Tocilizumab is associated with reduction of the risk of ICU admission and mortality in patients with SARS-CoV-2 infection

BackgroundIn some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management worldwide; therefore, clinical strategies to avoid ICU admission are needed. ObjectiveWe aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. MethodsA retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P= 0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0{middle dot}1, P=0.0001) of ICU admission or death. ConclusionTocilizumab in the early stages of the inflammatory flare, could reduce ICU admissions and mechanical ventilation use. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. Clinical implicationOur results suggest that tocilizumab administered to non-critically ill patients could reduce ICU admissions and mortality. Capsule summaryTocilizumab administered to non-critically ill patients with SARS-CoV-2 infection in the early stages of the inflammatory flare, could reduce an important number of ICU admissions and mechanical ventilation use.

El agua en la alimentación

Documento que pretende facilitar el trabajo de los educadores a la hora de fomentar la cultura del mejor consumo de agua. Incluye información sobre la importancia del agua en la educación nutricional, sobre el agua de consumo público, aguas de bebida envasada, refrescos, zumos, necesidades de ingesta de agua en la población, en las personas mayores, en embarazo y lactancia, en deportistas, etc.

Epidemiology of risk factors and symptoms associated with menopause in Spanish women.

OBJECTIVES: (1) To assess the prevalence of risk factors for osteoporosis and cardiovascular disease and the prevalence and severity of the appearance of menopausal symptoms among Spanish menopausal women. (2) To identify the main factors responsible for this severity. (3) To detect symptom differences between perimenopausal and postmenopausal women. METHODS: Cross-sectional descriptive study encompassing women aged 45-65 years in the whole Spanish territory. The study population sample was collected through random sampling. A total of 10,514 women were included. The sociodemographic, medical history and lifestyle data were assessed by means of a survey. The Kupperman scale was used to assess the severity of menopausal symptoms. RESULTS: The prevalence of risk factors for osteoporosis and cardiovascular disease were 67.6% and 74.8%, respectively. The most common risk factors were physical inactivity (53.6%), obesity (44.3%), arterial hypertension (36.6%), hypercholesterolemia (31.4%), low calcium intake (30.1%) and smoking (28.7%). The predominant symptoms experienced by menopausal women were hot flushes (51.4%), insomnia (45.7%) and irritability (42.2%). These were severe in 3.3% of the sample, moderate in 27.3%, mild in 24.6% while 44.8% had no symptoms. The prevalence of joint pain (40.1%) and depressive mood (40%) was higher in perimenopausal than in postmenopausal women. Logistic regression analysis showed that there were differences for age, BMI, smoking, social class and poor consumption of dairy products in the severity of menopausal symptoms. CONCLUSIONS: A high prevalence of risk factors for osteoporosis and cardiovascular disease was observed in our study. The main factors contributing to more severe menopausal symptoms were age, BMI, smoking social class and poor consumption of dairy products. In general, postmenopausal women presented significantly higher rates of menopausal symptoms when compared to perimenopausal women.

Seguimiento de un caso clínico con thuja occidentalis de hiperplasia gingival secundaria a tratamiento com DFH / Following a clinical case with Thuja occidentalis gingival hyperplasia secondary to treatment com HFD

La inflamación de la encía causada por la fenitoina, droga anticonvulsivamente utilizada en el tratamiento de la epilepsia, se presenta en algunos pacientes que han recibido esta droga.

Seguimiento de un caso clínico con thuja occidentalis de hiperplasia gingival secundaria a tratamiento com DFH / Following a clinical case with Thuja occidentalis gingival hyperplasia secondary to treatment com HFD

La inflamación de la encía causada por la fenitoina, droga anticonvulsivamente utilizada en el tratamiento de la epilepsia, se presenta en algunos pacientes que han recibido esta droga.