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

Design and implementation of support and planning for 360º recording. Recording techniques (video and audio) and problem solving: application to the recording of institutional and popular science videos. Part III

Proyecto de Innovación Docente que se ha traducido en empleabiliad de alguno de los alumnos participantesLa grabación 360º está introduciendo variaciones sustanciales en la forma de narrar y producir contenidos audiovisuales. La posibilidad de sumergir al espectador en un entorno totalmente inmersivo en el que cada punto de vista de atención es seleccionado por el propio espectador, implica un cambio de paradigma en el papel que ejerce el director o realizador como creador y narrador de los acontecimientos. Pero, en todo lo relacionado con la producción audiovisual, el dominio de la tecnología es fundamental para llegar a la excelencia. Resulta fundamental profundizar e investigar en todas las posibilidades técnicas antes de aplicarlo al mundo profesional. Llevamos trabajando desde el curso 2018-2019 en diseñar un protocolo que permita planificar creaciones de grabación 360º tanto en lo relacionado con el vídeo como con el audio. En el curso anterior, establecimos un protocolo y empezamos a colaborar con el proyecto nº 262 Innova-Docencia, “liderado por la profesora Dña. Teresa García Nieto, en el proyecto ‘Científic@s en prácticas’ mediante un convenio con el CSIC. El objetivo es crear producciones audiovisuales en 360º que divulguen la labor desarrollada en el organismo, integrando a los alumnos del Grado de Comunicación Audiovisual, con el objetivo de que aprendan esta técnica de grabación e implementen nuevas fórmulas narrativas asociadas a la misma. El proyecto ‘Científic@s en prácticas’ consiste en tratar de captar científicos entre alumnos preuniversitarios, por lo que creemos que la producción audiovisual puede servir de estímulo para que estos alumnos de la ESO puedan comprender la naturaleza de los objetivos del proyecto en el que participan. El proyecto resulta innovador por dos motivos principales: a) el alumnado aprende directamente sobre un proyecto real la aplicación de nuevas tecnologías de producción audiovisual y b) aprenden a elaborar protocolos mediante el aprendizaje de metodologías de investigación derivadas de aplicaciones y estudios sobre el proceso. Además, dada la novedad de esta tecnología 360º, ninguna asignatura del Grado de Comunicación Audiovisual aborda esta materia entre sus contenidos.360º filming is introducing substantial variations in the way audiovisual content is narrated and produced. The possibility of immersing the viewer in a totally immersive environment in which each point of view is selected by the viewer, implies a paradigm shift in the role of the director or producer as the creator and narrator of events. But, in everything related to audiovisual production, the mastery of technology is fundamental in order to achieve excellence. It is essential to delve into and investigate all the technical possibilities before applying it to the professional world. Since the 2018-2019 academic year, we have been working on designing a protocol that allows us to plan 360º recording creations both in terms of video and audio. In the previous academic year, we established a protocol and began to collaborate with project no. 262 Innova-Docencia, "led by the teacher Ms. Teresa García Nieto, in the project 'Científic@s en prácticas' through an agreement with the CSIC. The aim is to create 360º audiovisual productions that disseminate the work carried out in the organisation, integrating the students of the Audiovisual Communication Degree, with the objective that they learn this recording technique and implement new narrative formulas associated with it. The 'Scientists in practice' project consists of trying to recruit scientists among pre-university students, so we believe that audiovisual production can serve as a stimulus for these ESO students to understand the nature of the objectives of the project in which they are participating. The project is innovative for two main reasons: a) the students learn directly on a real project the application of new audiovisual production technologies and b) they learn to develop protocols by learning research methodologies derived from applications and studies on the process. Moreover, given the novelty of this 360º technology, no other subject in the Audiovisual Communication Degree includes this subject among its contents.Depto. de Ciencias de la Comunicación AplicadaFac. de Bellas ArtesFac. de Ciencias de la InformaciónFALSEsubmitte

A snapshot of antimicrobial resistance in Mexico. Results from 47 centers from 20 states during a six-month period.

AIM:We aimed to assess the resistance rates of antimicrobial-resistant, in bacterial pathogens of epidemiological importance in 47 Mexican centers. MATERIAL AND METHODS:In this retrospective study, we included a stratified sample of 47 centers, covering 20 Mexican states. Selected isolates considered as potential causatives of disease collected over a 6-month period were included. Laboratories employed their usual methods to perform microbiological studies. The results were deposited into a database and analyzed with the WHONET 5.6 software. RESULTS:In this 6-month study, a total of 22,943 strains were included. Regarding Gram-negatives, carbapenem resistance was detected in ≤ 3% in Escherichia coli, 12.5% in Klebsiella sp. and Enterobacter sp., and up to 40% in Pseudomonas aeruginosa; in the latter, the resistance rate for piperacillin-tazobactam (TZP) was as high as 19.1%. In Acinetobacter sp., resistance rates for cefepime, ciprofloxacin, meropenem, and TZP were higher than 50%. Regarding Gram-positives, methicillin resistance in Staphylococcus aureus (MRSA) was as high as 21.4%, and vancomycin (VAN) resistance reached up to 21% in Enterococcus faecium. Acinetobacter sp. presented the highest multidrug resistance (53%) followed by Klebsiella sp. (22.6%) and E. coli (19.4%). CONCLUSION:The multidrug resistance of Acinetobacter sp., Klebsiella sp. and E. coli and the carbapenem resistance in specific groups of enterobacteria deserve special attention in Mexico. Vancomycin-resistant enterococci (VRE) and MRSA are common in our hospitals. Our results present valuable information for the implementation of measures to control drug resistance