Should COVID-19 patients >75 years be Ventilated? An Outcome Study.

BACKGROUND: Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited. AIM: To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age. DESIGN: Retrospective cohort study. METHODS: Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. RESULTS: A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality. CONCLUSION: Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

Outcomes in patients with severe COVID-19 disease treated with tocilizumab: a case-controlled study.

BACKGROUND: COVID-19 is an ongoing threat to society. Patients who develop the most severe forms of the disease have high mortality. The interleukin-6 inhibitor tocilizumab has the potential to improve outcomes in these patients by preventing the development of cytokine release storm. AIMS: To evaluate the outcomes of patients with severe COVID-19 disease treated with the interleukin-6 inhibitor tocilizumab. METHODS: We conducted a retrospective, case-control, single-center study in patients with severe to critical COVID-19 disease treated with tocilizumab. Disease severity was defined based on the amount of oxygen supplementation required. The primary endpoint was the overall mortality. Secondary endpoints were mortality in non-intubated patients and mortality in intubated patients. RESULTS: A total of 193 patients were included in the study. Ninety-six patients received tocilizumab, while 97 served as the control group. The mean age was 60 years. Patients over 65 years represented 43% of the population. More patients in the tocilizumab group reported fever, cough and shortness of breath (83%, 80% and 96% vs. 73%, 69% and 71%, respectively). There was a non-statistically significant lower mortality in the treatment group (52% vs. 62.1%, P = 0.09). When excluding intubated patients, there was statistically significant lower mortality in patients treated with tocilizumab (6% vs. 27%, P = 0.024). Bacteremia was more common in the control group (24% vs. 13%, P = 0.43), while fungemia was similar for both (3% vs. 4%, P = 0.72). CONCLUSION: Our study showed a non-statistically significant lower mortality in patients with severe to critical COVID-19 disease who received tocilizumab. When intubated patients were excluded, the use of tocilizumab was associated with lower mortality.

Review on the use of dexamethasone and its impact on fertility and pregnancy

Purpose: Although benefit/risk analysis is usually undertaken prior to starting a treatment, some conditions will inevitably require the use of drugs with known side effects even during pregnancy. This is the case with dexamethasone use in ante natal care. The purpose of this review was to provide an overview of the uses of dexamethasone and its impacts on pregnancy and fertility in humans. Data source: The review is based on literature searches using PubMed and MeSH and authors' personal manuscript/abstract files and citations of known references. Study selection: The selection of articles reflects the authors' opinion as to originality and importance in the context of the review. The review included human and some aspects of animal study.Data extraction: The electronic searches were scrutinized and full manuscripts of all quotes considered relevant to the study were obtained. All the articles whose abstracts were not available were excluded.Results: Dexamethasone use has evolved over the years to include fertility treatment in both males and females in addition to its use in pregnancy to prevent respiratory distress syndrome in neonates despite its side effects due to the fact that its benefits outweigh the risks. Conclusions: Dexamethasone use has evolved over the years to include fertility treatment in addition to use in the prevention of respiratory distress syndrome. Low doses have no major adverse effects; however, repeated doses and long-term therapy are associated with more serious sequelae. It is recommended that dexamethasone therapy be incorporated into maternal and neonatal health care services

Effects of monosodium-L-glutamate administration on serum levels of reproductive hormones and cholesterol, epididymal sperm reserves and testicular histomorphology of male albino rats.

This study investigated the effects of administration of monosodium L-glutamate (MSG) on serum gonadotrophin-releasing hormone (GnRH), luteinising hormone (LH), testosterone and total cholesterol (TC), cauda epididymal sperm reserves (CESR) and testicular histomorphology of adult male albino rats. Eighty-four rats, randomly assigned to 7 groups of 12 rats each, were used for the study. Varying low doses (0.25, 0.50 or 1.00 g/kg body weight) of MSG were administered orally or subcutaneously at 48-h intervals for six weeks. Serum GnRH, LH, testosterone and TC, and CESR were evaluated on days 14, 28 and 42 of MSG administration. Testicular histomorphology was evaluated on day 42. The results showed that the mean serum GnRH, LH and testosterone levels, and the CESR of all the treated groups were significantly (P < 0.05) lower than those of the untreated control on days 14, 28 and 42 of MSG administration. The mean serum TC levels of all the treated groups were also significantly (P < 0.05) lower than those of the control group on days 14 and 28. No lesions were observed on sections of the testes. It was concluded that MSG administration for 14, 28 and 42 days led to significantly lower serum levels of GnRH, LH, testosterone and TC, and significantly lower CESR.

Antifertility activity of aqueous ethanolic leaf extract of Spondias mombin (Anacardiaceae) in rats.

BACKGROUND: Despite the availability of modern (orthodox) medicine, many developing countries, especially in the rural areas, still rely heavily on traditional healers and medicinal plants to meet their primary health care needs and that of their domestic animals. This has been attributed to easy accessibility and low cost of herbal medicine. In Eastern Nigeria, fresh leaves of Spondias mombin is widely used by the natives to aid delivery and to expel the placenta in small ruminants (sheep and goats), especially during difficult labour. OBJECTIVE: The present study was designed to evaluate the in vivo effects of leaf extracts of S. mombin on reproductive performance of female rats. METHODS: Acute toxicity test of the plant extract was carried out in rats of both sexes. The anticonceptive and abortifacient activity of the extract were investigated, including the Fertility Index or embryo score of control and treated animals. The estrogenic activity was determined using ovariectomized rats. RESULTS: The results revealed a relatively non-toxic plant extract. The extract displayed anticonceptive but not abortifacient activity as judged by the number of pregnant animals at the end of the third trimester of pregnancy. The extract did not exhibit any oestrogenic activity. CONCLUSION: Aqueous ethanol leaf extract of S. mombin has significant anticonceptive activity attributed to a direct action of the extract on the uterus.