ABSTRACT
Purpose: The effect of high altitude ( ≥ 1500â m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.
Subject(s)
COVID-19 , Adult , Aged , Altitude , Cohort Studies , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Middle Aged , Respiration, Artificial , Retrospective StudiesABSTRACT
Objetivo: Determinar la seroprevalencia de la enfermedad de Chagas del cantón Aguarico, provincia de Orellana. Selva amazónica ecuatoriana (2008-2015). Introducción: En el cantón Aguarico los primeros estudios investigativos sobre esta patología comprenden desde 1990 con 1.011 examinados y 61 positivos (3,40 %), 2003 con 6.866 examinados y 76 reactivos (2,40%), 2009 con una población de 2.083 pacientes con 73 reactivos, (3,60 %) y 2008-2015 con 2.235 examinados y 76 positivos (3,40 %) (presente investigación). Material y métodos: Se procesaron las muestras con la técnica Chagatest/Elisa recombinante v.3.0 para determinar positividad a la enfermedad de Chagas. Los casos positivos fueron reconfirmados por el INSPI, Instituto Nacional de Salud Pública e Investigación, con pruebas de hemoaglutinación indirecta (HAI) y Elisa. Con una absorbancia mayor a 1.300. Resultados: La seroprevalencia en las comunidades los porcentajes oscilaron entre (1,32 %) y (13,16 %). Con mayor frecuencia en el sexo femenino (60,53 %). El Riesgo Relativo (RR) de 1,17. El Odds Ratio (OR) 1,18. Siendo mayor el riesgo a desarrollar la enfermedad en los expuestos que en los no expuestos. Conclusiones: Los datos obtenidos confirman la presencia de un foco autóctono de la enfermedad de Chagas en la selva amazónica ecuatoriana. No se detectaron cuadros clínicos agudos ni patologías crónicas, al momento del estudio sin alteraciones radiológicas y con resultados de electrocardiogramas normales; se concluye que la presente investigación, los casos reactivos corresponderían a enfermedad de Chagas en fase indeterminada.
Objective: To determine the seroprevalence of Chagas disease in canton Aguarico Ecuadorian, Province of Orellana. Amazon Forest (2008-2015).Background: The first research studies on this pathology did in Canton Aguarico since 1990, have included 1.011 examined 61 positives (3,40 %), 2003 2.003 with 6866 examined and 76 reactive (2,40 %), 2009 with a population of 2.083 73 reagents, 3,60 %) and 2008-2015 with 2.235 examined and 76 positives (3,40 %) (Present research). Material and methods: the samples were processed using recombinant CHAGATEST / ELISA technique v.3.0 to determine the positivity to Chagas' disease. The National Institute of Public Health and Research (INSPI) reconfirmed positive cases with indirect hemagglutination (HAI) and ELISA tests. With an absorbance greater than 1300. Results: The sero-prevalence in the communities with percentages ranged from 1 (1,32 %) to 10 (13,16 %), often the greater frequency in females. 46 (60,53 %). The Relative Risk (RR) of 1.17. The Odds Ratio (OR) 1.18, being greater the risk to develop the disease in the exposed than in the unexposed ones. Conclusions: The data obtained confirm the presence of an indigenous provenance of Chagas' disease in the Ecuadorian Amazon Forest. There were not detected any acute clinical cases or chronic pathology at the time of the study, withoutradiological alterations and normal electrocardiogram; It is concluded that the present investigation, the reactive cases would correspond to Chagas disease in Indeterminate phase.
