Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy.
Background It was studied if early suPAR-guided anakinra treatment can prevent severe respiratory failure (SRF) of COVID-19.Methods 130 patients with suPAR ≥6 ng/ml were assigned to subcutaneous anakinra 100mg once daily for 10 days. Primary outcome was SRF incidence by day 14 defined as any respiratory ratio below 150 mmHg necessitating mechanical or non-invasive ventilation. Main secondary outcomes were 30-day mortality and inflammatory mediators; 28-day WHO-CPS was explored. Propensity-matched standard-of care comparators were studied.Results 22.3% with anakinra treatment and 59.2% comparators (hazard ratio, 0.30; 95%CI, 0.20-0.46) progressed into SRF; 30-day mortality was 11.5% and 22.3% respectively (hazard ratio 0.49; 95% CI 0.25-0.97). Anakinra was associated with decrease in circulating interleukin (IL)-6, sCD163 and sIL2-R; IL-10/IL-6 ratio on day 7 was inversely associated with SOFA score; patients were allocated to less severe WHO-CPS strata.Conclusions Early suPAR-guided anakinra decreased SRF and restored the pro-/anti-inflammatory balance.Trial Registration: ClinicalTrials.gov, NCT04357366
Background: The aim of this work is to assess the clinical and therapeutic characteristics of patients treated for necrotizing soft-tissue infection/necrotizing fasciitis (NSTI/NF) and determine their outcomes.
Patients and Methods: During the period 1/2012-12/2019 24 adults (18 males, 6 females, aged 33-91 years/mean age 52.4 years) with NSTI/NF were treated. Comorbidities were encountered in 20 (83.3%). Eighteen patients (Group I) presented late, with gangrene and systemic inflammatory response syndrome (9) or septic shock/ organ dysfunction (9). Six patients (Group II) presented early, with local pain, fever, and erythema. Affected areas included perineum-scrotum- external genitalia- abdominal wall or thigh, extremities-trunk, and gluteofemoral area in Group I, and scrotum, extremities, and labium majus in Group II.
Results: Intensive resuscitation and antibiotics were started immediately. All patients had a CT scan and underwent surgery within 4 hours from admission. All necrotic soft tissues were aggressively excised. Additionally, patients underwent Hartmann’s colectomy (3) or colostomy (3), thoracostomy (1), opening of compartments of extremities (2), and extrapelvic drainage (1).Wounds were packed open; specimens were sent for Gram stain/cultures and histology. From Group I, 14 remained intubated for 2-10 days, and 15 required 1-5 further limited debridements or incisions (mean 2). Histologically, tissue necrosis was confirmed in all patients, NF in 18. Infection was polymicrobial in 20. Antibiotics were modulated based on culture results. Four Group I diabetics with extended perineal NF died due to uncontrolled sepsis (16.66%). Survivors received antibiosis for 10-18 days (mean, 15), were helped with nutritional support, and they had a planned wound closure or reconstruction. Their mean hospitalization was 28 days (range, 12-46).
Conclusion: Improving diagnosis of NSTI/NF requires awareness for early recognition and prompt initiation of aggressive treatment, particularly for lesions extended beside perineum. Unfavourable outcome is affected by the delayed or inadequate surgery and the degree of multiple organ dysfunction on admission.
<b><i>Background:</i></b> Macrophage activation-like syndrome (MALS) and complex immune dysregulation (CID) often underlie acute respiratory distress (ARDS) in COVID-19. We aimed to investigate the effect of personalized immunotherapy on clinical improvement of critical COVID-19. <b><i>Methods:</i></b> In this open-label prospective trial, 102 patients with ARDS by SARS-CoV-2 were screened for MALS (ferritin >4,420 ng/mL) and CID (ferritin ≤4,420 ng/mL and low human leukocyte antigen (HLA)-DR expression on CD14-monocytes). Patients with MALS or CID with increased aminotransferases received intravenous anakinra; those with CID and normal aminotransferases received tocilizumab. The primary outcome was ≥25% decrease in the Sequential Organ Failure Assessment (SOFA) score and/or 50% increase in the respiratory ratio by day 8; 28-day mortality, change of SOFA score by day 28, serum biomarkers, and cytokine production by mononuclear cells were secondary endpoints. <b><i>Results:</i></b> The primary study endpoint was met in 58.3% of anakinra-treated patients and in 33.3% of tocilizumab-treated patients (<i>p</i>: 0.01). Most patients in both groups received dexamethasone as standard of care. No differences were found in secondary outcomes, mortality, and SOFA score changes. Ferritin decreased among anakinra-treated patients; interleukin-6, soluble urokinase plasminogen activator receptor, and HLA-DR expression increased among tocilizumab-treated patients. Survivors by day 28 who received anakinra were distributed to lower severity levels of the WHO clinical progression scale. Greater incidence of secondary infections was found with tocilizumab treatment. <b><i>Conclusion:</i></b> Immune assessment resulted in favorable anakinra responses among critically ill patients with COVID-19 and features of MALS<i>.</i>
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