Tocilizumab in Severe COVID-19 Pneumonia and Concomitant Cytokine Release Syndrome

Younger patients with COVID-19 may experience an exaggerated immune response to SARS-CoV-2 infection and develop cytokine release syndrome (CRS), which may be life threatening. There is no proven antiviral therapy for COVID-19 so far, but profound immunosuppression has recently been suggested as a treatment for COVID-19-associated CRS. We present a case of life-threatening CRS caused by COVID-19 infection with a favourable response to immunosuppressive therapy with tocilizumab (TCZ). The rapid clinical and biochemical improvement following TCZ administration suggests that treatment with immunotherapy can be life-saving in selected patients with COVID-19-induced CRS

Physiological responses of crop plants against Trichoderma harzianum in saline environment

The physiological response of crop plants against Trichoderma harzianum (Th-6) in a saline habitat was studied. Trichoderma harzianum (Th-6) is an endophytic fungus that shows salt tolerance and establishes a symbiotic relationship with a host plant. To evaluate the role of Trichoderma harzianum (Th-6) in mitigating the consequences of salinity stress on crop plants, seeds of maize and rice were coated with Trichoderma before sowing and salt treatment. Later, after germination, twenty-one day old seedlings were subjected to NaCl concentrations (50, 100 and 150 mM). Salinity negatively affected all investigated physiological parameters in both crops. Treatment of seeds with Trichoderma improved plant growth and Th-treated plants exhibited substantial physiological adjustment in a saline environment compared to Th-untreated plants. The Th-treated plants under salt stress showed higher relative water content and stomatal conductance, better photosynthetic performance and higher pigment concentrations, as well as higher catalase and superoxide dismutase activities. Moreover, proline content in salt stress environment was higher in Th-treated plants, while H2O2 content declined. The physiological role of Trichoderma harzianum in mitigating the salt related consequences of both crop plants is discussed

Chronic Q fever diagnosis—consensus guideline versus expert opinion

Chronic Q fever, caused by Coxiella burnetii, has high mortality and morbidity rates if left untreated. Controversy about the diagnosis of this complex disease has emerged recently. We applied the guideline from the Dutch Q Fe­ver Consensus Group and a set of diagnostic criteria pro­posed by Didier Raoult to all 284 chronic Q fever patients included in the Dutch National Chronic Q Fever Database during 2006–2012. Of the patients who had proven cas­es of chronic Q fever by the Dutch guideline, 46 (30.5%) would not have received a diagnosis by the alternative cri­teria designed by Raoult, and 14 (4.9%) would have been considered to have possible chronic Q fever. Six patients with proven chronic Q fever died of related causes. Until results from future studies are available, by which current guidelines can be modified, we believe that the Dutch lit­erature-based consensus guideline is more sensitive and easier to use in clinical practice

The incidence and outcome of AKI in patients with sepsis in the emergency department applying different definitions of AKI and sepsis

BACKGROUND: Sepsis is often accompanied with acute kidney injury (AKI). The incidence of AKI in patients visiting the emergency department (ED) with sepsis according to the new SOFA criteria is not exactly known, because the definition of sepsis has changed and many definitions of AKI exist. Given the important consequences of early recognition of AKI in sepsis, our aim was to assess the epidemiology of sepsis-associated AKI using different AKI definitions (RIFLE, AKIN, AKIB, delta check, and KDIGO) for the different sepsis classifications (SIRS, qSOFA, and SOFA). METHODS: We retrospectively enrolled patients with sepsis in the ED in three hospitals and applied different AKI definitions to determine the incidence of sepsis-associated AKI. In addition, the association between the different AKI definitions and persistent kidney injury, hospital length of stay, and 30-day mortality were evaluated. RESULTS: In total, 2065 patients were included. The incidence of AKI was 17.7-51.1%, depending on sepsis and AKI definition. The highest incidence of AKI was found in qSOFA patients when the AKIN and KDIGO definitions were applied (51.1%). Applying the AKIN and KDIGO definitions in patients with sepsis according to the SOFA criteria, AKI was present in 37.3% of patients, and using the SIRS criteria, AKI was present in 25.4% of patients. Crude 30-day mortality, prolonged length of stay, and persistent kidney injury were comparable for patients diagnosed with AKI, regardless of the definition used. CONCLUSION: The incidence of AKI in patients with sepsis is highly dependent on how patients with sepsis are categorised and how AKI is defined. When AKI (any definition) was already present at the ED, 30-day mortality was high (22.2%). The diagnosis of AKI in sepsis can be considered as a sign of severe disease and helps to identify patients at high risk of adverse outcome at an early stage

Necrotizing meningo-encephalitis due to Pseudomonas aeruginosa in a preterm infant

We report a preterm infant diagnosed with a late-onset Pseudomonas aeruginosa sepsis and necrotizing meningoencephalitis who died at the age of 12 days as a consequence of multiple organ failure. In this case report we show the importance of the application of different advanced MRI modalities. On the basis of the MRI findings, clinical presentation, and laboratory data, the diagnosis of a necrotizing encephalopathy secondary to Pseudomonas aeruginosa infection was established

Necrotizing meningo-encephalitis due to Pseudomonas aeruginosa in a preterm infant

\u3cp\u3eWe report a preterm infant diagnosed with a late-onset Pseudomonas aeruginosa sepsis and necrotizing meningoencephalitis who died at the age of 12 days as a consequence of multiple organ failure. In this case report we show the importance of the application of different advanced MRI modalities. On the basis of the MRI findings, clinical presentation, and laboratory data, the diagnosis of a necrotizing encephalopathy secondary to Pseudomonas aeruginosa infection was established.\u3c/p\u3

Study protocol for a multicentre prospective cohort study to identify predictors of adverse outcome in older medical emergency department patients (the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) study)

Abstract Background Older patients (≥65 years old) experience high rates of adverse outcomes after an emergency department (ED) visit. Reliable tools to predict adverse outcomes in this population are lacking. This manuscript comprises a study protocol for the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) study that aims to identify predictors of adverse outcome (including triage- and risk stratification scores) and intends to design a feasible prediction model for older patients that can be used in the ED. Methods The RISE UP study is a prospective observational multicentre cohort study in older (≥65 years of age) ED patients treated by internists or gastroenterologists in Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. After obtaining informed consent, patients characteristics, vital signs, functional status and routine laboratory tests will be retrieved. In addition, disease perception questionnaires will be filled out by patients or their caregivers and clinical impression questionnaires by nurses and physicians. Moreover, both arterial and venous blood samples will be taken in order to determine additional biomarkers. The discriminatory value of triage- and risk stratification scores, clinical impression scores and laboratory tests will be evaluated. Univariable logistic regression will be used to identify predictors of adverse outcomes. With these data we intend to develop a clinical prediction model for 30-day mortality using multivariable logistic regression. This model will be validated in an external cohort. Our primary endpoint is 30-day all-cause mortality. The secondary (composite) endpoint consist of 30-day mortality, length of hospital stay, admission to intensive- or medium care units, readmission and loss of independent living. Patients will be followed up for at least 30 days and, if possible, for one year. Discussion In this study, we will retrieve a broad range of data concerning adverse outcomes in older patients visiting the ED with medical problems. We intend to develop a clinical tool for identification of older patients at risk of adverse outcomes that is feasible for use in the ED, in order to improve clinical decision making and medical care. Trial registration Retrospectively registered on clinicaltrials.gov (NCT02946398; 9/20/2016)