Anakinra for severe forms of COVID-19: a cohort study
Coronaviruses can induce the production of interleukin (IL)-1β, IL-6, tumour necrosis factor, and other cytokines implicated in autoinflammatory disorders. It has been postulated that anakinra, a recombinant IL-1 receptor antagonist, might help to neutralise the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related hyperinflammatory state, which is considered to be one cause of acute respiratory distress among patients with COVID-19. This study aimed to assess the off-label use of anakinra in patients who were admitted to hospital for severe forms of COVID-19 with symptoms indicative of worsening respiratory function.
Link: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30164-8/fulltext
Low-cost dexamethasone reduces death by up to one third in hospitalized patients with severe respiratory complications of COVID-19
In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK. A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
Link: https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf
Updated Management Guidelines for Clostridioides difficile in Paediatrics
Clostridioides difficile is a spore-forming, anaerobic, Gram-positive bacterium. It causes infections (CDI) varying from self-limited diarrhoea to severe conditions, including toxic megacolon and bowel perforation. The article is to review diagnostic laboratory methods and discuss the most recent recommendations on CDI treatment in children. Vancomycin represents the first-line therapy for CDI, although in children metronidazole can still be used as a first-line drug. Fidaxomicin is a new treatment option with equivalent initial response rates as vancomycin but lower relapse rates of CDI. Actoxumab and bezlotoxumab, two human monoclonal antibodies (represent a future perspective against CDI) targeting C. difficile toxins A and B, respectively, have been developed, and two phase 3 clinical trials (MODIFY I and MODIFY II) studied the two antibodies’ efficacy to decrease recurrence in 2655 patients.
Link: https://www.mdpi.com/2076-0817/9/4/291/htm
Pancreatic cystic lesions in diabetes mellitus patients
Article review the frequency and risk factors of cystic lesions in diabetic patients. DM seems to play a major role in the process of cyst development, especially in patients without previous history of pancreatitis. Pseudocysts are the most common cystic lesions and may be formed in the setting of acute or chronic pancreatitis. Prevalence of cystic lesions was significantly higher in metformin users in comparison to other diabetic patients (p < 0.05).
