Background The impact of remdesivir (RDV) on COVID-19 mortality is controversial, and the mortality effect in sub-groups of baseline disease severity has been incompletely explored. The purpose of this study was to assess the association of RDV with mortality in patients with COVID-19. Methods In this retrospective cohort study we compared persons receiving RDV to persons receiving best supportive care (BSC). Patients hospitalized between 2/28/20 – 5/28/20 with laboratory confirmed SARS-CoV-2 infection were included when they developed COVID-19 pneumonia on chest radiography, and hypoxia requiring supplemental oxygen or SpO2 ≤ 94% on room air. The primary outcome was overall survival assessed with time-dependent Cox proportional-hazards regression and multivariable adjustment, including calendar time, baseline patient characteristics, corticosteroid use and effects for hospital. Results 1,138 patients were enrolled including 286 who received RDV, and 852 treated with BSC, 400 of whom received hydroxychloroquine. Corticosteroids were used in 20.4% of the cohort (12.6% in RDV and 23% in BSC). In persons receiving RDV compared to those receiving BSC the HR (95%CI) for death was 0.46 (0.31 – 0.69) in the univariate model, p<0.001 and 0.60 (0.40 – 0.90) in the risk-adjusted model, p=0.014. In the sub-group of persons with baseline use of low-flow oxygen, the HR (95%CI) for death in RDV compared to BSC was 0.63 (0.39 – 1.00), p=0.049. Conclusion Treatment with RDV was associated with lower mortality compared to BSC. These findings remain the same in the subgroup with baseline use of low-flow oxygen.

Persons in this region are at risk for acquiring this disease.

Nontuberculosis mycobacterial cervical lymphadenitis is a relatively common disease in immunocompetent children but a rare disease in immunocompetent adults. We report the diagnosis and treatment of Mycobacterium avium complex cervical lymphadenitis in an adult female. Our evaluation of immune competence, including gamma interferon (IFN-␥) and interleukin-12 (IL-12) signaling, found no evidence of deficiency. CASE REPORTA 54-year-old female with well-controlled hypothyroidism presented with a gradually enlarging right submandibular mass of several months' duration. She was otherwise asymptomatic and was treated with two courses of oral cephalexin with no discernible improvement. A fine-needle aspiration was performed that was nondiagnostic, and she subsequently developed a fistulous tract. Excision of the mass was undertaken, and a necrotic mass was found adjacent to the right submandibular gland. This was treated with an excision of the fistulous tract, right submandibular gland, and surrounding lymph nodes. Two of the five excised nodes and the fistula tract exhibited mixed necrotizing granulomatous inflammation. A Gram stain revealed heavy mononuclear cells, few polymorphonuclear white blood cells, and no organisms. Gomori methenamine silver and acid-fast bacilli stains were negative. Specimens were sent for culture, and standard aerobic and anaerobic bacterial cultures and fungal cultures were negative.Both a Mantoux skin test and a Quantiferon TB Gold test were negative. No antibiotics were initiated, pending the results of the mycobacterial culture. At 2 weeks, the culture became positive with acid-fast bacteria. This was ultimately identified as Mycobacterium avium complex, by means of a Mycobacterium avium complex AccuProbe (Gen-Probe, San Diego, CA), which, while unable to differentiate between M. avium and M. intracellulare, is otherwise quite specific; most clinical laboratories do not differentiate these species due to the cost and the lack of difference in treatment between species (3, 9). The isolate was susceptible to clarithromycin and clofazimine, intermediate to ciprofloxacin, rifabutin, ethambutol, streptomycin, and amikacin, and resistant to rifampin. As the patient's incision had healed well and a follow-up computerized tomography scan noted no clear evidence of a mass or infection, no antimicrobial treatments were initiated.An immunologic workup was undertaken given the rarity of this infection in adults. The patient's complete hematology profile was normal, with a normal differential of her white blood cells. A comprehensive metabolic panel, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), thyroidstimulating hormone (TSH), and vitamin D level were normal. She was HIV antibody negative, and flow cytometry of T and B lymphocytes was normal, with results as follows: number of TCD3 cells, 1,743 (83%); number of CD4 cells, 1,071 (51%); number of CD8 cells, 630 (30%); CD4/CD8 ratio, 1.7; and number of CD19 cells, 189 (9%). Immunoglobulin levels were as follows: IgG, 1,633; IgA, 21...