Frontiers in medicine
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Frontiers in medicine · Jan 2020
Lung Involvement in Primary Sjögren's Syndrome-An Under-Diagnosed Entity.
Interstitial lung disease (ILD) represents a frequent extra-glandular manifestation of primary Sjögren's Syndrome (pSS). Limited published data regarding phenotyping and treatment exists. Advances in managing specific ILD phenotypes have not been comprehensively explored in patients with coexisting pSS. ⋯ Median follow-up was 38.2 [12.4-119.6] months. Lung involvement in pSS is heterogeneous. Better phenotyping and tailored treatment may improve outcomes and requires further evaluation in larger prospective studies.
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Frontiers in medicine · Jan 2020
The Pipeline of Therapeutics Testing During the Emergency Phase of the COVID-19 Outbreak.
The coronavirus disease 19 (COVID-19) pandemic poses a serious threat to the sustainability of healthcare systems and is currently having a significant effect on living conditions worldwide. No therapeutic agent has yet proven to be effective for the treatment of COVID-19. The management of this disease currently relies on supportive care and the off-label and compassionate use of antivirals and immunomodulators. ⋯ The clinicaltrials.gov database and the European Union (EU) Clinical Trials Register were investigated on March 31, 2020, to identify all ongoing phase 1-4 research protocols testing pharmacological interventions targeting SARS-CoV-2 infection and/or clinical syndromes associated with COVID-19. Overall, six phase 1, four phase 1-2, 14 phase 2, ten phase 2-3, 19 phase 3, and nine phase 4 studies were identified, and the features of these studies are described in the present review. We also provide an updated overview of the change overtime in the pipeline following this emergency phase and based on the current epidemiology of the COVID-19 pandemic.
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Frontiers in medicine · Jan 2020
Development and Validation of a Sepsis Mortality Risk Score for Sepsis-3 Patients in Intensive Care Unit.
Background: Many severity scores are widely used for clinical outcome prediction for critically ill patients in the intensive care unit (ICU). However, for patients identified by sepsis-3 criteria, none of these have been developed. This study aimed to develop and validate a risk stratification score for mortality prediction in sepsis-3 patients. ⋯ As shown by the decision curve analysis, the score always had a positive net benefit. Conclusion: We observed moderate discrimination and calibration for the score termed Sepsis Mortality Risk Score (SMRS), allowing stratification of patients according to mortality risk. However, we still require further modification and external validation.
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Pulmonary Langerhans cell (LC) histiocytosis (PLCH) has unknown cause and is a rare neoplastic disorder characterized by the infiltration of lungs and various organs by bone marrow-derived Langerhans cells with an accompanying strong inflammatory response. These cells carry somatic mutations of BRAF gene and/or NRAS, KRAS, and MAP2K1 genes, which cause activation of the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) signaling pathway. PLCH occurs predominantly in young smokers, without gender predominance. ⋯ Histological examination of the lesion and demonstration of characteristic eosinophilic granulomas with the presence of LCs that display antigen CD1a or CD207 in immunohistochemistry are required for definite diagnosis. Smoking cessation is the most important recommendation for PLCH patients, but treatment of progressive PLCH and multisystem disease is based on chemotherapy. Recently, new targeted therapies have been implemented.
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Frontiers in medicine · Jan 2020
COVID-19 Induced Acute Respiratory Distress Syndrome-A Multicenter Observational Study.
Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. ⋯ ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay. Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients.