The response to the coronavirus disease 2019 (COVID-19) pandemic has been hampered by lack of an effective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antiviral therapy. Here we report the successful use of remdesivir in a patient with COVID-19 and the prototypic genetic antibody deficiency X-linked agammaglobulinaemia (XLA). Despite evidence of complement activation and a robust T cell response, the patient developed persistent SARS-CoV-2 pneumonitis, without progressing to multi-organ involvement. His unusual clinical course identifies a key role for SARS-CoV-2 antibodies in both viral clearance and progression to severe disease. In the absence of these confounders, we took an experimental medicine approach to examine the in vivoutility of remdesivir. Over two independent courses of treatment, we observed a dramatic, temporally correlated clinical and virological response, leading to clinical resolution and viral clearance, with no evidence of acquired drug resistance. We therefore provide unambiguous evidence for the antiviral efficacy of remdesivir in vivo, and its potential benefit in selected patients.
intravenous nutrition solutions have been well tolerated when the osmolality is less than 983 mmol/l but the daily risk of extravasation is 0-54 for "butterfly" needles and ofphlebitis 0 25 for short plastic catheters.' The daily risk of phlebitis with our fine silicone catheters was 0-016, with a median period of function of nine days. One patient with pancreatic abscess received 60 days of complete intravenous nutrition through a single catheter. There were no bacteraemic episodes related to the catheter, while the expected rate with central intravenous nutrition is 4%.Intravenous nutrition solutions providing 70% of non-protein calories as lipid are efficacious,,' but their use has been limited because they are unsupported by an adequate delivery system. Their use with a fine silicone catheter may avoid the need for central vein cannulation in 89% of inpatients requiring intravenous nutrition.
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