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

Characterizing carbapenemase-producing Escherichia coli isolates from Spain: high genetic heterogeneity and wide geographical spread

IntroductionCarbapenemase-Producing Escherichia coli (CP-Eco) isolates, though less prevalent than other CP-Enterobacterales, have the capacity to rapidly disseminate antibiotic resistance genes (ARGs) and cause serious difficult-to-treat infections. The aim of this study is phenotypically and genotypically characterizing CP-Eco isolates collected from Spain to better understand their resistance mechanisms and population structure.MethodsNinety representative isolates received from 2015 to 2020 from 25 provinces and 59 hospitals Spanish hospitals were included. Antibiotic susceptibility was determined according to EUCAST guidelines and whole-genome sequencing was performed. Antibiotic resistance and virulence-associated genes, phylogeny and population structure, and carbapenemase genes-carrying plasmids were analyzed.Results and discussionThe 90 CP-Eco isolates were highly polyclonal, where the most prevalent was ST131, detected in 14 (15.6%) of the isolates. The carbapenemase genes detected were blaOXA-48 (45.6%), blaVIM-1 (23.3%), blaNDM-1 (7.8%), blaKPC-3 (6.7%), and blaNDM-5 (6.7%). Forty (44.4%) were resistant to 6 or more antibiotic groups and the most active antibiotics were colistin (98.9%), plazomicin (92.2%) and cefiderocol (92.2%). Four of the seven cefiderocol-resistant isolates belonged to ST167 and six harbored blaNDM. Five of the plazomicin-resistant isolates harbored rmt. IncL plasmids were the most frequent (45.7%) and eight of these harbored blaVIM-1. blaOXA-48 was found in IncF plasmids in eight isolates. Metallo-β-lactamases were more frequent in isolates with resistance to six or more antibiotic groups, with their genes often present on the same plasmid/integron. ST131 isolates were associated with sat and pap virulence genes. This study highlights the genetic versatility of CP-Eco and its potential to disseminate ARGs and cause community and nosocomial infections

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Vehicle dynamic simulation and powertrain simulation of a heavy hybrid vehicle with interconnected suspensions

This thesis presents two simulations of a heavy hybrid vehicle, the first part of the thesis is focused on the specifications of the vehicle designed in accordance with the requirements based on the literature study of the soils where the vehicle will travel. The second part presents the study of the vehicle through two simulations. The first simulation is oriented on the dynamical behavior of the vehicle. The second simulation focuses on the energy management of the vehicle. The presented thesis is a multi-disciplinary study, combining knowledge on vehicle dynamics, hydraulic suspensions and hybrid systems. The dynamical simulation of the vehicle has been performed with Matlab/Simulink and the third party program Delft-Tire for the tire modelling. Specials features of Matlab have been used; SimMechanics for the modelling of the parts, links and joints of the vehicle, and SimHydraulics for the modelling of the hydraulic suspensions. The principal tests performed on the vehicle by the dynamical simulation are the tests defined by the NATO - STANAG standards as AVTP 03-170. The tests are a crossing obstacle test and different sine wave roads. The obstacle of the obstacle crossing test is an APG-10 obstacle, an 10 inch high step with vertical edges. The objective of this simulation is to verify the design of the suspension and to observe the forces created in each link of the suspension system in order to design the chassis and the suspension system. The sine wave driving tests are performed to highlight the influence of the different hydraulic connections. Finally the slalom test presents the influence of the hydraulic anti-roll bar. The results show that the vehicle suspension verifies the STANAG standard. The results show also that the forces applied at the wheel by the obstacle crossing defined in the AVTP 03- 170 are directly related to the diameter and the stiffness of the tire. The maximum forces encountered at the wheel corresponds to 2.5 G vertically and 1.5 G longitudinally. The sine wave driving and the slalom test are showing the benefits and the need for advanced hydraulic suspensions. The second simulation is the modelling of the hybrid power management of the vehicle. The simulation has been performed with the objectives to create a tool for sizing series hybrid powertrain. This simulation has also been performed with Matlab/Simulink and the Simscape Library. The tool created show that when, the vehicle is equipped with 150 kW of power generation and 300 kW of battery would be able to drive at a constant speed of 10 km/h with the terrain inputs evaluated from the literature study, but to create sufficient result the input parameters of the tools need to have a better definition

Historia del Banco de la República 1923-2015

Para contar la historia de la banca central de un país se pueden elegir varios caminos. Es posible adoptar un enfoque de carácter biográfico, siguiendo sucesivamente las trayectorias vitales y laborales de los personajes más influyentes en el desarrollo cronológico y administrativo de la entidad; otro método común es hacer un seguimiento de las normas y regulaciones internas y externas que marcaron hitos en la actividad del banco central; también es posible concentrarse en las ideas y doctrinas económicas imperantes a lo largo de la historia de la institución y analizar cómo se reflejaron en el diseño de las políticas y las actuaciones de las autoridades. En el caso de la historia del Banco de la República que ahora presentamos se ha adoptado un enfoque ecléctico, con plena conciencia de que el lector encontrará como producto final un texto heterogéneo. Hemos querido que en este trabajo participara un conjunto muy destacado de economistas e historiadores colombianos, todos con vínculos académicos, personales o profesionales con el Banco, y un rango muy amplio de experiencias, enfoques e intereses. Algunos de los escritores invitados se han ocupado, de tiempo atrás, en la historia económica con un enfoque clásico de ciencia social; otros se han centrado principalmente en los estudios teóricos y econométricos, de manera que su aproximación a esta historia es quizá más descriptiva y puntual. (Tomado del prólogo del libro

El copyright en cuestión. Diálogos sobre propiedad intelectual

Análisis desde un enfoque editorial y legal del debate sobre la propiedad intelectual y sus formas en el contexto digital. Un debate que interesa a profesores, estudiantes, editores, divulgadores, bibliotecarios y autores. En el libro se estudia los derechos de autor y las cuestiones relacionadas con la propiedad intelectual provocadas por el impacto de la tecnología en la edición, creación, docencia e investigación al tiempo que se ofrece propuestas de futuro para conciliar los puestos de vista de autores, universidades, lectores, editoriales y bibliotecas.In the book analysis and debate, from an editorial and legal approach, intellectual property and its forms in the digital environment is made. A debate that concerns teachers, students, publishers, disseminators, librarians and authors. In the book copyright issues and intellectual property caused by the impact of technology in the editing, creating, teaching and research is studied. Finally, proposals for the future are offered to reconcile the positions of view of authors, universities, readers, publishers and libraries

The role of bronchoscopy in patients with sars-cov-2 pneumonia

Altres ajuts: Sociedad Española de Neumología y Cirugía Torácica (SEPAR, PII 2020).Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. Results A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). Conclusion Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19

Investigaciones en construcción

El Instituto Unidad de Investigaciones Jurídico-Sociales Gerardo Molina, UNIJUS promueve y apoya el desarrollo e implementación de programas y proyectos de investigación que aporten al conocimiento de la realidad nacional e internacional, de las instituciones jurídicas, políticas y sociales, así como de las teorías jurídicas y políticas que contribuyan a la construcción de nuevas propuestas para la solución de las problemáticas que aquejan la sociedad. Por tal motivo, es fundamental el apoyo constante a la formación de semilleros de investigación en la Facultad de Derecho, Ciencias Políticas y Sociales de la Sede Bogotá, así como la consolidación de los semilleros ya existentes. En el año 2012, se desarrollaron las Convocatorias No. 12 y No. 13 para la selección de semilleros de Investigación en modalidad I y modalidad II. Como resultado de dicho proceso fueron seleccionadas doce propuestas de investigación integradas por un total de 32 estudiantes, quienes a su vez se encontraban vinculados a nueve grupos de investigación