Evaluación epidemiológica de tecnologías de salud

Con este documento se pretende introducir al lector en la evaluación epidemiológica de tecnologías sanitarias. Tras un primer capítulo de conceptos básicos y definiciones de términos fundamentales en evaluación de tecnologías, se revisarán las técnicas de evaluación a partir de la evidencia relevante disponible, por medio de su análisis crítico y síntesis. Este constituye el primer paso, y a veces el único, en toda evaluación y debe ser realizado de forma sistemática y rigurosa. Posteriormente se hará un breve repaso a los principales tipos de estudios epidemiológicos, tanto experimentales como observacionales, y se tratará como tema aparte, por sus características diferenciales, la evaluación de pruebas diagnósticas, haciendo especial énfasis en los conceptos de sensibilidad, especificidad y valores predictivos. Por último, se revisarán los principales conceptos de evaluación económica, un tema clave de la evaluación de tecnologías sanitarias.Agradecimientos, Índice de tablas, Índice de figuras, Introducción Conceptos básicos. Definiciones, ¿Qué entendemos por tecnologías sanitarias?, Epidemiología, Eficacia, efectividad, eficiencia. Seguridad, ¿Qué, cuándo y cómo debe ser evaluado?, Evaluación a partir de la evidencia disponible, Especificación del propósito de la evaluación, Especificación de los criterios de inclusión/exclusión de los estudios, Técnicas de búsqueda bibliográfica, Interpretación e integración de la evidencia, Revisiones narrativas de la literatura Elección de un sólo estudio, Sistema de votación, Meta análisis Juicios de expertos, Formulación de recomendaciones basadas en la calidad de la evidencia, Generación de datos nuevos, El papel de los estudios experimentales, Ensayo Clínico Aleatorio, El papel de los estudios observacionales, Estudios de cohortes, Estudios de casos y controles, Evaluación de pruebas diagnósticas, Evaluación económica Discusión, Bibliografía, Anex

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

Teleost IgD + IgM - B cells mount clonally expanded and mildly mutated intestinal IgD responses in the absence of lymphoid follicles

Immunoglobulin D (IgD) is an ancient antibody with dual membrane-bound and fluid-phase antigen receptor functions. The biology of secreted IgD remains elusive. Here, we demonstrate that teleost IgD+IgM- plasmablasts constitute a major lymphocyte population in some mucosal surfaces, including the gut mucosa. Remarkably, secreted IgD binds to gut commensal bacteria, which in turn stimulate IgD gene transcription in gut B cells. Accordingly, secreted IgD from gut as well as gill mucosae, but not the spleen, show a V(D)J gene configuration consistent with microbiota-driven clonal expansion and diversification, including mild somatic hypermutation. By showing that secreted IgD establishes a mutualistic relationship with commensals, our findings suggest that secreted IgD may play an evolutionary conserved role in mucosal homeostasis.Lucia González and Beatriz Abós are greatly acknowledged for technical assistance. This work was supported by the European Research Council (ERC Consolidator Grant 725061), the Spanish Ministry of Science, Innovation, and Universities (project AGL2017-85494-C2-1-R), and the Comunidad de Madrid (grant 2016-T1/BIO-1672)

Teleost IgD+IgM− B cells mount clonally expanded and mildly mutated intestinal IgD responses in the absence of lymphoid follicles

Acknowledgments Lucia González and Beatriz Abós are greatly acknowledged for technical assistance. This work was supported by the European Research Council (ERC Consolidator Grant 725061), the Spanish Ministry of Science, Innovation, and Universities (project AGL2017-85494-C2-1-R), and the Comunidad de Madrid (grant 2016-T1/BIO-1672).Immunoglobulin D (IgD) is an ancient antibody with dual membrane-bound and fluid-phase antigen receptor functions. The biology of secreted IgD remains elusive. Here, we demonstrate that teleost IgD+IgM− plasmablasts constitute a major lymphocyte population in some mucosal surfaces, including the gut mucosa. Remarkably, secreted IgD binds to gut commensal bacteria, which in turn stimulate IgD gene transcription in gut B cells. Accordingly, secreted IgD from gut as well as gill mucosae, but not the spleen, show a V(D)J gene configuration consistent with microbiota-driven clonal expansion and diversification, including mild somatic hypermutation. By showing that secreted IgD establishes a mutualistic relationship with commensals, our findings suggest that secreted IgD may play an evolutionary conserved role in mucosal homeostasis.Depto. de Genética, Fisiología y MicrobiologíaFac. de Ciencias BiológicasTRUEpu