Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

Mielopatía asociada con infección por HTLV-1: paraparesia espástica tropical / Myelopathy associated with HTLV-1 infection: tropical spastic paraparesia

RESUMEN La mielopatía asociada con infección por HTLV-1 o paraparesia espástica tropical (MAH/PET) es una enfermedad crónica degenerativa del sistema nervioso central que afecta principalmente a la médula espinal. Está asociada a la infección por el virus linfotrópico humano tipo 1 (HTLV-1) que pertenece a la familia Retroviridae. América Latina, Asia y África Subsahariana son zonas endémicas de infección por HTLV-1 y MAH/ PET, entre el 2 % y el 17 %, la mayoría asintomáticos. Colombia tiene una alta prevalencia y en especial en su costa pacífica. En las mujeres la infección por HTLV-1 es más prevalente que en los hombres sin que sea clara la causa; se transmite por transfusiones sanguíneas (principalmente de sangre completa), lactancia materna o relaciones sexuales, que es la forma de transmisón más común en pacientes con MAH/PET. La MAH/PET se presenta principalmente en adultos, su periodo de incubación hasta el desarrollo de síntomas varía de dos años hasta décadas. Las principales manifestaciones clínicas de esta enfermedad son la paraparesia y espastici-dad lentamente progresiva que afecta la marcha, asociada con síntomas de esfínteres, como vejiga neurogénica o estreñimiento. Para su diagnóstico se requiere resonancia magnética (RM) de cerebro y médula espinal y la prueba de Elisa, las más usada, con confirmación mediante western blot (WB). En la actualidad no existe un tratamiento específico para la MAH/PET. En el futuro, el uso de biomarcadores ayudará a la detección temprana de la enfermedad e incluso como posible diana terapéutica.

SUMMARY Myelopathy associated with HTLV-1 infection or tropical spastic paraparesis (MAH / PET) is a chronic degenerative disease of the Central Nervous System that mainly affects the spinal cord. It is associated with infection by human lymphotropic virus type 1 (HTLV-1) that belongs to the Retroviridae family. Latin America, Asia and Sub-Saharan Africa are endemic areas of infection by HTLV-1 and MAH / PET between 2 % and 17 %, most asymptomatic. Colombia has a high prevalence and especially on its Pacific coast. In women, HTLV-1 infection is more prevalent than in men without the cause being clear, it is transmitted by blood transfusions (mainly whole blood), breastfeeding and / or sexual intercourse, which is the most common form of transmission in patients with MAH / PET. MAH / PET occurs mainly in adults, its incubation period until the development of symptoms varies from 2 years to decades. The main clinical manifestations of this disease are slowly progressive paraparesis and spasticity affecting gait, associated with sphincter symptoms, such as neurogenic bladder or constipation. For its diagnosis, magnetic resonance imaging (MRI) of the brain, spinal cord and the most used ELISA test are required with confirmation by western blot (WB). Currently there is no specific treatment for HAM / PET. In the future, the use of biomarkers will help early detection of the disease and even as a possible therapeutic target.

ST-segment elevation in acute cholecystitis with uncontrolled hyperthyroidism

@#<p style="text-align: justify;"><strong>SYNOPSIS:</strong> A variety of non-cardiac conditions have been reported to present with ischemic heart disease clinically and electrocardiographically like cholecystitis which leads to nonspecific T-wave inversions or ST-segment depressions, rarely  it  leads  to  ST-segment  elevation.<br /><strong>CLINICAL PRESENTATION:</strong> We  report  a  case  of  a  58-year-old,male,  hypertensive,  diabetic,  and  with  hyperthyroidism on  medication.  Patient  presents  with  two  weeks history of  epigastric  pain  associated  with  nausea  and  vomiting.Symptoms spontaneously resolved until one day prior to admission  patient  developed  persistent  abdominal  pain.Patient  was  seen  at  a  local  hospital  wherein  work-up was  done  which  showed  leukocytosis  on  CBC, hydrops of  gallbladder  on  ultrasound. Further work-up were anteroseptal wall ST elevation on ECG with negative cardiac enzymes. Patient was advised transfer to our institution.  <br /><strong>PHYSICAL FINDINGS:</strong> Pertinent  Physical  exam  includes tachycardia, epigastric tenderness and positive Murphy's sign. During the course, patient developed fever and jaundice.  <br /><strong>LABORATORY WORK-UP:</strong> Repeat CBC still showed leukocytosis with  neutrophilia.  Repeat  electrocardiogram  showed anteroseptal  wall  ST  elevation  with  negative  Troponin.Echocardiogram showed adequate ejection fraction and adequate  wall  motion  contractility.Thyroid  function  test showed  increased  FT4  and  decreased  TSH.<br /><strong>TREATMENT:</strong> Patient was initially started with acute coronary syndrome  regimen.  Antibiotics  were  initiated  and  anti-thyroid and anti-diabetes drugs were adjusted accordingly.There  was  noted  progressive  abdominal  pain; hence, patient  was  referred  to  surgery.  Patient  was  cardio-pulmonary  and  endocrinologically  prepared  and  cleared  for  the  procedure.    Patient  tolerated  the  procedure.<br /><strong>OUTCOME:</strong> Patient  was  discharged  improved  with  noted improvement  of  the  electrocardiogram.</p>

Contribution of soil, sulfate, and biomass burning sources to the elemental composition of pm[10] from Mexico City

This study is aimed to identify sources of particulate matter with mean aerodynamic diameter below 10 microm [PM[10]] present in the atmosphere of the Metropolitan Area of Mexico City [MAMC], using samples obtained from January 1st to June 30th, 2009, analyzed with X-ray spectrometric techniques. MiniVol samplers were used to collect samples on polycarbonate filters in three sites [North, Center, and South] of the MAMC. The filters were exposed along 24 h every two days, starting at 8:00 AM, and then analyzed with particle induced X-ray emission [PIXE], a microPIXE [microPIXE] system, and X-ray fluorescence [XRF]. Statistical multivariate tests with positive matrix factorization [PMF] were conducted to identify possible contributing factors. The model HYSPLIT was used to determine back-trajectories and the MODIS database for fire spot localization. The multivariate methods identified five factors in the Center and South, and four in the North, including Soil, Sulfate, Fuel/Industry, and Biomass burning, with certain differences in the factors and contributions. Application of HYSPLIT back-trajectories associated these factors to three main Soil sources and points of secondary aerosols production, as well as locations where Biomass burning aerosols were originated. The combination of X-ray spectrometric methods, receptor modeling, back-trajectory determination, and fire site localization, allowed the identification of possible sources of PM[10] in the MAMC, namely, the dry Texcoco lake, the Toluca Valley, and the North dry plains for Soil aerosols, the influence of local industrial areas for Sulfate [secondary] aerosols, and the appearance of fires for Biomass burning

Aspectos sobre a polinizaçâo do "Dendezeiro" Elaeis guineensis Jacq. e do "Caiaué" Elaeis oleifera (H.B.K.) Cortés. (ARECACEAE)

This identifies insects visiting and/or pollinating the flowers of the study "African Oil Palm" Elaeis guineensis Jacq. and the "Brazilian Oil Palm" Elaeis oleifera (H.B.K.) Cortés. Insects were collected at different times of day at different locations, when the male inflorescences were at full anthesis. A total of 159 individual insects were collected including, among others, Meliponid bees: Trigona spp. (on African and Brazilian Oil Palms), Apis mellifera adansonii and Partamona sp. (on African Oil Palm). Also observed were a considerable number of insects in genus Elaeidobius (family Curculionidae) flying about the inflorescence, indicating that they also play a role in the pollination of both palm species. Beetle larvae in the family Lycidae were also noted on the plant inflorescences.

Este trabalho tem como objetivo a identificação dos insetos visitantes e polinizadores das flores do "dendê" Elaeis guineensis Jacq., e do "caiaué" Elaeis oleifera (H.B.K) Cortés, atráves de coletas em locais e horários diferentes, quando as inflorescências masculinas das plantas encontravam-se em plena antese. Um total de 159 insetos foram observados tendo sido constatado dentre os diversos tipos de visitantes, os meliponídeos: Trigona sp. ("dendê" e "caiaué"), Apis mellifera adansonni e Partamona sp. ("dendê"). Constatou-se ainda a presença de uma quantidade razoável de insetos da família Curculionidae do gênero Elaeidobius, que voavam em torno das inflorescências, sendo evidente a sua participação na polinização das espécies estudadas. Além disso, verificou-se a presença de larvas de um coléoptero da família lycidae, junto as inflorescências das plantas.