Inhibidores de la enzima convertidora de angiotensina y bloqueadores de los receptores de angiotensina II: ¿aumentan el riesgo de padecer COVID-19? / Angiotensin converting enzyme inhibitors and angiotensin receptor blocker: do they increase the risk of COVID-19?

Resumen Un nuevo coronavirus, llamado coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), se descubrió en diciembre de 2019 en Wuhan, China; el virus se intensificó rápidamente y el 11 de marzo de 2020 la Organización Mundial de la Salud lo declaró pandemia. Los datos emergentes sugieren que los pacientes mayores con COVID-19 asociado a otras afecciones comórbidas, como diabetes, hipertensión, y enfermedades cardíacas y pulmonares, son, en particular, más susceptibles, en comparación con las poblaciones generales y tienen mayor mortalidad. Aún no está claro si esta mayor asociación de hipertensión arterial con COVID-19 y el mayor riesgo de mortalidad están directamente relacionados con la hipertensión arterial u otras comorbilidades asociadas, o con el tratamiento antihipertensivo. Si bien el mecanismo patogénico subyacente que une la hipertensión y la gravedad de la infección por COVID-19 aún no se ha dilucidado, se ha planteado la hipótesis de que la activación excesiva del sistema renina-angiotensina (RAS) podría contribuir a la progresión de la lesión pulmonar relacionada con COVID-19. La preocupación sobre si los bloqueadores del receptor de angiotensina II (BRA) y los inhibidores de la enzima convertidora de angiotensina (IECA) pueden tener efectos nocivos sobre la morbilidad y la mortalidad de los pacientes con COVID-19 se basa en la especulación de que estos medicamentos aumentarían la regulación de la enzima convertidora de angiotensina II (ACE2), un receptor para el SARS-CoV-2, que aumentaría la carga viral y la lesión pulmonar. Los estudios recientes concuerdan con las recomendaciones de las sociedades científicas que plantean evitar la suspensión o cambio de medicación antihipertensiva, pues no hay evidencia que muestre que estos puedan ser tomados como factores de riesgo para gravedad o mortalidad por COVID-19.

Abstract A new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was discovered in December 2019 in Wuhan, China; the virus escalated rapidly and on March 11, 2020, the World Health Organization declared it a pandemic. Emerging data suggests that older patients with COVID-19 associated with other comorbid conditions such as diabetes, hypertension, heart and lung diseases are particularly more susceptible, compared to general populations, and have higher mortality. It is not yet clear whether this increased association of high blood pressure with COVID-19 and the increased risk of mortality are directly related to high blood pressure or other associated comorbidities, or to antihypertensive treatment. Although the underlying pathogenic mechanism linking hypertension and severity of COVID-19 infection remains to be elucidated, it has been hypothesized that excessive activation of the renin-angiotensin system (RAS) could contribute to the progression of COVID-19 related lung injury. Concern about whether angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors may have deleterious effects on morbidity and mortality in patients with COVID-19 is based on speculation that these drugs would increase the regulation of angiotensin II converting enzyme (ACE2), a receptor for SARS-CoV-2, which would increase viral load and lung damage. Recent studies are consistent with the recommendations of scientific societies that propose avoiding the suspension or change of antihypertensive medication, as there is no evidence that shows that these can be taken as risk factors for severity or mortality from COVID-19.

Breast state improvement by using the lymphatic drainage disposable bra pads

Background: The health and good esthetic conditions of the breast are important indicators of women’s life quality. One factor that negatively affects this quality is the breast ptosis, associated with the sagging of the mammary glands due to tissue stretching and the loss of tissue and skin elasticity. New tools and methods able to improve the shape and beautiful contour of the breast are highly desirable.Methods: We investigated how the disposable bra pads by BAE International Inc., having the lymphatic drainage effect for the breast, influenced the female breast state. We applied two methods, the ultrasound elasticity imaging and the pattern recognition of the nipples position, to monitor the breast state dynamics in two groups of females, the study and control ones.Results: Preliminary results showed that both the breast elasticity and the pattern of nipple positions improved for females wearing the bra pads as compared to females wearing regular bras without pads (P<0.05 for the difference between the two groups of females).Conclusions: Overall, the bra pads by BAE can be considered as an effective tool encouraging metabolism by improving the flow of blood circulation and lymph in the breast.

Effect of Acupuncture Plus Moxibustion on Immune Function in Patients with Bra-chiocephalic Takayasu Arteritis / 针刺研究

OBJECTIVE: To observe the influence of acupuncture and moxibustion on humoral immunity and cellular immunity related indexes in patients with bra-chiocephalic Takayasu arteritis (BCTA), so as to explore its underlying mechanisms in the treatment of Takayasu arteritis (TA). METHODS: A total of 31 BCTA patients (9 men and 22 women at age of 16-70 years) were treated by manual acupuncture stimulation of main acupoint Renying(ST 9)and auxillary acupoints as Jiquan (HT 1), Chize (LU 5), Fengchi (GB 20), bilateral Xinshu (BL15), Feishu (BL 13) and Geshu (BL 17), Jingming (BL 1), etc. according to clinical symptoms, with the needles retained for 20 min. Additionally, moxibustion was applied to Taiyuan (LU 9), BL 15, BL 13 and BL 17. The treatment was conducted twice daily for 4 weeks. Serum IgG, IgA, IgM, IgE, C3 , C4 contents, and CD 3＋， CD 4＋， CD 8＋ T lymphocytes contents were assayed by using immue turbidimetry and cell counting. RESULTS: Before the treatment and in these 31 BCTA patients, an abnormal increase was found in serum IgG content in 10 cases, IgM in 3 cases, IgE in 3 cases, C3 in 11 cases, CD 4＋ in 6 cases, and CD 8＋ in 9 cases, and an abnormal decrease was found in serum CD 3＋ level in 11 cases, CD 4＋ in 7 cases, as well as CD 8＋ in 4 cases. After the treatment, the increased levels of IgG, IgM, C3, CD 4＋ and CD 8＋ in patients with abnormally higher values were considerably down-regulated (P0.05). The CD 4＋ level in patients with normal value was significantly deun-regulated after the treatment (P<0.05), but still in the range of normal value. CONCLUSION: Acupuncture plus moxibustion can regulate some of the abnormally elevated and lowered humoral immunity and cellular immunity related indexes in BCTA patients, possibly having a favorable role in the treatment of BCTA.

Correction of simple breast ptosis using double-circle incision combined with dermal bra technique / 中华医学美学美容杂志

Objective To analyze the clinical outcomes of using double-circle incision combined with the dermal bra technique for the correction of simple breast ptosis.Methods From March 2010 to December 2014,88 patients underwent breast ptosis correction using the technique,among which 52 cases were classified into mild ptosis,27 moderate ptosis,and 9 severe ptosis.According to the extent of ptosis,varying size of the dermal bra were designed,and the mammary glandular flap was rotated,suspended and fixed onto the pectoralis fascia.For patients with insufficient size of the dermal bra,the polypropylene mesh was used to assist glandular suspension and fixation.Follow-up duration was between 3 to 24 months,and the surgical effect was evaluated from the following aspects:wound healing,breast sensory,shape,and texture,etc.Results The 4 cases (4.5％) had hematoma,and 3 cases (3.4％) suffered from poor wound healing.No case of fat liquefaction,necrosis of the nipple and areola complex,sensory disorder of NAC,or secondary ptosis was examined.Mammary contour was slightly rigid in the early postoperative period but gradually becoming natural with soft texture 3 months postoperatively.Conclusions Double-circle incision combined with the dermal technique is worth spreading in the clinical practice of breast ptosis correction for its satisfactory outcomes and low incidence of complications.

Multifunctional cellulolytic activities from Streptomyces osmaniensis for agricultural and enzyme industry

Aims: The aims of this study were to screen for cellulose degradation activity from actinomycetes using agar plate method, detect β-glucosidase activity, morphology and molecular taxonomy study. Methodology and results: Preliminary screening for cellulose degrading Actinomycete was done on the carboxymethyl cellulose agar (CMC agar) and detected by flooding with gram iodine. It was found that 190 isolates were cellulase producing actinomycetes. Actinomycete isolate CDF2L1D13 showed maximum clear zone around the colony and the highest hydrolysis capacity value was 3.93. β-glucosidase activity was examined by measuring the amount of paranitrophenol (pNP) librated by Tako method. Study on comparison of the enzyme activity in CMC broth with alternative broth was performed. The highest β-glucosidase activity was found on alternative production medium that supplemented rice bran as a carbon source. β-glucosidase activity was 0.401 U/mL. The optimum pH of alternative production medium for producing β-glucosidase was at pH value 7 and incubated at 30 °C. Isolate CDF2L1D13 was antagonistic actinomycete against rice blast pathogen (Pyricularia oryzae). The character of this isolate was showed white color of substrate mycelium, white color of aerial mycelium, gray spore and spiral spore chain. Actinomycete isolate CDF2L1D13 was phylogenetically similar to Streptomyces osmaniensis. Conclusion, significance and impact of study: The result from this study indicated that Streptomyces osmaniensis has the potential on β-glucosidase production and it is antagonistic actinomycete against Pyricularia oryzae.

Calidad de cuidado médico en una clínica de enfermedad renal avanzada con estrategia multi-causal / Medical care quality in an advanced kidney disease clinic

En enfermedad renal crónica etapa IV (ERC-IV) es alta la mortalidad y progresión a insuficiencia renal extrema (IRE). Objetivo: Valorar la calidad asistencial en una Clínica de Enfermedad Renal Crónica Avanzada (CERCA). Métodos: Estudio prospectivo de pacientes ERC- IV asistidos con un equipo multidisciplinario formal mediante estrategia de educación, asesoramiento nutricional, seguimiento clínico mensual, y tratamiento según metas de presión arterial (<130/80) reducción de proteinuria, uso de inhibidores de enzima de conversión (IECA) y/o Bloqueantes de receptores de angiotensina (BRA), tratamiento de dislipemia, y preparación para diálisis. Resultados: Se analizaron 150 pacientes, 50% masculino, 62,0 ± 14,4 años, Nefropatías vascular 20,4%, diabética 34,2% y 62,5% proteinúricos, con Índice de Charlson 3,67±1,57. En seguimiento de 1,4 años (IQ: 0,6-2,4) disminuyó la PA (147±35 a 132 ± 28mm), colesterol (210±55 a 179±50 mg/dL) y LDL (129±52 a 108±37 mg/dL) con aumento del uso de IECA/BRA (55,9 a 60,6 %) y estatinas (32,2 a 63,3%). La tasa de Mortalidad fue 5,3 e IRE 14,5/100 Pt- año. El Riesgo pérdida de FG mayor a la mediana o IRE aumentó con HTA, Pru >1 g/d y glomerulopatias y se redujo 90% con IEC/BRA (p<0.001). Al ingreso a diálisis la Hemoglobina ≥10g%, vacunación hepatitis B y acceso permanente fueron más frecuentes que en la población general. Conclusiones: En una Clínica multidisciplinaria con estrategia de control de riesgos se alcanzó mejor las metas de tratamiento, disminuyendo los factores de riesgo de progresión y mejorando el cuidado médico al ingreso a diálisis.

In stage IV chronic kidney disease (stage-IV CKD), mortality and progression to extreme renal failure (ERF) are high. Objective: Assessing the quality of health care in an Advanced Kidney Disease Clinic (AKDC). Methods: Prospective study of patients with stage-IV CKD treated by a multidisciplinary formal team through an educational strategy, nutritional advice, clinical nephrology follow-up, aimed at achieving blood pressure goals (<130/80), proteinuria reduction, use of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), dyslipidemia treatment and preparation for dialysis. Results: 150 patients were analyzed, 50% were males, of 62.0 ± 14.4 years of age, 20.4% had vascular kidney diseases, 34.2% had diabetes and 62.5% had proteinuria with a Charlson index of 3.67 ± 1.57. In the 1.4-year follow-up (IQ: 0.6- 2.4), there were decreases in the BP (147±35 to 132±28 mm), cholesterol (210±55 to 179±50 mg/ dl) and LDL (129±52 to 108±37 mg/dl), and there was an increase in the use of ACEI/ARB (55.9to 60.6%) and statins (32.2 to 63.3%). The mortality rate was 5.3 and the ERF rate was 14.5/100 patient-years. The glomerular function loss risk, which was higher than the median or ERF, increased with HTN, Pru >1 g/d and glomerular diseases, and had a 90% decrease with ACEI/ARB(p<0.001). At dialysis entry, hemoglobin levels of≥10g%, hepatitis B vaccination and permanent access were more frequent than in the general population. Conclusions: Treatment goals were best achieved in a multidisciplinary clinic with a riskcontrol strategy, reducing progression risk factors and improving medical care upon dialysis entry.

Study of standardization of seeds8 fruits of Lonicera Altaica Pall / Монголын Анагаах Ухаан

In Mongolia has described four species of Lonicera Altaica (Caprifoliaceae). Their habitats are Khubsugul, Khangai Khentei, Khobdo, Mongolian Altai, and Depression of Great Lakes, Mongol Daguur and the Gobi-Altai (Three beauty of Gobi) region of the country. The Tibetan medicine named berry Phan-ma'i bra'i bu (Lonicera Altaica) was used for vitality and energy supplier. In some medical texts, the berry was described to be used for longevity. Lonicera Altaica in Mongolian Traditional medicine is reputed for its treating liver, stomach and cardiac disorders, moreover, it is known for rejuvenation action. The Lonicera Altaica Lonicera altaica is found to be abundant among all other species. It s a black blue color ber­ries, with bitter taste. In Lonicera Altaica Pall was determined that ash no more than 5%, moisture 5% and organic and mineral ingredi­ent 0.5%. The quantity of flavonoid of fruits, seeds on Lonicera Altaica Pall was 5.598% by a method of spectrophotometry.

Immediate Volume Replacement with Latissimus Dorsi Muscle Flap after Quadrantectomy for Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Breast conserving surgery (BCS) is now widely accepted as the treatment of choice in early breast cancer. The extent of local excision has been controversial, owing to the risk of local recurrence and cosmesis. To improve breast cosmetic appearance following quadrantectomy for breast cancer, we propose a surgical technique of volume replacement with latissimus dorsi muscle (LD) flap. METHODS: Twenty-eight patients underwent the immediate reconstruction of the defect with a LD flap after quadrantectomy for breast cancer between January 1999 and December 2000 at Soonchunhyang University Hospital. All patients had postoperative radiotherapy to the residual breast and, where appropriate, to the axilla. The mean tumor size was 2.38 cm (0.5 to 5.5 cm). And the mean age of patient was 39.2 years (18 to 69 years). Cosmetic outcome was evaluated by means of panel assessment and breast retraction assessment. Fivepanel scales were E0 to E4. BRA values were calculated by simple vector geometry employing the Pythagorean theorem. RESULTS: 23 cases were scored as E0 (excellent, 82.1%), 4 case as E1 (good) and 1 case as E2 (moderate) cosmetic results. BRA values for the patients ranged 0.5 to 3.5 cm with a mean of 1.2 cm and for a group of 30 control women values ranged from 0.4 to 1.8 cm with mean value of 0.9 cm. When panel scores and BRA values were compared, 23 cases of excellent (E0) scoring had under the 3.5 cm of BRA value. No one of cases had over 3.5 cm of BRA value. 23 cases of excellent (E0) scoring old had satisfactory cosmetic results by panel scoring and BRA value. CONCLUSION: We concluded that the surgical technique of volume replacement with LD flap is useful for preventing breast deformity after quadrantectomy for breast cancer.