Signals were broadly positive for months, but never definitive: the tocilizumab story

BACKGROUND: Most COVID-19 treatment guidelines currently recommend tocilizumab in combination with dexamethasone in critically ill patients who are exhibiting rapid respiratory decompensation. OBJECTIVES: To produce a critical review and summary of the pathway which led to the repurposing of tocilizumab for COVID-19 treatment, from in vitro observations to guidelines recommendations. SOURCES: All studies evaluating the effectiveness of tocilizumab to treat COVID-19 disease published over July 2020-July 2021. CONTENT: Two large methodologically well conducted observational studies, the TESEO and the STOP COVID cohorts, showed a reduction in the risk of invasive mechanical ventilation or death in patients treated with tocilizumab as compared to standard of care in 2020. Concomitantly and up to February 2021 a number of small sample size randomized trials (RCTs) were showing discrepant results. These RCTs had a number of issues: small sample size, various designs and inclusion criteria and different dosages of tocilizumab used. The confidence interval of the meta-analytic estimate for the RCT results was consistent with the hypothesis of no efficacy of tocilizumab. In our opinion, this was mainly because the meta-analysis included small and heterogeneous studies. These results led to a delay in the inclusion of tocilizumab in guidelines which occurred only in the summer of 2021. IMPLICATIONS: Although observational studies are unable to control for unmeasured confounding, they can be put together quickly during a pandemic and promptly provide important information. The large sample size allows us to investigate effect measure modifiers and better target interventions. It is key that the effect size is somewhat large (RR>2), all sources of bias are properly accounted for and the direct evidence is weighted against these factors. It appears to us that for tocilizumab, not having dismissed the results of carefully designed and analysed observational studies in 2020 could have prevented many deaths over those months

The solvent effect on the electrocatalytic cleavage of carbon-halogen bonds on Ag and Au

In recent years it has been shown in detail how the electrocatalytic cleavage of carbonhalogen bonds is modulated by (a) the stepwise or concerted nature of the dissociative electrontransfer mechanism, which is influenced by the nature of the electrode surface, the type of halogen atom and the molecular structure of RX as a whole, and (b) the double-layer structure (as a function of the nature and bulkiness of the supporting electrolyte ions). In order to both complete and support the interpretative scheme thus developed, this work is focused on the solvent role. When one compares aprotic with protic organic solvents after appropriate intersolvental normalization, interesting peculiarities emerge, especially concerning protic media. Solvent proticity deeply affects both the reaction mechanism (on both non-catalytic and catalytic electrodes) and the extent of the catalytic effects. These items are discussed on the basis of a complete investigation carried out with a carefully controlled experimental protocol on two chloride and bromide couples, one aromatic and one aliphatic, representative of stepwise and concerted mechanisms, respectively, in four aprotic and four protic solvents, on both non-catalytic GC and catalytic Ag and Au electrodes. The results are discussed in the framework of a recently developed interpretative scheme of the carbon-halogen cleavage mechanism

"Egg of Columbus": single-step complete removal of chloride impurities from ionic liquids by AgCl deposition on silver electrode

Chloride impurities in ionic liquids (ILs), which can be present even in huge amounts depending on the IL synthetic route, are particularly critical for electrochemical processes; thus, their abatement is often mandatory. However, while their analytical quantification has been the subject of many studies involving a variety of techniques, the so far available processes for their abatement are still unsatisfactory, having low efficiency, and/or involving multiple steps, and/or being far from mild and easily scalable. In this context, like an "egg of Columbus", a quite simple and safe process for chloride abatement in ILs is proposed, practically coinciding with the electrolytic preparation of a Ag|AgCl electrode. It proceeds in a single step, at room temperature, at very low potentials, with nearly ideal current efficiencies, and with negligible side effects on the electrolyzed IL. The chloride impurities are quantitatively captured and accumulated on the silver wire and eliminated by simply removing the resulting Ag|AgCl electrode from the solution, with no need of subsequent treatments

Electrochemistry of cyclic triimidazoles and their halo derivatives: A casebook for multiple equivalent centers and electrocatalysis

A family of cyclic triazines, based on the triimidazo[1,2-a:1\u2032,2\u2032-c:1\u2033,2\u2033-e][1,3,5]triazine scaffold, has recently caught attention due to its variegated solid state photoluminescent properties (e.g., crystallization induced emission, fluomechanochromism, dual fluorescence, room temperature ultralong phosphorescence), tuned by proper functionalization of the cyclic core. From an electrochemical point of view, this family of heteroaromatic cyclic triazines is unexplored. A cyclic voltammetry study is here performed aiming to clarify structure/electroactivity relationship. The peculiar molecular structure of this class of molecules offers a multi-approach case study, spanning from multiple equivalent redox site interactions in small hoops (due to ideally C3h symmetry) to carbon-halogen bond reactivity in the presence of catalytic metal electrode surfaces (for \u2013Br and \u2013I derivatives). Results point to a poor heteroannular aromaticity along the rigid, planar cyclotrimer, with each equivalent redox site acting quite independently. An unusually higher electrocatalytic performance of gold with respect to silver electrode for the electrocleavage of carbon-halogen bonds (that decreases by increasing number of halo substituents) is tentatively explained in term of a specific interaction between gold and the nitrogen-rich planar cyclotrimer platform

Targeted photoimmunotherapy for cancer

Photodynamic therapy (PDT) is a clinically approved procedure that can exert a curative action against malignant cells. The treatment implies the administration of a photoactive molecular species that, upon absorption of visible or near infrared light, sensitizes the formation of reactive oxygen species. These species are cytotoxic and lead to tumor cell death, damage vasculature, and induce inflammation. Clinical investigations demonstrated that PDT is curative and does not compromise other treatment options. One of the major limitations of the original method was the low selectivity of the photoactive compounds for malignant over healthy tissues. The development of conjugates with antibodies has endowed photosensitizing molecules with targeting capability, so that the compounds are delivered with unprecedented precision to the site of action. Given their fluorescence emission capability, these supramolecular species are intrinsically theranostic agents

Breast tuberculosis: A case report of primary type mammary tuberculosis

Mammary tuberculosis is exceptional in developed countries. It can mimic an abscess or a granulomatous mastitis. In subjects coming from endemic areas, it is necessary to suspect a tuberculosis infection in case of recurrent mastitis refractory to antibiotics. Positivity of Quantiferon-TB Gold assay can help to confirm the clinical suspicion

Dasabuvir and Ombitasvir/Paritaprevir/Ritonavir with or without Ribavirin in Patients with HIV-HCV Coinfection. Real Life Interim Analysis of an Italian Multicentre Compassionate Use Program

Background and Aims: An HCV cure is now possible in a large proportion of HIV-HCV patient. We present real life results of a compassionate use program promoted by SIMIT (Infectious and Tropical Diseases Italian Society) of Dasabuvir and Ombitasvir/Paritaprevir/Ritonavir ± Ribavirin for 12 weeks in 213 HIV-HCV genotype 1 patients. Data on efficacy and tolerability of this strategy in HIV patients have been reported until now only in 43 non cirrhotic HIV subjects