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

Human mesenchymal stem cells efficiently manage oxidative stress

The transplantation of mesenchymal stem cells (MSCs) proves to be useful to treat pathologies in which tissue damage is linked to oxidative stress (OS). The aim of our work was to evaluate whether primary human MSCs (hMSCs) can manage OS. For this, in vitro we assessed the following parameters: (1) cell viability of hMSCs exposed to increasing concentrations of reactive oxygen species (ROS; source: hydrogen peroxide), reactive nitrogen species (RNS; source: S-nitroso-N-acetylpenicillamine), or both (ROS and RNS; source: 3-morpholinosydnonimine hydrochloride); (2) intracellular level of reactive species in hMSCs exposed to ROS and RNS; (3) basal gene expression and activity of superoxide dismutases, catalase, and glutathione peroxidase of hMSCs; (4) basal level of total glutathione (GSx) of hMSCs; and (5) cell viability of GSx-depleted hMSCs exposed to ROS and=or RNS. Results showed that hMSCs have a high resistance to OS-induced death, which correlates with low levels of intracellular reactive species, constitutive expression of enzymes required to manage OS, and high levels of GSx. When hMSCs were depleted of GSx they lose their capacity to manage OS. Thus, in vitro hMSCs were able to scavenge ROS and RNS and efficiently manage OS. If this potential is maintained in vivo, hMSCs could also contribute to tissue regeneration, limiting OS-induced tissue damage

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women

Optimisation et application des améliorations dans l'évaluation des compétences transversales conçues à partir de la vision multidisciplinaire d'ApreRED

The specific competences are acquired by the students and certified by passing the different subjects of the study plans. However, soft skills are not systematically worked on and are not evaluated, which means that their acquisition cannot be guaranteed. However, these skills are a fundamental basis in higher education and in the future employment of university graduates. The current methodological paradigm of Higher Education shows the importance of authentic and alternative evaluation of learning, based on relevant activities or execution tasks. AprenRED's work in recent years has focused on the field of soft skills. In this case, the objective of this study is to optimize and improve the strategies and instruments for evaluating soft skills, based on the results obtained in recent years, from our multidisciplinary perspective.Las competencias específicas son adquiridas por los estudiantes y certificadas mediante la superación de las diferentes materias de los planes de estudio. Sin embargo, las competencias transversales no se trabajan sistemáticamente y no se evalúan, lo que implica que no pueda garantizarse su adquisición. Sin embargo, dichas competencias son base fundamental en la formación superior y en la futura inserción laboral de los graduados universitarios. El actual paradigma metodológico de la Educación Superior muestra la importancia de la evaluación auténtica y alternativa de los aprendizajes, a partir de actividades o tareas de ejecución relevantes. El trabajo de AprenRED durante los últimos años se ha centrado en el campo de las competencias transversales. En este caso, el objetivo de este trabajo es optimizar y mejorar las estrategias e instrumentos de evaluación de las competencias transversales, en base a los resultados obtenidos en los últimos años, desde nuestra visión multidisciplinar.Des compétences spécifiques sont acquises par les étudiants et certifiées par la réussite des différentes matières des plans d'études. Cependant, les compétences transversales ne sont pas systématiquement travaillées et ne sont pas évaluées, ce qui ne permet pas de garantir leur acquisition. Or, ces compétences constituent une base fondamentale dans l'enseignement supérieur et dans l'emploi futur des diplômés universitaires. Le paradigme méthodologique actuel de l'enseignement supérieur montre l'importance d'une évaluation authentique et alternative des apprentissages, basée sur des activités ou des tâches d'exécution pertinentes. Le travail d'ApreRED ces dernières années s'est concentré sur le domaine des compétences transversales. Dans ce cas, l'objectif de ce travail est d'optimiser et d'améliorer les stratégies et les instruments d'évaluation des compétences transversales, sur la base des résultats obtenus ces dernières années, à partir de notre vision multidisciplinaire

Optimización y aplicación de rúbricas en la evaluación de competencias transversales, diseñadas desde la visión multidisciplinar de aprenred

Las competencias específicas son adquiridas por los estudiantes y certificadas mediante la superación de las diferentes materias de los planes de estudio. Con todo, las competencias transversales no se trabajan sistemáticamente y no se evalúan, lo que implica que no pueda garantizarse su adquisición. Sin embargo, dichas competencias son base fundamental en la formación superior y en la futura inserción laboral de los graduados universitarios. El actual paradigma metodológico de la educación superior muestra la importancia de la evaluación auténtica y alternativa de los aprendizajes, a partir de actividades o tareas de ejecución relevantes. El objetivo de este trabajo es optimizar y mejorar las rúbricas de evaluación para las competencias transversales, empleadas a través de los Formularios de Google, basándose en los resultados obtenidos en los últimos años. Las rubricas diseñadas desde nuestra visión multidisciplinar, tanto para los profesores como para los alumnos, se emplearon en 16 asignaturas diferentes, incluyendo una de máster, en 11 grados distintos, obteniendo 648 formularios por parte de los alumnos. Una de las 2 REIIT, 2022, 1,162-174 conclusiones de este trabajo es que las evaluaciones realizadas por el alumnado durante el curso 2020/21 fueron en general más positivas que las del curso 2019/20