ABSTRACT
SARS-CoV-2 has a predilection for cell groups that are rich in ACE2 and TMPRSS2 receptors, which are distributed throughout the human body, which means that, in addition to the primary site of contagion or primary infection, which is the respiratory system, the virus tends to spread by different mechanisms, affecting practically all the known organs, apparatuses and systems, with which its tropism becomes extensive, being able to condition diverse pictures together with the respiratory one.Copyright © 2023 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
ABSTRACT
Background. Since the beginning of the pandemic and its passage through the different affected continents, there have been differences in the presentation depending in part on the characteristics of each population, so it is important to know how it behaves in the local population. Methods. Clinical-epidemiological study in adults hospitalized for suspected COVID-19 at the General Hospital 71 of the City of Veracruz, Mexico, from April to December 2020. Demographic and clinical characteristics are studied, as well as a comparative and stratified analysis was performed by intubation and death. Results. 1212 patients are included, 53% are men, average age 49 years. 20.5% reported sudden onset of symptoms;the most frequent: fever (79.8%), headache (75.2%), cough (71%), myalgia (62%), arthralgia (58%) and dyspnea (46.3%). Comorbidities were reported in 54.7%, the most frequent: Hypertension (29.2%), Diabetes (29.1%) and obesity (13.9%). Regarding the outcomes, 120 (9.9%) required intubation and 300 (25%) died. Men requiring intubation were significantly older than women [62.5 vs 37.5%;p = 0.027]. The mean age of the intubated patients was higher compared to that of the non-intubated [60.5 vs 44.8 years;p = 0.001]. The male gender had a risk association for intubation. The group aged 60 years or older compared to those aged 59 years or younger had a higher risk of intubation. Clinical variables that had a risk association with intubation were: dyspnea, chest pain and prostration. Among comorbidities, hypertension and diabetes had a risk association with intubation. Female gender and headache had a protective association for intubation. In addition, odynophagia, rhinorrhea, and abdominal pain showed a protective association for intubation. There was no difference in terms of gender by death. The mean age of the patients who died was significantly older [64.5 vs 43.8 years;p = 0.001]. The clinical variables that had a risk association with death were: dyspnea, chest pain, polypnea, cyanosis and prostration. The protective variables were: rhinorrhea, odynophagia, headache and conjunctivitis Conclusion. By studying a population affected by COVID, its own characteristics and inherent risks can be known to help take local diagnosis and treatment strategies that ensure a better outcome for those affected.
ABSTRACT
Background. Baricitinib is a treatment authorized by the FDA for the treatment of moderate to severe COVID-19, despite this there are few approved drugs;polymerized type I collagen (PTIC) is a drug that has been used in Mexico with great potential for treating moderate to severe cases of COVID-19. Methods. Comparative, descriptive and retrospective analysis of two populations of adult patients affected by COVID-19 confirmed by antigen test or RT-PCR as well as CO-RADS 6 CT, who consented to be treated between 2020 and 2021, a population using oral baricitinib at a dose of 4mg/day/14 days and another using polymerized type I collagen intramuscularly at a dose of 1.5ml every 12 hours for 3 days, followed by 1.5ml every 24 hours for 4 days;The most affected age and gender, comorbidities and laboratory abnormalities are analyzed, as well as improvement in inflammatory and oxygenation indices measured by pulse oximetry and SAFI (SpO2/FiO2), finally the outcome of the patients and the presence of adverse events. Results. 80 patients for each group, the most affected gender was male;the average age in the PTIC group was 51 years and in the baricitinib group it was 56 years;the main comorbidities were obesity, diabetes and hypertension in both groups;the decrease in acute phase reactants such as CRP, D-dimer and ferritin was greater in the PTIC group compared to the baricitinib group, the latter drug requiring a regimen of more days to achieve the objectives of the first drug (PTIC 7 days and baricitinib 14 days);Similarly, in oxygenation measured, the PTIC group reached goals in less time compared to the baricitinib group, which required twice as many days of treatment to achieve adequate oxygenation;Regarding the outcomes, there was a higher mortality in the baricitinib group compared to the PTIC group (6.25% vs 3.75%). Regarding adverse events reported for the PTIC group, they were minor and related to the intramuscular administration of the drug in 7 patients, while in the baricitinib group, 5 patients were reported with added bacterial pneumonia. Conclusion. Polymerized type I collagen has anti-inflammatory and immunomodulatory potential similar to baricitinib in cases of moderate to severe COVID-19, even reaching treatment goals in less time both in inflammatory indices and in oxygenation indices.
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Background: One of the main complications of Covid-19 are the thrombotic events reported with different incidences in the different case series Aims: To identify the incidence of thrombotic events in patients affected by Covid-19 in a general hospital in Veracruz, Mexico during April to October 2020. Method(s): Descriptive and retrospective study in which the thrombotic events presented by patients who suffered from Covid-19 during the period from April to October 2020 are analyzed. Result(s): Data from 1,212 patients diagnosed with Covid-19 are included, 641 (53%) men and 571 (47%) women, with a mean age of 49 years. 663 (54.7%) patients suffered from some chronic disease, systemic arterial hypertension was the most common comorbidity (29.2%), followed by diabetes (29.1%), obesity (13.9%), cardiovascular disease (5.4%), asthma (4.5 %), chronic kidney disease (3.8%) and COPD (2.1%). Six cases with various thrombotic events (50% venous and 50% arterial) were identified, predominantly in women (66%) and with mild Covid-19 (66%), of which 1 had a poor prognosis (severe Covid). The incidence of thrombotic events was 0.5% in this case series. Conclusion(s): Thrombotic events, although of low incidence, should always be taken into account during the follow-up of patients with both mild and severe Covid-19, since they add greater morbidity and mortality. (Table Presented).
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Background. A large number of viral infections are characterized by the presence of cutaneous manifestations. Multiple dermatological manifestations have been observed in patients with COVID-19. Dermatological lesions in patients infected by SARS-CoV-2 such as livedo reticularis, rash and vascular lesions may represent manifestations of secondary phenomena such as paraviral rashes or by participation of the innate or adaptive immune system that cause vasodilation, vascular leakage or procoagulant effects Methods. Descriptive and observational study, adult patients with COVID-19 pneumonia were selected, confirmed by RT-PCR and chest CT. General symptoms, hematic cytometry results, pneumonia severity, prognosis as well as dermatological manifestations are characterized. Results. 100 patients were entered into the study, with an average age of 49.4 years, 54% male. The general symptoms with the highest incidence were: fever, cough and dyspnea characteristic of SARS-CoV-2 infection, followed by chest pain, headache, anosmia and dysgeusia. The main alteration of the hemogram was lymphopenia, no leukopenia or plaquetopenia was demonstrated. 54% of those affected had mild pneumonia, the rest severe pneumonia. 75% progressed towards improvement and 25% died. Among the dermatological manifestations identified, all occurred in cases with severe pneumonia, the one with the highest incidence was the morbilliform viral exanthema in 18%, the presence of diffuse partial alopecia in 7% as well as manifestations of lividity and maceration in 1%. Regarding alopecia, in 6% it was reversible androgenetic alopecia, having manifested during the acute stage of pneumonia (all men), in 1% it presented alopecia areata (male) that has been persistent beyond the acute phase and in frank recovery Demographic and clinical variables Conclusion. The incidence of dermatological manifestations is low in this study population, the most frequent being the morbilliform viral exanthema expected in a virus, however they present manifestations of low incidence such as reversible androgenetic alopecia associated with severity of the disease, a finding that has been documented recently as a manifestation associated with COVID-19.
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Background. Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods. Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results. We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/ mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134;Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0;the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Conclusion. Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.
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Background : Patients affected by COVID-19 are at risk of various venous and arterial thrombotic events, as well as embolic risks, the risk can vary from 17% to 78% according to the different published series. therefore, thromboprophylaxis must be imperative. Aims : To assess the use of rivaroxaban as thromboprophylaxis in recovered COVID-19 patients who are at thrombotic risk Methods : Descriptive and analytical study in patients who presented pneumonia due to COVID-19 in April and May 2020, who received LMWH during their hospital stay and at discharge with rivaroxaban 10 mg/day for 2 months. D-dimer was measured at the beginning of the study and 1 month after discharge. Thrombotic or hemorrhagic episodes are controlled after 1 and 2 months of treatment (June -July 2020). Results : 50 patients, women 40% and men 60%, with a median age of 42.9 years. 64% had mild pneumonia and 36% had severe pneumonia, mean initial D-dimer 556.5 ng/ml, 56% had D-dimer ≥ 500 ng/ ml at the time of hospital admission. Baseline D-dimer values were significantly higher in severe pneumonia. In the follow-up at one and two months, we found that D-dimer values were significantly higher among patients with severe pneumonia and also, in this group of patients, the percentage of patients with D-dimer levels ≥ 500 ng/mL in the first month of follow-up, was significantly higher in the group of patients who were hospitalized for severe pneumonia. During the first month of follow-up, there was a thrombotic event and a hemorrhagic event in the group of patients with severe pneumonia;By the second month of follow-up, there was a hemorrhagic event in the group with mild pneumonia, but this difference in frequencies was not statistically significant. TABLE 1 Variables stratified by type of pneumonia Conclusions : The incidence of thrombotic and hemorrhagic events was low, so the thromboprophylaxis scheme used in patients with recovered pneumonia due to COVID-19 is recommended. Rivaroxaban is safe to use like thromboprophylaxis.
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Background: Different indices have been devised that attempt to correlate the severity of the symptoms and predict mortality mainly in septic states and inflammation, with important results that validate their usefulness. In the present pandemic, to date, no indices have been used in severe cases of Covid- 19 that can predict the outcome. Result of the measurement of demographic and clinical variables Methods: It includes a cohort of patients with pneumonia confirmed by Sars Cov 2 PCR-RT, treated at the Veracruz Norte branch of the Instituto Mexicano del Seguro Social from April to May 2020, analyzing the neutrophil-lymphocyte, platelet-lymphocyte and immunity-systemic inflammation indices. Results: We included 100 patients, 54 (54%) women and 46 (46%) men, with a mean age of 49.4 ± 19.3 years. The mean of leukocytes was 10,103.0 ± 4,289.0 cel / mm3, neutrophils 8,509.3 ± 4,216.0 cel / mm3 and lymphocytes of 1,112.7 ± 585.4 cel / mm3;Regarding the hematological indices used to measure severity, we found that the mean of the INL was 10.7 ± 10.9, that of the IPL was 290.1 ± 229.2 and that of the IIIS was 2.6 ± 3.4 x 109. Regarding the type of pneumonia, 54 (54%) had mild pneumonia and 46 (46%) had severe pneumonia. Regarding hospital outcomes, 75 (75%) of the patients were discharged due to clinical improvement and 25 (25%) of the patients died during the hospital stay. The mean age was significantly higher in the group of patients who died during the hospital stay (45.9 ± 18.6 VS 60.0 ± 17.5 years, p = 0.001), the proportion of women who died was higher and tended to be statistically significant. The mean INL was 20.4 ± 16.9 in patients who died VS 7.5 ± 4.9 in patients who improved (p = 0.001). The mean IPL was 417.1 ± 379.7 in patients who died VS 247.7 ± 127.4 in patients who had improvement;p = 0.038. Finally, the mean IIIS was significantly higher in patients who died VS patients who had clinical improvement (4.8 ± 6.1 VS 1.9 ± 1.2;p = 0.030, respectively). In the correlation analysis, high and significant r were found in the three indices. Conclusion: Neutrophil-lymphocyte, platelet-lymphocyte and systemic immunity- inflammation indices in patients with Covid-19 pneumonia can be used as predictors of severity and predict hospital outcome.