Green Enzymatic Synthesis of Geranyl Butyrate: Process Optimization and Mechanistic Insights.

Flavor esters are organic compounds widely used in the food industry to enhance the aroma and taste of products. However, most chemical processes for the production of these flavoring compounds use toxic organic solvents. Some organic solvents derived from petroleum can leave behind residual traces in food products, which may raise concerns about potential health risks and contamination. In this study, we employ Eversa Transform 2.0, a commercial lipase derived from the lipase from Thermomyces lanuginosus, to produce geranyl butyrate in aqueous media. The chemical process was optimized using the Taguchi method, and a conversion of 93% was obtained at the optimal reaction conditions of: 1:5 molar ratio (v/v), 15% biocatalyst load (w/w), at 50 °C, in 6 h. Classic (molecular dynamics) and quantum (density functional theory) simulations unveiled amino acid residues involved in the stabilization of the enzyme-substrate complex. Detailed QM/MM mechanistic studies identified the nucleophilic attack of the deacylation reaction as the rate-limiting step of the entire mechanism, which has a free energy barrier of 14.0 kcal/mol.

Nature or Nurture: Is the Digestive System of the Pontoporia blainvillei Influenced or Determined by Its Diet?

The Franciscana (also known as the La Plata River Dolphin) is a small dolphin that lives in the coastal waters of Brazil, Uruguay, and Argentina. This species is considered the most endangered marine mammal in the western South Atlantic Ocean. Anatomic dissection of the digestive system of 19 animals of different ages, including 2 neonates, 12 juveniles, and 5 adults, was performed. Parameters related to length, breadth, weight, and diameter of the digestive viscera were considered in each case. Our results show that the Franciscana dolphin presents differential characteristics in relation to several parts of the digestive system, including, specifically, the tongue, the teeth, the stomach, and the small intestine. Thus, this paper add precious information to the actual knowledge of this vulnerable marine mammal species in order to improve conservation efforts.

Stefano Marcaccini: a pioneer in isocyanide chemistry.

Stefano Marcaccini was one of the pioneers in the use of isocyanide-based multicomponent reactions in organic synthesis. Throughout his career at the University of Florence he explored many different faces of isocyanide chemistry, especially those geared towards the synthesis of biologically relevant heterocycles. His work inspired many researchers who contributed to other important developments in the field of multicomponent reactions and created a school of synthetic chemists that continues today. In this manuscript we intend to review the articles on isocyanide multicomponent reactions published by Dr. Marcaccini and analyse their influence on the following works by other researchers. With this, we hope to highlight the immense contribution of Stefano Marcaccini to the development of isocyanide chemistry and modern organic synthesis as well as the influence of his research on future generations. We believe that this review will not only be a well-deserved tribute to the figure of Stefano Marcaccini, but will also serve as a useful inspiration for chemists working in this field.

Evaluation of different ensiling methods for Saccharina latissima preservation: influence on chemical composition and in vitro ruminal fermentation.

Saccharina latissima is a brown seaweed that could be used in ruminant feeding, but its fast deteriorating and seasonal growth nature limit their utilisation in the practice. Ensiling could be used as a preservation method, but information of its effects on the nutritional value of the seaweed is limited. This study evaluated the in vitro ruminal fermentation of different S. latissima silages using ruminal inoculum either from goats fed a mixed diet (60:40 oat hay:concentrate) or from sheep fed a high-forage diet (90:10 alfalfa hay:concentrate) to simulate different small ruminant production systems. S. latissima was ensiled in vacuum bags without additives (Control), with formic acid (4 g/kg seaweed; FA), with lactic acid bacteria (LAB) or with LAB after a pre-wilting treatment to reach a seaweed dry matter (DM) content of 30% (30LAB). Ensiling S. latissima decreased (p < 0.05) the content in DM, neutral detergent fibre and total extractable polyphenols, but nitrogen and fat content were unaffected. For both ruminal inoculums, ensiling decreased (p < 0.05) the asymptotic gas production after 120 h of fermentation (excepting for FA silage with goats' inoculum), but the total volatile fatty acid (VFA) production was unaffected. The VFA profile shifted towards greater (p < 0.05) acetate and lower (p < 0.05) propionate proportions in all silages compared with the pre-ensiling S. latissima. When goats inoculum was used, greater (p < 0.05) CH4 production compared with pre-ensiling S. latissima was observed in all silages, except Control one, which led to greater (p < 0.05) CH4/total VFA ratio. In contrast, no differences among samples (p > 0.05) in either CH4 production or CH4/total VFA ratio were observed when sheep' inoculum was used. Fermentation of all samples started earlier with goats' inoculum than with sheep' inoculum, which was attributed to the different diet fed to the animals. These results suggest that ensiling S. latissima with either formic acid or lactic acid bacteria could be a viable conservation method to preserve the nutritive value.

Long-Term Effectiveness of XEN 45 Gel-Stent in Open-Angle Glaucoma Patients.

Purpose: To assess the effectiveness of XEN45, either alone or in combination with phacoemulsification, in open-angle glaucoma (OAG) patients in clinical practice. Methods: Retrospective and single-center study conducted on OAG patients who underwent XEN45 implant, either alone or in combination with cataract surgery. We compared the clinical outcomes of the eyes of thosewho underwent XEN-solo versus those who underwent XEN+Phacoemulsification. The primary endpoint was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. Results: A total of 154 eyes, 37 (24.0%) eyes that underwent XEN-solo and 117 (76.0%) eyes that underwent XEN+Phacoemulsification, were included. The mean preoperative IOP was significantly lowered from 19.1±5.0 mmHg to 14.9±3.8 mmHg at month-36, p<0.0001. Preoperative IOP was significantly lowered from 21.2±6.2 mmHg and 18.4±4.3 mmHg to 14.3±4.0 mm Hg and 15.2±3.7 mmHg at month-36 in the XEN-solo and XEN+Phacoemulsification groups, p<0.0004 and p=0.0009; with no significant differences between them. In the overall study population, the mean number of antiglaucoma medications was significantly reduced from 2.1±0.8 to 0.2±0.6, p<0.0001. There were no significant differences in the proportion of eyes with a final IOP ≤14 mmHg and ≤16 mmHg between XEN-solo and XEN+Phaco groups (p=0.8406 and 0.04970, respectively). Thirty-six (23.4%) eyes required a needling procedure. Conclusion: XEN implant significantly lowered IOP and reduced the need of ocular hypotensive medication, while maintaining a good safety profile. Beyond week-1, there were no significant differences in IOP lowering between XEN-solo and XEN+Phacoemulsification groups.

The Castagnoli-Cushman Reaction.

Since the first reports of the reaction of imines and cyclic anhydrides by Castagnoli and Cushman, this procedure has been applied to the synthesis of a variety of lactams, some of them with important synthetic or biological interest. The scope of the reaction has been extended to the use of various Schiff bases and anhydrides as well as to different types of precursors for these reagents. In recent years, important advances have been made in understanding the mechanism of the reaction, which has historically been quite controversial. This has helped to develop reaction conditions that lead to pure diastereomers and even homochiral products. In addition, these mechanistic studies have also led to the development of new multicomponent versions of the Castagnoli-Cushman reaction that allow products with more diverse and complex molecular structures to be easily obtained.

The Respiratory System of the Arctocephalus australis in Comparison to the Dog as a Land-Carnivore: Are There Adaptations to Marine Life?

Marine mammals are divided into three groups, with similar adaptations resulting from their aquatic lifestyle: sirenians, pinnipeds, and cetaceans. The present work focused on the South American fur seal, or Arctocephalus australis, a carnivore included in the pinnipeds group. We assessed whether the anatomical features of the Arctocephalus australis' respiratory system are comparable to those of other land-carnivores or whether these individuals show anatomical adaptations related to their ability to dive or their breath-holding capacities. We studied 11 cadavers of Arctocephalus australis, which included adult (n = 2) and juvenile (n = 9) individuals, by anatomically dissecting their isolated entire respiratory system. Although it is generally similar to that in land-carnivores, we demonstrated that the Arctocephalus australis's respiratory apparatus shows several specific characteristics. Therefore, our results are of great importance for clinical diagnostic and wildlife conservation purposes.

Potential of Agroindustrial By-Products to Modulate Ruminal Fermentation and Reduce Methane Production: In Vitro Studies.

The effects of including wine lees (WL), exhausted olive cake (EOC) and a 1:1 mixture of EOC and tomato pomace (EOCTP) in diets for fattening ruminants on in vitro fermentation parameters and CH4 production were analysed. Ten diets were studied, containing either none of the tested by-products (control), or 6.0, 12.0 or 18.0% of WL, EOC and ECOTP formulated to have similar protein and fiber content. Diets were incubated in vitro with sheep ruminal fluid to measure gas production kinetics and fermentation parameters. Increasing the level of WL, EOC and EOCTP decreased linearly (p ≤ 0.009) the potential gas production, but other gas production parameters were unaffected (p > 0.05), excepting that EOCTP increased the gas production rate. No differences (p ≥ 0.0.05) among diets were observed in total volatile fatty acid (VFA) production at 24 h of incubation for EOC and EOCTP, but NH3-N concentration decreased (p ≤ 0.003). In contrast, WL at 12.0 and 18.0% decreased (p < 0.05) total VFA production and increased the acetate/propionate ratio (p < 0.05). None of the by-products had an effect on CH4 production (p ≥ 0.0.05). Results indicate that EOC and EOCTP could be included up to 18.0% in fattening diets, but lower levels of WL are recommended.

3-Year Outcomes of XEN Implant Compared With Trabeculectomy, With or Without Phacoemulsification for Open Angle Glaucoma.

PRCIS: Trabeculectomy (TRAB) surgery reduces the intraocular pressure (IOP) more than the XEN45 implant over 3 years. There is no difference in the number of antiglaucoma medications between the 2 procedures. The decision to perform either TRAB or XEN45 implantation must be evaluated on a case-by-case basis, taking into account the high rate of needling of the XEN45. PURPOSE: The aim of this study was to compare the differences between the efficacy and safety of the XEN45 implant and TRAB, either alone or in combination with phacoemulsification (PHACO), in patients with open angle glaucoma (OAG) at 36 months. METHODS: A retrospective, single-center and comparative study conducted on OAG patients who underwent XEN45 implantation or TRAB from 2016 to 2018. Patients were divided into 4 groups: group 1 (XEN45 alone), group 2 (XEN45+PHACO), group 3 (TRAB alone), and group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN45 implant), whereas groups 3 and 4 were also combined (TRAB surgery). IOP, number of glaucoma medications, and adverse events were evaluated. The main outcome measure was the reduction in IOP at 36 months postoperatively. RESULTS: One hundred thirty-four patients (134 eyes; 63 XEN45 and 71 TRAB) were included. The mean (95% confidence interval) IOP reduction at the end of the study follow-up was -6.3 (-11.0 to -1.6 mm Hg, P =0.025, XEN45 alone), -8.9 (-11.0 to -6.8 mm Hg, P <0.001, TRAB alone), -2.5 (-4.5 to -0.4 mm Hg, P =0.019, XEN45+PHACO), and -5.6 (-7.7 to -3.4 mm Hg, P <0.001, TRAB±PHACO). The proportion of patients achieving an IOP≥6 and ≤16 mm Hg without treatment at the end of the 36-month follow-up were 50.8% (32/63) in the XEN45 implant and 49.3% (35/71) in the TRAB surgery group, P =0.863. The mean number of glaucoma medications was significantly reduced in all the study groups. The needling rate was 19% in XEN45 versus 5.6% in the TRAB group ( P =0.030), and 2.81% and 36.6% of eyes in the TRAB group presented anterior chamber flattening and hyphema, respectively. CONCLUSIONS: TRAB surgery lowered IOP significantly more than XEN45 implant with or without phacoemulsification over 3 years and had a significantly lower need for additional needling surgery. Both procedures reduced glaucoma medications to a similar rate. These findings are relevant to the informed consent process and patient decisions for one procedure over the other.

The Digestive System of the Arctocephalus australis in Comparison to the Dog as a Land-Carnivore Model.

Marine mammals play a critical ecological role as both predator and prey. They are divided into three groups that share similar adaptations to their aquatic life, but that have very different origins and life patterns: sirenians, pinnipeds, cetaceans. The species object of our interest is the South American fur seal or Arctocephalus australis, a carnivore classified within the group of pinnipeds. The objective of the present study was to evaluate whether the anatomical characteristics of the Arctocephalus australis' digestive system are similar to that of other land-carnivores or if, on the contrary, this species shows anatomical adaptations related to their life in the ocean. The study was carried out on 11 cadavers of the species Arctocephalus australis, made up of two adults and nine juveniles, by means of the anatomical dissection of their entire isolated digestive system. We demonstrate that, with several exceptions, the anatomical characteristics of the digestive system of the Arctocephalus australis are similar to those in other carnivores. Therefore, our data constitute an important contribution for clinical diagnostic and conservation purposes, for both veterinarians and biologists.

Synthesis of imidazolocoumarins by the amide-directed oxidative cyclisation of enol-Ugi derivatives.

The oxidative C(sp3)-H intramolecular imination of hydroxycoumarin enol-Ugi adduct derivatives affords selectively diversely substituted imidazolocoumarins in one pot. The amide group derived from the enol-Ugi isocyanide component directs the functionalisation of the adjacent C(sp3)-H and then is lost as an isocyanate molecule in an unprecedented transformation. This strategy was applied for the synthesis of potential modulators of innate immune system receptor TLR7, which showed high binding affinities in the molecular docking studies.

1H NMR to analyse the lipid profile in the glyceride fraction of different categories of Iberian dry-cured hams.

The extraordinary organoleptic qualities of Iberian ham derive from the singular producing pig breed and from the traditional rearing conditions, both of which define its lipid content and composition. In this work 1H NMR spectroscopy is used for the first time to analyse the lipid profile of Iberian hams as determinant of quality. Quantification of fatty acids is readily obtained from the spectra, with the monounsaturated fatty acids standing out, especially in the higher quality hams. Unprecedently, triacylglyceride hydrolysis products formed during the curing process can also be directly detected and quantified. Furthermore, chemometric analysis of the NMR data allows to classify Iberian hams according to the pig's crossbreed and feeding regime. Principal component analysis shows fatty acid unsaturation and triacylglyceride hydrolysis as discriminating variables. 1H NMR spectroscopy has thus revealed as a convenient and powerful tool for the lipid analysis and classification of Iberian hams and for detection of fraud.

Molecular docking study and antireabsorptive activity of a semi-synthetic coumarin derivative from Platymiscium floribundum in the ligature-induced periodontitis in rats: the involvement of heme oxygenase-1.

OBJETIVE: This study aimed to evaluate the anti-resorptive activity of a semi-synthetic coumarin derivative from Platymiscium floribundum, named 6,7-dimethoxy-3-nitrocoumarin. MATERIAL AND METHODS: Molecular docking studies were performed to test the binding performance of the derivative against targets associated with alveolar bone loss (TNF-α, IL-1ß, and catalase) and a target considered an antioxidant defense (HO-1) during periodontitis. Periodontitis was induced by placing a nylon ligature around the second molars. The rats received for 11 days 6,7-dimethoxy-3-nitrocoumarin (0.01, 0.1, or 1 mg/kg) or vehicle. We investigated by RT-qPCR analysis (TNF-α, IL-1ß, and HO-1 mRNA expression levels) and by colorimetric assay (catalase activity) the mechanism of action mediated by 6,7-dimethoxy-3-nitrocoumarin. The in vivo toxicity of 6,7-dimethoxy-3-nitrocoumarin was evaluated. RESULTS: 6,7-Dimethoxy-3-nitrocoumarin (0.1 or 1 mg/kg) reduced alveolar bone loss (1.05 ± 0.24), when compared to vehicle-treated group (3.05 ± 0.30). The interactions of 6,7-dimethoxy-3-nitrocoumarin and the four targets (TNF-α, IL-1ß, catalase, and HO-1) showed firm bonds above 6.0 kcal/mol. 6,7-dimethoxy-3-nitrocoumarin (1 mg/kg) lowered mRNA expression levels of TNF-α (2.33 ± 0.56) and IL-1ß (19.87 ± 2.9), while it increased both the mRNA expression levels of HO-1 (43.40 ± 1.05) and the catalase activity (46.42 ± 4.59), when compared to vehicle-treated group (46.29 ± 8.43; 37.83 ± 4.38; 1.58 ± 0.11; 8.93 ± 1.86, respectively). The animals did not show any signs of toxicity. CONCLUSION: 6,7-Dimethoxy-3-nitrocoumarin decreased inflammatory bone loss in the ligature-induced periodontitis in rats, and the activation of the HO-1 pathway may contribute, at least partially, to its protective effects by reducing TNF-α and IL-1ß mRNA levels and increasing catalase activity. CLINICAL RELEVANCE: 6,7-Dimethoxy-3-nitrocumarin could be used as an adjunct to subgingival instrumentation during active and supportive periodontal treatment.

Mitigation of ruminal methane production with enhancing the fermentation by supplementation of different tropical forage legumes.

The aim of this research was to evaluate the influence of forage species adapted to the tropical region of Ecuador on gas production, enteric methane, digestion, and ruminal fermentation. The tree forage evaluated were C. arborea, E. fusca, B. forficata, E. poeppigiana, C. argentea, G. sepium, C. tora, and F. macrophylla. Ruminal fluid of four adult sheep fistulated with permanent cannulas in the rumen was used in the in vitro gas production technique. The in vitro gas production parameters were lower (P < 0.05) in the C. arborea (A = 41.68 mL gas/g DM, c = 0.044%/h and Lag = 1.654 h) and the average gas production rate for B. forficata was 1.017 mL/h (P < 0.05). C. arborea presented higher (P = 0.0001) effective degradation and real DM digestibility (40.461 g/kg and 82.51 mg/g, respectively). With respect to VFA, the highest (P < 0.05) proportion of acetic, propionic, and butyric was observed in C. arborea, G. sepium, and E. poeppigiana (72.52, 23.09, and 7.44 mol/100 mol, respectively) and the lowest (P = 0.0001) ratio: acetic/propionic was observed in G. sepium (2.92 mol/100 mol). The content of NH3-N (mg/L) showed no difference. The lowest (P = 0.0001) methane production was observed in C. arborea (1.23 mL CH4/g DM). The use of forage species of tropical climate rich in secondary metabolites in ruminant diets has the capacity to reduce the gas production and enteric methane; however, this is at the expense of the reduction of the fermentation of organic matter in the rumen.

Synthesis of Chromeno[3,4-b]piperazines by an Enol-Ugi/Reduction/Cyclization Sequence.

Keto piperazines and aminocoumarins are privileged building blocks for the construction of geometrically constrained peptides and therefore valuable structures in drug discovery. Combining these two heterocycles provides unique rigid polycyclic peptidomimetics with drug-like properties including many points of diversity that could be modulated to interact with different biological receptors. This work describes an efficient multicomponent approach to condensed chromenopiperazines based on the novel enol-Ugi reaction. Importantly, this strategy involves the first reported post-condensation transformation of an enol-Ugi adduct.

Immobilization of Amano lipase AK from Pseudomonas fluorescens on different types of chitosan-containing supports: use in the kinetic resolution of rac-indanol.

Amano lipase AK from P. fluorescens was immobilized on different types of chitosan-containing supports. Chitosan lower molecular weight (2.5%), chitosan lower molecular weight/sodium alginate (2.5%/2.5%) and chitosan lower molecular weight/carrageenan (2.5%/2.5%) allowed the highest values of immobilization yields (IY) of 81, 81 and 83%, respectively. Best activity results were achieved using chitosan average molecular weight (5%) and chitosan lower molecular weight/sodium alginate (2.5%/2.5%) as support, with values of 1.40 and 1.30 UpNPB/ggel and with recovery activities of 45.75 and 35.6%, respectively. These derivatives were evaluated in the kinetic resolution of rac-indanol to obtain a key intermediate in the synthesis of a drug used in the treatment of Parkinson's disease. The most efficient derivatives in the kinetic resolution were lipase immobilized on chitosan average molecular weight (5.0%) and chitosan low molecular weight/sodium alginate, the latter leading to obtaining both (S)-indanol and (R)-indanyl acetate with > 99% ee and 50% conversion.

Utilization of Avocado and Mango Fruit Wastes in Multi-Nutrient Blocks for Goats Feeding: In Vitro Evaluation.

This study was conducted to investigate the nutritive value of avocado and mango fruit wastes, and to assess the possibility of preserving the wastes into multi-nutrient blocks (MB). Both peels and a pulp:peels (PP) mixture of each fruit were analyzed for chemical composition and in vitro fermentation with goats' ruminal fluid. Wastes had low-dry matter (DM) content (<250 g/kg), with those from mango having high non-structural carbohydrates content (>800 g/kg DM) and those from avocado high fat levels (>580 g/kg DM). Mango wastes were fermented at a greater extent and faster rate than avocado ones. The PP mixture of each fruit was included into multi-nutrient blocks (MB) formulated to have similar chemical composition. There were only subtle differences in the fermentation of MB including wastes from either avocado or mango, but fermentation of avocado-MB resulted in significantly (p ≤ 0.032) greater acetate and lower propionate proportions than mango-MB. Including the PP mixture in the formulation of MB for goats feeding is a feasible option to reduce the environmental impact of avocado and mango fruit wastes, but studies on the acceptance of the MB by goats and their stability over long-time storage periods are needed.

In Vitro and In Situ Evaluation of Broccoli Wastes as Potential Feed for Ruminants.

The potential of broccoli wastes (florets and stems) as ruminant feed was analyzed using in vitro and in situ techniques. Both stems and florets had high moisture content (90.6 and 86.1%, respectively), but the stems contained (% dry matter) lower levels (p < 0.05) of crude protein (CP; 23.2 vs. 30.8%) and ether extract (2.91 vs. 6.15%) and tended to have greater sugars content (p = 0.071; 33.4 vs. 19.6%) than florets. Stems had greater in vitro dry matter rumen degradability (45.3%; 24 h incubation) and lower in vitro CP intestinal digestibility (82.7%) compared with florets (42.2 and 90.1%, respectively). Rumen degradability of protein was high (<85%) for both fractions. In a second experiment, diets including different proportions of broccoli were formulated and fermented in vitro. The replacement of 24% of conventional feeds (wheat, soybean meal and wheat bran) in a concentrate by dried broccoli increased the amount of organic matter fermented in vitro and the NH3-N concentrations of a mixed diet including 40% of the concentrate. Including dried broccoli in the diet produced only small modifications in the volatile fatty acid profile and did not affect CH4 emission.

Preserving Porphyra umbilicalis and Saccharina latissima as Silages for Ruminant Feeding.

The study analyzed the characteristics, chemical composition, and in vitro gas production kinetics of Porphyra umbilicalis and Saccharina latissima silages. Each seaweed was ensiled in vacuum bags (three bags/silage) following a 2 × 3 factorial design, with two pre-treatments (unwilted or pre-wilted) and three silage types: unwashed seaweed ensiled without additive; seaweed washed and ensiled without additive; and seaweed washed and ensiled with 4 g of formic acid (FAC) per kg seaweed. Silages were kept for 3 months in darkness at 20 °C. Pre-wilting prevented (p < 0.001) effluent formation and reduced (p ≤ 0.038) the production of NH3-N and volatile fatty acids for both seaweeds. Both pre-wilting and washing increased (p < 0.05) the ruminal degradability of P. umbilicalis silages but not of S. latissima silages. The pH of the FAC-treated silages was below 4.0, but ranged from 4.54 to 6.23 in non FAC-treated silages. DL-lactate concentrations were low (≤23.0 g/kg dry matter) and acetate was the predominant fermentation product, indicating a non-lactic fermentation. The estimated ruminal degradability of the P. umbilicalis and S. latissima silages was as average, 59.9 and 86.1% of that for high-quality rye-grass silages, respectively, indicating a medium-low nutritional value of these seaweed silages for ruminants.

Description of patients with severe COVID-19 treated in a national referral hospital in Peru. / Caracterización de pacientes con COVID-19 grave atendidos en un hospital de referencia nacional del Perú.

In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.

Con el objetivo de describir las manifestaciones de pacientes con enfermedad por coronavirus 2019 (COVID-19), se evaluaron variables sociodemográficas, antecedentes, manifestaciones clínicas y radiológicas, tratamientos y evolución en pacientes que ingresaron por emergencia, del 6 al 25 de marzo de 2020, al Hospital Nacional Edgardo Rebagliati Martins en Lima. Se registraron 17 pacientes: el 76% eran varones, edad promedio de 53,5 años (rango de 25 a 94); el 23,5% había regresado del extranjero; 41,2% referido de otros establecimientos de salud; 41,2% ingresó a ventilación mecánica; falleció el 29,4% (5 pacientes). Los factores de riesgo detectados fueron adulto mayor, tener hipertensión arterial y obesidad; los principales síntomas, tos, fiebre y disnea; los hallazgos de laboratorio frecuentes, proteína C reactiva elevada y linfopenia; la presentación radiológica predominante, el infiltrado pulmonar intersticial bilateral. Se reporta una primera experiencia en el manejo de pacientes con diagnóstico de la COVID-19 grave en el Perú.