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1.
Revista Politecnica ; 47(1):7-16, 2021.
Article in Spanish | Scopus | ID: covidwho-1552145

ABSTRACT

In this article we present the mathematical compartmental SARS-CoV-2 model, with asymptomatic patients, used by the Research Center on Mathematical Modelling (MODEMAT) to study the spread of the virus in Ecuador, as well as the developed Bayesian variational approach to estimate the model parameters, under uncertainty of the observed data. Thanks to this framework, we are able to estimate periodically the effective reproduction number and carry out short-term forecasts, using an ensemble method, of the incidence of the epidemic. © 2021, �Escuela Politecnica Nacional. All rights reserved.

3.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509180

ABSTRACT

Background: Endothelial dysfunction is crucial in moderate to severe SARS-CoV-2 infection. Preeclampsia is an endothelial pregnancyrelated syndrome that shares some clinical and analytical features with COVID19. COVID19 signs in pregnant women might be misdiagnosed as preeclampsia leading to an iatrogenic preterm delivery. Aims: To address whether endothelial damage, microvascular thrombosis and dysregulated immune response exhibit different patterns in preeclampsia and COVID19 in pregnancy. Methods: Plasma samples were obtained from pregnant women with COVID19 pneumonia classified into moderate ( n = 10) or severe disease ( n = 9). Endothelial damage and immune response markers were assessed, including VCAM-1, TNF-receptor I (TNFRI), angiotensin II (ANGII), heparan sulfate (HS), PAI-1, dsDNA for neutrophil extracellular traps (NETs), C5b9, thrombomodulin (TM) and ADAMTS-13 activity. Results were compared to those in SARS-CoV-2 negative including healthy pregnant women as controls (C, n = 10), and patients with preeclampsia (PE, n = 13). Results: All endotheliopathy markers were significantly increased in severe COVID19 and PE patients compared to healthy pregnants ( p <0,05, Table 1), except TM and ADAMTS-13 activity. Patients with moderate COVID19 presented a biomarker profile similar to the observed in control patients. Severe COVID19 and PE profiles were distinctive among them regarding four markers: VCAM-1, TNFRI and ANGII, clearly higher in PE, and HS, significantly lower in PE. The principal component analysis (PCA) in Figure 1, demonstrated the separation between severe COVID19 and PE from moderate COVID19 or uncomplicated pregnancies. The first and second components explained 29.1% and 18.4% of the variance between groups. (Figure Presented) Conclusions: Severe COVID19 exhibits signs of endothelial damage and immune dysregulation and some of them are shared with preeclampsia. However, there are specific markers with the potential to discriminate between both conditions. Investigation in this direction could help to develop new strategies for the prevention and treatment of both entities. Grants: Fundació Clínic (HCB/2020/0401), JazzPharmaceuticals (IST-16-10355), Fundació La Marató de TV3 (202026-10).

4.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509004

ABSTRACT

Background : Previous reports describe high rates of venous thromboembolism (VTE) in critically ill COVID-19 patients. Consequently, intermediate and therapeutic doses anticoagulation have been used in clinical practice, potentially exposing patients to a higher risk of bleeding. Aims : To evaluate the rate of thrombosis, bleeding and mortality comparing prophylactic, intermediate or therapeutic doses in critically ill COVID-19 patients. Methods : All COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020 were included. Patients were categorized into three groups according to the highest anticoagulant dose received: prophylactic, intermediate and therapeutic. Incidence of VTE, bleeding and mortality were compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding with clinical characteristics and the anticoagulant regimen. Results : 201 patients were included. 78 (39%) received prophylactic, 94 (47%) intermediate and 29 (14%) therapeutic doses. There were no differences in VTE and mortality between groups. In contrast, bleeding events were more frequent in patients receiving therapeutic (31%) and intermediate (15%) doses than in those receiving prophylactic doses (5%) ( P < 0.001 and P < 0.05 respectively). Major bleedings were also more frequent in patients with anticoagulant doses ( P < 0.01). The anticoagulant dose was the strongest determinant for bleeding (odds ratio [OR] 2.4, 95% confidence interval (CI) 1.26-4.58, P = 0.008) but had no impact on VTE (OR 0.97, 95%CI 0.58-1.68, P = 0.92). Conclusions : Critically ill COVID-19 patients receiving intermediate or therapeutic doses of heparin appear to have a higher risk of bleeding without a decrease of VTE events and mortality.

5.
Crit Care ; 25(1): 381, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1506432

ABSTRACT

BACKGROUND: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. METHODS: This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). RESULTS: Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. CONCLUSION: Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.


Subject(s)
COVID-19/physiopathology , Intensive Care Units/trends , Microvessels/physiopathology , Respiratory Care Units/trends , Respiratory Distress Syndrome/physiopathology , Severity of Illness Index , Adult , Aged , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Male , Mexico/epidemiology , Microcirculation/physiology , Middle Aged , Muscle, Skeletal/blood supply , Muscle, Skeletal/physiopathology , Prospective Studies , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/epidemiology , Spain/epidemiology
9.
American Journal of Nuclear Medicine and Molecular Imaging ; 11(4):300-306, 2021.
Article in English | EMBASE | ID: covidwho-1391137

ABSTRACT

Coronavirus disease 2019 (COVID-19) pathology is associated with neoangiogenesis and interstitial pneumonia.68Ga-PSMA-11-PET/CT is able to image in vivo PSMA (Prostate-Specific Membrane Antigen) expression on both prostate cancer (PCa) cells and neovasculature endothelial cells. The aim of the case series was to explore pulmonary PSMA expression not related to cancer in patients with PCa and concomitant COVID-19. In this retrospective, multicenter case series, patients who underwent68Ga-PSMA-11-PET/CT for PCa and concomitant proven COVID-19 infection were analyzed. Patients were stratified according to68Ga-PSMA-11 intensity of uptake in the lung (SUVmax). Low uptake: < blood pool;mild-to-moderate uptake: > blood pool and < liver;intense uptake: > liver. Potential correlation between pulmonary68Ga-PSMA-11 uptake not related to PCa and CT patterns typical for COVID-19 was assessed. Nine patients were included, all of them presenting abnormal68Ga-PSMA-11 uptake, at different grades: 2/9 low, 6/9 mild-to-moderate, 1/9 high. Uptake distribution was generally bilateral, peripheral and posterior, positively matching with ground-glass CT alterations in 7/9 (78%) patients, while mismatch was observed in 2/9 (22%). 1/9 patients presented PCa lung metastases at68Ga-PSMA-11.68Ga-PSMA-11-PET/CT detected increased PSMA uptake within the lung, not related to PCa, matching with CT typical COVID-19 patterns in almost all patients. Further studies are needed to evaluate the role of68Ga-PSMA-11 PET in COVID-19 patients and the potential role of PSMA overexpression as a biomarker for neoangiogenesis, in both oncological and infective disorders.

11.
Enfermeria Global ; 20(3):591-600, 2021.
Article in English | Scopus | ID: covidwho-1362729

ABSTRACT

Introduction: In recent months, the emergence of SARS-CoV-2 as a global pandemic has caused a devastating impact on health worldwide. Health systems have been overwhelmed, and the follow-up of those patients who require continuous monitoring and evaluation, such as Amyotrophic Lateral Sclerosis (ALS), have been negatively affected. Material and method: A search of the current literature has been carried out to determine the impact of the Covid-19 pandemic on the quality of life of patients diagnosed with Amyotrophic Lateral Sclerosis and their family. Results: The diagnosis, treatment, follow-up and home care of these patients have been modified, adapting them as much as possible to the technology and available resources to try to minimize the loss of quality of life of patients diagnosed with Sclerosis Amyotrophic lateral and ensuring comprehensive care. Conclusion: Despite numerous efforts and advances in research, both in the case of ALS and COVID- 19, there is still a long way to go. © COPYRIGHT Servicio de Publicaciones - Universidad de Murcia

13.
Critical Care Medicine ; 48(12):e1350-e1355, 2020.
Article in English | MEDLINE | ID: covidwho-1209752

ABSTRACT

OBJECTIVES: Infection by severe acute respiratory syndrome coronavirus-2 can induce uncontrolled systemic inflammation and multiple organ failure. The aim of this study was to evaluate if plasma exchange, through the removal of circulating mediators, can be used as rescue therapy in these patients. DESIGN: Single center case series. SETTING: Local study. SUBJECTS: Four critically ill adults with coronavirus disease 19 pneumonia that failed conventional interventions. INTERVENTIONS: Plasma exchange. Two to six sessions (1.2 plasma volumes). Human albumin (5%) was used as the main replacement fluid. Fresh frozen plasma and immunoglobulins were administered after each session to avoid coagulopathy and hypogammaglobulinemia. MEASUREMENTS AND MAIN RESULTS: Serum markers of inflammation and macrophage activation. All patients showed a dramatic reduction in inflammatory markers, including the main cytokines, and improved severity scores after plasma exchange. All survived to ICU admission. CONCLUSIONS: Plasma exchange mitigates cytokine storm, reverses organ failure, and could improve survival in critically ill patients with coronavirus disease 2019 infection.

14.
Rev Esp Quimioter ; 34(3): 238-244, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1173137

ABSTRACT

OBJECTIVE: In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. METHODS: A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. RESULTS: A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. CONCLUSIONS: Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Bed Occupancy , COVID-19/immunology , Female , Humans , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2
15.
Historia Y Comunicacion Social ; 26:31-40, 2021.
Article in Spanish | Web of Science | ID: covidwho-1154713

ABSTRACT

This article reflects on the speech of March 8, 2020. This speech has become evidence of an alleged belated reaction of the Spanish government to the pandemic. We analyze the criticisms levelled against the government to establish whether the disapproval contributed to the enhancement of the debate on the management of the pandemic or, on the contrary, contributed to the generation of a hate speech against women and feminism. We analyze the discursive and communicative strategies used by the PP, Ciudadanos and VOX parties. Also, the strategies used in the Twitter accounts of women spokespersons for these parties. The work argues that the criticisms made by the government's opponents mask the articulation of strategies aiming at distorting the feminist movement.

16.
Rev Esp Quimioter ; 34(2): 136-140, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1119722

ABSTRACT

OBJECTIVE: Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. METHODS: We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. RESULTS: A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. CONCLUSIONS: In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Inpatients , Adenosine Monophosphate/therapeutic use , Aged , Alanine/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/mortality , Cohort Studies , Dexamethasone/therapeutic use , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Spain/epidemiology , Treatment Outcome
19.
Annals of the American Thoracic Society ; 17(9):1164-1168, 2020.
Article in English | GIM | ID: covidwho-972910

ABSTRACT

The aim of the article was to present the characteristics of gas exchange, pulmonary mechanics, and ventilatory management of 50 patients with laboratory-confirmed SARS-CoV-2 infection, who developed ARDS and underwent invasive MV (IMV). By March 25th, 2020, 50 patients with laboratory-confirmed SARS-CoV-2 infection and ARDS had been admitted to our hospital. Table 1 shows the demographic and clinical characteristics of these patients. The median (interquartile range [IQR]) age was 66 (57-74) years. Thirty-six patients (72%) were men. Upon ARDS diagnosis, 44% of patients were initially classified as having moderate ARDS, whereas 24% were classified as having mild ARDS and 32% were classified as having severe ARDS. ICU and hospital lengths of stay were prolonged, and tracheostomy was performed in 30 (60%) patients. Hospital mortality was 34%. SARS-CoV-2-induced ARDS produced an impairment in gas exchange and pulmonary mechanics comparable with those of prior cohorts with non-SARS-CoV-2 ARDS. As in other studies, VR was high, and the most frequent presentation was moderate ARDS. On average, Crs in the cohort with SARS-CoV-2-induced ARDS was also found to be comparable, but with remarkable heterogeneity. Other studies have reported similar, higher, or lower Crs in SARS-CoV-2-induced ARDS. As Crs decreases alongside the collapse of alveolar units due to lung edema, several factors may provide explanations for such reported differences, including treatments, intubation strategies, and the stage of the disease. In our cohort with early SARS-CoV-2-induced ARDS, the time from ICU admission to intubation was only 24 hours, despite the use of high-flow nasal cannula or NIV in some cases. Although driving pressure and end-inspiratory plateau pressure were within the protective range, mechanical power was found to be slightly high and might have promoted lung injury. In patients undergoing prone positioning, PaO2/FiO2 improvement was followed by an increase in Crs, suggesting recruitment and aeration of previously collapsed alveoli. In this study, mortality was similar to that reported in other studies of critically ill patients with SARS-CoV-2 pneumonia.

20.
Neurología (English Edition) ; 2020.
Article in English | ScienceDirect | ID: covidwho-836998

ABSTRACT

INTRODUCTION The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. METHODS We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. RESULTS Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls;this difference was statistically significant. DISCUSSION Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities. Resumen INTRODUCCIÓN La población anciana es la más amenazada por COVID-19, con mayores tasas de mortalidad. El objetivo de este trabajo es analizar la letalidad en una cohorte de pacientes de COVID-19 con demencia degenerativa. MÉTODOS Hicimos un estudio descriptivo de casos-control de una muestra de pacientes diagnosticados con demencias neurodegenerativas primarias. RESULTADOS De los 88 pacientes incluidos en el estudio, 24 pacientes con COVID-19 fallecieron: 10/23 (43,4%) eran pacientes con diagnóstico de demencia y 14/65 (21,5%) pacientes del grupo control, una diferencia estadísticamente significativa. DISCUSIÓN La letalidad entre los pacientes con demencia degenerativa primaria por COVID-19 es significativamente mayor en comparación con otros pacientes con edades medias y comorbilidades similares, según nuestro estudio.

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