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

Nuestro concepto de prótesis parcial de oído

At the end of the 50´s Dr. Austin used for the first time a polythene crosspiece (support) to substitute a damaged ossicular chain and later Dr. Seehy coined with the words TORP and PORP where the chain was replaced by a prosthesis either totally or partially. Since then, different materials and systems have been used to perform those prosthesis, as the results weren´t so satisfactory as it was expected. In our surgical experience for years, we have found the same unsatisfactory results and for that reason we have designed a new system of prosthesis to reconstruct partially the chain with satisfactory results.A finales de la década de los 50 el Dr. Austin utilizó, por primera vez, un �puntal� de polietileno como sustituto de la cadena osicular dañada y, posteriormente, el Dr. Seehy acuñó los términos TORP y PORP para nombrar las prótesis totales o parciales de la cadena. Desde entonces se han utilizado distintos materiales y modelos para realizar las prótesis dado que los resultados no eran lo satifactorios que se desaban. En nuestra experiencia quirúrgica a lo largo de los años nos hemos tropezado con los mismos resultados insatisfactorios, lo que nos llevó a diseñar un nuevo modelo de prótesis para la reconstrucción parcial de la cadena con unos resultados alentadores