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

A comparison of alpha and beta diversity patterns of ferns, bryophytes and macrolichens in tropical montane forests of southern Ecuador

We present a first comparison of patterns of alpha and beta diversity of ferns, mosses, liverworts and macrolichens in neotropical montane rainforests, and explore the question whether specific taxa may be used as surrogates for others. In three localities in southern Ecuador, we surveyed terrestrial and epiphytic species assemblages in ridge and slope forests in 28 plots of 400 m² each. The epiphytic habitat was significantly richer in ferns, liverworts, and macrolichens than the terrestrial habitat; mosses, however, were primarily terrestrial. Alpha diversity of ferns and of liverworts was congruent in both habitats. Mosses were similar to ferns and liverworts only in the epiphytic habitat. Macrolichens did not share patterns of alpha diversity with any other group. Beta diversity of ferns, mosses and liverworts (lichens excluded due to low species richness) was similar in the terrestrial habitat, but not in the epiphytic habitat. Our results demonstrate that patterns of alpha diversity of the studied taxa cannot be used to predict patterns of beta diversity. Moreover, diversity patterns observed in epiphytes are different from terrestrial plants. We noted a general coincidence in species patterns of liverworts and ferns. Diversity patterns of macrolichens, in contrast, were completely independent from any other taxonomic group studied

Non-woody life-form contribution to vascular plant species richness in a tropical American forest

We provide total vascular plant species counts for three 1-ha plots in deciduous, semi-deciduous and evergreen forests in central Bolivia. Species richness ranged from 297 species and 22,360 individuals/ha in the dry deciduous forest to 382 species and 31,670 individuals/ha in the evergreen forest. Orchidaceae, Pteridophyta and Leguminosae were among the most species-rich major plant groups in each plot, and Peperomia (Piperaceae), Pleurothallis (Orchidaceae) and Tillandsia (Bromeliaceae), all epiphytes, were the most species-rich genera. This dominance of a few but very diverse and/or widespread taxa contrasted with the low compositional similarity between plots. In a neotropical context, these Central Bolivian forest plots are similar in total species richness to other dry deciduous and humid montane forests, but less rich than most Amazonian forests. Nevertheless, lianas, terrestrial herbs and especially epiphytes proved to be of equal or higher species richness than most other neotropical forest inventories from which data are available. We therefore highlight the importance of non-woody life-forms (especially epiphytes and terrestrial herbs) in Andean foothill forest ecosystems in terms of species richness and numbers of individuals, representing in some cases nearly 50% of the species and more than 75% of the individuals. These figures stress the need for an increased inventory effort on non-woody plant groups in order to accurately direct conservation actions