Survival of COVID-19 with Multimorbidity Patients.

BACKGROUND: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.

Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion. / Descripción del bloqueo del plexo braquial ecoguiado en espacio costoclavicular mediante abordaje medial y evaluación de la alteración en la perfusión regional secundaria.

INTRODUCTION: Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index. OBJECTIVE: To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes. MATERIALS AND METHODS: Description of the technique and administration of 20ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index. RESULTS: In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching the interscalenic space as far as the secondary trunks. Successful blocks were observed in 91% of patients after 25minutes. All the parameters reflecting sympathetic block increased significantly. The humeral artery blood flow showed an increase from 108 ± 86 to 188±141ml/min (P=.05), skin temperature from 32.1±2 to 32.8±9°C (P=.03) and perfusion index from 4±3 to 9±5 (P=.003). CONCLUSIONS: The medial approach of the ultrasound-guided costoclavicular block is anatomically feasible, with high clinical effectiveness using 20ml of 1.5% mepivacaine. The sympathetic block can be evaluated with all three parameters studied.

Axillary brachial plexus block duration with mepivacaine in patients with chronic renal failure. Case-control study. / Duración de bloqueo axilar con mepivacaína 1,5% en pacientes con insuficiencia renal crónica programados para fístula arteriovenosa. Estudio casos-controles.

INTRODUCTION: Regional anaesthesia is commonly preferred for arteriovenous fistula (AVF) creation. Previous studies suggest a shorter block duration in patients with chronic renal failure, maybe because of the changes in regional blood flow. The aim of our study was to evaluate the duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure scheduled for AVF compared with healthy controls. METHODS: Patients scheduled for AVF creation for the first time (GIRC) were included. They were compared with patients without renal failure (GC), with similar anthropometric characteristics. Ultrasound-guided axillary blocks with 20mL of 1.5% mepivacaine were performed on all patients. We evaluated onset time, humeral artery diameter and blood flow before and after the block, as well as the block duration. RESULTS: Twenty-three patients (GIRC: 12 and GC: 11) were included. No differences between groups were observed in block duration (GIRC: 227±43min vs GC: 229±27min; P=.781), or in onset time (GIRC: 13±5min vs GC: 12.2±3min; P=.477). The humeral blood flow before and after block was significantly lower in the GIRC (pre-block: GIRC: 52±21ml/min GC: 100±62ml/min; P=.034 and p ost block: GIRC: 130±57ml/min and GC: 274±182ml/min; P=.010). There was no significant correlation between the duration of the block and the preblock humeral blood flow (Spearman Rho: 0.106; P=.657) or the postblock humeral blood flow (Spearman Rho: 0.267; P=.254). CONCLUSION: The duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure was similar to that of the control patients. The duration of axillary brachial plexus block seems not to be related to changes in regional blood flow.

Inactivation of Apaf1 reduces the formation of mutant huntingtin-dependent aggregates and cell death.

Polyglutamine expansions in some proteins associated with neurodegenerative diseases, such as Huntington's disease or several ataxias, lead to insoluble aggregates in the cell. These aggregates accumulate through a mechanism that is not yet fully understood, but it activates cell death pathways and contributes to kill the cell. Here, we show that apoptotic protease activating factor 1 (Apaf1) down-regulation, or treatment with pharmacological Apaf1 inhibitor SVT016426, decreases both polyglutamine-induced aggregation and polyglutamine-induced apoptotic cell death in different cellular models. We demonstrate that Apaf1 binds to both Htt and to heat shock protein chaperone Hsp70, and that this interaction is altered in the presence of the pharmacological inhibitor of Apaf1. Based on our findings, we hypothesize that Apaf1 enhances polyglutamine aggregation by reducing the cellular protein levels of available functional Hsp70.

[Open talar enucleation with talar loss: a case report]. / Enucleación talar expuesta con pérdida del astrágalo: reporte de un caso.

Talar enucleation is a very infrequent injury; the reported cases have a traumatic etiology. These injuries are important because they occur in individuals in productive ages and result in irreversible complications and sequelae, such as talarthrosis, osteomyelitis and avascular necrosis. This is why we report herein the case of a 33 year-old patient with posttraumatic open enucleation of the left talus, with bone loss at the site of trauma. He was treated with cadaver bone graft plus subtalar arthrodesis using a retrograde endomedullary nail. We present the patient's one-year course and follow-up.

The phylogenetic position of aardvark (Orycteropus afer) as suggested by its myoglobin.

Skeletal muscle myoglobin of the aardvark (Orycteropus afer) was isolated and its primary structure determined. The amino-acid sequence was then used in conjunction with previously established myoglobin sequences to evaluate the phylogenetic relationships of the aardvark. The most parsimonious trees constructed from this myoglobin sequence data either alone or when combined with lens alpha-crystallin A sequence data depict the aardvark lineage as one of the most ancient among Eutheria.

Interaction of ligands with the distal glutamine in elephant myoglobin.

The effects of distal glutamine (E7) replacement in elephant myoglobin were studied by comparing the temperature-dependent nitrosyl electron spin resonance spectra, redox potentials, and the acid-alkaline equilibria of elephant and human myoglobins. For myoglobins containing a distal histidine, the nitrosyl ESR spectra do not exhibit superhyperfine splitting until near liquid helium temperatures (Yoshimura, T., Ozaki, T., Shintani, Y., and Watanabe, H. (1979) Arch. Biochem. Biophys. 193, 301-313). Studies presented here show that the ESR spectra of nitrosyl elephant myoglobin exhibit 9-line superhyperfine splitting well above liquid nitrogen temperatures, similar to the temperature profiles of isolated heme complexes (Morse, R.H. (1980) Fed. Proc. 39, 2006). It is concluded that the shift in the spectral equilibrium to higher temperature indicates a diminished interaction between NO and the distal position in elephant myoglobin. In addition, the redox potential of elephant myoglobin was found to be nearly 100 mV greater than that of human myoglobin, and the pKa of the acid-alkaline equilibrium (oxidized myoglobin) was 8.5, being 0.4 unit less than that of other vertebrate myoglobins. These different reactivities between elephant and human myoglobins are discussed based on the nature of charge interactions between polar ligands and distal glutamine and histidine.

Tropomyosin from adult human skeletal muscle is partially phosphorylated.

Alpha and beta tropomyosins were isolated from postmortem adult human psoas and pectoralis major muscles. 31P nuclear magnetic resonance and amino acid analysis were used to show that 10% of the major alpha tropomyosin component was phosphorylated. The 31P NMR spectra also suggested that human beta tropomyosin was phosphorylated, but to a lesser extent.

Ochotona princeps (pika) myoglobin: an appraisal of lagomorph phylogeny.

Myoglobin was purified from skeletal muscle of the pika (Ochotona princeps) and its primary structure was determined. This sequence was added to the set of 64 already known vertebrate myoglobin sequences and used to evaluate the phylogenetic position of the pika among other mammals, using a computerized search procedure based on maximum parsimony criteria. The pika is clearly related to the rabbit (Oryctolagus cuniculus), with which it is traditionally associated as a member of the order Lagomorpha. A monophyletic group composed of Lagomorpha, Scandentia, and Carnivora is a consistent feature of the dendrograms produced. An association of Carnivora and Lagomorpha casts doubt on the results of those investigations using rabbit antisera in systematic studies and depending on carnivores as an outside reference group for cladogram construction.

Electron microscopy supports a fibrous substructure for lens intermediate filaments.

The substructure of intermediate filaments from bovine lens cortical fiber cells was investigated by electron microscopy. Native filaments and synthetic ones regenerated from the total cytoskeletal extract and from the three purified subunits were examined. The morphologies from these various sources were essentially identical, with the exception that filaments reconstituted from one of the purified polypeptides were much shorter, very contorted and showed strings of aggregated protein. The solid cylindrical, unbranching filaments consisted of a helical arrangement of at least two, 5 nm diameter strands. The evidence indicated that each strand was composed of two, 2 nm diameter protofilaments which were also helically constructed (right-handed) with a periodicity of 11.6 nm. Intermediate filament diameter varied widely (8-14.8 nm, average 11.3 nm) and in a direct, linear manner relative to the apparent progression (helical) angle of the strands across the filaments face. These conclusions were obtained from observations on negatively stained intact filaments and reconstituted 4.4 nm fibrils and on positively stained transverse sections of fixed and embedded filaments.

An exceptional amino acid replacement on the distal side of the iron atom in proboscidean myoglobin.

Amino acid sequence determination of elephant myoglobin revealed the presence of the unusual substitution E7 His leads to Gln. Stereochemical analyses suggest that the most suitable residue which can functionally substitute for His at this position in vertebrate globins is Gln. Physiochemical studies imply that the slower rate of autooxidation of elephant myoglobin is the result of this substitution which may confer some selective advantage on the species. Comparative sequence data of paenungulate myoglobins suggest that the His leads to Gln mutation probably occurred in an ancestor of Elephantinae.

Subunit characterization of lens intermediate filaments.

The intermediate filaments from the bovine ocular lens can be fractionated into three 54000 dalton polypeptides (alpha, beta and gamma) which are present in equimolar quantities and differ from one another with respect to isoelectric point, two-dimensional peptide map pattern and total amino acid composition. The polypeptides, for which the name lentin is proposed, were purified from the 8 M urea extract of the water-insoluble residue of the cortical fiber cells by ion-exchange chromatography on DE- and CM-cellulose. The regeneration of native-appearance filaments from each purified fraction, or combinations thereof, definitively established the three polypeptides as the subunit species. Additionally, small diameter 'protofilaments' were regenerated when one or two fractions were utilized, but not when all three fractions were combined. This, together with the fact that the stoichiometric yield of the three species was invariably equimolar, suggests that alpha, beta, and gamma may be distinct entities not related by artifactual interconversion.

The myoglobin of primates X.

The amino acid sequences of skeletal muscle myoglobins from two old-world monkeys, Presbytis entellus and Erythrocebus patas, as well as one new-world monkey, Cebus apella wer inferred by homology of the tryptic and peptic peptides with the known sequence of human myoglobin and by selective dansyl-Edman degradation. These new sequences were examined phylogentically in conjunction with the 15 primate sequences already reported. It is clear that myoglobin evolution has been extremely conservative among cercopithecoid primates, so much so that the two surviving subfamilies cannot be distinguished using this protein.

The amino acid sequence of alligator (Alligator mississippiensis) myoglobin. Phylogenetic implications.

The amino acid sequence of myoglobin from cardiac muscle of the American alligator (Alligator mississippiensis) was established by alignment of overlapping peptides and dansyl-Edman degradation. The chain initiating methonine seems to be retained. Thus, this molecule has 154 amino acid residues rather than 153 as in other tetrapod myoglobins. Maximum parsimony analysis indicated that alligator myoglobin diverges more from both bird and mammal myoglobins than these latter do from each other. The phylogenetic implications are discussed with respect to a possible diphyletic origin for diapsid reptiles.

The amino acid sequence of elephant (Elephas maximus) myoglobin and the phylogeny of Proboscidea.

The complete amino acid sequence of skeletal myoglobin from the Asian elephant (Elephas maximus) is reported. The functional significance of variations seen when this sequence is compared with that of sperm whale myoglobin is explored in the light of the crystallographic model available for the latter molecule. The phylogenetic implications of the elephant myoglobin amino acid sequence are evaluated by using the maximum parsimony technique. A similar analysis is also presented which incorporates all of the proteins sequenced from the elephant. These results are discussed with respect to current views on proboscidean phylogeny.

Characterization of the myoglobin of the lamprey Petromyzon marinus.

Myoglobin has been identified in the myocardium of the lamprey Petromyzon marinus, one of the most primitive of all vertebrates. This protein was isolated by ammonium sulphate fractionation and purified by successive chromatography on Ultrogel AcA 54, DEAE-Sephadex and CM-23 cellulose. The molecule differs substantially from the monomeric hemoglobins found in the lamprey as evidenced by its elution profile on DEAE-Sephadex and the fingerprint pattern of its enzymically-produced peptides. The functional significance of this protein in Agnatha is discussed.

The use of amino acid sequence analysis in assessing evolution.

The thirteen year history of assessing evolution by amino acid sequence analysis has made apparent the limitations imposed upon this system by the finite nature of the characters. This finiteness exists on several levels and ultimately expresses itself as parallelism, back mutation and the retention of primitive characters in the sequences of proteins from present day species and the putative ancestral protein chains. Sequence analysis shares these problems with other molecular approaches, but because it is concerned both with the nucleotide substitutions in the genome and with the functional roles of proteins, it has unique advantages. For example, the large fluctuation in the rate of fixation of mutations in a protein's evolution can be detected and used to point out the unreliability of any molecular clock for estimating divergence dates. Moreover, when consideration is given to studies which assign functional significance to specific amino acid sites in a protein, changes in function during the descent of a protein can be appreciated and their significance correlated with organismal evolution.