Uso de plasma de convalecientes de COVID-19 en pacientes hospitalizados por SARS-CoV-2 de moderada grave-dad en la Región de Los Ríos, Chile / Assessing Convalescent Plasma Efficacy in Moderate COVID-19 Hospitalizations: A Bicentric Retrospective Study

INTRODUCCIÓN: COVID-19 cobró millones de vidas especialmente en la era pre-vacunas. Estudios preliminares mostraban eficacia promisoria del plasma de personas convalecientes anti SARS-CoV-2 (PPC). Objetivo: evaluar la eficacia del PPC en hospitalizados por COVID-19 de moderada gravedad. MATERIAL Y MÉTODOS: Estudio retrospectivo, bicéntrico, en adultos hospitalizados por COVID-19 moderado (no crítico) que requirieron oxigenoterapia. Al plasma donado por sobrevivientes de cuadros leves (600 cc) se les realizó búsqueda de IgG anti SARS-CoV-2. Se evaluó su impacto en mortalidad, estadía hospitalaria (días) y necesidad de ventilación mecánica (VMI). RESULTADOS: De los 119 pacientes incluidos, 58% eran hombres (edad mediana 60 años), 88% poseía comorbilidad y 43% tenía "CALL score" de alto riesgo. 43 pacientes (36%) recibieron PPC, sólo 15 (12,6%) precozmente (< 7 días). 22 pacientes debieron trasladarse a unidad intensiva, 18 recibieron VMI y 15 fallecieron (12,6%). El uso de PPC no se asoció a cambios en la mortalidad (p = 0,16), necesidad de VMI (p = 0,79) ni en la estadía hospitalaria (p = 0,24). Su administración en forma precoz (< 7 días de síntomas) tampoco demostró asociación significativa. La presencia de cardiopatía y el requerir posteriormente VMI fueron factores independientes asociados a mortalidad. CONCLUSIONES: El uso de PPC en pacientes hospitalizados por COVID-19 de moderada gravedad no se asoció a menor mortalidad, estadía hospitalaria ni necesidad de VMI.

INTRODUCTION: COVID-19 claimed millions of lives, mainly in the pre-vaccine era. Preliminary studies showed promising efficacy of convalescent plasma against SARS-CoV-2 (CP). Objective: To evaluate the efficacy of CP in patients hospitalized for COVID-19 with moderate severity. METHODS: Retrospective, bicentric study including adults hospitalized for moderate (non-critical) COVID-19 who required oxygen therapy. CP donated by survivors of mild cases (600 cc) were searched for IgG anti-SARS-CoV-2. Its impact on mortality, hospital stay (days), and need for mechanical ventilation (IMV) was evaluated. RESULTS: Of the 119 patients included, 58% were men (median age 60 years), 88% had comorbidity, and 43% had a high-risk CALL score. Forty-three patients (36%) received CP, only 15 (12.6%) early (< 7 days). Twenty-two patients had to be transferred to the intensive care unit; 18 received IMV, and 15 died (12.6%). The use of CP was not associated with changes in mortality (p = 0.16), need for IMV (p = 0.79), or hospital stay (p = 0.24). Its early administration (< 7 days of symptoms) did not show a significant association either. The presence of heart disease and subsequently requiring IMV were independent factors of mortality. CONCLUSIONS: The use of CP in patients hospitalized for moderately severe COVID-19 was not associated with lower mortality, hospital stay, or the need for IMV.

[Assessing Convalescent Plasma Efficacy in Moderate COVID-19 Hospitalizations: A Bicentric Retrospective Study]. / Uso de plasma de convalecientes de COVID-19 en pacientes hospitalizados por SARS-CoV-2 de moderada grave-dad en la Región de Los Ríos, Chile.

INTRODUCTION: COVID-19 claimed millions of lives, mainly in the pre-vaccine era. Preliminary studies showed promising efficacy of convalescent plasma against SARS-CoV-2 (CP). OBJECTIVE: To evaluate the efficacy of CP in patients hospitalized for COVID-19 with moderate severity. METHODS: Retrospective, bicentric study including adults hospitalized for moderate (non-critical) COVID-19 who required oxygen therapy. CP donated by survivors of mild cases (600 cc) were searched for IgG anti-SARS-CoV-2. Its impact on mortality, hospital stay (days), and need for mechanical ventilation (IMV) was evaluated. RESULTS: Of the 119 patients included, 58% were men (median age 60 years), 88% had comorbidity, and 43% had a high-risk CALL score. Forty-three patients (36%) received CP, only 15 (12.6%) early (< 7 days). Twenty-two patients had to be transferred to the intensive care unit; 18 received IMV, and 15 died (12.6%). The use of CP was not associated with changes in mortality (p = 0.16), need for IMV (p = 0.79), or hospital stay (p = 0.24). Its early administration (< 7 days of symptoms) did not show a significant association either. The presence of heart disease and subsequently requiring IMV were independent factors of mortality. CONCLUSIONS: The use of CP in patients hospitalized for moderately severe COVID-19 was not associated with lower mortality, hospital stay, or the need for IMV.

Clinical features of 47 patients infected with COVID-19 admitted to a Regional Reference Center

ABSTRACT Background: During the first pandemic wave, Covid-19 reached Latin America cities. Aim: To report clinical features and outcomes of a group of patients with Covid-19 admitted to a Chilean regional reference Center. Material and Methods: Cases were identified by a compatible clinical picture and a positive PCR or serological test. Clinical features of patients were retrieved from medical records. Results: Forty-seven adult patients (45 diagnosed by PCR, 2 by serology) were admitted between epidemiological weeks 13 to 33, corresponding to 4.4% of total regional cases. Hospitalization occurred at a median of 10 days after onset of symptoms. Fifty one percent of patients had 60 years or more. Hypertension, obesity and diabetes mellitus were present in 57, 45 and 32 % of cases, respectively. Nineteen percent of patients had no comorbid condition nor were elderly. Two cases were women in their second trimester of pregnancy. Positive IgM or IgM/IgG results obtained by rapid serological testing, had limited sensitivity during the first week (67%). Seventeen patients (36.2%) were transferred to an intensive care unit (ICU) due to respiratory failure. Chest imaging demonstrated a classical COVID-19 pattern in 87%. By univariate analysis, admission to ICU was significantly associated with tachypnea and higher CALL (comorbidity, age, lymphocyte count and lactate dehydrogenase) score. Four patients died (rendering a hospital mortality of 8.5%) and length of stay was ≥ 14 days in 46.8% of patients. By univariate analysis, mortality was associated with immunosuppression and ICU admission. Conclusions: In our regional Center, patients admitted with COVID-19 had usual risk factors and had a prolonged stay. Hospital mortality was associated with immunosuppression and ICU admission.

Antecedentes: Durante la primera ola pandémica, COVID-19 llegó a las ciudades de América Latina. Objetivos: Informar las características clínicas y los resultados asociados a COVID-19 en un grupo de pacientes ingresados en un Centro de referencia regional en el sur de Chile. Material y Métodos: Los casos fueron identificados por un cuadro clínico compatible asociado a RT-PCR positiva o prueba serológica. La información clínica de los pacientes se obtuvo de sus fichas. Resultados: Entre las semanas epidemiológicas 13 y 33 ingresaron 47 pacientes adultos (45 diagnosticados por PCR, 2 por serología), lo que representa el 4,4% del total de casos regionales. La hospitalización se produjo con una mediana de 10 días después del inicio de los síntomas. El 51% de los pacientes tenía 60 años o más. La hipertensión arterial (57,4%), la obesidad (44,7%) y la diabetes mellitus 2 (31,9%) fueron prevalentes, pero el 19% no presentaba comorbilidades ni era un adulto mayor. Dos casos ocurrieron en mujeres embarazadas en el segundo trimestre. Los resultados positivos de IgM o IgM / IgG obtenidos mediante pruebas serológicas rápidas tuvieron una sensibilidad limitada durante la primera semana (66,7%). Diecisiete pacientes (36,2%, grupo crítico) fueron trasladados a UCI por insuficiencia respiratoria. Las imágenes de tórax demostraron un patrón COVID-19 clásico en el 87% de los casos. Por análisis univariado, el ingreso en UCI se asoció significativamente con taquipnea y puntuaciones CALL (comorbidity, age, lymphocyte count and lactate dehydrogenase) elevadas. Cuatro pacientes fallecieron (mortalidad hospitalaria 8,5%) y la estadía hospitalaria fue ≥ 14 días en el 47% de los pacientes. Por análisis univariado la mortalidad se asoció a inmunodepresión y al ingreso a UCI. Conclusiones: En nuestro Centro regional, COVID-19 se asoció a factores de riesgo conocidos y tuvo una estadía prolongada. La mortalidad hospitalaria se asoció con inmunosupresión o ingreso a UCI.

Clinical features of 47 patients infected with COVID-19 admitted to a Regional Reference Center.

BACKGROUND: During the first pandemic wave, Covid-19 reached Latin America cities. AIM: To report clinical features and outcomes of a group of patients with Covid-19 admitted to a Chilean regional reference Center. MATERIAL AND METHODS: Cases were identified by a compatible clinical picture and a positive PCR or serological test. Clinical features of patients were retrieved from medical records. RESULTS: Forty-seven adult patients (45 diagnosed by PCR, 2 by serology) were admitted between epidemiological weeks 13 to 33, corresponding to 4.4% of total regional cases. Hospitalization occurred at a median of 10 days after onset of symptoms. Fifty one percent of patients had 60 years or more. Hypertension, obesity and diabetes mellitus were present in 57, 45 and 32 % of cases, respectively. Nineteen percent of patients had no comorbid condition nor were elderly. Two cases were women in their second trimester of pregnancy. Positive IgM or IgM/IgG results obtained by rapid serological testing, had limited sensitivity during the first week (67%). Seventeen patients (36.2%) were transferred to an intensive care unit (ICU) due to respiratory failure. Chest imaging demonstrated a classical COVID-19 pattern in 87%. By univariate analysis, admission to ICU was significantly associated with tachypnea and higher CALL (comorbidity, age, lymphocyte count and lactate dehydrogenase) score. Four patients died (rendering a hospital mortality of 8.5%) and length of stay was ≥ 14 days in 46.8% of patients. By univariate analysis, mortality was associated with immunosuppression and ICU admission. CONCLUSIONS: In our regional Center, patients admitted with COVID-19 had usual risk factors and had a prolonged stay. Hospital mortality was associated with immunosuppression and ICU admission.

[Antiphospholipid antibodies in idiopathic membranous nephropathy]. / Anticuerpos antifosfolípidos en nefropatía membranosa idiopática.

BACKGROUND: Antiphospholipid antibodies have been found in the sera from patients with idiopathic and secondary glomerulopathies, mainly related to lupus. No special attention has been devoted to idiopathic membranous nephropathy, a glomerular disease with a high frequency of thrombotic complications, particularly of the renal vein. AIM: To study the presence and significance of antiphospholipid antibodies in idiopathic membranous nephropathy. MATERIAL AND METHODS: Anticardiolipin and anti-ss2-glycoprotein-I IgG antibodies were measured in serum samples from 21 patients with idiopathic membranous nephropathy (age range 11-75 years, 5 female). The medical records of 20 of these patients were reviewed, looking for vascular complications and nephrological evolution during a follow-up period that ranged from two to 277 months. RESULTS: Five patients had anticardiolipin antibody titers over the cutoff for normal values, and two others were positive for anti-ss2-glycoprotein-I, without cross-reactivity. There was no difference in the incidence of thrombotic complications in the renal vein, or other locations, between these seven patients and the remaining patients. No differences in the clinical course of the nephropathy were detected either. CONCLUSIONS: Antiphospholipid antibodies may be found in patients with primary membranous nephropathy. They are not related to thrombosis or a worse evolution.

Calibre and Microtubule Content of the Non-Medullated and Myelinated Domains of Optic Nerve Axons of Rats.

Calibres and microtubule contents of the non-medullated and myelinated domains of optic nerve axons of adult rats were studied with the electron microscope. The cross-sectional areas of the non-medullated domain was 0.25 microm2, and that of the myelinated domain 0.40 microm2, that is, greater by 59%. The increase in size was uneven across the axonal population; it was marked in fine and medium sized axons, and modest in the largest axons. The number of microtubules increased with axonal size; the density, however, decreased from 85 mirotubules/microm2 in 0.1 microm2 axons to about 20 in 1.2 microm2 axons. In axons of equal cross sectional area, the microtubular density of the myelinated and non-medullated domains was the same. Microtubular density values of optic axons resemble those of dorsal roots more than those of peripheral nerve axons of equal calibre. The facts that optic axons increase in size and gain microtubules behind the eyeball while the microtubular packing decreases suggest a local regulation of the axonal cytoskeleton.