Effect of co-treatment of COVID-19 with Remdesivir / Efecto del cotratamiento de COVID-19 con Remdesivir

Abstract Background: Due to the COVID-19 pandemic, randomized clinical studies were conducted with Remdesivir in combination with Bariticinib or Dexamethasone, which have shown effectiveness for the treatment of COVID-19. Objective: We analyzed the effect of co-treatment with Remdesivir in a retrospective in Mexico. Methods: Thirty-four patients treated with Remdesivir in combination with Baricitinib or Dexamethasone were included. Age, sex, comorbidities, signs, and symptoms were recorded at hospital admission, intubation needs, intensive care unit (ICU) requirements, days of hospital stay and their evolution, as well as laboratory data upon admission and upon admission terminate Remdesivir treatment. Results: Most were male, with an age of 56.5 years (49 years-60.3 years), whose main comorbidity was obesity. The main symptoms on admission were dyspnea and cough. Thirty-two patients received the short Remdesivir regimen, 22 were co-treated with Baricitinb and 12 with Dexamethasone. Most did not require ICU care, 9 patients died, 19% of those co-treated with Baricitinib and 42% of those co-treated with Dexamethasone. A significant decrease in hemoglobin, protein, albumin and LDH levels was observed. Conclusion: In this study, we observed lower mortality in patients co-treated with Baricitinib vs those co-treated with Dexamethasone, and a hospital stay similar to that reported in randomized clinical studies.

Resumen Introducción: Debido a la pandemia de COVID-19, se realizaron estudios clínicos aleatorizados con Remdesivir en combinación con Bariticinib o Dexametasona, que han demostrado efectividad para el tratamiento de COVID-19. Objetivo: Se realizo un análisis del efecto del co-tratamiento con Remdesivir en una muestra retrospectiva en México. Métodos: Se incluyeron 34 pacientes tratados con Remdesivir en combinación con Baricitinib o Dexametasona. Se registraron edad, sexo, comorbilidades, signos y síntomas al ingreso hospitalario, necesidades de intubación, requerimientos de unidad de cuidados intensivos (UCI), días de estancia hospitalaria y su evolución, así como datos de laboratorio al ingreso y al ingreso al final del tratamiento con Remdesivir. Resultados: La mayoría eran varones, con una edad de 56.5 años (49 años-60.3 años), cuya principal comorbilidad era la obesidad. Los principales síntomas al ingreso fueron disnea y tos. Treinta y dos pacientes recibieron el régimen corto de Remdesivir, 22 fueron cotratados con Baricitinb y 12 con Dexametasona. La mayoría no requirió atención en UCI, 9 pacientes fallecieron, 19% de los cotratados con Baricitinib y 42% de los cotratados con Dexametasona. Se observó una disminución significativa en los niveles de hemoglobina, proteínas, albúmina y LDH. Conclusión: En este estudio observamos una menor mortalidad en los pacientes cotratados con Baricitinib frente a los cotratados con Dexametasona, y una estancia hospitalaria similar a la reportada en estudios clínicos aleatorizados.

Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas / Care models at the second level: Experience of the Medical Specialties Unit

Resumen Objetivo: Reportar la implementación y los beneficios del Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas, su utilidad en el manejo y seguimiento de los pacientes con enfermedades crónicas. Material y métodos: Se lograron implementar 9 consultorios de atención médica de la siguiente forma, 2 de Endocrinología, 3 consultorios de Clínica de Enfermedades Crónicas, uno de educación en diabetes e hipertensión, así como 3 de apoyo nutricional. Se midió valores absolutos del número de consultas durante los años 2017, 2018, 2019 y parte del 2020. Así mismo se buscó identificar las patologías más prevalentes con la idea en tener un mejor control y seguimiento de los pacientes, con una mejor organización de personal de atención médico y de enfermería. Resultados y discusión: Se lograron incrementar los números de consulta, con un control y seguimiento más estricto de los pacientes, además de los beneficios en cuanto a la formación y capacitación de médicos residentes, generales tanto militares como profesionales de la salud civiles para enfrentar estos padecimientos prevalentes en nuestro país.

Abstract Objective: To report the implementation as well as the benefits of the Comprehensive Care Model at the second level: Experience of the Medical Specialties Unit, and assess its usefulness in the management and monitoring of patients with chronic diseases. Material and methods: 9 medical care clinics were implemented as follows, 2 for Endocrinology, 3 Clinics for Chronic Diseases, one for education in diabetes and hypertension, as well as 3 for nutritional support. Absolute values of the number of consultations were measured during the years 2017, 2018, 2019 and part of 2020. Likewise, it was sought to identify the most prevalent pathologies with the idea of having a better control and monitoring of patients, with a better organization of medical and nursing care personnel. Results and discussion: It was possible to increase the consultation numbers, with a stricter control and monitoring of patients, in addition to the benefits in terms of training and training of resident doctors, both military generals and civilian health professionals to face these prevalent conditions in our country.

PCSK-9 Inhibitors in a Real-World Setting and a Comparison Between Alirocumab and Evolocumab in Heterozygous FH Patients.

A real-world setting study of familial hypercholesterolemia (FH) patients who received Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in a specialized referral center in Mexico City. Ten patients between the ages of 18 and 70 years, with a diagnosis of FH according to Dutch Lipid Clinic Network (DLCN) criteria, with failure to achieve their Low-density lipoprotein Cholesterol (LDL-C) goals, and with standard therapy between 2016 and 2017 enrolled in a simple randomization in which a group of 5 participants received alirocumab (75 mg every 2 weeks) and the remaining 5 patients received evolocumab (140 mg every 2 weeks). Comparative analysis was made, analyzing the means of LDL at baseline at 4, 6, and 12 weeks. The evolocumab group had an average initial LDL-C of 277 mg/dL, which, after 12 weeks of treatment, was significantly reduced to 116 mg/dL; P = 0.04 (95% confidence interval [CI]: 11.5-310.9). The alirocumab group with a mean initial LDL-C of 229 mg/dL showed a reduction of LDL-C levels at 12 weeks of treatment to 80 mg/dL; P = 0.008 (95% CI: 63.8-233.7). In conclusion, PCSK9 inhibitors are an excellent treatment option in patients with FH who do not reach their LDL-C goals with standard therapy or due to intolerance to the standard therapy. There is no difference in the lipid-lowering effect between both PSCK9 inhibitors.