Nhận xét về hiệu quả của Tocilizumab trong điều trị hỗ trợ bệnh nhân Covid-19

TÓM TẮT Đặt vấn đề: Sự bùng phát Coronavirus 2019 (COVID-19) đã lây lan nhanh chóng trên toàn thế giới và trở thành một đại dịch toàn cầu, nhiều phương pháp điều trị đang được nghiên cứu, trong đó ức chế interleukin 6 là một phương pháp tỏ ra hiệu quả. Báo cáo này nhằm đánh giá hiệu quả của Tocilizumab trong điều trị hỗ trợ bệnh nhân Covid-19. Báo cáo trường hợp: 4 trường hợp bệnh nhân được xác nhận Covid-19 bằng phương pháp PCR, đang được điều trị Trung tâm Hồi sức tích cực người bệnh Covid-19 thuốc bệnh viện Trung Ương Huế tại thành phố Hồ Chí Minh, viêm phổi nặng cần phải thông khí hỗ trợ. Bệnh nhân được điều trị phác đồ bao gồm tocilizumab cho kết quả tăng interleukin 6 sau 1 tuần điều trị. Kết luận: Trong thử nghiệm lâm sàng liên quan đến bệnh nhân viêm phổi nặng do Covid-19, cho thấy Interleukin - 6 tăng sau 1 tuần điều trị. ABSTRACT COMMENTS ON THE EFFECTIVENESS OF TOCILIZUMAB IN THE SUPPORTIVE TREATMENT OF COVID-19 PATIENTS Introduction: The outbreak of Coronavirus 2019 (COVID-19) has spread rapidly across the globe and has become a global pandemic. Many treatments are being studied, of which interleukin 6 inhibition is an effective method. Case report: Fourcases of patients confirmed covid-19 by PCR method, being treated at COVID-19 Intensive Care Center of Hue Central Hospital in Ho Chi Minh city, severe pneumonia requires ventilation assistance. The patients were treated with a regimen including Tocilizumab that resulted in increased interleukin 6 results after 1 week of treatment. Conclusion: In a clinical trial involving patients with severe pneumonia caused by Covid-19, it was found that Interleukin 6 increased after 1 week of treatment. Keywords: Interleukin 6, Tocilizumab, Covid-19

Re-expansion Pulmonary Edema in a patient with Secondary Spontaneous Pneumothorax Following Closed Thoracostomy: A Case Report

Although re-expansion pulmonary edema (RPE) is rare (incidence rate <1%), it is associated with a mortality rate of >20%; therefore, early diagnosis and treatment are important. We report a case of RPE following chest tube insertion in a patient with spontaneous pneumothorax. We have specifically focused on the mechanism underlying RPE and the possible etiology. An 82-year-old man with a history of chronic anemia, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension was referred to the emergency department for management of recurrent right-sided pneumothorax. We performed emergency closed thoracostomy for suspected tension pneumothorax, which led to stabilization of the patient’s vital signs; however, he coughed up frothy pink sputum accompanied by severe right-sided chest pain 30 min postoperatively. The patient showed new-onset right pulmonary consolidation on chest radiography, as well as desaturation, tachycardia, and tachypnea and was diagnosed with RPE. He was transferred to the intensive care unit for mechanical ventilation and supportive treatment using diuretics, ionotropic agents, and prophylactic antibiotics. RPE gradually resolved, and the patient was extubated 3 days after admission. He has not experienced recurrent pneumothorax or pulmonary disease for 4 months. We emphasize the importance of RPE prevention and that aggressive ventilator care and supportive treatment can effectively treat RPE following an accurate understanding of the underlying pathogenetic mechanisms and risk factors.

Clinical Analysis of a Case of Pseudohypoparathyroidism

Objective — To investigate the clinical treatment effect of pseudoparathyroidism. Methods — A case of pseudoparathyroidism admitted to our hospital was clinically diagnosed and treated, and analyzed. Results — The patient received standard treatment in our hospital, and the clinical symptoms were significantly improved. Conclusion — Timely and correct diagnosis and symptomatic supportive treatment are of great significance to improve the prognosis of pseudohypoparathyroidism patients.

Disseminated Human Parvovirus B19 Infection Induced Multiple Organ Dysfunction Syndrome in an Adult Patient With Alcoholic Hepatitis Complicated by Hemolytic Anemia: A Case Report and Literature Review

BackgroundHuman parvovirus B19 (B19) can cause acute hepatitis and is attributed to the high mortality of alcoholic hepatitis (AH). B19 infection is generally self-healing in previously healthy people, but it can cause fatal effects in some high-risk groups and increase its virulence and infectivity. Disseminated B19 infection-induced multiple organ dysfunction syndrome (MODS) in patients with AH has not been reported yet. Here, we described B19 viremia in an adult patient with AH accompanied by hemolytic anemia (HA), leading to disseminated infection and secondary MODS, as well as self-limiting B19 infections in seven nurses caring for him. Meanwhile, we reviewed the literature on AH and B19 infection.Case PresentationA 43-year-old male patient with AH accompanied by HA was transferred to the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, on March 31, 2021. After supportive treatment, his transaminase and bilirubin levels were reduced, but his anemia worsened. He received a red blood cell (RBC) infusion on April 9 for hemoglobin (Hb) lower than 6 g/dl. On April 13, he suddenly had a high fever. Under empirical anti-infection, his high fever dropped and maintained at a low fever level; however, his anemia worsened. On April 25, he was transferred to the medical intensive care unit (MICU) due to severe pneumonia, acute respiratory distress syndrome (ARDS), acute aplastic crisis (AAC), and hemophagocytic syndrome (HPS), which were subsequently confirmed to be related to B19 infection. After methylprednisolone, intravenous immunoglobulin (IVIG), empirical anti-infection, and supportive treatment, the lung infection improved, but hematopoietic and liver abnormalities aggravated, and systemic B19 infection occurred. Finally, the patient developed a refractory arrhythmia, heart failure, and shock and was referred to a local hospital by his family on May 8, 2021. Unfortunately, he died the next day. Fourteen days after he was transferred to MICU, seven nurses caring for him in his first two days in the MICU developed self-limiting erythema infectiosum (EI).ConclusionsB19 infection is self-limiting in healthy people, with low virulence and infectivity; however, in AH patients with HA, it can lead to fatal consequences and high contagion.

A Systematic Review of Herbal Medicine in the Treatment of Cirrhotic Ascites

Objectives: The purpose of this study was to investigate the trend in the research on cirrhotic ascites using t herbal medicine.Methods: This review was conducted using six electronic databases(NDSL, KMBASE, Koreantk, KISS, KISTI, KoreaMed) with no restriction in year. The search term was ‘liver cirrhosis’, ‘ascites’, or ‘cirrhotic ascites’, ‘herbal medicine’, ‘traditional Chinese medicine’, and ‘randomized clinical trial’, and there was no restriction in year. The searched studies were analyzed according to the type of research.Results: After scanning the titles and abstracts, 13 articles were ultimately included. Of the outcome measures of 13 studies, effective rate, liver function test, and ascites regression time were included in the meta-analysis, which showed that the effective rate of herbal medicine-supportive treatment combination therapy was 1.27 times higher than that of supportive treatment alone, and the difference was statistically significant.Conclusions: We analyzed the trends of cirrhotic ascites treatment in herbal medicine through this review. It is necessary to conduct further studies, such as well-designed clinical trials based on the results from experimental research.

Scleroderma renal crisis in a patient with paraneoplastic systemic sclerosis

The incidence of malignancy is increased in systemic sclerosis (SS). Nevertheless, only a few cases of paraneoplastic SS (pSS) have been described. Scleroderma renal crisis is an uncommon but severe complication of SS, with acute kidney failure, abrupt onset of hypertension and microangiopathy. We present the case of a previously healthy patient who was diagnosed with ovarian carcinoma and underwent chemotherapy with carboplatin and paclitaxel. In association with the cancer, she developed SS and scleroderma renal crisis. She received initial supportive treatment, but her renal function worsened, and she started on hemodialysis. Furthermore, she received adjuvant surgical treatment for the cancer. Eighty-four days after cytoreductive surgery, her renal function recovered, and her SS manifestations improved.

Yellow Fever

Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice from direct liver damage. The virus is endemic in tropical areas of Africa and Central and South America. There is no specific treatment or antiviral drug for yellow fever but appropriate supportive treatment in hospitals improves survival rates. Vaccination is the single most important preventive measure. Several yellow fever vaccines are manufactured by different developers. All of them are safe, affordable, and appear to provide protection for >30–35 years. Some are WHO-prequalified. The Eliminate Yellow Fever Epidemics (EYE) Strategy launched in 2017 aims at protecting at-risk populations, preventing international spread, and containing outbreaks rapidly. By 2026, it is expected that more than 1 billion people will be protected against the disease.

TP10.1.2Evaluating the impact of the COVID-19 pandemic on the presentation and management of UGI cancer at a district general hospital

Introduction It has been predicted that the COVID-19 pandemic would disrupt the delivery of UK cancer treatment pathways. This study aims to assess the mode of presentation and type of management offered to oesophagogastric (OG) and hepatopancreaticobiliary (HPB) cancer patients at a busy district general hospital during the pandemic. Methods Confirmed OG and HPB cancer patients were identified in the local MDT database. Patients were identified between 01/03/2020 - 30/09/2020 (pandemic), and 01/03/2019 - 30/09/2019 (pre-pandemic). Mode of presentation and management was identified and compared. Results In 2019, 42 and 15 patients were diagnosed with OG and HPB cancers, compared to 25 and 19 patients in 2020, respectively. 26 (46%) patients were referred via 2ww pathway in 2019, compared to 29 (66%) in 2020. The number of cancers referred routinely or emergently were 28 (49%) and 2 (4%) in 2019, compared to 2 (5%) and 9 (20%) in 2020, respectively (p &lt; 0.0001). Patients suitable for curative treatment were 16 (28%) and 7 (16%), in 2019 and 2020, respectively. Palliative or supportive treatment was offered to 26 (46%) and 14 (25%) patients in 2019, compared to 21 (48%) and 10 (23%) patients in 2020, respectively. Conclusion 2ww referrals were similar to 2019, while routine referrals reduced significantly. A marked, but not significant, reduction in patients suitable for curative intent is noted, perhaps due to delay in presentation despite the continuation of cancer surgical services. Further work on creating “COVID-free” pathways and increasing awareness of service availability would improve detectability of curable disease.