Evaluation of infliximab/tocilizumab versus tocilizumab among COVID-19 patients with cytokine storm syndrome.

Coronavirus Disease 2019 (COVID-19) continues to spread rapidly. Monoclonal antibodies as well as anti-tumor necrosis factor are considered promising treatments for COVID-19. A prospective cohort study in which patients are divided into three groups. Group 1: moderate and severe COVID-19 patients received standard treatment; Group 2: moderate and severe COVID-19 patients received tocilizumab; Group 3: moderate and severe COVID-19 patients received treatment with infliximab and tocilizumab. 153 patients were recruited in the study. 40 received standard treatment alone, 70 received tocilizumab with standard treatment, and 43 received tocilizumab/infliximab with standard treatment. There was a significant difference in length of hospital stay (10.3, 8.9, and 7.6 days respectively P = 0.03), need for a non-invasive mechanical ventilator (4, 5, and one patient; P = 1.2E-8), intensive care admission (32, 45, and 16 patients; P = 2.5E-5), the occurrence of sepsis (18, 12, and 10 patients; P = 0.005) and in death (42.5%, 14.2%, and 7%; P = 0.0008) which were significantly lower in tocilizumab/infliximab group compared to tocilizumab and standard of care groups. Our study showed that tocilizumab/ infliximab in addition to standard of care was considered a promising treatment for moderate and severe COVID-19 patients.Trial registration number: ClinicalTrials.gov NCT04734678; date of registration: 02/02/2021.

Pentoxifylline Effects on Hospitalized COVID-19 Patients with Cytokine Storm Syndrome: A Randomized Clinical Trial.

COVID-19 is a fatal, fast-spreading pandemic, and numerous attempts are being made around the world to understand and manage the disease. COVID-19 patients may develop a cytokine-release syndrome, which causes serious respiratory diseases and, in many cases, death. The study examined the feasibility of employing legally available anti-inflammatory pentoxifylline (PTX), a low toxicity and cost medication, to mitigate the hyper-inflammation caused by COVID-19. Thirty adult patients who tested positive for SARS-CoV2 were hospitalized owing to the cytokine storm syndrome. They were given 400 mg of pentoxifylline orally TID according to the standard COVID-19 protocol of the Egyptian Ministry of Health. Besides this, a group of thirty-eight hospitalized COVID-19 patients who received the standard COVID-19 protocol was included in the study as a control group. The outcomes included laboratory test parameters, clinical improvements, and number of deaths in both groups. After receiving PTX, all patients showed a significant improvement in C reactive protein (CRP), and interleukin-6 (IL-6) levels at p < 0.01 and p = 0.004, respectively, while there was an increase in total leukocyte count (TLC) and neutrophil-to-leucocyte ratio (NLR) at p < 0.01 compared to their baseline levels. The D-dimer level showed a significant increase in the treatment group at p < 0.01, while showing no statistically significant difference in the control group. The median initial ALT (42 U/L) in the treatment group showed a decrease compared to the control group (51 U/L). No statistical significance was reported regarding clinical improvement, length of stay, and death percentages between the two groups. Our results showed no significant improvement of PTX over controls in clinical outcomes of hospitalized COVID-19 patients. Nevertheless, PTX displayed a positive effect on certain inflammatory biomarkers.

Evidence for the Efficacy of a High Dose of Vitamin D on the Hyperinflammation State in Moderate-to-Severe COVID-19 Patients: A Randomized Clinical Trial.

Background and Objectives: Vitamin D supplementation plays a key effect in lowering cytokine storms among COVID-19 patients by influencing the activity of the renin-angiotensin system and the production of the angiotensin-2 converting enzyme. The study was conducted to explore the effect of high-dose intramuscular vitamin D in hospitalized adults infected with moderate-to-severe SARS-CoV-2 in comparison with the standard of care in the COVID-19 protocol. Materials and Methods: Two groups of patients were compared in this prospective randomized controlled trial as the vitamin D was administered orally to group 1 (alfacalcidol 1 mcg/day) and intramuscularly to group 2 (cholecalciferol 200,000 IU). One hundred and sixteen participants were recruited in total, with fifty-eight patients in each group. Following the Egyptian Ministry of Health's policy for COVID-19 management, all patients received the same treatment for a minimum of five days. Results: A significant difference was recorded in the length of hospital stay (8.6 versus 6.8 days), need for high oxygen or non-invasive mechanical ventilator (67% versus 33%), need for a mechanical ventilator (25% versus 75%), clinical improvement (45% versus 55%), the occurrence of sepsis (35% versus 65%), and in the monitored laboratory parameters in favor of high-dose vitamin D. Moreover, clinical improvement was significantly associated with the need for low/high oxygen, an invasive/non-invasive mechanical ventilator (MV/NIMV), and diabetes, while mortality was associated with the need for MV, ICU admission, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and the occurrence of secondary infection. Conclusions: Our study showed that high-dose vitamin D was considered a promising treatment in the suppression of cytokine storms among COVID-19 patients and was associated with better clinical improvement and fewer adverse outcomes compared to low-dose vitamin D.

Novel technique for transcatheter closure of sinus venosus atrial septal defect: The temporary suture-holding technique.

BACKGROUND: Transcatheter repair of sinus venosus atrial septal defect (SVASD) has become an alternative option to surgical repair. There are potential significant complications related to stent stability in the superior vena cava (SVC) and potential migration of the stent that need to be addressed. Therefore, the technique is still evolving. OBJECTIVES: To report results of a new modification "the suture technique" that improves safety profile of positioning and securing a covered stent in the SVC. METHODS: This is a descriptive, single center, retrospective review of patients who underwent SVASD closure using the suture technique at our institution between 02/2020 and 08/2022. RESULTS: Fourteen patients underwent transcatheter repair of SVASD using the suture technique. All procedures were successful. The suture technique allowed precise stent placement in all patients without any migration or complication. Six patients required additional stent placement at the level of the SVC. One patient had an additional covered stent placed to eliminate a tiny residual shunt. Two patients had negligible residual shunts at the time of the procedure. At follow-up, all patients clinically improved and had significant reduction in right heart size on echocardiography and/or magnetic resonance imaging. No arrhythmia was reported in any patient. None required re-intervention after a mean follow-up of 16.5 ± SD 10.5 months. CONCLUSIONS: The suture technique appears to be safe modification. Although our study involves small sample size with no comparative group, we believe our technique offers greater control over stent positioning, reducing the risk of stent embolization and residual shunting in transcatheter closure of SVASD.

Characterization and antimicrobial properties of cotton fabric loaded with green synthesized silver nanoparticles.

In the present study, antimicrobial formulations, based on silver nanoparticles (AgNPs) and butyl acrylate binder, were prepared and applied to a cotton fabric, followed by gamma-radiation or thermal curing, to protect it against the undesirable microbial effects. AgNPs were prepared by a biological method, using the biomass filtrate of fungus Alternaria alternata. Nanoparticles were characterized by UV-vis spectroscopy, transmission electron microscopy, energy dispersive X-ray spectroscopy, and dynamic light scattering. Besides, the thermal stability, surface morphology, color strength, and mechanical properties of treated fabric were investigated. Treated cotton fabric showed good quantitative and qualitative antimicrobial activity; the bacterial reduction efficiency reached ∼100% for Escherichia coli and Staphylococcus aureus. They revealed excellent resistance to biodegradation caused by soil microflora. Moreover, they exhibited high durability of the attained antimicrobial activities, even after 20 washing cycles; where they achieved 99.1% and 98.7% reduction of E. coli and S. aureus bacterial counts, respectively.

Optimization of chitin yield from shrimp shell waste by Bacillus subtilis and impact of gamma irradiation on production of low molecular weight chitosan.

Chitin and chitosan have been produced from the exoskeletons of crustacean shells such as shrimps. In this study, seventy bacterial isolates, isolated from soil, were tested for proteolytic enzymes production. The most efficient one, identified as Bacillus subtilis, was employed to extract chitin from shrimp shell waste (SSW). Following one-variable-at-a-time approach, the relevant factors affecting deproteinization (DP) and demineralization (DM) were sucrose concentration (10%, w/v), SSW concentration (5%, w/v), inoculum size (15%, v/v), and fermentation time (6days). These factors were optimized subsequently using Box-Behnken design and response surface methodology. Maximum DP (97.65%) and DM (82.94%) were predicted at sucrose concentration (5%), SSW concentration (12.5%), inoculum size (10%, containing 35×10(8) CFU/mL), and fermentation time (7days). The predicted optimum values were verified by additional experiment. The values of DP (96.0%) and DM (82.1%) obtained experimentally correlated to the predicted values which justify the authenticity of optimum points. Overall 1.3-fold increase in DP% and DM% was obtained compared with 75.27% and 63.50%, respectively, before optimization. Gamma-irradiation (35kGy) reduced deacetylation time of irradiated chitin by 4.5-fold compared with non-irradiated chitin. The molecular weight of chitosan was decreased from 1.9×10(6) (non-irradiated) to 3.7×10(4)g/mol (at 35kGy).

Biodegradation of used engine oil by novel strains of Ochrobactrum anthropi HM-1 and Citrobacter freundii HM-2 isolated from oil-contaminated soil.

Used engine oil (UEO) constitutes a serious environmental problem due to the difficulty of disposal off or reuse. Ten bacterial strains with biodegradation potential were isolated from UEO-contaminated soil sample using enrichment technique. Two strains which exhibited the highest degradation %, 51 ± 1.2 and 48 ± 1.5, respectively, were selected. Based on the morphological, biochemical characteristics and 16S rRNA sequence analysis, they were identified as Ochrobactrum anthropi HM-1 (accession no: KR360745) and Citrobacter freundii HM-2 (accession no: KR360746). The different conditions which may influence their biodegradation activity, including UEO concentration (1-6 %, v/v), inoculum size (0.5-4 %, v/v), initial pH (6-8), incubation temperature (25-45 °C), and rotation speed (0-200 rpm), were evaluated. The optimum conditions were found to be 2 % UEO, 2 % inoculum size, pH 7.5, incubation temperature 37 °C, and 150 rpm. Under the optimized conditions, strains HM-1, HM-2, and their mixture efficiently degraded UEO, they achieved 65 ± 2.2, 58 ± 2.1, and 80 ± 1.9 %, respectively, after 21 days of incubation. Biodegradation of UEO was confirmed by employing gas chromatography analysis. Gamma radiation (1.5 kGy) enhanced the degradation efficiency of irradiated bacterial mixture (95 ± 2.1 %) as compared to non-irradiated (79 ± 1.6 %). Therefore, strains HM-1 and HM-2 can be employed to develop a cost-effective method for bioremediation of used engine-oil-polluted soil.

Photocatalytic degradation of methylene blue and inactivation of pathogenic bacteria using silver nanoparticles modified titanium dioxide thin films.

Titanium dioxide (TiO2) is a well-studied photocatalyst that is known to break down organic molecules upon ultraviolet irradiation. TiO2 thin films were fabricated on glass substrates using the doctor-blade procedure, the film surface was modified with silver nanoparticles to increase its visible light response. The Ag-TiO2 films were characterized by transmission electron microscopy, scanning electron microscopy equipped with energy dispersive spectrometry and X-ray diffraction. The photocatalytic degradation of methylene blue (MB) and inactivation of Gram-negative bacteria Escherichia coli and Gram-positive bacteria Staphylococcus aureus were studied. The modified films presented enhanced photocatalytic efficiency and can decompose MB solution two-times faster than the unmodified TiO2 films, under illumination of sunlight. A nominal degradation (15 %) was observed in control MB under sunlight. The degradation efficiency of Ag-TiO2 films slightly decreased after five consecutive experiments. Ag-TiO2 films revealed very effective bactericidal activity against both E. coli and S. aureus. The photocatalytic inactivation toward E. coli and S. aureus showed a similar trend with much higher effectiveness toward E. coli under the same experimental conditions. The inactivation efficiency was maximized and reached 95 % for S. aureus and 97 % for E. coli, after 180 min incubation. These results demonstrate the potential of application of Ag-TiO2 photocatalysis as a method for treatment of diluted waste waters in textile industries.

Radiopacity of nonmetallic root canal posts.

PURPOSE: This study determined the radiopacity of a group of nonmetallic posts. MATERIALS AND METHODS: Four specimens were cut from 7 posts, and tooth sections were cut from extracted teeth. Radiographic images of all specimens along with an aluminum step wedge were obtained on occlusal films. Optical density readings for each specimen image were determined with a transmission densitometer. Radiopacity values were subsequently calculated as equivalents of aluminum thickness. RESULTS: Analysis of variance revealed significant differences in radiopacity values among the posts (P < .001). One nonmetallic post that was made of zirconium had a radiopacity value significantly greater than that of enamel. Another, made of glass fibers, acrylic resin, and fillers, had a radiopacity that was greater than that of dentin but smaller than that of enamel. The remaining 3 nonmetallic posts had radiopacity values lower than dentin. CONCLUSION: The 3 posts with radiopacity that was lower than dentin cannot be considered sufficiently radiopaque.