Low-dose tocilizumab is associated with improved outcome and a low risk of secondary infection in severe COVID-19 pneumonia.

BACKGROUND: Respiratory failure and death are the leading causes of severe Coronavirus disease 2019 (COVID-19). Hyper-inflammation and cytokine storm cause lung damage. This study aimed to compare the low-dose and high-dose effects of tocilizumab, an IL-6 receptor antagonist. METHOD: Patients with severe pneumonia and hyper-inflammation signs because of COVID-19 were included in this retrospective study. Patients receiving tocilizumab <200 mg intravenously were classified as the low-dose group, and receiving ≥200 mg as the high-dose group, and those not treated with tocilizumab as the control group. Demographic and clinical data of patients who died and survived in both low-high dose and control patients were compared. According to symptom day and radiological infiltration, patients with tocilizumab were also evaluated in two groups as early and late periods at tocilizumab administration time. RESULTS: A total of 160 patients were included in the study; 70 were treated with a low dose and 50 with high-dose tocilizumab. Forty patients were in the control group. Age, comorbidity and clinical features were similar in the control, low-dose tocilizumab and high-dose tocilizumab groups. The mortality rate (12.9%, 30.0%, 37.5, P = .008) was less in the low-dose tocilizumab group. The secondary infection rate was higher in the high-dose group than in the low-dose tocilizumab and control groups (44.0%, 10.0%, 10.0%, P < .001). Distinguishing between those patients who died and survived, age (OR: 1.1589, P < .001), higher APACHE II scores (OR: 1.225, P = .001) and needs for non-invasive mechanical ventilation (OR: 14.469, P < .001) were the most critical risk factors. Low-dose tocilizumab was associated with a lower mortality rate (OR: 0.244, P = .012). CONCLUSION: The use of tocilizumab at a low dose is associated with lower secondary infections and mortality.

Antibody production against COVID-19 in hemodialysis patients / Producción de anticuerpos contra COVID-19 en pacientes en hemodiálisis

Abstract Introduction: Dialysis patients may have a very high prevalence and death rate for COVID-19. The aim of this study is to show the level of antibody against SARS-CoV-2 in hemodialysis and staff working in the same dialysis center. Methods: Anti-SARS-CoV-2 IgG antibodies were studied in 156 hemodialysis patients and 27 staff. After a 5-minute resting period, blood pressure was measured and then subsequent to an approximately 12-hour fasting period, blood sample were drawn for biochemistry parameters and anti-SARS-CoV-2 IgG antibodies. Results: Three of hemodialysis patients were diagnosed with COVID-19 in March and their PCR tests were positive. The symptoms of these patients were extreme fatigue and muscle weakness. Anti-SARS-CoV-2 IgG antibodies tests were performed on all patients and staff in July. In total, 13/156 (8.3%) patients were diagnosed as COVID-19 based on anti-SARS-CoV-2 antibodies. The other 10 patients were asymptomatic. The staff and 143 hemodialysis patients had IgG (-). Hemodialysis patients who had anti-SARS-CoV-2 IgG (+) antibodies had decreased level of haemoglobin and high levels of C-reactive protein and alkaline phosphatase. Conclusions: Antibody tests are particularly important for detecting people with COVID-19 who have few or no symptoms. It has also been seen that the spread of infection in the dialysis center can be prevented by very strict precautions.

Resumen Introducción: Los pacientes que se realizan diálisis tienen una prevalencia y una tasa de mortalidad muy alta en lo que respecta a la COVID-19. El objetivo de este estudio fue mostrar la concentración de anticuerpos contra el SARS-CoV-2 en los pacientes de hemodiálisis de un centro y en el personal que trabaja en ese lugar. Material y métodos: Se investigaron los anticuerpos IgG contra el SARS-CoV-2 en 156 pacientes que reciben hemodiálisis y en 27 trabajadores. Se midió la tensión arterial luego de 5 minutos de reposo y, luego de un ayuno de aproximadamente 12 horas, se extrajeron muestras de sangre para determinar variables bioquímicas y la concentración de anticuerpos IgG contra el SARS-CoV-2. Resultados: En marzo, a través de pruebas PCR, se les diagnosticó COVID-19 a tres pacientes en hemodiálisis. Los síntomas de estos pacientes fueron fatiga extrema y debilidad muscular. En julio se realizaron pruebas de anticuerpos IgG contra el SARS-CoV-2 a todos los pacientes y al personal. En total, de los 156 pacientes, 13 (8,3 %) fueron diagnosticados con COVID-19 según los anticuerpos contra el SARS-CoV-2. Los otros 10 resultaron asintomáticos. El personal y 143 pacientes en hemodiálisis tuvieron resultados negativos para IgG. Los pacientes en HD con resultados positivos para IgG contra el SARS-CoV-2 presentaron niveles disminuidos de hemoglobina y niveles altos de proteína C reactiva y fosfatasa alcalina. Conclusiones: Las pruebas de anticuerpos son particularmente importantes para detectar personas con COVID-19 que tengan pocos síntomas o ninguno. También se ha visto que es posible prevenir la propagación de la infección en el centro de diálisis mediante precauciones muy estrictas.

Factors influencing on development of COVID-19 pneumonia and association with oral anti-diabetic drugs in hospitalized patients with diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) increases mortality and morbidity in patients with coronavirus disease (COVID-19). In this study, it was aimed to assess factors influencing on COVID-19 pneumonia in hospitalized patients with diabetes and association with oral anti-diabetic drugs. MATERIALS AND METHODS: This cross-sectional study included 432 patients with type 2 diabetes mellitus diagnosed with COVID-19. Data regarding clinical characteristics, demographic characteristics, intensive care unit (ICU) rate in patients admitted to ICU, laboratory results on day 1 and 7, thoracic computed tomography (CT) findings and oral anti-diabetic drugs used were extracted from medical records. In all patients, 75-days mortality was recorded. Data were assessed independently. RESULTS: There was pneumonia in 386 (89.4%) of 432 patients with diabetes. The risk for pneumonia was markedly higher in patients on DPP-4 inhibitors; however, there was no significant among other oral anti-diabetic groups and subgroups. In addition, elevated CRP was linked to the increased risk for pneumonia. Only patients in the pneumonia group had SGLT-2 inhibitor use. During follow-up, 91 patients died. In Cox regression analysis, low Glasgow Coma Scale score, and increased lactate dehydrogenase levels were identified as significant independent risk factors for mortality. CONCLUSION: The study indicated that DPP-4 inhibitor used and elevated CRP level were associated with pneumonia development. Only patients in the pneumonia group had SGLT-2 inhibitor use. No oral anti-diabetics was found to be associated with COVID-19 related death.

Adsorption kinetics of malachite green onto activated carbon prepared from Tunçbilek lignite.

Adsorbent (T3K618) has been prepared from Tunçbilek lignite by chemical activation with KOH. Pore properties of the activated carbon such as BET surface area, pore volume, pore size distribution, and pore diameter were characterized by t-plot based on N2 adsorption isotherm. The N2 adsorption isotherm of malachite green on T3K618 is type I. The BET surface area of the adsorbent which was primarily contributed by micropores was determined 1000 m2/g. T3K618 was used to adsorb malachite green (MG) from an aqueous solution in a batch reactor. The effects of initial dye concentration, agitation time, initial pH and adsorption temperature have been studied. It was also found that the adsorption isotherm followed both Freundlich and Dubinin-Radushkevich models. However, the Freundlich gave a better fit to all adsorption isotherms than the Dubinin-Radushkevich. The kinetics of adsorption of MG has been tested using pseudo-first-order, pseudo-second-order and intraparticle diffusion models. Results show that the adsorption of MG from aqueous solution onto micropores T3K618 proceeds according to the pseudo-second-order model. The intraparticle diffusion of MG molecules within the carbon particles was identified to be the rate-limiting step. The adsorption of the MG was endothermic (DeltaH degrees = 6.55-62.37 kJ/mol) and was accompanied by an increase in entropy (DeltaS degrees = 74-223 J/mol K) and a decrease in mean value of Gibbs energy (DeltaG degrees = -6.48 to -10.32 kJ/mol) in the temperature range of 20-50 degrees C.