Condiciones de vulnerabilidad, sociodemográficas y clínicas de la población diagnosticada con COVID-19 incluida en la estrategia de atención primaria en salud del municipio de Mosquera 2020 / Vulnerability, socio-demographic and clinical conditions of the Covid 19 affected population included in the 2020 primary health care strategy of the municipality of Mosquera

Introducción: en diciembre de 2019 la Comisión Municipal de Salud y Sanidad de Wuhan, China, reportó 27 casos de neumonía de causa desconocida llegando a Colombia. Los municipios implementaron estrategias para minimizar contagios como lo hizo Mosquera, Cundinamarca, sin embargo no se conoció la caracterización de la población afectada por COVID-19. Objetivo: analizar las condiciones de vulnerabilidad, sociodemográficas y clínicas de la población con COVID-19 incluida en la estrategia de atención primaria en salud. Metodología: estudio cuantitativo, observacional, de corte transversal, retrospectivo, con análisis de condiciones de vulnerabilidad, características sociodemográficas y clínicas de la población diagnosticada con COVID-19 del municipio de Mosquera en la época de la pandemia durante el año 2020. Resultados: 4.610 casos positivos para COVID-19, 99% en la zona urbana, edad 5% entre 0-11 años, 4% entre 12-17 años, 21% entre 18-28 años, 59% entre 29-59 años y 12% más de 60 años. La población más afectada fueron adultos 58%, régimen contributivo 82% y mujeres 56%. Del total 73% fue sintomático, 92% no requirió hospitalización y la mayoría de los positivos tuvieron entre 2 a 3 contactos estrechos (29%), de los cuales 82% fue asintomático. Conclusiones: la pandemia por COVID-19 ha tenido impactos negativos desproporcionados en poblaciones desfavorecidas y desatendidas en todo el mundo. La desigualdad y los determinantes sociales relacionados que afectan a ciertos grupos, están en relación directamente con los resultados de salud adversos de las poblaciones vulnerables durante la pandemia.

Introduction: as of December 2019, the Municipal Health Commission of Wuhan, China, reported 27 cases of pneumonia of unknown etiology coming to Colombia. The municipalities implemented strategies to minimize contagions as did Mosquera, Cundinamarca. However, information describing the characteristics of the COVID-19 affected population was limited. Objective: to analyze the vulnerability, sociodemographic and clinical conditions of the population with COVID-19 included in the primary health care strategy. Methodology: quantitative, observational, cross-sectional, retrospective study, analyzing the vulnerability, sociodemographic and clinical conditions of COVID-19 confirmed cases reported in the municipality of Mosquera during the 2020 phase of the pandemic. Results: 4,610 COVID-19 positive cases were included, of which 99% lived in the urban area. Five percent were between 0 -11 years old, 4% between 12 -17, 21% between 18-28, 59% between 29-59 and 12% over 60. The most affected populations were adults (58%), people covered by the contributory health regime (82%) and women (56%). Of the total number of participants, 73% were symptomatic, 92% did not require hospital admission and most of the positive cases reported 2 to 3 close contacts (29%), of which 82% were asymptomatic. Conclusions: the COVID-19 pandemic has had disproportionate negative impacts on disadvantaged and underserved populations worldwide. Inequality and social determinants affecting certain groups are directly related to adverse health outcomes among vulnerable populations during the pandemic.

Neutrophil-lymphocyte ratio as a link between complex pedal ulcers and poor clinical results after infrainguinal surgical revascularization.

BACKGROUND: Our aim was to evaluate the influence of preoperative neutrophil-lymphocyte ratio (NLR) on patency and clinical results after infrainguinal surgical revascularization for chronic limb ischemia. METHODS: Retrospective analysis of 150 infrainguinal autologous bypasses performed to infragenicular popliteal artery or tibial vessels in 140 (93%) patients with chronic limb-threatening ischemia (CLTI) and in 10 (7%) with disabling claudication. NLR was calculated using blood samples obtained 24 hours preoperatively. The cohort was stratified into 2 groups according to interquartile ranges of NLR: "ELEVATED-NLR" (Quartile 4 N.=37) and "LOW-NLR" (Quartile 1-2-3 N.=113). Reperfused ulcers were described using the WIfI classification. Patency, freedom from MALE and amputation-free survival at 24 months were calculated using the Kaplan-Meier method. Univariate comparisons between NLR groups were performed using the Log-Rank test. Statistical differences on univariate analysis were adjusted in a multivariate model (Cox regression). RESULTS: NLR values were similar between CLTI and claudication. Ischemic ulcers were more frequent, (83.4% vs. 59.3% P<0.01), more severe (W2-3: 37.8% vs. 22.1% P=0.01) and pedal infection was deeper (fI 2-3: 40.5% vs. 18.6% P=0.003) in "ELEVATED-NLR" group. Severe ischemia (I3) was similar between groups. High NLR values were independent predictors of patency loss (HR: 1.77 CI95% [1.01-3.10] P=0.04), MALE (HR: 2.04 CI95% [1.03-4.04] P=0.04) and worse amputation-free survival (HR:2.10 CI95% [1.06-4.14] P=0.03) rates at 24 months. CONCLUSIONS: High preoperative NLR values are associated with severe and deep infected ulcers and predicts primary patency loss, higher major adverse limb events and worse amputation-free survival rates on long-term follow-up after infrainguinal surgical revascularization.

Long-Term Effects of Bosentan on Cardiovascular Events in Hispanic Patients with Intermittent Claudication: Four-Year Follow-up of the CLAU Trial : The CLAU Randomized Trial Long-Term Outcome.

INTRODUCTION: The Clinical and Endothelial Function Assessment after Endothelin Receptor Antagonist (CLAU) trial demonstrated the effect of bosentan on the endothelial function, inflammatory status and claudication distance in Hispanic patients with incipient peripheral arterial disease (PAD). Our aim was to assess the protective effect on cardiovascular events of bosentan versus conventional anti-atherosclerosis therapy. METHODS: CLAU included 56 patients with intermittent claudication, randomized 1:1 to receive bosentan for 12 weeks (n = 27) or placebo (n = 29), associating the best medical treatment. Log-rank and hazard ratio (HR) analyses were performed to estimate the relative efficacy of bosentan in preventing incidence of major adverse events (MAE) including target limb revascularization (TLR), amputation, myocardial infarction (MI), and all-cause death; major cardiovascular adverse events (MACE) including TLR, amputation, MI, stroke, and cardiovascular-cause death; and major adverse limb events (MALE), which combines TLR and amputation. RESULTS: During the follow-up period (34 ± 5 months), five MAE occurred in the control group only (17.2%), including two TLR, one amputation, one stroke, and an MI. The ratio of event-free survival for MAE to 3 years follow-up was higher in the group treated with bosentan (100% vs 66%, p = 0.01, HR = 76; 95% confidence interval 0.05-104,677, p = 0.24). A similar trend was observed in incidence of MACE (100% vs 66%, p = 0.01) and MALE (100% vs 80%, p = 0.15). CONCLUSION: Treatment with bosentan in the early low-to-mild stages of PAD may prevent cardiovascular events and the need for lower limb revascularization in the Hispanic population. Trial Registration ClinicalTrials.gov identifier NCT25102012.

Carotid stenting with proximal cerebral protection in symptomatic low-grade vulnerable recurrent carotid stenosis.

BACKGROUND: Although the management of carotid disease is well established for symptomatic lesions ⩾70%, carotid revascularization for symptomatic low-grade (⩽50%) stenosis is not actually supported by data from randomized clinical trials. Such patients may occasionally have recurrent neurological symptoms despite optimal medical treatment owing to vulnerable plaques. In such cases, carotid artery stenting (CAS) may represent an option for treatment but this has not been tested in clinical trials. This study analyzed early and long-term outcomes of CAS performed in patients with low-grade symptomatic recurrent carotid stenosis. METHODS: From a prospective registry of 322 carotid revascularization in symptomatic patients, 21 consecutive patients with low-grade symptomatic recurrent carotid stenosis who underwent CAS with proximal cerebral protection device Mo.Ma, after ruling out any other source of cerebral embolization, were involved in the study.All patients had suggestive evidence of unstable plaque or plaque ulceration. RESULTS: Procedural technical success rate was 100%. No 30-day stroke or death occurred, and no patients had recurrent neurological events related to the revascularized hemisphere during follow up. No 30-day local complications were reported. No late carotid occlusions were detected. There was one late death, and no stroke-related deaths. Survival rates were 100% at 1 year and 96% at 3 years. CONCLUSIONS: This study shows that CAS is a well-tolerated, effective and durable treatment for patients with recurrent symptomatic low-grade carotid stenosis associated with a vulnerable plaque. Patients had excellent protection against further ischemic events and survived long enough.

Differential mRNA expression of inflammasome genes NLRP1 and NLRP3 in abdominal aneurysmal and occlusive aortic disease.

NLRP1 and NLRP3 inflammasomes might differentially mediate the chronic inflammatory response in abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD). We measure differential relative gene expression of NLRP1 and NLRP3 inflammasomes in aortic tissues from 30 patients undergoing AAA open repair compared to aortic biopsies from 30 patients undergoing surgery to treat AOD. Aortic wall samples from autopsy without aortic disease were used as controls. NLRP3 was overexpressed in patients with AAA and AOD (RQ 1.185 ± 0.15, and 1.098 ± 0.05, respectively) compared to donors (RQ 1.001 ± 0.08) (OR 2.8, 95% CI 1.2-4.3, p < 0.05 for AAA and OR 2.1, 95% CI 1.1-3.8, p < 0.05 for AOD). NLRP1 gene expression was significantly upregulated in patients with AOD (RQ 1.197 ± 0.09). Meanwhile, NLRP1 was normal expressed in AAA (RQ 1.003 ± 0.07) as well as in autopsy aortic specimens (RQ 1.005 ± 0.11). Enhanced NLRP1 expression in AOD was even significant when compared to AAA (OR 2.3, 95% CI 1.2-3.3, p < 0.05) or controls (OR 2.2, 95% CI 1.1-3.1, p < 0.05). According to our findings, NLRP3 could be involved in the common etiology of AAA and AOD, whereas NLRP1 appears to have a specific role in AOD development.

Differential mRNA expression of inflammasome genes NLRP1 and NLRP3 in abdominal aneurysmal and occlusive aortic disease.

NLRP1 and NLRP3 inflammasomes might differentially mediate the chronic inflammatory response in abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD). We measure differential relative gene expression of NLRP1 and NLRP3 inflammasomes in aortic tissues from 30 patients undergoing AAA open repair compared to aortic biopsies from 30 patients undergoing surgery to treat AOD. Aortic wall samples from autopsy without aortic disease were used as controls. NLRP3 was overexpressed in patients with AAA and AOD (RQ 1.185 ± 0.15, and 1.098 ± 0.05, respectively) compared to donors (RQ 1.001 ± 0.08) (OR 2.8, 95% CI 1.2-4.3, p < 0.05 for AAA and OR 2.1, 95% CI 1.1-3.8, p < 0.05 for AOD). NLRP1 gene expression was significantly upregulated in patients with AOD (RQ 1.197 ± 0.09). Meanwhile, NLRP1 was normal expressed in AAA (RQ 1.003 ± 0.07) as well as in autopsy aortic specimens (RQ 1.005 ± 0.11). Enhanced NLRP1 expression in AOD was even significant when compared to AAA (OR 2.3, 95% CI 1.2-3.3, p < 0.05) or controls (OR 2.2, 95% CI 1.1-3.1, p < 0.05). According to our findings, NLRP3 could be involved in the common etiology of AAA and AOD, whereas NLRP1 appears to have a specific role in AOD development.

Carotid Stenting in Patients With High Risk Versus Standard Risk for Open Carotid Endarterectomy (REAL-1 Trial).

Carotid stenting (CAS) has been mainly offered to those patients considered at "high risk" for open carotid endarterectomy based on available data from large randomized clinical trials. However, several recent studies have called medical "high risk" into question for CAS indication. The REAL-1 trial evaluated the safety and perioperative and long-term effectiveness in patients with significant carotid artery stenosis with "high-risk" criteria treated with CAS and proximal protection device (MOMA) compared with those with standard surgical-risk features. This nonrandomized double-arm registry included 125 patients (40% symptomatic), 71 (56%) with "standard-risk" and 54 (44%) with "high-risk" criteria. The primary end point was the cumulative incidence of any major adverse event, a composite of stroke, myocardial infarction, and death within 30 days after the intervention or ipsilateral stroke after 30 days and up to 4 years. There was no significant difference in primary end point rate at 30 days between patients at "standard risk" and those with "high risk" (1.4% vs 1.9% respectively; hazard ratio for "standard risk" 1.1; 95% CI 0.8 to 1.2, p = 0.77) nor estimated 4-year rate of ipsilateral stroke (1.3% vs 1.8%; hazard ratio for "standard risk" 1.05, 95% CI 0.86 to 1.14, p = 0.9). In conclusion, 4-year postprocedure results demonstrated that CAS with proximal device (MOMA) is safe and effective for patients with and without "high-risk" for carotid endarterectomy.

Rationale and Design of Randomized Clinical Trial for the Assessment of Macitentan Efficiency as Coadjuvant Treatment to Open and Endovascular Revascularization in Critical Limb Ischemia.

INTRODUCTION: Critical limb ischemia (CLI) is defined by ischemic rest pain, tissue loss, or both, secondary to arterial insufficiency, and its prevalence is increasing mainly as a result of the worldwide high prevalence of diabetes. Currently, there are no available conclusive data on the efficacy of any coadjuvant therapy after revascularization procedure benefiting amputation and patency rates. Macitentan is an orally active dual endothelin (ET) receptor antagonist that may contribute to reduce the amputation rate and improve revascularization patency in CLI. METHODS/DESIGN: REVASC is a proposed pilot, open-label, controlled, randomized, single-center clinical double-blind trial to be conducted in Spain on a study population of European patients with CLI, which will compare the clinical outcomes and cost-effectiveness of macitentan coadjuvant treatment after limb revascularization with the standard antiplatelet treatment strategy for severe limb ischemia. Patients are randomized 1:1 to receive macitentan or placebo for 12 weeks. The primary clinical end point will be amputation-free survival rate at 12 months, defined as the time to major (above the ankle) amputation for the index (trial) limb or death from any cause, whichever comes first. Secondary outcomes include overall survival, quality of life, in-hospital mortality and morbidity, repeat interventions, healing of tissue loss, and hemodynamic changes following revascularization. Sample size is estimated as 120 patients. The economic analysis will consist of two components: a "within-study" analysis, which will be based on study end points; and a "model-based" analysis, which will extrapolate and compare costs and effects likely to accrue beyond the study follow-up period. DISCUSSION: The REVASC trial is designed to be pragmatic and represents current practice of the real-world population management after limb revascularization for CLI due to atherosclerosis. Current evidence does not support any coadjuvant treatment. A new pathway of treatment may be opened with the use of ET receptor antagonists in these patients.