RESUMO
Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab used, the stage in which the drug is administered or the severity of disease presentation. Thus, we performed a retrospective multicentric study in 140 patients with moderate to critical COVID-19, 79 of which received tocilizumab in variable standard doses (< 400 mg, 400-800 mg or > 800 mg), either at the viral (1-7 days post-symptom onset), early inflammatory (8-15) or late inflammatory (16 or more) stages, and compared it with standard treated patients. Mortality, reduced respiratory support requirements and pathology markers were measured. Tocilizumab significantly reduced the respiratory support requirements (OR 2.71, CI 1.37-4.85 at 95%) and inflammatory markers (OR 4.82, CI 1.4-15.8) of all patients, but mortality was only reduced (4.1% vs 25.7%, p = 0.03) when the drug was administered at the early inflammatory stage and in doses ranging 400-800 mg in severely-ill patients. Despite the apparent inability of Tocilizumab to prevent the progression of COVID-19 into a critical presentation, severely-ill patients may be benefited by its use in the early inflammatory stage and moderate doses.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Tratamento Farmacológico da COVID-19 , Proteína C-Reativa/análise , COVID-19/mortalidade , COVID-19/patologia , Relação Dose-Resposta a Droga , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Razão de Chances , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Análise de Sobrevida , Taxa de SobrevidaAssuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Fígado , México , SARS-CoV-2RESUMO
Introducción: El Grupo de Neurociencias de Antioquia utiliza como protocolo de evaluación cognitiva la batería cognitiva del CERAD. Objetivo: Validar una serie de pruebas neuropsicológicas utilizadas para el diagnóstico de enfermedades neurodegenerativas en una población colombiana. Procedimiento: La muestra estuvo conformada por 848 participantes. Además 151 personas con demencia de Tipo Alzheimer (DTA) y 36 con Deterioro Cognitivo Leve (DCL). Resultados: Para los dominios cognoscitivos evaluados se encontraron coeficientes de consistencia superiores a 0.70. La confiabilidad test-retest presentó coeficientes de correlación intraclase mayores a 0.70. Entre grupos se encontraron diferencias estadísticamente significativas (p<0.05). Se encontraron correlaciones de moderadas a altas entre las pruebas neuropsicológicas y las escalas que miden severidad de la demencia y la funcionalidad. Discusión: Las pruebas utilizadas son útiles para la evaluación de las enfermedades neurodegenerativas, la comunidad científica podrá contar con normas ajustadas a los factores sociodemográficos característicos de nuestra población y otras que presenten características similares a esta población colombiana.
Introduction: Antioquia Neurosciences Group used as a cognitive assessment protocol, the CERAD cognitive battery. Objective: To validate a series of neuropsychological tests used for diagnosis of neurodegenerative disease in a Colombian population. Procedure: The sample consisted of 848 participants. In addition 151 people with dementia of Alzheimer type (DAT) and 36 with mild cognitive impairment (MCI). Results: For the cognitive domains assessed by this protocol consistency coefficients were above 0.70. The test-retest reliability intraclass correlation coefficients showed greater than 0.70. Between groups differences were statistically significant (p <0.05). We found moderate to high correlations between neuropsychological tests and scales that measure severity of dementia and functionality. Discussion: The tests used are useful for the evaluation of neurodegenerative diseases, the scientific community may have rules tailored to the sociodemographic characteristics of our population and that may be useful in populations that have similar characteristics to this Colombian population.