The association between immunosuppressants use and COVID-19 adverse outcome: National COVID-19 cohort in South Korea

PurposeThere is uncertainty of the effect of immunosuppression, including corticosteroids, before COVID-19 infection on COVID-19 outcomes. The aim of this study was to investigate the relationship between prehospitalization immunosuppressants use (exposure), and COVID-19 patient outcomes. MethodsWe conducted a population-based retrospective cohort study using a nationwide healthcare claims database of South Korea as of May 15, 2020. Confirmed COVID-19 infection in hospitalized individuals aged 40 years or older were included for analysis. We defined exposure variable by using inpatient and outpatient prescription records of immunosuppressants from the database. Our primary outcome was a composite endpoint of all-cause death, intensive care unit (ICU) admission, and mechanical ventilation use. Inverse probability of treatment weighting (IPTW)-adjusted logistic regression analyses were used, to estimate odds ratio (OR) and 95% confidence intervals, comparing immunosuppressants users and non-users. ResultsWe identified 4,349 patients, for which 1,356 were immunosuppressants users and 2,903 were non-users. Patients who used immunosuppressants were at increased odds of the primary outcome of all-cause death, ICU admission and mechanical ventilation use (IPTW OR 1.32; 95% CI: 1.06 - 1.63). Patients who used corticosteroids were at increased odds of the primary outcome (IPTW OR 1.33; 95% CI: 1.07 - 1.64). ConclusionWe support the latest guidelines from the CDC, that people on immunosuppressants are at high risk of severe COVID-19 and immunocompromised people may need booster COVID-19 vaccinations. FundingYGCs work was partially supported by 2020R1G1A1A01006229 awarded by the National Research Foundation of Korea.

The association between statin and COVID-19 adverse outcomes: National COVID-19 cohort in South Korea

BackgroundThere currently exists limited and conflicting clinical data on the use of statins amongst COVID-19 patients. Given the both paucity and lack of consensus among data on statins efficacy and safety amongst COVID-19 patients, the current guideline is to continue statin in COVID-19 patients, who have previously been treated with statins. The aim of this paper was to compare hospitalized patients with COVID-19 who did and did not receive statins, in terms of COVID-19 outcomes. MethodsWe conducted population-based retrospective study using South Koreas nationwide healthcare database as of May 15 2020. We identified 4,349 patients hospitalized with COVID-19 and aged 40 years or older. The cohort entry was defined as the date of hospitalization. Statin users were individuals with inpatient and outpatient prescription records of statins in the 240 days before cohort entry, and non-users were those without such records during this period. Our primary outcome was a composite endpoint of all-cause death, intensive care unit (ICU) admission, mechanical ventilation use and cardiovascular outcomes (myocardial infarction (MI), transient cerebral ischemic attacks (TIA) or stroke). We conducted inverse probability of treatment weighting (IPTW)-adjusted logistic regression analysis to estimate odds ratio (OR) and corresponding 95% confidence intervals (CI), to compare outcomes between statin users and non-users. Findings1,115 patients were statin users (mean age = 65.9 years; 60% female), and 3,234 were non-users (mean age = 58.3 years; 64% female). Statin use was not associated with increased risk of the primary outcome (IPTW OR 0.82; 95% CI: 0.60-1.11). Subgroup analysis showed a protective role of statins, for individuals with hypertension (IPTW OR 0.40; 95% CI: 0.23-0.69, p for interaction: 0.0087). InterpretationGiven that statins are not detrimental and that it may be beneficial amongst hypertensive patients and relatively cheap, we would encourage further investigation into statin for the prevention and treatment of COVID-19. FundingYGCs work was partially supported by 2020R1G1A1A01006229 awarded by the National Research Foundation of Korea. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThere is limited and conflicting data reporting on statin use among COVID-19 patients, and its association with COVID-19 outcomes Added value of this studyWe report no difference in COVID-19 outcomes between patients who used and did not use statins prior to COVID-19 diagnosis, except in hypertensive patients in which statins was shown to have a protective effect. Implications of all the available evidenceAs statins are not detrimental and relatively cheap, we encourage further investigation into statin for the prevention and treatment of COVID-19.

The protective association between statins use and adverse outcomes among COVID-19 patients: a systematic review and meta-analysis

IntroductionStatins may reduce a cytokine storm, which has been hypothesized as a possible mechanism of severe COVID-19 pneumonia. The aim of this study was to conduct a systematic review and meta-analysis to report on adverse outcomes among COVID-19 patients by statin usage. MethodsLiteratures were searched from January 2019 to December 2020 to identify studies that reported the association between statin usage and adverse outcomes, including mortality, ICU admissions, and mechanical ventilation. Studies were meta-analyzed for mortality by the subgroups of ICU status and statin usage before and after COVID-19 hospitalization. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately. ResultsThirteen cohorts, reporting on 110,078 patients, were included in this meta-analysis. Individuals who used statins before their COVID-19 hospitalization showed a similar risk of mortality, compared to those who did not use statins (HR 0.80, 95% CI: 0.50, 1.28; OR 0.62, 95% CI: 0.38, 1.03). Patients who were administered statins after their COVID-19 diagnosis were at a lower risk of mortality (HR 0.53, 95% CI: 0.46, 0.61; OR 0.57, 95% CI: 0.43, 0.75). The use of statins did not reduce the mortality of COVID-19 patients admitted to the ICU (OR 0.65; 95% CI: 0.26, 1.64). Among non-ICU patients, statin users were at a lower risk of mortality relative to non-statin users (HR 0.53, 95% CI: 0.46, 0.62; OR 0.64, 95% CI: 0.46, 0.88). ConclusionPatients administered statins after COVID-19 diagnosis or non-ICU admitted patients were at lower risk of mortality relative to non-statin users.

Colchicine use in patients with COVID-19: a systematic review and meta-analysis

IntroductionColchicine may inhibit inflammasome signaling and reduce proinflammatory cytokines, a purported mechanism of COVID-19 pneumonia. The aim of this systematic review and meta-analysis is to report on the state of the current literature on the use of colchicine in COVID-19 and to investigate the reported clinical outcomes in COVID-19 patients by colchicine usage. MethodsThe literature was searched from January 2019 through January 28, 2021. References were screened to identify studies that reported the effect of colchicine usage on COVID-19 outcomes including mortality, intensive care unit (ICU) admissions, or mechanical ventilation. Studies were meta-analyzed for mortality by the subgroup of trial design (RCT vs observational) and ICU status. Studies reporting an risk ratio (RR), odds ratio (OR) and hazard ratio (HR) were analyzed separately. ResultsEight studies, reporting on 16,248 patients, were included in this review. The Recovery trial reported equivalent mortality between colchicine and non-colchicine users. Across the other studies, patients who received colchicine had a lower risk of mortality - HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.22 (95% CI: 0.09, 0.57). There was no statistical difference in risk of ICU admissions between patients with COVID-19 who received colchicine and those who did not - OR of 0.26 (95% CI: 0.06, 1.09). ConclusionColchicine may reduce the risk of mortality in individuals with COVID-19. Further prospective investigation may further determine the efficacy of colchicine as treatment in COVID-19 patients in various care settings of the disease, including post-hospitalization and long-term care.

Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

OBJECTIVE: The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. METHODS: Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. RESULTS: Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. CONCLUSION: Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.

En Plaque Meningioma in Thoracic Spine: Case Report

Spinal en plaque meningioma is rarely found in the spinal canal, although lateral sphenoid wing meningioma displays a propensity for growth en plaque. We encountered a case of completely circumferential spinal en plaque meningioma, which is an even rarer condition. Herein, we report the CT & MRI findings along with a review of the related literature.

Post-Traumatic Syringomyelia Treated with Expansile Duraplasty and Syringosubarachnoid Shunt : Case Report

No abstract available.

Endovascular Treatment of Basilar Bifurcation Aneurysm with Open Access of Vertebral Artery

Microsurgical clipping is considered the treatment of choice for ruptured intracranial aneurysms. However, ruptured posterior circulation aneurysms remain technically difficult to expose or clip and outcomes in these cases are poorer than those seen in cases of anterior circulation aneurysms. Therefore, endovascular treatment becomes another treatment option in cases of ruptured posterior circulation aneurysms. But, the vertebral artery may not be selected due to luminal narrowing, which are atherosclerotic stenosis clinically, congenital anomalies, or acquired kinking, and structural problem of angle between aorta, subclavian artery and vertebral artery. In these cases, other approaches can be used through, for example, subclavian, axillary, or brachial artery approach. But sometimes such prcedures may be also inappropriate. One other approach is direct percutaneous vertebral artery approach. Though this one also doesn't overcome many clinical and anatomical problems. The authors present two cases of ruptured basilar tip aneurysms which was treated with endovascular Guglielmi detachable coil embolization with open surgery and catheterization, because the one had anatomical problem, and the other had structural problem.

Anterior Ceervical Interbody Fusion: Comparison Study between Simple Fusion, Locked and Non-locked Plating Systems

The use of metallic plate and screws in the anterior cervical fusion has become generally acceptable and popular. Mainly, there are two different plating systems available. However, there has been few attempts to compare their clinical results with and without a plating system or between two different systems in a single series of clinical study. The authors reviewed 117 patients who underwent anterior cervical fusion during the period of January 1992 to September 1996. Simple fusion without a plating system was applied in 55 cases(group 1), a bicortical non-locked plate screw system in 25(group 2), and a monocortical locked plate screw system in 37(group 3). The average follow-up period was 13. 2 months. In group 1, twenty-two patients(40%) with fracture-dislocation or corpectomy required a rigid brace such as halo brace and Minerva cast for 3 months postope ratively and seven patients(13%) experienced graft complications, mainly graft extrusion. In group 2 and 3, the patients required only soft b races for 4 to 8 weeks and no patients experienced serious graft complications like ones in group 1 but, instead two patients with screw breakages, two back-outs and one non-union were observed. In comparison of the clinical complications such as hoarsness, there were no significant differences between the groups. In conclusion, the plating system in anterior cervical fusion appears to be safe despite the facts that mo re technical demands are required during surgery. It also provides better postoperative stability in the spine and permits earlier ambulation without a rigid brace. A monocortical locked plate screw system appears to have less hardware failures and better su rgical results than a bicortical non-locked plate screw system.

Management of Perimedullary Giant Arteriovenous Fistula(Type IV c)by Embolization Operative Ligation

Intradural perimedullary arteriovenous fistulas(type IV spinal cord arteriovenous malformations) that occur at cervical level are rarely reported in the literature. A twelve year-old male patient was presented with suddenly developed progressing quadriparesis. MR imaging and angiography demonstrated focal intramedullary hemorrage at C5 vertebral level and intradural perimedullary arteriovenous fistula at C4 vertebral level and ectatic endocranial venous drainage, fed by anterior spinal artery, radicular branch of right vertebral artery, right thyrocervical trunk. The large draining vein ascends toward and into the posterior fossa along route which was anterior to the lower brain stem. The initial treatment consisted of selective embolization of arterial feeders arising from the right thyrocervical trunk and anterior spinal artery. The embolization procedures were performed using GDC coil. Eight days after embolization, corpectomy was performed at the C4-5 level and fistula ligation was done. Following these procedures, the patient has progressively improved in motor and sensory function and post operative angiogram revealed disappearance of fistula and abnormal endocranial venous drainage.

Neurilemmomas of the Cervicla Vagus Nerve: A Case Report

A case of the recurrent neurilemmoma of vagus nerve in the neck is presented. It was located in the upper third of the right lateral neck. The patient was presented with hoarseness and monoparesis of the right arm. The tumor was composed of large cystic portion and solid nodule in the right carotid fossa. Since total surgical removal of the tumor could cause functional deterioration of the involved vagus nerve, it was removed by means of intracapsular enucleation. Postoperatively, the monoparesis of the right arm was disappeared with preservation of vagus nerve function. It would appear that an intracapsular enucleation may be advisible in some cases of neurilemmomas of the cervical vagus nerve to maintain the function of the involved vagus nerve.

Intraoperative Facial EMG Monitoring during Decompression Operation for Hemifacial Spasm

Hemifacial spasm is a relatively uncommon but distressing condition characterized by insiduous development of paroxysmal, involuntary, unilateral hyperkinetic facial movement. In patients with hemifacial spasm, there is an abnormality in the facial nerve or its nucleus which allows the stimulus applied to one branch of the facial nerve to spread to other branches of that same nerve. This lateral spread response is presumed to be due to cross transmission of the antidromic activity in the branch of the facial nerve, and intraoperative monitoring of lateral spread responses provides a useful way of confirming complete facial nerve decompression. In 17 consecutive patients, intraoperative electromyographic(EMG) recordings were made from facial muscles during microvascular decompression for hemifacial spasm. At the beginning of the operation, electrical stimulation of the temporal or zygomatic branch of the facial nerve gave rise to electrically recordable activity in the mentalis muscle(lateral spread), with a latency of about 10msec, that in ten patients, lasted until the facial nerve was decompressed; In seven patients, however, it disappeared when the arachnoid membrane was opened. Early disappearance of lateral spread was frequently occurred in single offending vessel or cases where there was loose compression. Postsurgically the 16 patients in whom the lateral spread response disappeared totally were free from spasm after the operation and in the remaining patient, there was much improvement. These results support the use of lateral spread response monitoring during decompression surgery for hemifacial spasm, and provide strong circumstantial evidence that vascular cross-compression is an important etiologic factor in hemifacial spasm. During a decompression operation for hemifacial spasm, the authors now routinely monitor facial EMG response.

Intradural Dissecting Aneurysms Treated by Extreme Lateral Transcondylar Approach(2 cases)

We expierenced two cases of intradural verteral artery dissecting aneurysms. The presenting symptom was subarachnoid hemorrhage in one case and ischemic symptom in the other. The preoperative angiographic finding typically showed fusiform dilatation and proximal and/or distal narrowing of the affected artery. In one case, the vertebral artery was clipped distal to the PICA and in the other case trapping was performed through the extreme lateral transcondylar approaches. This approach permits a control of the aneurysm through the direct view of whole length of the vertebral artery, lower cranial nerves and ventral brain stem. In order to obtain ample view and to save the lower cranial nerves and perforating vessels, jugular tubercle should be sufficiently drilled out. Postoperitive neurological outcomes were favorable except mild hoarseness for some period in trapping case.