RESUMO
Background: We investigated whether abatacept, a selective costimulation modulator, provides additional benefit when added to standard-of-care for patients hospitalized with Covid-19. Methods: We conducted a master protocol to investigate immunomodulators for potential benefit treating patients hospitalized with Covid-19 and report results for abatacept. Intravenous abatacept (one-time dose 10 mg/kg, maximum dose 1000 mg) plus standard of care (SOC) was compared with shared placebo plus SOC. Primary outcome was time-to-recovery by day 28. Key secondary endpoints included 28-day mortality. Results: Between October 16, 2020 and December 31, 2021, a total of 1019 participants received study treatment (509 abatacept; 510 shared placebo), constituting the modified intention-to-treat cohort. Participants had a mean age 54.8 (SD 14.6) years, 60.5% were male, 44.2% Hispanic/Latino and 13.7% Black. No statistically significant difference for the primary endpoint of time-to-recovery was found with a recovery-rate-ratio of 1.14 (95% CI 1.00-1.29; p=0.057) compared with placebo. We observed a substantial improvement in 28-day all-cause mortality with abatacept versus placebo (11.0% vs. 15.1%; odds ratio [OR] 0.62 [95% CI 0.41- 0.94]), leading to 38% lower odds of dying. Improvement in mortality occurred for participants requiring oxygen/noninvasive ventilation at randomization. Subgroup analysis identified the strongest effect in those with baseline C-reactive protein >75mg/L. We found no statistically significant differences in adverse events, with safety composite index slightly favoring abatacept. Rates of secondary infections were similar (16.1% for abatacept; 14.3% for placebo). Conclusions: Addition of single-dose intravenous abatacept to standard-of-care demonstrated no statistically significant change in time-to-recovery, but improved 28-day mortality. Trial registration: ClinicalTrials.gov ( NCT04593940 ).
RESUMO
Objective: To identify the factors associated with the interference of gynecological cancer screening in women aged 25-69 years, according to the Demographic and Family Health Survey (ENDES) for the years 2019 and 2020. Materials and methods: Quantitative, observational, analytical cross- sectional study. It was a secondary database analysis obtained by ENDE for the years 2019 and 2020. Generalized linear Poisson family crude and adjusted models were used to estimate the association. The measure of association. The measure of association used was the adjusted prevalence ratio (Rpa) with 95% confidence interval (95% CI). Results: We worked with a total of 18,113 women aged 25-69 who were interviewed at the ENDES 2019-2020. In the descriptive analysis, it is observed that 19.3% did not take a PAP smear (PAP) and 53.6% did not perform "screening for breast cancer". Women with a primary education level have 19% and 58% more opportunities to present interference for taking PAP and screening for breast cancer respectively (RPa: 1,19, 95% CI 1.08-1,31 and RPa:1.58, 95% CI 1:51 1:64). Living in the jungle increases 56%and 20%more chance of presenting interference for taking PAP and screening for breast cancer respectively (RPa: 1.46, 95% CI 1.42-1.71 and RPa: 1.20, 95% CI: 1.15- 1.25). The level of knowledge increases the interference for taking PAP and screening for breast cancer by 43% and 3% respectively (RPa: 1.43, 95% CI: 1.34- 1.54 and RPa: 1.03, 95% CI:1.00 -1.06) Conclusions: Sociodemographic, sociocultural and economic factors have a marked influence on the performance of gynecological cancers such as cervical cancer and breast cancer, so it is necessary to implement strategies to promote the prevention of these pathologies.
Objetivo: Identificar los factores asociados con la interferencia de los cribados para cánceres ginecológicos en mujeres peruanas de 25 69 años de edad, según la Encuesta Demográfica y de Salud Familiar (ENDES) de los años 2019 y 2020. Materiales y métodos: Estudio cuantitativo, observacional, analítico de corte transversal. Fue un análisis de base de datos secundaria obtenido por ENDES de los años 2019 y 2020. Se usó modelos lineales generalizados de familia Poisson crudas y ajustadas para poder estimar la asociación. La medida de asociación utilizada fue la razón de prevalencia ajustada (RPa) con un intervalo de confianza al 95% (IC95%). Resultados: Se trabajó con un total de 18113 mujeres peruanas de 25-69 años entrevistadas en la ENDES 2019-2020. En el análisis descriptivo se observa que un 19,3% no se realizó la toma de Papanicolaou (PAP) y 53,6 no se realizó "cribado para cáncer de mama". Las mujeres con nivel educativo primario tienen 20% y 58% más oportunidades de presentar interferencia para la toma de PAP y cribado para cáncer de mama respectivamente (RPa: 1.20, IC95%: 1.09-1.32 y RPa: 1.58, IC95%: 1.52-1.65). Vivir en la selva aumenta en 57% y 20% más oportunidades de presentar interferencia para la toma de PAP y cribado para cáncer de mama respectivamente (RPa: 1.57, IC95%: 1.43-1.71 y RPa: 1.20, IC95%: 1.15-1.25). El nivel de conocimiento aumenta en un 44% y 4% la interferencia para la toma de PAP y cribado para cáncer de mama respectivamente (RPa: 1.44, IC95%: 1.34-1.54 y RPa: 1.04, IC95%: 1.01-1.07). Conclusión: Los factores sociodemográficos, socioculturales y económicos influyen de manera marcada en la realización de los cribados de cánceres ginecológicos como el cáncer de cuellouterino y el cáncer de mama, por lo que es necesario implementar estrategias para promover la prevención de estas patologías.