COVID-19’lu Gebe Tedavisinde Pentaglobin Etkinliği

Amaç: COVID-19, Aralık 2019’dan itibaren Çin’in Wuhan bölgesinden tüm dünyaya yayılarak pandemi oluşturan yeni tip koronavirüstür. Gebelik, kadınları viral enfeksiyonlara karşı savunmasız hale getiren, bağışıklık sisteminde kısmi baskılanmaya ve advers sonuçlara sebep olan bir süreçtir. Biz burada hastamızda antiviral immünomodülatör tedavi ve antitrombotik profilaksiye ek olarak adjuvan tedavi;IgM ve IgA ile zenginleştirilmiş intravenöz immünoglobulin preperatı pentoglobin kullanım deneyimimizi sunduk. Olgu: Yirmi yedi yaşında 37 haftalık gebe, nefes darlığı şikayetiyle pandemi servise yatışı yapıldı. Hastanın üç gün önce nazal sürüntüde PZR testi pozitif olup aşıları yapılmadı. Rezervuarlı maskeyle 14 Lt/dk’den O2 desteğine rağmen SpO2 <95 olan ve solunum sıkıntısı derinleşen hasta acil sezaryene alınarak, spinal anestezi yapıldı. Post-op pandemi servisine çıkarılan hasta takipne ve saturasyonunun düşmesiyle ikinci gün yoğun bakımımıza kabul edildi. Bilinci açık, koopere olan hastanın (rezervuarlı maskeyle 14 Lt/dk O2 desteğinde) SpO2 %85, solunum sayısı: 24/dk, TA: 140/80 mmHg’dı. Arteriyel kan gazında ph: 7,44, PCO2 : 27, HCO3 : 20, biyokimyasal tetkiklerinde WBC: 13.900 K/ul, PLT: 21.000/mm³, CRP: 148 mg/dL, D-dimer: 4471 ng/mL idi. Favipiravir, metil prednizolon, piperasilin sodyum, tazobaktam sodyum, tosılizumab, clexane tedavide verildi. Yoğun bakıma gelişinin ikinci günü solunum sıkıntısının artmasıyla hasta entübe edildi. Sedasyon başlanıp 12 saat aralarla prone pozisyonu yapıldı. PA akciğer grafisinde konsolidasyon artışları ve solunum seslerinin kabalaşmasıyla meropenem, üç günlük 5 mL/kg pentaglobin eklendi. FiO2 : 40 ile PO2 : 95 olan peak basınçları 25-28 mmHg’ye kadar gerileyen hasta, mekanik ventilasyonun yedinci günü ekstübe edilip servise devredildi. Sonuç: Pentaglobin, şiddetli bakteriyel enfeksiyonlar, sepsis, septik şok tedavisinde endike olan bir preparattır. COVID-19 pnömonisinde pentoglobin tedavisiyle mortalite, hastanede kalış ve invaziv ventilasyon ihtiyacının azaldığı gösterilmiştir. Sitokin hiperaktivasyonunu yavaşlatıp kısa sürede klinik remisyon ve radyolojik bulgularla iyileşmeye neden olmaktadır. [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

"Impact of pentaglobin in severe COVID 19 pneumonia- a prospective study."

BACKGROUND: The current COVID-19 pandemic has become a global public health crisis and presents a serious challenge in treatment of severe COVID pneumonia patients. With an imperative need for an effective treatment, we aimed to study the effectiveness of Pentaglobin, an intravenous immunoglobin in the treatment of severe Covid-19 pneumonia patients. METHODS: This is an open-label non-randomised controlled study. Patients in the study group (n = 17) received Pentaglobin in addition to standard therapy and the control group (n = 19) received only the standard of care treatment. Severity of illness were quantified by severity scores and inflammatory laboratory parameters were compared between the two groups. RESULTS: The average length of hospital stay in pentaglobin group were 12.35 ± 6.98 days compared to 10.94 ± 4.62 days in standard treatment group with mean difference of 1.4 days (p value = 0.4). Pentaglobin did not provide an added advantage in terms of reducing the duration of hospital stay. There was no significant difference between both the groups in terms of requirement of invasive ventilation (p = 0.56) and mortality (p = 0.86). CT Severity score (OR = 1.39 95% CI = 1.09-1.77, P = 0.01), APACHE II score (OR = 1.16 95% CI = 0.99-1.35, P = 0.05) and the SOFA score (OR = 2.11 95% CI = 1.13-3.93, P = 0.02) were independent predictors of mortality. CONCLUSION: The administration of pentaglobin in COVID -19 patients has no significant effect in reducing the risk of mechanical ventilation or death, in disease worsening or in reduction of inflammation.

Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis.

BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite treatment being in line with current guidelines, mortality remains high in those with septic shock. Intravenous immunoglobulins represent a promising therapy to modulate both the pro- and anti-inflammatory processes and can contribute to the elimination of pathogens. In this context, there is evidence of the benefits of immunoglobulin M (IgM)- and immunoglobulin A (IgA)-enriched immunoglobulin therapy for sepsis. This manuscript aims to summarize current relevant data to provide expert opinions on best practice for the use of an IgM- and IgA-enriched immunoglobulin (Pentaglobin) in adult patients with sepsis. MAIN TEXT: Sepsis patients with hyperinflammation and patients with immunosuppression may benefit most from treatment with IgM- and IgA-enriched immunoglobulin (Pentaglobin). Patients with hyperinflammation present with phenotypes that manifest throughout the body, whilst the clinical characteristics of immunosuppression are less clear. Potential biomarkers for hyperinflammation include elevated procalcitonin, interleukin-6, endotoxin activity and C-reactive protein, although thresholds for these are not well-defined. Convenient biomarkers for identifying patients in a stage of immune-paralysis are still matter of debate, though human leukocyte antigen-antigen D related expression on monocytes, lymphocyte count and viral reactivation have been proposed. The timing of treatment is potentially more critical for treatment efficacy in patients with hyperinflammation compared with patients who are in an immunosuppressed stage. Due to the lack of evidence, definitive dosage recommendations for either population cannot be made, though we suggest that patients with hyperinflammation should receive an initial bolus at a rate of up to 0.6 mL (30 mg)/kg/h for 6 h followed by a continuous maintenance rate of 0.2 mL (10 mg)/kg/hour for ≥ 72 h (total dose ≥ 0.9 g/kg). For immunosuppressed patients, dosage is more conservative (0.2 mL [10 mg]/kg/h) for ≥ 72 h, without an initial bolus (total dose ≥ 0.72 g/kg). CONCLUSIONS: Two distinct populations that may benefit most from Pentaglobin therapy are described in this review. However, further clinical evidence is required to strengthen support for the recommendations given here regarding timing, duration and dosage of treatment.

Administration of Immunoglobulins in SARS-CoV-2-Positive Patient Is Associated With Fast Clinical and Radiological Healing: Case Report.

Polyclonal preparation of IgM as an adjuvant therapy has been reported as a relevant immunomodulant therapy in several infectious diseases, exhibiting, in most cases, improvement of the clinical course. No drug has demonstrated therapeutic efficacy for COVID-19. Immunomodulatory treatment with hydroxychloroquine and biologics as tocilizumab, in fact, has not proven to show satisfactory results in several reports. We therefore treated a selected patient with interstitial multifocal pneumonia, positive to COVID-19, with polyclonal preparation of immunoglobulins as an adjuvant therapy, obtaining in few days clinical remission and improvements in radiological findings. Based on this case report, we suggest that clinical trials are conducted to test the efficacy and safety of polyclonal immunoglobulins for adjunctive therapy of COVID-19.