Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov ( NCT04381936 ). Findings Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research.

Shortage of face masks is a current critical concern since the emergence of coronavirus-2 or SARS- . In this work, we compared the melt-blown (MB) filter, which is commonly used for the N95 face mask, with nanofiber (NF) filter, which is gradually used as an effective mask filter, to evaluate their reusability. Extensive characterizations were performed repeatedly to evaluate some performance parameters, which include filtration efficiency, airflow rate, and surface and morphological properties, after two types of cleaning treatments. In the first cleaning type, samples were dipped in 75% ethanol for a predetermined duration. In the second cleaning type, 75% ethanol was sprayed on samples. It was found that filtration efficiency of MB filter was significantly dropped after treatment with ethanol, while the NF filter exhibited consistent high filtration efficiency regardless of cleaning types. In addition, the NF filter showed better cytocompatibility than the MB filter, demonstrating its harmlessness on the human body. Regardless of ethanol treatments, surfaces of both filter types maintained hydrophobicity, which can sufficiently prevent wetting by moisture and saliva splash to prohibit not only pathogen transmission but also bacterial growth inside. On the basis of these comparative evaluations, the wider use of the NF filter for face mask applications is highly recommended, and it can be reused multiple times with robust filtration efficiency. It would be greatly helpful to solve the current shortage issue of face masks and significantly improve safety for front line fighters against coronavirus disease.

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BackgroundThere is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.MethodsA structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.Results377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.ConclusionsPneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

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Core-shell nanofibers with the ability to carry multiple drugs are attracting the attention to develop appropriate drug delivery systems for wounds dressing applications. In this study, biocompatible core-shell nanofibers have been designed as a promising dual-drug carrier with the capability of delivering both water-soluble and organic solvent-soluble drugs simultaneously. With the aim of fabricating the core-shell nanofibers, the dipping method has been employed. For this propose, core nanofibers made from polyvinyl alcohol (PVA) were immersed in various concentrations of polyacrylonitrile (PAN) and cross-linked by dipping into ethanol. Diclofenac sodium salt (DSs) and gentamicin sulfate (GENs) have been loaded into the core and shell nanofibers as models of the drug, respectively. The morphology study of core-shell nanofibers showed that the concentrations between 1% w/w up to 2% w/w PAN/GENs, with deep penetration into the internal layers of PAV/DSs nanofibers could lead to the core-shell structure. The cytotoxicity results showed the competency of designed core-shell nanofibers for wound dressing application. Also, the release profile exhibits the controllable behavior of drug release.