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

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

Diseño de un marco semántico para la recuperación contextualizada de documentos científicos en el ámbito sanitario Design of a semantic framework for contextualized retrieval of scientific documents in the health domain

La atención médica personalizada requiere combinar información pública de diversas fuentes con información disponible sobre un paciente o grupo de pacientes. Un problema bien conocido en el ámbito de la gestión de la información es la enorme cantidad de información disponible. Además, las soluciones actuales no aprovechan las ventajas de las últimas aportaciones en el campo del procesamiento semántico. Este problema es especialmente relevante en el ámbito de la salud, ya que sus procesos clave dependen de manera determinante del acceso a información de alta calidad, completa, actualizada y relevante. Esta propuesta tiene como objetivo proporcionar soluciones novedosas para la gestión y recuperación de información en el ámbito de ciencias de la salud para hacer frente a la situación descrita. Para ello, hemos desarrollado un modelo semántico para representar perfiles de salud y caracterizar fuentes de información relevante y así poder completar un repositorio semántico con referencias de contenido y sus propiedades. Además, proponemos las herramientas necesarias para consultar esta Base de Conocimiento a partir de los perfiles semánticos de los pacientes. La solución propuesta, presentada aquí como una prueba de concepto, pretende contribuir al avance de las tecnologías aplicadas a la salud personal y la medicina basada en la evidencia. Las herramientas desarrolladas también pueden ser utilizadas con el fin de hacer uso del conocimiento existente para dar soporte a la revisión sistemática de informes, estudios y análisis relevantes según las condiciones de salud de los pacientes individuales o perfiles de los pacientes.Personalized healthcare requires recombining heterogeneous publicly available data with a patient's or group of patient's profile. A well-known problem in state-of-the-art information management is the overwhelming amount of information available. Besides, state-of-the-art solutions do not take advantage of modern semantic processing to adequately transform data into knowledge. This issue is especially relevant in the health domain, as key processes depend dramatically on the access to high quality, complete, up-to-date, and relevant content (e.g. diagnostics, risk assessment, public health interventions, etc.). This proposal aims to provide novel information management and retrieval solutions in the domain of health sciences to address the situation discussed above. More specifically, we introduce semantic reasoning to retrieve the most relevant knowledge available according to the health profile of a given person. For this, we developed a semantic model to represent health profiles of people and to characterize existing sources of relevant information in order to crawl them to populate a semantic repository with content references and properties. We outline the tools needed to query the knowledge base using the semantic profiles of individuals to get the most relevant content. The proposed solution, discussed here as a proof-of-concept, aims to contribute to the realm of personal health and evidence-based medicine technologies. The tools developed could also be used to take advantage of existing knowledge to facilitate a systematic review of reports, studies and analysis that may be relevant to the health conditions of single patients or patient profiles

Concentrations of chlorinated pollutants in adipose tissue of yellow-legged gulls (Larus michahellis) from Spain Role of gender and age

Concentrations of 7 different polychlorinated biphenyl (PCB) congeners, and eleven organochlorine pesticides (OCPs) and metabolites, including DDTs (dichlorodiphenyltrichloroethane), HCHs (hexachlorocyclohexane isomers), Endosulfan, Endosulfan sulfate, Endrin, Dieldrin and HCB (hexachlorobenzene), were determined in adipose tissue of 57 yellow-legged gulls collected from NW and N Spain. Furthermore, the possible differences due to two endogenous factors, age and gender, were determined. All the analyzed PCBs were detected in over 66% of the samples, with levels of 291.9 (PCB 180), 34.5 (PCB 118), 0.7 (PCB 28), 432.6 (PCB 153), 225.5 (PCB 138), 1.3 (PCB 101) and 0.4 (PCB 52) µg/kg of adipose tissue. With respect to the OCPs and metabolites, only 4,4'-DDE and HCB were detected in more than 50% of the samples, with means of 360.6 and 2.5 µg/kg of adipose tissue, respectively. From all the considered contaminants, only 4,4'-DDE levels presented significant differences depending on the gender, with females showing higher values than males (p < 0.01). Significant differences (p < 0.001) were also found related to age for the levels of PCBs 180, 138, 101, 28 and 153, as well as 4,4'-DDE, with adult levels being higher than those in young birds. The results of the present study constitute a baseline to better assess the environmental impacts of PCB and OCP contamination at other coastal sites for future biomonitoring studies, with particular emphasis on gender- and age-related differences