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We explore here the systems-based regulatory mechanisms that determine human blood pressure patterns. This in the context of the reported negative association between hypertension and COVID-19 disease. We are particularly interested in the key role that plays angiotensin converting enzyme 2 (ACE2), one of the first identified receptors that enable the entry of the SARS-CoV-2 virus into a cell. Taking into account the two main systems involved in the regulation of blood pressure, that is, the Renin-Angiotensin system and the Kallikrein-Kinin system, we follow a Bottom-Up systems biology modeling approach in order to built the discrete Boolean model of the gene regulatory network that underlies both the typical hypertensive phenotype and the hypotensive/normotensive phenotype. These phenotypes correspond to the dynamic attractors of the regulatory network modeled on the basis of publicly available experimental information. Our model recovers the observed phenotypes and shows the key role played by the inflammatory response in the emergence of hypertension. Source code go to the next url: https://github.com/cxro-cc/red_ras_kks © 2023, EasyChair. All rights reserved.
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BACKGROUND: Multisystemic inflammatory syndrome of the adult, a new condition associated with an irregular immune response similar to that of children, is characterized by shock, heart failure or persistent hypotension, dyspnea on exertion, mild-moderate hypoxemia, gastric symptoms and elevated markers of systemic inflammation after severe COVID-19 pneumonia. CLINICAL CASE: A 56-year-old patient, uncontrolled diabetic, who presented symptoms associated with dyspnea, desaturation, chest pain and persistent fever, previously with severe pneumonia after one month of treatment. He was treated with oxygen, steroids and antibiotics for 3 weeks, but his symptoms worsened and he developed severe orthopnea, hypotension, chest pain, dyspnea at rest and severe desaturation, as well as elevation of inflammation markers (C-reactive protein, ESR, D-dimer, ferritin). Tomography of the chest showed residual pneumonia based on consolidation and ground glass. Echocardiogram evidenced diastolic dysfunction, myopericarditis and secondary endocarditis. Multisystemic inflammatory syndrome of the adult was diagnosed and patient was treated with IV immunoglobulin and steroid with a favorable response to treatment. CONCLUSION(S): This case shows that the adult systemic inflammatory syndrome is a differential diagnosis in a patient with shock of unknown etiology, heart failure and severe dyspnea previously infected by SARS-CoV-2. Immunoglobulin and steroid are the effective first-line treatment with excellent clinical response.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Objective: To describe the epidemiological and clinical profile of pediatric patients who were treated for suspected COVID-19 infecion, between March and October 2020, at the Hospital Universitario San Ignacio (HUSI), in Bogota, Colombia. Material(s) and Method(s): Cross-sectional design. Description of patients aged 1 month to 1 day before their 18th birthday, assessed between March and October 2020, who were approached by any pediatric care service of a university hospital for suspected COVID-infection. 19, according to current national and institutional protocols. Demographic variables and the reason for consultation of all individuals with suspected infection were recorded. Only when SARS-CoV-2 infection was confirmed were variables related to clinical aspects of the disease and its evolution recorded. Result(s): 920 medical records of pediatric patients with suspected SARS-CoV-2 infection were evaluated, of which there were 157 confirmed cases with COVID-19 infection. The main reason for consultation to suspect infection was fever in 50% of the cases. In patients with virological confirmation, 32.48% of the cases attended required hospital management. MIS-C was suspected in 5 patients who required intensive care unit management. In the evaluated period, there were no deaths associated with COVID-19 infection. Conclusion(s): SARS-CoV-2 infection is related in most cases to a spectrum of mild disease in the pediatric population. This study may be larger than pediatric patients presenting with gastrointestinal rather than respiratory symptoms, and the frequency of renal complications should be taken into account in patients in whom the systemic inflammatory syndrome associated with COVID-19 is suspected.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.
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Introduction: AlthoughCOVID-19 and anemia are associated with higher risk for Acute Kidney Injury (AKI), to the best of our knowledge no studies have analyzed the association of admission hemoglobin with Major Adverse Kidney Events (MAKE) in patients with COVID-19 and AKI. Method(s): Retrospective cohort study of 412 hospitalized patients with severe COVID-19. MAKE was defined as a composite of 28-day mortality, progression to AKI stage 3, and renal replacement therapy. A COX regression analysis was used to determine the independent association of hemoglobin level with risk of MAKE. Result(s): The mean age of the 412 patients was 55+/-15 years, 35.9% were male, had a mean Body Mass Index (BMI) of 28.2+/-5.5 kg/m2, and median in-hospital stay was 10 (6-17) days. Overall, patients had a mean hemoglobin level of 12.8+/-2.8g/dL, and 62.1%, 23.8%, 8.7%, and 5.3% presented a 24-hour hemoglobin >13g/dL, 10-13g/dL, 9.9-8g/dL, and < 8g/dL, respectively. Likewise, the 28-day mortality was 20.4%, 22.3% progressed to AKI stage 3 and 9.5% required RRT. The univariate analysis showed that a 24-hour hemoglobin >13 g/dL had a lower risk for 28-day mortality (HR=0.634 [0.503-0.800]), AKI at any stage (0.457 [0.304-687]), progression to AKI stage 3 (0.666 [0.527-0.841]) and RRT requirement (0.626 [0.489-0.801]). After COX regression analysis, a hemoglobin >13g/dL was associated with lower risk to present MAKE (0.541 [0.338-0.866]), independently of age, sex, BMI, diabetes, hypertension, chronic kidney disease, mechanical ventilation, and proinflammatory markers. Conclusion(s):A hemoglobin >13 g/dL level was independently associated with lower risk to present MAKE in hospitalized patients with severe COVID-19. [Formula presented] Conclusion(s): A hemoglobin >13 g/dL level was independently associated with lower risk to present MAKE in hospitalized patients with severe COVID-19. No conflict of interestCopyright © 2023
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This paper analyzes the initial stage of the pandemic COVID-19 in Mexico. The objective is to test whether the contagion risk perception and the authorities' initial prevention messages influenced the COVID-19 deaths. We estimate longitudinal elasticities of deaths to confirmed COVID-19 cases by accounting for measurement error and endogeneity issues. We find that confirmed cases and poverty levels are endogenous. The limitation arises because of the underreported COVID-19 deaths. Our contribution is to identify an association with the individual and political risk perception to the number of COVID-19 deaths. The results show that municipalities with more confirmed cases aware of being in contact with another person affected by COVID-19 have fewer deaths. However, emergency management, federal and state, had weak effects of reducing the lethality rate. We infer that better individual risk awareness is an essential factor in reducing the number of deaths from COVID-19. JEL Classification: C23, H12, H75, I10, O54. © 2021 The Author(s).
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En Europa, la amplia cobertura vacunal, juntamente con las actuales tasas de infección de la población por el virus SARS-CoV-2 ponen de manifiesto la necesidad de vacunas de segunda generación que constituyan un refuerzo seguro y efectivo contra nuevas variantes de SARS-CoV-2. El refuerzo heterólogo con vacunas de proteína recombinante con capacidad de protección frente a las variantes del virus podría ser una buena estrategia para mejorar la protección contra la COVID-19. Métodos: Ensayo clínico (NCT05246137) de fase III, abierto, no-controlado y multicéntrico en una cohorte de voluntarios (≥ 16 años) vacunados con AstraZeneca, Janssen, Pfizer-BioNTec o Moderna al menos 3 meses antes de la administración de una dosis de refuerzo con la vacuna de proteína recombinante PHH-1V (basada en las variantes Alfa y Beta). La reactogenicidad tras el recuerdo heterólogo se evaluó en función del régimen de vacunación primaria recibido y del historial previo de infección por SARS-CoV-2. Resultados: De los 2.646 sujetos que completaron el día 14 posvacunación, el 86,96% presentó al menos un efecto adverso, la mayoría de intensidad leve o moderada. Las reacciones adversas más comunes fueron dolor en el lugar de la inyección (82,01%), fatiga (31,25%) y dolor de cabeza (30,88%). En el análisis de subgrupos, no se observaron diferencias relevantes en el perfil de seguridad según la primovacunación recibida ni según el historial de COVID-19. Ninguna de las vacunaciones primarias previas mostró más reactogenicidad que otras después de la vacunación de refuerzo con PHH-1V. Conclusiones: La vacuna PHH-1V fue bien tolerada y segura, independientemente de la vacunación primaria recibida o de una infección previa por COVID-19. El refuerzo heterólogo con PHH-1V puede ser una estrategia segura e interesante para las próximas campañas de vacunación en individuos ya inmunizados con vacunas de mRNA y/o vector.
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The devastating effects of COVID-19 pandemic led the Spanish government to adopt exceptional emergency regulations that forced the confinement of the entire population and, therefore, the cessation of on-site teaching. This forced the migration of teaching methodologies to virtual formats in a few weeks. The lack of specific resources and experience in online teaching, and the need of a rapid response meant that the measures adopted fostered a hybrid model between online and face-to-face teaching. This paper presents the context and the approach taken in the methodological adaptation of three subjects of Electronic Engineering with different characteristics. In addition, the results of the evaluation of these measures by students, obtained through a survey, are presented. The results show that virtualisation has produced a fictitious improvement in students' grades, as the assessment evidences. The students considered very positive the use of synchronous learning as opposed to asynchronous format, as well as all the activities that promoted direct communication between the student and the lecturer. Another generalised opinion extracted from the results of the survey is that the new measures have implied an excess of work for students. The experience gained and the students' opinions can be very useful for the design of blended learning formats, which seem to be a very promising alternative in the future of University, although this change seems to be non-trivial in such experimental studies as engineering.
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Introduction and objectives: This report describes the cardiac pacing activity performed in Spain in 2020, including the number and type of implanted devices, demographic and clinical factors, and data on remote monitoring. Methods: Information consisted of the European Pacemaker Patient Card, data submitted to the cardiodispositivos.es online platform, the databases of participating centers, and supplier-reported data. Results: A total of 14 662 procedures were registered from 102 hospitals, representing 39.2% of the estimated activity. The implantation rates of conventional and low-energy resynchronization pacemakers were 759 and 31 units per million population, respectively. In all, 520 leadless pacemakers were implanted, 70 with atrioventricular synchrony. The mean age at implantation was high (78.8 years), and the most frequent electrocardiographic change was atrioventricular block. There was a predominance of dual-chamber pacing mode but VVI/R single-chamber pacing was used in 19% of patients in sinus rhythm, depending on age and sex. Remote monitoring capability was present in 18.5% of implanted conventional pacemakers and 45.6% of low-energy resynchronization pacemakers, although registration in this system increased by 53% in 2020. Conclusions: In 2020, in the context of the SARS-CoV-2 pandemic, the number of implanted conventional pacemakers decreased by 8% and cardiac resynchronization therapy by 4.6%. The number of leadless pacemakers increased by 16.5%. Sequential pacing was predominant, influenced by age and sex. Home monitoring played a fundamental role as a mode of follow-up in this SARS-CoV-2 pandemic year. (C) 2021 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
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Background : Massive bleeding(MB) is associated with coagulopathy and high mortality. Currently, there are diverse approaches to the management of MB. The main difference is the number of blood products in the transfusion packages, which include red blood cells(RBC), fresh frozen plasma(FFP) and platelet concentrates(PC). The use of hemostatic agents like fibrinogen concentrate(FC), tranexamic acid and prothrombin complex concentrate (PCC) has been shown to reduce mortality.Our MB protocol utilizes a ratio of 4RBC:4FFP:1PC in the initial transfusion package. Our hospital administrates approx. 12000 blood products/year. The anesthetics team is experienced with the use of Rotational thrombelastometry (ROTEM) in the management of MB. Aims : This study aimed to determine the use of blood components and hemostatic agents during MB in our hospital. Methods : We performed a retrospective review of MB cases from January 2018 to December 2020. Patient demographics, indications and laboratory records were analyzed. ROTEM guided transfusion was performed by the team of anesthesiologists managing the patient. Results : During this period, a total of 108 MB were detected, with an average of 36/year. The medium age for these events was 57.18 y (range of 18-88 y) and included 49 females and 59 males. MB were associated with surgery(57), cirrhotic complications(27), trauma(20), obstetric bleeding(4).The blood products used were 850 RBC(average 7.87/patient) and 169 PC(average 1.56/patient). Of the 510 FFP units(average 4.72/patient) that were thawed, 411(average 3.84/patient) were used. The remaining units were discarded. Tranexamic acid was used in 70 patients and CCP in 13.There was a favorable outcome in 83 cases and 25 patients died from the major bleeding event.A decrease in MB events was recorded during the COVID pandemic. Conclusions : The optimal way to resuscitate patients with MB remains unclear, and clinical trials are difficult to perform in this setting. We believe that uniform approach for the management of MB is deleterious to the best use of blood products.
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Purpose: Work-family conflict is an important topic which had an evolution, starting from a static definition, where work and family domains were divided, to a more dynamic and complex balance. COVID-19 has influenced society and created a significant distress among families and working activity, and this topic has been characterised by a major interest, considering some old definitions where this balance was considered problematic but not as an enriching opportunity. Design/methodology/approach: The authors used SCOPUS to find all records mentioning work-family conflict, by considering book, article and review, excluding conference paper and considering only records written in English language. After a duplicated and not pertinent record removal, the authors obtained a number of 675 records. The authors considered 437 records from SCOPUS to create a cluster map. Findings: Using SCOPUS and VOSviewer the authors have clustered 5 different areas, which are regrouped in next clusters considering keywords with most co-occurrence and significancy: Work-life balance and burnout gender cluster job stress and performance social and family support job satisfaction. Research limitations/implications: Cluster map is origined only by SCOPUS database. Originality/value: This work aims to find a state of art about this topic, creating hypothesis where this problem has been exacerbated by 2020 due to important society modifications created by COVID-19, where recent evolution of work-family balance has been complicated by papers which come back to consider this balance as problematic. © 2021, Tancredi Pascucci, Brizeida Hernàndez Sanchèz and Josè Carlos Sanchéz Garcìa.
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Telemedicine worldwide and in Mexico has been very useful during the COVID-19 pandemic. Being able to provide health care services where distance is a critical factor, at a time when health services are saturated, and where face-to-face care implies a risk for both the health care provider and the patients, it has been indispensable during the pandemic. The speed with which telemedicine services have been implemented globally has been very different. There are still great challenges to be solved in order to provide this type of care worldwide. It should be noted that telemedicine complements patient care, rather than replacing the usual face-to-face care.
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Mexico experiences great challenges in public health and its health system. Demographic transition combines the coexistence of infectious and chronic-degenerative diseases. Respiratory diseases are some of the major public health problems and have been aggravated by the advent of respiratory pandemics: Influenza A H1N1 in 2009 and COVID-19 by SARS-CoV-2 during 2020. In this period, the National Institute of Respiratory Diseases (INER), the main training center for specialized human resources in Mexico, like other centers for the specialty of pulmonary medicine, has undergone a profound transformation towards the healthcare integration of respiratory and critical care medicine. Nevertheless, the great lack of specialized human resources in this area has become more evident during the current epidemiological emergency. It confirms that the proposal to integrate pulmonary and critical care medicine into a single specialty may be one of the compelling and effective responses to match some of the greatest challenges of medicine in our country.
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BACKGROUND: In the epidemic phase of the coronavirus in Mexico a phenomenon called persistent symptoms has been described, which occur in all patients who have developed the disease, but despite its improvement in time, they present a series of diverse symptoms that do not allow them to continue their daily life normally during the resolution phase of the disease. OBJECTIVE: To determine the persistence of post-COVID-19 symptoms in a population cared at a third level hospital of Puebla. MATERIAL AND METHOD: An observational and descriptive study of the population attended in the Pneumology outpatient clinic at Hospital Ángeles Puebla. Post-COVID 19 patients were asked a symptom questionnaire within 30-60 days after their symptoms or resolution of the symptoms under the following variables: Age, sex, BMI, comorbidities, tobacco index, symptoms in acute COVID-19 infection, established treatment, days of resolution of symptoms, presence of symptoms after resolution of the disease RESULTS: Fifty patients were included (30% women and 70% men), 84% presented persistent symptoms after the resolution of the disease, of which fatigue, headache, chest tightness and dyspnea were the main ones. CONCLUSIONS: This work demonstrates in a population the importance of symptoms after COVID-19 infection, which are of clinical relevance for the total resolution of the disease and aimed at improving the quality of life of recovered patients. © 2020 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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BACKGROUND: In February 2020 World Health Organization (WHO) declared a pandemic for COVID-19 disease (coronavirus disease 2019). In the treatment, the evidence suggests the use of biological medications to counteract the so-called cytochemical storm in order to decrease systemic inflammation and therefore reduce morbidity and mortality. CLINICAL CASES: Six patients (four male, 66.6% and two women, 33.3%) with average age of 58.1 years (range: 41-71) with diagnosis of severe pneumonia due to COVID-19 and the administration of two implied treatments in the cytochemical storm, such as tocilizumab and ruxolitinib. This paper described their clinical evolution in an intensive care unit of a private hospital of Puebla, Puebla. The most important findings were: relieve at 48 hours in the clinical parameters and reduction of inflammation markers after the application of biological drugs. There were not adverse reactions. CONCLUSIONS: The use of tocilizumab, ruxolitinib or both are medications that reduced systemic inflammation in patients with severe pneumonia due to COVID-19. © 2020 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.