The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset (NCT04348656). Patients were allocated 2:1 to 500 ml of convalescent plasma or standard of care. The composite primary outcome was intubation or death by 30 d. Exploratory analyses of the effect of convalescent plasma antibodies on the primary outcome was assessed by logistic regression. The trial was terminated at 78% of planned enrollment after meeting stopping criteria for futility. In total, 940 patients were randomized, and 921 patients were included in the intention-to-treat analysis. Intubation or death occurred in 199/614 (32.4%) patients in the convalescent plasma arm and 86/307 (28.0%) patients in the standard of care arm—relative risk (RR) = 1.16 (95% confidence interval (CI) 0.94–1.43, P = 0.18). Patients in the convalescent plasma arm had more serious adverse events (33.4% versus 26.4%; RR = 1.27, 95% CI 1.02–1.57, P = 0.034). The antibody content significantly modulated the therapeutic effect of convalescent plasma. In multivariate analysis, each standardized log increase in neutralization or antibody-dependent cellular cytotoxicity independently reduced the potential harmful effect of plasma (odds ratio (OR) = 0.74, 95% CI 0.57–0.95 and OR = 0.66, 95% CI 0.50–0.87, respectively), whereas IgG against the full transmembrane spike protein increased it (OR = 1.53, 95% CI 1.14–2.05). Convalescent plasma did not reduce the risk of intubation or death at 30 d in hospitalized patients with COVID-19. Transfusion of convalescent plasma with unfavorable antibody profiles could be associated with worse clinical outcomes compared to standard care.

Rationale: Treatment with inhaled corticosteroids (ICS) for those with chronic obstructive pulmonary disease (COPD) has been shown to be associated with an increased incidence of pneumonia. However, it is unclear if this is associated with increased mortality. Objectives: The aim of this study was to examine the effects of prior use of ICS on clinical outcomes for patients with COPD hospitalized with pneumonia. Methods: We conducted a retrospective cohort study using the national administrative databases of the Department of Veterans Affairs. Eligible patients had a preexisting diagnosis of COPD, had a discharge diagnosis of pneumonia, and received treatment with one or more appropriate pulmonary medications before hospitalization. Outcomes included mortality, use of invasive mechanical ventilation, and vasopressor use. Conclusions: For patients with COPD, prior use of ICS is independently associated with decreased risk of short-term mortality and use of mechanical ventilation after hospitalization for pneumonia.Keywords: inhaled corticosteroids; pneumonia; chronic obstructive pulmonary disease; mortality Chronic obstructive pulmonary disease (COPD) is the fourth most frequent cause of chronic morbidity and mortality in developed countries (1). One of the current recommended COPD treatments by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) is inhaled corticosteroids (ICS) for symptomatic patients with a documented bronchodilator response on spirometry or for patients with FEV 1 less than 50% predicted, which is indicative of moderate-to-severe COPD (2). Although ICS treatment reduces the overall frequency of exacerbations of COPD (3), evidence suggests that ICS treatment is associated with an increased risk of pneumonia (4-6).Despite several studies demonstrating that patients with COPD have an increased likelihood of developing pneumonia when receiving ICS (4-8), it remains unclear if use of ICS is associated with adverse medical outcomes for patients with COPD. Prior studies examining the effect of COPD on pneumonia-related mortality have led to conflicting conclusions (9-11). Two systematic reviews examining the use of ICS therapy to manage COPD found no significant differences in mortality (4, 5). Another study comparing COPD exacerbation rates between patients being treated with either salmeterol or a combination of salmeterol and fluticasone demonstrated that all-cause mortality was similar for patients hospitalized with pneumonia regardless of prior use of ICS (6). However, they did find increased mortality for users of ICS with pneumonia within 30 days of hospitalization. Another recent study showed that use of ICS was associated with lower 30-and 90-day mortality after pneumonia; however, this study was not able to examine other clinically relevant outcomes or assess the effects of other appropriate respiratory medications received (12).The aim of our study was to examine the association between prior use of ICS and clinical outcomes, including mortality, need Studies demonstrate that...

Objectives Deep brain stimulation (DBS) has been established as a safe, effective therapy for movement disorders (Parkinson’s disease, essential tremor, etc.), and its application is expanding to the treatment of other intractable neuropsychiatric disorders including Depression and Obsessive-Compulsive Disorder (OCD). Several published studies have supported the efficacy of DBS for severely debilitating OCD. However, questions remain regarding the optimal anatomical target and the lack of a bedside programming paradigm for OCD DBS. Management of OCD DBS can be highly variable and is typically guided by each center’s individual expertise. In this paper, we review the various approaches to targeting and programming for OCD DBS. We also review the clinical experience for each proposed target, and discuss the relevant neuroanatomy. Methods A PubMed review was performed searching for literature on OCD DBS and included all articles published before March 2012. We included all available studies with a clear description of the anatomical targets, programming details, and the outcomes. Results Six different DBS approaches were identified. High frequency stimulation with high voltage was applied in most cases, and predictive factors for favorable outcomes were discussed in the literature. Conclusion DBS remains an experimental treatment for medication refractory OCD. Target selection and programming paradigms are not yet standardized, though, an improved understanding of the relationship between the DBS lead and the surrounding neuroanatomical structures will aid in the selection of targets and the approach to programming. We propose to form a registry to track OCD DBS cases for future clinical study design.