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

Uno : revista de didáctica de las matemáticas

Resumen basado en el de la publicaciónTítulo, resumen y palabras clave disponibles en español y en inglésLa enseñanza de la geometría es un aspecto que en los dos primeros ciclos de primaria se imparte de forma muy superficial y poco significativa, dejando al margen el desarrollo de la capacidad espacial. Sin embargo, relacionar la geometría del entorno cotidiano con las matemáticas ofrece una motivación intrínseca de cara al aprendizaje de esta área. Por ello, se presenta una serie de actividades que tienen como nexo de unión la elaboración de un cuento que incorpora en su desarrollo la descripción de un monumento emblemático como es la Alhambra de Granada. La futura visita al propio recinto confirmará que la simetría es parte de nuestra cultura y que la creación artística necesita de las matemáticas, y de ahí su gran importancia en la vida cotidiana. Esta experiencia se ha llevado a la práctica resultando muy satisfactoria tanto para el alumnado como para el profesorado.Biblioteca de Educación del Ministerio de Educación y Formación Profesional; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]