Blocking EGFR with nimotuzumab: a novel strategy for COVID-19 treatment.

Background: Lung injury and STAT1 deficit induce EGFR overexpression in SARS-CoV-2 infection. Patients & methods: A phase I/II trial was done to evaluate the safety and preliminary effect of nimotuzumab, an anti-EGFR antibody, in COVID-19 patients. Patients received from one to three infusions together with other drugs included in the national guideline. Results: 41 patients (31 severe and 10 moderate) received nimotuzumab. The median age was 62 years and the main comorbidities were hypertension, diabetes and cardiovascular disease. The antibody was very safe and the 14-day recovery rate was 82.9%. Inflammatory markers decreased over time. Patients did not show signs of fibrosis. Conclusion: Nimotuzumab is a safe antibody that might reduce inflammation and prevent fibrosis in severe and moderate COVID-19 patients. Clinical Trial Registration: RPCEC00000369 (rpcec.sld.cu).

Background: After SARS-CoV-2 infection, many cells in the lung express a new receptor called EGFR. Overexpression of EGFR can worsen the pulmonary disease and provoke fibrosis. Patients & methods: The initial impact of using a drug that blocks EGFR, nimotuzumab, was evaluated in COVID-19 patients. Results: 41 patients received nimotuzumab by the intravenous route together with other medications. The median age was 62 years, and patients had many chronic conditions including hypertension, diabetes and cardiac problems. Treatment was well tolerated and 82.9% of the patients were discharged by day 14. Serial laboratory tests, x-rays and CT scan evaluations showed the improvement of the patients. Conclusion: Nimotuzumab is a safe drug that can be useful to treat COVID-19 patients.

Miopía en pacientes con retinopatía de la prematuridad / Myopia in patients with Retinopathy of Prematurity

Objetivos: describir el comportamiento del defecto miópico hasta el año de vida, en pacientes que desarrollaron retinopatía de la prematuridad, y determinar los principales factores de riesgo del mismo. Método: se realizó un estudio descriptivo, longitudinal, prospectivo en 37 pacientes que, habiendo sido tratados o no por retinopatía de la prematuridad, mantuvieron un seguimiento estable en consulta posterior a la fase aguda de la enfermedad. Fueron evaluadas a los seis y 12 meses de vida teniendo en cuenta las variables edad gestacional al nacer, peso al nacer, tipo de retinopatía de la prematuridad, presencia de miopía. Resultados: la mediana de edad gestacional y peso al nacer fueron 30,2 semanas y 1 287 g. A los seis meses cinco ojos de 27 pacientes (considerando solo los ojos derechos) presentaron miopía, lo cual representa el 18,5 por ciento. A los 12 meses este valor se incrementó a 44,4 por ciento. La edad gestacional y el peso al nacer no mostraron relación con el desarrollo de miopía (p = 0,072 y p = 0,397) a los 12 meses. En pacientes con retinopatía de la prematuridad grave el defecto miópico resultó más frecuente (p = 0,003). Conclusiones: la prematuridad y el peso al nacer no constituyeron variables que influyeran en la aparición de miopía. Por el contrario, la retinopatía de la prematuridad grave sí se asoció con una mayor miopía, sobre todo a los 12 meses(AU)

Objectives: to describe the behavior of the myopic defect up to one year of life, in patients who developed retinopathy of prematurity, and to determine the main risk factors for it. Method: a descriptive, longitudinal, prospective study was carried out in 37 patients who, having been treated for retinopathy of prematurity or not, maintained a stable follow-up in consultation after the acute phase of the disease. They were evaluated at 6 and 12 months of life taking into account the variables gestational age at birth, birth weight, type of retinopathy of prematurity, presence of myopia. Results: Median gestational age and birth weight were 30.2 weeks and 1287g. At 6 months, 5 eyes of 27 patients (considering only the right eyes) presented myopia, which represents 18.5 percent. At 12 months this value increased to 44.4 percent. Gestational age and birth weight were not related to the development of myopia (p = 0.072) and p = 0.397) at 12 months. In patients with severe retinopathy of prematurity, myopic defect was more frequent (p = 0.003). Conclusions: prematurity and birth weight were not variables that influenced the appearance of myopia. On the contrary, severe retinopathy of prematurity was associated with greater myopia, especially at 12 months(AU)

Nimotuzumab for COVID-19: case series.

Background: In COVID-19, EGFR production is upregulated in the alveolar epithelial cells. EGFR overexpression further activates STAT-3 and increases lung pathology. The EGFR pathway is also one of the major nodes in pulmonary fibrosis. Methods: Nimotuzumab, a humanized anti-EGFR antibody, was used to treat three patients with severe or moderate COVID-19. The antibody was administered in combination with other drugs included in the national COVID-19 protocol. Results: Nimotuzumab was well tolerated. IL-6 decreased from the first antibody infusion. Clinical symptoms significantly improved after nimotuzumab administration, and the CT scans at discharge showed major resolution of the lung lesions and no signs of fibrosis. Conclusion: Safe anti-EGFR antibodies like nimotuzumab may modulate COVID-19-associated hyperinflammation and prevent fibrosis. Clinical Trial Registration: RPCEC00000369 (RPCEC rpcec.sld.cu).

Lay abstract Background: In COVID-19, the protein EGFR is overactive in the infected lung cells. Methods: Nimotuzumab, an anti-EGFR antibody, was used to treat three patients with severe or moderate COVID-19. The antibody was administered in combination with other drugs included in the national COVID-19 protocol. Results: Nimotuzumab was safe. The most important inflammatory markers decreased from the first administration. The patients' clinical symptoms and imaging results improved significantly. Conclusion: Anti-EGFR antibodies like nimotuzumab may contribute to the recovery of COVID-19 patients without long-term consequences.

Health Care-Associated Infection in Solid Organ Transplant Recipients.

BACKGROUND: Health care-associated infection (HAI) represent a global health problem with an increase in hospital stays, deaths, and monetary costs. Recipients of solid organ transplants are a population at risk. The objectives of the study were to characterize the incidence of HAI in renal and hepatic transplant recipients as well as to compare them with the population without transplants in intensive care units (ICU). METHODS: The data on the incidence of HAI, localization, microorganisms, and demographics were taken from the patients admitted between the years 2013 to 2018 (n = 4307) from the registration of the Project for the Reduction of Nosocomial Infection in Intensive Care Units. The variables were compared with those of renal transplant (n = 96) and liver transplants (n = 68) recipients. RESULTS: Renal transplant recipients showed 26% incidence of HAI. The most frequent were surgical site infection (SSI), urinary tract infection, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 3.8%. Liver transplant recipients showed 41% incidence of HAI. The most frequent were tracheobronchitis associated with mechanical ventilation, SSI, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 37%. The population without transplants in the ICU showed 17% incidence of HAI. The most frequent were respiratory infections associated with mechanical ventilation, primary bacteremia, and SSI; the most frequent microorganism was Acinetobacter spp, mortality 21%. CONCLUSIONS: HAI in recipients of solid organ transplants (renal and hepatic) have a higher incidence than in a population without transplants. The location and causal microorganisms have particularities that must be taken into account for the development of prevention protocols.