ABSTRACT
BackgroundSevere coronavirus disease 2019 (COVID-19) is characterized, in part, by an excessive inflammatory response. Evidence from animal and human studies suggests that vagus nerve stimulation can lead to reduced levels of various pro-inflammatory cytokines. We conducted a prospective randomized controlled study (SAVIOR-I) to assess the feasibility, efficacy, and safety of non-invasive vagus nerve stimulation (nVNS) for the treatment of respiratory symptoms and inflammatory markers among patients who were hospitalized for COVID-19 (ClinicalTrials.gov identifier: NCT04368156). MethodsParticipants were randomly assigned in a 1:1 allocation to receive either the standard of care (SoC) alone or nVNS therapy plus the SoC. The nVNS group received 2 consecutive 2-minute doses of nVNS 3 times daily as prophylaxis. Efficacy and safety were evaluated via the incidence of specific clinical events, inflammatory biomarker levels, and the occurrence of adverse events. ResultsOf the 110 participants who were enrolled and randomly assigned, 97 (nVNS, n=47; SoC, n=50) had sufficient available data and comprised the evaluable population. C-reactive protein (CRP) levels decreased from baseline to a significantly greater degree in the nVNS group than in the SoC group at day 5 and overall (ie, all postbaseline data points collected through day 5, combined). Procalcitonin level also showed significantly greater decreases from baseline to day 5 in the nVNS group than in the SoC group. D-dimer levels were decreased from baseline for the nVNS group and increased from baseline for the SoC group at day 5 and overall, although the difference between the treatment groups did not reach statistical significance. No significant treatment differences were seen for clinical respiratory outcomes or any of the other biochemical markers evaluated. No serious nVNS-related adverse events occurred during the study. ConclusionsnVNS therapy led to significant reductions in levels of inflammatory markers, specifically CRP and procalcitonin. Because nVNS has multiple mechanisms of action that may be relevant to COVID-19, additional research into its potential to be used earlier in the course of COVID-19 and possibly mitigate some of the symptoms associated with post-acute COVID-19 syndrome is warranted.
ABSTRACT
Los tumores del retroperitoneo pueden ser malignos o benignos y se clasifican según el tejido donde se originan. Entre ellos, los tumores renales son los que cobran cada día mayor representatividad, en especial, el carcinoma renal de células claras, en sus disímiles formas de presentación clínica, incluyendo un numeroso grupo de pacientes asintomáticos. Se presentó el caso de una paciente femenina con dolor lumbo-abdominal izquierdo de carácter gravativo asociado a infecciones urinarias periódicas, de varios meses de evolución. Mediante ultrasonido halló una imagen compleja, predominantemente quística, en el polo superior del riñón izquierdo con elementos sólidos en su interior y finos tabiques, que no descartaba la posibilidad de un carcinoma variedad quística; después de ser sometida al tratamiento quirúrgico, el estudio histológico del tumor se demostró que se trataba de un schwannoma de cavidades renales, tipo benigno. La evolución de la paciente ha sido satisfactoria.
Retroperitoneal tumors can be malignant or benign and they are classified according to the tissue where they are originated. Among them, kidney tumors are those that are becoming increasingly representative, particularly renal clear cell carcinoma, in their different forms of clinical presentation, including a large group of asymptomatic patients. The case of a female patient with left lumbo-abdominal pain is presented, associated with recurrent urinary tract infections, several months of evolution. By ultrasound, one predominantly cystic complex picture was found in the upper pole of the left kidney with solid elements inside and thin walls, which did not rule out the possibility of a variety cystic carcinoma; after being subjected to surgical treatment, tumor histology showed that it was schwannoma of renal cavities, benign type. The evolution of this patient was successful.
Subject(s)
Humans , Neoplasms , Neurilemmoma , Latin American and Caribbean Center on Health Sciences InformationABSTRACT
Los tumores del retroperitoneo pueden ser malignos o benignos y se clasifican según el tejido donde se originan. Entre ellos, los tumores renales son los que cobran cada día mayor representatividad, en especial, el carcinoma renal de células claras, en sus disímiles formas de presentación clínica, incluyendo un numeroso grupo de pacientes asintomáticos. Se presentó el caso de una paciente femenina con dolor lumbo-abdominal izquierdo de carácter gravativo asociado a infecciones urinarias periódicas, de varios meses de evolución. Mediante ultrasonido halló una imagen compleja, predominantemente quística, en el polo superior del riñón izquierdo con elementos sólidos en su interior y finos tabiques, que no descartaba la posibilidad de un carcinoma variedad quística; después de ser sometida al tratamiento quirúrgico, el estudio histológico del tumor se demostró que se trataba de un schwannoma de cavidades renales, tipo benigno. La evolución de la paciente ha sido satisfactoria(AU)
Retroperitoneal tumors can be malignant or benign and they are classified according to the tissue where they are originated. Among them, kidney tumors are those that are becoming increasingly representative, particularly renal clear cell carcinoma, in their different forms of clinical presentation, including a large group of asymptomatic patients. The case of a female patient with left lumbo-abdominal pain is presented, associated with recurrent urinary tract infections, several months of evolution. By ultrasound, one predominantly cystic complex picture was found in the upper pole of the left kidney with solid elements inside and thin walls, which did not rule out the possibility of a variety cystic carcinoma; after being subjected to surgical treatment, tumor histology showed that it was schwannoma of renal cavities, benign type. The evolution of this patient was successful(AU)
