scholarly journals Experience with the use of recombinant humanized monoclonal antibodies to the human receptor for interleukin-6 in patients with CoVID-19

2020 ◽  
Vol 12 (3) ◽  
pp. 28-33 ◽  
Author(s):  
D. А. Gusev ◽  
М. А. Vashukova ◽  
I. P. Feduniak ◽  
V. B. Musatov ◽  
V. A. Kapatsyna
Keyword(s):  
Interleukin 6 ◽  
Careful Analysis ◽  
Global Challenge ◽  
Reactive Protein ◽  
Humanized Monoclonal Antibody ◽  
Pathogenetic Therapy ◽  
Duration Of Hospitalization ◽  
Coronavirus Infection ◽  
Severity Of The Disease ◽  
Human Receptor

The new coronavirus infection (COVID-19) has become a truly global challenge for all of humanity, and, above all, for the healthcare system. Among its most important aspects requiring careful analysis are the clinical and laboratory features of the course of the disease, which make it possible to determine approaches to pathogenetic therapy in severe forms of the disease. Materials and methods. A retrospective analysis of medical records of patients (n = 31) of severe COVID-19 patients who were hospitalized in St. Petersburg City Clinical Hospital for Infectious Diseases named after S.P. Botkin ”in March – May 2020. Clinical and laboratory characteristics were evaluated, including the level of ferritin, C-reactive protein, D-dimer, interleukin-6, depending on the severity of the disease. The criteria for the appointment of a recombinant humanized monoclonal antibody to the human receptor for interleukin-6 (INN – tocilizumab) in patients with a severe course of the disease and its effectiveness are determined. Results. In the treatment of severe patients with COVID-19, it is necessary to carefully evaluate the clinical picture of the course of the disease, which may be ahead of changes in laboratory parameters. The introduction of tocilizumab leads to a rapid regression of general infectious symptoms, subjective and objective manifestations of respiratory failure and, as a consequence, a decrease in the duration of hospitalization. It is extremely important that the drug is administered in a timely manner during the rise of the “cytokine storm”. The time for optimal administration of tocilizumab begins from 8-9 days from the onset of the disease, until the patient is transferred to mechanical ventilation.

scholarly journals tocilizumab in the treatment of systemic inflammatory response in a patient with CoVID-19 (clinical case)

2020 ◽  
Vol 12 (3) ◽  
pp. 90-93
Author(s):  
D. D. Avdoshina ◽  
A. G. Dyachkov ◽  
D. A. Gusev
Keyword(s):  
Monoclonal Antibody ◽  
Inflammatory Response ◽  
Clinical Experience ◽  
Interleukin 6 ◽  
Clinical Case ◽  
Saint Petersburg ◽  
Humanized Monoclonal Antibody ◽  
Anticytokine Therapy ◽  
Human Receptor

Improving the approaches to treating COVID-19 infection opens up the possibility for using previously known groups of drugs that demonstrate their effectiveness in the pathogenetic treatment of this disease. Significant clinical experience in the field of treatment of COVID-19 have been accumulated in Clinical Infectious Diseases Hospital named after S.P. Botkin, Saint-Petersburg, Russia. The case study demonstrates the timeliness and effectiveness of anticytokine therapy with COVID-19, the possibility of using a recombinant humanized monoclonal antibody to the human receptor for interleukin-6 (IL-6) (tocilizumab).

scholarly journals Possibilities of immunocorrection in COVID-19 therapy of patients on an outpatient basis

2021 ◽  
Vol 5 (7) ◽  
pp. 468-472
Author(s):  
L.R. Mukhamadieva ◽  
◽  
G.A. Mavzyutova ◽  
G.Kh. Mirsayeva ◽  
G.M. Khasanova ◽  
...  
Keyword(s):  
Standard Therapy ◽  
Comparison Group ◽  
Main Group ◽  
Outpatient Basis ◽  
Moderate Degree ◽  
Reactive Protein ◽  
Complex Therapy ◽  
Pathogenetic Therapy ◽  
Coronavirus Infection ◽  
Russian Medical

Aim: to evaluate the clinical efficacy of azoximer bromide inclusion in the complex therapy of patients with a confirmed diagnosis of COVID-19 (moderate degree) who were receiving treatment on an outpatient basis. Patients and Methods: data from medical records of 100 patients who were treated in outpatient clinics for COVID-19 in Ufa (June–November 2020) were retrospectively evaluated. There were 2 groups of 50 patients: the main group receiving azoximer bromide and the comparison group receiving only standard therapy. The criteria for evaluating the therapy efficacy were the dynamics of the disease clinical picture, laboratory parameters characterizing inflammation. Results: in the main group, the relief of complaints and a significant condition improvement according to physical examination were recorded significantly earlier — after 9.68±5.23 days versus 13.00±4.95 days in the comparison group (p=0.0012). The period of body temperature normalization in patients receiving immunomodulatory therapy was 7.20±1.41 days, which is significantly less than in patients receiving standard therapy — 16.20±2.74 days (p=0.0001). When contacting the outpatient clinic, all patients had an increase in the level of C-reactive protein: in the main group — up to 13.91±17.28 mg/L, in the comparison group — up to 12.22±8.32 mg/L (p=0.71). The result of therapy was a decrease in this indicator to 6.28±5.06 mg/L and 4.44±3.73 mg/L, respectively (p=0.0314). On the 17th day after the treatment initiation, all patients had antibodies (IgM and IgG) to SARS-CoV-2. Conclusions: azoximer bromide inclusion in the complex therapy of patients with COVID-19 allows for faster normalization of the patients’ condition, is not accompanied by adverse events and can be considered as a pathogenetic therapy variant of patients with COVID-19 with a predominantly severe course in the setting of concomitant diseases. KEYWORDS: coronavirus infection, SARS-CoV-2, COVID-19, pneumonia, immunocorrection, pathogenetic therapy, azoximer bromide. FOR CITATION: Mukhamadieva L.R., Mavzyutova G.A., Mirsayeva G.Kh. et al. Possibilities of immunocorrection in COVID-19 therapy of patients on an outpatient basis. Russian Medical Inquiry. 2021;5(7):468–472 (in Russ.). DOI: 10.32364/2587-6821-2021-5-7-468-472.

scholarly journals Lymphopenia acted as an adverse factor for severity in patients with COVID-19: a single-centered, retrospective study

2020 ◽  
Author(s):  
Jiheng Liu ◽  
Heng Li ◽  
Ming Luo ◽  
Jiyang Liu ◽  
Lingzhen Wu ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Clinical Laboratory ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prolonged Duration ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease ◽  
Adverse Factor

Abstract Purpose: The outbreak of SARS-CoV-2 began in December and rapidly caused a pandemic. To investigate the significance of lymphopenia for the severity of the disease, this study was performed.Methods: 115 patients confirmed COVID-19 from a tertiary hospital in Changsha, China were enrolled. The clinical, laboratory, treatment and outcome data were collected and compared between patients with lymphopenia or not.Results: The median age was 42 years (1-75). 54 patients (47.0%) of the patients had lymphopenia on admission. In the group of lymphopenia, more patients had hypertension (30.8% vs 10.0%, P=0.006) and coronary heart disease (3.6% vs 0%, P=0.029) and more patients with leucopenia (48.1% vs 14.8%, P<0.001) and eosinophilia (92.6% vs 54.1%, P<0.001) were observed. Lymphopenia was also correlated with severity grades of pneumonia (P<0.001) and C-reactive protein (CRP) level (P=0.0014). Lymphopenia was associated with a prolonged duration of hospitalization (17.0 days vs 14.0 days, P=0.002). Moreover, the recovery of lymphocyte appeared the earliest before CRP and chest radiographs in severe cases, suggesting its predictive value for disease improvement. Conclusion: Our results showed the clinical significance of lymphopenia for predicting the severity of COVID-19 and the recovery of the disease, emphasizing the need to monitor the lymphocyte count dynamically.

Pathogenetic mechanisms of hypofibrinogenemia in COVID-19

2021 ◽  
Author(s):  
С.Е. Работинский ◽  
Е.Л. Буланова
Keyword(s):  
Initial Therapy ◽  
Genetically Engineered ◽  
Biological Drugs ◽  
Reactive Protein ◽  
Interleukin 6 Receptor ◽  
Duration Of Hospitalization ◽  
Coronavirus Infection ◽  
Polymerase Chain

Введение. Коагулопатия у пациентов с новой коронавирусной инфекцией COVID-19 имеет важное значение в течении и прогнозе заболевания. Типичными проявлениями коагулопатии в острой фазе болезни является склонность к гиперкоагуляции, гиперфибриногенемии и повышенному тромбообразованию. Гипофибриногенемия при COVID‑19 широко не представлена в литературе, и частота, а также причины её развития неизвестны. Одной из возможных причин возникновения гипофибриногенемии является применение генно-инженерных биологических препаратов (ГИБП), однако механизмы развития данного состояния не ясны. Цель исследования: определить роль терапии антагонистами рецепторов интерлейкина-6 при развитии гипофибриногенемии у пациентов с COVID-19-пневмонией, клиническую значимость гипофибриногенемии и механизм её возникновения. Материалы и методы. В ретроспективное исследование путём случайной выборки включено 239 пациентов в возрасте от 18 до 96 лет с подтверждённой методом полимеразной цепной реакции SARS-CoV-2 инфекцией, КТ-признаками (при поступлении в стационар) вирусной пневмонии 2–4 степени и длительностью госпитализации более 2 сут. Всем пациентам проводили лабораторный мониторинг, включавший определение значений гемоглобина, тромбоцитов, С-реактивного белка (СРБ), печёночных ферментов и фибриногена по Клаусу. Всем пациентам проводилась стартовая терапия гидроксихлорохином и азитромицином. Тоцилизумаб на момент исследования был единственным ГИБП, применяемым в стационаре. Терапия тоцилизумабом была проведена 164 (68,6%) пациентам. В исследовании учитывали максимальные и минимальные значения гемоглобина, тромбоцитов, фибриногена и СРБ в течение всей госпитализации. Результаты. Гипофибриногенемия различной степени выраженности наблюдалась у 39 пациентов, получивших тоцилизумаб, что значимо выше частоты гипофибриногенемии у 2 пациентов, не получавших терапию тоцилизумабом (ОР = 8,9; 95% ДИ = 2,2–25,9). Заключение. Применение тоцилизумаба у пациентов с COVID‑19 достоверно повышает риск развития гипофибриногенемии. Background. Coagulopathy in patients with new coronavirus infection COVID-19 is important for the course and prognosis of the disease. Hypercoagulation, hyperfibrinogenemia and thrombosis are typical manifestations of coagulopathy in the acute phase of the disease. Hypofibrinogenemia in COVID‑19 is not widely reported in the literature, and the frequency and reasons of its development are unknown. The use of genetically engineered biological drugs (GEBD) may be one of the possible causes of hypofibrinogenemia but the mechanisms of its development are not clear. Objectives: to determine the role of therapy with interleukin-6 receptor antagonists in the development of hypofibrinogenemia in patients with COVID-19-pneumonia, the clinical significance of hypofibrinogenemia and the mechanism of its occurrence. Patients/Methods. A randomized retrospective study included 239 patients aged 18 to 96 years with confirmed by polymerase chain reaction SARS-CoV-2 infection, computed tomography signs (upon admission to the hospital) of viral pneumonia (grade 2–4) and a duration of hospitalization of more than 2 days. All patients underwent laboratory monitoring, including the determination of hemoglobin, platelets, C-reactive protein (CRP), liver enzymes and fibrinogen according to Claus. All patients received initial therapy with hydroxychloroquine and azithromycin. At the time of the study, tocilizumab was the only GEBD drug used in the hospital. Therapy with tocilizumab was performed in 164 (68.6%) patients. The study took into account the maximum and minimum values of hemoglobin, platelet, fibrinogen and CRP levels during the hospitalization. Results. Hypofibrinogenemia of varying severity was observed in 39 patients treated with tocilizumab, that was significantly higher than hypofibrinogenemia frequency in 2 patients who did not receive tocilizumab (RR = 8.9; 95% CI = 2.2–25.9). Conclusions. Tocilizumab usage in patients with COVID-19 significantly increases the risk of hypofibrinogenemia.

Clinical Characteristics and Outcomes of Influenza in Hospitalized Pediatric Patients in King Chulalongkorn Memorial Hospital

2020 ◽  
Vol 103 (11) ◽  
pp. 1220-1229
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Associated Factors ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Memorial Hospital ◽  
Molecular Testing ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease

Objective: To describe clinical characteristics and outcomes of laboratory-confirmed influenza in hospitalized children in a tertiary care center and to identify factors associated with the severity. Materials and Methods: The present study was a retrospective medical chart review study conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Data were extracted from children aged under 15 years old hospitalized between January 2014 and December 2018. Patients who had laboratory-confirmed influenza by rapid antigen detection or molecular testing were included. Severe influenza was defined as patients who developed influenza complications or duration of hospitalization for more than three days. Multivariate logistic regression was used to identify the associated factors with the severity of the disease. Results: Three hundred fifty-seven influenza patients were included with median age of 43 months (IQR 19 to 81), of which 63.3% were aged under 60 months. There were 174 patients (48.7%) with comorbidities, most common were immunosuppression (18.2%), chronic pulmonary disease (12.2%), and congenital heart disease (11.5%). Fifty-seven out of 183 patients (31.1%) had history of influenza vaccination in the medical records. One hundred sixty-one patients (45.1%) had 212 influenza complications including influenza-related pneumonia (89, 24.9%), secondary bacterial infection (53, 14.8%), and neurologic complications (47, 13.2%), in which 27 cases (7.6%) were transferred to intensive care unit (ICU). Four cases (1.1%) died but not directly related to influenza. Associated factors with complicated influenza were aged less than 24 months [aOR 2.67 (95% CI 1.68 to 4.26)] and presence of chronic lung disease [aOR 4.34 [95% CI 2.01 to 9.35)]. Conclusion: Two-third of the children hospitalized with influenza were younger than 60 months. Nearly half developed complications most associated with the age of less than two years old and patients with chronic lung disease. Low rates of vaccination were demonstrated. Keywords: Influenza, Pediatrics, Complications, Pneumonia, Hospitalization

Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

2018 ◽  
Vol 69 (2) ◽  
pp. 375-378
Author(s):  
Catalin Pricop ◽  
Ileana Adela Vacaroiu ◽  
Daniela Radulescu ◽  
Daniel Andone ◽  
Dragos Puia
Keyword(s):  
Renal Impairment ◽  
Serum Creatinine ◽  
Young Patients ◽  
Kidney Injury ◽  
Contralateral Kidney ◽  
Reactive Protein ◽  
Ureteral Lithiasis ◽  
Unilateral Hydronephrosis ◽  
Duration Of Hospitalization ◽  
History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

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