[Impact of hyperglycemia on the prognosis of patients hospitalized for severe pneumonia in COVID-19]

Background: Adequate glycemic control improves the prognosis of patients hospitalized for pneumonia associated with severe COVID-19. Objective: To evaluate the impact of hyperglycemia (HG) on the prognosis of patients hospitalized for severe pneumonia associated with COVID-19 in unvaccinated patients. Material and methods: Prospective cohort study. We included patients hospitalized from August 2020 to February 2021, with severe COVID-19 pneumonia, not vaccinated against SARS-CoV-2. Data was collected from admission to discharge. We used descriptive and analytical statistics according to the data distribution. ROC curves were used to determine the cut-off points with the highest predictive performance for HG and mortality, with the IBM SPSS program, version 25. Results: We included 103 patients, 32% women, 68% men, age 57 +/- 13 years;58% were admitted with HG (191, IQR 152-300 mg/dL) and 42% with normoglycemia (NG < 126 mg/dL). Mortality was higher in HG at admission 34 (56.7%) than in NG 13 (30.2%) (p = 0.008). HG was associated with diabetes mellitus 2 and neutrophilia (p < 0.05). The risk of death increases 1.558 times (95% CI 1.118-2.172) if HG is at admission and 1.43 times (95% CI 1.14-1.79) during hospitalization. Maintaining NG throughout the hospitalization contributed independently to survival (RR = 0.083 [95% CI 0.012-0.571], p = 0.011). Conclusion: HG significantly impacts prognosis by increasing mortality more than 50% during hospitalization for COVID-19. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

[The impact of COVID-19 in a cohort of patients with systemic sclerosis]

Background: COVID-19 brought with it unknowns related to systemic sclerosis. Objective: To know the clinical evolution and prognosis of COVID-19 in a cohort of patients with systemic sclerosis. Methods: During the pandemic, we had digital contact with a cohort of 197 patients with SSc. If they had any condition that met the suspected definition of COVID-19, they underwent polymerase chain reaction testing for SARS-CoV-2;they were treated on an outpatient or hospital basis without interfering with their treatment. They followed their evolution every 24 hours until they became asymptomatic or died. Results: Thirteen patients (6.6%), nine diffuse cutaneous (dcSSc), and four limited cutaneous (lcSSc) developed COVID-19 during nine months of follow-up. The immunosuppressants used at the time of the disease were: mycophenolate mofetil, methotrexate, and prednisone, in low doses. Seven patients had interstitial lung disease (ILD). The main symptoms were chest pain, cough, dyspnea, dysgeusia, and anosmia, 1 with mild symptoms without pneumonia, 11 with mild pneumonia, and one with severe pneumonia that required hospital management. Only one (7.7%) presented severe pneumonia, was hospitalized, and died. Conclusions: COVID-19 disease in patients with SSc can be overcome in most cases, even when they are ILD and were using immunosuppressants at the time of infection with the SARS-CoV-2 virus. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

The effect of COVID-19 on patients with preexisting autoimmune diseases

In December 2019, a new Coronavirus called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), appeared in China, spreading rapidly around the globe and becoming a pandemic. SARS-CoV-2 is the cause of a serious life-threatening disease known as COVID-19. The risk of SARS-CoV-2 infection in patients with preexisting systemic autoimmune diseases (AID) appears to be slightly higher than in the general population, but the clinical course does not appear to be different. However, we must bear in mind that the use of corticosteroids, immunomodulatory drugs, and biological therapy in patients with AID can modulate the risk of hospitalization and death. The alterations in the innate and adaptive immune response found in patients with cytokine storm due to COVID-19 are the reasons for the high morbidity and mortality. Thus, clinicians should early identify the symptoms and closely monitor patients with risk factors for developing these complications and the interactions with other systems such as the immune-neuro-endocrine system. © 2023 Elsevier Inc. All rights reserved.

Side effects of the COVID-19 vaccines

The ability to eradicate deadly diseases and decrease the mortality of others makes vaccines one of the most important discoveries of the last century. Despite already having effective vaccines, scientific advances continue developing new antigens capable of producing more significant immune responses to achieve stronger immunity. © 2023 Elsevier Inc. All rights reserved.

COVID-19: the impact of the cytokine storm on the immune-neuroendocrine system

The term "cytokine storm” was first proposed in 1993 by Ferrara et al. In 1991, Chatenaud described a systemic clinical picture called "Cytokine Release Syndrome” very similar to "Cytokine Storm Syndrome” so these terms can be used synonymously. During the COVID-19 pandemic, high-risk individuals (>65 years, with comorbidities) may develop cytokine storms as a consequence of multiorgan involvement seen during the acute and post-COVID-19 phases. On the other hand, the term immune neuroendocrine system was first proposed by Besedovsky H et al. Evidences obtained during COVID-19 infection demonstrated that SARS-CoV-2 infections can affect the immune neuroendocrine system, both in its invasion stage of different organs and tissues and in the recovery stage. This damage is caused by viral infection and/or cytokine storm. This chapter analyzes the devastating effect of SARS-CoV-2 infection and the cytokine storm on the immune neuroendocrine system. These evidences may lead to new therapeutic proposals. © 2023 Elsevier Inc. All rights reserved.

[Stress, anxiety, and depression in health workers during the COVID-19 pandemic]

Background: Mental health is an integral part of health. Having some psychiatric condition without treatment predisposes to a poor quality of life. These alterations have been found with an incidence of up to 50% in the general population. There are very few studies in Mexico on these conditions in health workers during the COVID-19 pandemic. Objective: To determine the prevalence of stress, anxiety, and depression during the COVID-19 pandemic in health workers. Material and methods: A descriptive, cross-sectional observational study was conducted on health workers in a tertiary hospital, through the application of randomized and self-completed surveys, in search of levels of stress, anxiety, and depression during the COVID-19 pandemic. Results: 44.7% of those surveyed showed depression, 83.1% anxiety, and 66.3% stress. The main groups affected were female staff, singles, and medical residents. Those with type 2 diabetes mellitus had higher anxiety and depression. Conclusion: The prevalence of stress, anxiety, and depression in health workers is similar to that of the general population in our study. Depression was the alteration most found. The scrutiny of alterations in mental health in health workers is of the utmost importance, with greater emphasis in the context of the aforementioned pandemic.

Risk factors and outcomes of autoimmune/inflammatory diseases during covid-19 infection: A comparative study

Objectives: To determine the risk factors, impact and outcomes of COVID-19 in autoimmune / inflammatory diseases (AID). Methods: Case (patients with AID) and controls (patients without AID) study. Both groups with SARS-CoV-2 by PCR. Clinical, biochemical, treatment and outcome characteristics were determined. Spearman correlation, X2 and multivariate analysis were performed. Results: AID, 90 (49.49 ± 14.2 years) vs controls, 90 (52.58 ± 13.5 years). AID: systemic lupus erythematosus (SLE) (n = 20, 22.2%), systemic sclerosis (n = 16, 17.8%), rheumatoid arthritis (n = 14, 15.6%), primary antiphospholipid syndrome (n = 12, 13.3%), autoimmune encephalitis (AIE) (n = 6, 6.7%), granulomatosis with polyangiitis (GPA) (n = 5, 5.6%) and multiple sclerosis (n = 3, 3.3%) were the most frequent. Treatment: anticoagulant 73.3%, glucocorticoid 53.3% and antimalarials 35.6%. The AID patients had less invasive mechanical ventilation (IMV) (p = 0.004), lower death (p = 0.006) and lower discharge with O2 (p = 0.001) (Table 1). AID: creatinine correlate positively with days with IMV (rho = 539, p 0.024). In AID, AIE and O2 saturation ≤ 88% provided risk for IMV (OR 88.42, CI 3.9-196.7, p = 0.005 and OR 10.05, CI 1.2-83.7, p = 0.033, respectively) while antimalarials were protective for IMV (OR 0.08, CI 0.0-0.9, p = 0.042). Regarding death in AID, oxygen saturation ≤ 88% and CO-RADS ≥4 were risk factors (OR 5.12, CI 1.5-16.4, p = 0.006 and OR 8.84, CI 1.2-64.0, p = 0.031, respectively) and anticoagulant use was protective (OR 0.26, CI 0.0-0.8, p = 0.019) (Table 2). Conclusion: Our study suggests that patients with AID have a better outcome than the control group. Multiple factors are involved in this outcome such as surveillance, chronic use of antimalarials, steroid and anticoagulation.We propose that at the molecular level high levels of IFN may be a protective factor for complications from SARS-CoV-2 infection. New longitudinal and molecular level studies in patients with mild/moderate, severe and critical COVID-19 will be necessary to know the impact of COVID-19 in AID.