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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.

Chlorthalidone 6.25 mg in combination with atenolol 25 mg is effective and safe in stage I (JNC 7) essential hypertensive patients. This low dose of chlorthalidone could reduce dose-related concerns over metabolic adverse effects and may lead to wider usage of this proven antihypertensive agent in combination therapy.

Objectives: COVID-19 is highly contagious, and health care workers are at high risk of being infected. We carried out a rapid survey to estimate the proportion of HCWs who are serologically positive for SARS-CoV-2 in the Lokmanya Tilak Municipal General Hospital, Mumbai, India. Material and Methods: After the consent of the hospital authorities, volunteers were asked to report at a special booth set up in the hospital between May 1, 2020, and May 16, 2020. After consent, each worker was administered a questionnaire using a handheld computer which had questions on symptoms in the past 30 days, place of posting (COVID designated area or other), work category (doctor/nurse/others), use of personal protective equipment, smoking, comorbidity, and exposure followed by a test for COVID-19 using the STANDARD Q COVID-19 IgM/ IgG Duo Test of SD Biosensor. We estimated weighted seroprevalence with 95% confidence limits after adjusting for the work category. We calculated the adjusted odds ratio (aOR) using logistic regression with seropositivity as an outcome variable and others as independent variables. Results: The final sample included 501 and 1051 subjects working in the COVID area and non-COVID area, respectively, covering 35% of the total staff of the hospital. Overall, 6.9% (95% CI of 5.7–8.2) of the hospital staff was serologically positive for SARS-Cov-2, similar in the COVID area –5.7 (3.8–8.1) and non-COVID area –7.2 (5.7–9.0). Age more than 50 years (aOR 2.65; 1.45–4.85) and being in others work category 2.84 (1.34–6.02) were identified as significant predictors of being seropositive. Only 10% of the subjects reported COVID-like illness in the past 1 month. Conclusion: The overall modest prevalence of infection among the health care workers, especially non-doctors and nurses, and similarity of prevalence in COVID and non-COVID area staff indicate the possibility of non-hospital source of infection.

ObjectiveHigh blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.MethodsTotal 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.ResultsThe study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na+, K+, Cl-)and fasting blood sugar, evident across the treatment groups.ConclusionChlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option.