Outbreak of the new type coronavirus infection, known as coronavirus infection 2019 (COVID-19), has begun in December 2019, in Wuhan, China. As of today, 3 April 2020, 972,640 people affected and 50,325 people died from Severe Acute Respiratory Syndrome-Coronavirus 2. There is not any standard treatment for coronavirus infection 2019; however, there are promising data for hydroxychloroquine and some anti-retroviral drugs. Programmed death-1 (PD-1)/programmed death ligand-1 (PDL-1) pathway is an important target for the cancer immunotherapy. However, there is a robust pre-clinical and clinical data regarding inhibitor effect of this pathway on the acute or chronic viral infections. Thus, blockade of this pathway may lead to an anti-viral effect and decrease viral load. Here, we report the clinical course of coronavirus infection 2019 infection of a patient in whom older aged, having multiple co-morbidities, and taking nivolumab for metastatic malignant melanoma. In contrast to her older age, comorbidities, and cancer diagnosis, she was in a good condition, and there was also no pneumonia finding. We think that this good clinical course of coronavirus infection 2019 infection may be related to blockade of PD-1/PDL-1 pathway with nivolumab. It is impossible to say that blockade of PD-1/PDL-1pathway is a treatment option for COVID-19; however, we want to share our experience.
Introduction: Guidelines recommend using a pulse oximeter rather than
arterial blood gas (ABG) for COVID-19 patients. However, significant
differences can be observed between oxygen saturation measured by pulse
oximetry (SpO2) and arterial oxygen saturation (SaO2) in some clinical
conditions. We aimed to assess the reliability of pulse oximeter in
patients with COVID-19 Methods: We retrospectively reviewed ABG analyses
and SpO2 levels measured simultaneously with ABG in patients
hospitalized in COVID-19 wards. Results: We categorized total 117
patients into two groups; in whom the difference between SpO2 and SaO2
was 4% (acceptable difference) and >4% (large
difference). Large difference group exhibited higher neutrophil count,
C-reactive protein, ferritin, fibrinogen, D-dimer and lower lymphocyte
count. Multivariate analyses revealed that increased fibrinogen,
increased ferritin and decreased lymphocyte count were independent risk
factors for large difference between SpO2 and SaO2. The total study
group demonstrated the negative bias of 4.02% with the limits of
agreement of −9.22% to 1.17%. The bias became significantly higher in
patients with higher ferritin, fibrinogen levels and lower lymphocyte
count. Conclusion: Pulse oximeters may not be sufficient to assess
actual oxygen saturation especially in COVID-19 patients with high
ferritin and fibrinogen levels and low lymphocyte count low SpO2
measurements.
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