RESUMEN
Importance: As there is no definitive treatment available for covid-19 pneumonia, with timed administration of tocilizumab as an adjuvant therapy in moderate to severe covid-19 pneumonia, we can reduce mortality due to cytokine storm. Objective: To determine effectiveness of tocilizumab as an adjuvant therapy in moderate to severe covid-19 pneumonia patients. Design: Retrospective Observational study from the time period of April 2020 to December 2020. Setting: This study has been carried out at SSG Hospital, a tertiary care hospital at Vadodara, Gujarat. Participants: 80 moderate to severe COVID-19 positive patients in the group of age 18-80 years requiring hospitalisation in whom tocilizumab (8mg/kg to a maximum dose of 800mg) was given, were enrolled in the study. The following patient details were collected and studied in relation to the use of tocilizumab- Biodata, Presenting complaints, past history of any illness, Drug history, Vitals and physical examination, Investigations, Treatment. Exposures: 80 patients of moderate to severe COVID-19 pneumonia who were given Injection tocilizumab (8mg/kg to a maximum dose of 800mg) were selected retrospectively. Main outcomes and Measures: We have correlated the outcome in the form of discharged or death with the help of parameters likes: Time to Clinical Improvement, Ventilator-Free Days, Duration of ICU Stay, Time to Clinical Failure, and Time to Hospital Discharge Results: Out of the total 80 patients, 29 patients were in the age group of more than 60 years, of which 7 were discharged and 22 died. The other 51 patients were less than 60 years of age, of which 28 patients were discharged and the rest 23 died. (p value 0.007). 63 patients out of the total 80 patients were males of which 31 (49.21%) recovered while 32 (50.79%) of them died. 5 (29.11%) females out of the total 17 female covid positive patients recovered while the other 12 (70.59 %) died. (p value 0.14) Conclusion and Relevance: In our study, we have observed that even after giving tocilizumab mortality was higher in patients above 60 years of age, two or more co-morbidities, SpO2 of less than 85% on the room air, SOFA scoring of more than or equal to 3, radiological involvement of more than 2 zones, higher score (>3) of inflammatory markers, higher level of mode of respiratory support like BiPAP or invasive ventilation. . This shows that the ideal time to give tocilizumab is when the patient is on NRBM support. By this it gives the maximum benefit. There was no difference in outcome in patients of either gender, blood pressure and on admission blood sugar levels, and co-administration of injection Ramdesivir. Significant percentage of patients died who had uncontrolled diabetes mellitus with insignificant p value, so further studies are required to find out the association.
RESUMEN
Background: Diabetic nephropathy is one of the commonest and most dreaded complications of Diabetes. The Aim was to evaluate the significance of microalbuminuria and creatinine clearance for detecting incipient diabetic nephropathy, and to find out the prevalence of nephropathy among freshly detected Type 2 diabetic patients with vs. those without hypertension, hypercholesterolemia and/or obesity.Methods: In this prospective study, 100 recently diagnosed diabetics were studied. Group A had 50 patients with at least one risk factor are hypertension, hypercholesterolemia and obesity. Group B had 50 patients without any of the aforementioned factors. Patients were investigated for presence of Diabetic nephropathy with abnormal serum Creatinine, creatinine clearance and urinary albumin levels.Results: As many as 43 out of 100 patients were found to have Diabetic nephropathy. The number was significantly higher in group A compared to group B (34/50 vs. 9/50). Incidence of nephropathy was higher with higher number of associated risk factors. Urinary microalbuminuria was the commonest abnormality, Serum creatinine was found in only 30.23% of total positive cases.Conclusions: Incidence of diabetic nephropathy is much larger than imagined in freshly diagnosed/new onset cases of DM type 2. Author also conclude that hypertension, obesity and hypercholesterolemia can contribute to development of nephropathy (68% vs. 18% in those who had the factors vs. those who didn抰). Also, urinary microalbuminuria appears to be much more sensitive than serum creatinine as screening tool.