Understanding the impact of stress on cognitive processes, particularly decision-making, is crucial as it underpins behaviors essential for survival. However, research in this domain has yielded disparate results, with inconsistencies evident across stress-induction paradigms and drug administration protocols designed to investigate specific stress pathways or neuromodulators. Building upon empirical studies, this research identifies a multifaceted matrix of variables contributing to the divergent findings. This matrix encompasses factors such as the temporal proximity between stressors and decision tasks, the nature of stressors and decision contexts, individual characteristics including psychobiological profiles and affective states at the time of decision-making and even cultural influences. In response to these complexities, we propose a comprehensive model that integrates these relevant factors and their intricate interplay to elucidate the mechanisms governing decision-making during stressful events. By synthesizing these insights, our model not only refines existing paradigms but also provides a framework for future study designs, offering avenues for theoretical advancements and translational developments in the field of stress's impact on cognitive functions. This research contributes to a deeper understanding of the nuanced relationship between stress and decision-making, ultimately advancing our knowledge of cognitive processes under challenging conditions.
The observation of a weak proton-emission branch in the decay of the 3174-keV 53mCo isomeric state marked the discovery of proton radioactivity in atomic nuclei in 1970. Here we show, based on the partial half-lives and the decay energies of the possible proton-emission branches, that the exceptionally high angular momentum barriers, [Formula: see text] and [Formula: see text], play a key role in hindering the proton radioactivity from 53mCo, making them very challenging to observe and calculate. Indeed, experiments had to wait decades for significant advances in accelerator facilities and multi-faceted state-of-the-art decay stations to gain full access to all observables. Combining data taken with the TASISpec decay station at the Accelerator Laboratory of the University of Jyväskylä, Finland, and the ACTAR TPC device on LISE3 at GANIL, France, we measured their branching ratios as bp1 = 1.3(1)% and bp2 = 0.025(4)%. These results were compared to cutting-edge shell-model and barrier penetration calculations. This description reproduces the order of magnitude of the branching ratios and partial half-lives, despite their very small spectroscopic factors.
We present the case of an elderly patient who presented with an allergic reaction secondary to fruit consumption and subsequently developed a non-ST-elevation coronary syndrome. (AU)
Se presenta el caso de un paciente adulto mayor que presenta un reacción alergica secundaria al consumo de fruta y posteriormente desarrolla un sindrome coronario sin elevacion del ST. (AU)
Humans , Male , Aged , Fruit/adverse effects , Kounis Syndrome , Non-ST Elevated Myocardial Infarction , Food Hypersensitivity
Presentación del caso. Se trata de una mujer de 44 años de edad, con historia de cefalea occipital, lenguaje incoherente y pensamiento confuso. Inicialmente presentaba diez puntos en la escala de Glasgow y una hemiparesia izquierda. La tomografía computarizada de cráneo, reportó edema cerebral con lesión hipodensa talámica derecha y deterioro neurológico progresivo.El electroencefalograma evidenció desaceleración unilateral hemisférica derecha. El estudio del líquido cefalorraquídeo describió hiperproteinorraquia y un recuento a predominio linfocitario de 450 células con glucorraquia conservada, sin presencia de bacterias. Intervención terapéutica. se manejó con soporte ventilatorio invasivo y con tratamiento antibiótico y antiviral a dosis meníngeas, además de anticonvulsivantes. Los hallazgos tomográficos de control reportaron una hidrocefalia; se colocó una derivación ventricular tipo Becker. La serología IgM resultó positiva para virus de Epstein Barr y se identificó el genoma viral en el líquido cefalorraquídeo, a través de la prueba de reacción en cadena de polimerasa. La tomografía cerebral de control, evidenció la persistencia de la ventriculomegalia y de edema cerebral, lo que generó el diagnóstico de una encefalitis de etiología viral complicada con epilepsia secundaria por una lesión estructural desmielinizante del hemisferio cerebral derecho. Evolución clínica. La intervención terapéutica con inmunoglobulina intravenosa generó una mejoría del estado general. Fue posible retirar la derivación ventricular y la ventilación pulmonar diez y 19 días después del ingreso, respectivamente. La paciente se encuentra actualmente en fisioterapia con persistencia de hemiparesia izquierda, alteraciones de la marcha, disartria y episodios convulsivos controlados durante los últimos seis meses
Case presentation. This case is about a 44 years old woman with a history of occipital headache, incoherent speech and confused thinking. She initially presented ten points on the Glasgow scale and left hemiparesis. Cranial CT scan reported cerebral edema with right thalamic hypodense lesion and progressive neurological deterioration. The electroencephalogram showed unilateral right hemispheric deceleration. The cerebrospinal fluid study showed hyperproteinuria and a predominantly lymphocyte count of 450 cells with preserved glycorrhachia, without the presence of bacteria. Treatment.was managed with invasive ventilatory support and antibiotic and antiviral treatment at meningeal doses, in addition to anticonvulsants. Control tomographic findings showed hydrocephalus; a Becker type ventricular shunt was placed. IgM serology was positive for Epstein Barr virus and the viral genome was identified in the cerebrospinal fluid by polymerase chain reaction test. The control brain tomography showed persistent ventriculomegaly and cerebral edema, which led to the diagnosis of encephalitis of viral etiology complicated by epilepsy secondary to a demyelinating structural lesion of the right cerebral hemisphere. Outcome. Therapeutic intervention with intravenous immunoglobulin was performed with improvement of the general condition, it was possible to remove the ventricular shunt and pulmonary ventilation ten and 19 days after admission, respectively. The patient is currently in physical therapy with persistence of left hemiparesis, gait disturbances, dysarthria, and controlled convulsive episodes during the last six months.
Humans , Female , Herpesvirus 4, Human , El Salvador
Introducción. El shock séptico es la manifestación más grave de sepsis con tasas de letalidad que pueden llegar hasta el 80%. En los últimos años, ha cobrado relevancia la diferencia arteriovenosa de dióxido de carbono, por su implicación teórica en el metabolismo anaerobio y su significado respecto del normal funcionamiento celular. Por lo antes mencionado, creemos necesario realizar un estudio que nos permita establecer la utilidad de la diferencia arteriovenosa de dióxido de carbono en el paciente con shock séptico de la unidad de cuidados intensivos, como medida indirecta de la perfusión tisular y de la utilización de oxígeno por los tejidos, que nos permita establecer un diagnóstico precoz y el pronóstico de los pacientes críticamente enfermos. Métodos. Estudio observacional, descriptivo y transversal. Muestra de veintiocho pacientes adultos. Resultados. Como se ha registrado en otras series, la mayor parte de los pacientes afectados por shock séptico, en nuestro estudio, fueron hombres mayores de 65 años, con al menos una comorbilidad, siendo el principal sitio de infección el respiratorio (67,9%), asociado a una alta tasa de mortalidad (67%). Conclusiones. Los pacientes con diferencia arteriovenosa de PCO2 mayor a 6 mmHg tienen un riesgo aumentado de muerte de 3,2 veces. (AU)
Introduction. Septic shock is the most serious manifestation of sepsis with mortality rates that can reach up to 80%. In recent years, the arteriovenous carbon dioxide difference has gained relevance, due to its theoretical implication in anaerobic metabolism and its significance with respect to normal cell function. Due to the aforementioned, we believe it is necessary to carry out a study that allows us to establish the usefulness of the arteriovenous carbon dioxide difference in the patient with septic shock in the intensive care unit as an indirect measure of tissue perfusion and utilization. of oxygen through the tissues, which allows us to establish an early diagnosis and prognosis of critically ill patients. Methods. Observational, descriptive and cross-sectional study. Sample of 28 adult patients. Results. As has been reported in other series, most of the patients affected by septic shock in our study were men over 65 years of age, with at least one comorbidity, the main site of infection being respiratory (67.9%), associated with a high mortality rate (67%) Conclusions. Patients with an arteriovenous PCO2 difference greater than 6 mmHg have a 3.2-fold increased risk of death. (AU)
Humans , Male , Female , Adult , Middle Aged , Aged , Shock, Septic/mortality , Carbon Dioxide/blood , Blood Gas Analysis , Cross-Sectional Studies , Observational Study
Evidence of the effectiveness of the tests used to diagnose Helicobacter pylori (H. pylori) in primary healthcare is limited. This cross-sectional study aims to assess the accuracy of tests used for to diagnose H. pylori infection in primary care patients and its relationship with gastroduodenal pathologies. Over 12 months, 173 primary care patients with dyspeptic symptoms were referred for upper gastrointestinal endoscopy to obtain gastric biopsies, and venous blood was extracted from them. H. pylori infection was detected using a rapid urease test (RUT), real-time polymerase chain reaction (RT-PCR), H. pylori-IgG ELISA, and Western blot (WB). The culture and histological findings were used as the reference standard for H. pylori infection. H. pylori prevalence was 50%. There were no significant differences between men and women overall or by age group. The presence of H. pylori was associated with chronic moderate gastritis and its absence with chronic inactive gastritis, as well as the combination of gastritis and gastric lesions (p < 0.05). RUT and ELISA H. pylori -IgG tests showed the highest overall performance (accuracy 98.9% and 84.4%), followed by WB and RT-PCR (accuracy 79.3% and 73.9%). These findings support the notion that combined invasive and noninvasive methods, such as RUT and H. pylori-IgG ELISA, can be a primary diagnostic screening tool for detecting H. pylori among adult dyspeptic patients in Cuba's primary care setting.
BACKGROUND: The adherence of the elderly to therapeutic programs, either they are pharmacological or psychosocial, is generally low. OBJECTIVE: Identifying predictive variables of adherence of a social program from elderly with multifunctional independence or mild dependence. METHOD: Prospective longitudinal design with 104 elderly participants in a social program. The inclusion criteria were: to participate in a social program for elderly, present functional independence or mild dependence, without depression clinically confirmed. Descriptive analyzes were performed with the study variables in addition to hypothesis testing and linear and logistic regression models to identify predictive variables of adherence. RESULTS: 22% of the participants met the minimum adherence, observing better compliance in younger people (p = 0.004), among those who had a better Health-Related Quality of Life (p = 0.036) and better health literacy levels (p = 0.017). According to a linear regression model, the variables associated with adherence were: social program of origin (OR = 5,122), perception of social support (OR = 1,170), cognitive status (OR = 2,537). CONCLUSION: The level of adherence of the older people of the study can be evaluated as low, which is consistent with the findings of the specialized literature. The variables identified with predictive capacity on adherence were social program of origin, a condition that can be incorporated into the design of the interventions in order to facilitate territorial equity. It is also important to highlight the importance of health literacy and the risk of dysphagia in the level of adherence.
Health Literacy , Quality of Life , Humans , Aged , Prospective Studies , Social Support
Temporal discounting is a phenomenon where a reward loses its value as a function of time (e.g., a reward is more valuable immediately than when it delays in time). This is a type of intertemporal decision-making that has an association with impulsivity and self-control. Many pathologies exhibit higher discounting rates, meaning they discount more the values of rewards, such as addictive behaviors, bipolar disorder, attention-deficit/hyperactivity disorders, social anxiety disorders, and major depressive disorder, among others; thus, many studies look for the mechanism and neuromodulators of these decisions. This systematic review aims to investigate the association between pharmacological administration and changes in temporal discounting. A search was conducted in PubMed, Scopus, Web of Science, Science Direct and Cochrane. We used the PICO strategy: healthy humans (P-Participants) that received a pharmacological administration (I-Intervention) and the absence of a pharmacological administration or placebo (C-Comparison) to analyze the relationship between the pharmacological administration and the temporal discounting (O-outcome). Nineteen studies fulfilled the inclusion criteria. The most important findings were the involvement of dopamine modulation in a U-shape for choosing the delayed outcome (metoclopradime, haloperidol, and amisulpride). Furthermore, administration of tolcapone and high doses of d-amphetamine produced a preference for the delayed option. There was a time-dependent hydrocortisone effect in the preference for the immediate reward. Thus, it can be concluded that dopamine is a crucial modulator for temporal discounting, especially the D2 receptor, and cortisol also has an important time-dependent role in this type of decision. One of the limitations of this systematic review is the heterogeneity of the drugs used to assess the effect of temporal discounting.
Introduction: cardiovascular complications due to COVID-19 infection are very frequent. However, these complications are rarely reported as a vaccine reaction. Case presentation: a female patient with no significant cardiovascular history developed functional class deterioration 14 days after her third dose of the BBIBP-CorV vaccine, along with three syncopal episodes. She was seen at a primary care level and an electrocardiogram was ordered which showed Mobitz 2 atrioventricular block which progressed to a complete block. Molecular tests for COVID-19 infection were negative, as were immunological studies for collagen disease, Chagas, and viral myocarditis. A transthoracic echocardiogram showed no regional kinetic disturbances, and the ejection fraction was preserved at 60%. Cardiac magnetic resonance imaging showed edema in the T2-STIR sequences, and subepicardial enhancement in the medial distal lateral region was compatible with acute myocarditis. The patient required a permanent pacemaker. Discussion: electrical or mechanical dysfunction secondary to a COVID-19 vaccine is anecdotal, with few reports in the literature. In a review of both the 2021 European Society of Cardiology and the 2018 American Heart Association Guidelines on cardiac pacing and cardiac resynchronization therapy, no recommendation was found for these types of events associated with COVID-19 or following vaccination. An international network should be created to report these events and thus determine general management guidelines. For now, the recommendations must be individualized for these patients. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2602).
This study presents a draft genome sequence of a Newcastle disease virus (NDV) strain (VFAR-136) isolated from a fighting cock (Gallus gallus) in the south of Peru. Strain VFAR-136 is a new report of NDV genotype VII circulating in Peru.
Introduction: Ferrokinetic alterations are associated with the worsening of cardiovascular diseases, their role being unknown in depth. Objective: To determine the association between ferrokinetic with acute myocardial infarction with and without ST elevation in patients with coronary disease. Methods: Analytical observational study in a sample of 72 patients who were admitted to a Coronary Care Unit of a fourth level Institution during the period from July 2017 to May 2018. The statistical association analysis was performed with the Chi-square test. Results: The main gender affected was male, in ages over 56 years. The main comorbidity was arterial hyperten-sion in 53.7% for ST-elevation infarction and in 74.2% for non-ST-elevation infarction. The prevalent ferrokinetic alteration was iron deficiency, in 36.6% of the patients with ST elevation and in 41.9% without ST elevation. Low hemoglobin levels were present on admission in 24.4% of patients with ST elevation and in 32.3% of those without ST elevation, associated with low hemoglobin values on day 7 of hospitalization. Deaths occurred in 2.77%, which presented low iron levels without anemia and infarction with ST elevation and shock. The gender variable presented a statistically significant association (p = 0.034) with the serum iron level. Conclusions: Iron deficiency is a very common disorder with a higher mortality rate, so these parameters should be evaluated in cardiovascular diseases
Introducción: Las alteraciones ferrocinéticas se asocian con un empeoramiento de las enfermedades cardiovasculares, pero se desconoce en profundidad su papel.Objetivo: Determinar la asociación entre la ferrocinética con el infarto agudo al miocardio con y sin elevación del segmento ST en pacientes con enfermedad coronaria. Métodos: Estudio observacional analítico en una muestra de 72 pacientes que ingresaron a una unidad de cuidados coronarios de una institución de cuarto nivel durante el lapso de julio de 2017 a mayo de 2018. El análisis de asociación estadística se realizó con la prueba de chi cuadrado. Resultados: El principal género afectado fue el masculino, en edades superiores a 56 años. La principal comorbilidad fue hipertensión arterial, en un 53,7 % para infarto con elevación del segmento ST, y en un 74,2 % para infarto sin elevación de dicho segmento. La alteración ferrocinética prevalente fue el déficit de hierro, en un 36,6 % de los pacientes con elevación del intervalo ST y en un 41,9 % sin elevación del segmento ST. Las concentraciones bajas de hemoglobina estuvieron presentes al ingreso en el 24,4 % de los pacientes con elevación del ST y en el 32,3 % de aquellos sin elevación del ST, aso-ciado con valores bajos de hemoglobina al séptimo día de hospitalización. Ocurrieron fallecimientos en el 2,77 %, con cantidades bajas de hierro sin anemia e infarto con elevación del segmento ST y choque. La variable género presentó asociación estadísticamente significativa (p = 0,034) con el nivel de hierro sérico. Conclusiones: La ferropenia es una alteración muy frecuente con una relación de mayor mortalidad, por lo que estos parámetros deberían evaluarse en enfermedades cardiovasculares
Introdução: Os distúrbios ferrocinéticos estão associados à piora da doença cardiovascular, mas seu papel é pouco conhecido. Objetivo: Determinar a associação entre a ferrocinética e o infarto agudo do miocárdio com e sem elevação do segmento ST em pacientes com doença cardíaca coronária. Métodos: Estudo observacional analítico em uma amostra de 72 pacientes admitidos em uma unidade de tratamento coronariano de uma instituição de quarto nível durante o período de julho de 2017 a maio de 2018. A análise de associação estatística foi realizada usando o teste do qui-quadrado. Resultados: O principal gênero afetado foi o masculino, com idade superior a 56 anos. A principal comorbidade foi a hipertensão, em 53,7% para infarto do miocárdio com elevação do segmento ST e 74,2% para infarto do miocárdio sem elevação do segmento ST. O distúrbio ferrocinético preva-lente foi a deficiência de ferro em 36,6% dos pacientes com elevação do segmento ST e 41,9% sem elevação do segmento ST. Concentrações baixas de hemoglobina estavam presentes na admissão em 24,4% dos pacientes com elevação do segmento ST e em 32,3% daqueles sem elevação do segmento ST, associadas a valores baixos de hemoglobina ao sétimo dia de hospitalização. Ocorreram mortes em 2,77%, com baixo teor de ferro sem anemia e infarto com elevação do segmento ST e choque. O gênero foi associado de forma estatisticamente significativa (p = 0,034) ao nível de ferro sérico. Conclusões: A deficiência de ferro é um distúrbio muito comum com uma associação com o aumento da mortalidade, por tanto, esses parâmetros devem ser avaliados em doenças cardiovasculares
Infarction , Hemoglobins , Ferritins , Iron
Se presenta el caso de una paciente adulta joven con antecedente de ovario poliquístico e infección reciente por COVID 19 que inicia con cuadro de astenopia y visión borrosa junto con cefalea, se realiza fondo de ojo con papiledema bilateral, estudios de laboratorio y neuro imagen sin hallazgos positivos, también punción lumbar con presión de apertura elevada por lo que se diagnostica hipertensión intracraneal idiopática con posterior mejoría post punción.
The case of a young adult patient is presented with a history of polycystic ovary and recent infection by COVID 19 that starts with asthenopia and blurred vision along with headache, fundus examination with bilateral papilledema was performed, laboratory and neuroimaging studies without positive findings, also lumbar puncture with elevated opening pressure so idiopathic intracranial hypertension was diagnosed with subsequent post puncture improvement.
Introducción: La babesiosis es una enfermedad causada por protozoos intraeritrocíticos con características clínicas que son similares a las de la malaria, se transmite a los seres humanos a través de la picadura de una garrapata infectada, ocasionalmente por transfusión. A nivel global la prevalencia de la enfermedad es desestimada; se desconoce esa proporción en Latinoamérica y Venezuela. Caso clínico: Paciente masculino de 29 años con fiebre de 15 días, ictericia, dolor abdominal, en quien se sospechó malaria por epidemiología y síntomas, se descartaron otras entidades como endocarditis, leptospirosis, tuvo serología positiva para ehrlichiosis, sin embargo, persistió clínica a pesar del tratamiento con cloroquina, clindamicina y doxiciclina; por tanto, se realizaron estudios complementarios con hallazgo de inclusiones intraeritrocíticas compatibles con babesiosis e inició terapia con clindamicina y quinina por 7 días con evolución satisfactoria. Discusión: El caso reportado requirió de un ejercicio clínico y apoyo interdisciplinario para un desenlace adecuado. Entre los diagnósticos diferenciales de enfermedades intraeritrocitarias se encuentra la babesiosis cuyos síntomas son inespecíficos, pero orienta su diagnóstico al indagar en el antecedente epidemiológico. El tratamiento incluye Atovacuona con Azitromicina o alternativas como Clindamicina con Quinina. Conclusiones: El presente caso fue bastante complejo dado su forma de presentación y al ser una enfermedad con una baja prevalencia en nuestro país, sin embargo, predominó el juicio clínico logrando el mejor resultado posible.
Introduction: Babesiosis is a disease caused by intraerythrocyte protozoa with clinical characteristics that are similar to those of malaria, it is transmitted to humans through the bite of an infected tick, occasionally by transfusion. Globally, the prevalence of the disease is underestimated; this proportion is unknown in Latin America and Venezuela. Clinical case: A 29-year-old male patient with a 15-day fever, jaundice, abdominal pain, in whom malaria was suspected based on epidemiology and symptoms, other entities such as endocarditis, leptospirosis were ruled out, he had positive serology for ehrlichiosis, however, it clinical symptoms persisted despite treatment with chloroquine, clindamycin and doxycycline; therefore, complementary studies were conducted with findings of intraerythrocyte inclusions compatible with Babesiosis and started treatment with clindamycin and quinine for 7 days and presented satisfactory evolution. Discussion: The reported case required a clinical exercise and interdisciplinary support for an adequate outcome. Among the differential diagnoses of intraerythrocyte diseases is babesiosis whose symptoms are non-specific, but guides its diagnosis by inquiring into the epidemiological history. Treatment includes atovaquone with azithromycin or alternatives such as clindamycin with quinine. Conclusions: The present case was quite complex given its form of presentation and being a disease with a low prevalence in our country, however, clinical judgment predominated, achieving the best possible result.
Introducción: la enfermedad por COVID-19 puede provocar una gran variedad de problemas de salud a largo plazo, como deterioro de la función pulmonar, reducción del rendimiento del ejercicio y disminución de la calidad de vida. Nuestro estudio tuvo como objetivo investigar la eficacia, viabilidad y seguridad de la rehabilitación pulmonar en pacientes con COVID-19 y comparar los resultados entre pacientes con un curso leve/moderado y grave/crítico de la enfermedad. Material y métodos: los pacientes en la fase posaguda de un curso leve a crítico de COVID-19 ingresados en un programa integral de rehabilitación pulmonar, se incluyeron en este estudio de cohorte prospectivo y observacional. Se evaluaron antes y después varias medidas de rendimiento del ejercicio, distancia de caminata de 6 minutos, función pulmonar (capacidad vital forzada (CVF)) y calidad de vida (encuesta de salud de formato corto de 36 preguntas (SF-36)). Se incluyeron 43 pacientes en el estudio (20 con COVID leve/moderado y 23 con COVID grave/crítico). Resultados: al ingreso los pacientes tenían una distancia de caminata reducida (leve: mediana 401 m, rango intercuartílico (IQR) 335-467 m; severo: 108 m, 84-132 m); una CVF deteriorada (leve: 72 %, severo: 35 %), y una puntuación baja de salud mental SF-36 (leve: 52 puntos, severo: 32 puntos. Los pacientes recibieron sesiones ajustadas a sus capacidades físicas y en ambos subgrupos mejoraron en la prueba de caminata de 6 minutos (leve/moderada: +54 m, severo/crítico: +117 m, ambos p <0.002), en CVF (leve/moderada: + 8.9 % , p = 0.004; severo/crítico: + 12.4 %, p <0.003) y en el componente mental SF-36 (leve / moderado: +6.8 puntos, p = 0.062; severo/crítico: +16.7 puntos, -p <0,005). Discusión y conclusiones: un programa de ejercicio bien estructurado resulta en un beneficio en las esferas de capacidad aeróbica, volúmenes pulmonares y calidad de vida; en tal sentido, se recomienda ampliar las muestras poblacionales para poder aplicar nuestro protocolo a otros centros encargados de la rehabilitación de pacientes con COVID-19.
Introduction: COVID-19 disease can cause a wide variety of long-term health problems, such as impaired lung function, reduced exercise performance, and decreased quality of life. Our study aimed to investigate the efficacy, feasibility, and safety of pulmonary rehabilitation in patients with COVID-19 and to compare the results between patients with a mild/moderate and severe/critical course of the disease. Materials and Methods: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive pulmonary rehabilitation program were included in this prospective, observational cohort study. Various measures of exercise performance, 6-minute walk distance, lung function (forced vital capacity (FVC)), and quality of life (36-question short-form health survey (SF-36)) were assessed before and after. We include 43 patients in this study (20 with mild/moderate COVID and 23 with severe/critical COVID-19). Results: At admission, patients had reduced walking distance (mild: median 401 m, interquartile range (IQR) 335-467 m; severe: 108 m, 84-132 m), impaired FVC (mild: 72%, severe: 35%,) and a low SF-36 mental health score (mild: 52 points, severe: 32 points). This patients received sessions adjusted to their physical abilities, and in both subgroups the patients improved on the walking test of 6 min (mild/moderate: +54m, severe/critical: +117m, both p < 0.002), FVC (mild/moderate: +8.9%, p=0.004; severe/critical: +12.4%, p <0.003) and mental component SF-36 (mild / moderate: +6.8 points, p = 0.062; severe / critical: +16.7 points, -p <0.005). Discussion and Conclusions: A well-structured exercise program results in a benefit in the patients' spheres of aerobic capacity, lung volumes and quality of life, in this sense it is recommended to expand population samples to be able to apply our protocol to other centers in charge of the rehabilitation of COVID 19 patients.
Humans , Exercise , COVID-19 , Rehabilitation , Pulmonary Medicine , Walking , Exercise Therapy
COVID-19 pandemic has accelerated the development of vaccines against its etiologic agent, SARS-CoV-2. However, the emergence of new variants of the virus lead to the generation of new alternatives to improve the current sub-unit vaccines in development. In the present report, the immunogenicity of the Spike RBD of SARS-CoV-2 formulated with an oil-in-water emulsion and a water-in-oil emulsion with squalene was evaluated in mice and hamsters. The RBD protein was expressed in insect cells and purified by chromatography until >95% purity. The protein was shown to have the appropriate folding as determined by ELISA and flow cytometry binding assays to its receptor, as well as by its detection by hamster immune anti-S1 sera under non-reducing conditions. In immunization assays, although the cellular immune response elicited by both adjuvants were similar, the formulation based in water-in-oil emulsion and squalene generated an earlier humoral response as determined by ELISA. Similarly, this formulation was able to stimulate neutralizing antibodies in hamsters. The vaccine candidate was shown to be safe, as demonstrated by the histopathological analysis in lungs, liver and kidney. These results have shown the potential of this formulation vaccine to be evaluated in a challenge against SARS-CoV-2 and determine its ability to confer protection.
COVID-19 , Viral Vaccines , Adjuvants, Immunologic , Animals , Antibodies, Neutralizing , Antibodies, Viral , COVID-19/prevention & control , Cricetinae , Emulsions , Humans , Immunogenicity, Vaccine , Mice , Mice, Inbred BALB C , Models, Animal , Pandemics/prevention & control , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Squalene , Water
Within the framework of the current COVID-19 pandemic, there is a race against time to find therapies for the outbreak to be controlled. Since vaccines are still tedious to develop and partially available for low-income countries, passive immunity based on egg-yolk antibodies (IgY) is presented as a suitable approach to preclude potential death of infected patients, based on its high specificity/avidity/production yield, cost-effective manufacture, and ease of administration. In the present study, IgY antibodies against a recombinant RBD protein of SARS-CoV-2 were produced in specific-pathogen-free chickens and purified from eggs using a biocompatible method. In vitro immunoreactivity was tested, finding high recognition and neutralization values. Safety was also demonstrated prior to efficacy evaluation, in which body weight, kinematics, and histopathological assessments of hamsters challenged with SARS-CoV-2 were performed, showing a protective effect administering IgY intranasally both as a prophylactic treatment or a post-infection treatment. The results of this study showed that intranasally delivered IgY has the potential to both aid in prevention and in overcoming COVID-19 infection, which should be very useful to control the advance of the current pandemic and the associated mortality.
COVID-19 , SARS-CoV-2 , Animals , Antibodies , COVID-19/prevention & control , Chickens , Humans , Immunoglobulins , Pandemics
The coronavirus disease-19 (COVID-19) pandemic has already claimed millions of lives and remains one of the major catastrophes in the recorded history. While mitigation and control strategies provide short term solutions, vaccines play critical roles in long term control of the disease. Recent emergence of potentially vaccine-resistant and novel variants necessitated testing and deployment of novel technologies that are safe, effective, stable, easy to administer, and inexpensive to produce. Here we developed three recombinant Newcastle disease virus (rNDV) vectored vaccines and assessed their immunogenicity, safety, and protective efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in mice and hamsters. Intranasal administration of rNDV-based vaccine candidates elicited high levels of neutralizing antibodies. Importantly, the nasally administrated vaccine prevented lung damage, and significantly reduced viral load in the respiratory tract of vaccinated animal which was compounded by profound humoral immune responses. Taken together, the presented NDV-based vaccine candidates fully protected animals against SARS-CoV-2 challenge and warrants evaluation in a Phase I human clinical trial as a promising tool in the fight against COVID-19.
COVID-19 , Viral Vaccines , Administration, Intranasal , Animals , Antibodies, Neutralizing , Antibodies, Viral , COVID-19/prevention & control , Cricetinae , Mice , Newcastle disease virus/genetics , SARS-CoV-2/genetics , Vaccination , Vaccines, Synthetic/genetics
We conducted a phase I-IIa, randomized, monocentric, double-blind, placebo-controlled clinical trial to evaluate the safety and impact of the combination treatment of Itolizumab and insulin on preserving beta cell function in adults with recent-onset type 1 diabetes. Twelve patients were randomly assigned to three treatment groups, each receiving a different Itolizumab dose (0.4/0.8/1.6 mg/kg body weight, respectively) and a placebo group. All patients received concomitant intensive multiple-dose insulin therapy. Endogenous insulin secretion was assessed by the measurement of C-peptide during the mixed-meal tolerance test. No serious adverse events were reported. No changes in the total daily insulin doses, glycated hemoglobin levels, and stimulated C-peptide were observed between the Itolizumab and placebo groups at 52 weeks. A significant decrease in stimulated C-peptide was observed during the follow-up period (p = 0.012). One subject treated with 1.6 mg of Itolizumab showed a marked increase in the levels of stimulated C-peptide three years after completion of the trial. Taken together, this is the first study to demonstrate that combination treatment with Itolizumab and insulin is safe in humans and does not affect the residual function of beta cells up to 52 weeks. The findings from our study show preliminary evidence that high doses of Itolizumab could potentially arrest the loss of beta cell function in the long term. Further studies with a longer follow-up and larger numbers of patients are envisaged to assess the effect with high dose Itolizumab.
Resumen Introducción: la pandemia por COVID-19 ha generado un costo inexorable a los gobiernos y una mortalidad elevada en términos generales, el proceso de vacunación es la única estrategia efectiva en disminuir la morbimortalidad en general, sin embargo, dicha administración no está exenta de riesgos. Presentación del caso: presentamos el caso clínico de una paciente de género femenino de la séptima década, quien es vacunada contra el COVID-19 y tras cuatro días posteriores a la segunda dosis de vacuna anti COVID-19, comienza a presentar lesiones purpúricas que inician en miembros inferiores y ascienden progresivamente hasta el tronco asociado a artralgias intensas, dolor abdominal y náuseas. Es ingresada encontrándose recuentos plaquetarios menores a 10 mil plaquetas y se hace el diagnóstico de una púrpura trombocitopénica inmune asociada a la vacuna de AstraZeneca contra COVID-19, iniciándose terapia inmunosupresora específica. Discusión: el presente caso constituye la aparición de una púrpura trombocitopénica idiopática, patología poco frecuente con un amplio repertorio de eventos desencadenantes encontrándose las infecciones y reacciones vacunales dentro de los principales detonantes. La presente reacción vacunal es poco frecuente siendo lo anecdótico en específico la presencia de púrpura trombocitopénica inmune, hasta el momento son muy escasas las descripciones en la literatura sobre este tipo de reacción vacunal razón por la cual se decide recopilar y publicar el mismo mencionando la evidencia científica disponible más reciente sobre el tema. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2268).
Abstract Introduction: the COVID-19 pandemic has generated an inexorable cost for governments and an elevated mortality overall. Vaccination is the only effective strategy for decreasing overall morbidity and mortality; however, this vaccination is not without risks. Case presentation: we present the clinical case of a female patient in her seventies who was vaccinated against COVID-19 and four days after the second dose of the COVID-19 vaccine developed purpuric lesions beginning on her lower limbs and ascending progressively towards the trunk, associated with intense arthralgias, abdominal pain and nausea. She was admitted with platelet counts of less than 10,000, was diagnosed with immune thrombocytopenic purpura associated with the AstraZeneca COVID-19 vaccine, and was started on specific immunosuppressive therapy. Discussion: this is a case of idiopathic thrombocytopenic purpura, a rare pathology with a broad repertoire of triggering events, with infections and vaccine reactions among the main triggers. This vaccine reaction is rare, with the specific anecdotal point being the presence of immune thrombocytopenic purpura. To date, there are very few descriptions of this type of vaccine reaction in the literature, which is why we chose to compile and publish it, mentioning the most recent scientific evidence available on the subject. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2268).
Introduction: The presence of metabolic syndrome and cardiovascular risk in HIV positive patients has been overlooked in patients with HIV infection. Objectives: To evaluate the frequency of metabolic syndrome and compare cardiovascular risk stratification according to the Framingham, PROCAM, and SCORE equations in HIV patients. Methodology: A cross-sectional study of 760 HIV-infected adults from January 2016 to December 2018. The presence of metabolic syndrome was assessed using the ATP-III criteria, and the cardiovascular risk score was examined. Results: The most frequent comorbidities were smoking, hypercholesterolemia, and high blood pressure. Student's T test was carried out, showing differences in the classification of low to moderate risk. The number of HIV-infected male patients identified as having moderate cardiovascular risk according to the Framingham risk equation was two folds compared to those with the PROCAM and SCORE systems. Conclusions: This study showed a high prevalence of patients with low cardiovascular risk. It is appropriate to consider cardiovascular risk factors in patients with HIV, since they are very frequently associated with adverse outcomes of this type.
Introducción: La presencia del síndrome metabólico y el riesgo cardiovascular en pacientes VIH positivos ha sido desestimado en pacientes con infección por VIH. Objetivos: Evaluar la frecuencia del síndrome metabólico y comparar la estratificación del riesgo cardiovascular según las ecuaciones de Framingham, PROCAM y SCORE en pacientes con VIH. Metodología: estudio transversal de 760 adultos infectados por el VIH en el periodo enero de 2016-diciembre de 2018. Se evaluó la presencia de síndrome metabólico a través de los criterios del ATP-III y se examinó la puntuación de riesgo cardiovascular. Resultados: Las comorbilidades más frecuentes fueron el tabaquismo, la hipercolesterolemia y la hipertensión arterial. Se realizó la prueba T de Student, y a partir de ella se lograron apreciar diferencias en categorización de riesgo bajo a moderado. El número de pacientes varones infectados por el VIH identificados como de riesgo cardiovascular moderado según la ecuación de riesgo de Framingham fue mayor del doble en comparación con los sistemas PROCAM y SCORE. Conclusiones: El estudio mostró una alta prevalencia de pacientes con bajo riesgo cardiovascular. Es pertinente considerar los factores de riesgo cardiovascular en pacientes con VIH, ya que estos se encuentran frecuentemente asociados con desenlaces adversos de este tipo.
Introdução: A presença da síndrome metabólica e do risco cardiovascular em pacientes HIV positivos tem sido negligenciada em pacientes com infecção por HIV. Objetivos: Avaliar a frequência da síndrome metabólica e comparar a estratificação do risco cardiovascular de acordo com as equações de Framingham, PROCAM e SCORE em pacientes com HIV. Metodologia: estudo transversal de 760 adultos infectados com HIV no período de Janeiro de 2016-Dezembro de 2018. A presença de síndrome metabólica foi avaliada através de critérios ATP-III e a pontuação de risco cardiovascular foi examinada. Resultados: As comorbilidades mais frequentes foram o tabagismo, a hipercolesterolêmia e a hipertensão. Realizou-se o teste T Student, e a partir dele foram apreciadas as diferenças de categorização de risco baixo a moderado. O número de pacientes masculinos infectados com HIV identificados como de risco cardiovascular moderado de acordo com a equação de risco de Framingham foi mais do dobro em comparação com o PROCAM e SCORE. Conclusões: O estudo mostrou uma elevada prevalência de pacientes com baixo risco cardiovascular. É pertinente considerar fatores de risco cardiovascular em pacientes com HIV, uma vez que estes estão frequentemente associados a resultados cardiovasculares adversos.
HIV , Prevalence , Risk Factors , Mortality
