Autoantibodies against ACE2 and angiotensin type-1 receptors increase severity of COVID-19.

The renin-angiotensin system (RAS) plays a major role in COVID-19. Severity of several inflammation-related diseases has been associated with autoantibodies against RAS, particularly agonistic autoantibodies for angiotensin type-1 receptors (AA-AT1) and autoantibodies against ACE2 (AA-ACE2). Disease severity of COVID-19 patients was defined as mild, moderate or severe following the WHO Clinical Progression Scale and determined at medical discharge. Serum AA-AT1 and AA-ACE2 were measured in COVID-19 patients (n = 119) and non-infected controls (n = 23) using specific solid-phase, sandwich enzyme-linked immunosorbent assays. Serum LIGHT (TNFSF14; tumor necrosis factor ligand superfamily member 14) levels were measured with the corresponding assay kit. At diagnosis, AA-AT1 and AA-ACE2 levels were significantly higher in the COVID-19 group relative to controls, and we observed significant association between disease outcome and serum AA-AT1 and AA-ACE2 levels. Mild disease patients had significantly lower levels of AA-AT1 (p < 0.01) and AA-ACE2 (p < 0.001) than moderate and severe patients. No significant differences were detected between males and females. The increase in autoantibodies was not related to comorbidities potentially affecting COVID-19 severity. There was significant positive correlation between serum levels of AA-AT1 and LIGHT (TNFSF14; rPearson = 0.70, p < 0.001). Both AA-AT1 (by agonistic stimulation of AT1 receptors) and AA-ACE2 (by reducing conversion of Angiotensin II into Angiotensin 1-7) may lead to increase in AT1 receptor activity, enhance proinflammatory responses and severity of COVID-19 outcome. Patients with high levels of autoantibodies require more cautious control after diagnosis. Additionally, the results encourage further studies on the possible protective treatment with AT1 receptor blockers in COVID-19.

Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients.

The prognosis of a patient with COVID-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with COVID-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, laboratory, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1152 patients presented with SARS-CoV-2 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 h of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤ 5%, 6-25%, and > 25% exhibited disease progression, respectively. A risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis.

Anafilaxia a fluido seminal humano / Anaphylactic reaction to human seminal fluid

No disponible

Síndrome de Charles Bonnet / Charles Bonnet syndrome

No disponible

Valoración del enfermo drogodependiente en los servicios de urgencias / Valuation of the drug addict patient in emergency services

En los servicios de Urgencias es habitual la atención a pacientes drogodependientes, tanto por procesos derivados de la vía de administración de la droga, como por el uso, abuso y el abandono de la misma. Lo más frecuente es ver casos de sobredosis por opiáceos, alcohol, benzodiacepinas y/o cocaína, presentándose los tres primeros como coma y siendo por cocaína lo más frecuente el dolor torácico y las alteraciones psíquicas. En la práctica hay pocos antídotos eficaces, existiendo para los opiáceos (naloxona) y para las benzodiacepinas (flumazenilo), en el resto de los casos debemos conformarnos con las medidas generales de tratamiento de cualquier intoxicación y, sobre todo, tratar de evitar las posibles complicaciones derivadas del bajo nivel de conciencia. Actualmente existe un número creciente de abuso de sustancias de síntesis con efecto fundamentalmente simpaticomimético que sólo podemos tratar de forma general disminuyendo este efecto con benzodiacepinas

In Emergency services the attention of drug addict patients is usual, due to processes of administration or the use, abuse and abandonment of drugs. Cases of overdose by opiates, alcohol, benzodiazepines and/or cocaine are the most frequent. On the first three as a coma and, on those caused by cocaine, the most usual is chest pain and physic irregularities. In practice there are few effective antidotes, those being for opiates (naloxone) and benzodiazepines (flumazenil). For the other cases we have to stick to the general measures for the treatment of any intoxication and, most of all, try to avoid the possible complications derived from a low level of conscience. Currently there is a rising number of substance abuse regarding synthetic substances with basically sympathomimetic effect, which we can only treat in a general way, decreasing this effect with benzodiazepines