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

Relationship of psychological and behavioral factors in patients with temporomandibular disorders and patients with migraine

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Odontología, Departamento de Odontología Conservadora y Prótesis Bucofacial, leída el 8/11/2019Los trastornos temporomandibulares (TTM) se refieren a un grupo de patologías que incluyen dolor en la articulación temporomandibular (ATM), área preauricular, músculos masticatorios, ruidos articulares y desviación o restricción en el rango de movimiento mandibular; abundantes pruebas han identificado numerosos factores biopsicosociales que aumentan el riesgo de aparición y persistencia de TTM. La migraña se define como un dolor de cabeza primario con ataques que duran de 4 a 72 horas y se caracteriza por un dolor pulsátil unilateral de intensidad moderada a severa agravada por la actividad física de rutina y asociada con náuseas, fotofobia y / o fonofobia. Ambas patologías, presenta una comorbilidad de alrededor del 70%, son deshabilitantes y afectan a todas las áreas de la vida, incluido el funcionamiento social y ocupacional. Tanto en migraña como en TTM juegan un papel muy importante los factores psicológicos, que ha sido ampliamente descritos en la literatura, tales como ansiedad, depresión, somatización e incluso algunos rasgos de personalidad. Por tanto, es muy relevante en el diagnóstico el eje II o biopsicosocial del individuo para su estudio y como parte de la enfermedad. Al evaluar todos los factores que contribuyen a la enfermedad, en lugar de dar primacía a los factores biológicos por sí solos, un modelo biopsicosocial permitiría explicar por qué algunos individuos experimentan como condiciones de "enfermedad" lo que otros consideran simplemente como "problemas de la vida". Aunque existen numerosos estudios sobre cómo afectan los factores psicológicos a las migrañas y al TTM, hay pocos precedentes que estudien ambas patologías de forma conjunta, a pesar de su comorbilidad. Además, aunque si se describe, no se suele tener en cuenta y se controla la presencia de migraña en los estudios sobre TTM, y la presencia de TTM en los estudios sobre migraña. Objetivo: Describir los factores psicológicos y comportamentales implicados en pacientes que padecen migrañas; en pacientes con TTM dolorosos musculares, pacientes con la combinación de ambas patologías, así como en la población control del estudio...Temporomandibular disorders (TMD) refer to a group of pathologies that include pain in the temporomandibular joint (TMJ), preauricular area, masticatory muscles, joint noises and deviation or restriction in the range of mandibular movement; Abundant tests have identified numerous biopsychosocial factors that increase the risk of onset and persistence of TMD. Migraine is defined as a primary headache with attacks that last from 4 to 72 hours and is characterized by a unilateral pulsating pain of moderate to severe intensity aggravated by routine physical activity and associated with nausea, photophobia and/or phonophobia. Both pathologies present a comorbidity of around 70%, are disabling and affect all areas of life, including social and occupational functioning. In both migraine and TTM, psychological factors play a very important role, which has been widely described in the literature, such as anxiety, depression, somatization and even some personality traits. Therefore, the axis II or biopsychosocial axis of the individual is very relevant in the diagnosis for its study and as part of the disease. By evaluating all the factors that contribute to the disease, instead of giving primacy to the biological factors alone, a biopsychosocial model would explain why some individuals experience as "disease" conditions what others simply consider "health problems". lifetime". Although there are numerous studies on how psychological factors affect migraines and TTM, there are few precedents that study both pathologies together, despite their comorbidity. In addition, although it is described, it is not usually taken into account and the presence of migraine is controlled in the studies on TMD, and the presence of TMD in studies on migraine. Objective: Describe the psychological and behavioral factors involved in patients suffering from migraines; in patients with painful muscular TMD, patients with the combination of both pathologies, as well as in the control population of the study...Depto. de Odontología Conservadora y PrótesisFac. de OdontologíaTRUEunpu

Psychological and Behavioral Factors Involved in Temporomandibular Myalgia and Migraine: Common but Differentiated Profiles

Background: Many studies have revealed high comorbidity and a clear association between temporomandibular disorders (TMD) and migraine. Furthermore, evidence points out that common psychological and behavioral factors might be related to the observed TMD and migraine association. However, this association and the underlying psychological factors are poorly understood. Objective: The main goal of this study was to describe the psychological and behavioral factors involved in TMD myalgia and migraine. Methods: A sample of 142 participants were recruited to form 4 groups: migraine patients (ICHD-III criteria), painful-TMD patients (Myalgia DC/TMD criteria), patients suffering from both pathologies according to the same criteria, and control patients. After a dental and neurological examination, the patients filled several psychological questionnaires validated for the Spanish population to assess anxiety (STAI), depression (DEP), stress coping (CRI), and somatic, anxiety, and depression symptoms (BSI-18). Results: The TMD myalgia patients, in general, showed a state of elevated anxiety, somatization, and reduced coping strategies, while the patients with migraine presented greater anxiety symptoms, depression (dysthymia trait and state), and somatization. Conclusions: According to the data of the present study, situational anxiety (transient emotional state), together with the lack of coping strategies, could be more associated with TMD myalgia, while anxiety, as a more stable and long-lasting emotional state, together with depression, might be more related to migraine. Further longitudinal studies are needed to unravel whether these differentiated profiles are a consequence or possible risk factors for migraine and TMD