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

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Plan para la promoción y mejora de la convivencia escolar a través de la mediación escolar

El trabajo obtuvo el Segundo Premio de la Modalidad A de los 'Premios Tomás García Verdejo' a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso académico 2013/2014Se describe el Plan para la promoción y la mejora de la convivencia escolar a través de la mediación escolar llevado a cabo en el CEIP Antonio Machado (Almendralejo, Badajoz), que tiene como objetivos mejorar el clima de convivencia en el Centro y favorecer una mayor implicación de las familias y la sociedad en su conjunto y la adopción de medidas encaminadas a potenciar la educación en valores, las habilidades sociales y la regulación de la convivencia. Entre las actividades que se realizaron se encuentran: un taller de entrenamiento en habilidades para la resolución de conflictos y la escuela de familiasExtremaduraES

La hora 31

Este proyecto se basa en la organización de actividades extraescolares que se desarrollan fuera del horario lectivo. Están orientadas a ser una alternativa de ocio para que los alumnos ocupen su tiempo libre y amplíen su cultura. Para la organización de muchas de estas actividades ha sido necesaria la colaboración con otras instituciones, sobre todo del entorno del centro. Se plantean objetivos generales como estrechar relaciones entre los diferentes sectores de la comunidad educativa y poder lograr un ambiente de trabajo y estudio favorable y así, generar un mejor rendimiento académico de los alumnos y la máxima implicación por parte de los profesores; que los alumnos desarrollen hábitos de vida saludables y provocar en estos una visión positiva del centro y no solo como centro de formación académica; y desarrollar y favorecer inquietudes culturales en los alumnos. La metodología se basa en el diseño de actividades que ofrecen una enseñanza multidisciplinar que complementa los contenidos curriculares. Las actividades realizadas se agrupan en torno a cuatro ámbitos, el sociolingüístico, el cientificotécnico, el artístico y el deportivo. Entre las actividades destacan talleres de matemáticas, de teatro, de creación de páginas web, de fotografía, la creación de una revista escolar y organización de viajes y clubes de tiempo libre. Se adjunta una relación de unas actividades descritas a través de fichas y algunos materiales creados durante su realización.Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Ordenación AcadémicaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective