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Purpose: Cytotoxic T-lymphocyte antigen-4 (CTLA-4) checkpoint pathway may related to hemophagocytic lymphohistiocytosis (HLH);the association between COVID-19 and HLH is still debated. Our aim is to describe a CTLA-4 deficient patient presenting with leishmania and EBV triggered-HLH, and the clinical and immune responses to SARS-CoV-2 generated during her follow-up Methods: NK-cytotoxic function assessed by 51Cr-K562 lytic assay;lymphocyte subsets, perforin expression, NK-cell degranulation and coexpression of CD25 and CD134 on memory T-cells by flow cytometry Whole exome sequencing with Sanger confirmation Results: A 16-year-old female was first admitted in March 2020 with severe thrombopenia and readmitted 3 months later to study polyadenopathy. In October 2020, she suffered a mild COVID-19 mild (ageusia, anosmia) showing positive IgG anti-SARS-CoV-2-Spike (694.0 UA/mL) 6 months after the infection. In March 2021 -during her third hospital admission- she fullfilled HLH criteria along with leishmaniasis infection and EBV reactivation. Later on we have found granulomatous-lymphocytic interstitial lung disease (GLILD). Normal serum immunoglobulins, weakly positive ASMA and anti-thyroglobulin autoantibodies were detected. Circulating lymphocytes and HLHoriented studies were all normal. A new, 'de novo' heterozygous missense mutation c.425G>A (p.Gly142Asp) in CTLA-4 was identified affecting a conserved domain of the protein and probably pathogenic according to our in silico results (PolyPhen). Following both the second (June 2021) and third SARS-CoV-2 BNT162b2 vaccine immunization specific IgG>40.000 UA/mL and positive anti-SARS-CoV-2-Spike memory CD4+ T-cell responses were detected Conclusion(s): We report a young patient with a new heterozygous germline mutation in CTLA-4 associating HLH induced by common triggers (leishmania, EBV) but no by SARS-CoV-2 infection. This case does not support a relevant role of SARS-Cov-2 as potential etiological trigger of HLH. Our patient has been able to generate robust specific responses against SARS-CoV-2, while other reported insufficient CTLA-4 patients show suboptimal antibody responses to SARS-CoV-2 probably due to their stronger immunosuppressor therapies.
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Guanajuato state in Mexico has high frequency of confirmed cases of COVID-19. Health-care workers are the most exposed to contagion due to contact with patients infected by SARS-CoV-2. The objective was to know the seroprevalence of antibodies (IgG) anti-SARS-CoV-2 in health-care workers from Secretary of Health from Guanajuato State. It was a cross-sectional, retrolective study, using database from the ENSERO-COVID program. It was recollected data about exposure in work and in community by contact with confirmed cases of COVID-19. The anti-SARS-CoV IgG antibody titer was determined, considering 1.4 or higher as positive. It used Chi squared test to show relationship between variables, Z for two proportions to test hypotheses and logistic regression for show the effect of exposure and test positive for antibodies. 4,047 registries were reviewed, 376 (9.29%) were positive for the presence of SARSCoV-2 antibodies. There is an association between the type of work unit (type determined by hospitalizing COVID-19 patients or not) with seropositivity (P <0.05). There was no effect of performance areas to be seropositive. Community exposure had an effect on being seropositive OR = 1.44 (1.17 - 1.79). Training in the proper use of personal protective equipment had a protective effect on being seropositive with OR = 0.79 (0.64 -0.99). Exposure in the community to a confirmed case to SARS-CoV-2 is found to have a significant association with the presence of anti-SARS-CoV-2 antibodies. Training in the proper use of personal protection equipment is a protector against SARS-CoV-2 infection. There is a significant association between the type of unit and the presence of anti-SARS-CoV-2 antibodies. Given the increase in the number of confirmed cases of SARS-CoV-2, it is vitally important that health workers adequately protect themselves both at the community and workplace level. Copyright © 2022 Oriental Scientific Publishing Company. All rights reserved.
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INTRODUCTION: The rate of pediatric patients diagnosed with Sars Cov 2 has increased since the early stages of the pandemic. Gastrointestinal symptoms have been demonstrated to be relatively common in pediatric COVID-19 patients as well as severe complications like PIMS syndrome because of the expression of ACE II in different areas of the digestive tract which serves as a receptor for their entry and infection in the body. During the last months of the omicron variant wave, we observed some gastrointestinal conditions in pediatric patients days after the resolution of the Sars Cov 2 acute infection period, sparking our interest to execute further research and analysis. OBJECTIVE(S): Describe the presence of functional gastrointestinal disorders as a post-covid infection sequel METHODS: We performed a descriptive, cross-sectional, observational, retrospective study, were we recollected the clinical and epidemiological data from the medical records of pediatric patients with a history of Sars cov-2 infection confirmed with positive PCR or antigen (sars cov-2) tests at Hospital Angeles Lomas, Mexico City. We included children from 6 months up to 16 years of age, who presented functional gastrointestinal disorders at a minimum 15 days after the infection that fulfilled Rome IV criteria. We evaluated the frequency and proportion of the qualitative variables;we obtained the arithmetic mean and the standard deviation for the quantitative variables with normal distribution RESULTS: We included data from 30 patients with confirmed covid 19 diseases by positive pcr or antigen (sars cov-2) tests, with a mean age 5.327 +/- 3.8 years Min: 7 months Max: 16 years, with a female predominance of 56.7% vs 43% male patients. During the acute infection by covid, 20% presented respiratory symptoms, 13.3% gastrointestinal symptoms, 36.7% only fever, 3.3% dysgeusia and 26.7% were asymptomatic. Adequate nutritional status was detected in 93% of the patients. The mean days the patients presented manifestations was 32 +/- 14 days, at a minimum 15 days, with a maximum of 63 days, being the most frequent functional gastrointestinal disorders: abdominal pain 90%, bloating 76%, vomit and reflux 33%, diarrhea 30%, constipation 26.7%. There was no weight loss in the patients, the appropriate treatment was given for each case. There was no complication in 90% of the patients, 10% presented acute abdominal pain and were transferred to the emergency room, 1 patient was diagnosed with appendicitis and 2 patients with mesenteric lymphadenitis. CONCLUSION Special attention must be paid to toddler and preschooler patients with Sars Cov 2 infection, regardless of the clinical manifestation in acute infections, mild or asymptomatic, functional gastrointestinal disorders may occur in the first 2 months after a positive PCR test. The ileum and the colon are places in which there is a greater expression of the ACE II, so when the enterocytes are invaded by SARS CoV-2, they may produce alterations in absorption and other mechanisms that could be the cause of these consequences. It is of vital importance that all pediatricians are aware of the consequences of the disease to prevent misdiagnosis.
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This research evaluated the effect of the COVID-19 social isolation orders on traffic volume, traffic violations and road crashes in the city of Fortaleza, Brazil. Using data from automated traffic enforcement cameras, a reduction in traffic volume between 30% and 50% was observed during the social isolation period. However, even with the traffic volume reduction, the absolute number of speeding and red-light running violations were 13% and 26% higher than prepandemic levels, respectively. When controlling for traffic exposure, the violation rates increased by more than 100%. After social isolation restrictions were lifted and the traffic volumes returned to prepandemic levels, both traffic violations and traffic violation rates remained at elevated levels (14% to 44% higher than prepandemic levels), possibly related to a nationwide decision that delayed the issuing of violation tickets. Using an interrupted time-series approach and segmented Poisson and negative binomial regression models, it was found that the fatal crash rate was 1.66 times greater during the period of social isolation compared to the prepandemic levels but returned to prepandemic levels following the removal of the social isolation restrictions. A significant reduction in injury crash rate was observed during and following the period of social isolation restrictions;however, the authors hypothesize that this is related to injury crash underreporting during the pandemic. © 2022 American Society of Civil Engineers.
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INTRODUCTION: the impact of maternal SARS-CoV2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV2 infection, as well as the implemented measures following recommendations from the Sociedad Espanola de Neonatologia. METHODS: observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR:37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV2 transmission is low when complying to the recommendations issued by Sociedad Espanola de Neonatologia, allowing rooming-in and promoting breastfeeding.
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The Severe Acute Respiratory Syndrome Coronavirus 2, first detected in Wuhan, China, in 2019, had spread all over the world. It has caused the COVID-19 pandemic. Nowadays, there are effective and safe vaccines proven against this virus. The goal of this study was to verify it among health-care workers from the Institute of Public Health from Guanajuato State who received the BioNTech/Pfizer vaccine. For this purpose, we designed a quantitative cross-sectional study. The database was obtained from a previous strategy program by the Institute of Public Health from Guanajuato State called ENSERO-COVID. The available data consisted of two chemiluminescence measures of the IgG anti-Spike antibodies after one and six months of the BioNTech/Pfizer vaccine two doses application. The survey also included self-reported reactions to this vaccine. Frequency tables are presented for descriptive purposes. We performed the chi-square test, the z test for proportions, and the t-test for comparisons. Also, two linear regression models were fitted between the first and second chemiluminescence levels stratifying by prior infection by SARS-CoV-2. The database consisted of 177 records. Of them, 45 (25.4%) were positive for SARS-CoV-2 before vaccination. Only one person did not react to the two doses of vaccine application. Most of the self-reported reactions ceased in a short period -less than three days-. The differences observed, regarding chemiluminescence levels, between those with and without prior infection by SARS-CoV-2 were not statistically significant. More analyses are required to assess the long-term effects of the BioNTech/Pfizer ® vaccine.
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Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.
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The development of DNA-sensing platforms based on new synthetized Methylene Blue functionalized carbon nanodots combined with different shape gold nanostructures (AuNs), as a new pathway to develop a selective and sensitive methodology for SARS-CoV-2 detection is presented. A mixture of gold nanoparticles and gold nanotriangles have been synthetized to modify disposable electrodes that act as an enhanced nanostructured electrochemical surface for DNA probe immobilization. On the other hand, modified carbon nanodots prepared a la carte to contain Methylene Blue (MB-CDs) are used as electrochemical indicators of the hybridization event. These MB-CDs, due to their structure, are able to interact differently with double and single-stranded DNA molecules. Based on this strategy, target sequences of the SARS-CoV-2 virus have been detected in a straightforward way and rapidly with a detection limit of 2.00 aM. Moreover, this platform allows the detection of the SARS-CoV-2 sequence in the presence of other viruses, and also a single nucleotide polymorphism (SNPs). The developed approach has been tested directly on RNA obtained from nasopharyngeal samples from COVID-19 patients, avoiding any amplification process. The results agree well with those obtained by RT-qPCR or reverse transcription quantitative polymerase chain reaction technique.
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Background: Knowledge about SARS-CoV2 infection in pregnancy and exposed newborns is deficient. We performed a longitudinal analysis of innate immune system status and determined soluble cytokines of women infected with SARS-CoV2 during pregnancy and their newborns Methods: Women with confirmed SARS-CoV2 infection (RT-PCR+ or SARS-CoV2 anti-IgM/IgG+) (COVID MOTHER group, CM n=29, median age of 31 years) and their SARS-CoV2 exposed uninfected newborns were recruited from Hospital Gregorio Marañón, Spain. Peripheral blood mononuclear cells (PBMCs), cord cells and plasma were collected at birth and 6 months later (n=15). The immunophenotyping of innate components (natural killer cells [NK] and monocytes) was studied on cryopreserved PBMCs and cord cells by multiparametric flow cytometry. Up to 4 soluble pro/anti-inflammatory cytokines were assessed in plasma and cord plasma by ELISA assay. CM was compared to a healthy non-SARS-CoV2 infected mothers' group matched by age (SARS-CoV2 PCR-and SARS-CoV2 anti-IgM/IgG-)(Uninfected Mothers, UM n=16) and their newborns (n=16) Results: On NK cell assays, CM show at baseline lower percentage of CD16++ subset, higher NKG2D and lower NKG2A expression on CD16++ and CD56++ subsets and reduced CD57 expression compared to UM;proportion of CD16++ subset and percentage of NKG2D reverted after 6 months(A). Regarding monocytes, CM show increased levels of CD62L and decreased CD49d expression on classical subset, elevated intermediate monocytes proportion and decreased CD40 expression on patrolling subset(B). No differences were found 6 months later. No newborn was infected by SARS-CoV2 and the phenotype analyzed on cord cells shows lower frequency of NK subsets compared with unexposed children and increased CD16++ subset after 6 months(C). In monocytes distribution, exposed children present lower frequency of total monocytes and its subsets than unexposed. Classical monocytes show significant changes at follow-up time-point(D). Increased TNFα and IL10 levels were found on CM compared to UM. Strong and direct correlations were observed between the age and IL6(E). No differences were observed in soluble cytokine levels comparing both groups of newborns Conclusion: SARS-CoV2 infection during pregnancy shows differences in activation, maturation and endothelial markers on innate immune system that could lead newborns clinical implications at birth. However, altered cell proportions and phenotypes found at SARS-CoV2 at birth time and on their exposed newborns is later reverted.
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Background: The objective of this study was to identify which air pollutants, atmospheric variables and health determinants could influence COVID-19 mortality in Spain. This study used information from 41 of the 52 provinces in Spain (from Feb. 1, to May 31, 2021). Generalized Linear Models (GLM) with Poisson link were carried out for the provinces, using the Rate of Mortality due to COVID-19 (CM) per 1,000,000 inhabitants as dependent variables, and average daily concentrations of PM10 and NO2 as independent variables. Meteorological variables included maximum daily temperature (Tmax) and average daily absolute humidity (HA). The GLM model controlled for trend, seasonalities and the autoregressive character of the series. Days with lags were established. The relative risk (RR) was calculated by increases of 10 g/m3 in PM10 and NO2 and by 1 â in the case of Tmax and 1 g/m3 in the case of HA. Later, a linear regression was carried out that included the social determinants of health. Results: Statistically significant associations were found between PM10, NO2 and the CM. These associations had a positive value. In the case of temperature and humidity, the associations had a negative value. PM10 being the variable that showed greater association, with the CM followed of NO2 in the majority of provinces. Anyone of the health determinants considered, could explain the differential geographic behavior. Conclusions: The role of PM10 is worth highlighting, as the chemical air pollutant for which there was a greater number of provinces in which it was associated with CM. The role of the meteorological variables-temperature and HA-was much less compared to that of the air pollutants. None of the social determinants we proposed could explain the heterogeneous geographical distribution identified in this study. Supplementary Information: The online version contains supplementary material available at 10.1186/s12302-022-00617-z.
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This study aims to identify the combined role of environmental pollutants and atmospheric variables at short term on the rate of incidence (TIC) and on the hospital admission rate (TIHC) due to COVID-19 disease in Spain. This study used information from 41 of the 52 provinces of Spain (from Feb. 1, 2021 to May 31, 2021). Using TIC and TIHC as dependent variables, and average daily concentrations of PM10 and NO2 as independent variables. Meteorological variables included maximum daily temperature (Tmax) and average daily absolute humidity (HA). Generalized linear models (GLM) with Poisson link were carried out for each provinces The GLM model controlled for trend, seasonalities, and the autoregressive character of the series. Days with lags were established. The relative risk (RR) was calculated by increases of 10 µg/m3 in PM10 and NO2 and by 1 °C in the case of Tmax and 1 g/m3 in the case of HA. Later, a linear regression was carried out that included the social determinants of health. Statistically significant associations were found between PM10, NO2, and the rate of COVID-19 incidence. NO2 was the variable that showed greater association, both for TIC as well as for TIHC in the majority of provinces. Temperature and HA do not seem to have played an important role. The geographic distribution of RR in the studied provinces was very much heterogeneous. Some of the health determinants considered, including income per capita, presence of airports, average number of diesel cars per inhabitant, average number of nursing personnel, and homes under 30 m2 could explain the differential geographic behavior. As findings indicates, environmental factors only could modulate the incidence and severity of COVID-19. Moreover, the social determinants and public health measures could explain some patterns of geographically distribution founded.
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Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollution/analysis , COVID-19/epidemiology , Humans , Nitrogen Dioxide , Particulate Matter/analysis , Spain/epidemiologyABSTRACT
Introduction: During the present Sars cov-2 pandemic, pregnant women are considered high-risk group population due to a state of immune compromise. Previous knowledge regarding pregnant women and their newborns is rapidly changing as new covid discoveries are unraveled, paying special attention on newborns evolution during their first days of life. Objectives: To determine impact of Sars Cov2 infection on the expected birth weight of newborns of infected mothers. Methods: It is a descriptive, cross-sectional, observational and retrospective study involving the analysis of clinical records of patients from the infectiology service of the Hospital Español Mexico. The study includes newborns from mothers between the ages of 18 to 48 infected with Sars Cov2, confirmed by a PCR test. The study excludes patients with incomplete records. We evaluated the frequency and proportion of the qualitative variables;we obtained the arithmetic mean and the standard deviation for the quantitative variables with normal distribution. Results: Data included 36 patients from the infectology service between the months of March 2020 to April 2021, with positive PCR for sars cov 2, with a mean age of 34.28 ± 5.86 years, mainly presented the following comorbidities: : obesity in 27.8%, hypothyroidism 11.1%, diabetes 13.9%, gestational hypertension 13.9%. The principal symptoms presented by the mothers were respiratory in 19.4%, gastrointestinal 13.9%, asymptomatic presentation 47.2%. Newborns results were obtained with a mean gestational age of 37.3 ± 2.6, with a male predominance of 52.8%, with a mean birth weight of 2811.1 ± 616.7, height 47.64 ± 3.7. About 16.4% of the patients were premature, only 4 were admitted to the neonatal intensive care unit, due to sepsis, pediatric inflamatory multisystemic syndrome, and an intrauterine growth restriction. All the newborns had a negative PCR test despite the positive PCR of all the mothers Conclusion: Newborns from mothers infected with Sars cov 2, were born with appropriate weight for their gestational age. The immune system of newborn babies protects to have adequate nutrition during the gestational period, however, some presented inflammatory and vascular complications. Special emphasis should be done on maternal metabolic clinical history, such as obesity, metabolic syndrome, and hypothyroidism since these comorbidities can impact negatively in the prognosis of the infected mother and the newborn. It is very important to perform a nutritional screening during prenatal care for an adequate metabolic programming in early life in children.
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Introduction: The global spread of the SARS-CoV-2 virus has resulted in a worldwide pandemic with important socio-health repercussions. Current clinical experience and several published retrospective studies suggest that digestive symptoms are common in infected patients. [1][2] The aim of this study was to evaluate the frequency of gastrointestinal (GI) symptoms and complications in patients with COVID-19 disease managed on an outpatient basis. Aims & Methods: International, multicenter, prospective cohort study was conducted in 18 centers from Latin America, Asia, Africa and Europe. Subjects ≥18 years old, with COVID-19 disease, managed on an outpatient basis were included. Followed up period was 6 months. Baseline characteristics, comorbidities, GI symptoms or complications, hospital admission, ICU admission and mortality data were collected. A descriptive analysis of the study results was performed. A multivariate analysis was carried out, evaluating the association of GI symptoms and complications with age, baseline characteristics, comorbidity and COVID-19 treatments received. The adjusted Odd Ratio (ORa) was calculated assuming a significance level of p <0.05. Results: The preliminary analysis included a total of 436 patients. The median age was 35 years, interquartile range (IQR) 27-48 years. Two hundred and ten patients (48.2%) were male. The median of age-adjusted Charlson Comorbidity Index was 0 (IQR 0-1). The most frequent GI symptoms were anorexia 216 (49.5%), diarrhea 207 (47.5%), nausea 134 (30.7%), abdominal pain 122 (28%) and abdominal distension 121 (27.8%). At 4-week follow- up, symptoms resolved in most cases. Multivariate analysis showed that nausea was associated with Ivermectin treatment ORa 3.24 (95% CI 1.11-9.43) p= 0.030;abdominal pain was associated with Hydroxychloroquine treatment ORa 5.27 (95% CI 1.52-18.19) p= 0.009;diarrhea was associated with age ORa 0.966 (95% CI 0.93-0.99), p= 0.020 and Hydroxychloroquine treatment ORa 6.9 (95% CI 1.55-30.79), p= 0. 011;abdominal distension was associated with body mass index ORa 1.147 (95% CI 1.05-1.24), p< 0.001 and Hydroxychloroquine treatment ORa 7.6 (95% CI 2.00-29.51), p= 0.003. Digestive complications were infrequent (1 gastritis, 2 duodenitis, 1 jejunal ulcer, 3 hypertransaminasemia, 1 enteritis, 1 colitis). Twenty-three patients (5.3%) required hospital admission, of whom 4 (0.9%) required ICU admission and 2 (0.5%) died. Conclusion: Anorexia, diarrhea, nausea, abdominal pain and abdominal bloating were common symptoms in patients with COVID-19 disease managed on an outpatient basis. GI complications were infrequent in patients with COVID-19 who do not require hospitalization. Treatment with Hydroxychloroquine and Ivermectin was associated with more GI symptoms in COVID-19 outpatients.
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Due to the Coronavirus Disease 2019 (COVID-19), some social sectors were affected;one of them is girls and women, and it is feared some inequalities may worse. Objective. To analyze pneumonia, hospitalizations, and fatality among confirmed cases of COVID-19, by the state of residence, in Mexican women under 19 years. A quantitative, ecological, comparative, and retrolective study was designed. The study population was female patients under 19 years whose data was available from the Mexican open National Epidemiological Surveillance System database up to March 31, 2021. For each Mexican state and at the national level, the proportion of pneumonia, hospitalized, and Case Fatality Ratio (CFR) among confirmed cases were calculated, besides descriptive statistics. The state with the lowest proportion of pneumonia, hospitalizations, and CFR was used as the baseline group to calculate Odds Ratio (ORs) and Attributable Fraction both in exposed and the population. The linear relationship between pneumonia cases proportion and hospitalizations with CFR was tested. Test results with p-values under .05 were considered statistically significant. Data analysis was performed in STATA 13.0 ® (Stata Corp., College Station, TX, USA). The number of registries analyzed was 48,091. Attributable Fractions were above 0.7 for most states. Most ORs were high and statistically significant. The correlation between hospitalization proportion, pneumonia proportion, and CFR was high. High values for the Attributable Fractions and ORs were observed among states from the Mexican coastlines. Level and quality of attention vary across states, which was observed through the values of Attributable Fractions and ORs. Although women under 19 years seem to be mildly affected by COVID-19 in clinical regard, the socioeconomic effects of the pandemic in this sector must be studied and addressed. The sharing of strategies among states may benefit the attention of the COVID-19 emergency is a primary goal.
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Following the pandemic outbreak, several works have proposed to diagnose COVID-19 with deep learning in computed tomography (CT);reporting performance on-par with experts. However, models trained/tested on the same in-distribution data may rely on the inherent data biases for successful prediction, failing to generalize on out-of-distribution samples or CT with different scanning protocols. Early attempts have partly addressed bias-mitigation and generalization through augmentation or re-sampling, but are still limited by collection costs and the difficulty of quantifying bias in medical images. In this work, we propose Mixing-AdaSIN;a bias mitigation method that uses a generative model to generate de-biased images by mixing texture information between different labeled CT scans with semantically similar features. Here, we use Adaptive Structural Instance Normalization (AdaSIN) to enhance de-biasing generation quality and guarantee structural consistency. Following, a classifier trained with the generated images learns to correctly predict the label without bias and generalizes better. To demonstrate the efficacy of our method, we construct a biased COVID-19 vs. bacterial pneumonia dataset based on CT protocols and compare with existing state-of-the-art de-biasing methods. Our experiments show that classifiers trained with de-biased generated images report improved in-distribution performance and generalization on an external COVID-19 dataset. © 2021, Springer Nature Switzerland AG.
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BACKGROUND: There are studies that analyze the role of meteorological variables on the incidence and severity of COVID-19, and others that explore the role played by air pollutants, but currently there are very few studies that analyze the impact of both effects together. This is the aim of the current study. We analyzed data corresponding to the period from February 1 to May 31, 2020 for the City of Madrid. As meteorological variables, maximum daily temperature (Tmax) in ºC and mean daily absolute humidity (AH) in g/m3 were used corresponding to the mean values recorded by all Spanish Meteorological Agency (AEMET) observatories in the Madrid region. Atmospheric pollutant data for PM10 and NO2 in µg/m3 for the Madrid region were provided by the Spanish Environmental Ministry (MITECO). Daily incidence, daily hospital admissions per 100.000 inhabitants, daily ICU admissions and daily death rates per million inhabitants were used as dependent variables. These data were provided by the ISCIII Spanish National Epidemiology Center. Generalized linear models with Poisson link were performed between the dependent and independent variables, controlling for seasonality, trend and the autoregressive nature of the series. RESULTS: The results of the single-variable models showed a negative association between Tmax and all of the dependent variables considered, except in the case of deaths, in which lower temperatures were associated with higher rates. AH also showed the same behavior with the COVID-19 variables analyzed and with the lags, similar to those obtained with Tmax. In terms of atmospheric pollutants PM10 and NO2, both showed a positive association with the dependent variables. Only PM10 was associated with the death rate. Associations were established between lags 12 and 21 for PM10 and between 0 and 28 for NO2, indicating a short-term association of NO2 with the disease. In the two-variable models, the role of NO2 was predominant compared to PM10. CONCLUSIONS: The results of this study indicate that the environmental variables analyzed are related to the incidence and severity of COVID-19 in the Community of Madrid. In general, low temperatures and low humidity in the atmosphere affect the spread of the virus. Air pollution, especially NO2, is associated with a higher incidence and severity of the disease. The impact that these environmental factors are small (in terms of relative risk) and by themselves cannot explain the behavior of the incidence and severity of COVID-19.
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The first reinfection in the world in Hong Kong, later in Europe (Holland, Belgium) and USA, was documented. In Mexico until November 2020 there are no medical articles that tell us about reinfection;in Celaya Guanajuato the case of a female patient presented with symptoms of COVID-19, 2 polymerase chain reaction in real time tests are performed, in the Laboratory of Public Health from Guanajuato State in an interval of time, less than 5 months;the first in June 2020, with a positive result, received symptomatic treatment and isolation at home for 14 days, negative IgG antibodies test 38 days later;the second time, she presented clinical data on COVID-19 in November From 2020. It was not find references about re-infections by SARS-CoV-2 in Mexico;in Celaya Guanajuato was presented the case of female patient who has symptoms of COVID-19, with new positive PCR, required hospitalization and high-flow oxygen therapy when presenting with pneumonia, was performed simple chest Computing tomography, IgG and IgM antibodies. The evolution was good with discharge from hospitalization 72 hours after admission, continuing his outpatient management until discharge.