RationaleThere are few treatment options for severe COVID-19 pneumonia. Opaganib is an oral treatment under investigation.ObjectiveEvaluate opaganib treatment in hospitalized patients with severe COVID-19 pneumonia.MethodsA randomized, placebo-controlled, double-blind phase 2/3 trial was conducted in 60 sites worldwide from August 2020 to July 2021.Patients received either opaganib (n=230; 500mg twice daily) or matching placebo (n=233) for 14 days.Main Outcome MeasurementsPrimary 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.Main ResultsPre-specified primary and secondary outcome analyses did not demonstrate statistically significant benefit (except 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 FiO2levels 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 hours) by day 14 of opaganib treatment increased (76.9% vs 63.4%: p-value =0.033). There was a 62.6% reduction in intubation/mechanical ventilation (6.84% vs 17.91%; p-value=0.012) and a clinically meaningful 62% reduction in mortality (5.98% vs 16.7%; p-value=0.019) by day 42. No new safety concerns observed.ConclusionsPost-hoc analysis supports opaganib benefit in COVID-19 severe pneumonia patients that require lower supplemental oxygen (≤60% FiO2). Further studies are warranted.Trial registration numberNCT04467840

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Gemcitabine is a medication used to treat various types of malignant neoplasms. Its association with hemolytic uremic syndrome (HUS) has been described in few cases, although these cases have resulted in mortality rates of at least 50%. We report on the case of a 25-year-old patient with cholangiocarcinoma in remission who developed microangiopathic hemolytic anemia with acute anuric renal failure after receiving 5 cycles of gemcitabine chemotherapy; this condition was consistent with HUS caused by the side effects of this drug. The administration of gemcitabine was stopped, and hemodialysis, blood transfusions, plasma exchanges, steroids, doxycycline, and rituximab were used to treat the patient. A favorable outcome was achieved; in particular, hemolysis was controlled, and renal function was completely recovered.

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La endocarditis infecciosa (EI) es generada por microorganismos de la  superficie endocárdica, llevando posteriormente a la formación de vegetaciones. Es más comúnmente causada por organismos gram positivos, tales como Staphylococcus y Streptococcus; los gram negativos son culpables de alrededor del 10% de todos los casos de endocarditis. Menos del 2% de las endocarditis infecciosas son causadas por gérmenes gram negativos no HACEK (Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, y Kingella), incluyendo Pseudomonas aeruginosa;esta última afecta principalmente a pacientes inmunocomprometidos, conduciendo a infecciones nosocomiales severas, con altas tasas de morbi-mortalidad, y se asocia con usuarios de drogas intravenosas, infecciones por catéter y enfermedad valvular protésica. Los orígenes comunes han sido los tractos respiratorio, urinario o infecciones del torrente sanguíneo. Nosotros describimos el caso de un paciente masculino, de 73 años de edad,  inmunocompetente, quien presentó endocarditis infecciosa en la válvula aórtica protésica.