Background: We assessed outcome of patients with moderate and severe COVID-19 following treatment with convalescent plasma (CP) and the association with IgG levels in transfused CP. Methods: A prospective cohort study. Primary outcome was improvement at day 14 defined as alive, not on mechanical ventilation, and moderate, mild, or recovered from COVID-19. Antibody levels in CP units were unknown at the time of treatment. IgG against the spike protein S1 was subsequently measured by ELISA. Neutralizing antibodies titers were determined in a subset. Outcome was assessed in relation to the mean antibody level transfused to the patients (4.0 versus >4.0). Findings: Of 49 patients, 11 (22.4%) had moderate, 38 (77.6%) had severe disease, 28 were ventilated. At day 14, 24 (49.0%) patients improved, 9 (18.4%) died, and 13 (26.5%) were ventilated. In 14/98 (14.3%) CP units

Knowledge of the outcomes of critically ill patients is crucial for health and government officials who are planning how to address local outbreaks. The factors associated with outcomes of critically ill patients with coronavirus disease 2019 (Covid-19) who required treatment in an intensive care unit (ICU) are yet to be determined. Methods: This was a retrospective registry-based case series of patients with laboratory-confirmed SARS-CoV-2 who were referred for ICU admission and treated in the ICUs of the 13 participating centers in Israel between 5 March and 27 April 2020. Demographic and clinical data including clinical management were collected and subjected to a multivariable analysis; primary outcome was mortality. Results: This study included 156 patients (median age = 72 years (range = 22–97 years)); 69% (108 of 156) were male. Eighty-nine percent (139 of 156) of patients had at least one comorbidity. One hundred three patients (66%) required invasive mechanical ventilation. As of 8 May 2020, the median length of stay in the ICU was 10 days (range = 0–37 days). The overall mortality rate was 56%; a multivariable regression model revealed that increasing age (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), the presence of sepsis (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), and a shorter ICU stay(OR = 0.90 for each day, 95% CI = 0.84–0.96) were independent prognostic factors. Conclusions: In our case series, we found lower mortality rates than those in exhausted health systems. The results of our multivariable model suggest that further evaluation is needed of antiviral and antibacterial agents in the treatment of sepsis and secondary infection.

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Nonmelanoma skin cancer is the most common malignancy and immunosuppression is a key risk factor. Despite the promising data demonstrating the efficacy of immune checkpoint inhibition in the treatment of cutaneous squamous cell carcinoma (cSCC), most immunosuppressed patients are not included in immunotherapy trials due to the risk for toxicity and the lack of data regarding cSCC immune landscape in immunosuppressed patients. To characterize the specific alterations accounting for a diminished antitumor immune response in immunosuppressed patients, we used multispectral imaging on cSCC pathology specimens from immunosuppressed patients with age and stage matched immunocompetent controls. We show that densities of CD68+ cells are diminished in immunosuppressed patients. Moreover, using an organ transplant recipient cohort from two cancer centers, we found significantly lower effector T-cells densities as compared with controls. Overall, density of CD68+ and CD8+LAG3+ cells were predictors of disease-specific and disease-free survival. These findings provide insight into the patterns of immune infiltrating cells in patients with different types of immunosuppression; leading us to conjecture that different immune based therapeutic approaches may be needed to treat immunosuppressed cSCC patients.

Paediatric OSA affects a large number of children and has multiple end-organ sequelae. The prevalence of obstructive sleep apnoea (OSA) in the paediatric population is approximately 3% and has been reported as high as 59% in children with obesity. 1 Paediatric obstructive sleep apnoea (OSA) is characterised by snoring, apnoeas, intermittent hypoxia and hypercapnia, sleep fragmentations, frequent arousals and circadian rhythm disturbances. These OSAinduced issues result in a variety of end-organ manifestations with effects on the heart, lungs, brain, gut microbiome and genitourinary systems. While many of these have been demonstrated to be reversible, the effects on some of the organ systems, including the brain, have not shown easy reversibility. Specifically, children sleep

Objective: To discuss persistent facial nerve stimulation (FNS) related to repeated electrostatic discharge (ESD) shock following cochlear implantation. Methods: Single case report with literature review. Results: FNS is a feared complication after cochlear implantation, occurring in approximately 7% of cases, with most patients having anatomic abnormalities. The presented case has no anatomical abnormalities but reported frequent environmental static shock. FNS during the first 1 to 3 seconds of processor attachment caused a significant decrease in the patient’s quality of life, requiring subsequent re-implantation with full resolution. Conclusions: FNS is a complication of cochlear implantation that can cause a great deal of distress and discomfort. Frequent electrostatic discharge (ESD) contributed to device malfunctioning and FNS in a patient with otherwise normal anatomy and should be avoided if possible.

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