ABSTRACT
Introduction: The use of the interleukin-6 blocker tocilizumab in critically-ill mechanically ventilated patients with coronavirus disease 2019 (COVID-19) is less well studied. Research Question or Hypothesis: Is tocilizumab effective in mechanically ventilated COVID-19 patients. Study Design: A multicenter retrospective study conducted in six Saudi Arabian hospitals. Methods: Patients admitted between March 2020 to January 2021 were screened. Confirmed COVID-19 mechanically ventilated adult patients (≥18 years old) were included. Mortality after mechanical ventilation was the primary outcome and rate of extubation rate was the secondary outcome. To achieve balance in the data, we implemented inverse propensity score weighting (IPSW) and propensity score matching (PSM). In addition to performing survival analysis on the primary outcome, Cox proportional modeling with time dependency covariance was used to account for immortal bias. For the secondary outcome, competing risk analysis was implemented with death while intubated being the competing risk. Results: A total of 889 patients were screened and 456 patients were eligible for inclusion (tocilizumab, n=193, control, n= 263). The mean age (±SD) for tocilizumab arm was 59.3(±14.2) and 58.5(±13.7) years for the control arm. Adequate balance in covariates of interest was achieved in the IPSW and PSM analyses. In the IPSW analysis, tocilizumab was associated with lower mortality (HR=0.37, 95%CI=0.55-0.69) but not in the PSM analysis with (HR=0.80, 95%CI=0.57-1.12). After accounting for immortal time bias both the IPSW (HR=0.82, 95%CI=0.62-1.10) and the PSM (HR=0.86, 95%CI=0.64-1.16,) analyses showed no difference in overall mortality. Conversely, tocilizumab was associated with a higher rate of extubation (33.6%) versus the control arm (11.9%) with subdistributional hazards (SHR= 3.1, 95%CI=1.86-5.16). Conclusion: Tocilizumab was not effective in reducing mortality in mechanically ventilated COVID-19 patients. However, a higher extubation rate was observed. A large randomized controlled trial in this population is needed.
ABSTRACT
Background: Anxiety is seen among students even during normal times. The COVID-19pandemic is believed to have increased anxiety and depression among the students. Purpose: An investigation was done to assess the anxiety levels and coping strategies of nursing students in Saudi Arabia. The influence of demographics on the anxiety levels and coping strategies were also determined. Methods: A cross-sectional study was conducted using a questionnaire through Google forms. The questionnaire had items related to demographics such as age, sex, etc., along with a question to know about the confidence of students to work as nurses. A GAD-7 scale was used to assess anxiety levels and BriefCope was used to determine coping strategies. Statistics were performed using non-parametric tests, factorial analysis, and linear regression. Results: More than half of the participating students experienced moderate to severe anxiety. The anxiety levels were not influenced significantly by demographics except the young age. More than 50% of the students were reluctant to work as nurses and this affected the anxiety score significantly. Factorial analysis grouped variables into six factors. Linear regression showed a positive correlation of these factors with anxiety. Conclusion: Anxiety score revealed that Saudi nursing students had moderate to severe anxiety. The combined number of students reluctant or scared to work was more than those who were confident to work as nurses. A positive association was observed between factor variables with mild and moderate anxiety.