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

Plan de cuidados estandarizados para pacientes con cirugía percutánea (nefrolitotomía): aplicación en el programa informático Gacela

In the University Hospital «Río Hortega» in Valladolid, since 1988 approximately 780 patients have been treated with percutaneous surgery. Surgery with percutaneous approach would be defined as the surgical act on the structure, in this case, renal and uretheral, which access tract to the organ is carried out through the skin, precisely a nephrostomy. In our Unit 77% of the cases of percutaneous surgery it is applied in the treatment of renal lithiasis-uretheral when other treatments fail or are not feasible, for example unsuccessful lithotripsy, ureteral calculus of difficult approach, coralliform kidney calculis, etc. It is also applied in tumoral treatments, endopyelotomy, etc. A priori this surgery is of preferential choice because it is minimally invasive. On the other hand, the introduction of the GAZELLE computer program allows standardizing the Nursing Cares , what facilitates the creation of a specific cares plan for this type of patients, since the diagnoses and care actions described are common in a high percentage of cases treated (close to 100%). The taxonomy used in the description of nursing diagnoses corresponds to the classification NANDA and the actions are found in the database of the GAZELLE program.La aparición de nuevas tecnologías trae añadida nuevas formas de abordaje quirúrgico. En el Hospital Universitario «Río Hortega» de Valladolid, desde el año 1988 se han tratado aproximadamente 780 pacientes con cirugía percutánea. Cirugía con abordaje percutáneo se definiría como el acto quirúrgico sobre la estructura, en este caso, renal y ureteral cuya vía de acceso o de entrada al órgano se efectúa a través de la piel, concretamente una nefrostomía. En nuestra Unidad, un 77% de los casos de cirugía percutánea es aplicada en el tratamiento de litiasis renales-ureterales cuando otros tratamientos fallan o no son factibles, por ejemplo litotricias fallidas, cálculos ureterales de mal abordaje, cálculos renales coraliformes, etc.También se aplica en tratamientos tumorales, endopielotomías, etc. A priori esta cirugía es de elección preferente por ser mínimamente invasiva. Por otra parte, la implantación del programa informático GACELA permite estandarizar los cuidados enfermeros, lo que facilita la creación de un plan de cuidados específico para este tipo de pacientes, ya que los diagnósticos y acciones cuidadoras descritas son comunes en un alto porcentaje de casos tratados (próximo al 100%). La taxonomía empleada en la descripción de diagnósticos enfermeros corresponde a la clasificación NANDA y las acciones se encuentran en la base de datos del programa GACELA

Use of Venetoclax in Patients with Relapsed or Refractory Acute Myeloid Leukemia: The PETHEMA Registry Experience

The effectiveness of venetoclax (VEN) in relapsed or refractory acute myeloid leukemia (RR-AML) has not been well established. This retrospective, multicenter, observational database studied the effectiveness of VEN in a cohort of 51 RR-AML patients and evaluated for predictors of response and overall survival (OS). The median age was 68 years, most were at high risk, 61% received &ge;2 therapies for AML, 49% had received hypomethylating agents, and ECOG was &ge;2 in 52%. Complete remission (CR) rate, including CR with incomplete hematological recovery (CRi), was 12.4%. Additionally, 10.4% experienced partial response (PR). The CR/CRi was higher in combination with azacitidine (AZA; 17.9%) than with decitabine (DEC; 6.7%) and low-dose cytarabine (LDAC; 0%). Mutated NPM1 was associated with increased CR/CRi. Median OS was 104 days (95% CI: 56&ndash;151). For the combination with AZA, DEC, and LDAC, median OS was 120 days, 104 days, and 69 days, respectively; p = 0.875. Treatment response and ECOG 0 influenced OS in a multivariate model. A total of 28% of patients required interruption of VEN because of toxicity. Our real-life series describes a marginal probability of CR/CRi and poor OS after VEN-based salvage. Patients included had very poor-risk features and were heavily pretreated. The small percentage of responders did not reach the median OS

Use of Venetoclax in Patients with Relapsed or Refractory Acute Myeloid Leukemia: The PETHEMA Registry Experience.

The effectiveness of venetoclax (VEN) in relapsed or refractory acute myeloid leukemia (RR-AML) has not been well established. This retrospective, multicenter, observational database studied the effectiveness of VEN in a cohort of 51 RR-AML patients and evaluated for predictors of response and overall survival (OS). The median age was 68 years, most were at high risk, 61% received ≥2 therapies for AML, 49% had received hypomethylating agents, and ECOG was ≥2 in 52%. Complete remission (CR) rate, including CR with incomplete hematological recovery (CRi), was 12.4%. Additionally, 10.4% experienced partial response (PR). The CR/CRi was higher in combination with azacitidine (AZA; 17.9%) than with decitabine (DEC; 6.7%) and low-dose cytarabine (LDAC; 0%). Mutated NPM1 was associated with increased CR/CRi. Median OS was 104 days (95% CI: 56-151). For the combination with AZA, DEC, and LDAC, median OS was 120 days, 104 days, and 69 days, respectively; p = 0.875. Treatment response and ECOG 0 influenced OS in a multivariate model. A total of 28% of patients required interruption of VEN because of toxicity. Our real-life series describes a marginal probability of CR/CRi and poor OS after VEN-based salvage. Patients included had very poor-risk features and were heavily pretreated. The small percentage of responders did not reach the median OS