Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

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

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. 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. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Schistosomiasis mansoni in an area of low transmission: II. Risk factors for infection Esquistossomose mansônica em área de baixa transmissão: II. Fatores de risco para infecção

Risk factors for Schistosoma mansoni infection were identified using a 1:1 matched case-control design. The work was conducted in the municipality of Pedro de Toledo, São Paulo State, Brazil, an area where the snail host is Biomphalaria tenagophila. Information on water contact patterns, knowledge, attitudes and pratices (kap), socioeconomic and sanitary conditions were obtained by mean of questionnaires. The crude odds ratio estimates and the adjusted odds ratio estimates using the logistic regression model are presented. Most of the examined individuals admitted recent water contacts (90.6% of the cases). The most frequent reason for contact was swimming, playing and fishing and the preferential site of contact was the river. According to the logistic regression technique, the main risk factors for infection were: a) water contact through swimming, playing and fishing; b) fording; c) bad hygiene. We concluded that recreational activities are the main reasons for schistosomiasis transmission in Pedro de Toledo and leisure alternatives should be offered to the local population.<br>A partir de um estudo de caso-controle por pareamento (1:1) foram determinados os fatores de risco para infecção por Schistosoma mansoni. O trabalho foi desenvolvido no município de Pedro de Toledo, São Paulo, Brasil, área onde Biomphalaria tenagophila é o hospedeiro intermediário. Por meio de questionários foram obtidas informações sobre o padrão de contato com águas naturais; percepção da doença e condições sanitárias e socio-econômicas. Os fatores de risco foram estimados individualmente e através de modelo logístico. A maioria dos pesquisados admitiu contatos recentes com águas naturais (90,6% dos casos). O motivo mais freqüente para estes contatos foi nadar, brincar e pescar. O rio representou o principal local de contato com águas naturais. De acordo com a técnica de regressão logística, os principais fatores de risco foram: a) contato com água para nadar, brincar, pescar; b) vadear; c) más condições de higiene. Concluímos que as atividades recreativas são as principais responsáveis pela transmissão da esquistossomose em Pedro de Toledo e alternativas de lazer devem ser oferecidas a esta população

O clado Merianthera e as tribos Merianieae e Microliceae (Melastomataceae) na Serra Negra, Minas Gerais

Resumo Apresenta-se um estudo taxonômico do clado Merianthera e das tribos Merianieae e Microlicieae (Melastomataceae) na Serra Negra, localizada no Complexo da Mantiqueira, região sul da Zona da Mata de Minas Gerais, Brasil. O clado Merianthera está representado por Behuria parvifolia, Huberia nettoana e Cambessedesia hilariana, Merianieae está representada apenas por Meriania claussenii, enquanto Microlicieae está representada por Lavoisiera imbricata, Microlicia serpyllifolia, Rhynchanthera dichotoma, Trembleya elegans, Trembleya parviflora e Trembleya phlogiformis. A região vem sofrendo impactos devido à plantação de Pinus e Eucalyptus, especulação imobiliária, visitação desorganizada, coleta ilegal de plantas, bem como o aumento das áreas de pastagem, de modo que várias espécies se encontram sob constante ameaça. Em relação à conservação, deve-se ressaltar as espécies B. parvifolia, H. nettoana e M. claussenii, provavelmente ameaçadas de extinção a nível regional ou nacional. No presente artigo são apresentadas chaves de identificação, descrições, ilustrações, informações sobre distribuição geográfica e comentários morfológicos para os táxons desses grupos representados na Serra Negra