Modeling mortality risk in patients with severe COVID-19 from Mexico.

Background: Severe acute respiratory syndrome caused by a coronavirus (SARS-CoV-2) is responsible for the COVID-19 disease pandemic that began in Wuhan, China, in December 2019. Since then, nearly seven million deaths have occurred worldwide due to COVID-19. Mexicans are especially vulnerable to the COVID-19 pandemic as Mexico has nearly the worst observed case-fatality ratio (4.5%). As Mexican Latinos represent a vulnerable population, this study aimed to determine significant predictors of mortality in Mexicans with COVID-19 who were admitted to a large acute care hospital. Methods: In this observational, cross-sectional study, 247 adult patients participated. These patients were consecutively admitted to a third-level referral center in Yucatan, Mexico, from March 1st, 2020, to August 31st, 2020, with COVID-19-related symptoms. Lasso logistic and binary logistic regression were used to identify clinical predictors of death. Results: After a hospital stay of about eight days, 146 (60%) patients were discharged; however, 40% died by the twelfth day (on average) after hospital admission. Out of 22 possible predictors, five crucial predictors of death were found, ranked by the most to least important: (1) needing to be placed on a mechanical ventilator, (2) reduced platelet concentration at admission, (3) increased derived neutrophil to lymphocyte ratio, (4) increased age, and (5) reduced pulse oximetry saturation at admission. The model revealed that these five variables shared ~83% variance in outcome. Conclusion: Of the 247 Mexican Latinos patients admitted with COVID-19, 40% died 12 days after admission. The patients' need for mechanical ventilation (due to severe illness) was the most important predictor of mortality, as it increased the odds of death by nearly 200-fold.

Clinical predictors of lung function in patients recovering from mild COVID-19.

BACKGROUND: Few studies have assessed lung function in Hispanic subjects recovering from mild COVID-19. Therefore, we examined the prevalence of impaired pulmonary diffusing capacity for carbon monoxide (DLCO) as defined by values below the lower limit of normal (< LLN, < 5th percentile) or less than 80% of predicted in Hispanics recovering from mild COVID-19. We also examined the prevalence of a restrictive spirometric pattern as defined by the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) being ≥ LLN with the FVC being < LLN. Finally, we evaluated previous studies to find factors correlated to impaired DLCO post-COVID-19. METHODS: In this observational study, adult patients (n = 146) with mild COVID-19 were recruited from a long-term follow-up COVID-19 clinic in Yucatan, Mexico, between March and August 2021. Spirometry, DLCO, and self-reported signs/symptoms were recorded 34 ± 4 days after diagnosis. RESULTS: At post-evaluation, 20% and 30% of patients recovering from COVID-19 were classified as having a restrictive spirometric pattern and impaired DLCO, respectively; 13% had both. The most prevalent reported symptoms were fatigue (73%), a persistent cough (43%), shortness of breath (42%) and a blocked/runny nose (36%). Increased age and a restrictive spirometric pattern increased the probability of having an impaired DLCO while having a blocked nose and excessive sweating decreased the likelihood. The proportion of patients with previous mild COVID-19 and impaired DLCO increased by 13% when the definition of impaired DLCO was < 80% predicted instead of below the LLN. When comparing previous studies, having severe COVID-19 increased the proportion of those with impaired DLCO by 21% compared to those with mild COVID-19. CONCLUSIONS: One-third of patients with mild COVID-19 have impaired DLCO thirty-four days post-diagnosis. The criteria that define impaired DLCO and the severity of COVID-19 disease affects the proportion of those with impaired DLCO at follow-up. One-fifth of patients have a restrictive spirometric pattern.

Pneumomediastinum Associated with COVID-19: A Case Series.

Coronavirus disease 2019 (COVID-19), caused by the new coronavirus SARSCoV-2, is an infectious disease that has caused an increase in hospitalizations for pneumonia; the spectrum of clinical presentation is variable. One such presentation, pneumomediastinum (PM), is defined as the presence of air or some other gas in the mediastinum. It is a rare condition, usually benign and self-limited; it has been seen in patients with COVID-19. Although most cases are, as explained above, self limited and in addition, can be managed conservatively, close monitoring is recommended, as PM can cause life-threatening hemodynamic and respiratory disturbances. We present a case series of 4 patients with SARS CoV-2 infection, in whom PM was found, and who were admitted to the Regional Hospital of High Specialty of the Yucatan Peninsula during the period of May 2020 through August 2020.

Humoral immune response in healthcare workers after two doses of a BNT162b2 mRNA vaccine in Yucatan, Mexico.

The antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as the host immune response after vaccination and viral infection have shown to be highly heterogeneous. This is a case series study analysing humoral immune response and vaccination side effects after two doses of a BNT162b2 mRNA among healthcare workers (HCWs) in Mexico. All participants were scheduled for their two doses of mRNA BNT162b2 vaccine and provided information through a questionnaire: demographic characteristics, antibody serum titres and vaccination-related side effects. Blood samples were obtained for serology testing after the first and second doses of vaccine. No serious adverse effects due to vaccination were reported; nonetheless, non-medical HCWs reported more side effects after the second dose. The previous infection with SARS-CoV-2 boosted immune response after receiving the first vaccination (roughly 30 times higher than those without previous infection); nonetheless, after the second dose, the immune response did not show a higher titre as might be expected.

Secondary spontaneous pneumothorax: a time to re-evaluate management.

Spontaneous pneumothorax (SP) is defined as the presence of air in the pleural cavity and remains a significant health problem. Secondary SP (SSP) is associated with underlying lung diseases, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD), and is associated with poor outcomes. The current guidelines in the management of SSP have not been updated since the last decade; therefore, new protocols focused on the management of SSP should be evaluated. We present two cases of patients admitted with SSP who were treated conservatively due to haemodynamic stability. In both cases, the pneumothoraces resolved without further complications.

Clinical impact of obesity on respiratory diseases: A real-life study.

BACKGROUND: Obesity has become an epidemic that affects Mexico; significantly interferes with respiratory physiology by decreasing lung volumes, therefore, might be considered as a relevant risk factor associated with the development of respiratory diseases. OBJECTIVE: Our primary outcome was to analyze the frequency and risk factors between obesity and respiratory disease in the Mexican population. MATERIALS AND METHODS: An observational, single-center, descriptive study, which included the totality of patients who were referred for medical attention at the Respiratory and Thorax Surgery Unit at the Hospital Regional de Alta Especialidad de la Península de Yucatán during the period from January 2015 to December 2018. The cases were grouped based on the existence or not of respiratory disease and the presence or absence of obesity (body mass index [BMI] >30 kg/m2). RESULTS: A total of 1167 patients were included; about 39% of the population had average BMI 36.5 kg/m2. The primary respiratory diseases in obese patients were Obstructive Sleep Apnea Syndrome (OSAS, 19%) and asthma (15%). The logistic regression analysis showed a direct association between the presence of obesity with respiratory disease (odds ratio 1.58, 95% confidence interval 1.22-2.03, P < 0.001), the strength of this association was related with asthma and OSAS. CONCLUSION: The presence of obesity is an independent risk factor for respiratory disease, primarily for OSAS and asthma.

[Overview of the interstitial lung disease in the Southeast of Mexico]. / Panorama de la enfermedad pulmonar intersticial en el sureste de México.

Background: Interstitial lung disease (ILD) corresponds to a heterogeneous group of pathologies that differ in etiology with common clinical and radiological manifestations. In Latin America and Mexico, reports are scarce and the need for studies to understand the scenario is emphasized. Objective: To analyze a multidimensional profile in patients with interstitial lung disease in Yucatan. Method: This is an observational, prospective, analytic, descriptive study including consecutive patients diagnosed with ILD over a 4-year period. Demographic and clinical data, lung function tests, chest imaging, serum immunological profile, and echocardiographic findings were recorded. Differences between subgroups were analyzed performing a one-way analysis of variance (ANOVA). Results: 110 patients were included. The median age was 60 years and women were most affected. The main cause of ILD was related with connective tissue diseases (CTD). A group subanalysis revealed that Idiopathic pulmonary fibrosis (IPF) was common in males with a history of smoking and an imaging pattern of usual interstitial pneumonia. Lung function tests showed a moderate-to-severe pulmonary restriction (FVC 55%p) and mild hypoxemia (PaO2 79mmHg). Positive antinuclear antibodies are less likely in cases with IPF (20 vs. 65%; p = 0.006). Conclusion: In Southeastern Mexico, ILD occurs in women in their seventh decade of life; the most common cause is related with CTD. Our results support that ILD has a heterogeneous expression and is relevant the need for subsequent studies characterizing each ILD.

Introducción: La enfermedad pulmonar intersticial (EPI) corresponde a un grupo heterogéneo de patologías que difieren en su etiología pero tienen manifestaciones clínicas y radiológicas comunes. En Latinoamérica y México los reportes son escasos, enfatizando la necesidad de estudios que permitan conocer su escenario clínico-epidemiológico. Objetivo: Realizar un análisis multidimensional y contrastado de la EPI en la población de la Península de Yucatán. Método: Estudio observacional, prospectivo, analítico y descriptivo, que incluye la totalidad de pacientes diagnosticados de EPI en un período de 4 años. Se registraron datos demográficos y clínicos, pruebas de función pulmonar, imagenología del tórax, perfil inmunológico y ecocardiografía transtorácica. Se analizaron las diferencias según la etiología mediante análisis de la varianza de una sola vía (ANOVA). Resultados: Se incluyeron 110 pacientes con una mediana de edad de 60 años y predominio del sexo femenino. La causa principal de la EPI fue relacionada con enfermedad del tejido conectivo. El subanálisis de grupos mostró que la fibrosis pulmonar idiopática (FPI) es frecuente en los varones con antecedente de tabaquismo y patrón tomográfico de neumonía intersticial usual. Las pruebas de función pulmonar demostraron restricción pulmonar moderadamente grave (FVC 55%p) e hipoxemia leve (PaO2 79 mmHg). La positividad de anticuerpos antinucleares ocurre en menor proporción en la FPI (20 vs. 65%, p = 0.006). Conclusiones: En el sureste de México, la EPI ocurre en mujeres de la séptima década de la vida y se relaciona con enfermedad del tejido conectivo. Nuestros resultados respaldan que la EPI tiene expresión heterogénea y se requieren estudios subsecuentes sobre cada tipo de enfermedad.

Risk Factors for Mortality in Hospitalized Patients with COVID-19: An Overview in a Mexican Population.

BACKGROUND: Currently, Mexico ranks third worldwide in mortality due to coronavirus disease pandemic 2019 (COVID-19) and reliable information is scarce, with the available data focused on epidemiological characteristics. This study aimed to identify the risk factors associated with mortality and outcomes in hospitalized Mexican patients with COVID-19. METHODS: We prospectively assessed patients admitted to a COVID-19 reference center in southeast Mexico between March 28 and June 30, 2020. Mortality was defined as survivors or non-survivors and univariate and multivariate logistic regression analyses were performed to explore the association of the clinical characteristics and laboratory parameters with mortality. RESULTS: We included 200 patients with a mean age of 55 years, 69% were men and 72% had at least one chronic comorbidity. Eighty-six patients required invasive mechanical ventilation (IMV) with an overall mortality rate of 82.5%. Only 51% of the patients with IMV were admitted to the intensive care unit (ICU), with a survival rate of 27.3%, but only 7.2% for patients without ICU admissions (p=0.014). The multivariate analysis found that a neutrophil-to-lymphocyte ratio ≥9 (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.05-10.53) albumin <3.5 g/dL (OR, 3.76; 95% CI, 1.56-9.07), lactate dehydrogenase (LDH) level ≥725 U/L (OR, 5.45; 95% CI, 2.36-12.57), and IMV (OR, 64.7; 95% CI, 15.20-275.39) were independent risk factors associated with mortality. CONCLUSION: Neutrophil-to-lymphocyte ratio, LDH, albumin, and IMV were independent risk factors for mortality in Mexican patients with COVID-19. Also, the availability of ICU resources is invaluable for better outcomes in critically ill patients. Our results could provide clinical information for timely decision-making in low-and-middle income countries to overcome the pandemic.

Bleomycin-Induced Cryptogenic Organizing Pneumonia Manifested as Spontaneous Pneumothorax in a Patient with Classic Seminoma.

Cryptogenic Organizing Pneumonia (COP) can manifest like a collagen disorder or infectious diseases, or be caused by drug induced toxicity. This paper presents the case of a 24 year-old man diagnosed with classic seminoma, treated with chemotherapy scheme that included bleomycin (accumulated dose, 120 units). The patient was admitted at the hospital due to rapidly-progressing dyspnea and thoracic pain. The diagnostic approach revealed the presence of a spontaneous pneumothorax, while a lung biopsy documented COP. Despite treatment, the patient died from disease progression.