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

Alcance y limitaciones de la justicia internacional

El presente libro hace parte de los trabajos del grupo de justicia internacional de la Red Multidisciplinar de Investigación “Perspectiva Epistemológica Ibero-Americana sobre la Justicia” Volumen 4, coordinada desde el Instituto Ibero-Americano de la Haya para la Paz, los Derechos Humanos y la Justicia Internacional. Así mismo, se inscribe dentro de los siguientes proyectos de investigación: (i) “Principios de armonización entre la función y alcance de la Justicia Internacional y las demandas surgidas en los procesos políticos de transición”, financiado por el Fondo de Investigación de la Universidad del Rosario, Bogotá, Colombia —FIUR—; y (ii) “La función de los órganos judiciales y arbitrales internacionales en la ejecución de un eventual acuerdo de paz en Colombia fruto de la renegociación resultante del Referéndum del 2 de octubre de 2016”, financiado por la Facultad de Jurisprudencia de la Universidad del Rosario. Ambos proyectos se encuentran adscritos a la línea de investigación “Crítica al Derecho Internacional desde Fundamentos Filosóficos”, del Grupo de Investigación de Derecho Internacional de la Facultad de Jurisprudencia de la Universidad del Rosario, Bogotá, Colombia

La función de la Corte Penal Internacional: visiones plurales desde una perspectiva interdisciplinar

El presente libro hace parte de los trabajos del grupo de justicia nacional de la “Red de Investigación Perspectivas Iberoamericanas sobre la Justicia”, coordinada desde el Instituto Ibero-Americano de la Haya para la Paz, los Derechos Humanos y la Justicia Internacional (IIH) (Países Bajos). Así mismo, se inscribe dentro de los proyectos de investigación: (a) “La función de la Corte Penal Internacional desde las teorías de la justicia en el derecho internacional” (2019-2020), cofinanciado por la Facultad de Jurisprudencia de la Universidad del Rosario (Bogotá, Colombia) y el IIH (Países Bajos); y (b) “La respuesta del derecho internacional a la corrupción asociada al crimen transnacional organizado” (2019-2021), con número de referencia VFPC009, cofinanciado por la Dirección de Investigación e Innovación y la Facultad de Jurisprudencia de la Universidad del Rosario (Bogotá, Colombia), así como por el IIH (Países Bajos). Ambos proyectos se encuentran adscritos a la línea de investigación “Crítica al derecho internacional desde fundamentos filosóficos”, del Grupo de Investigación en DI de la Facultad de Jurisprudencia de la Universidad del Rosario

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN