Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. cyclosporine. The patient was hydrated, and antibiotic prophylaxis was started (Table 1). Unfortunately, the patient's respiratory function further deteriorated, and laboratory findings were suggestive of cytokine release syndrome with remarkably elevated (431 pg/ml) serum interleukin-6 levels. A single i.v. infusion of tocilizumab (8 mg/kg per d) was attempted. Two days after, oxygen was no longer required (Figure 1). The patient was discharged home and completely recovered from acute kidney injury. Early detection of cytokine release syndrome biomarkers is recommended and should prompt anti-inflammatory interventions. Larger studies are needed to confirm the utility and safety of interleukin-6 inhibition combined with dexamethasone in kidney transplant recipients with COVID-19. 1. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China [e-pub ahead of print]. Clin Infect Dis.
and Barbara Zucker School of Medi. RATIONALE: There is limited information on the impact of anaphylaxis, a potentially life threatening allergic reaction, in the elderly. This study explores the factors that contribute to under recognition of anaphylaxis in this age group. METHODS: A retrospective analysis of hospitalized patients aged ≥65 years in NY from 2000-2010 was conducted using the Statewide Planning and Research Cooperative System (SPARCS), a statewide administrative database. Cases were identified using anaphylaxis ICD-9 codes or an ICD-9-based diagnostic algorithm incorporating the National Institutes of Allergy and Infectious Disease (NIAID) diagnostic criteria. Cases identified by the algorithm method likely represent missed cases of anaphylaxis. Multinomial regression analysis was used to model selected variables associated with ascertainment method. RESULTS: Of the 3,673 hospitalizations analyzed, anaphylaxis ICD-9 codes identified 1790 (48.7%) cases, the algorithms identified 1701 (46.3.%) and 182 (5.0%) were identified by both. Age ≥85 and 75-84 were 2.4 (95% confidence interval 1.92-2.90) and 1.4 (95% CI 1.25-1.69) times more likely to be in the Algorithm group, respectively. Males were 1.2 times more likely to be included in the Algorithm group (95% CI 1.06-1.41). African Americans, other race and unknown were 1.8 (95% CI 1.52-2.24), 1.4 (95% CI 1.09-1.79) and 1.6 (95% CI 1.10-2.44), times more likely, respectively, to be included in the Algorithm group. Asians were 0.6 times less likely to be included in the Algorithm group (95% CI 0.39-0.98). CONCLUSIONS: Being of older age, male and of minority race were associated with increased likelihood of having unrecognized inpatient anaphylaxis.
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