Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis

Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus. Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35­18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90­5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality.The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75­51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20­21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICUmortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89­21.36). Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive

Sandimmun vs Neoral: comparación entre dos tipos de Ciclosporina en pacientes con trasplante de riñón / Sandimmun vs Neoral: comparison between two types of cyclosporine in patients with kidney transplantation

We present a comparative trial between Sandimmun, the original cyclosporine presentation, and a modified one, called Neoral, in microemulsion, to increase the blood absortion and stability of the product. We built for each product, an absorption kinetic curve and we applied it to three patients with stable renal function, using the same dosage that was used for ciclosporine. We observed a greater absorption and stability in the blood levels of Neoral. We analyzed hundred blood samples in 25 patients and we found a higher level of this product; this lead us to make possible that in 72% of the patients we could diminish the daily dosis in 5 to 10%. The patient's renal function was stable and no complications or secondary effects were present with Neoral.

Frecuencia de genes y haplotipos del sistema HLA en la poblacion Panameña / Gene frequency and haplotypes of the HLA system in the Panamanian population

The authors determined the frequency of genes and haplotypes of the HLA system in 965 panamanian men and women not related to each other, between 6 and 65 years of age. The HLA-A locus genes with the highest frequency (f) were A2, with f 0.1763; A24, f 0.1584; A30, f 0.1340; A23, f 0.1069; A3, f 0.0774. The other 20 genes each had less than 0.07. The genes with the highest frequency for locus HLA-B were B35, f 0.1946; B44, f 0.0904; B7, f 0.0774; B60 and B61, f 0.0582. For locus HLA-C, the most frequent genes were Cw3 with f 0.1549 and Cw4, f 0.1444. For locus HLA-DR, the most frequent genes were DR2 with f 0.1283; DR3, f 0.0620; DR7, f 0.0409. The most frequent haplotypes in the panamanian population were A2-B35 with f 0.0382; A3-B35, f 0.0191; A24-35, f 0.0287; A24-B61, f 0.0239; A29-B44, f 0.0287; A30-B42, f 0.0239; A23-B44, f 0.0191; A1-B8, f 0.0143. The authors conclude that the panamanian population exhibits a high degree of polymorphism for loci HLA-A, B and C, while for locu HLA-DR the frequency is the median when compared with that in caucasian, negro and oriental groups; and that, according to locus, predominant genes originating from these groups and found, corroborating the multiracial origen of the panamanian population