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.

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Background: Hyperthyroidism is associated with altered cardiac autonomic nervous activity (CANA). Heart Rate Variability (HRV) analysis is a promising technique to quantify CANA and therefore can be done in hyperthyroidism. Objective: To observe the HRV parameters in patients with hyperthyroidism to find out the influence of excess thyroid hormone on cardiac autonomic nervous activities. Method: The cross sectional study was carried out on 60 hyperthyroid patients (groupB)aged 30-50 years in the Department of Physiology, BSMMU, Dhaka from 1 st July 2007 to 30 th June 2008. Age and sex matched 20 apparently healthy euthyroids were also studied for comparison (group A). On the basis of treatment, they were further divided into group B 1 consisting of 30 untreated newly diagnosed patients and group B 2 consisting of 30 hyperthyroid patients treated with antithyroid drugs for at least 2 months. The patients were selected from the Out Patient Department of Endocrinology, BSMMU, Dhaka. To assess thyroid status, serum TSH and serum FT 4 levels were measured by AxSym system and time domain measures of HRV such as mean R-R interval, mean heart rate, SDNN and RMSSD were assessed from 5minute(short term) ECG recording by a polygraph. For statistical analysis Mann-Whitney U test was done. Results: Mean R-R interval was significantly (P<0.001) lower but mean heart rate was significantly (P<0.001) higher in untreated patients than those of treated and euthyroids subjects. These values were found almost similar when compared between euthyroids and treated hyperthyroids. Similarly SDNN and RMSSD were significantly lower in untreated hyperthyroids than both euthyroids (P<0.001) and treated hyperthyroids (P<0.01). Conclusion: This study concluded that decreased vagal modulation on heart rate may occur in hyperthyroidism, which may be restored following adequate treatment of the disease.