Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India.

BACKGROUND: Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD: This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS: Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION: Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.

Comparative Evaluation of Antibacterial Efficacy of Silver and Cadmium Nanoparticles and Calcium Hydroxide against Enterococcus faecalis Biofilm.

AIM: The purpose of this study was to evaluate and compare the antibacterial efficacy of calcium hydroxide medicament, silver (AgNPs) and cadmium nanoparticles (CdSNPs) as medicament against the biofilms of Enterococcus faecalis on dentin sections. E. faecalis is commonly detected in asymptomatic and persistent endodontic infections. METHODS: Twenty standard size dentin sections were prepared. E. faecalis was inoculated on these dentin sections for four weeks to form the bacterial biofilm. Twenty dentin sections were segregated into four different groups with five specimens in each group. Group I was kept as control group, and antibacterial efficacy was tested by treating biofilms with Ca(OH) 2 medicament, 0.02% AgNP and CdSNP gels for 7 days. The ultrastructure of biofilms from each group was examined under scanning electron microscope and was visually evaluated and compared for different groups. RESULTS: Ca(OH)2 exhibited a slight disruption of E. faecalis biofilm. Both AgNP and CdSNP medicaments disrupted E. faecalis biofilm effectively after 7 days of inoculation. AgNPs disrupted the biofilm more effectively than CdSNPs. Biofilms in control group, which was irrigated with saline, did not show any disruption of biofilm, which could be seen as homogenous layer over most of dentin sections. CONCLUSIONS: This study suggests that both AgNP and CdNP gels are effective against E. faecalis and can be used as a medicament to eliminate residual bacterial biofilms during root canal disinfection. AgNP medicament is more effective than CdNP, whereas Ca(OH) 2 is not effective against E. faecalis biofilms. CLINICAL SIGNIFICANCE: Incomplete clearance and the development of antibiotic resistance in E. faecalis are the important factors for failure of root canal treatment. When cationic nanoparticles are introduced for the treatment of biofilms, it can interact with both extracellular polymeric substances and bacterial cells. The initial electrostatic attraction between positively charged nanoparticles and negatively charged bacterial surface leads to bacterial killing via the production of reactive oxygen species. Metal nanoparticles that are effective against E. faecalis have a significant potential role in the prevention and treatment of such cases, as bacteria do not develop resistance against metal nanoparticles.

Nutritional enrichment of broiler breast meat through dietary supplementation of Indian ginseng Withania somnifera and synbiotic substances under semi-arid climatic conditions.

AIM: The present study was conducted to explore the effect of supplementation of Withania somnifera and synbiotics alone or in combination on the composition of broiler breast meat under heat stress conditions. MATERIALS AND METHODS: A 42-day feeding trial was conducted on 360 broiler chicks randomly allotted into eight treatment groups with three replicates each under completely randomized design. The T1 group was kept as control whereas T2-T4 were supplemented with 0.5%, 1%, and 1.5% W. somnifera root powder; T5 and T6 were supplemented with 0.025% and 0.050% synbiotic and T7 and T8 were fed on diet containing 0.25% W. somnifera+0.025% synbiotic and 0.50% W. somnifera+0.05% synbiotic, respectively. Three broilers from each replicate were sacrificed at the end of the trial to estimate crude protein (CP), ether extract and ash content of the breast muscle on dry matter basis. RESULTS: Significantly higher CP values and lower ether extract values were observed in 1.5% W. somnifera supplemented group (T4) or in group supplemented with 0.50% W. somnifera and 0.05% synbiotic (T8). The ash content of breast meat was observed non-significant in T1-T4 groups however the inclusion of synbiotics in T5-T8 groups significantly raised the ash contents. CONCLUSION: The study concluded that inclusion of 0.5% W. somnifera with 0.05% synbiotic substance enriches the total protein content and reduces the total lipids content of broiler breast meat under heat stress conditions.

Development of PR genes panel for screening aphid-tolerant cultivars in Brassica juncea.

The exorbitant yield loss incurred by Indian farmers every year (10-90%) in rapeseed-mustard (Brassica juncea) is chiefly attributed to the progressive infestation of mustard fields by Lipaphis erysimi (Kalt.), a major insect pest belonging to the family of Homoptera. Currently there are no successful tolerant cultivars developed by conventional means in Brassica juncea with systemic plant responses in the form of direct or indirect defenses against aphid attack. Lack of specific methods for screening large numbers of genotypes required in breeding for selection of tolerant cultivars in mustard is one of the main causes of slow progress in developing resistant varieties of Brassica juncea. Traditional phenotype-based breeding has to be augmented with recent molecular approaches for potential genotype selection and cultivar development in Brassica juncea. In current study a pathogen-responsive gene panel was developed which could be used for expression-assisted breeding program in mustard for selection of tolerant types against aphid infestation, minimizing the huge crop losses suffered by farmers every year.

Dyselectrolytemia in acute kidney injury causing tetany and quadriparesis.

A 40-year-old female, presented with prerenal acute kidney injury secondary to diarrhoea. With appropriate hydration, she went into diuretic phase and subsequently developed hypokalemic quadriparesis with hypocalcaemic tetany due to hypomagnesemia and subclinical vitamin D deficiency. The patient improved with oral potassium, magnesium, calcium and vitamin D supplementation.

Screening for common clinical conditions in older women.

The prevalence of diabetes mellitus, dyslipidemia, hypertension, and thyroid disease is higher in older women, placing these women at increased risk of cardiovascular disease. The presenting features of these conditions are most often clinically silent. Effective treatments for these conditions are available to prevent cardiovascular disease morbidity and mortality. An overview of current screening guidelines for these common conditions is presented.