Experience with the use of siltuximab in patients with SARS-CoV-2 infection.

OBJECTIVE: The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS: Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS: The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS: Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.

Real-life use of remdesivir in hospitalized patients with COVID-19.

OBJECTIVE: Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. METHODS: We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. RESULTS: A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. CONCLUSIONS: In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.

Actualidad en el diagnóstico y manejo del acretismo placentario / Update on the diagnosis and treatment of placenta accreta

El acretismo placentario es una entidad que incrementa considerablemente la morbimortalidad materna y fetal. Gracias al advenimiento de nuevos métodos diagnósticos como la resonancia magnética, la cistoscopia, los marcadores séricos, el ultrasonido doppler, etc., el diagnóstico prenatal es factible. El manejo del acretismo placentario de forma tradicional supone la realización de histerectomía multidisciplinaria, involucrando a cirujanos generales, oncoginecólogos o uroginecólogos. Algunos autores han propuesto al manejo conservador como una solución adecuada en ciertos casos, ya sea con el uso de diversos medicamentos que incluyen quimioterápicos o bien de forma expectante. Sin embargo, aún no existe evidencia sólida que determine si el manejo conservador o tradicional es el mejor.

Placenta accreta supposes a special situation that increases the fetal and maternal mo rb i mortality of considerable form. Thanks all new arrival methods as the image of magnetic resonance, the cystoscopy, serum markers, doppler ultrasound, etc., the prenatal diagnostic is feasible. The management of placenta accreta of traditional form supposes a multidisciplinary approach form hysterectomy execution, involving general surgeons, oncogynecologist or urogynecologist. Some authors have proposed the conservative management as an adequate solution in certain cases, whether with the use of several drugs including chemotherapy or expectant form. Nevertheless, not yet solid evidence exists if the surgical traditional approach or the conservative management is the best option.

Post-stroke movement disorders: report of 56 patients.

BACKGROUND: Although movement disorders that occur following a stroke have long been recognised in short series of patients, their frequency and clinical and imaging features have not been reported in large series of patients with stroke. METHODS: We reviewed consecutive patients with involuntary abnormal movements (IAMs) following a stroke who were included in the Eugenio Espejo Hospital Stroke Registry and they were followed up for at least one year after the onset of the IAM. We determined the clinical features, topographical correlations, and pathophysiological implications of the IAMs. RESULTS: Of 1500 patients with stroke 56 developed movement disorders up to one year after the stroke. Patients with chorea were older and the patients with dystonia were younger than the patients with other IAMs. In patients with isolated vascular lesions without IAMs, surface lesions prevailed but patients with deep vascular lesions showed a higher probability of developing abnormal movements. One year after onset of the IAMs, 12 patients (21.4%) completely improved their abnormal movements, 38 patients (67.8%) partially improved, four did not improve (7.1%), and two patients with chorea died. In the nested case-control analysis, the patients with IAMs displayed a higher frequency of deep lesions (63% v 33%; OR 3.38, 95% CI 1.64 to 6.99, p<0.001). Patients with deep haemorrhagic lesions showed a higher probability of developing IAMs (OR 4.8, 95% CI 0.8 to 36.6). CONCLUSIONS: Chorea is the commonest movement disorder following stroke and appears in older patients. Involuntary movements tend to persist despite the functional recovery of motor deficit. Deep vascular lesions are more frequent in patients with movement disorders.

Does willingness to pay vary by race/ethnicity? An analysis using mammography among low-income women.

As part of a population-based intervention to improve periodic mammogram screening, we examined WTP for mammography in five ethnic groups. Through random digit dialing, we contacted households in low-income census tracts of Alameda County, California (San Francisco Bay area). Women who met the ethnicity, age and cancer-free eligibility criteria were invited to participate. For the baseline assessment, women were surveyed over the phone in their preferred language. Of the 1465 surveyed women, 499 identified themselves as African-American, 199 were Chinese, 167 were Filipino, 300 were Latina, and 300 were non-Hispanic white. Bivariate and multivariate analysis showed that WTP varied significantly by ethnicity (P<0.05). We also found that when Filipino and Chinese women had a female relative with breast cancer, they were willing to pay less money for a mammogram. African-American, Latino, and non-Hispanic white women, however, were willing to pay more money for a mammogram if a female relative had had breast cancer. This ethnic difference, when there is a familial link to breast cancer, needs further study as it has implication for genetic testing. Nevertheless, WTP studies that do not account for ethnic differences may be overstating net benefits to society.

Células NK en la infección VIH-1 / NK cells in HIV-1 infection

La inmunodeficiencia producida por el virus de la inmunodeficiencia humana (VIH-1), puede ser una consecuencia de la estrategia que el virus lleva a cabo para sobrevivir en el huésped. La infección por VIH-1 no sólo afecta a las células CD4+ sino también a otros componentes de la respuesta adaptativa e innata. Cada día mayor número de trabajos apoyan la idea de que la función de las células NK, que son un componente esencial del sistema inmunitario innato y también del adaptativo, están dañadas durante la infección por VIH-1. Sin embargo, no se conoce ni la magnitud del deterioro de estas células ni su contribución al progreso de la enfermedad. En nuestro laboratorio, estamos analizado las bases celulares y moleculares del defecto funcional de las células NK de individuos infectados por VIH-1. Consideramos que el conocimiento del papel de las células NK en la infección VIH-1 contribuirá a un mejor entendimiento de la patogénesis del síndrome de inmunodeficiencia adquirida (SIDA). (AU)

Willingness to pay for mammography: item development and testing among five ethnic groups.

The goal of this study was to develop a willingness to pay (WTP) question for mammography that is appropriate for low income, ethnically-diverse women. Through qualitative research with 50 low income women of five ethnic groups we developed both a WTP question and a willingness to travel question (WTT). After being refined through interviews with 41 women, these questions were pilot tested on a random sample of 52 low income, ethnically-diverse women in the San Francisco area. Results show that the concepts underlying WTP and WTT were culturally appropriate to the five ethnicities in this study. Analyses generally confirm the validity of the WTP and WTT questions. As expected, WTP was associated with household income, perceived risk of cancer, and knowledge that one needs a mammogram even after a clinical breast examination. Despite the small samples, WTP varied among the ethnic groups. Additionally, WTT was moderately correlated with the natural log of WTP (r = 0.58, P < 0.001). These questions are now in use in a larger clinical trial and future analyses will explore willingness to pay and willingness to travel within and across the ethnic groups.

Movement disorders in 30 patients with tuberculous meningitis.

BACKGROUND: Movement disorders may appear during tuberculous meningitis (TbM). OBJECTIVE: To investigate the variety of movement disorders seen in TbM and consider possible pathogenic mechanisms. DESIGN: We established two diagnostic categories for TbM: definite and probable. All patients were examined clinically and with laboratory tests, computed tomographic scan, or magnetic resonance imaging. SETTING: A university hospital in Quito, Ecuador. RESULTS: Thirty of 180 consecutively studied patients with TbM developed movement disorders. Twenty-four months after treatment was completed, we determined a prognosis for the patients. Seven patients had chorea, three dystonia, and 20 tremor. One of the patients with tremor also had myoclonus and one with dystonia had tremor. The average age of the patients with chorea was lower than that of the patients with dystonia and tremor. Two patients with chorea, one with dystonia, and three patients with tremor died. The patients with chorea and dystonia had more severe disease. We found little correlation between the type, distribution, or severity of abnormal movements and the computed tomography scan or magnetic resonance image findings. CONCLUSIONS: Tremor is the most common movement disorder seen in the course of TbM. Chorea is more frequently found in young children. Deep vascular lesions are more common among patients with movement disorders.

Mediastinal mass following chemotherapy in patients with Ewing sarcoma and osteosarcoma.

Thymic hyperplasia following combination chemotherapy for malignant disease is very uncommon in adolescents and adults. Our experience includes a thymic enlargement noted on the sequential computed tomography (CT) in three patients who were disease-free after chemotherapy for Ewing sarcoma (2) and osteosarcoma (1). The development of an anterior mediastinal mass after successful chemotherapy does not always imply relapse of malignant disease. To prevent inappropriate treatment, the possibility of benign aetiology must be considered.

[Society, family, and gender in Santa Fe, New Granada, until the end of the colony]. / Sociedad, familia y genero en Santafe, Nueva Granada, a finales de la colonia.

PIP: The author examines family structure in Santa Fe, the capital of New Granada, a Spanish colony that included Colombia, Ecuador, Panama, and Venezuela. The focus is on the late eighteenth and early nineteenth centuries. He finds that social class structure was closely related to ethnic group and skin color, and that the sex ratio was biased toward women. Women also headed nearly 50% of all households. Data are mainly from the 1801 smallpox census.^ieng

Cerebral cysticercosis and stroke.

BACKGROUND AND PURPOSE: In 1985 we initiated a protocol for examining the relationship between cerebral cysticercosis and stroke. METHODS: In 420 stroke patients admitted to our department, our standard protocol of tests included blood tests, cardiac investigations, angiography, and immunologic cerebrospinal fluid measures. We assessed the following possible risk factors: arterial hypertension, diabetes, cardiopathy, high levels of cholesterol and triglycerides, smoking, alcohol abuse, and cerebral cysticercosis. RESULTS: Of the 420 patients with stroke, we found cerebral cysticercosis in 31, five of whom were greater than 65 years of age and 26 of whom were less than or equal to 65 years. We determined that cerebral cysticercosis was the only possible risk factor for stroke in one of the five older patients and 15 of the 26 younger and middle-aged patients. Cortical infarctions were found in five of the 31 patients, with cerebral cysticercosis and lacunar infarctions in nine of these patients. One patient had intracystic hemorrhage. In 16 cases, neurological deficit was related to single or multiple cysts, colloids, granulomas, diffuse lesions, or pericystic edema. All patients with cerebral cysticercosis quickly recovered from their neurological deficit, except one who had a hemorrhagic cyst and died and another who remained disabled. CONCLUSIONS: We established that, in patients with neurocysticercosis, occlusion of the small cortical or penetrating vessels at the base of the brain caused by arteriopathy was the most common mechanism of the stroke. Moreover, there is a probable association between cerebral cysticercosis and the susceptibility to stroke, particularly among young and middle-aged patients.

Tuberculous meningitis. Short course of chemotherapy.

In March 1986, we began a 6-month short course trial of therapy for tuberculous meningitis, in which 28 patients were analyzed. The diagnosis was based on the following cerebrospinal fluid test results: in 53.5% of the cases, Mycobacterium tuberculosis was identified by direct smear; in 57%, culture in Löwenstein-Jensen medium was positive; in 83.3%, the detection of anti-bacille Calmette-Guérin (BCG) antibodies by enzyme-linked immunosorbent assay was positive; and in 74%, the dosification of adenosine deaminase activity was positive. In addition, in 21.4% of the cases, the diagnosis was established by means of autopsy findings. Moreover, the diagnosis was supported by bacteriological analyses from another tissue or body fluids. Despite the administration of an antituberculous therapy, 32.4% of the patients died: all of the decreased had reached the last stage of the disease by the beginning of treatment. Sixteen percent of the patients who survived after more than 18 months of follow-up after therapy had ended suffered neurological sequelae. With the 6-month therapeutic regimen, the morbidity/mortality is similar to that found in the longer-course therapies. The latter regimen is therefore thought to be a good and acceptable therapeutic option for the treatment of tuberculous meningitis.

Neurocysticercosis. Short course of treatment with albendazole.

Eighteen patients with nonenhancing parenchymal brain cysts were treated with albendazole; 9 patients were treated for 3 days and 9 patients for 1 month at daily doses of 15 mg/kg of body weight. Three months after starting therapy, results showed that in both groups the treatment was highly effective. Control studies carried out in the same group before the trial did not show any significant improvement. Five patients were controls and were treated only with symptomatic drugs. The total diameter of the lesions was reduced from 220.1 mm to 52.1 mm, which signifies a reduction of 76.3% in patients treated for a period of 3 days, and from 278.5 mm to 82.1 mm, which is 70.5%, in patients treated for 30 days. We conclude that albendazole administered according to the 3-day therapeutic scheme proposed above is as highly effective for the treatment of parenchymal brain cysticercosis as the 30-day scheme.