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León Román F, Pintado-Cort B, García-Casado D, Muñiz-González F, López García-Asenjo JA, Díaz-Rodríguez C, Montoro-López MN, Loucel-Bellino M, Recio-Moreno B, Rebollo-Garrido S, Martínez-Hernández Y, Cusacovich I. Rituximab for the treatment of acute exacerbation of interstitial lung disease associated with connective tissue disease. RMD Open 2023; 9:e003479. [PMID: 37673443 PMCID: PMC10496654 DOI: 10.1136/rmdopen-2023-003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Acute exacerbation of interstitial lung disease (AE-ILD) is a severe complication with a poor prognosis. No clinical trials have supported the use of rituximab in AE-ILD associated with connective tissue disease. METHODS We present a series of four cases in which administration of rituximab was associated with appropriate clinical, radiological and functional progress. RESULTS The four patients were alive 30 days after discharge following their exacerbation. CONCLUSIONS Given the speed of action, safety and efficacy profile observed for rituximab, we believe that this agent should be further investigated in clinical trials so that it could be included in the daily clinical management of this severe condition.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Rebollo-Garrido
- Pulmonology Nursing Department, Hospital Recoletas Campo Grande, Valladolid, Spain
| | | | - Ivan Cusacovich
- Internal Medicine Department, Hospital Recoletas Campo Grande, Valladolid, Spain
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Cusacovich I, Sánchez-Lite I, Toribio B, González JM, Pérez-Rubio A, Andaluz-Ojeda D. Prevalence of nonalcoholic fatty liver disease in a Spanish town: a population-based study. Rev Clin Esp 2023:S2254-8874(23)00071-1. [PMID: 37302463 DOI: 10.1016/j.rceng.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Nonalcoholic fatty liver disease (NAFLD) is western countries' most important cause of hepatic steatosis and hypertransaminasemia. The objective was to evaluate the prevalence of NAFLD among 261025 people in the East Valladolid public healthcare area in Spain. METHODS We randomly selected 1800 participants from a public healthcare system card database, representing most of the population. We performed a medical record, measurement of anthropometric parameters, abdominal ultrasound, and blood tests to rule out hepatic disease in all patients. We calculated the FLI score in all patients. RESULTS 448 participants agreed to participate in the study. The prevalence of nonalcoholic fatty liver disease in our study was 22,3% [18,5%-26,2%]. Prevalence was highest between 50 and 70 years, increasing with age (p < 0,006). There were no significant differences in sex (p = 0,338). The median Body mass index was 27,2, and NAFLD was related to the weight (p < 0,001) and abdominal perimeter (p < 0,001). Logistic regression analysis showed GGT lower than 26 UI/ml, body mass index higher than 31, and HOMA IR greater than 2.54 as independent factors to predict NAFLD in the sample. NAFLD diagnosis matched with an elevated FLI score in 88% of cases. CONCLUSION According to other epidemiological studies, NAFLD's prevalence is very high. A complete study with a clinical consultation, image studies, and blood tests in all patients allows us to assess the prevalence of NAFLD in the population.
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Affiliation(s)
- I Cusacovich
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Spain.
| | - I Sánchez-Lite
- Department of Radiology, Hospital Clínico Universitario de Valladolid, Spain
| | - B Toribio
- Department of Radiology, Hospital Clínico Universitario de Valladolid, Spain
| | - J M González
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valladolid, Spain; Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo
| | - A Pérez-Rubio
- Department of epidemiology, Hospital Clínico Universitario de Valladolid, Spain
| | - D Andaluz-Ojeda
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Spain
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3
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León-Román F, Pintado-Cort B, García-Asenjo JAL, García-Casado D, Cusacovich I, Loucel M, Recio-Moreno B, Muñiz-González F. Growing Pulmonary Nodule of Unknown Origin in a 61-Year-Old Woman. Am J Med 2023; 136:446-448. [PMID: 36649834 DOI: 10.1016/j.amjmed.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | | | - Ivan Cusacovich
- Internal Medicine Department, Hospital Recoletas Campo Grande, Valladolid, Spain; Internal Medicine Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Mauricio Loucel
- Thoracic Surgery Department, Hospital Recoletas Campo Grande, Valladolid, Spain; Thoracic Surgery Department, Hospital Clínico Universitario, Valladolid, Spain
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Corral-Gudino L, Cusacovich I, Martín-González JI, Muela-Molinero A, Abadía-Otero J, González-Fuentes R, Ruíz-de-Temiño Á, Tapia-Moral E, Cuadrado-Medina F, Martín-Asenjo M, Miramontes-González P, Delgado-González JL, Ines S, Abad-Manteca L, Usategui-Martín I, Ruiz-Albi T, Miranda-Riaño S, Rodríguez-Fortúnez P, Rodríguez-Jiménez C, López-Franco E, Marcos M. Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalised adults with severe COVID-19 pneumonia: An open-label randomised trial. Eur J Clin Invest 2023; 53:e13881. [PMID: 36169086 PMCID: PMC9538428 DOI: 10.1111/eci.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/10/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The efficacy and safety of high versus medium doses of glucocorticoids for the treatment of patients with COVID-19 has shown mixed outcomes in controlled trials and observational studies. We aimed to evaluate the effectiveness of methylprednisolone 250 mg bolus versus dexamethasone 6 mg in patients with severe COVID-19. METHODS A randomised, open-label, controlled trial was conducted between February and August 2021 at four hospitals in Spain. The trial was suspended after the first interim analysis since the investigators considered that continuing the trial would be futile. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 mg once daily for up to 10 days or methylprednisolone 250 mg once daily for 3 days. RESULTS Of the 128 randomised patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group versus 4.8% in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; p = 0.98). None of the secondary outcomes (admission to the intensive care unit, non-invasive respiratory or high-flow oxygen support, additional immunosuppressive drugs, or length of stay), or prespecified sensitivity analyses were statistically significant. Hyperglycaemia was more frequent in the methylprednisolone group at 27.0 versus 8.1% (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; p = 0.007). CONCLUSIONS Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.
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Affiliation(s)
- Luis Corral-Gudino
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ivan Cusacovich
- Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain.,Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Jose Ignacio Martín-González
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Alberto Muela-Molinero
- Internal Medicine Department, Hospital Universitario de León, Gerencia Regional de Salud de Castilla y Leon (SACYL), León, Spain
| | - Jésica Abadía-Otero
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Roberto González-Fuentes
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Ángela Ruíz-de-Temiño
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Elena Tapia-Moral
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Francisca Cuadrado-Medina
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Miguel Martín-Asenjo
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Pablo Miramontes-González
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Jose Luis Delgado-González
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Sandra Ines
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Laura Abad-Manteca
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Iciar Usategui-Martín
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Tomás Ruiz-Albi
- Pneumology Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Sara Miranda-Riaño
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Patricia Rodríguez-Fortúnez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Consuelo Rodríguez-Jiménez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Esperanza López-Franco
- UICEC, Complejo Asistencial Universitario de Salamanca - Instituto de Investigación Biomédica de Salamanca (IBSAL), Plataforma SCReN, Salamanca, Spain
| | - Miguel Marcos
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain.,UICEC, Complejo Asistencial Universitario de Salamanca - Instituto de Investigación Biomédica de Salamanca (IBSAL), Plataforma SCReN, Salamanca, Spain
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Gutierrez CD, Abadia-Otero J, Cusacovich I, Martín-González JI, Muela-Molinero A, Corral-Gudino L, González-Fuentes R, de Temiño ÄR, Moral ET, Cuadrado-Medina F, Martín-Asenjo M, Gonzalez PM, Delgado Morales JL, Ines S, Abad-Manteca L, Usategui-Martín I, Ruíz-Albí T, Miranda-Riaño S, Rodríguez-Fortúnez P, Rodríguez-Jiménez C, López-Franco E, Marcos M. 1125. Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalized adults with severe COVID-19 pneumonia: an open-label randomized trial. Open Forum Infect Dis 2022. [PMCID: PMC9752252 DOI: 10.1093/ofid/ofac492.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Pulse glucocorticoid therapy is used in COVID-19 infection. We evaluated the effectiveness of methylprednisolone 250 mg/d for 3 days vs. dexamethasone 6 mg/d for 10 days in patients with severe but not critical COVID-19 pneumonia. Methods A multicentre, randomized, open-label, controlled trial was conducted between February 2021 and August 2021 at 4 hospitals in Spain and included 128 hospitalized adults with confirmed COVID-19 pneumonia needing oxygen therapy but not critically ill. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 once daily for 10 days or methylprednisolone 250 mg once daily for 3 days. The primary outcome was 28-day mortality. Results Of the 128 randomized patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group vs. 4.8 % in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; P=0.98). The post-hoc added composite outcome of mortality at 90 days or intubation was 15.9% in the 250 mg methylprednisolone group vs. 15% in the 6 mg dexamethasone group (absolute risk difference, -0.9% [95% CI, -13.8 to 12.3%];P=0.83). Hyperglycaemia was more frequent in the methylprednisolone group, at 27.0 vs. 8.1 % (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; P=0.007). Conclusion Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation. Disclosures Carlos Dueñas Gutierrez, MD, ViIV, GILEAD, Jannsen, MSD: Lecture fees.
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Andaluz-Ojeda D, Vidal-Cortes P, Aparisi Sanz Á, Suberviola B, Del Río Carbajo L, Nogales Martín L, Prol Silva E, Nieto del Olmo J, Barberán J, Cusacovich I. Immunomodulatory therapy for the management of critically ill patients with COVID-19: A narrative review. World J Crit Care Med 2022; 11:269-297. [PMID: 36051937 PMCID: PMC9305685 DOI: 10.5492/wjccm.v11.i4.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/01/2021] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Understanding the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies.
AIM To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets.
METHODS A comprehensive literature search was developed. Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate. Finally, a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed. This recommendation was made based on the consensus of all the authors.
RESULTS A brief rationale on the SARS-CoV-2 pathogenesis, immune response, and inflammation was developed. The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed. Finally, based on the level of scientific evidence, a recommendation was established for each of them.
CONCLUSION Although several promising therapies exist, only the use of corticosteroids and tocilizumab (or sarilumab in absence of this) have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19. Endotypes including both, clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.
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Affiliation(s)
- David Andaluz-Ojeda
- Department of Critical Care, Hospital Universitario HM Sanchinarro, Hospitales Madrid, Madrid 28050, Spain
| | - Pablo Vidal-Cortes
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | | | - Borja Suberviola
- Department of Intensive Care, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
| | - Lorena Del Río Carbajo
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | - Leonor Nogales Martín
- Department of Intensive Care, Hospital Clínico Universitario de Valladolid, Valladolid 47005, Spain
| | - Estefanía Prol Silva
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | - Jorge Nieto del Olmo
- Department of Intensive Care, Complejo Hospitalario Universitario de Ourense, Ourense 32005, Spain
| | - José Barberán
- Department of Internal Medicine, Hospital Universitario HM Montepríncipe, Hospitales Madrid, Boadilla del Monte 28860, Madrid, Spain
| | - Ivan Cusacovich
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid 47005, Spain
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