Difference in mortality rates in hospitalized COVID-19 patients identified by cytokine profile clustering using a machine learning approach: An outcome prediction alternative.

COVID-19 is a disease caused by the novel Coronavirus SARS-CoV-2 causing an acute respiratory disease that can eventually lead to severe acute respiratory syndrome (SARS). An exacerbated inflammatory response is characteristic of SARS-CoV-2 infection, which leads to a cytokine release syndrome also known as cytokine storm associated with the severity of the disease. Considering the importance of this event in the immunopathology of COVID-19, this study analyses cytokine levels of hospitalized patients to identify cytokine profiles associated with severity and mortality. Using a machine learning approach, 3 clusters of COVID-19 hospitalized patients were created based on their cytokine profile. Significant differences in the mortality rate were found among the clusters, associated to different CXCL10/IL-38 ratio. The balance of a CXCL10 induced inflammation with an appropriate immune regulation mediated by the anti-inflammatory cytokine IL-38 appears to generate the adequate immune context to overrule SARS-CoV-2 infection without creating a harmful inflammatory reaction. This study supports the concept that analyzing a single cytokine is insufficient to determine the outcome of a complex disease such as COVID-19, and different strategies incorporating bioinformatic analyses considering a broader immune profile represent a more robust alternative to predict the outcome of hospitalized patients with SARS-CoV-2 infection.

Edema agudo de pulmón secundario a tocolíticos (Reporte de un caso) / Acute pulmonary edema associated with tocolytics (It reports a case)

Justificación: Desde hace más de 30 años se han utilizado los beta-agonistas con el fin de inhibir la actividad uterina prematura, disminuyendo la mortalidad perinatal. Sin embargo, desde entonces se ha descrito el edema agudo de pulmón como efecto adverso potencialmente fatal. Objetivo: En este artículo, se discutirá un caso clínico y se revisarán los factores predisponentes y los posibles mecanismos fisiopatológicos en la génesis del edema pulmonar secundario a tocolíticos, así como, el diagnóstico y manejo más adecuado del mismo según diferentes revisiones. Conclusión: se resalta la posibilidad etiológica de los tocolíticos como causantes del edema pulmonar.