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

Temas de coyuntura. Elecciones Cataluña 21-D: coyuntura de polarización

Este es un texto sobre una coyuntura aún no resuelta, que tiene explicaciones afincadas en el momento, pero cuya comprensión pasa por creencias y prejuicios que permanecían latentes por décadas y ahora se manifiestan. Dada esta circunstancia, la brevedad impedirá entrar en detalles que podrían ser importantes, lo que es necesario advertir debido a la extrema polarización en que se ha desarrollado el acontecimiento por analizar

Los alcances de un nuevo proyecto socialdemócrata. La primera legislatura de José Luis Rodríguez Zapatero

José Luis Rodríguez Zapatero llegó al gobier-no español en medio de una gran expectativa y con la aparente obligación de cumplir con com-promisos de campaña que implicaban dar a la política un importante giro. El sello que impri-mió a su primera legislatura produjo cambios profundos ya que en ella se abrieron a debate público temas que, por su carácter conflictivo, no habían sido previamente objeto de una dis-cusión a fondo, como es el caso de los estragos de la Guerra Civil. En este artículo se hace un recorrido por la historia contemporánea espa-ñola con el objeto de contextualizar el alcance y los límites de las reformas emprendidas por este presidente; a su vez, contribuye al debate sobre la democracia en España a partir de un recuento retrospectivo de los rasgos del modelo que aluden a la memoria histórica para expli-car el intento del presidente Zapatero de saldar cuentas con el pasado y de emprender, bajo el concepto de socialismo cívico, una nueva vía de gobierno fundada en la ampliación de los dere-chos y el fortalecimiento del Estado de bienestar

Radicality and moderation in the language of Europe’s extreme right

Following the resurgence of the extreme right in Europe, we have witnessed several attempts to classify these parties and group them together under a common label. These eforts have shown that there are signifcant diferences within this “family”. Some of these diferences, such as the variations in the degree of radicalisation of their discourses, have not received the attention they merit. The goal of this research is to show that these diferences in radicality indicate how individual parties adapt, through the use of language, in response to the specifc cultural contexts in which they operate. To this end, we have performed an analysis of the language employed in fve party platforms, linking the diferences to the determinants of their environments.Depto. de Ciencia Política y de la AdministraciónFac. de Ciencias Políticas y SociologíaTRUEpu

The impact of the use of games on student academic performance: gamification as a way to improve the teaching of political, legal and social issues

El juego es una herramienta básica para el aprendizaje, aunque poco utilizada en el Espacio de Educación Superior. El uso de los juegos en las aulas puede contribuir no sólo a mejorar la percepción de la docencia por parte de nuestro alumnado (lo cual a su vez podría transmitirse en una mejor percepción de los estudios de la Universidad Complutense), sino que también pueden conducir a un mayor conocimiento de los procesos dinámicos en los que vivimos hoy día facilitando que los participantes comprendan mejor su naturaleza dinámica. Cuando se simula una situación, los participantes se dan cuenta de cómo funciona el sistema político en movimiento y se preparan para enfrentarlo en la vida real. Además, las simulaciones también son divertidas, hacen que los estudiantes se involucren más en el estudio y profundicen su conocimiento al fomentar su interés. En este Proyecto de Innovación Docente profesores de distintas facultades y universidades analizamos el uso del juego en las aulas y su impacto en el rendimiento de nuestro alumnado.Universidad Complutense de MadridDepto. de Ciencia Política y de la AdministraciónFac. de Ciencias Políticas y SociologíaFALSEsubmitte

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols