D dimer concentration variation as predictor of mortality in patients with COVID-19.

OBJECTIVE: To evaluate the D dimer levels after the admission of patients with COVID-19 and to stablish cut-off points that are associated with more complications. MATERIALS AND METHODS: Prospective study with inpatients with severity criteria that compared the D dimer levels at admission and 48 hours later;mean D dimer concentrations were evaluated and cut-off points were stablished. RESULTS: Considering D dimer 48 hours after admission, patients that did not survive had mean levels of 5380 ng/mL versus 1811.3 ng/mL among those that survived (p < 0.005);a cut-off point of 1725 ng/mL was stablished that predicted mortality with sensitivity of 85.7%, specificity of 63%, and negative predictive value of 89.4%. In the group of patients that required invasive mechanical ventilation, mean D dimer was 4672.2 ng/mL versus 1652.6 ng/mL in those who did not need it (p < 0.001) and a cut-off point of 1770 ng/mL was calculated which predicted invasive mechanical ventilation with sensitivity of 84.6%, specificity of 63%, and negative predictive value of 89.4%. CONCLUSIONS: D dimer concentrations after 48 hours of admission can discard the development of complications, so its determination may be useful for determining the adverse evolution risk. (English) [ FROM AUTHOR] OBJETIVO: Evaluar las concentraciones de dímero D posteriores al ingreso de pacientes con COVID-19 y estipular puntos de corte que se asocien con complicaciones. MATERIALES Y MÉTODOS: Estudio prospectivo efectuado en pacientes hospitalizados con criterios de severidad que comparó las concentraciones de dímero D al ingreso y a las 48 horas;se compararon las medias de dímero D y se estipularon puntos de corte. RESULTADOS: Respecto al dímero D a las 48 horas, los pacientes que fallecieron tuvieron una media de 5380 ng/mL, a diferencia de los que no con 1811.3 ng/mL (p < 0.005);se estableció un punto de corte de 1725 ng/mL para predecir mortalidad con sensibilidad del 85.7%, especificidad del 63% y valor predictivo negativo del 89.4%. La media de dímero D de los que requirieron ventilación mecánica invasiva fue de 4672.2 ng/mL contra 1652.6 ng/mL (p < 0.001) y el punto de corte de 1770 ng/mL predice ventilación mecánica invasiva con sensibilidad del 84.6%, especificidad del 63% y valor predictivo negativo del 89.4%. CONCLUSIONES: Las concentraciones de dímero D a las 48 horas de ingreso en pacientes con COVID-19 pueden descartar la aparición de complicaciones, por lo que este marcador es útil para determinar el riesgo de evoluciones adversas. (Spanish) [ FROM AUTHOR] Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

SARS-CoV-2 RNA and antibody detection in human milk from a prospective multicenter study in Spain (preprint)

BackgroundDuring the COVID-19 pandemic in 2020, breastfeeding in women positive for SARS-CoV-2 was compromised due to contradictory data regarding potential viral transmission. However, growing evidence confirms the relevant role of breast milk in providing passive immunity by generating and transmitting specific antibodies against the virus. Thus, our study aimed to develop and validate a specific protocol to detect SARS-CoV-2 in breast milk matrix as well as to determine the impact of maternal SARS-CoV-2 infection on presence, concentration, and persistence of specific SARS-CoV-2 antibodies. Study design/MethodsA prospective multicenter longitudinal study in Spain was carried out from April to December 2020. A total of 60 mothers with SARS-CoV-2 infection and/or recovered from COVID-19 were included (n=52 PCR-diagnosed and n=8 seropositive). Data from maternal-infant clinical records and symptomatology were collected. A specific protocol was validated to detect SARS-CoV-2 RNA in breast milk, targeting the N1 region of the nucleocapsid gene and the envelope (E) gene. Presence and levels of SARS-CoV-2 specific immunoglobulins (Igs) -IgA, IgG, and IgM-in breast milk samples from COVID-19 patients and from 13 women before the pandemic were also evaluated. ResultsAll breast milk samples showed negative results for SARS-CoV-2 RNA presence. We observed high intra- and inter-individual variability in the antibody response to the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein for each of the three isotypes IgA, IgM and IgG. Protease domain (MPro) antibodies were also detected in milk. In general, 82.9 % of the milk samples were positive for at least one of the three antibody isotypes, being 52.86 % of those positive for all three Igs. Positivity rate for IgA was relatively stable over time (65.2 - 87.5 %), whereas it raised continuously for IgG (47.8 % the first ten days to 87.5 % from day 41 up to day 206 post-PCR confirmation). ConclusionsConsidering the lack of evidence for SARS-CoV-2 transmission through breast milk, our study confirms the safety of breastfeeding practices and highlights the relevance of virus-specific SARS-CoV-2 antibody transfer, that would provide passive immunity to breastfed infants and protect them against COVID-19 disease. This study provides crucial data to support official breastfeeding recommendations based on scientific evidence.

Global Impunity Index 2020 (GII 2020). Impunity Levels in the World (preprint)

The goal of the Global Impunity Index (GII) is to make visible, in quantitative terms, the impunity worldwide and its relationship with other complex phenomena such as inequality, corruption, and violence. • The GII is the most important international academic effort to measure—in comparative terms—levels of impunity worldwide. The GII’s quantitative methodology focuses on measuring the structure and operation of the security and justice systems, as well as respect for human rights in each country. • Based on the GII statistical results (and open access to our databases), researchers in universities, the media, civil society organizations, international agencies, global companies and the general public may carry out their own qualitative analysis by dimension, focused on each country and region. • From our first report, dated 2015, we have highlighted that measuring impunity is in itself very important; however, high impunity rates may also be related with social and economic inequality, access to justice and a weak Rule of Law, insufficient economic development, difficulties in attracting new sources of foreign investment and tourism, and, equally important, increased human rights violations. • The GII-2020 does not measure the impact of the COVID-19 pandemic on impunity. However, given the link between impunity and inequality it would be important to analyze how the pandemic may exacerbate insecurity and violence and further restrict access to justice and other public goods. If so, those regions with high levels of marginalization and lower levels of progress in the Rule of Law, as it is the case of Latin America, Africa, Central Asia, and Asia-Pacific would face a negative impact.