ABSTRACT
Introduction: The on-going Corona-Virus Disease 2019 (COVID-19) pandemic has spread rapidly across the globe. Tocilizumab is a recombinant monoclonal antibody to Interleukin-6 (IL-6) receptor. An increasing number of studies across the world is reporting the use of tocilizumab in treating COVID-19 patients or at risk of developing cytokine storm. Apart from clinical and laboratory parameters, High Resolution Computed Tomographic (HRCT) chest scan is a promising tool to identify patients very early in the course of COVID-19 disease. Aim: The purpose of this retrospective research study is to find whether high chest CT Severity Score (CTSS) on HRCT thorax scan predict the clinical requirement of tocilizumab injection in COVID-19 patients. Materials and Methods: In this retrospective study, during the period from May 2020 to July, 2020, 250 patients with confirmed Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) diagnosed of COVID-19 on first or repeat sample and who also underwent HRCT scan of the chest, were assigned chest CTSS. From data obtained, patients were categorised into two groups based on mild and severe CTSS. Patients with higher CTSS have a higher future possibility of developing the cytokine storm and hence the requirement of tocilizumab can be reliably predicted. All statistical analysis was performed in IBM SPSS version 20. Results: Out of a total of 250 patients, 72 patients were given tocilizumab injection. The average CTSS was 29.8±6.38 in the tocilizumab injection group. Only 8% of patients with mild CTSS received tocilizumab injection while 60% of patients with severe CTSS received tocilizumab injection (p<0.001). Out of 72 patients who received tocilizumab injection, 16.7% had mild CTSS while 83.3% had severe CTSS (p<0.001). Average values of inflammatory markers like CRP, D-Dimer, Ferritin, LDH, and IL-6;were significantly higher in severe CTSS and tocilizumab group (p<0.001). Conclusion: CTSS may be used as a new decisive tool in triaging in-hospital COVID-19 patients. Categorising patients in mild and severe CTSS early in the disease course, even before the marked worsening of laboratory parameters and development of cytokine storm may help initiate early treatment and thereby save many lives.
ABSTRACT
This article describes the structure of the trillion-dollar CMBS and CLO markets and their current distressed states, given the ongoing economic effects of the COVID-19 pandemic. It then outlines various disputes that may arise from this distress. For CMBS, these include control and valuation disputes;waterfall disputes;"busted deal" disputes;REIT, "repo," and margin call disputes;fraudulent selling and misrepresentation disputes;and repurchase claims. For CLOs, the potential disputes involve CLO managers, CLO arrangers, CLO investors and trustees, and CLO valuation issues. In each instance, the article describes the parties involved, the legal issues that are likely to arise, and- where possible-the applicable law from prior litigation in respect to the same or similar issues. The article concludes that many of these disputes are likely to result in litigation again soon, given the ongoing effects of the COVID-19 pandemic and current economic forecasts within the CMBS and CLO markets.