Impact of Tocilizumab on Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: A Single-Center Experience

Background: Tocilizumab is an interleukin-6 receptor antagonist hypothesized to blunt the uncontrolled immune response, cytokine release syndrome, in severe COVID-19 and prevent attributable morbidity and mortality. Objective: The objective of this study was to assess the impact of tocilizumab on clinical outcomes in COVID-19-associated cytokine release syndrome. Methods: Single-center, retrospective cohort study assessing sixty-nine adult patients receiving tocilizumab for suspected COVID-19 cytokine release syndrome. The primary outcome was change in WHO clinical status scale on day seven post-dose analyzed using the Wilcoxon signed rank test. Secondary outcomes assessed impact of timing of administration on clinical outcome. Safety analyses included development of neutropenia, thrombocytopenia, transaminitis, and sepsis within 7 days post-dose. Statistical analyses were conducted using Microsoft Excel. Results: No aggregate clinical change was found between day 0 and day 7. Eleven patients improved, twenty-seven worsened, and thirty-one showed no change. Clinical outcomes were weakly correlated with time from symptom onset (rs = 0.21; p = 0.08) or hospital admission (rs = -0.08; p = 0.49) to dose. In-hospital mortality was 63%. Sepsis was diagnosed in 21 patients, five of which were post-dose. Transaminitis, neutropenia, and thrombocytopenia occurred in seven, one, and six patients, respectively. Conclusion: Tocilizumab did not appear to influence clinical outcomes in our study population, irrespective of timing of administration. Adverse events were not considered drug-related.

Download Full-text

“Tocilizumab-an option for patients with COVID-19 associated cytokine release syndrome: A single center experience”, a retrospective study-original article

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2021.02.011 ◽

2021 ◽

Vol 63 ◽

pp. 102165

Author(s):

Aijaz Zeeshan Khan Chachar ◽

Khurshid Ahmed Khan ◽

Javeid Iqbal ◽

Adnan Hussain Shahid ◽

Mohsin Asif ◽

...

Keyword(s):

Retrospective Study ◽

Cytokine Release ◽

Cytokine Release Syndrome ◽

Single Center ◽

Single Center Experience

Download Full-text

Repeat and Relapsing Peritonitis Microbiological Trends and Outcomes: A 21-Year Single-Center Experience

International Journal of Nephrology ◽

10.1155/2021/6662488 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Marina Reis ◽

Catarina Ribeiro ◽

Ana Marta Gomes ◽

Clara Santos ◽

Daniela Lopes ◽

...

Keyword(s):

Clinical Outcomes ◽

Catheter Removal ◽

Control Group ◽

Single Center ◽

Cure Rate ◽

Technique Survival ◽

Tenckhoff Catheter ◽

Single Center Experience ◽

The Impact ◽

Multiple Episodes

Peritonitis is a major peritoneal dialysis complication. Despite a high cure rate, relapsing and repeat peritonitis is associated with Tenckhoff catheter biofilm and multiple episodes of peritoneal damage. In relapsing peritonitis, prompt catheter removal is mandatory; otherwise, in repeat peritonitis, there is not a clear indication for catheter removal. It is questionable if the approach to removal should be different. There are few recent data on repeat and relapsing peritonitis microbiology and clinical outcomes since most studies are from the past decade. This study evaluates the microbiology, clinical outcomes, and impact of relapsing and repeat peritonitis on technique survival and the impact of catheter removal in development of further peritonitis episodes by the same microorganism. We developed a single-center retrospective study from 1998 to 2019 that compared repeat and relapsing peritonitis with a control group in terms of causative microorganisms, cure rate, catheter removal, and permanent and temporary transfer to hemodialysis. We also compared repeat and relapsing peritonitis clinical outcomes when Tenckhoff catheter was not removed. Comparing to the control group, the repeat/relapsing group had a higher cure rate (80.4% versus 74.5%, p = 0.01 ) and lower rate of hospitalization (10.9% versus 27.7%, p = 0.01 ). Technique survival was superior in the repeat/relapsing group (log rank = 4.5, p = 0.03 ). Gram-positive peritonitis was more common in the repeat/relapsing group especially Streptococci viridans (43.5% versus 21.3%, p = 0.01 ) and Gram-negatives in the control group (26.6% vs 9.0%, p = 0.02 ). When the Tenckhoff catheter was not removed after a repeat episode, 58.6% developed a new repeat/relapsing episode versus 60.0% in the relapsing group. Although repeat and relapsing peritonitis have a higher cure rate, it leads to further episodes of peritonitis and consequent morbidity. When Tenckhoff catheter was not removed, the probability of another peritonitis episode by the same microorganism is similar in repeat and relapsing peritonitis.

Download Full-text

The Impact of Peritonitis on Clinical Outcomes of PD Patients: A Single Center Experience

Turkish Journal of Nephrology ◽

10.5152/turkjnephrol.2019.3155 ◽

2019 ◽

Vol 28 (1) ◽

pp. 54-61

Author(s):

Zuhal Atan Ucar ◽

◽

Yener Koc ◽

Taner Basturk ◽

Feyza Bayraktar Caglayan ◽

...

Keyword(s):

Clinical Outcomes ◽

Single Center ◽

Single Center Experience ◽

The Impact

Download Full-text

Clinical Outcomes of Venoarterial Extracorporeal Life Support in 462 Patients: Single-Center Experience

10.1055/s-0040-1705490 ◽

2020 ◽

Author(s):

K. Zhigalov ◽

A. Alofesh ◽

J. Easo ◽

H. Eichstaedt ◽

J. Ennker ◽

...

Keyword(s):

Clinical Outcomes ◽

Life Support ◽

Extracorporeal Life Support ◽

Single Center ◽

Single Center Experience

Download Full-text

Maxillary expansion or contraction and occlusal contact adjustment: effectiveness of current aligner treatment

Clinical Oral Investigations ◽

10.1007/s00784-021-03780-4 ◽

2021 ◽

Author(s):

Ulrike Riede ◽

Sandra Wai ◽

Sabrina Neururer ◽

Bärbel Reistenhofer ◽

Gregor Riede ◽

...

Keyword(s):

Clinical Outcomes ◽

Measuring Method ◽

Rank Test ◽

Treatment Goals ◽

Maxillary Expansion ◽

Clinical Model ◽

Occlusal Contact ◽

Planning Software ◽

Signed Rank ◽

Signed Rank Test

Abstract Objectives To evaluate the precision of aligner (Invisalign®) treatment with the current material (SmartTrack®) in achieving expansion or contraction of the maxilla and occlusal contacts as simulated in the proprietary planning software (ClinCheck®, CC). Materials and methods Thirty patients thus treated were retrospectively evaluated. Four maxillary models were analyzed per patient: a pretreatment model, a scan-based CC model, a posttreatment clinical model, and a CC model reflecting the treatment outcome as initially simulated. Thirteen transverse parameters were measured on each model separately by two investigators. Occlusal contacts were also analyzed. Results The measuring method was validated by both investigators arriving at similar results for the effectiveness by which the simulated treatment goals had been clinically achieved. Significant differences (p < 0.05; Wilcoxon signed-rank test) were observed for transfer precision from the casts to the planning software and between the simulated and clinical outcomes. Intense occlusal contacts in the simulations materialized less common (≈ 2%) than ideal contacts (≈ 60%) in the clinical outcomes. Conclusions The effectiveness of achieving the simulated transverse goals was 45% and was generally not found to be better with SmartTrack® than with the previously used Ex30® material. Out of 100 simulated occlusal contacts, 40 will never materialize, and achieving around 60 will adequately ensure a clinically favorable contact pattern. Clinical relevance With the caveat that any overcorrection will to some extent reduce the precision, it seems perfectly possible to make deliberate use of overcorrection in current aligner therapies for transverse maxillary expansion or contraction.

Download Full-text