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.

Práticas educativas na atenção básica: um estudo de caso sobre métodos de ensino / Eduacational practices in primary care: a case study of teaching methods

Introdução: A reorientação do modelo assistencial, a partir da Atenção Básica foiestabelecida pelo Ministério da Saúde (MS), visando uma ruptura com o modelo assistencialcurativista. Na busca da construção de um novo paradigma da produção social da saúde,preconizou-se o compromisso com a promoção da saúde e a qualidade de vida daspessoas, tendo como principal dispositivo a educação em saúde. O MS preconiza odesenvolvimento da educação em saúde numa perspectiva dialógica, emancipadora,participativa e criativa, com vistas a contribuir para a promoção da autonomia dos usuários.Encontra-se na literatura estudos que valorizam a importância de processos educativosconforme propõe o MS. Observa-se, no entanto, que nestes estudos a ênfase recai sobre osresultados, secundarizando o processo. Decorre daí a necessidade no campo da educaçãoem saúde de dar maior visibilidade e inteligibilidade ao modo como às práticas vem sendodesenvolvidas, ou seja, ao modo como os princípios propostos pelo MS vêm sendo(re)significados e objetivados pelos profissionais de saúde no concreto. Objetivo: Analisaros métodos educacionais que fundamentam as práticas educativas desenvolvidas emgrupos nas unidades básicas de saúde (UBS). Metodologia: Trata-se de um Estudo deCaso, realizado em três UBS. Para coleta de dados foram utilizadas várias fontes deevidências, triangulando técnicas - a observação participante com registro fotográfico ediário de campo, entrevista com os profissionais e a análise documental. Os dados foramanalisados utilizando-se como referencial a Análise do Conteúdo. Resultados: Da análiseobteve-se três categoriais representativas dos métodos educacionais. A primeira relacionaseao método diretivo pautado na perspectiva da heteroestruturação do conhecimento; asegunda ao método não-diretivo fundado na perspectiva da autoestruturação e a terceirarelaciona-se ao método relacional pautado na perspectiva da interestruturação...

Introduction: The reorientation of care model, from the Primary Care was established by theMinistry of Health (MH), seeking a break from the curative model of care. In pursuit ofbuilding a new paradigm of social production of health, called the commitment to promotinghealth and quality of life, with the primary device health education. MH recommends thedevelopment of health education in a dialogical perspective, empowering, participatory andcreative, with a view to contributing to the promotion of the autonomy of users. It is found inthe literature that emphasize the importance of educational processes as proposed by theMH. There is, however, that these studies the emphasis is on results, the process sidelined.Hence the need in the field of health education to give greater visibility and intelligibility to theway the practices have been developed, how the principles of MH has been (re) meaningsand targeted by health professionals in the concrete. Objective: To assess the educationalmethods that underlie educational practices developed in groups at Basic Health Units (BHU)Methodology: This is a case study conducted in three BHU. For data collection wereused several sources of evidence, triangulating techniques - participant observation andphotographic field diary, interviews with professionals and documentary analysis. Data wereanalyzed using as reference the Content Analysis. Results: The analysis was obtainedrepresenting three categories of educational methods. The first relates to the direct methodbased on an approach of heteroestruturação of knowledge, the second method based onnon-directive approach autoestruturação and the third relates to the method based on anapproach of relational interestruturação. Methods of analysis of four key issues emergedobserved. The first refers to the occurrence within the educational practices in two differentways to mediate the relationship between subject and object...

Transtorno dismórfico corporal sob a perspectiva da análise do comportamento / Body dysmorphic disorder under the perspective of the behavior analysis

O objetivo do trabalho foi investigar comportamentos classificados como Transtorno Dismórfico Corporal e suas contingências de desenvolvimento e manutenção. Foi um estudo descritivo-exploratório por meio de entrevistas, com sete participantes e seus familiares, para levantar algumas hipóteses baseadas nos princípios teóricos do Behaviorismo Radical. Encontraram-se comportamentos depressivos, obsessivos, compulsivos e delirantes; de esquiva social; checagem no espelho e rituais de camuflagem. Nas histórias de vida, identificaram-se: educação coercitiva, grande valorização da beleza, reduzidas interações sociais, acidentes ocorridos, comentários sobre parte do corpo e cirurgias. Sob o controle de estímulos específicos, como o defeito alegado e o olhar dos outros, muitas classes de comportamentos tinham a função de fuga/esquiva. Os comportamentos eram reforçados negativamente, porque evitavam a exposição aos outros e críticas. Alguns comportamentos foram descritos por meio da esquiva experiencial, pois tinham a função de evitar o contato com experiências privadas aversivas, trazendo grandes prejuízos nas áreas social, ocupacional e familiar.

The objective of this study was the investigation of behaviors classified as Body Dysmorphic Disorder and the contingencies of its development and maintenance. A descriptive exploratory study was done using the interviews with seven patients and their families to raise some hypothesis based on the theoretical principles of Radical Behaviorism. Checking the supposed defect in the mirror; camouflage rituals; social avoidance; depressive behaviors; obsessive-compulsive behaviors and delusions was found. Their life history indicated a coercive education, great emphasis on beauty, restrictive social interactions, accidents and commentary on parts of the body by others and many plastic surgeries. Under the specific stimulus control like his own alleged defect and the regard of others, many participants' classes of behavior had the function of escape/avoidance and was negatively reinforced, preventing participants from exposing themselves to others and being criticized. Some behaviors were described as experiential avoidance, as they had the function of avoiding their private aversive condition bringing some major consequences in social, personal and occupational areas.

Cases Studies of Intussusception with Special References

This paper present 105 cases which were admitted to the Department of Pediatrics of Dong San Presbyterian Hospital from Jan. 1978 to July, 1980 The results are summarized as follows; 1) Age incidence, 94% of patients were under age of two, 88.2% of patients were under one year, and adults were high incidence in Korea. 2) Male to female ratio was 2.1:1 3) In seasonal incidence, spring was relatively high. 4) In 76.4% of cases, their body weight were over 50 percentile of Korean normal infants and children. 5) The patients who visited hospital within 24 hrs. from onset of symptom was occupied in 57.7%. 6) The cardinal symptom and signs were vomiting (89.4%), abdominal pain. Irritability, crying, (72.9%), mucous bloody stool (70.6%) and abdominal mass (42.1%) 7) In analysis by intussusception type(40.0%), ileocolic type (23.5%), ileoileal type(17.6%), jejunojejunal type (17.6%), in adults. 8) In simple abdominal X-ray figures showed the dilatation due to gastrostomy 52.9% and phenomenon of fluid retention 30.6%. 9) Etiologic causes were confirmed only 7.1% in children and 29.4% in adults, the causes in 92% were idiopathic in children and 70.6% in adults respectively. 10) In previous illness, we find out its predisposing factors 42.4% in children. 11) Hydrostatic barium reduction was successed in 47.1% of all cases and operative cases were 47%