Background: The novel human coronavirus, severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), was declared a global pandemic by the World Health Organization on March 11, 2020. Hence, there is an urgency to find effective treatment. Of those patients afflicted in the United States, many have required treatment with ventilator secondary to acute respiratory distress syndrome (ARDS). Data are needed regarding the benefit of treatment and prevention of the cytokine storms in COVID-19 patients with Tocilizumab. Methods: Clinical outcomes data for patients admitted to Orange Regional Medical Center with confirmed COVID-19 from Mar 15, 2020 to Apr 20, 2020 were identified through electronic health record chart review. We conducted a retrospective case-control study in confirmed COVID 19 positive patients with ARDS requiring mechanical ventilation and compared outcome in terms of mortality and length of stay amongst those who received Tocilizumab as treatment modality opposed to those that did not. Results: A total of 94 patients with COVID-19 ARDS were analyzed. 44 were in the study group and 50 in the control group. We tried to match both group as close as possible in terms of age, sex, BMI and HS score- calculated using inflammatory markers- ferritin, triglycerides, AST and fibrinogen. The median age was 55.5 years in the study group and 66 in the control group, difference was not statistically significant. Average HS score was 114 in the Tocilizumab group and 92 in the control group, difference was statistically significant with P<0.0001. Also, the patients in the study group had elevated levels of IL-6, triglycerides, AST, ferritin which were statistically significant with p < 0.0001 when compared to the control group. Length of stay was longer, average 17.9 days in the Tocilizumab. Survival rate was much lower at 48 % in the control group and 61.36 % in patients who received Tocilizumab with significant P value of < 0.00001. The number needed to treat (NNT) was 7.48, if we treat 8 patients with Tocilizumab, 1 will not die. Conclusions: Cytokine Release Syndrome (CRS) occurs in a large number of patients with severe COVID-19, which is also an important cause of death. IL- 6 is the key molecule of CRS, so IL-6R antagonist Tocilizumab may be of value in improving outcomes. In our study Tocilizumab group seemed to have improved survival outcome. Results have to be interpreted with caution since this is a retrospective study and mortality is affected by multiple, confounding factors. We await the results of ongoing randomized controlled trials to definitely answer the question of whether Tocilizumab improves survival in COVID-19 ARDS patients.

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INTRODUCTION: With over three million deaths worldwide, COVID-19 is still a global pandemic, hence an urgent need for risk stratification. METHODS: retrospective study, included 245 adult patients admitted to Garnet Health Medical Center with confirmed COVID-19 results from March to May 2020. Further classified into 3 groups; intubated COVID-19 positive, intubated COVID-19 negative and non-intubated COVID-19 positive. Primary outcome for mortality, ventilator duration, ICU and length of hospital stays were compared. Statistical analysis was done by 1way ANOVA and statistical significance defined as P >0 .05. RESULTS: 245 patients were analyzed; 105 intubated COVID-19 positive, 115 intubated COVID-19 negative and 25 non-intubated COVID-19 positive groups. Mean age was 60.45, 63.22 and 65.96 years with male predominance 72.38%, 53.04% and 60% respectively. Caucasians seemed more affected 53.33%, 73.91% and 40% followed by African Americans. Chronic medical conditions included hypertension (63.80%, 68.69% and 84%), diabetes mellitus (44.76%, 34.78% and 48%) and asthma (13.33%, 10.43% and 8%) respectively. Mortality was 45.71% in intubated COVID-19 positive, 34.23% in intubated COVID-19 negative and 16% in non-intubated COVID-19 positive patients. COVID-19 positive patients were intubated for a mean duration of 22.14 days compared to 8.69 days in COVID-19 negative patients. Mean ICU and hospital length of stay were 16.01 and 23.7 days in intubated COVID-19 positive patients, 8.83 and 11.25 days in intubated COVID-19 negative patients, while mean ICU and hospital durations were 2.84 and 12.12 days in COVID-19 positive non-intubated patients respectively; P = 0.0001. Acute Respiratory Distress Syndrome (ARDS), in COVID-19 positive intubated patients (82.85%), acute kidney injury (AKI) (80%) with 32.38 % needing continuous renal replacement therapy (CRRT). While in COVID-19 negative intubated patients 66.95% developed AKI with 17.3 % needing CRRT and only 5.21% patients developed ARDS. COVID-19 positive non-intubated patients AKI was predominant in 64% with no CRRT and 28% developed ARDS. CONCLUSIONS: COVID-19 positive intubated patients had greater mortality, ventilator duration, length of ICU and hospital stays. This study identified risk factors and complications that may be associated in COVID-19.

Background:The COVID-19 pandemic poses a number of problems for health systems around the world, especially those related to reproductive health, with an uneven impact on those with the fewest resources. Aim of the study: was to assess women utilization of contraceptive methods during COVID-19 pandemic in zagazig city. Subjects and method: Study design: Descriptive study. Setting: The study was conducted at two settings: El-Nahal and Ghazala maternal and child health center in Zagazig city. Subjects: A purposive sample of 290 women in the child bearing age was included in the study. Tools of data collection: Two tools were used; Structured interview questionnaire and questionnaire of women's utilization of contraceptive methods during COVID-19 pandemic in Zagazig city. Results: More than two fifth of the studied women who were using contraception for the first time or change to a new method preferred to use hormonal methods followed by natural methods, barrier methods and finally copper IUD. Transportation and administrative barriers were the main barriers during covid-19 pandemic that lead to stop/discontinuation of FP methods. Conclusion:The vast majority of women were visiting MCH to obtain regular methods, others were the first time or switching to new method. The most commonly utilized methods by the majority of women were hormonal methods; lower percentages were using natural methods and the least used were barrier methods with slight increase in utilization of natural and barrier methods than before COVID-19. Recommendations: Promoting public facilities and centers with universal infection control measures and those services offered that are up to the quality standards can help increase women's use of contraceptive methods during COVID-19 as this will lessen the fear of attracting infection for both health care providers and women seeking contraceptive care in these facilities.