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

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Contradicciones : un estudio de la construcción de la identidad femenina en Shugo Chara! de PEACH-PIT

El shōjo manga Shugo Chara!, de PEACH-PIT, nos presenta una protagonista que puede proyectar sus deseos de futuro en cuatro proyecciones de su propia identidad, llamadas shugo chara. Esta obra, como parte de un género de cómic japonés destinado a chicas de 9 a 13 años y de un subgénero que trabaja la consecución de poderes mágicos, representa la formación de la identidad de la protagonista como joven. Sus múltiples transformaciones, tanto mágicas como naturales, cuestionan la dualidad del género y la naturalidad de sus conceptualizaciones y categorizaciones, insistiendo en las múltiples posibilidades inherentes a la adolescencia. Al mismo tiempo, pero, es una obra definitivamente conservadora que insiste en la posición liminar de la adolescencia y la su temporalidad, reforzando la idea social de la mujer adulta como esposa y madreEl shōjo manga Shugo Chara!, de PEACH-PIT, ens presenta una protagonista que pot projectar els seus desitjos de futur en quatre projeccions de la seva pròpia identitat anomenades shugo chara. Aquesta obra, com a part d'un gènere de còmic japonès destinat a noies de 9 a 13 anys i un subgènere que treballa la consecució de poders màgics, representa la formació de la identitat de la protagonista com a jove. Les seves múltiples transformacions, tant màgiques com naturals, qüestionen la dualitat del gènere i la naturalitat de les seves conceptualitzacions i categoritzacions, insistint en les múltiples possibilitats inherents a l'adolescència. Al mateix temps, però, és una obra definitivament conservadora que insisteix en la posició liminar de l'adolescència i la seva temporalitat, reforçant en última instància la idea social de la dona adulta com a esposa i marePEACH-PIT's shōjo manga Shugo Chara! shows a main character who can project her future wishes upon four of her identity projections called shugo chara. This work is part of a Japanese comic genre aimed for girls between 9 and 13 years old and of a subgenre about magical powers. It talks about the main character's identity formation as a girl. Therefore, her multiple transformations, both magical and natural, question the duality of gender and the natural quality of its conceptions and categorizations, focusing on the multiple possibilities inherent on being a teenager. However, it ultimately is a definitely conservative work that insists on the liminal position of the girl and her temporality, strengthening the social idea of the woman as wife and mothe

Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study

Liver cirrhosis is a major cause of death worldwide. Cirrhosis develops after a long asymptomatic period of fibrosis progression, with the diagnosis frequently occurring late, when major complications or cancer develop. Few reliable tools exist for timely identification of individuals at risk of cirrhosis to allow for early intervention. We aimed to develop a novel score to identify individuals at risk for future liver-related outcomes. We derived the LiverRisk score from an international prospective cohort of individuals from six countries without known liver disease from the general population, who underwent liver fibrosis assessment by transient elastography. The score included age, sex, and six standard laboratory variables. We created four groups: minimal risk, low risk, medium risk, and high risk according to selected cutoff values of the LiverRisk score (6, 10, and 15). The model's discriminatory accuracy and calibration were externally validated in two prospective cohorts from the general population. Moreover, we ascertained the prognostic value of the score in the prediction of liver-related outcomes in participants without known liver disease with median follow-up of 12 years (UK Biobank cohort). We included 14 726 participants: 6357 (43·2%) in the derivation cohort, 4370 (29·7%) in the first external validation cohort, and 3999 (27·2%) in the second external validation cohort. The score accurately predicted liver stiffness in the development and external validation cohorts, and was superior to conventional serum biomarkers of fibrosis, as measured by area under the receiver-operating characteristics curve (AUC; 0·83 [95% CI [0·78-0·89]) versus the fibrosis-4 index (FIB-4; 0·68 [0·61-0·75] at 10 kPa). The score was effective in identifying individuals at risk of liver-related mortality, liver-related hospitalisation, and liver cancer, thereby allowing stratification to different risk groups for liver-related outcomes. The hazard ratio for liver-related mortality in the high-risk group was 471 (95% CI 347-641) compared with the minimal risk group, and the overall AUC of the score in predicting 10-year liver-related mortality was 0·90 (0·88-0·91) versus 0.84 (0·82-0·86) for FIB-4. The LiverRisk score, based on simple parameters, predicted liver fibrosis and future development of liver-related outcomes in the general population. The score might allow for stratification of individuals according to liver risk and thus guide preventive care. None. [Abstract copyright: Copyright © 2023 Elsevier Ltd. All rights reserved.