[Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City]. / Alteraciones cardiovasculares en el síndrome inflamatorio multisistémico pediátrico asociado a COVID-19 en un hospital pediátrico de tercer nivel de la Ciudad de México.

Objective: The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Method: Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. Results: During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 µL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). Conclusions: The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.

Objetivo: Exponer las alteraciones cardiovasculares en los pacientes diagnosticados con síndrome inflamatorio multisistémico pediátrico (PIMS) asociado a COVID-19 durante la pandemia por SARS-CoV-2 con el fin de comprender la enfermedad, su evolución y el manejo óptimo al diagnóstico. Método: Estudio retrospectivo, observacional, transversal y analítico de pacientes con diagnóstico de PIMS de acuerdo con los criterios de la Organización Mundial de la Salud en el Instituto Nacional de Pediatría, de marzo de 2020 a diciembre de 2021. Resultados: Durante el periodo de estudio se diagnosticaron 77 pacientes con PIMS. Los resultados demostraron una correlación entre el estado de choque y la alteración de los marcadores de laboratorio (plaquetas 144217.29 ± 139321.6 µl [p < 0.001], procalcitonina 27.37 ± 38.37 ng/ml [p = 0.05] y ferritina 1937.87 ± 2562.63 [p < 0.001]). La función ventricular en los pacientes con choque se registró significativamente menor en comparación con aquellos sin choque (49.6 ± 9.1 % vs. 58.1 ± 8.4 %; t de Student p < 0.001), así como lesión en la arteria coronaria izquierda (p = 0.02). Existe una correlación entre el NT-proBNP y la disfunción ventricular (Kruskal-Wallis p = 0.007). Se encontró significancia estadística en la asociación entre fallecimiento, elevación de los marcadores inflamatorios y disfunción ventricular (p < 0.001). Conclusiones: Las alteraciones cardiovasculares observadas fueron, en orden de frecuencia, derrame pericárdico (25.7%), miocarditis (15%), disfunción ventricular leve (13.5%) y aneurisma pequeño coronario con predominio de la arteria coronaria izquierda y la descendente anterior.

[Diagnosis and treatment in a series of patients with cardiac corrected transposition of the great arteries (double discordance)]. / Diagnóstico y tratamiento en una serie de pacientes con transposición corregida de las grandes arterias (doble discordancia cardiaca).

Objective: The atrio-ventricular and ventricle-arterial double discordance (DD) or corrected transposition of the great arteries is a rare heart disease, it occurs in 0.02-0.07 of every 1,000 live newborns. The objective of the study is to describe the diagnosis, treatment and evolution of a series of patients with DD. Method: A retrospective and descriptive study was carried out, reviewing the records of patients diagnosed with DD in the last 22 years. Descriptive statistics were performed. Numerical variables were obtained using means and standard deviation and categorical variables using frequencies and percentages. Results: Thirty patients were studied in 22 years with a ratio of 1.5:1 for men, with a mean age of 20 months. The situs was solitus in 24/29 patients (82.7%). Ventricular septal defect was the most frequent lesion in 25/29 (86.2%) Tricuspid insufficiency in 70%. Four patients diagnosed with pulmonary atrial hypertension. With atrio-ventricular block 20%. One with Wolff-Parkinson-White syndrome. Surgical treatment was carried out in 70% of patients. Eight with Glenn procedure (26.6%) and 4 with Fontan surgery (13.3%). Follow-up ranged from 1 month to 17 years. Five died (16.6%). Of the 25 patients in follow-up, 18 patients (72%) had normal ventricular function, 5 with Grade II Ross classification (20%) and 2 in Grade III (8%). Conclusions: The quality of life of these patients is improving and there is still controversy in the literature about the ideal time to perform the most appropriate surgical procedure.

Objetivo: La doble discordancia auriculo-ventricular y ventrículo-arterial (DD) o transposición corregida de las grandes arterias, se presenta en 0.02-0.07 de cada 1,000 recién nacidos vivos. El objetivo del estudio es describir el diagnóstico, tratamiento y evolución de pacientes con DD. Método: Se realizó un estudio retrospectivo y descriptivo, revisando los registros de pacientes con DD en los últimos 22 años. Se realizó estadística descriptiva. Las variables numéricas se obtuvieron mediante medias y desviación estándar y las categóricas mediante frecuencias y porcentajes. Resultados: Se estudiaron 30 pacientes con una relación de 1.5:1 para el varón, con una edad media de 20 meses. El situs fue solitus en 24/29 pacientes (82.7%). La comunicación interventricular fue la lesión más frecuente en 25/29 pacientes (86.2%), insuficiencia tricuspídea en el 70%. Cuatro pacientes con diagnóstico de hipertensión arterial pulmonar. Con bloqueo atrio-ventricular un 20%. Uno con síndrome de Wolff-Parkinson-White. El tratamiento quirúrgico se realizó en el 70% de los pacientes. Con procedimiento de Glenn 8 (26.6%) y 4 cirugías de Fontan (13.3%). El seguimiento fue de 1 mes a 17 años. Cinco fallecieron (16.6%). De los 25 restantes, 18 pacientes (72%) con función ventricular normal, 5 con clasificación de Ross grado II (20%) y 2 en G III (8%). Conclusiones: La calidad de vida de estos pacientes está mejorando, aún existe controversia sobre el momento ideal para realizar el procedimiento más adecuado quirúrgico.

Immunogenicity of RV1 and RV5 vaccines administered in standard and interchangeable mixed schedules: a randomized, double-blind, non-inferiority clinical trial in Mexican infants.

Introduction: Rotavirus-associated diarrheal diseases significantly burden healthcare systems, particularly affecting infants under five years. Both Rotarix™ (RV1) and RotaTeq™ (RV5) vaccines have been effective but have distinct application schedules and limited interchangeability data. This study aims to provide evidence on the immunogenicity, reactogenicity, and safety of mixed RV1-RV5 schedules compared to their standard counterparts. Methods: This randomized, double-blind study evaluated the non-inferiority in terms of immunogenicity of mixed rotavirus vaccine schedules compared to standard RV1 and RV5 schedules in a cohort of 1,498 healthy infants aged 6 to 10 weeks. Participants were randomly assigned to one of seven groups receiving various combinations of RV1, and RV5. Standard RV1 and RV5 schedules served as controls of immunogenicity, reactogenicity, and safety analysis. IgA antibody levels were measured from blood samples collected before the first dose and one month after the third dose. Non-inferiority was concluded if the reduction in seroresponse rate in the mixed schemes, compared to the standard highest responding scheme, did not exceed the non-inferiority margin of -0.10. Reactogenicity traits and adverse events were monitored for 30 days after each vaccination and analyzed on the entire cohort. Results: Out of the initial cohort, 1,365 infants completed the study. Immunogenicity analysis included 1,014 infants, considering IgA antibody titers ≥20 U/mL as seropositive. Mixed vaccine schedules demonstrated non-inferiority to standard schedules, with no significant differences in immunogenic response. Safety profiles were comparable across all groups, with no increased incidence of serious adverse events or intussusception. Conclusion: The study confirms that mixed rotavirus vaccine schedules are non-inferior to standard RV1 and RV5 regimens in terms of immunogenicity and safety. This finding supports the flexibility of rotavirus vaccination strategies, particularly in contexts of vaccine shortage or logistic constraints. These results contribute to the global effort to optimize rotavirus vaccination programs for broader and more effective pediatric coverage.Clinical trial registration: ClinicalTrials.gov, NCT02193061.

Effect of school reopening on pediatric morbidity and mortality during the third epidemiological wave of COVID-19 in a Mexican state / Efecto de la reapertura de escuelas en la morbimortalidad pediátrica durante la tercera ola epidemiológica por COVID-19 en un estado mexicano

Abstract Background: Determining the effect of reopening schools on pediatric SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection rates increased the need to share the experience of governments in many geographic regions for better future decision-making in similar health emergencies. Methods: Through a prospective study based on a population-based cohort, students from 18,988 schools in the State of Mexico who began returning to school were followed. Daily sanitation filters were implemented in each school and district liaisons were informed on a daily basis through a negative network. Identified cases were confirmed by reverse transcriptase-polymerase chain reaction. Simple case frequencies, percentages, and incidences of COVID-19 were estimated. State incidences were compared with the national incidence. Results: A total of 3,586 cases were confirmed; 2,048 (57.1%) were children. Twenty-four (0.6%) were hospitalized for moderate to severe COVID-19; nine (37.5%) died, and only one was a schoolchild. From week 36, an average infection rate of 0.36 was observed. The highest infection rate in schoolchildren was observed in epidemiologic week 40 (1.01); from this week on, a decrease in the number of cases was observed until week 50. Conclusions: The use of non-pharmaceutical interventions has more advantages than limitations, as long as the strategies are homogeneous and properly implemented to ensure adequate control of infections.

Resumen Introducción: La determinación del efecto de reabrir las escuelas sobre las tasas de infección pediátrica por SARS-CoV-2 (síndrome respiratorio agudo grave coronavirus 2) incrementó la necesidad de trasmitir la experiencia de los gobiernos de muchas regiones geográficas para mejores decisiones futuras en emergencias sanitarias similares. Métodos: Mediante un estudio prospectivo basado en una cohorte poblacional se dio seguimiento a los alumnos de 18,988 escuelas del Estado de México que iniciaron con el regreso a clases. Se implementaron filtros sanitarios diarios en cada escuela y cotidianamente se informaban a los enlaces jurisdiccionales a través de una red negativa. Los casos identificados eran confirmados a través de RT-PCR (reacción en cadena de la polimerasa con transcriptasa inversa). Se estimaron frecuencias simples de casos, porcentajes e incidencias de COVID-19. Las incidencias del estado se compararon con la incidencia nacional. Resultados: Un total de 3,586 casos fueron confirmados; 2,048 (57.1%) correspondieron a niños. Veinticuatro (0.6%) fueron hospitalizados por COVID-19 moderado a grave; nueve (37.5%) fallecieron, y solamente una correspondió a un escolar. A partir de la semana 36 se observó una tasa promedio de infecciones de 0.36. En la semana epidemiológica 40 se observó la mayor tasa de infección en escolares (1.01); a partir de esta semana se observa un declive de los casos hasta la semana 50. Conclusiones: La implementación de intervenciones no farmacéuticas tiene más ventajas que limitaciones, siempre y cuando las estrategias sean homogéneas y correctamente ejecutadas, lo que asegurará un adecuado control en los contagios.

Effect of school reopening on pediatric morbidity and mortality during the third epidemiological wave of COVID-19 in a Mexican state.

BACKGROUND: Determining the effect of reopening schools on pediatric SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection rates increased the need to share the experience of governments in many geographic regions for better future decision-making in similar health emergencies. METHODS: Through a prospective study based on a population-based cohort, students from 18,988 schools in the State of Mexico who began returning to school were followed. Daily sanitation filters were implemented in each school and district liaisons were informed on a daily basis through a negative network. Identified cases were confirmed by reverse transcriptase-polymerase chain reaction. Simple case frequencies, percentages, and incidences of COVID-19 were estimated. State incidences were compared with the national incidence. RESULTS: A total of 3,586 cases were confirmed; 2,048 (57.1%) were children. Twenty-four (0.6%) were hospitalized for moderate to severe COVID-19; nine (37.5%) died, and only one was a schoolchild. From week 36, an average infection rate of 0.36 was observed. The highest infection rate in schoolchildren was observed in epidemiologic week 40 (1.01); from this week on, a decrease in the number of cases was observed until week 50. CONCLUSIONS: The use of non-pharmaceutical interventions has more advantages than limitations, as long as the strategies are homogeneous and properly implemented to ensure adequate control of infections.

INTRODUCCIÓN: La determinación del efecto de reabrir las escuelas sobre las tasas de infección pediátrica por SARS-CoV-2 (síndrome respiratorio agudo grave coronavirus 2) incrementó la necesidad de trasmitir la experiencia de los gobiernos de muchas regiones geográficas para mejores decisiones futuras en emergencias sanitarias similares. MÉTODOS: Mediante un estudio prospectivo basado en una cohorte poblacional se dio seguimiento a los alumnos de 18,988 escuelas del Estado de México que iniciaron con el regreso a clases. Se implementaron filtros sanitarios diarios en cada escuela y cotidianamente se informaban a los enlaces jurisdiccionales a través de una red negativa. Los casos identificados eran confirmados a través de RT-PCR (reacción en cadena de la polimerasa con transcriptasa inversa). Se estimaron frecuencias simples de casos, porcentajes e incidencias de COVID-19. Las incidencias del estado se compararon con la incidencia nacional. RESULTADOS: Un total de 3,586 casos fueron confirmados; 2,048 (57.1%) correspondieron a niños. Veinticuatro (0.6%) fueron hospitalizados por COVID-19 moderado a grave; nueve (37.5%) fallecieron, y solamente una correspondió a un escolar. A partir de la semana 36 se observó una tasa promedio de infecciones de 0.36. En la semana epidemiológica 40 se observó la mayor tasa de infección en escolares (1.01); a partir de esta semana se observa un declive de los casos hasta la semana 50. CONCLUSIONES: La implementación de intervenciones no farmacéuticas tiene más ventajas que limitaciones, siempre y cuando las estrategias sean homogéneas y correctamente ejecutadas, lo que asegurará un adecuado control en los contagios.

Easy-to-use R functions to separate reduced-representation genomic datasets into sex-linked and autosomal loci, and conduct sex assignment.

Identifying sex-linked markers in genomic datasets is important because their presence in supposedly neutral autosomal datasets can result in incorrect estimates of genetic diversity, population structure and parentage. However, detecting sex-linked loci can be challenging, and available scripts neglect some categories of sex-linked variation. Here, we present new R functions to (1) identify and separate sex-linked loci in ZW and XY sex determination systems and (2) infer the genetic sex of individuals based on these loci. We tested these functions on genomic data for two bird and one mammal species and compared the biological inferences made before and after removing sex-linked loci using our function. We found that our function identified autosomal loci with ≥98.8% accuracy and sex-linked loci with an average accuracy of 87.8%. We showed that standard filters, such as low read depth and call rate, failed to remove up to 54.7% of sex-linked loci. This led to (i) overestimation of population FIS by up to 24%, and the number of private alleles by up to 8%; (ii) wrongly inferring significant sex differences in heterozygosity; (iii) obscuring genetic population structure and (iv) inferring ~11% fewer correct parentages. We discuss how failure to remove sex-linked markers can lead to incorrect biological inferences (e.g. sex-biased dispersal and cryptic population structure) and misleading management recommendations. For reduced-representation datasets with at least 15 known-sex individuals of each sex, our functions offer convenient resources to remove sex-linked loci and to sex the remaining individuals (freely available at https://github.com/drobledoruiz/conservation_genomics).

Niveles de fertilización con calcio, magnesio y azufre en genotipos de arveja voluble (Pisum sativum L.) en Nariño

Nariño es el principal productor de arveja de Colombia. En su cultivo, se fertiliza con nitrógeno, fósforo y potasio, pero no se conoce el efecto de otros nutrimentos. Esta investigación tuvo como objetivo evaluar el efecto de diferentes niveles de calcio, magnesio y azufre sobre los componentes de rendimiento de arveja voluble, en los municipios de Gualmatán, Pupiales y Puerres, en suelos Andisoles y, en Ipiales y Potosí, en suelos Inceptisoles. En cada localidad, se utilizó un diseño de bloques completos al azar, con arreglo en parcelas divididas y tres repeticiones, donde el factor A correspondió a cinco genotipos de arveja y el factor B, a cinco niveles de fertilización con calcio, magnesio y azufre. Los resultados indicaron respuesta positiva de los rendimientos a la aplicación de estos elementos. El nivel de fertilización 112,5-50-25 kg.ha-1 de Ca, Mg y S, respectivamente, presentó mayor rendimiento que el nivel establecido por la información del análisis de suelos o testigo en Gualmatán, Pupiales y Potosí, mientras que, en Puerres, hubo respuesta al nivel más alto, 135-60-30, de los mismos elementos. Los otros niveles de fertilización fueron similares al testigo. En Ipiales, la variedad Sureña presentó rendimientos similares para todos los niveles de fertilización. San Isidro presentó su mayor rendimiento, con el nivel 112,5-50-25 kg.ha-1, de calcio magnesio y azufre. Las líneas con gen afila L3 y L18 igualaron los rendimientos de las variedades comerciales Sureña, Alcalá y San Isidro, en Potosí y en Pupiales.

Nariño is the main pea producer in Colombia. The crop is fertilizer with nitrogen, phosphorus, and potassium, but the effect of other nutrients is unknown. The objective of this research was to evaluate the effect of different levels of calcium, magnesium, and sulfur on the performance components of voluble pea in the municipalities of Gualmatán, Pupiales, and Puerres on Andisols, and in Ipiales and Potosí on Inceptisols soils. A randomized complete block design was used with divided plots and three replications, where factor A corresponded to five pea genotypes and factor B to five levels of fertilization with calcium, magnesium, and sulfur. The results indicated positive response of the yields to the application of these elements. The level of fertilization 112.5-50-25 kg.ha-1 of Ca, Mg, and S respectively, presented a higher yield than the level established by information from the soil analysis or control in Gualmatán, Pupiales and Potosí, while in Puerres there was a response at the highest level 135-60-30 of the same elements. The other levels of fertilization were similar to the control. In Ipiales Sureña variety presented similar yields for all fertilization levels. San Isidro presented its highest yield with a level of 112.5-50-25 kg.ha-1 of calcium, magnesium and sulfur. The lines with the L3 and L18 genes matched the yield of the commercial varieties Sureña, Alcalá and San Isidro in Potosí and Pupiales.

Cell death induction by mycelium extracts from Pleurotus spp. on cervical cancer cell lines.

Mushrooms have health benefits, including anti-tumoral properties. We evaluated the cytotoxic and cell death induction effects of water-soluble extracts of Pleurotus ostreatus and Pleurotus eryngii mycelium in the cervical cancer cell lines HeLa (HVP18+) and SiHa (HVP16+) as well as the non-tumoral cell line HaCaT. Both Pleurotus extracts presented similar protein patterns from 190 to 10 kDa and displayed protease activity on a gelatine substrate. The mycelium extracts of both Pleurotus strains induced a dose-dependent cytotoxic effect on HPV+ cells IC50 65 µg), whereas HaCaT cells were less susceptible (IC50 90 µg). The cytotoxic effect at the IC50 concentration was not associated with apoptosis, the activation of Caspases-3/7 was not significantive; only P. eryngii induced a moderate (1.2-fold) increase in SiHa cells. Pleurotus extracts induced autophagy, mainly in SiHa cells (4.3-fold). Neither extracts induced changes in p53 protein expression, suggesting that the cytotoxic effect could be due to p53-independent pathways.

Experimental methods to study sleep disruption and immune balance in urban children with asthma.

Study Objectives: We describe research methods developed to examine effects of sleep disruption on changes in immune balance, lung function, and cognitive performance in a sample of urban, ethnically diverse children with persistent asthma. Two case examples (8- and 10-year-old males) are presented to highlight methods of the current study and illustrate effects of experimentally disrupted sleep on the immune balance profile (Th1/Th2 cytokines), key sleep variables from polysomnography data, and lung function in our sample. Methods: Children follow an individualized structured sleep schedule consistent with their habitual sleep need (≥9.5 hours' time in bed) for six days before a laboratory-based experimental sleep protocol. Children then spend two successive nights in the sleep lab monitored by polysomnography: a baseline night consisting of uninterrupted sleep, and a disruption night, during which they are awoken for 2 minutes between 20-minute intervals of uninterrupted sleep. Evening and morning blood draws bracket baseline and disruption nights for immune biomarker assessment. Results: A shift towards immune imbalance following the sleep disruption protocol was observed in these illustrative cases. Conclusions: Data from these case examples provide evidence that the experimental protocol caused disruptions in sleep as observed on polysomnography and had the hypothesized downstream effects on immune balance associated with clinical asthma control. Documenting the effects of sleep disruption on immune function in children with persistent asthma is a crucial step towards understanding associations between sleep, immune balance, and asthma outcomes and provides important information for developing novel interventions for youth with asthma and suboptimal sleep. Clinical Trials: Not applicable.

Tunable Spin Injection in High-Quality Graphene with One-Dimensional Contacts.

Spintronics involves the development of low-dimensional electronic systems with potential use in quantum-based computation. In graphene, there has been significant progress in improving spin transport characteristics by encapsulation and reducing impurities, but the influence of standard two-dimensional (2D) tunnel contacts, via pinholes and doping of the graphene channel, remains difficult to eliminate. Here, we report the observation of spin injection and tunable spin signal in fully encapsulated graphene, enabled by van der Waals heterostructures with one-dimensional (1D) contacts. This architecture prevents significant doping from the contacts, enabling high-quality graphene channels, currently with mobilities up to 130 000 cm2 V-1 s-1 and spin diffusion lengths approaching 20 µm. The nanoscale-wide 1D contacts allow spin injection both at room and at low temperature, with the latter exhibiting efficiency comparable with 2D tunnel contacts. At low temperature, the spin signals can be enhanced by as much as an order of magnitude by electrostatic gating, adding new functionality.

Self-perceived knowledge level of epidemic management in medical residents prior to the start of the COVID-19 pandemic in Mexico.

INTRODUCTION: COVID-19 was declared a pandemic in March 2020, requiring a comprehensive response from all healthcare systems, including Mexico's. As medical residents' training did not involve epidemic response, we decided to evaluate their level of training on this subject, specifically self-perceived knowledge level and capacity to respond to epidemiological crises. METHODOLOGY: Medical residents from two hospitals belonging to PEMEX (Mexico's state-owned petroleum company) were included in a cross-sectional study. All participants answered a modified version of the survey developed by the University of Lovaina's Center for Research and Education in Emergency Care. Participants were analyzed according to their relevant "clinical" or "surgical" residency tracks. Data were analyzed using through Chi-square tests, t-tests, Mann-Whitney U tests, Kruskal-Wallis tests, and Pearson and Spearman correlation coefficients with significance established at p < 0.05. RESULTS: Of a total of 94 resident participants in this study, 56.7% self-perceived themselves as being poorly prepared to confront the pandemic. Only 25.5% of the participants referred previous experience in medical responses to public health emergencies, and only 35.1% reported ever receiving education on this topic. CONCLUSIONS: Medical residents-who have been involved with caring for victims of the pandemic-are under the general perception that they are not prepared, experienced, or educated enough to respond to such a widespread massive public health emergency.

COVID-19 epidemiology in a Mexican tertiary care hospital.

INTRODUCTION: As a result of COVID-19, many hospitals underwent a conversion for the care for this disease. OBJECTIVE: To analyze COVID-19 hospital epidemiological behavior from March to August 2020. METHODS: Through a series of cases, COVID-19 epidemiological behavior at the hospital was analyzed, for which simple case rates, percentages and incidence of COVID-19 per 100 hospital discharges were estimated. RESULTS: Out of 491 subjects who tested positive for SARS-CoV-2, 156 (31.7 %) were hospitalized for clinical data of moderate to severe disease. Average age was 59.1 years; 121 cases (75 %) were discharged due to improvement, and 32 (20.5 %), due to death. Average age of those who died was 69.7 years, and the most affected age group was 60 to 80 years (45.4 %). Calculated lethality was 20.5 per 100 hospital discharges, while that calculated taking into account positive patients (outpatients and hospitalized patients) was 6.5. CONCLUSIONS: COVID-19 epidemiological behavior was similar to that described in other studies; however, lethality and mortality are above national average. The analysis of this and of the factors that favored it in our population is pending.

INTRODUCCIÓN: A consecuencia de COVID-19, numerosos hospitales sufrieron una reconversión para la atención de esta enfermedad. OBJETIVO: Analizar el comportamiento epidemiológico hospitalario de COVID-19 entre marzo y agosto de 2020. MÉTODOS: En una serie de casos se analizó el comportamiento epidemiológico de COVID-19 en un hospital de tercer nivel, para lo cual se estimaron frecuencias simples de casos, porcentajes e incidencia por cada 100 egresos hospitalarios. RESULTADOS: De 491 sujetos con prueba positiva para SARS-CoV-2, 156 (31.7 %) fueron hospitalizados por datos clínicos de enfermedad moderada a grave. La edad promedio fue de 59.1 años; 121 casos (75 %) egresaron por mejoría y 32 (20.5 %), por defunción. El promedio de edad de quienes fallecieron fue de 69.7 años y el grupo etario más afectado fue el de 60 a 80 años (45.4 %). La letalidad calculada fue de 20.5 por 100 egresos hospitalarios, mientras que la calculada tomando en cuenta los pacientes positivos (ambulatorios y hospitalizados) fue de 6.5. CONCLUSIONES: El comportamiento epidemiológico de COVID-19 fue similar al descrito en otros estudios; sin embargo, la letalidad y la mortalidad están por encima de la media nacional. Está pendiente el análisis de estas y de los factores que las favorecieron en nuestra población.

Efficacy and safety of canakinumab in the treatment of adult-onset Still's disease: A systematic review.

BACKGROUND: Adult-onset Still's disease (AOSD) is a rare inflammatory disease, typically characterized by spiking fever, skin rash, and arthralgia or arthritis. Its conventional treatment includes NSAIDs and corticosteroids, and DMARDs as second-line therapy. Frequently, IL-1 inhibitors are also required, mainly in patients refractory to traditional therapy. Canakinumab is a monoclonal antibody that binds IL-1ß with high affinity and specificity, making it appropriate for therapeutic purposes in AOSD. OBJECTIVE: The aim of this systematic review was to identify and compile the current data on the efficacy and safety of canakinumab in the treatment of AOSD. METHODS: Following the guidelines established by the PRISMA statement, we searched Scopus, Web of Science, Pubmed, and Cochrane Library for relevant literature up to March 2021. The inclusion criteria comprised: randomized controlled trials, pooled analyses, observational studies, case series, and case reports. RESULTS: Seventeen studies published from 2012 to 2021 were evaluated; 11 of these correspond to case series or case reports, four observational studies, one placebo-controlled phase II trial, and one analysis of pooled systemic juvenile idiopathic arthritis data. In general, out of a total of 99 patients, 68.7% of these presented a complete remission of the systemic and arthritic manifestations at the end of the observation period, while 16.2% of the patients showed a partial improvement of the symptoms and the remaining (15.1%) did not show clinical improvement or were excluded. Moreover, 210 adverse events were reported in 69 patients during canakinumab treatment, of which the majority correspond to respiratory tract infections, arthralgia, disease flares, abdominal pain, nausea, and diarrhea, whereas the most common severe adverse events included macrophage activation syndrome and serious infections. Also, a corticosteroid-sparing effect was observed in a large percentage of patients. CONCLUSION: More studies with solid evidence are needed to support the efficacy of canakinumab in AOSD, although its use is encouraged by the increasing favorable results reported and the efficacy of other IL-1 inhibitors. It was also associated with an acceptable safety profile, similar to expected in IL-1 inhibitor therapy. However, future studies with well-defined endpoints are warranted to examine further the usefulness of canakinumab in AOSD.