Knowledge and attitudes of undergraduate medical students in Kenya towards solid organ donation and transplantation: Are Africa’s future clinicians prepared?

Background: Solid organ donation and transplantation remains grossly underdeveloped in most African countries. The knowledge and attitude of tomorrow’s professionals may be key to the improvement of these services. Methods: A sample of undergraduate medical students from all the medical schools in Kenya offering Bachelor of Medicine and Bachelor of Surgery degrees were surveyed using a self-administered, web-based questionnaire, between July and September 2018. Results: Of the 303 participants, 167 (55.1%) were female. Only 8.9% of the students had read the laws governing transplantation in Kenya. An even lower percentage (3.3%) felt that they had learned enough about solid organ donation and transplantation from their medical curriculum. More than half (53%) of the respondents would subscribe as solid organ donors, which reduced to 47% when it came to consenting to donating their relatives’ organs. Less than half of the students (40%) considered they would be comfortable introducing the topic or confident answering questions (23%) related to organ donation and transplantation. Only 9.9% of the sample had ever spoken to a patient about organ donation. There was no significant association between level of study (preclinical versus clinical) and comfort introducing the topic of organ donation (P = 0.206) or experience talking to a patient about the subject (P = 0.102). Conclusion: Undergraduate medical students have significant knowledge gaps regarding organ donation and transplantation and feel ill-prepared to approach a potential donor or transplant recipient. &nbsp

Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs

Objective: We performed a systematic review and meta-analysis for exploring clinical benefits and safety of tocilizumab in addition to standard of care (SOC) in treating patients with coronavirus disease 2019 (COVID-19). Methods: An electronic search was carried out in PubMed, EMBASE, Cochrane Library, and Science Direct, as well as in medRxiv preprint server, to identify eligible studies. Only randomized Controlled Trials (RCTs) that compared mortality events and/or adverse events between a tocilizumab + SOC group and a SOC-only control group were included. The primary outcome was 28-day mortality. Secondary outcomes include progression to severe disease, defined as need for mechanical ventilation (MV) or intensive care unit (ICU) admission, and adverse events (AE). Results: A total of nine studies (6,490 participants) could be included in this meta-analysis, with 3,358 participants in the tocilizumab + SOC group and 3,132 participants in the SOC-only group. The overall mortality rate was lower in the tocilizumab group compared to the SOC-only group, though the difference was not statistically significant (odds ratio [OR], 0.87; 95% CI, 0.73-1.04; I2, 15%). This finding was unaffected by subgroup analyses based on initial use of steroids or mechanical ventilation at baseline. Patients receiving tocilizumab were 26% less likely to progress to MV, and this difference was statistically significant (OR, 0.74; 95% CI, 0.64-0.86; I2, 0%). Among patients who were not in ICU at randomization, the tocilizumab group had 34 % lower rate of ICU admission compared to the SOC-only group (OR, 0.66; 95% CI, 0.40-2.14; I2, 29%). The occurrence of serious infections was lower in the tocilizumab group (OR, 0.57; 95% CI, 0.36-0.89; I2, 21%). Conclusion: Tocilizumab is generally well-tolerated in COVID-19. Although this drug does not appear to have a significant benefits on survival, it may have a role in preventing progression to intensive care and MV