ABSTRACT
In COVID-19, the inflammatory cytokine-release syndrome is associated with the progression of the disease. Itolizumab is a monoclonal antibody that recognizes human CD6 expressed in activated T cells. The antibody has shown to be safe and efficacious in the treatment of moderate to severe psoriasis. Its effect is associated with the reduction of pro-inflammatory cytokines release, including IFN-γ, IL-6 and TNF-α. Here, we report the outcome of three severe and critically ill COVID-19 patients treated with itolizumab as part of an expanded access protocol. Itolizumab was able to reduce IL-6 concentrations in all the patients. Two of the three patients showed respiratory and radiological improvement and were fully recovered. We hypothesize this anti-inflammatory therapy in addition to antiviral and anticoagulant therapy could reduce COVID-19 associated morbidity and mortality.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antigens, CD/immunology , Antigens, Differentiation, T-Lymphocyte/immunology , COVID-19 Drug Treatment , Cytokine Release Syndrome/drug therapy , Aged, 80 and over , Biomarkers/blood , COVID-19/pathology , Critical Illness , Cytokine Release Syndrome/pathology , Drug Therapy, Combination , Female , Humans , Interleukin-6/blood , Male , Middle Aged , SARS-CoV-2 , Treatment OutcomeABSTRACT
Objetivo: Realizar un análisis de decisión para escogencia entre succionilcolina y rocuronio en la inducción de secuencia rápida con base en su eficacia y la presentación de eventos adversos. Métodos: Se realizó el análisis de decisión mediante la construcción de árboles de decisiones, con sus respectivos nodos de decisión, oportunidades y utilidades. Los datos fueron tomados de la literatura médica y de una encuesta a profesionales de la anestesia y estudiantes de posgrado en anestesiología; luego éstos fueron procesados por el software Treenage con la realización de los análisis de sensibilidad. Resultados: El árbol de decisión de la literatura médica demuestra un valor esperado para la rama de succionilcolina de 6.50, superior al de la rama de rocuronio, cuyo valor es de 5.22. El árbol de decisión de la encuesta muestra a la succionilcolina como opción a escoger con un valor esperado de 9.08, por encima del valor esperado del rocuronio el cual es de 8.17. Conclusión: La succionilcolina es la mejor escogencia con base en su efectividad clínica para condiciones de intubación traqueal en la inducción de secuencia rápida, y también, es la mejor opción cuando se tienen en cuenta sus efectos adversos.
Objective: To perform a decision analysis for choosing between succinylcholine and rocuronium in a rapid sequence induction situation based on their efficacy and reported adverse effects. Methods: Decision analysis by building decision trees, with their respective decision nodes, opportunities and usefulness was made. The data was taken from the medical literature and a survey performed on anesthesia professionals and anesthesiology residents; then was processed by the Treenage software with sensitivity analysis. Results: The decision tree based on the medical literature shows an expected value for the succinylcholine branch of 6.50, higher than the rocuronium branch with a value of 5.22. The decision tree of the survey shows the succinylcholine as an option to choose with an expected value of 9.08, above the expected value of rocuronium which is 8.17. Conclusion: Succinylcholine is the best choice based on tis clinical effectiveness conditions for tracheal intubation in rapid sequence induction, and it is the best option when consideration its adverse effects.
Subject(s)
Humans , Neuromuscular Depolarizing Agents , Intubation, Intratracheal , Succinylcholine , Succinylcholine/adverse effects , Decision Support Techniques , Decision TreesABSTRACT
La incidencia de neuropatía después de anestesia regional (subaracnoidea y epidural) es una complicación neurológica infrecuente. Su manejo inadecuado contribuye al desarrollo de secuelas neurológicas permanentes. Posterior a anestesia neuroaxial para cesárea, una paciente presentó neuropatía de su miembro inferior izquierdo luego de varias punciones con aguja Quincke® Nº 27. La paciente procede de un área rural de Ubaté Cundinamarca, y no cumplió las recomendaciones para el manejo de su neuropatía prolongada quizás debido a sus condiciones socioculturales.Los autores hacen una revisión de la literatura sobre lesiones neurológicas después de anestesia regional.
The incidence of neuropathy following regional anesthesia (subarachnoid and epidural anesthesia) is a very infrequent neurological complication. Its inadequate management contributes to the development of permanent neurological sequelas. A patient after neuraxial anesthesia for cesarean delivery presented left lower extremity neuropathy associated with several punctions of Quincke® needle number 27. The patient lives in a rural area of Ubaté-Cundinamarca, and she didn´t follow the recommendations for the management of her prolonged neuropathy, maybe because of her social and culturales conditions. The authors made a review of the literature on neurological injuries after regional anesthesia.
