ABSTRACT
BACKGROUND: Immune dysregulation is one of the main reasons for mortality and morbidity in coronavirus disease 2019 (COVID-19). Mycobacterium w (Mw) is recently approved for gram-negative sepsis. Moreover, it is also found effective in COVID-19 patients in previous studies. The traditional route of administration for Mw is intradermal, which has a limitation of administering 0.1 mL per injection and local injection site reaction. Intravenous (IV) administration of Mw has not been explored in COVID-19. We report the retrospective analysis of six critically ill COVID-19 patients who received Mw (IV). PATIENTS AND METHODS: At baseline, all patients in this case series required O2 supplementation, and their inflammatory biomarkers were elevated. All patients received 0.6 mL Mw (high-dose) in normal saline along with the standard-of-care treatment. RESULTS: After Mw administration, gradual improvement in O2 requirement was observed and patients were discharged from the hospital with no mortality. A reduction in mean C-reactive protein (CRP) (51.48-18.52 mg/dL), interleukin-6 (IL-6) (260.22-14.47 pg/mL), and FiO2 (81.67-43.33) was also observed. No side effects were observed with the use of Mw by IV route. CONCLUSION: Use of 0.6 mL Mw by IV route in this case series was associated with decreased O2 supplementation without any side effects in critically ill patients of COVID-19. HOW TO CITE THIS ARTICLE: Patel PS, Patel S, Shah V, Aswani V, Narwaria M. Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19. Indian J Crit Care Med 2021;25(9):1066-1068.
ABSTRACT
Insulinomas account for 60% of islet cell tumours (ICT) and are typically hypervascular, solitary small tumours, 90% of which measure less than 2 cm and 30% measuring less than 1 cm in diameter. Approximately 10% are multiple, 10% are malignant and 4-7% are associated with MEN I; these tumours are usually multiple and can be malignant in up to 25%. The tumour is characterized by endogenous hypersecretion of insulin and the subsequent development of symptoms of neuroglycopenia and symptoms resulting from the catecholaminergic response, which may not always be present. Early localisation of the disease is essential to prevent lethal hypoglycaemia. We report a case of insulinoma in a 27 year old male and review of diagnostic modalities to localise the tumour and open v/s laparoscopic enucleation of the tumour.
