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

Acercamiento antropológico de la alimentación y salud en México Anthropological approach to nutrition and health in Mexico

En este artículo presento un panorama de la alimentación en México, particularmente sobre la ciudad de México desde una perspectiva antropológica considerando aspectos socioculturales y económicos. Inicia con una breve revisión de los estudios antropológicos sobre alimentación en México, para reconocer tanto los aportes metodológicos como los principales problemas de estudio. Posteriormente, se presentan algunos datos de contextualización del país y de la ciudad que enmarcan los datos nutricios y alimentarios característicos. En las siguientes secciones se proponen algunas explicaciones sobre algunos de los fenómenos alimentarios contemporáneos, donde la obesidad es la característica principal en una sociedad de reciente acceso al consumo masivo, al mismo tiempo que se enfrenta al ideal cultural de delgadez. Los datos sobre la alimentación en México y los fenómenos sociales relacionados dan cuenta de la complejidad del fenómeno alimentario y de cómo los procesos macrosociales afectan las decisiones cotidianas de la gente. El análisis antropológico de la alimentación en la población mexicana ha permitido mostrar la relación entre estos procesos históricamente y en fechas recientes. Son la muestra de la utilidad de la metodología antropológica para estudiar la alimentación contemporánea, llena de contradicciones, que tienen que ver con el desarrollo del capitalismo y la sociedad de consumo, la promoción al consumo, y el acceso inmediato a él, la medicalización de la vida cotidiana, las ideas sobre el control corporal, y la imagen como un elemento de estatus.<br>This paper presents an overview of food in Mexico, particularly in Mexico City, from an anthropological perspective considering sociocultural and economic aspects. It begins with a brief review of anthropological studies on food in Mexico to recognize both the methodological contributions as the major problems of study. Subsequently, are presented some facts of contextualization of the country and city that frame the distinctive food and nutritional data. The following sections propose some explanations of some of the phenomena of contemporary food, where obesity is the main feature in a society of recent consumer access, while facing the cultural ideal of thinness. The data on food in Mexico and related social phenomena account for the complex nature of food and how macro-processes affect people's everyday decisions. The anthropological analysis of food in the Mexican population has been allowed to show the relationship between these processes historically and recently. They are the sign of the usefulness of anthropological methodology to study contemporary food, full of contradictions that have to do with the development of capitalism and consumer society, consumer promotion, and immediate access to it, the medicalization everyday life, ideas about body control, and image as an element of status