Intranasal Versus Intravenous Dexamethasone to Treat Hospitalized COVID-19 Patients: A Randomized Multicenter Clinical Trial.

BACKGROUND: SARS-CoV2 induces flu-like symptoms that can rapidly progress to severe acute lung injury and even death. The virus also invades the central nervous system (CNS), causing neuroinflammation and death from central failure. Intravenous (IV) or oral dexamethasone (DXM) reduced 28 d mortality in patients who required supplemental oxygen compared to those who received conventional care alone. Through these routes, DMX fails to reach therapeutic levels in the CNS. In contrast, the intranasal (IN) route produces therapeutic levels of DXM in the CNS, even at low doses, with similar systemic bioavailability. AIMS: To compare IN vs. IV DXM treatment in hospitalized patients with COVID-19. METHODS: A controlled, multicenter, open-label trial. Patients with COVID-19 (69) were randomly assigned to receive IN-DXM (0.12 mg/kg for three days, followed by 0.6 mg/kg for up to seven days) or IV-DXM (6 mg/d for 10 d). The primary outcome was clinical improvement, as defined by the National Early Warning Score (NEWS) ordinal scale. The secondary outcome was death at 28 d between IV and IN patients. Effects of both treatments on biochemical and immunoinflammatory profiles were also recorded. RESULTS: Initially, no significant differences in clinical severity, biometrics, and immunoinflammatory parameters were found between both groups. The NEWS-2 score was reduced, in 23 IN-DXM treated patients, with no significant variations in the 46 IV-DXM treated ones. Ten IV-DXM-treated patients and only one IN-DXM patient died. CONCLUSIONS: IN-DMX reduced NEWS-2 and mortality more efficiently than IV-DXM, suggesting that IN is a more efficient route of DXM administration.

The Impact of the COVID-19 Pandemic in Postoperative Neurosurgical Infections at a Reference Center in México.

The COVID-19 pandemic has had a major global impact on the treatment of hospitalized surgical patients. Our study retrospectively evaluates the impact of the COVID-19 pandemic at a neurosurgical reference center in Mexico City. We compared the number of neurosurgeries, the rate and type of postoperative infections, the causative microorganisms and in-hospital mortality rates in a 4-year period, from the pre-pandemic year 2019 until 2022. A total of 4150 neurosurgical procedures were registered. In 2020 the total number of surgeries was reduced by 36% compared to 2019 OR = 0.689 (95% CI 0.566-0.834) p ≤ 0.001, transnasal/trans sphenoidal pituitary resections decreased by 53%, and spinal surgeries by 52%. The rate of neurosurgical infections increased from 3.5% in 2019 to 5.6% in 2020 (p = 0.002). Regarding the microorganisms that caused infections, gram positive cocci accounted for 43.5% of isolates, Klebsiella spp. and Pseudomonas spp. caused one third of the infections. No significant differences were found for in-hospital mortality nor patterns of resistance to antibiotics. The number of surgeries increased in the last two years, although the infection rate has returned to pre-pandemic levels. We observed a lower impact from subsequent waves of COVID-19 and despite an increase in the number of surgeries, the surgeries have not amounted to the full pre-pandemic levels.

Intranasal dexamethasone: a new clinical trial for the control of inflammation and neuroinflammation in COVID-19 patients.

BACKGROUND: By end December of 2021, COVID-19 has infected around 276 million individuals and caused over 5 million deaths worldwide. Infection results in dysregulated systemic inflammation, multi-organ dysfunction, and critical illness. Cells of the central nervous system are also affected, triggering an uncontrolled neuroinflammatory response. Low doses of glucocorticoids, administered orally or intravenously, reduce mortality among moderate and severe COVID-19 patients. However, low doses administered by these routes do not reach therapeutic levels in the CNS. In contrast, intranasally administered dexamethasone can result in therapeutic doses in the CNS even at low doses. METHODS: This is an approved open-label, multicenter, randomized controlled trial to compare the effectiveness of intranasal versus intravenous dexamethasone administered in low doses to moderate and severe COVID-19 adult patients. The protocol is conducted in five health institutions in Mexico City. A total of 120 patients will be randomized into two groups (intravenous vs. intranasal) at a 1:1 ratio. Both groups will be treated with the corresponding dexamethasone scheme for 10 days. The primary outcome of the study will be clinical improvement, defined as a statistically significant reduction in the NEWS-2 score of patients with intranasal versus intravenous dexamethasone administration. The secondary outcome will be the reduction in mortality during hospitalization. CONCLUSIONS: This protocol is currently in progress to improve the efficacy of the standard therapeutic dexamethasone regimen for moderate and severe COVID-19 patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04513184 . Registered November 12, 2020. Approved by La Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS) with identification number DI/20/407/04/36. People are currently being recruited.

High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19.

INTRODUCTION: High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. METHODS: We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. RESULTS: HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6-75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09-1.47; p < 0.01), Rox index at 1 hour (0.82, 0.7-0.96; p = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19-0.62; p < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11-20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20-36) days, respectively]. CONCLUSION: Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.

Impact of preemptive hospitalization on health outcomes at the temporary COVID-19 hospital in Mexico City: a prospective observational study.

INTRODUCTION: In response to the evolution of the coronavirus disease 2019 (COVID-19) pandemic, the admission protocol for the temporary COVID-19 hospital in Mexico City has been updated to hospitalize patients preemptively with an oxygen saturation (SpO2) of >90%. METHODS: This prospective, observational, single-center study compared the progression and outcomes of patients who were preemptively hospitalized versus those who were hospitalized based on an SpO2 ⩽90%. We recorded patient demographics, clinical characteristics, COVID-19 symptoms, and oxygen requirement at admission. We calculated the risk of disease progression and the benefit of preemptive hospitalization, stratified by CALL Score: age, lymphocyte count, and lactate dehydrogenase (<8 and ⩾8) at admission. RESULTS: Preemptive hospitalization significantly reduced the requirement for oxygen therapy (odds ratio 0.45, 95% confidence interval 0.31-0.66), admission to the intensive care unit (ICU) (0.37, 0.23-0.60), requirement for invasive mechanical ventilation (IMV) (0.40, 0.25-0.64), and mortality (0.22, 0.10-0.50). Stratification by CALL score at admission showed that the benefit of preemptive hospitalization remained significant for patients requiring oxygen therapy (0.51, 0.31-0.83), admission to the ICU (0.48, 0.27-0.86), and IMV (0.51, 0.28-0.92). Mortality risk remained significantly reduced (0.19, 0.07-0.48). CONCLUSION: Preemptive hospitalization reduced the rate of disease progression and may be beneficial for improving COVID-19 patient outcomes.

SARS-CoV-2 Breakthrough Infections in Fully Vaccinated Individuals

ImportanceWhile COVID-19 vaccines are highly effective against disease, breakthrough infections may occur in the context of rising variants of concern. ObjectiveWe paired random and passive surveillance nucleic acid testing with analysis of viral whole genomic sequences to detect and describe breakthrough infections, focusing in a university community. DesignAnterior nasal swabs were collected from individuals for a nucleic acid amplification test (NAAT) for detection of SARS-CoV-2. A subset of NAAT positive samples was sequenced to determine variants associated with infections. Included in the testing and sequencing protocol were individuals that were fully vaccinated. SettingThis study was performed as part of a surveillance program for SARS-CoV-2 on a university campus with 49,700 students and employees. ParticipantsSurveillance testing was random and included approximately 10% of the population each week. Additionally, individuals self-identified with COVID-19 related symptoms or those that had close contact with SARS-CoV-2 positive individuals were also tested.

A Colombian experience involving SpineJack®, a consecutive series of patients experiencing spinal fractures, percutaneous approach and anatomical restoration 2016-2017.

BACKGROUND: Spinal fractures are becoming more frequent and should be handled as a severe and endemic pathology that requires timely diagnosis and adequate treatment. The classification of the AOSpine is currently the classification used for this type of fractures, not only for its approach, but to predict surgical management. METHODS: These patients had spinal fracture reduction procedures done through percutaneous way with expander endovertebral implants, and intraosseous fixation using SpineJack® intravertebral implants plus Cohesion® cement. Within the follow-up scheme, subsequent measurements were taken after a week, a month after surgery, 3 months after the procedure and after 6 months of follow-up. STATA® (Statistical Analysis System, version 12.1, SAS Institute Inc., Cary, NC, USA) was used for all analyzes. The Wilcoxon or Student's t-test was used for comparisons in pairs depending on the normality of the distribution. RESULTS: A clinical follow-up is performed to 20 consecutive patients experiencing spinal compression fractures (SCF) who received percutaneous treatment involving SpineJack® and Cohesion® cement, resulting in a statistically significant decrease of both pain and pain-related disability. No complications arose from the procedure. CONCLUSIONS: According to the observations, which reflect what is found in the world literature, this is an effective and safe way of handling SCF.

Influencia de la conciliación familiar y laboral sobre la salud / Influence of the familiar and working conciliation relating to health

Introducción: En el día a día de la atención primaria pediátrica se detectan problemas que pueden estar relacionados con la falta de tiempo de los padres para sus hijos. El objetivo de este trabajo es ofrecer una primera aproximación de cómo afecta la falta de conciliación familiar y laboral a la salud de las familias atendidas. Material y métodos: Estudio multicéntrico, descriptivo, transversal, con muestreo oportunista (n= 203). Los progenitores respondieron voluntariamente a una encuesta, específica según la edad de los niños, sobre las condiciones laborales, la presencia de estrés y el tiempo dedicado a los hijos. Resultados: El 34,98% de la muestra manifiesta estrés percibido como de origen laboral. En un 52,19% de las familias ninguno de los progenitores finaliza su jornada laboral antes de las 17:00 horas. Se halla una relación estadísticamente significativa (p <0,05) entre el horario laboral de los progenitores y la presencia de estrés: finalizar la jornada laboral más tarde de las 17:00 horas aumenta la probabilidad de padecer estrés. Nos e observan relaciones significativas entre la presencia de estrés y el número de visitas al centro. Conclusiones: La incompatibilidad de horarios laborales y escolares actúa como factor de riesgo para la aparición de estrés familiar. La conciliación familiar y laboral es un derecho de las familias y de la sociedad, y su falta puede dañar seriamente la salud de los progenitores y de los hijos. En consecuencia, se deben realizar estudios posteriores para disponer de más datos sobre la forma en que afecta la falta de conciliación familiar y laboral a la salud (AU)

Introduction: On a day-to-day basis of pediatric primary care, some problems, which are detected, may be related to the lack of parents’ time for their children. The aim is to provide a first objective approximation of how the lack of family and working conciliation affects the health of the families cared for. Material and methods: Multicenter, descriptive, transversal studies, with opportunistic sampling (n= 203). Parents voluntarily responded to a survey, specific according to the age of the children, about working conditions, presence of stress, and the time spent with their children. Results: 34.98% of the sample showed stress perceived as of job related origin. In a 52.19% of the families, neither parent’s workday ends before 5:00 pm. There is a statistically significant relation (p <0.05) between the working hours of parents and the presence of stress: when the end of the workday is later than 5:00 pm, the possibility of stress is increased. No significant relationship was observed between the presence of stress and number of visits to the center. Conclusions: The incompatibility of work and school schedules acts as a risk factor in the occurrence of family stress. Reconciling work and family is a right of families and society, and its absence can seriously damage the health of parents and children. Therefore, further studies should be performed to yield more data on how the lack of family and working conciliation affects on the health (AU)