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SARS-CoV-2 is associated with a severe inflammatory response contributing to respiratory and systemic manifestations, morbidity, and mortality in patients with coronavirus disease 2019 (COVID-19).

Tocilizumab (TCZ) efficacy on mortality and length of hospital stay was retrospectively evaluated in patients who received TCZ and compared with that in controls with a similar severity of COVID-19. The primary endpoint was survival probability on day 28. The secondary endpoints included survival at day 14 and length of hospital stay.

Of the 148 patients included in the study, 62 received TCZ and standard of care, whereas 86 served as a control group and received only standard of care. The two groups were similar, although TCZ-treated patients were more likely to exhibit hypertension (46.7% vs. 29.8%), chronic kidney disease (14.5% vs. 1.1%), and high Charlson score (1.18 vs. 1.00; p = 0.006) and less likely to receive corticosteroid treatment (48.5% vs. 93.0%). TCZ was associated with lower mortality on both day 28 (16.1% vs. TC-S 7009 order 37.2%, p = 0.004) and day 14 (9.7% vs. 24.4%, p = 0.022). The hospital stay was longer in the TCZ-treated than in the control group (15.6 ± 7.59 vs.17.7 ± 7.8 days, p = 0.103). Ten patients (16.0%) in the TCZ-treated group developed infections.

TCZ was associated with a lower likelihood of death despite resulting in higher infection rates and a non-significant longer hospital stay.

TCZ was associated with a lower likelihood of death despite resulting in higher infection rates and a non-significant longer hospital stay.Candida infection is seen in patients with weak or disrupted host responses. Cutaneous candidiasis typically affects the intertriginous areas and presents with a red plaque surrounded by satellite lesions. Diagnosis of cutaneous candidiasis is made by visual inspection followed by potassium hydroxide normal saline microscopic preparation (wet mount) and polymerase chain reaction identification or culture of fungal organism. The following case describes a 38-year-old patient with limited mobility who presented with a peri sacral lesion that was first assumed to be a decubitus ulcer by nursing facility staff, but proved to be a cutaneous infection by Candida tropicalis, a less common Candida species. The unusual location as well as the characteristic C. tropicalis micro- and macroscopic appearance are described which ultimately led to the diagnosis of a cutaneous fungal infection in an otherwise immunocompetent individual that was resolved with fluconazole therapy. Our case report emphasizes the need for early diagnosis of cutaneous lesions in patients with limited mobility in consideration that not all Candida species thrive in similar environments and can present in unusual locations of the human body. Although rare, C. tropicalis could be found in this vulnerable population.Histoplasma is endemic in North and Central America. We describe a case of disseminated histoplasmosis in a heart transplant recipient outside the known endemic areas. A 68-year-old gentleman known to have dilated cardiomyopathy. He underwent left ventricular assist device (LVAD) implantation in India and 2 years later did heart transplant in King Faisal Specialist and Research Center Hospital. Six weeks post-transplant he presented with headache and fever. All investigations were negative, and he was discharged home. Four days after discharge he presented with headache, fever, blurred vision, and an episode of loss of consciousness. Examination showed an ill looking patient who is highly febrile. Repeated work up showed pancytopenia. A repeat LP was negative. Bone marrow biopsy showed Small intracellular organisms. Extended work up revealed a positive Histoplasma urinary antigen, positive Histoplasma PCR from the bone marrow biopsy. Patient was started on Liposomal Amphotericin followed by Itraconazole with marker clinical improvement. This is the first reported case of disseminated Histoplasmosis in Saudi Arabia. We postulate that the patient had reactivation of a latent infection acquired at the time of LVAD insertion in India rather than donor derived infection by the negative fungal culture and PCR done on the donor’s lung granuloma tissue.

Preliminary studies showed that coronavirus disease 2019 (COVID-19) disrupts body immune system, including dysregulation of cytokine interleukin-6 (IL-6). IL-6 inhibitors agents have been used as treatment options for COVID-19, yet their benefit as therapeutic agents remains unclear.

We performed a systematic review and meta-analysis to synthesize the available evidence on the potential therapeutic effect of IL-6 inhibitor agents for the treatment of COVID-19.

Two authors initially screened and reviewed the relevant studies from available databases. The data extracted will be tabulated and analyzed for the outcomes. The primary outcome was mortality. Secondary outcomes included discharge from the hospital, length of stay, and requirement for mechanical ventilation. The quality of each study was assessed using OCEBM ratings.

We reviewed 18 studies with a total of 3303 subjects. Tocilizumab was the most commonly used in the studies (15 studies). Meta-analysis of included studies revealed significant reduction in mortality with tocilizumab and sarilumab (RR = 0.61, 95% CI 0.49-0.76). Other outcomes including hospital discharge (RR = 1.04, 95% CI 0.86-1.24), length of stay (mean difference -1.96 days, 95% CI -4.24 to 0.33) or requirement for mechanical ventilation (RR = 0.68, 95% CI 0.32-1.45) revealed no differences of IL-6 inhibitor agents compared to controls.

Available evidence suggests that IL-6 inhibitor agents reduce the risk of mortality in COVID-19, especially in severe conditions. Further well-designed trials are needed for assessing its efficacy and safety for COVID-19.

Available evidence suggests that IL-6 inhibitor agents reduce the risk of mortality in COVID-19, especially in severe conditions. Further well-designed trials are needed for assessing its efficacy and safety for COVID-19.

Event-related potentials (ERPs) are reported to be altered in relation to cognitive processing deficits in attention deficit hyperactivity disorder (ADHD). However, this evidence is mostly limited to cross-sectional data. The current study utilized neurofeedback (NFB) as a neuromodulatory tool to examine the ERP correlates of attentional and inhibitory processes in adult ADHD using a single-session, within-subject design.

We recorded high-density EEG in 25 adult ADHD patients and 22 neurotypical controls during a Go/NoGo task, before and after a 30-minute NFB session designed to down-regulate the alpha (8-12Hz) rhythm.

At baseline, ADHD patients demonstrated impaired Go/NoGo performance compared to controls, while Go-P3 amplitude inversely correlated with ADHD-associated symptomatology in childhood. Post NFB, task performance improved in both groups, significantly enhancing stimulus detectability (d-prime) and reducing reaction time variability, while increasing N1 and P3 ERP component amplitudes. Specifically for ADHD patients, the pre-to-post enhancement in Go-P3 amplitude correlated with measures of improved executive function, i.