Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series

The cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of hyperinflammatory state and might also be effective in COVID-19 disease. However, the best dosing regimen and the timing of infusion is currently unknown, specifically in obese patients. We report the first cases of tocilizumab administration in obese patients during the first days of COVID-19 worsening hypoxemia. This infusion was not adjusted by weight, following the manufacturer maximal dose limit. We kept a strict monitoring for possible infections, prior and during the treatment. All patients showed good improvements on chest-computed tomography images and oxygenation and were discharged from hospital shortly after, without complications or intubation. This case series highlights that tocilizumab seems to be effective to treat hyperinflammation of critical COVID-19 obese patients, even when the infusion of the ideal dose is not feasible to be administered. It also shows the importance of early timing in the decision to treat and the relevance of infections exclusion prior to the induction of immunosuppression by tocilizumab.

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Faculty Opinions recommendation of Effect of a single-cycle alternative dosing regimen for rituximab for recalcitrant pemphigus: a case series of 9 patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13952990.15408103 ◽

2012 ◽

Author(s):

Silke Hofmann

Keyword(s):

Case Series ◽

Dosing Regimen ◽

Single Cycle

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Durable ventricular assist device implantation for systemic right ventricle: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa359 ◽

2020 ◽

Author(s):

Naoki Tadokoro ◽

Satsuki Fukushima ◽

Takaya Hoashi ◽

Shin Yajima ◽

Takura Taguchi ◽

...

Keyword(s):

Right Ventricle ◽

Ventricular Assist Device ◽

Case Series ◽

Transoesophageal Echocardiography ◽

Class Iii ◽

Assist Device ◽

Ventricular Assist ◽

Systemic Right Ventricle ◽

Computed Tomography Images ◽

Atrial Switch

Abstract Background A systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood. Case summary Four patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients. Discussion The indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.

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Roux-en-Y gastric bypass in dialysed morbidly obese patients as a preparation for a kidney transplantation: case series

Videosurgery and Other Miniinvasive Techniques ◽

10.5114/wiitm.2011.32852 ◽

2013 ◽

Vol 2 ◽

pp. 174-177 ◽

Cited By ~ 1

Author(s):

Monika Proczko ◽

Łukasz Kaska ◽

Jarek Kobiela ◽

Tomasz Stefaniak ◽

Dariusz Zadrożny ◽

...

Keyword(s):

Gastric Bypass ◽

Kidney Transplantation ◽

Case Series ◽

Morbidly Obese ◽

Obese Patients

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Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report

Diabetes Metabolic Syndrome and Obesity Targets and Therapy ◽

10.2147/dmso.s9981 ◽

2010 ◽

Vol Volume 3 ◽

pp. 281-283 ◽

Cited By ~ 20

Author(s):

Robert J. Tanenberg ◽

Walter J. Pories

Keyword(s):

Gastric Bypass ◽

Type 1 Diabetes ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Case Series ◽

Obese Patients ◽

Case Series Report ◽

Severely Obese ◽

Series Report

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Diagnosis of lung cancer: a necropsy-based study of 128 cases (1997–2016)

Tumori Journal ◽

10.1177/0300891620949665 ◽

2020 ◽

pp. 030089162094966

Author(s):

Pietro Gino Barbieri ◽

Dario Mirabelli

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Case Series ◽

The Elderly ◽

Positive Finding ◽

Chest Computed Tomography ◽

Pleural Plaques ◽

High Prevalence ◽

Diagnosis Of Lung Cancer ◽

Clinical Records

Background: The diagnosis of lung cancer (LC) may be difficult to make in the elderly. We report on the diagnostic elements available in life in an LC necropsy case series of asbestos-exposed workers and describe the frequency of non-neoplastic asbestos-related diseases as biological exposure indices. Methods: We reviewed pathologic and clinical records of an unselected series of autopsies (1997–2016) in patients with LC employed in the Monfalcone shipyards. We assessed the consistency with autopsy results of diagnoses based on, respectively, radiologic, cytologic, and histologic findings. Results: Data on 128 autopsy-confirmed LC cases were available; in life, 119 had been diagnosed as LC. Among these, 49 had histologic confirmation of diagnosis (17 with immunophenotyping); histology had been negative in 4. Cytology had been the main positive finding and the basis for diagnosis in 24 cases, but had been negative in 13. Chest computed tomography had been the basis for diagnosis in 45; in 18 cases, it had been negative. Nine patients had received a diagnosis different from LC, among whom 4 had been suspected to have malignant pleural mesothelioma by chest computed tomography. Pleural plaques were found in 124 and histologic asbestosis in 46 cases. Conclusions: Autopsies confirmed all LC diagnoses received in life, including 46 that would have been considered only possible LC based on clinical workup. The overall survival in this case series was poor. The high prevalence of pleural plaques and asbestosis suggest severity of asbestos exposures.

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Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans

Clinical Kidney Journal ◽

10.1093/ckj/sfaa086 ◽

2020 ◽

Vol 13 (3) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Rui Wang ◽

Hong He ◽

Cong Liao ◽

Hongtao Hu ◽

Chun Hu ◽

...

Keyword(s):

Computed Tomography ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Ground Glass Opacity ◽

High Sensitivity ◽

Chest Ct ◽

Maintenance Hemodialysis ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Reactive Protein

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide. Methods We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans. Results Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead. Conclusions Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.

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The utility of chest computed tomography (CT) and RT-PCR screening of asymptomatic patients for SARS-CoV-2 prior to semiurgent or urgent hospital procedures

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.331 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1375-1377 ◽

Cited By ~ 1

Author(s):

Aditya S. Shah ◽

Lara A. Walkoff ◽

Ronald S. Kuzo ◽

Matthew R. Callstrom ◽

Michael J. Brown ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Tertiary Care ◽

Case Series ◽

Chest Ct ◽

Study Cohort ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Tertiary Care Medical Center ◽

Asymptomatic Patients

AbstractObjective:Presently, evidence guiding clinicians on the optimal approach to safely screen patients for coronavirus disease 2019 (COVID-19) to a nonemergent hospital procedure is scarce. In this report, we describe our experience in screening for SARS-CoV-2 prior to semiurgent and urgent hospital procedures.Design:Retrospective case series.Setting:A single tertiary-care medical center.Participants:Our study cohort included patients ≥18 years of age who had semiurgent or urgent hospital procedures or surgeries.Methods:Overall, 625 patients were screened for SARS-CoV-2 using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest computed tomography (CT) between March 1, 2020, and April 30, 2020.Results:Of the 625 patients, 520 scans (83.2%) were interpreted as normal; 1 (0.16%) had typical features of COVID-19; 18 scans (2.88%) had indeterminate features of COVID-19; and 86 (13.76%) had atypical features of COVID-19. In total, 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with a CT scan that yielded an atypical finding. Of the 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab 1 week after their initial swab. Also, 1 patient with a chest CT categorized as typical had a follow-up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. After surgery, none of the patients developed signs or symptoms suspicious of COVID-19 that would indicate the need for a repeated RT-PCR or CT scan.Conclusion:In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low-prevalence population.

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