Cardiac troponin as major mortality risk factor in SARS-CoV-2 infection

Background: The COVID-19 pandemic has collapsed the health system, making it necessary to identify factors that help to predict and stratify the risk of patients on admission. Many factors have been used in clinical practice, but the scientific evidence available to date is limited. Purpose: The objective of this study was to identify clinical and analytical predictors of 30-day mortality in SARS-CoV- 2 infection. Methods: A total of 1708 consecutive patients hospitalized in our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Cox regression analysis was performed to assess whether sex and race, smoking habit, chronic kidney disease, D-dimer, heart disease (defined as a history of acute myocardial infarction, heart failure, atrial fibrillation) and troponin at admission (cTnI levels greater than the 99th percentile of a healthy population) were related to the 30-day mortality of these patients. Results: Baseline characteristic are shown in the table 1. Median hospital length of stay was 9 days (IQR 5 to 16). A total of 338 patients (19.8%) died within 30 days and 153 (9.0%) were admitted to the ICU. Furthermore, 52.1% of patients developed ARDS and 9.3% required non-invasive ventilation. A troponin at admission greater than the 99th percentile of a healthy population (HR 1.9, 95% CI 1.4-2.5, p<0.001) and a Charlson Comorbidity Index above 4 (HR 2.6, 95% CI 1.9-3.6, p<0.001) were independent predictors of 30-day mortality in patients admitted due to COVID- 19 infection. Conclusions: At admission time, troponin values and patient comorbidity (Charlson Comorbidity Index ≥4) can be useful as prognostic markers of SARS-CoV-2 infection. (Figure Presented).

Multiple myeloma and COVID-19

BACKGROUND: The current COVID-19 pandemic modifies current immunosuppressive treatment guidelines against several nephrological diseases. CLINICAL CASE: A 69-year-old female patient. Her current condition began with a nonspecific clinical picture of asthenia, adynamia, abdominal pain, nausea, and emesis. Upon admission to the service, serum sodium of 111 was found and correction of hydro-electrolytic imbalance was performed. Serum creatinine of 4.41 was found with an estimated glomerular filtration rate of 9.6 mL/min/1.73m2, in addition to hemoglobin anemia of 6.3 mg/dL. A TNK catheter was inserted in the operating room. While in the peritoneal dialysis unit, patient regained kidney function with a filtration rate of 20 mL/min. Patient was then readmitted to the internal medicine floor, where anemia and persistent hypercalcemia stood out. After being evaluated by the Hematology service, final diagnosis was multiple myeloma. Shortly before starting treatment, patient started exhibiting fever, cough, and headache. Chest tomography provided data suggestive of COVID-19. CONCLUSIONS: The clinical manifestations of multiple myeloma and chronic kidney disease are very varied, so the diagnostic approach is very important to avoid wrong diagnoses.

Information Security Practices in Times of Pandemic. Case Universidad del Valle, Tulua campus

The pandemic generated by COVID-19 implied massive confinement strategies as an emergency public response within the framework of the police law to combat the level of contagion. Additionally, this situation implied changing the different forms of social interaction such as education, health care and employment. In a directly proportional way, crime took advantage of the situation to intensify electronic crimes such as phishing, fake news and, in general, activities such as malware injection. The purpose of the research was to identify information security practices in a university community by means of a survey, under a mixed research approach that considered, among other variables, the pandemic as a precursor of new digital hygiene habits. Among the most representative results, it is highlighted that both professors and students have an acceptable knowledge of information security, despite not receiving significant training by governmental entities such as the National Police. Finally, it is concluded that institutional efforts to combat this type of crime have not been sufficient and therefore there is a lack of awareness strategies to promote better digital hygiene.

Mortality from COVID-19 and late diagnosis in the early stages of the pandemic in Bolívar-Colombia

Introduction: Patients who died from COVID-19 at the beginning of the pandemic show particular clinical-epidemiological characteristics and their identification as well as the aspects associated with the diagnosis are fundamental for the implementation of public health strategies that allow the sanitary protection of the most vulnerable groups. Objective: To determine the clinical-epidemiological characteristics of patients who died from COVID-19 and its association with late diagnosis in the early stages of the pandemic in the department of Bolívar-Colombia. Material and Methods: Descriptive cross-sectional study with a sample of 51 patients who died from COVID-19;the relative frequency of the clinical-epidemiological risk factors of these patients was calculated and a bivariate analysis was performed to show the association with the possibility of being diagnosed after death, using the disparity ratio (OR) with its confidence interval. Results: The 47,2 % of the diagnoses were made after death;the average between the onset of symptoms and death was approximately 13 days, in which heart disease (58,5 %) and hypertension (35,8 %) were evidenced as important comorbidities. The association with diagnosis after death is related to the cases reported in April and May (p = 0.03), being older than 80 years (p = 0.03) and having malnutrition (p = 0.04). Conclusions: In the context of the department of Bolívar, failures are observed in the timely diagnosis of some vulnerable population groups, thus special attention should be paid to patients with heart disease to avoid high mortality.

Lung compliance clusters of COVID-ARDS identify distinct subgroups with increased mortality

INTRODUCTION: SARS-CoV-2 has been associated with high rates of severe hypoxemic respiratory failure. Severe COVID-19 is characterized by rapid development of acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. ARDS is considered a heterogeneous disorder and the presence of a uniform inciting agent with SARS-CoV-2 allows us to investigate subphenotypes of ARDS. We hypothesized that subphenotypes based on early lung compliance in patients with COVID-ARDS may be associated with disease outcomes including mortality. We sought to test this hypothesis in patients with COVID-ARDS. METHODS: Patients in the Yale New Haven Health System from 3/15/2020 to 5/14/2020 were included if they had a positive SARS-CoV-2 test and required intubation. After exclusion for missing data or transfer from satellite facilities, 140 of patients were included for analysis. Clinical, demographic, ventilator, and laboratory parameters were abstracted from the EMR. To identify ARDS subphenotypes, we implemented unsupervised clustering using a partitioning around medoids (PAM) algorithm on average compliance over the three days following intubation. Clustering was also performed on the NHLBI ALVEOLI cohort for use as comparator. RESULTS: Patients received a median of 6.2 cc/kg of IBW on day 1 and 6.2 on day 3. Plateau pressure was less than 30cm H2O in 81% patients and driving pressure was less than 15 in 69% of patients. Median lung compliances were day 1: 30.4 mL/cm H2O [23.0-36.1];day 2: 28.7 mL/cm H2O [21.6-36.8];and day 3: 29.7 mL/cm H2O [23.2-37.6]. By Berlin criteria, 21% of patients had mild ARDS, 46% moderate, and 26% were severe. 61% of patients were proned. Using PAM, three distinct clusters based on compliance were identified (low [LC], medium [MC], and high [HC]). Median day 1 compliance in HC group was 38.0 mL/cm H2O [33.1-44.2], 29.3 [25.2-32.3] in MC, and 19.5 mL/cm H2O [16.7-22.8] in LC. Compared to the HC group, there were no differences in PEEP, day 1 P/F ratio or tidal volume, and ventilatory ratio. HC group had higher P/F ratio day 3, lower tidal volume day 3, and lower driving pressures. There were no differences in biomarkers, comorbidities, vasopressors, paralytics, or sedatives between groups. However, Kaplan-Meier plot demonstrated higher mortality in the HC group. Cox regression model demonstrated persistence of higher mortality in the HC compared to MC group. These differences were not present in the ALVEOLI cohort. CONCLUSION: In COVID-ARDS, a subphenotype characterized by early high compliance was associated with higher mortality when compared to non-COVIDARDS patients.

Preserving innate memory to overcomeSARS-CoV-2 infection through the mevalonate pathway

Background: Easily accessible therapies have been proposed to treat SARS-CoV-2 infection. Given that themevalonate pathway is critical in preventing nonspecific inflammation, events that interfere in this pathway inmononuclear or epithelial lung cells might determine the outcome of infected patients. Based on its mechanism ofaction, we hypothesize that in patients with metastatic cancer (MC), zoledronic acid (ZA) may influence the severityof COVID-19 disease. Methods: In silico analysis compared normalized expression levels of prenylation-related genes in mononuclearand epithelial cells, between infected and noninfected SARS-CoV and SARS-CoV-2 samples, from available GEOdatasets. RNA analysis was done using R v3.6.3. Counts were normalized with EdgeR, and ggpubr package and was used to compute t-tests. For analyzing samples from GSE150728, Partek Flow was used to align and normalizereads from single-cell RNA. Results: Analysis of data from the 2003 SARS outbreak (GSE1739) showed that PBMCs isolated from infectedpatients expressed lower levels of HMGCR, FNTA, COX10, and PGGT1B (<0.05). In vitro results from SARS-CoV-infected Calu-3 cells (GSE17400) showed a trend of downregulation of MVK, RABGGTA, FDFT1, FNTA, andRAB27A (n=3/group). Next, we analyzed the transcriptional response to SARS-CoV-2 in Calu-3 and A549-infectedcells in vitro (GSE147507). Differential downregulation of FNTA, MVK, HMGCR, and FDPS (p<0.05), and onlyupregulation of FNTA and PGGT1B (p<0.05), was observed in Calu-3 cells. The same dataset offered expressiondata from autopsy-derived, COVID-19-infected bronchial tissue from 2 patients. Here, we found that FDFT1, FNTA, HMGCR, RABGGTA, and FDPS were downregulated >1.5-fold as compared to their healthy controls. Infected A549cells showed decreased levels of MVK and RABGGTA (p<0.05). In SARS-CoV-2-infected A549 cells, ACE2transduction upregulated RABGGTA, HMGCR, COX10, and RAB27B when compared to non-transduced infectedcells. This suggested that downregulation of prenylation might occur upon binding of the viral spike protein to theACE2 receptor. Finally, we analyzed single-cell RNA-seq transcripts from uninfected PBMCs (no SARS reads)isolated from acutely ill SARS-CoV-2 patients (GSE150728). Here, we found no differences in the expression of anyof these genes. This suggests that disruption of the mevalonate pathway may only account to infected cells. Conclusion: In light of these findings, coronaviruses may hijack the mevalonate pathway and induce autoimmunity.Response to coronavirus infection may differ in patients with MC under treatment with ZA, statins, or othersubstances that interfere with prenylation-mediated small vesicle trafficking (i.e., hydroxychloroquine, nicotine).Hence, studies that investigate SARS-CoV-2 disease severity in patients under treatment with ZA are stronglyneeded.

Liver implications during the covid-19 pandemic

The infection generated by the novel coronavirus SARS-CoV-2, named Coronavirus Disease 2019 (COVID-19) emerged late December of 2019 in China. It is currently categorized as a pandemic by the World Health Organization. Studies have focused on cardiac, pulmonary, and renal effects of this infection, but liver test abnormalities have also been documented. This alteration may be a consequence of viral hepatitis, pharmacological toxicity, inflammation, or shock. It is also considered a marker of prognosis and severity of the disease. The impact of SARS-CoV-2 infection in patients with pre-existing liver disease or liver transplant recipients is unclear, and different hypotheses exist regarding the higher or lower risk of severe disease and decompensation of the underlying disease. © 2020 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva.