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

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 11

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 11, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR), Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTAG), Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kleber Ramírez (UPTM), Mérida – Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (C.A.B.B.O.P.P), Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE), Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia - Venezuela, Centro de Investigaciones Internacionales SAS (CIN), Antioquia - Colombia.y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Capítulo 3. La política criminal en Estados Unidos y prácticas político-criminales similares en Colombia

Describir la política criminal de un país, desde su concepción amplia, supone analizar variables que no se limitan a la información suministrada por el sistema penal. Sin embargo, no es menos importante analizar las conductas que efectivamente se persiguen con la fuerza punitiva del Estado. El objetivo de esta investigación es analizar la incoherencia entre el discurso y la práctica de la política criminal colombiana, desde la posible réplica de las decisiones político-criminales de un país como Estados Unidos y su intromisión efectiva en las libertades sociales e individuales de los ciudadanos.La metodología de análisis consiste, a partir de variables comparables y desde la criminalización terciaria, en estudiar el panorama general de la política criminal en Estados Unidos, con el fin de evaluar la posible incidencia de sus prácticas en la realidad colombiana. También se analiza la influencia de las prácticas o movimientos minoritarios de justicia restaurativa que se vienen adelantando en Estados Unidos. A partir de un método cualitativo, se pretende comprender la política criminal macro estadounidense, y lo que se denomina en el documento la política criminal disidente de esta política criminal mayoritaria. Para efectos de lo anterior, las preguntas de investigación giran en torno a ¿quiénes están en la cárcel?, ¿por qué delitos?, ¿cuáles son los límites de afectación de derechos y con qué objeto?Las anteriores variables nos ayudan a tener un acercamiento desde la criminalización terciaria al panorama general de la política criminal. Sin embargo, para obtener el panorama completo desde la criminalización terciaria, es importante incluir también los movimientos minoritarios, los proyectos disidentes de esa política criminal general, y sobre todo, la injerencia que esta política criminal alterna tiene en los territorios, más aún en un sistema federado como lo es Estados Unidos. Si bien las variables de análisis en su mayoría refieren a la situación carcelaria, no se delimita el objeto de estudio a la política penitenciaria, dado que el enfoque no es analizar el sistema penitenciario, sino las causas de algunas variables que lo determinan.Esta investigación plantea que, si bien en Estados Unidos existe una respuesta a la criminalidad desde un enfoque retribucionista de persecución y represión penal, existe una contracorriente con un discurso político criminal disidente que desde lo micro también incide en los resultados locales. Lo que sugiere esta investigación, sin el ánimo de ser exhaustiva, es la posible réplica en Colombia de prácticas retributivas en las decisiones político-criminales, y por tanto un choque con el discurso a la luz de los postulados constitucionales. Lo anterior es importante con el fin de entender el origen de los problemas en nuestro sistema penitenciario, dado que sin una comprensión ontológica de sus antecedentes y elementos que lo componen, no es posible plantear soluciones a sus problemas estructurales.Describing the criminal policy of a country, from its broad conception, involves analyzing variables that are not limited to the information provided by the criminal system. Nevertheless, is not minor to analyze which behaviors are being prosecuted by the State. The purpose of this work is to analyze the incoherence between de practice and the discourse of the Colombian’s criminal policy, from the view of the United States criminal decisions.The methodology of this work consists in studying the general frame of the criminal policy in the United States, in order to evaluate the possible incidence of its practices in the Colombian reality. All above from comparable data. The influence of minority practices or movements of restorative justice that are being executed in some states of the United States are also analyzed. From a qualitative method, we aim to understand the criminal policy of the United States, and how is called in this document, the dissident criminal policy. For this purpose, the guiding research questions are: Who is in jail? By which crimes? What are the limits of the State to affect rights and for what purpose?The above variables help us to have an approach from the general frame of criminal policy. However, to obtain the complete picture, it is important to include also the minority movements, the dissident projects of that general criminal policy, and above all, the interference that this alternative criminal policy has in the territories, even more, in a federated system as it is in the United States. Although the mostly analysis data refers to the prison situation, the purpose of this work is not limited to penitentiary policy, instead, the purpose is to analyze the causes of his stato quo.This research suggests that although there is a response to crime from a retribution perspective, there is a dissenting criminal political answer that also affects the local results from the micro level. What this research suggests, without the intention of being exhaustive, is the possible replication in Colombia of retributive practices in political-criminal decisions, and therefore, incoherence between practice and discourse in the light of constitutional postulates. The foregoing is important in order to understand the origin of the problems in our prison system, given that without an ontological understanding of its antecedents and elements that compose it, it is not possible to propose solutions of structuralproblems

Ser mujer en prisión: el estereotipo de los afectos como pena en la prisión de mujeres

Este trabajo se propone poner en discusión el papel que tienen las relaciones afectivas en la vida de las mujeres en prisión. A partir de un recorrido histórico sobre la identidad femenina y la injerencia de este estereotipo en la pena privativa de la libertad, se propone revisar el papel que juegan las relaciones afectivas en este contexto. El objetivo es identificar las necesidades de la mujer en prisión, especialmente sus vínculos afectivos, para orientar las decisiones de política pública y no fomentar, a partir de una presunta resistencia al régimen penitenciario, estereotipos que, por el contrario, podrían solapar la servidumbre consentida. ¿Son las relaciones afectivas, para las mujeres en prisión, una forma de resistencia o de dominación? Para responder a estar pregunta la metodología utilizada fue el análisis discursivo a partir de la revisión de literatura etnográfica, sociológica, psicológica y antropológica sobre el feminismo y la mujer en prisión.This work aims to put into discussion the function that relationships have in life of women´s in prison. From a historical point of view about female identity and how it interferes in the prison punishment, this work looks forward making affective relationships in prison an important issue. Once affective needs of women in prison are identified, public policy could make decisions that do not promote stereotypes, confusing them by a supposedly resistance but that probably cover up a tolerate servitude. Are affective relationships, for women in prison, a form of resistance or domination? The methodological approach taken is the ethnography sociological, psychological and anthropology literature review. It is expected to extend the content of this research to an ethnographic study that will allow us to review the definitions and importance that women in prison give to affective relationships

Capítulo V. La innecesaria reinserción social en el paradigma social de la modernidad

El propósito de este trabajo ha sido realizar un recorrido histórico por los significados sociales e individuales de los antecedentes del castigo penal en la sociedad corporativa del mundo medieval, y del fin de la reinserción social. Más allá de la estructura de poder que define los contenidos normativos, me propuse comprender, desde la literatura y antropología histórica, el contenido significativo del concepto de libertad, sufrimiento infligido y reinserción en la sociedad corporativa del mundo medieval. Este estudio me permitió intuir un posible error estructural del fin de la reinserción social en el castigo propuesto por la modernidad ilustrada. Confío en que al comprender los valores subyacentes del imaginario colectivo, sea posible la consciente incorporación de valores que se contrapongan a los actuales, donde el sufrimiento resulta como una única forma de respuesta a la criminalidad.The purpose of this work was to describe some social and individual meanings of criminal punishment and social reintegration for the corporate society of the western model. I aimed to look further to the definition and normative contents about punishment, suffering and social reintegration to understand the meaning these concepts had for corporate communities. The intuition is that social reintegration of the enlightened has a structural error in the type of society on which it is supposed to work. Once this error is recognized, it would be the first step to incorporate new values that allow communities to imagine new ways of responding to criminality rather than sufferin

Genetic studies in the recently divergent Eligmodontia puerulus and E. moreni (Rodentia, Cricetidae, Sigmodontinae) from Puna and Monte deserts of South America

Eligmodontia is a genus of phyllotine rodents adapted to arid environments with seven recognized species. The sister species E. puerulus and E. moreni are distributed in the adjacent highland Puna and lowland Monte deserts respectively, and show remarkable morphological and chromosomal differences. However, analyses of the cytochrome b gene showed important variability, without reciprocal monophyly between them. In order to study the evolutionary processes involved in the diversification of both taxa, we analyzed 1161 bp of the mitochondrial control region and flanking sequences (N = 60), as well as 759 bp of the first exon of the nuclear gene IRBP (N = 14). Individuals of both species from Jujuy, Catamarca and Mendoza Provinces of Argentina were previously karyotyped. Results showed that the mitochondrial sequences present high haplotype and nucleotide diversity within all population, and no haplotype was shared between both species. FST indicated that populations of both species were moderately structured. The network was constituted by two major haplogroups, one composed by E. puerulus samples from Jujuy, and the other composed of sequences of all studied populations. The Bayesian analysis showed three clusters, matching the network. Phylogenetic analysis recovered two clades with high support, in coincidence with the network groups. There was only one close join between sequences of both species, corresponding to samples from Catamarca. Thus, mitochondrial data suggested hybridization between both species in Catamarca, with asymmetric introgression. The IRBP showed low variability and, in the phylogenetic analysis, the sequences of E. puerulus form a monophyletic group with intermediate support, whereas those of E. moreni collapse into a basal polytomy. Our data indicated a recent divergence and absence of introgression in the nuclear genomes. The results at the population level with mitochondrial sequences, together with integrative taxonomy at the species level in a biogeographic context, suggest that climatic and geologic changes could have had an important role in the determination of genetic variability patterns observed in these rodents.Fil: Armella Sierra, Alicia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas; ArgentinaFil: Castillo, Elio Rodrigo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas; ArgentinaFil: Labaroni, Carolina Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas; ArgentinaFil: Barrandeguy, Maria Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas; ArgentinaFil: Marti, Dardo Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas; ArgentinaFil: Ojeda, Ricardo Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Investigaciones de las Zonas Áridas. Provincia de Mendoza. Instituto Argentino de Investigaciones de las Zonas Áridas. Universidad Nacional de Cuyo. Instituto Argentino de Investigaciones de las Zonas Áridas; ArgentinaFil: Lanzone, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Posadas; Argentin