Effect of Opaganib on Supplemental Oxygen and Mortality in Patients with Severe SARS-CoV-2 Based upon FIO2 Requirements

Once a patient has been diagnosed with severe COVID-19 pneumonia, treatment options have limited effectiveness. Opaganib is an oral treatment under investigation being evaluated for treatment of hospitalized patients with severe COVID-19 pneumonia. A randomized, placebo-controlled, double-blind phase 2/3 trial was conducted in 57 sites worldwide from August 2020 to July 2021. Patients received either opaganib (n = 230; 500 mg twice daily) or matching placebo (n = 233) for 14 days. The primary outcome was the proportion of patients no longer requiring supplemental oxygen by day 14. Secondary outcomes included changes in the World Health Organization Ordinal Scale for Clinical Improvement, viral clearance, intubation, and mortality at 28 and 42 days. Pre-specified primary and secondary outcome analyses did not demonstrate statistically significant benefit (except nominally for time to viral clearance). Post-hoc analysis revealed the fraction of inspired oxygen (FIO2) at baseline was prognostic for opaganib treatment responsiveness and corresponded to disease severity markers. Patients with FIO2 levels at or below the median value (≤60%) had better outcomes after opaganib treatment (n = 117) compared to placebo (n = 134). The proportion of patients with ≤60% FIO2 at baseline that no longer required supplemental oxygen (≥24 h) by day 14 of opaganib treatment increased (76.9% vs. 63.4%; nominal p-value = 0.033). There was a 62.6% reduction in intubation/mechanical ventilation (6.84% vs. 17.91%; nominal p-value = 0.012) and a clinically meaningful 62% reduction in mortality (5.98% vs. 16.7%; nominal p-value = 0.019) by day 42. No new safety concerns were observed. While the primary analyses were not statistically significant, post-hoc analysis suggests opaganib benefit for patients with severe COVID-19 requiring supplemental oxygen with an FIO2 of ≤60%. Further studies are warranted to prospectively confirm opaganib benefit in this subpopulation.

[Orthotopic replacement of the urinary bladder in females]

Orthotopic cystoplasty for various diseases of the urinary bladder was made in 58 females aged 22 to 78 years (mean age 52.5 +/- 5.8 years) in 1996-2005. Surgery was indicated in muscular-invasive cancer of the bladder (n = 35, 60.3%), microcystis (n = 21, 36.3%), bladder atonia (n = 1, 1.7%), vesicovaginal fistula (n = 1, 1.7%). The reservoir was made of iliac segment in 50 (86,2%) patients, of gastric body - in 8 (13.8%) patients. Postoperative complications arose in 7 (12.1%) patients, late complications occurred in 4 (6.8%). Postoperative lethality was not registered, 12 months later 3 (5.2%) patients died of cancer progressiion. Day continence after ileo- and gastrocystoplasty was 93.3 and 87.8%, night - 45.2 and 32.8%, respectively. Urodynamics was satisfactory. Chronic continence occurred in 3 (5.6%) patients. Satisfactory clinical and functional results of artificial reservoir creation in females support advantages of this method of urine derivation. Gastrocystoplasty is a promising method of urinary bladder replacement. It is important to assess function of the lower urinary tract before operation. Reservoir-vaginal fistula is a new kind of urogenital fistulas. It is treated by transvaginal fistuloraphy.

[Results of monopolar versus quasibipolar transurethral resection of the prostate and urinary bladder]

We compared efficacy and safety of mono- vs quasibipolar transurethral resection (TUR) for 198 patients treated with TUR. The patients were randomized into two groups by the TUR variant: mono-or quasibipolar. Comparison ofpre- and postoperative examinations data in the above two groups demonstrated: blood sodium decreased more in patients from monopolar TUR group, the absence of TUR-syndrome and less frequent and severe symptoms of obturator nerve irritation after quasibipolar TUR. Use of salt solution in quasibipolar TUR allowed us to avoid such a severe postoperative complication as TUR-syndrome. Thus, transurethral resection in physiological solution is an operation of choice in surgical treatment of prostatic adenoma and superficial cancer of the urinary bladder.

[Urodynamics of artificial urinary bladder]

Radical cystectomy with creation of orthotopic reservoir from various segments of gastrointestinal tract was made in 120 patients (99 males, 21 females, age 37-74 years) with muscular-invasive cancer of the urinary bladder (UB) in 1996-2004. Replacement of UB was made according to the Studer and Hautmann method in 38 and 27 patients, respectively. S-cystoplasty was performed in 31 patients. The gastric segment was used for creation of the reservoir in 24 patients. Three patients died. Three to twelve month follow-up recorded the best functional results in patients after Studer cystoplasty.

[Appendicouretheroplasty]

Repair of long uretheral defects with the appendix (appendi-couretheroplasty--AUP) was made in 5 patients. Stenosis of the lumbar urether was caused by a gunshot wound in one patient. Uretheral strictures developed after iatrogenic injury during extended gynecological operations in 3 women. The strictures arose after radiotherapy in one female. The man has undergone plastic reconstruction of the upper third of the right ureter, while women - replacement of the pelvic urether, including one case on the left. In two cases a modified surgical technique was used for better appendicocystanastomosis--a flap was dissected from the cupola of the cecum. In one case surgery was combined with simultaneous contralateral Boari's operation, in the other case--with transvaginal suturing of the vesicovaginal fistula. Exacerbation of chronic pyelonephritis occurred in one patient. In the other case antegrade pyeloureterography has detected stricture of ureteroappendicoanastomosis. Resection of the stricted place and reanastomosing were performed in this patient. Passability of the urinary tract recovered in all the patients. Thus, replacement of any part of the right and pelvic part of the left ureter with the appendix is feasible with good results.