ABSTRACT
Aims This study aimed to investigate the potential of tocilizumab therapy in minimizing mortality and mechanical ventilation (MV) requirements among hospitalized COVID-19 patients. Methods A single-center, retrospective, observational cohort study of 375 patients with severe COVID-19 (from March 1 to April 22, 2020) included 150 patients treated with tocilizumab and 225 consecutive control patients adjusted for age and sex. Both groups received concomitant standard of care treatments in addition to tocilizumab. The statistical methods relied on survival analyses, conditional logistic regression models, and contingency analyses. The outcomes included in-hospital mortality and the MV requirement. Results Tocilizumab associated with improved in-hospital mortality (34.7% vs 46.7%, P = 0.0136) and lower requirement for MV on days 1, 3, and 5 after treatment (P = 0.005, P < 0.0001, and P = 0.0021, respectively). Lower mortality was observed if tocilizumab was administered within 48 hours after admission (P = 0.0226). Older age and low blood oxygen saturation on admission decreased the odds of survival (P < 0.005). Conclusions Our study demonstrates a significant reduction in mortality and decreased requirement of MV with tocilizumab treatment in addition to the standard of care. Early administration of tocilizumab within 48 hours reduces the risk of mortality.
ABSTRACT
Objective: The objective of the study was to determine the knowledge, attitude and practices of surgical interns, residents and surgeons in the time of COVID-19. Methods: A cross-sectional study was conducted on surgical interns, trainees, registrar and consult-ants working in public and private sector tertiary care hospitals of Karachi. Non-Convenience sampling technique is used. A total of 184 patients were included. The study was performed on assessing patients' demographics, basic knowledge and awareness of COVID 19 and individuals' practices toward COVID 19 in their professional routines. Data were stored and analyzed using IBM-SPSS version 23.0. Pearson Chi Square test was used to test the association outcomes, awareness and attitude items on COVID-19 between private and public sector hospitals. P-values less than 0.05 were considered statistically significant Results: The study comprised a total of 184 participants. Mostly from public 115(63%) rest 69(37%) belonged private sector hospitals. Most respondents 122(66.3%) were aware of COVID 19 incubation, symptoms and the detection of patients at risk and modalities of transmission in operating rooms. Results showed among public vs Private sector hospitals (81.7% / 68.1%) were treating corona virus, there were (35.7% / 46.3%) screening and admitted the cases, (56.5% / 62.4) tentative numbers of COVID-19 cases reported range from 0-25, (40.9%/11.6%) surgeons were assigned additional duties for COVID-19 by hospital management found statistically significant with "p<0.01". Conclusion: It is concluded after this study that the surgeons in Pakistan are well aware of the situation, have adequate knowledge of the risk factors and symptoms of COVID-19. But statistically, probably because of limited resources and work load, there is a substantial gap in practices between public and private sector surgeons. There is also a dire need to develop local guidelines related to preventive measures in our health care systems according to our demands and supply.
ABSTRACT
INTRODUCTION: Coronavirus Disease 2019 (COVID-19) can lead to rapid respiratory decompensation requiring mechanical ventilation. There is limited evidence regarding the efficacy of existing treatment for severe COVID-19 infection. The purpose of this study was to assess the efficacy and safety of tocilizumab (TCZ) alone or with the combination of corticosteroids and therapeutic anticoagulation in intensive care unit (ICU) patients on mechanical ventilation with COVID-19 infection. METHODS: A single-center observational cohort study was conducted at an urban community teaching hospital in the New York City area between March 9, 2020 and April 28, 2020. The primary outcome of this study was in-hospital mortality. Secondary outcomes included 30-day mortality, duration of mechanical ventilation, ICU length of stay, and hospital length of stay. RESULTS: A total of 152 COVID-19 positive ICU patients were included in this study, of which 40 (26.7%) patients received one dose of TCZ 400 mg IV and three patients received an additional 400 mg dose. There were no statistically significant differences noted between the treatment and control group in regards to in-hospital mortality [31 (77.5%) vs. 94 (83.9%), P = 0.35], 30-day mortality [28 (70%) vs. 90 (80.4%), P = 0.18], or duration of mechanical ventilation (13 days ± 15.4 vs. 9.7 days ± 10.6, P = 0.22). Patients receiving TCZ had a significantly longer ICU and hospital length of stay [(15.1 days ± 16.1 vs. 9.6 days ± 9.8, P = 0.05) and (25.5 ± 29.9 vs. 14.1 ± 16.9, P = 0.03), respectively]. There was no difference in the incidence of thromboembolic complications [7 (17.5%) vs. 9 (8%), P = 0.13] or atrial fibrillation [4 (10%) vs. 13 (11.6%), P = 1.0] between the two groups. No anaphylactic or injective site reactions were noted. Results of multivariate linear and logistic regression analyses demonstrated that corticosteroids and anticoagulants were not independent predictors of duration of mechanical ventilation or in hospital mortality. CONCLUSIONS: The use of TCZ alone or in combination with corticosteroids and therapeutic anticoagulation was not associated with a decreased risk of mortality or shorter duration of mechanical ventilation in critically ill patients with COVID-19 infection. Additional studies are needed to evaluate the efficacy of TCZ for COVID-19.