Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Activités biologiques des champignons : recherches actuelles sur les facteurs de risque des maladies cardio-vasculaires

International audienc

Current research findings on the effects of selected mushrooms on cardiovascular diseases

International audienceFor about 50 years, scientists have studied the biological activities of Macromycetes on different pathologies. In this article different fungal activities that reduce the effects of risk factors for cardiovascular diseases are reviewed. Among the 17 species tested on animals, 16 demonstrated at least one of the following activities: ability to reduce hypercholesterolemia or to cure dyslipoproteinemia, possibility to decrease arterial hypertension or hyperglycemia, and ability to cure disturbances in platelet aggregation

Activités biologiques des champignons : Utilisations en médecine traditionnelle

L'article très long, a été coupé en deux. Il est donc paru dans deux numéros consécutifs à savoir : . Francia C., Fons F., Poucheret P. et Rapior S. Activités biologiques des champignons : Utilisations en médecine traditionnelle. Annales de la Société d’Horticulture et d’Histoire Naturelle de l’Hérault, 147 (4), 77-88 (2007), (suite) 148 (1), 5-17 (2008).International audienceLes champignons supérieurs occupent une place particulière au sein du monde vivant et pendant longtemps, les hommes ont éprouvé des sentiments contradictoires envers eux. Incapables d'expliquer ration-nellement le cycle de vie des Macromycètes, nos ancêtres les ont tour à tour adorés puis rejetés avec crainte. Contrairement aux plantes médici-nales, fort bien connues et employées pendant des siècles, les champi-gnons supérieurs n'ont été que peu utilisés en thérapeutique. La méde-cine traditionnelle a employé quelques espèces, mais leurs indications sont souvent empiriques et mêlées de superstitions propres à chaque peuple. Historiquement les pays orientaux ont été les premiers à recon-naître les champignons comme une importante source de médicaments. La recherche occidentale commence seulement à étudier ce réservoir si peu exploité, de composés thérapeutiques