ORAL PROLøFERATøF VERRÜKÖZ LÖKOPLAZø: BøR VAKA RAPORU

Oral verrüköz lezyonlar, genellikle yavaş ilerleyen, gri veya beyaz renkte, yanak mukozası ve dişetinde siğil şeklinde ekzofitik büyümelerdir. Verrüköz karsinoma VK , verrüköz hiperplazi VH , proliferatif verrüköz lökoplaki PVL veya invaziv skuamöz hücreli karsinom SHK şeklinde görülebilirler. Çalışmamızda, PVL tanisi konulan bir vaka raporunu sunmaktayiz. PVL ilk defa Hansen ve ark tarafindan aciklanmis bir lezyondur, hiperkeratotik hastalÕ÷Õn devamÕ olarak gözlenir. Az rastlanÕlan, multi-fokal, yüksek malign transformasyon potansiyeli olan oral lökoplaki çeúididir. Lezyon, avantajlarÕ nedeniyle diyot lazer kullanÕlarak tedavi edildi. Bu avantajlardan birkaçÕ úöyle sÕralanabilir: azalmiú enfeksiyon riski, ödem ve post-operatif a÷rÕ, malign transformasyon riskinin azalmasÕ, daha az invaziv bir yaklaúÕm olmasÕ gibi. PVL tanÕsÕ ile tedavi edilen hastalar malign transformasyon OSHK riski bulundu÷u için 6 ayda bir rutin kontrollere ça÷ÕrÕlmalÕdÕ

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)