Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Preclinical anti-inflammatory effects of dry powder of Caléndula officinalis

Para demostrar la actividad antiinflamatoria del polvo seco Caléndula officinalis secado por atomización se emplearon dosis de 50, 150 y 450 mg/Kg y se evaluó el efecto sobre la inflamación aguda provocada por carragenina, dextrán, histamina y serotonina y granuloma inducido por discos de algodón en ratas y edema auricular inducido por aceite de crotón en ratones. El polvo seco mostró efecto inhibitorio sobre los diferentes modelos empleados sin afectar el peso del timo y las glándulas suprarrenales. Estos resultados muestran que el método de secado por atomización permite la obtención de una materia prima de Caléndula officinalis activa frente a procesos inflamatorios de naturaleza diversa.With the objective to demonstrate the anti-inflammatory effect of Calendula officinalis dry powder, doses of 50, 150 and 450 were used on inflammation induced by carragenin, dextran, histamine and serotonine, the granulome induced by cotton pellets in rats and ear inflammation induced by croton oil in mice. The spray dried powder of Calendula officinalis inhibited the inflammatory process in all animal model employed without affecting tymus's and adrenal's weight. These results show that the powder of Calendula officinalis obtained by spray drying is active in inflammatory processes of diverse nature.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Influence of the microencapsulation process on the pharmacological effect of Cucurbita pepo L. seed lipids

Las semillas de Cucurbita pepo L., por su elevado porcentaje de aceite fijo, son ricas en ácidos grasos poliinsaturados, fitoesteroles, tocoferoles y carotenoides, empleándose tradicionalmente como antiinflamatorio en el tratamiento de la hiperplasia benigna prostática. La microencapsulación mediante secado por aspersión del extracto lipídico de las semillas de Cucurbita pepo L., empleando polímeros naturales modifica el estado de agregación del extracto, permitiendo así presentarlo en forma sólida para elaborar tabletas o cápsulas. La microencapsulación le confiere una mayor biodisponibilidad, lográndose un efecto antiinflamatorio con dosis inferiores al extracto lipídico sin microencapsular originado por el alto grado de dispersión que le confiere el proceso de microencapsulación.Most fixed oil of Cucurbita pepo L. seeds is composed by polyunsaturated fatty acids, fitoesterols, tocoferols and carotenoids, and is traditionally used as anti-inflammatory in the treatment of the benign prostatic hyperplasia. The microencapsulation by spray drying of the Cucurbita pepo L. seeds lipidic extract, using natural polymers, modifies the state of aggregation of the extract, allowing this way to present it in solid form to elaborate tablets or capsules. The microencapsulation generates a higher bioavailability, being achieved an anti-inflammatory effect with minor dose to the non microencapsulated lipidic extract, owed to the high dispersion degree that produces the microencapsulation processes.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Hacia una cultura del agua

El escritor Frank Herbert describió, en su trilogía de ciencia ficción Dune , un tipo de existencia humana situada en un planeta desértico, Arrakis, donde el agua es el bien más preciado. Allí cada individuo debe vivir reciclando permanentemente todos sus fluidos corporales para poder obtener el agua que requiere para sobrevivir y cuando alguien muere toda el agua que contiene su cuerpo es reciclada para uso de la comunidad. En ese lugar llorar a los muertos es el símbolo de máxima prodigalidad. La Tierra, por el contrario de Arrakis, igual que el cuerpo humano, es fundamentalmente agua. Está compuesta en un 75% de agua. De esta, 97.5% es salada y apenas 2.5% dulce. La Tierra está rodeada por agua en forma de nubes, sus polos los cubren mantos de nieve y hielo. El planeta Tierra es más líquido que sólido: debiera llamarse planeta Agua. El agua es la raíz de la vida, patrimonio de la humanidad,. componente básico para el progreso, Es un bien público. Más que un derecho, es una necesidad vital. Está en peligro. Reflexionar sobre el agua nos pone a navegar en un mar de problemas. Se abusa de ella. Se la atropella. Se destruyen ecosistemas. Se sobre-explotan y contaminan las fuentes y las corrientes. El mal uso del agua deja predecir lo evidente, un mundo sediento, similar a Arrakis. Poco serán las actuales guerras del petróleo en comparación con las eventuales guerras por el agua

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America.

In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. Mean age for all participants was 66.7 ( = 7.7) years and mean education was 15.4 ( = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact ( < .001,  = .031); while Blacks reported experiencing discrimination more often ( < .001,  = .050). Blacks and Latinos reported more positive coping ( < .001,  = 040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination. The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact. Massachusetts General Hospital Department of Psychiatry

Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study

Background Population distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications.Methods A sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) &gt;0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness.Results In never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p&lt;0.05), with no significant differences in other chronic respiratory symptoms or CT findings. FVC and exhaled CO were identified as independent risk factors for low DLCO.Conclusion Reduced DLCO is a frequent disorder among smokers without airflow limitation, associated with decreased exercise capacity and with CT findings suggesting that it may be a marker of smoking-induced early vascular damage.Trial registration number NCT03028207

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective