Asociación entre SARS-COV-2 y enfermedades crónicas en personal de salud. Un programa de medicina preventiva / Association between SARS-COV-2 and chronic diseases in health personnel. A preventive medicine program

RESUMEN Objetivo La infección por SARS-CoV-2 ha sido relacionada con hipertensión, obesidad y diabetes para riesgo de hospitalización y muerte. Con respecto a las enfermedades pulmonares obstructivas, la literatura es diversa; hay variación en la frecuencia de estas y por ende en su relación con la COVID-19. La evidencia disponible únicamente detalla a los pacientes hospitalizados, y es escasa la referida a trabajadores de la salud, por lo que el analizar las principales comorbilidades en este grupo resulta de ayuda para la implementación de programas preventivos. El objetivo de este estudio fue describir la prevalencia y la asociación de diversas comorbilidades con la infección por SARS-CoV-2 en trabajadores de la salud. Métodos Estudio transversal analítico, en trabajadores del principal centro de referencia nacional para enfermedades respiratorias de México, que acudieron a atención para descarte de infección por SARS-CoV-2 mediante un programa preventivo; para el tamaño de muestra se usó fórmula para cálculo de proporciones. Se analizaron medidas de resumen y asociación. Resultados La prevalencia de COVID-19 fue de 22,9 %. Las comorbilidades más frecuentes en cuanto a prevalencia fueron: sobrepeso (29,0 %), obesidad (13,2 %), tabaquismo (8,6 %), hipertensión (5,5 %), rinitis alérgica (3,9 %) y asma (2,8 %). El sobrepeso, la obesidad y la vacunación contra SARS-CoV-2 tuvieron razones de momios para prevalencia de 1,78, 1,72 y 0,43, respectivamente. Las personas vacunadas y con comorbilidades tienen menor duración de la enfermedad (p=0,001). Conclusiones La obesidad y el sobrepeso muestran asociación con SARS-CoV-2, la vacunación es un factor protector, sobre todo en aquellos pacientes con comorbilidades.

ABSTRACT Objective The SARS-CoV-2 infection has been linked to hypertension, obesity and diabetes as risks of hospitalization and death. Regarding obstructive pulmonary diseases, the scientific literature is diverse; finding variation in the frequency of these and therefore their relationship with COVID-19. The available evidence only details hospitalized patients, with insufficient information referring to health workers, so analyzing the main comorbidities in this group is helpful for the implementation and improvement of preventive programs. The objective of this study was to describe the prevalence and association of comorbidities with SARS-CoV-2 infection in health care workers. Methods Analytical cross-sectional study, in workers of the main national reference center for respiratory diseases in Mexico, who came to care to rule out SARS-CoV-2 infection through a preventive program; calculation of proportions was performed for the sample size. Summary and association measures were calculated. Results The prevalence of COVID-19 was 22.9 %. The most frequent comorbidities were: overweight obesity, smoking, hypertension, allergic rhinitis and asthma, with prevalences of 29.0 %, 13.2 %, 8.6 %, 5.5 %, 3.9%, 2.8 % respectively. Overweight, obesity and vaccination against SARS-CoV-2 had Prevalence Ratios of 1.78, 1.72 and 0.43 respectively. Conclusions Obesity and overweight show association with SARS-CoV-2; vaccination is a protective factor, especially in people with comorbidities.

Hypothalamic-pituitary-gonadal axis disturbance and its association with insulin resistance in kidney transplant recipients / Distúrbio do eixo hipotálamo-hipófise-gonadal e sua associação com resistência à insulina em receptores de transplante renal

Abstract Objective: To evaluate hypothalamic-pi- tuitary-gonadal (HPG) axis alterations at 1 and 12 months after kidney transplan- tation (KT) and their association with in- sulin resistance. Methods: A retrospective clinical study was conducted in a tertiary care center in kidney transplantation recipients (KTRs) aged 18- 50 years with primary kidney disease and stable renal graft function. LH, FSH, E2/T, and HOMA-IR were assessed at 1 and 12 months after KT. Results: Twenty-five KTRs were included; 53% were men, and the mean age was 30.6±7.7 years. BMI was 22.3 (20.4-24.6) kg/m2, and 36% had hypogonadism at 1 month vs 8% at 12 months (p=0.001). Re- mission of hypogonadism was observed in all men, while in women, hypogonadotropic hypogonadism persisted in two KTRs at 12 months. A positive correlation between go- nadotrophins and age at 1 and 12 months was evident. Fifty-six percent of patients had insulin resistance (IR) at 1 month and 36% at 12 months (p=0.256). HOMA-IR showed a negative correlation with E2 (r=- 0.60; p=0.050) and T (r=-0.709; p=0.049) at 1 month, with no correlation at 12 months. HOMA-IR at 12 months after KT correlated positively with BMI (r=0.52; p=0.011) and tacrolimus dose (r=0.53; p=0.016). Conclusion: Successful KT restores the HPG axis in the first year. Hypogonadism had a negative correlation with IR in the early pe- riod after KT, but it was not significant at 12 months.

Resumo Objetivo: Avaliar as alterações do eixo hipotálamo-hipófise-gonadal (HHG) em 1 e 12 meses após transplante renal (TR) e sua associação com a resistência à insulina. Métodos: Foi realizado um estudo clínico retrospectivo em um centro de cuidados terciários em receptores de transplante renal (RTR) com idade entre 18-50 anos com doença renal primária e função do enxerto renal estável. LH, FSH, E2/T e HOMA-IR foram avaliados em 1 e 12 meses após o TR. Resultados: foram incluídos 25 RTR; 53% eram homens e a média de idade foi de 30,6±7,7 anos. O IMC foi de 22,3 (20,4-24,6) kg/m2 e 36% apresentaram hipogonadismo em 1 mês vs 8% aos 12 meses (p=0,001). A remissão do hipogonadismo foi observada em todos os homens, enquanto nas mulheres, o hipogonadismo hipogonadotrófico persistiu em dois RTR aos 12 meses. Ficou evidente uma correlação positiva entre gonadotrofinas e idade em 1 e 12 meses. Cinquenta e seis por cento dos pacientes apresentaram resistência à insulina (RI) em 1 mês e 36% aos 12 meses (p=0,256). O HOMA-IR mostrou uma correlação negativa com E2 (r=-0,60; p=0,050) e T (r=-0,709; p=0,049) em 1 mês, sem correlação em 12 meses. O HOMA-IR aos 12 meses após TR correlacionou-se positivamente com o IMC (r=0,52; p=0,011) e a dose de tacrolimus (r=0,53; p=0,016). Conclusão: O TR bem-sucedido restaura o eixo HHG no primeiro ano. O hipogonadismo apresentou uma correlação negativa com a RI no período inicial após o TR, mas essa correlação não foi significativa aos 12 meses.

Hypothalamic-pituitary-gonadal axis disturbance and its association with insulin resistance in kidney transplant recipients.

OBJECTIVE: To evaluate hypothalamic-pi- tuitary-gonadal (HPG) axis alterations at 1 and 12 months after kidney transplan- tation (KT) and their association with in- sulin resistance. METHODS: A retrospective clinical study was conducted in a tertiary care center in kidney transplantation recipients (KTRs) aged 18- 50 years with primary kidney disease and stable renal graft function. LH, FSH, E2/T, and HOMA-IR were assessed at 1 and 12 months after KT. RESULTS: Twenty-five KTRs were included; 53% were men, and the mean age was 30.6±7.7 years. BMI was 22.3 (20.4-24.6) kg/m2, and 36% had hypogonadism at 1 month vs 8% at 12 months (p=0.001). Re- mission of hypogonadism was observed in all men, while in women, hypogonadotropic hypogonadism persisted in two KTRs at 12 months. A positive correlation between go- nadotrophins and age at 1 and 12 months was evident. Fifty-six percent of patients had insulin resistance (IR) at 1 month and 36% at 12 months (p=0.256). HOMA-IR showed a negative correlation with E2 (r=- 0.60; p=0.050) and T (r=-0.709; p=0.049) at 1 month, with no correlation at 12 months. HOMA-IR at 12 months after KT correlated positively with BMI (r=0.52; p=0.011) and tacrolimus dose (r=0.53; p=0.016). CONCLUSION: Successful KT restores the HPG axis in the first year. Hypogonadism had a negative correlation with IR in the early pe- riod after KT, but it was not significant at 12 months.

Comparison between the persistence of post COVID-19 symptoms on critical patients requiring invasive mechanical ventilation and non-critical patients.

BACKGROUND: During follow-up, patients severely affected by coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV), show symptoms of Post-Intensive Care Syndrome (PICS) such as cognitive impairment, psychological disability, and neuromuscular deconditioning. In COVID-19 pandemic, it is a priority to develop multidisciplinary post-acute care services to address the long-term multisystemic impact of COVID-19. RESEARCH QUESTION: Which are the most relevant multisystemic sequelae in severe post-COVID-19 patients? STUDY DESIGN AND METHODS: Observational chart review study that included adult patients discharged from a referral hospital for respiratory diseases in Mexico after recovering from severe COVID-19 disease from December 23, 2020, to April 24, 2021. Data were collected from 280 of 612 potentially eligible patients to evaluate persistent symptoms and compare sequelae in patients who required intubation, using a standardized questionnaire of symptoms, in addition to findings reported during the face-to-face health assessment. Univariable and multivariate analyses were performed for the association among the requirement of IMV and the long-term persistence of symptoms. RESULTS: 280 patients were included. The median age was 55 (range, 19 to 86) years, and 152 (54.3%) were men. The mean length of hospital stay was 19 (SD, 14.1) days. During hospitalization 168 (60%) participants received IMV. A large proportion of these patients reported fatigue (38.7%), paresthesia (35.1%), dyspnea (32.7%) and headache (28%); meanwhile only 3 (1.8%) of them were asymptomatic. Patients who required intubation were more likely to have neuropsychiatric (67.3% vs 55.4%; OR, 1.79 [95% CI, 1.08 to 2.97]) and musculoskeletal involvement (38.7% vs. 25.9%; OR, 1.92 [95% CI, 1.12 to 3.27]), adjusted for age,sex and hospitalization time. INTERPRETATION: The proportion of patients requiring intubation was 60%, reporting persistent symptoms in 98% of them. Neuropsychiatric and musculoskeletal symptoms were the most predominant symptoms in these patients, with a significant difference. Post-COVID-19 syndrome is a frequent problem in patients who required IVM. Physicians in ICU and in care of COVID-19 patients should be aware of this syndrome in order to avoid more complications.