Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.

INTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project.

BACKGROUND: To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. METHODS: Total, sex- and age-specific weekly all-cause mortality for 2015-2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015-2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. RESULTS: Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. CONCLUSIONS: This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.

Premature mortality attributable to COVID-19: potential years of life lost in 17 countries around the world, January-August 2020.

BACKGROUND: Understanding the impact of the burden of COVID-19 is key to successfully navigating the COVID-19 pandemic. As part of a larger investigation on COVID-19 mortality impact, this study aims to estimate the Potential Years of Life Lost (PYLL) in 17 countries and territories across the world (Australia, Brazil, Cape Verde, Colombia, Cyprus, France, Georgia, Israel, Kazakhstan, Peru, Norway, England & Wales, Scotland, Slovenia, Sweden, Ukraine, and the United States [USA]). METHODS: Age- and sex-specific COVID-19 death numbers from primary national sources were collected by an international research consortium. The study period was established based on the availability of data from the inception of the pandemic to the end of August 2020. The PYLL for each country were computed using 80 years as the maximum life expectancy. RESULTS: As of August 2020, 442,677 (range: 18-185,083) deaths attributed to COVID-19 were recorded in 17 countries which translated to 4,210,654 (range: 112-1,554,225) PYLL. The average PYLL per death was 8.7 years, with substantial variation ranging from 2.7 years in Australia to 19.3 PYLL in Ukraine. North and South American countries as well as England & Wales, Scotland and Sweden experienced the highest PYLL per 100,000 population; whereas Australia, Slovenia and Georgia experienced the lowest. Overall, males experienced higher PYLL rate and higher PYLL per death than females. In most countries, most of the PYLL were observed for people aged over 60 or 65 years, irrespective of sex. Yet, Brazil, Cape Verde, Colombia, Israel, Peru, Scotland, Ukraine, and the USA concentrated most PYLL in younger age groups. CONCLUSIONS: Our results highlight the role of PYLL as a tool to understand the impact of COVID-19 on demographic groups within and across countries, guiding preventive measures to protect these groups under the ongoing pandemic. Continuous monitoring of PYLL is therefore needed to better understand the burden of COVID-19 in terms of premature mortality.

Niveles de angiotensina (1-7) en ratas con distinto genotipo de enzima convertidora de angiotensina I y efecto de la hipertensión renovascular / Levels of angiotensin (1-7) in rats with different ace genotypes and effect of renovascular hypertension

La mayor actividad de la enzima convertidora de angiotensina I (ECA) determina mayores niveles de angiotensina (Ang) II y menores de Ang-(1-7). Hemos observado mayores niveles de Ang II en ratas normotensas con mayor actividad de ECA y simultáneamente mayor hipertensión renovascular. Planteamos que en esta situación los niveles de Ang (1-7) podrían modificarse por la HTA y además ser inversamente proporcionales a la actividad de ECA y a los niveles de Ang II. Métodos: se determinó angiotensina II y (1-7) plasmáticas en ratas normotensas e hipertensas renovasculares (modelo Goldblatt 2 riñones, 1 clip) en cepas F2 homocigotas Brown Norway (BN, con ECA elevada) o Lewis (con ECA baja). Resultados: Promedio (ES). Los niveles de hipertensión arterial e HVI fueron similares en ambas cepas en los grupos Goldblatt. Los niveles plasmáticos de Ang II fueron 509 (37) U/ml en ratas BN normotensas y 173 (25) U/mL en ratas Lewis normotensas (p <0,05). Los niveles plasmáticos de Ang (1-7) fueron 4 veces mayores en ratas Lewis normotensas que las normotensas BN (p <0,05) y se elevaron significativamente con la hipertensión (p <0,05). Conclusión: Estos resultados podrían explicar la diferencia en la magnitud de la HTA observada previamente entre ambos genotipos de ECA y la mayor tendencia a presentar hipertensión arterial en hombres que presentan el alelo D del polimorfismo ECA I/D.

Menores niveles de angiotensina (1-7) en pacientes hipertensos esenciales con genotipo ECA deleción/deleción / Lower levels of angiotensin (1-7) in hypertensive patients with the deletion/deletion ace genotype

Una menor actividad de enzima convertidora de angiotensina I, genéticamente determinada en aproximadamente un 40 por ciento en humanos , determinaría mayores niveles de Ang (Ang) II, lo que no ha sido observado. Sin embargo, no se conoce lo que ocurre en este contexto con los niveles de Ang (1-7), un péptido con acciones vasodilatadores y antiproliferativas antogónicas a las que ejerce Ang II. Hipótesis: los niveles de este péptido pudieran elevarse en presencia de niveles más bajos de ECA (sujetos homocigotos ECA II) en relación con los pacientes homocigotos ECA DD (con ECA genéticamente más lata). Métodos: se estudiaron 18 pacientes hipertensos esenciales homocigotos sin tratamiento (9 ECA DD y 9 ECA II). Se determinó actividad de ECA y niveles de angiotensinas II y (1-7) plasmáticos. Resultados (promedio ± 12,9 ng/ml vs 69,6 ± 8,4 ng/ml). Sin embargo los niveles de Ang (1-7) fueron 4 veces más elevados en los pacientes hipertensos con genotipo ECA II (58,2 ±18,8 ng/ml vs 14,5 ± 3,3 ng/ml, p <0,05). Conclusión: La presencia de mayor actividad de ECA determinada genéticamente, se asocia con menores niveles plasmáticos de Ang (1-7). Este fenómeno pudiera estar mediado por diferente actividad de ECA y/o de endopeptidasa neutra y ayudaría a explicar algunos fenómenos patogénicos asociados a la presencia del alelo D en humanos.

Moraxella catarrhalis en la infecciones respiratorias altas / Moraxella catarrhalis in upper respiratory infections

Durante 12 meses se estudian las infecciones otorrinolaringológicas en dos hospitales de Lima, tanto en niños como en adultos, con especial énfasis en Moraxella catarrhalis. Se tomaron 318 muetras de igual número de pacientes, de los cuales el 40 por ciento resultó negativo a bacterias patógenas. Del 60 por ciento restante se identificó "Staphylococcus aureus" como el causante del 31 por ciento de las infecciones, seguido de "Streptococcus pneumoniae" con el 19 por ciento, luego Moraxella Catarrhalis con 16 por ciento y en cuarto lugar Haemophilus influenzae con 10 por ciento. Rinorrea purulenta fue el principal síntoma en todos los casos. Streptococcus pneumoniae, moraxella catarrhalis y Haemophilus influenzae se aislaron mayoritariamente en niños menores de 14 años. El 15 por ciento de los A. aureus fueron oxacilino-resistentes, el 11 por ciento de S. pneumoniae fueron resistentes a la penicilina, el 70 por ciento de M. catarrhalis eran productoras de B-lactamasa y el 5 por ciento de H. influenzae también producian B-lactamasa. Nuestros resultados permiten orientar mejor el tratamiento antibiótico de la infecciones respiratorias altas.