ABSTRACT
We show an unusual case of ulcerative colitis and sarcoidosis. This case has detailed images of skin lesions, biopsies and PET-CT results. There is limited evidence regarding the association of inflammatory bowel disease and other granulomatous diseases, especially sarcoidosis.
ABSTRACT
Introduction/objectives: An interleukin-6 inhibition strategy could be effective in selected COVID-19 patients. The objective is to present our experience of tocilizumab use in patients with severe COVID-19. Methods: Observational retrospective cohort study. Hospitalized patients were evaluated by our multidisciplinary team for eventual use of tocilizumab. Patients with progressive ventilatory impairment and evidence of a hyperinflammatory state despite usual treatment received tocilizumab 8 mg/kg intravenous (maximum dose 800 mg), in addition to standard treatment. The use and time of use of mechanical ventilation (MV), the change of the Alveolar-arterial (A-a) gradient, of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and of inflammation laboratory parameters after 72 h of tocilizumab use was evaluated. Results: 29 patients received tocilizumab. 93.1% were men, 37.9% were obese, and 34.5% had hypertension. Of the 20 patients who were not on MV when receiving tocilizumab, 11 required non-invasive MV, for an average of 5 days, and one of them required intubation. A-a gradient, PaO2/FiO2, and inflammation parameters improved significantly. A better lymphocyte count, which improved significantly after tocilizumab use, was significantly associated with less use of MV. Five patients presented positive culture samples after tocilizumab, three being of clinical significance. A lower lymphocyte count was associated with having a positive culture. No other significant adverse events were seen. Conclusion: Our study suggests the utility and shows the safety of tocilizumab use in COVID-19 patients who have respiratory failure and evidence of hyperinflammation. Lymphocyte improvement was a predictor of good response.
ABSTRACT
The pandemic of the new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has urged the nations to an unprecedented world-wide reaction, including an accelerated exploration of therapeutic options. In the absence of a vaccine and specifically designed antivirals, the medical community has proposed the use of various previously available medications in order to reduce the number of patients requiring prolonged hospitalizations, oxygen therapy, and mechanical ventilation and to decrease mortality from coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine are among the proposed drugs and are the most widely used so far, despite the lack of robust evidence on their usefulness. The objective of this article is to review and discuss the possible role of these drugs in the therapy of COVID-19.
Subject(s)
Antiviral Agents/therapeutic use , Chloroquine/therapeutic use , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Betacoronavirus , COVID-19 , Clinical Trials as Topic , Humans , Pandemics , SARS-CoV-2ABSTRACT
The financial coverage granted by law in Chile for patients with psoriatic arthritis who require biological treatment is of paramount importance and a great advance. However physicians must be knowledgeable about the advantages and limitations of this therapy. The challenge of clinicians is to choose the drug with the greater odds of achieving therapeutic success, with less adverse events and lower costs for our health system. This article aims to help doctors to select the best biological treatment for a specific patient, trying to optimize its effectiveness, minimizing adverse effects, always looking for an efficient use of resources.
Subject(s)
Humans , Physicians/psychology , Biological Factors/therapeutic use , Arthritis, Psoriatic/drug therapy , Clinical Decision-Making , ChileABSTRACT
The financial coverage granted by law in Chile for patients with psoriatic arthritis who require biological treatment is of paramount importance and a great advance. However physicians must be knowledgeable about the advantages and limitations of this therapy. The challenge of clinicians is to choose the drug with the greater odds of achieving therapeutic success, with less adverse events and lower costs for our health system. This article aims to help doctors to select the best biological treatment for a specific patient, trying to optimize its effectiveness, minimizing adverse effects, always looking for an efficient use of resources.
Subject(s)
Arthritis, Psoriatic , Biological Factors , Clinical Decision-Making , Physicians , Arthritis, Psoriatic/drug therapy , Biological Factors/therapeutic use , Chile , Humans , Physicians/psychologySubject(s)
Abatacept/therapeutic use , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Immunoconjugates/administration & dosage , Pain Measurement , Quality of Life , Adult , Antirheumatic Agents/therapeutic use , Chile , Cohort Studies , Female , Hospitals, Public , Humans , Longitudinal Studies , Male , Middle Aged , Risk Assessment , Severity of Illness Index , Statistics, Nonparametric , Treatment OutcomeABSTRACT
For years the mainstay of antiphospholipid syndrome treatment has been anticoagulation and antiplatelet therapy, but the autoimmune nature of the disease, and complications of these therapies, created the need to develop new therapeutic strategies. New therapeutic alternatives inhibit at different levels, the cascade of events leading to the pro-thrombotic state characteristic of the antiphospholipid syndrome. We conducted a literature review of these new treatments, focusing on the pathophysiological bases that support them and their possible clinical applications.
Subject(s)
Humans , Antiphospholipid Syndrome/drug therapy , Agmatine/analogs & derivatives , Agmatine/therapeutic use , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antiphospholipid Syndrome/physiopathology , Dipeptides/therapeutic use , Glucocorticoids/therapeutic use , Hydroxychloroquine/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Thrombosis/drug therapyABSTRACT
For years the mainstay of antiphospholipid syndrome treatment has been anticoagulation and antiplatelet therapy, but the autoimmune nature of the disease, and complications of these therapies, created the need to develop new therapeutic strategies. New therapeutic alternatives inhibit at different levels, the cascade of events leading to the pro-thrombotic state characteristic of the antiphospholipid syndrome. We conducted a literature review of these new treatments, focusing on the pathophysiological bases that support them and their possible clinical applications.