Tratamiento con ustekinumab de placa de psoriasis moderada a severa cuando la escala de intensificación con adalimumab falla

La psoriasis es una enfermedad inflamatoria con un importante impacto en la calidad de vida de los pacientes. Los tratamientos sistémicos convencionales para la psoriasis no son fármacos seguros y eficaces a largo plazo. Las novedades inmunológicas en las que están implicados los linfocitos T en la patogenia de la psoriasis ha orientado la investigación, mediante tecnología recombinante de ADN, a la búsqueda de nuevos fármacos que bloqueen pasos específicos de la formación de placas de psoriasis. Los tratamientos biológicos actúan inhibiendo la activación y maduración de las células presentadoras de antígeno, inhibiendo la activación y proliferación de los linfocitos T, desviando la respuesta inmune del tipo 1 al 2, reduciendo el número de linfocitos T de memoria activados y bloqueando la acción de las citocinas. Adalimumab y Ustekinumab son los tratamientos biológicos en los que vamos a enfocar este estudio

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation