After months of restrictive containment efforts to fight the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) epidemic, European countries are planning to reopen. To support the process, we conducted a cross-sectional survey among the Hungarian population to estimate the prevalence of
Endothelial cells express surface angiotensin-converting enzyme 2 (ACE2), the main receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that promotes the infection of endothelial cells showing activation and damage. Bronchoalveolar lavage fluid from coronavirus disease-2019 (COVID-19) subjects showed a critical imbalance in the renin-angiotensin-aldosterone system with the upregulated expression of ACE2. Recently, intravenous recombinant ACE2 was reported as an effective therapy in severe COVID-19 by blocking the viral entry to target cells. Here, we present a case of a critically ill COVID-19 patient with acute respiratory distress syndrome where circulating ACE2 was first measured to monitor disease prognosis. ACE2 activity increased about 40-fold over the normal range and showed a distinct time course as compared to 2-3-fold higher levels of endothelium biomarkers. Although the level of soluble E-selectin followed the clinical status of our patient similar to ferritin and IL-6 levels, the dramatic rise in serum ACE2 activity may act as an endogenous nonspecific protective mechanism against SARS-CoV-2 infection that preceded the recovery of our patient.
Background: Pseudomonas aeruginosa infections are a serious threat in intensive care units (ICUs). The aim of this confirmatory, randomized, multicenter, placebo-controlled, double-blind, phase 2/3 study was to assess the efficacy, immunogenicity, and safety of IC43 recombinant Pseudomonas aeruginosa vaccine in non-surgical ICU patients.Methods: Eight hundred patients aged 18 to 80 years admitted to the ICU with expected need for mechanical ventilation for ≥ 48 h were randomized 1:1 to either IC43 100 μg or saline placebo, given in two vaccinations 7 days apart. The primary efficacy endpoint was all-cause mortality in patients 28 days after the first vaccination. Immunogenicity and safety were also evaluated. Findings: All-cause mortality rates at day 28 were 29.2% vs 27.7% in the IC43 and placebo groups, respectively (P = .67). Overall survival (Kaplan-Meier survival estimates, P = .46) and proportion of patients with ≥ one confirmed P. aeruginosa invasive infection or respiratory tract infection also did not differ significantly between both groups. The geometric mean fold increase in OprF/I titers was 1.5 after the first vaccination, 20 at day 28, after the second vaccination, and 2.9 at day 180. Significantly more patients in the placebo group (96.5%) had ≥ one adverse event (AE) versus the IC43 100 μg group (93.1%) (P = .04). The most frequently reported severe AEs in the IC43 and placebo groups were respiratory failure (6.9% vs 5.7%, respectively), septic shock (4.1% vs 6.5%), cardiac arrest (4.3% vs 5.7%), multiorgan failure (4.6% vs 5.5%), and sepsis (4.6% vs 4.2%). No related serious AEs were reported in the IC43 group.
Összefoglaló. Az új típusú koronavírus-fertőzés (COVID–19) nagy
terhet ró az egészségügyi ellátórendszerre és a társadalomra. A betegségnek
három nagy szakasza van, melyek alapvetően meghatározzák a kezelést. Az I–IIA
fázisban az antivirális, míg a IIB–III. fázisban a gyulladásgátló kezelés áll
előtérben, melyhez intenzív terápiás, szupportív kezelés csatlakozik. A jelen
ajánlás kizárólag a gyógyszeres kezelésre vonatkozik, és a rendelkezésre álló
bizonyítékok alapján foglalja össze a terápiás lehetőségeket. Emellett egy
javasolt kezelési algoritmust is tartalmaz. Orv Hetil. 2021; 162(17):
643–651.
Summary. The novel coronavirus infection (COVID-19) places a heavy
burden on the health care system and our society. There are three major stages
in the disease that fundamentally determine treatment approaches. Phases I–IIA
require primarily antiviral treatment. In phases IIB–III, anti-inflammatory
treatment is needed accompanied by intensive and supportive care. This
recommendation applies only to pharmacotherapy and summarizes the therapeutic
options based on the available evidence. It also includes a proposed treatment
algorithm. Orv Hetil. 2021; 162(17): 643–651.
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