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BACKGROUND: Tocilizumab is an anti-IL-6 therapy widely adopted in the management of the so-called "cytokine storm" related to SARS-CoV-2 virus infection, but its effectiveness, use in relation to concomitant corticosteroid therapy and safety were unproven despite widespread use in numerous studies, mostly open label at the start of the pandemic. METHODS: We performed a systematic review and meta-analysis of case-control studies utilising tocilizumab in COVID-19 on different databases (PubMed/MEDLINE/Scopus) and preprint servers (medRxiv and SSRN) from inception until 20 July 2020 (PROSPERO CRD42020195690). Subgroup analyses and meta-regressions were performed. The impact of tocilizumab and concomitant corticosteroid therapy or tocilizumab alone versus standard of care (SOC) on the death rate, need for mechanical ventilation, ICU admission and bacterial infections were assessed. RESULTS: Thirty-nine studies with 15,531 patients (3657 cases versus 11,874 controls) were identified. Unadjusted estimates (n = 28) failed to demonstrate a protective effect of tocilizumab on survival (OR 0.74 ([95%CI 0.55-1.01], p = 0.057), mechanical ventilation prevention (OR 2.21 [95%CI 0.53-9.23], p = 0.277) or prevention of ICU admission (OR 3.79 [95%CI 0.38-37.34], p = 0.254). Considering studies with adjusted, estimated, tocilizumab use was associated with mortality rate reduction (HR 0.50 ([95%CI 0.38-0.64], p < 0.001) and prevention of ICU admission (OR 0.16 ([95%CI 0.06-0.43], p < 0.001). Tocilizumab with concomitant steroid use versus SOC was protective with an OR of 0.49 ([95%CI 0.36-0.65], p < 0.05) as was tocilizumab alone versus SOC with an OR of 0.59 ([95%CI 0.34-1.00], p < 0.001). Risk of infection increased (2.36 [95%CI 1.001-5.54], p = 0.050; based on unadjusted estimates). CONCLUSION: Despite the heterogeneity of included studies and large number of preprint articles, our findings from the first eight of the pandemic in over 15,000 COVID-19 cases suggested an incremental efficacy of tocilizumab in severe COVID-19 that were confirmed by subsequent meta-analyses of large randomized trials of tocilizumab. This suggests that analysis of case-control studies and pre-print server data in the early stages of a pandemic appeared robust for supporting incremental benefits and lack of major therapeutic toxicity of tocilizumab for severe COVID-19.
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Tratamiento Farmacológico de COVID-19 , Pandemias , Anticuerpos Monoclonales Humanizados , Humanos , SARS-CoV-2 , Nivel de Atención , Resultado del TratamientoRESUMEN
BACKGROUND: Identifying the strengths and weakness points is one of the effective methods to analyze current status, and prioritizing actions based on the gap between current and optimal status is necessary for short-term and long-term planning in departments and colleges. The aim of this study was to determine the gap between current and optimal status of curriculum leadership in the postgraduate courses in two Iranian universities. MATERIALS AND METHODS: In this cross-sectional study, a sample of 212 faculty members from the two Iranian universities (one medical and one nonmedical) was randomly selected through stratified random sampling method. Data were collected by using a researcher-made questionnaire, with 55 items categorized in four areas of main dimensions in curriculum leadership. The validity of the questionnaire was determined by curriculum studies scholars, and the reliability was confirmed as the Cronbach's alpha calculated 0.969. Data were analyzed using descriptive and inferential statistics according to the variables. RESULTS: There was a gap in all dimensions and roles. The maximum gap (-1.70) with the highest frequency (98%) were related to "improving the educational atmosphere" dimension. As for items, the maximum gap (-2.41) was related to "society needs and expectations and the labor market" in "curriculum development and revision" dimension. CONCLUSION: The negative gap between all dimensions of curriculum leadership implies faculty members' dissatisfaction. Curriculum leadership at universities, colleges and departments of the study in all aspects need to be improved. Hence, it is necessary for managers to make use of the viewpoints of the faculty members to decrease the gap.
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Reaction of 4-aminoacetophenone and 4-bromobenzaldehyde in ethanol resulted in the formation of the monodentate V-shaped Schiff base (E)-1-(4-((4-bromo-benzylidene)amino)phenyl)ethanone (L). Interaction of L with different di- and trivalent metal ions revealed disubstituted derivatives. The ligand and its complexes were characterized by elemental analysis, mass, IR and NMR spectrometry. Biological activities of the ligand and complexes against the Escherchia coli and Staphylococcus aureus bacterias, and the two fungus Aspergillus flavus and Candida albicans were screened. The cytotoxicity of the compounds were checked as antitumor agents on liver carcinoma cell line (HepG2). They exhibited in vitro broad range of antitumor activities towards the cell line; the [ZnL2(H2O)2](NO3)2 complex was stronger antitumor towards HepG2 cell line as well as two breast cancer cell lines (MCF7 and T47D) relative to cis-platin.
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Antiinfecciosos/farmacología , Antineoplásicos/farmacología , Complejos de Coordinación/síntesis química , Complejos de Coordinación/farmacología , Bases de Schiff/síntesis química , Bases de Schiff/farmacología , Elementos de Transición/farmacología , Antiinfecciosos/síntesis química , Antifúngicos/farmacología , Antineoplásicos/síntesis química , Bacterias/efectos de los fármacos , Muerte Celular/efectos de los fármacos , Línea Celular Tumoral , Hongos/efectos de los fármacos , Humanos , Ligandos , Espectroscopía de Resonancia Magnética , Pruebas de Sensibilidad Microbiana , Bases de Schiff/química , Espectrofotometría Infrarroja , Elementos de Transición/síntesis químicaRESUMEN
OBJECTIVES: Critical thinking is an important outcome criterion of higher education in any discipline. Medical and paramedical students always encounter with many new problems in clinical settings and medicinal laboratory, and critical thinking is an essential skill in obtaining a better approach for problem solving. We performed a pre-and post-test to evaluate the change of critical thinking skills in medical sciences students who enrolled in Isfahan University of Medical Sciences in Iran during the academic years 2008-2010. METHODS: In a longitudinal design study, the critical thinking skills were compared in medical sciences students in two sequential semesters using the California Critical Thinking Skills Test. The test is divided into two parts (parts 1 and 2), including 17 items in each part. Based on proportional stratified sampling, a groups of students (group 1, n=159) were selected from the university population, who enrolled in medicine, pharmacy, nursing, and rehabilitation colleges. The students in group 1 were asked to complete the part 1 of the test (phase I). After one semester, another group (group 2, n=138) from the same population was randomly selected, and they were asked to complete the part two (phase II). The students' demographic data also were recorded. The California critical thinking skills test was translated and it validity and reliability were approved before. RESULTS: No significant difference was observed between the two groups in the demographic data. The students critical thinking scores in phase II significantly reduced in comparison with phase 1 (p<0.05). The phase II scores in subdivisions of analysis, inference, inductive reasoning, and deductive reasoning also failed to demonstrate improvement. CONCLUSION: It seems curriculum reform is necessary to improve the students' critical thinking.
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Unusual Schiff base ligand, 4-ethanimidoyl-6-[(1E)-N-(2-hydroxy-4-methylphenyl)ethanimidoyl]benzene-1,3-diol, L, was synthesized via catalytic process involving the interaction of some metal ions with a macrocyclic Schiff base (MSB). The transition metal derivatives [ML(H(2)O)(4)](NO(3))(3), M=Cr(III) and Fe(III), [NiL(H(2)O)(4)](NO(3))(2), [ML(H(2)O)(2)](NO(3))(2), M=Zn(II) and Cd(II), [Cl(2)Pd(µ-Cl)(2)PdL], [PtL(Cl)(2)] and [PtL(Cl)(4)] were also synthesized from the corresponding metal species with L. The Schiff bases and complexes were characterized by elemental analysis, mass spectrometry, IR and (1)H NMR spectroscopy. The crystal structure of L was determined by X-ray analysis. The spectroscopic studies revealed a variety of structure arrangements for the complexes. The biological activities of L and metal complexes against the Escherchia coli as Gram-negative bacteria and Staphylococcus aureus as Gram-positive bacteria, and the two fungus Aspergillus flavus and Candida albicans were screened. The cytotoxicity of [PtL(Cl)(2)] complex, a cis-platin analogous, was checked as an antitumor agent on two breast cancer cell lines (MCF7 and T47D) and human liver carcinoma cell line (HepG2).
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Antibacterianos/química , Antifúngicos/química , Derivados del Benceno/química , Complejos de Coordinación/química , Bases de Schiff/química , Elementos de Transición/química , Antibacterianos/farmacología , Antifúngicos/farmacología , Aspergillus flavus/efectos de los fármacos , Infecciones Bacterianas/tratamiento farmacológico , Derivados del Benceno/farmacología , Candida albicans/efectos de los fármacos , Complejos de Coordinación/farmacología , Cristalografía por Rayos X , Escherichia coli/efectos de los fármacos , Humanos , Modelos Moleculares , Micosis/tratamiento farmacológico , Bases de Schiff/farmacología , Staphylococcus aureus/efectos de los fármacos , Elementos de Transición/farmacologíaRESUMEN
BACKGROUND AND STUDY AIMS: Data about dual hepatitis C (HCV) and B (HBV) co-infection are still scarce, especially in endemic areas such as Egypt. Therefore, we aimed to characterise the virologic and histologic pattern of dual B/C co-infection in a tertiary care centre in Egypt. PATIENTS AND METHODS: After obtaining approval from the review board, a retrospective design to evaluate the data registry between January 2009 and December 2012 of patients with dual HCV and HBV seropositivity (BC-group) at the Viral Hepatitis Unit in Ministry of Health and Assiut University Hospital, Egypt was conducted. Data for hepatitis B e antigen (HBe-Ag) and anti-HB core status, anti-hepatitis delta virus (anti-HDV), HBV-DNA and HCV-RNA assays and liver biopsy (METAVIR scoring) results were collected. Two other matched groups of mono-HCV (C-group) and HBV (B-group) were selected as controls. All patients were naive for antiviral therapy. RESULTS: A total of 3300 patients were enrolled. Dual infection was observed in 25 (0.7%) patients (all males, mean=35.2±10.2years). Four patients (16%) were HBe-Ag-positive. Six (24%) patients were HBV-DNA-negative and all were positive for HCV RNA. Between groups, raised alanine aminotransferase (ALT) was found in 76%, 41.7% and 49.2% of the BC, B and C groups, respectively (p=0.023). HBV DNA >2000IUml(-1) was more in the B-group than in the BC-group (63.9% vs. 36%; p=0.042) and HCV RNA >800,000IUml(-1) was more in the BC-group than in the C-group (28% vs. 12.3%; p=0.009). Histologically, there is no statistical significant difference between the three groups. CONCLUSION: Dual hepatitis B/C infection is not uncommon and their virologic and histologic profile is modest. Further evaluation with regard to treatment and long-term follow-up is warranted.
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Coinfección , Hepatitis B , Hepatitis C , Adolescente , Adulto , Biomarcadores/sangre , Biopsia , Estudios de Casos y Controles , Coinfección/sangre , Coinfección/patología , Coinfección/virología , ADN Viral/sangre , Egipto , Femenino , Hepacivirus/genética , Hepatitis B/sangre , Hepatitis B/patología , Hepatitis B/virología , Anticuerpos contra la Hepatitis B/sangre , Antígenos e de la Hepatitis B/sangre , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/inmunología , Hepatitis C/sangre , Hepatitis C/patología , Hepatitis C/virología , Humanos , Hígado/patología , Hígado/virología , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Sistema de Registros , Estudios Retrospectivos , Adulto JovenRESUMEN
Ring annuloplasty is the most common strategy for correction of ischemic mitral regurgitation. When a commercial prosthesis is unavailable or too expensive, an autogenous annuloplasty ring can be handmade by the surgeon. The aim of this study was to compare short-term results of mitral valve repair with autologous annuloplasty rings and the SJM Tailor flexible prosthesis. Between March 2004 and April 2006, 100 patients undergoing coronary artery bypass grafting and mitral ring annuloplasty for ischemic regurgitation were randomly assigned to either type of prosthesis. Transesophageal and transthoracic echocardiography showed no significant differences between these techniques in terms of immediate success of the repair and its durability at 3, 6, and 9 months postoperatively. Autogenous rings are easy to make, cost-effective, and always available. Our short-term results suggest that they may be an acceptable alternative to a commercially produced prosthesis for patients with ischemic mitral regurgitation.
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Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Isquemia Miocárdica/cirugía , Vena Safena/trasplante , Ecocardiografía , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Trasplante AutólogoRESUMEN
Large pericardial effusions develop in 30% of patients after cardiac surgery, and reach their maximum size after 10 days, with tamponade in 1%. The aim of this prospective randomized case-controlled study was to assess the effectiveness of a posterior pericardiotomy in preventing early and late (>30 days) development of pericardial effusion. Between April 2005 and May 2006, 410 patients with a mean age of 68.4 +/- 9.2 years undergoing coronary artery bypass grafting alone or combined with valve surgery were divided into 2 groups of 205 each. In the pericardiotomy group, a 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve. Echocardiography was performed at discharge and 15 and 30 days after the operation. At 15 and 30 days postoperatively, 90.2% and 97% of patients in the pericardiotomy group were free of effusion; while none in the control group were free of effusion. A posterior pericardiotomy is easy to perform and seems to be a safe and effective means of preventing postoperative effusion and its adverse consequences.
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Puente de Arteria Coronaria/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Derrame Pericárdico/prevención & control , Pericardiectomía , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , UltrasonografíaRESUMEN
INTRODUCTION: Large pericardial effusions after cardiac surgery develop in 30% of patients and reach their maximum size on approximately day 10 postoperatively. Tamponade develops in approximately 1% of patients with large pericardial effusions. Effusion may be prevented by posterior pericardiotomy, but its role and possible adverse consequences are controversial. We sought to further investigate the effectiveness of this technique. METHOD: This prospective randomized case-control study was carried out on 410 patients, mean age 68.4 +/- 9.2 years, who underwent coronary artery bypass graft surgery alone or combined with valve surgery during the period between April 2005 and May 2006. A 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve in the pericardiotomy group. Echocardiographic study was performed at the time of discharge and 15 and 30 days after surgery. RESULTS: After 15 and 30 days postsurgery, respectively, 178 (90.2%) and 192 (97%) of patients from the pericardiotomy group and none from the conventional group were free of effusion (P < .05). CONCLUSION: Posterior pericardiotomy is easy to perform and is a safe and effective means to prevent postoperative effusion and its early and delayed adverse consequences.