ABSTRACT
Maintaining an active medical research career is a multifaceted undertaking, and many challenges arise, even under normal circumstances. Therefore, the Australian government mandated COVID19 lockdowns and worksite restrictions from 2020 2021 inflicted an additional layer of complexity to an already complicated career for most researchers. A critical issue I faced during these COVID19 lockdowns was to establish whether our research focus was considered an essential service during a period of time when the public health advice was to restrict the movement of research staff and students by enacting new laws to ensure they stay at home. My research team members were also rightfully worried about contracting COVID19 during a period when a viable vaccine was not available. In this presentation, I will be covering some of the adaptive changes I implemented during the COVID19 lockdowns to ensure the continuity of our research program, which includes: 1) Proactive engagement with our medical institute and university COVID-19 taskforces to formulate a joint vision of which research areas should be prioritised during these lockdowns in pursuit of both treatments and vaccines;2) Continuous communication with my research team to encourage, motivate and energise staff and students to allow them to contribute to the research program meaningfully;3) Provide flexible working hours for research team members to work within the confinements of a reduced worksite footprint with an appreciation for social distancing;and 4) Contingency planning to ensure if one research team member contracts COVID-19, there are others with the cross-functional skillset to take over their responsibilities. Taking such steps ensured the rapid development of a new treatment regime that was showing impressive results in reversing multi-organ dysfunction in another clinically challenging area in intensive care units (sepsis). Following the preclinical assessment of safety and efficacy of this new treatment regime, we were able to compassionately treat a critically ill COVID19 patient receiving intensive care at Austin Health. In a short period of time, we saw improved regulation of blood pressure, arterial blood oxygen levels and kidney function. The patient was able to be taken off machine ventilation 12 days after starting sodium ascorbate treatment and discharged from hospital without any complications 22 days later. This research has now informed the design and commencement of multi-centre randomised controlled clinical trials at four hospital intensive care units in Australia.
ABSTRACT
Anti-SARS-CoV-2 neutralizing monoclonal antibodies treatments have been studied through randomized controlled trials and have demonstrated efficacy for prevention and early COVID-19 treatment. Their use in real life is different from studies in many points. Variant changes, vaccination coverage, treated groups with nAbs which are different from clinical trials are topics discussed in this paper.
ABSTRACT
Currently, there is not any specific effective treatment for COVID-19. There are many studies published and ongoing especially on adult patients. Treatment options in pediatric patients are determined according to the agents used in adult patients. Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Supportive therapy forms the basis of the treatment as the symptoms and disease course in children are mild. There are currently no randomized controlled trials of drugs that can be used to treat COVID-19 in children. However, in severe clinical cases, the drugs used in adults are evaluated and used on a case-by-case basis. There is a growing need for well-designed controlled clinical trials to better define the safety and efficacy of potential treatments for COVID-19 in children.
ABSTRACT
Psoriasis is a chronic inflammatory skin condition characterized by scaly erythematous patches or plaques affecting the extensor surfaces that are prominent but spreading to all areas of the body, including the flexor surfaces. Psoriasis occurs when the body's immune system attacks the skin;the interleukin (IL)-12 and IL-17/23 axes play a major role in its pathogenesis. Biologic therapies targeting IL-17 or IL-23 have emerged as an important treatment option for psoriasis and have led to substantial improvements in patients' quality of life. This systematic review aimed to evaluate the comparative efficacy and safety of secukinumab, ustekinumab and guselkumab for the treatment of moderate to severe plaque psoriasis. Based on the final analysis, there were 10 articles, namely 5 RCTs and 5 observational. We found that patients who were given secukinumab showed a rapid response, whereas guselkumab was superior in terms of long-term response (approximately 1 year) and complete remission compared to other biologics. Among all the biologics assessed, ustekinumab showed relatively low efficacy.
ABSTRACT
Despite the measures taken and the molecular advances for the development of new agents for the control of SARS-CoV-2 infection, there is still insufficient development of an effective treatment. The objective of the review was to de-scribe the clinical studies and reported articles on drugs used as possible therapeutic agents for COVID-19 and the main conclusions on their reuse. A non-systematic review through PubMed, ScienceDirect, and clinical trials at ClinicalTrials. gov on original articles and case report in English and Span-ish that will report information on COVID-19 treatment and its main conclusions. Articles that were not relevant or that did not mention updated information to that reported in other articles were excluded. A total of 99 bibliographic references were included. COVID-19 appears as a multisystemic disease with variable clinical symptoms. Since no specific treatment is yet known, multiple drugs have been proposed that attack the different pathways of SARS-CoV-2. For severe disease in patients who require hospitalization and oxygen support, the use of remdesivir, dexamethasone, or tocilizumab is recommended if there are patient conditions that apply to use them. The use of ivermectin, colchicine, lopinavir/ritonavir, hydroxy-chloroquine, and chloroquine have not reported benefits that surpass adverse effects.
ABSTRACT
Case report - Introduction: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening disease occurring in up to 1% of antiphospholipid syndrome (APS) cases. It was first defined in 1992 and remains a difficult to treat entity with a mortality rate of 37%. We describe a patient with systemic lupus erythematosus (SLE) and CAPS presenting with simultaneous multi-organ injuries who was successfully managed with 'triple' therapy including cyclophosphamide. Case report - Case description: A 42-year-old female presented to her local hospital with chest pain and worsening vision. She had a background of SLE, triple antibody-positive APS (previous DVT, pregnancy loss and strokes), hypertension, a metallic mitral valve, a previous myocardial infarction and pre-existing visual impairment due to a prior intra-cerebral bleed related to anticoagulation. Examination revealed a faint malar rash, cortical blindness and long tract neurological signs. Her ECG showed ischaemic changes and the admission troponin was significantly raised (3773ng/L). An echocardiogram showed new left ventricular dysfunction and a subsequent cardiac MRI was in keeping with coronary artery disease. Investigations showed an acute kidney injury, newly deranged liver function tests and a raised INR (>11, with no bleeding). Complement was normal with a low dsDNA titre. Urinalysis revealed proteinuria and a protein creatinine ratio measured 176mg/mmol. MRI diffusion weighted brain imaging showed acute bilateral occipital and left fronto-parietal infarcts. She had symptoms of a lupus flare with arthralgia and a butterfly facial rash. COVID-19 PCR tests were negative and she had not been recently vaccinated. She was diagnosed with CAPS and transferred to St Thomas' hospital intensive care. On arrival, she received 1mg intravenous vitamin K followed by triple therapy for CAPS: an unfractionated heparin infusion, oral prednisolone 40mg daily, 5 days of plasma exchange and, given her background of SLE, she was treated with intravenous cyclophosphamide (according to the EUROLUPUS regimen). Intravenous methylprednisolone was avoided due to a previous hypertensive encephalopathy reaction. She responded rapidly. Her troponin fell from a peak of 5054 to 294ng/ L, her creatinine settled at a new baseline (232umol/L) and her liver function normalised. She was switched back to warfarin due to her metallic valve and started on aspirin for cardiovascular secondary prevention. She required physical and occupational therapy due to her strokes but recovered well. Case report - Discussion: According to the 2003 criteria, CAPS can be classified as definite when there is evidence of: -3 organs involved, development of manifestations simultaneously or within a week, confirmation by imaging and/or histopathology of small vessel occlusion and positive antiphospholipid antibodies. Probable CAPS is when 3 out of the 4 criteria are present. In this case, three organs were confirmed to be involved with imaging showing cerebral and cardiac ischaemia. Her creatinine rose from a base of 190 to 289umol/L coupled with a high protein creatinine ratio confirming renal involvement. A Budd-Chiari syndrome was also suspected due to deranged liver function tests and INR, though imaging performed after therapy did not confirm this. A biopsy of any of these four organs was not feasible given the severity of her presentation and coagulopathy. There are no randomised controlled trials but data from the CAPS registry guides treatment and management follows a logical approach: anticoagulation to treat thrombosis, glucocorticoids for inflammation and plasma exchange (or IVIG) to remove the circulating autoantibodies. Triple therapy was associated with a reduced mortality compared to no treatment (28.6% versus 75%, respectively). Following analyses from the CAPS registry we also chose to treat with cyclophosphamide, which is associated with improved survival in patients with SLE. This decision was based on the clinical features of an SLE flare as opposed to serological grounds. There have b en reports of rituximab and eculizumab being used successfully in CAPS, though generally as a last resort. As complement activation is seen in animal models of antiphospholipid syndrome thrombosis and rituximab is often used in refractory SLE, they may prove to be promising agents for refractory CAPS. Case report - Key learning points: 1. Prompt recognition and early treatment is vital in managing CAPS 2. Triple therapy with anticoagulation, glucocorticoids and plasma exchange / IVIG is associated with better survival in CAPS 3. Cyclophosphamide is associated with better survival in patients with CAPS and concomitant SLE.
ABSTRACT
The most reported symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were initially fever, dry cough, and sore throat. However, as we continue to review the literature, the loss of taste and smell were also added as clinical symptoms of the novel SARS-CoV-2. At present, the effects of SARS-CoV-2 on the auditory system is still not well-understood. This study is mini-review and aims to find out more about the relationship between SARS-CoV-2 and hearing loss through review of the literature. From our findings, hearing loss is the primary otological symptom of SARS-CoV-2, followed by tinnitus and dizziness. In conclusion, SARS-CoV-2 may have an effect on our auditory system, but due to the small sample sizes in the existing literature, further prospective studies are warranted to determine the relationship between the virus and hearing loss. Copyright © The Author(s) 2022.
ABSTRACT
Background: Rheumatology is a field of daily advancements in terms of diagnostics, pathophysiology, and management. Such advancements are the result of basic sciences, translational, and clinical research. Physical and financial support, which are provided by individuals and organizations, are vital for any form of research. The political and financial instability in the Arab world has affected the process of healthcare advancement and the research output. Material(s) and Method(s): This review looked into the number of rheumatological clinical publications that individual Arab countries produced from 2017 till 2021 which were cited by PubMed/MEDLINE. Publications that included authors from multiple countries were excluded. Publications were then sorted according to type;randomized controlled trial (RCT), cohort, cross-sectional, systematic review, narrative review, and case report. Publications were also sorted according to the Arab world regions;North and East Africa (NEA), Middle East (ME), and Arabian Peninsula (AP). Result(s): Egypt had the highest number of publication among NEA countries, and all Arab countries in general, with 261 publications including 23 RCTs. Saudi Arabia had the highest number of publications among AP countries with 81 publications. However, no individual AP country published a RCT. Lebanon had the highest number of publications among ME countries, but the majority of publications were reviews and case reports. Notably, the number of publications increased in certain countries during the COVID-19 era. Conclusion(s): Despite the political instability and lack of funds, the Arab world is still able to produce clinical rheumatological publications. The impact of such publications on the daily practice of Rheumatology remains questionable.