Convalescent plasma associates with reduced mortality and improved clinical trajectory in patients hospitalized with COVID-19

BACKGROUNDEvidence supporting convalescent plasma (CP), one of the first investigational treatments for coronavirus disease 2019 (COVID-19), has been inconclusive, leading to conflicting recommendations. The primary objective was to perform a comparative effectiveness study of CP for all-cause, in-hospital mortality in patients with COVID-19.METHODSThe multicenter, electronic health records–based, retrospective study included 44,770 patients hospitalized with COVID-19 in one of 176 HCA Healthcare–affiliated community hospitals. Coarsened exact matching (1:k) was employed, resulting in a sample of 3774 CP and 10,687 comparison patients.RESULTSExamination of mortality using a shared frailty model, controlling for concomitant medications, date of admission, and days from admission to transfusion, demonstrated a significant association of CP with lower mortality risk relative to the comparison group (adjusted hazard ratio [aHR] = 0.71; 95% CI, 0.59–0.86; P < 0.001). Examination of patient risk trajectories, represented by 400 clinico-demographic features from our real-time risk model (RTRM), indicated that patients who received CP recovered more quickly. The stratification of days to transfusion revealed that CP within 3 days after admission, but not within 4 to 7 days, was associated with a significantly lower mortality risk (aHR = 0.53; 95% CI, 0.47–0.60; P < 0.001). CP serology level was inversely associated with mortality when controlling for its interaction with days to transfusion (HR = 0.998; 95% CI, 0.997–0.999; P = 0.013), yet it did not reach univariable significance.CONCLUSIONSThis large, diverse, multicenter cohort study demonstrated that CP, compared with matched controls, is significantly associated with reduced risk of in-hospital mortality. These observations highlight the utility of real-world evidence and suggest the need for further evaluation prior to abandoning CP as a viable therapy for COVID-19.FUNDINGThis research was supported in whole by HCA Healthcare and/or an HCA Healthcare–affiliated entity, including Sarah Cannon and Genospace.     

Beneficial Effects of Aluminum on the Progression of Lead‐Induced Nephropathy in Rats

We studied the effect of aluminum on lead‐induced nephropathy in male albino rats. Five groups of male albino rats were given either water only or lead acetate (125 mg/kg body weight) and/or aluminum chloride (50 mg/kg body weight or 100 mg/kg body weight) for a period of 90 days. Aluminum was found to prevent the lead‐induced increase in the relative organ (kidney) weight in a dose‐dependent manner. Aluminum also prevented lead‐induced increase in plasma creatinine levels of the treated animals. Estimation of lead concentration in kidneys of different treatment groups revealed that the net deposition of lead was lower in animals which were given both lead acetate and aluminum chloride simultaneously. The results showed that aluminum offers some protection against lead‐induced nephrotoxicity in a time‐ and dose‐dependent manner.     

Comparison of post-cataract surgery endophthalmitis rates using syringing or regurgitation on pressure over the lacrimal sac as a preoperative screening tool for nasolacrimal duct obstruction: An impact assessment of protocol alteration due to the COVID-19 pandemic

Purpose:To compare the post-cataract endophthalmitis (PCE) rates among eyes undergoing syringing or regurgitation on pressure over the lacrimal sac (ROPLAS) test prior to cataract surgery.Methods:We performed a single-center, retrospective, comparative analysis of eyes developing PCE who underwent syringing prior to cataract surgery (group A) in the pre-COVID-19 era between November 1 2019 and January 31, 2020 and the eyes that underwent ROPLAS test prior to cataract surgery (group B) in the COVID-19 era between November 1, 2020 and January 31, 2021.Results:A total of 87,144 eyes underwent cataract surgery during the two time periods of the study. Syringing was performed in 48,071 eyes, whereas ROPLAS was performed in 39,073 eyes. In group A, 19 eyes (0.039%) developed PCE, whereas 20 eyes (0.051%) developed PCE in group B (P = 0.517). Between the two groups, the grade of anterior chamber cellular reaction (P = 0.675), hypopyon (P = 0.738), and vitreous haze (P = 0.664) were comparable. Gram-positive organisms were detected in 4 eyes in group A and 6 eyes in group B; 2 eyes in group A had gram-negative bacilli. The presenting visual acuity (Group A: LogMAR 1.42 and Group B: LogMAR 1.30) and final visual acuity (Group A: LogMAR 0.52 and Group B: LogMAR 0.5) were comparable between the two groups. (P = 0.544 and 0.384, respectively).Conclusion:The rates of PCE were comparable among the eyes undergoing either syringing test or ROPLAS prior to cataract surgery.     

Response to Marabotto et al.

Biopsies have important value in assessing for nonerosive reflux disease.     

Synthesis of some new 2-(substituted-phenyl)-5-(N,N-diphenylaminomethyl)-1,3,4-oxadiazoles: a safer anti-inflammatory and analgesic agents

A series of 2-(substituted-phenyl)-5-(N,N-diphenylaminomethyl)-1,3,4-oxadiazoles (3-15) were synthesized. The compounds were evaluated for their anti-inflammatory, analgesic, ulcerogenic and lipid peroxidation actions. The percentage inhibition in edema at different time intervals indicated that compounds 8, 11, 12, 14 and 15 exhibited good anti-inflammatory potential. The results illustrate that 2-(2-acetoxyphenyl)-5-(N,N-diphenylaminomethyl)-1,3,4-oxadiazole (15) and 2-(3,4-dimethoxyphenyl)-5-(N,N-diphenylaminomethyl)-1,3,4-oxadiazole (12) showed best anti-inflammatory activity among the series tested. Furthermore, activity is higher in case of chloro substitution as compared to methyl substitution. The compounds synthesized were also evaluated for their ulcerogenic and lipid peroxidation action and showed superior GI safety profile along with reduction in lipid peroxidation as compared to that of ibuprofen.     

Synthesis and biological evaluation of some novel 1,4-dihydropyridines as potential antitubercular agents

Recent studies showed that 1,4-dihydropyridine-3,5-dicarbamoyl derivatives with lipophilic groups have significant antitubercular activity. In this study, we have synthesized new derivatives of 1,4-dihydropyridines bearing carbmethoxy and carbethoxy group at C-3 and C-5 of the 1,4-dihydropyridine ring. In addition, 1H-pyrazole ring is substituted at C-4 position. These analogues were synthesized by multi-component Hantzsch reaction. The in vitro antitubercular activity of compounds against Mycobacterium tuberculosis H(37) Rv was evaluated. The lowest minimum inhibitory concentration value, 0.02 μg/mL and SI > 500, was found for dimethyl 1,4-dihydro-4-(3-(4-nitrophenyl)-1-phenyl-1H-pyrazol-4-yl)-2,6-dimethylpyridine-3,5-dicarboxylate 3f, diethyl 1,4-dihydro-4-(3-(4-fluorophenyl)-1-phenyl-1H-pyrazol-4-yl)-2,6-dimethylpyridine-3,5-dicarboxylate 4c and diethyl 1,4-dihydro-4-(3-(4-bromophenyl)-1-phenyl-1H-pyrazol-4-yl)-2,6-dimethyl pyridine-3,5-dicarboxylate 4e, making them more potent than first-line antitubercular drug isoniazid. In addition, these compounds exhibited relatively low cytotoxicity.     

Role of hormones in acne vulgaris

Objective

To elucidate the role of endogenous hormones like testosterone, progesterone, estrogen, insulin-like growth factor, insulin and glucocorticoids in a common skin condition acne vulgaris.

Design and methods

We conducted a systematic review of the literature and abstracted the data for every published cut point.

Results

We screened more than 1000 studies and found that serum testosterone, progesterone, glucocorticoids, insulin and insulin-like growth factors are increased in patients with acne vulgaris and serum estrogen levels are low in patients.

Conclusions

Various endogenous hormones play important role in the pathogenesis of acne vulgaris. Thus, in the clinical practice it is important to evaluate serum levels of these hormones and patients must be treated accordingly to avoid serious endocrine disorders at an early age.