Objectives Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. Methods A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. Results Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. Conclusion Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis.

Air pollutants are capable to enter bloodstream through the nose, mouth, skin and the digestive tract. Hemolysis is the premature destruction of red blood cells (RBCs) membranes. This can affect metabolism of RBCs and reduce cell life. Each of these adverse effects could lead to anemia, jaundice and other pathological conditions. Hemolysis can induce by the mineral components adsorbed on the particles. The aim of this study was to evaluate hemolysis of RBCs treated by airborne PM 10 (PM with aerodynamic diameter ≤ 10 μm) in vitro. Study had two main stages including sampling and preparation of PM 10 suspension, and hemolysis test. Particle samples were collected by means of a high-volume sampler on fiberglass filters. The PM 10 was extracted through dry ultrasonic method. Blood sample was incubated by PM 10 at concentrations 50–300 μg/mL for 3 h. Hemolysis percent was assessed through measurement of Hemoglobin concentration in test samples and total blood hemoglobin (TBH) sample by the cyanmethemoglobin method. Analysis of variance (ANOVA) and Tukey post-hoc test were applied to compare mean values of hemolysis percent between different PM concentrations. Method used in current study is suggested for investigation of toxic effects of airborne particle matter (PM 1 , PM 2.5 and PM 10 ) on human RBCs.

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Emerging and hazardous environmental pollutants like phthalic acid esters (PAEs) are one of the recent concerns worldwide. PAEs are considered to have diverse endocrine disrupting effects on human health. Industrial wastewater has been reported as an important environment with high concentrations of PAEs. In the present study, four short-chain PAEs including diallyl phthalate (DAP), diethyl phthalate (DEP), dimethyl phthalate (DMP), and phthalic acid (PA) were selected as a substrate for anaerobic fixed film fixed bed reactor (AnFFFBR). The process performances of AnFFFBR, and also its kinetic behavior, were evaluated to find the best eco-friendly phthalate from the biodegradability point of view. According to the results and kinetic coefficients, removing and mineralizing of DMP occurred at a higher rate than other phthalates. In optimum conditions 92.5, 84.41, and 80.39% of DMP, COD, and TOC were removed. DAP was found as the most bio-refractory phthalate. The second-order (Grau) model was selected as the best model for describing phthalates removal.

Background Ethical care provided by nurses to earthquake victims is one of the main subjects in nursing profession. Objectives Given the information gap in this field, the present study is an attempt to explore the nurses’ experience of ethical care provided to victims of an earthquake. Research design and method A hermeneutic phenomenological study was performed. The participants were 16 nurses involved in providing care to the injured in Kermanshah earthquake, Iran. They were selected using purposeful sampling, and in-depth and semi-structured interviews were carried out. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann et al. Ethical considerations The study was approved by the Research Council and Ethics Committee of Urmia University of Medical Sciences, Iran. Findings Data analyses revealed four themes and 10 sub-themes that illustrated nurses’ experience of ethical care during earthquake. The themes were (1) Respecting humanistic values (sacrifice, stepping beyond task description, and voluntary work), (2) Commitment to ethics (honesty, confidentiality, and trustworthiness), (3) Respecting dignity of victims (respecting cultural values, maintaining privacy, having humanistic perspective, and effective communication), and (4) Spiritual support (helping patients to do religious rituals Psychological support). Conclusion The results showed the nurses’ experience with providing care to earthquake victims. The findings underlined ethics and ethical values in providing nursing care during disasters. It is suggested that special courses on the importance of nursing ethics in critical situations be incorporated into nursing curriculums and in-service educations.