients’ typical history, symptomatology, chest imaging findings and elevated bio-inflammatory parameters.  In all 10 patients given hdM, clinical stabilization and/or improvement was noted within 4-5 days after initiation of hdM. All hdM patients, including 3 with moderately severe ARDS and 1 with mild ARDS, survived; none required MV. The 7 COVID19(+) patients were discharged at an average of 8.6 days after initiation of hdM. The 3 highly probable COVID19 patients on hdM were discharged at an average of 7.3 days after hdM initiation. Average hospital stay of those not given hdM (non-hdM) COVID19(+) patients who were admitted during the same period and recovered was 13 days. To provide perspective, although the groups are not comparable, 12 of the 34 (35.3%) COVID19(+) non-hdM patients admitted during the same period died, 7/34 (20.6%) required MV; while 6 of 15 (40%) non-hdM (-) by RT-PCR but highly probable COVID19 pneumonia patients also died, 4/15  (26.7%) required MV. No significant side-effects were noted with hdM except for sleepiness, which was deemed favorable by all patients, most of whom had anxiety- and symptom-related sleeping problems previously. HdM may have a beneficial role in patients treated for COVID19 pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter hospital stay, and possibly lower mortality. HdM was well tolerated. This is the first report describing the benefits of hdM in patients being treated for COVID19 pneumonia.  Being a commonly available and inexpensive sleep-aid supplement worldwide, melatonin may play a role as adjuvant therapy in the global war against COVID19. 

scholarly journals ETMR-08. INTERNATIONAL CONSENSUS PROTOCOL FOR EMBRYONAL TUMOR WITH MULTILAYER ROSETTES

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii324-iii324
Author(s):  
Derek Hanson ◽  
Nicolas Andre ◽  
Susan Chi ◽  
Mariella Filbin ◽  
Michael Fisher ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Clinical Investigation ◽  
Case Series ◽  
High Dose ◽  
Consensus Protocol ◽  
Retrospective Case ◽  
International Consensus ◽  
Small Series ◽  
Dismal Prognosis ◽  
Biological Studies

Abstract Embryonal tumors with multilayer rosettes (ETMR) are rare and highly-aggressive central nervous system (CNS) neoplasms which occur primarily in young children and carry a dismal prognosis. To date, no large clinical investigations have been conducted to determine the optimal therapy for ETMR. Data from retrospective case series suggest that our most aggressive standard therapies are not sufficient for cure in the majority of cases. New treatment approaches incorporating pre-clinical data and the known biology of ETMR are therefore urgently needed. A German drug screen using the patient-derived ETMR BT183 cell line and its xenograft revealed anti-tumor activity of topotecan, doxorubicin, and actinomycin D; three agents used infrequently for treating infant CNS tumors. Additional results from a small series of ETMR patients suggest that optimization of induction chemotherapy using these active agents may improve response and survival outcomes. In 2019, an international panel of pediatric neuro-oncology experts convened to advance therapy for ETMR. A consensus protocol was developed incorporating maximal safe surgical resection, induction chemotherapy with active pre-clinical agents, intrathecal chemotherapy, radiotherapy, and high-dose chemotherapy. This international consensus protocol represents the first prospective clinical investigation specific to ETMR and will be available through a treatment registry globally and as a clinical trial at select centers. The study aims to improve survival by providing aggressive, optimized therapy for ETMR and will serve as a platform to explore new biologically-promising agents. The investigation will also provide valuable prospective outcome data and correlative biological studies to serve as baseline comparators for future clinical trials.

scholarly journals Clinical Frailty Score (CFS) versus Hospital Frailty Risk Score (HFRS) for predicting mortality and other adverse outcome in hospitalized patients with COVID‐19: Spanish case series

2021 ◽  
Author(s):  
Jose‐Manuel Ramos‐Rincon ◽  
Oscar Moreno‐Perez ◽  
Hector Pinargote‐Celorio ◽  
Jose‐Manuel Leon‐Ramirez ◽  
Mariano Andres ◽  
...  
Keyword(s):  
Risk Score ◽  
Adverse Outcome ◽  
Case Series ◽  
Hospitalized Patients ◽  
Frailty Score

scholarly journals High-dose intravenous methotrexate in the management of breast cancer with leptomeningeal disease: Case series and review of the literature

2019 ◽  
Vol 12 (4) ◽  
pp. 189-193 ◽  
Author(s):  
Jonathan T. Kapke ◽  
Robert J. Schneidewend ◽  
Zeeshan A. Jawa ◽  
Chiang-Ching Huang ◽  
Jennifer M. Connelly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Series ◽  
Leptomeningeal Disease ◽  
High Dose ◽  
Review Of The Literature ◽  
Disease Case

Incomplete septal cirrhosis after high-dose methylprednisolone therapy and regression of liver injury

2014 ◽  
Vol 35 (2) ◽  
pp. 674-676 ◽  
Author(s):  
Elisabetta Grilli ◽  
Vincenzo Galati ◽  
Nicola Petrosillo ◽  
Franca Del Nonno ◽  
Andrea Baiocchini
Keyword(s):  
Liver Injury ◽  
High Dose ◽  
High Dose Methylprednisolone ◽  
Incomplete Septal Cirrhosis

scholarly journals Inhaled High Dose Nitric Oxide is a Safe and Effective Respiratory Treatment in Spontaneous Breathing Hospitalized Patients with COVID-19 pneumonia

Nitric Oxide ◽  
2021 ◽  
Author(s):  
Bijan Safaee Fakhr ◽  
Raffaele Di Fenza ◽  
Stefano Gianni ◽  
Steffen B. Wiegand ◽  
Yusuke Miyazaki ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Spontaneous Breathing ◽  
Hospitalized Patients ◽  
High Dose ◽  
Respiratory Treatment
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