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BackgroundDuring the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. ObjectiveThe purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. MethodsA retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. ResultsThe unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. ConclusionsIn this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.

Research into explainable artificial intelligence (XAI) methods has exploded over the past five years. It is essential to synthesize and categorize this research and, for this purpose, multiple systematic reviews on XAI mapped out the landscape of the existing methods. To understand how these methods have developed and been applied and what evidence has been accumulated through model training and analysis, we carried out a tertiary literature review that takes as input systematic literature reviews published between 1992 and 2023. We evaluated 40 systematic literature review papers and presented binary tabular overviews of researched XAI methods and their respective characteristics, such as the scope, scale, input data, explanation data, and machine learning models researched. We identified seven distinct characteristics and organized them into twelve specific categories, culminating in the creation of comprehensive research grids. Within these research grids, we systematically documented the presence or absence of research mentions for each pairing of characteristic and category. We identified 14 combinations that are open to research. Our findings reveal a significant gap, particularly in categories like the cross-section of feature graphs and numerical data, which appear to be notably absent or insufficiently addressed in the existing body of research and thus represent a future research road map. [ABSTRACT FROM AUTHOR]

A 29-year-old male presented to the emergency department with acute chest pain, elevated blood pressure, and mild dyspnea. Initial laboratory investigations revealed significant abnormalities, including leukocytosis, markedly elevated hemoglobin (20.5 g/dL), and increased hematocrit (59.9%). Cardiac biomarkers showed a substantial rise in troponin-I levels, peaking at 16,176 ng/L. Electrocardiogram demonstrated T-wave inversion in anterolateral leads, suggestive of myocardial ischemia or NSTEMI. Further investigation, including bone marrow biopsy and genetic testing, confirmed a diagnosis of polycythemia vera (PV) with a positive JAK2V617F mutation. Treatment was initiated with hydroxyurea and interferon to manage PV, along with ticagrelor for thrombosis prevention. This case highlights the importance of considering hematological disorders such as PV in young patients presenting with atypical cardiovascular events, emphasizing the need for evaluation in such cases. [ABSTRACT FROM AUTHOR]