Convalescent plasma therapy in patients with COVID-19

IntroductionPassive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19.MethodThe data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively.ResultsDuration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (≤5 days, 6?10 days, 11?15 days) (p=0.001).ConclusionCP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.     

Paradox in the cubital tunnel syndrome—frequent involvement of left elbow: first report

Objective

Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy in the arm, but the existence of a compressive cause has not been determined conclusively and the majority of the cases are idiopathic. In this paper, involvement sides of limbs of patients with cubital tunnel syndrome were studied.

Material and methods

Between October 2008 and December 2011, the clinical assessment of consecutive operated patients with cubital tunnel syndrome in Rize Education and Research Hospital were analysed. The diagnosis and severity of syndrome was based on electro-diagnostic study.

Results

This study included 57 consecutive patients with cubital tunnel syndrome (39 men, 18 women; mean age, 44,7 years; range, 23–79 years; mean age, 44,7 years; range, 23–79 years); 31 patients underwent surgical treatment. Involvement was on the right side in 18 and on the left in 39 patients. Severity scores and MCV were statistically significant between sides.

Conclusion

Profound involvement with cubital tunnel was found in left elbow. According to the finding of non-dominant elbow involvement in our study, the exact etiology and ideal management of cubital tunnel syndrome continues to be heavily debated.     

The role of baseline and post‐procedural frontal plane QRS‐T angles for cardiac risk assessment in patients with acute STEMI

Background

To our knowledge, no study so far investigated the importance of post‐procedural frontal QRS‐T angle f(QRS‐T) in ST segment elevation myocardial infarction (STEMI). The aim of our study was to investigate the role of baseline and post‐procedural f(QRS‐T) angles for determining high risk STEMI patients, and the success of reperfusion.

Methods

A total of 248 patients with first acute STEMI that underwent primary percutaneous coronary intervention (pPCI) or thrombolytic therapy (TT) between 2013 and 2014 were included in this study. Baseline f(QRS‐T) angle was defined as the angle which measured from the first ECG at the time of hospital admission. Post‐procedural (QRS‐T) angle was defined according to the treatment strategy as follows: the angle which measured from the post‐PCI ECG in patients treated with pPCI; the angle which measured from the ECG taken 90 min after onset of therapy in patients treated with TT.

Results

The baseline (101.9° ± 48.0 vs. 72.1° ± 49.1, p = 0.014) and post‐procedural f(QRS‐T) angles (95.7° ± 48.1 vs. 58.1° ± 47.1, p = 0.002) were significantly higher in patients who developed in‐hospital mortality than the patients who did not develop in‐hospital mortality. Also, f(QRS‐T) angle measured at 90 min was significantly lower in patients with successful thrombolysis group compared to failed thrombolysis group (53.2° ± 42.8 vs. 77.3° ± 52.9, p = 0.033), whereas baseline f(QRS‐T) angle was similar between two groups (78.6° ± 53.4 vs. 78.9° ± 54.0, p = 0.976). Multivariate analysis showed that post‐procedural f(QRS‐T) angle ≥89.6° (odds ratio: 3.541, 95% confidence interval: 1.235–10.154, p = 0.019), but not baseline f(QRS‐T) angle, was independent predictor of in‐hospital mortality.

Conclusion

f(QRS‐T) angle may be used as a beneficial tool for determining high risk patients in acute STEMI. Unlike previous studies, we showed for the first time that that post‐procedural f(QRS‐T) can predict in‐hospital mortality and TT failure.

     

Retrieval of a Greenfield IVC Filter Displaced to the Right Brachiocephalic Vein

During insertion of a central venous sheath an inferior vena cava stainless steel Greenfield filter was dislodged to the right brachiocephalic vein without a free end. Successful retrieval was achieved by using a combination of a guidewire and a snare. Percutaneous retrieval of this vena cava filter is feasible with minimal risk using this method.     

The Expanded Amnion Sign

Objective. The purpose of this study was to assess the positive predictive value for confirming early embryonic death in the clinical scenario wherein an embryo is identified without a visible heartbeat, but the embryonic crown‐rump length (CRL) is 5 mm or less. Methods. We conducted a retrospective study of 882 first‐trimester sonograms with abnormal findings among women who were threatening to abort. Eight hundred six met the inclusion criteria. Results. Among the cohort of 806 cases, 520 (64.5%) had an identifiable embryo, and 255 of those with an identifiable embryo had a visible amnion (49.0%). One hundred sixteen of the 255 with a visible amnion and an identifiable embryo without a heartbeat had a CRL that measured 5 mm or less (45.5%). The CRL of these embryos ranged from 1.7 to 5.4 mm (ie, when rounded to the nearest millimeter, these embryos would be 5 mm) with the breakdown as follows: those measuring less than or equal to 3.4 mm (n = 28), those measuring 3.5 to 4.4 mm (n = 45), and those measuring 4.5 to 5.4 mm (n = 43). Eight of these 116 patients did not have any documented follow‐up. In the remaining 108 patients, pregnancy failure was confirmed. Conclusions. We conclude that any embryo that is surrounded by an amnion and that also lacks a heartbeat has unfortunately but definitively died. This is equally true for embryos measuring less than 5 mm in CRL.     

Genotype–phenotype correlations in individuals with pathogenic RERE variants

Heterozygous variants in the arginine‐glutamic acid dipeptide repeats gene (RERE) have been shown to cause neurodevelopmental disorder with or without anomalies of the brain, eye, or heart (NEDBEH). Here, we report nine individuals with NEDBEH who carry partial deletions or deleterious sequence variants in RERE. These variants were found to be de novo in all cases in which parental samples were available. An analysis of data from individuals with NEDBEH suggests that point mutations affecting the Atrophin‐1 domain of RERE are associated with an increased risk of structural eye defects, congenital heart defects, renal anomalies, and sensorineural hearing loss when compared with loss‐of‐function variants that are likely to lead to haploinsufficiency. A high percentage of RERE pathogenic variants affect a histidine‐rich region in the Atrophin‐1 domain. We have also identified a recurrent two‐amino‐acid duplication in this region that is associated with the development of a CHARGE syndrome‐like phenotype. We conclude that mutations affecting RERE result in a spectrum of clinical phenotypes. Genotype–phenotype correlations exist and can be used to guide medical decision making. Consideration should also be given to screening for RERE variants in individuals who fulfill diagnostic criteria for CHARGE syndrome but do not carry pathogenic variants in CHD7.