Political Leadership for a New World: Global Changes and the Covid-19 Pandemic

This article analyzes and contextualizes the phenomenon of political leadership in the context of the world of limited and moderate globalization after the global health crisis caused by the Covid-19 pandemic. As a result of this pandemic and of changes prior to it, a new world is emerging, characterized by profound global transformations, as well as the recurring prominence of states, national institutions and of political leaders. These actors draw our attention through two questions: what features define the socio-political context in which political leaders must act? What qualities and styles do such leaders need to incorporate in the face of current challenges? In response to both questions, contextual factors are first analyzed in terms of national and global leadership. Then, the context and the concept of globalization are outlined, arguing how that contributes to understanding the current political dynamics. Third, the main theories on leadership are reviewed, conceptualized in light of the new world. Lastly, we reflect on the present context, the qualities and styles of leadership.

Kidney disease and the coronavirus pandemic 2019 covid-19. An clinical perspective

Since the last months of 2019, SARS-CoV-2 was identified as a highly contagious virus, March 11, 2020 WHO classified SARS-CoV-2 as a pandemic. Since April 21, 2020 Mexican Government declared Phase 3 of his Contingency plan to fight SARS-CoV-2 pandemic. SARS-CoV-2 is mainly a respiratory virus, but there are reports of involvement in organs distant from the lungs, including the kidneys. SARS-CoV-2 kidney involvement is sign of worse prognosis. Is important to know the characteristics of this injury, the way to diagnose it, its treatment and how to prevent it. Here we review some theories about kidney injury related to SARS-CoV-2 infection and its histopathological correlation. We also evaluate the relationship between SARS-CoV-2 and Angiotensin Converting Enzyme 2 receptors, the kidney injury related to the use of the novels therapies against SARS-CoV-2, renal replacement therapies prescription in SARS-CoV-2 y in kidney transplant patients. Since the lasts months SARS-CoV-2 has invaded and modified our knowledge and daily routine. Healthcare staff from the different specialties, including Nephrologist must keep in constant learning and training to fight against this pandemic with the better weapons.

Complications and causes of death of patients with COVID-19 requiring extracorporeal respiratory support. A subanalysis of the ECMOVIBER study

Objective: To describe the most frequent complications and causes of death of COVID-19 patients requiring extracorporeal respiratory support. Methods: Descriptive analysis of the ECMOVIBER registry, including 25 ECMO centers in Spain (23) and Portugal (2). All adult (>18 years old) COVID-19 patients requiring veno-venous ECMO between 1st March and 1st December 2020 were included. The follow up period ended 1st December 2020. Demographic data, comorbidities and complications during ECMO [acute kidney injury, ventilator associated pneumonia (VAP), hemorrhage and thrombosis] were recorded. Results are described using median (interquartile range) or frequency (percentage). Results: A total of 316 patients [age 55 (47-60), 253 (80%) male] were included. Only 21 (7%) patients had prior respiratory disease and 12 (4%) chronic kidney disease. One hundred and thirty-one (41%) patients received anticoagulation prior to cannulation and 94 (30%) suffered concomitant bacterial coinfection prior to ECMO initiation. Eighty-two (26%) patients developed acute kidney injury of which 73 (89%) required continuous renal replacement therapy;50 (16%) suffered at least one thrombotic episode during the extracorporeal support (47 deep venous thrombosis, 3 pulmonary embolism) and 41 (13%) presented haemorrhagic shock. In 109 (34%) patients clots in the circuit were identified and 20 of them (18%) required at least one circuit change. The most frequent infectious complication was VAP [154 patients (49%)]. One hundred and twenty (38%) patients died on ECMO and 9 (3%) after decannulation. The most frequently reported causes of death were multiorgan dysfunction [37 (29%)], persistent respiratory failure due to COVID- 19 [23 (18%)] and septic shock [20 (15%)]. Death during cannulation occurred in 11 cases (3% of the total population). Conclusions: Complications during extracorporeal respiratory support in COVID-19 patients are frequent. VAP may complicate up to half of the cases. Persistent COVID-19 was the cause of death of almost one fifth of the population.