RESUMO
BACKGROUND: Age, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course. OBJECTIVES: We aimed to assess the underlying effect of long-term exposure to NO2 and PM10 on the severity and mortality of COVID-19. METHODS: A retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO2 and PM10 and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated. RESULTS: We found that the long-term exposure to PM10 is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM10 showed the highest effects estimates (1.65, 95% CI 1.32-2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94-4.40), followed by PM10 (2.37, 95% CI 1.71-3.32). Finally, an increase of 1 µg/m3 in PM10 concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths. DISCUSSION: These results demonstrate that long-term PM10 burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Material Particulado/análise , Material Particulado/toxicidade , SARS-CoV-2 , Fatores de Tempo , Organização Mundial da SaúdeRESUMO
AIM: Assessing the effect of statin therapy (ST) at hospital admission for COVID-19 on in-hospital mortality. METHODS AND RESULTS: Retrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk. Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients [1234 men, 923 women; age: 67 y/o (IQR 54-78)] admitted to the hospital were retrieved from the clinical records in anonymized manner. Three hundred and fifty-three deaths occurred. Five hundred and eighty-one patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on ST than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: P = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared with the GM non-statin group (17.4%; P = 0.045). The Cox model applied to the CSH function [HR = 0.58(CI: 0.39-0.89); P = 0.01] and the competing-risks FG model [HR = 0.60 (CI: 0.39-0.92); P = 0.02] suggest that statins are associated with reduced COVID-19-related mortality. CONCLUSIONS: A lower SARS-CoV-2 infection-related mortality was observed in patients treated with ST prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.
Assuntos
COVID-19 , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Pandemias , SARS-CoV-2RESUMO
Lipids are indispensable in the SARS-CoV-2 infection process. The clinical significance of plasma lipid profile during COVID-19 has not been rigorously evaluated. We aim to ascertain the association of the plasma lipid profile with SARS-CoV-2 infection clinical evolution. Observational cross-sectional study including 1411 hospitalized patients with COVID-19 and an available standard lipid profile prior (n: 1305) or during hospitalization (n: 297). The usefulness of serum total, LDL, non-HDL and HDL cholesterol to predict the COVID-19 prognosis (severe vs mild) was analysed. Patients with severe COVID-19 evolution had lower HDL cholesterol and higher triglyceride levels before the infection. The lipid profile measured during hospitalization also showed that a severe outcome was associated with lower HDL cholesterol levels and higher triglycerides. HDL cholesterol and triglyceride concentrations were correlated with ferritin and D-dimer levels but not with CRP levels. The presence of atherogenic dyslipidaemia during the infection was strongly and independently associated with a worse COVID-19 infection prognosis. The low HDL cholesterol and high triglyceride concentrations measured before or during hospitalization are strong predictors of a severe course of the disease. The lipid profile should be considered as a sensitive marker of inflammation and should be measured in patients with COVID-19.
Assuntos
COVID-19/etiologia , HDL-Colesterol/sangue , Triglicerídeos/sangue , Idoso , COVID-19/sangue , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
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Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Dor no Peito/etiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/patologia , Envelhecimento/patologia , Pavilhão Auricular/lesões , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnósticoRESUMO
La enfermedad celíaca (EC) es una alteración sistémica de carácter autoinmune desencadenada por el consumo de gluten y prolaminas en individuos con predisposición genética. Los autoanticuerpos específicos anti-transglutaminasa 2 de tipo IgA, incluyendo antiendomisio y antigliadina, con alta especificidad, son marcadores de elección para su diagnóstico. Aproximadamente el 1 % de los casos de EC se presentan en asociación con inmunodeficiencia selectiva de IgA. Presentamos un caso de EC asociado a inmunodeficiencia selectiva de IgA que muestra posibles dificultades para su diagnóstico (AU)
Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten and prolamine consumption in individuals with genetic predisposition. Specific anti-transglutaminase 2 IgA autoantibodies, including highly specific anti-endomysial and anti-gliadin antibodies, are markers of choice for diagnosis. Approximately 1 % of CD cases are associated with selective IgA immunodeficiency. We report a case of CD associated with selective IgA immunodeficiency that shows possible difficulties for diagnosis (AU)
Assuntos
Humanos , Masculino , Adulto , Doença Celíaca/diagnóstico , Imunoglobulina A/análise , Deficiência de IgA/complicações , Deficiência de IgA/diagnóstico , Deficiência de IgA/terapia , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Diagnóstico Diferencial , Glutens/efeitos adversos , Dieta Livre de Glúten/métodos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Atenção Primária à Saúde , Edema , Abdome/patologia , AbdomeRESUMO
No disponible
Assuntos
Humanos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Protocolos Clínicos , Impactos da Poluição na SaúdeAssuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Testes Diagnósticos de Rotina/estatística & dados numéricos , Gerenciamento Clínico , Pneumonia Bacteriana/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/economia , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Testes Diagnósticos de Rotina/economia , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Pneumonia Bacteriana/economia , Pneumonia Bacteriana/epidemiologia , Avaliação de Programas e Projetos de Saúde , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Procedimentos Desnecessários/economiaRESUMO
El Síndrome de Budd Chiari se caracteriza por la obstrucción del retorno venoso de los venas hepáticas, la vena cava inferior o la aurícula derecha. El presente caso ilustra el índice de sospecha clínica necesario para el diagnóstico precoz del Síndrome de Budd Chiari cuando las pruebas complementarias iniciales (transaminasasas y ECO Abdominal) no son concluyentes (AU)
Budd Chiari Syndrome is characterised by the obstruction of venous return of the hepatic veins, the inferior vena cava and the right atrium. This case illustrates the index of clinical suspicion necessary for early diagnosis of Budd Chari Syndrome when initial complementary tests (transaminases and abdominal ultrasound) are not conclusive (AU)
Assuntos
Humanos , Feminino , Adulto , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/terapia , Diagnóstico Precoce , Trombose Venosa/complicações , Anticoncepcionais Orais/efeitos adversos , Flebografia , Síndrome de Budd-Chiari/induzido quimicamente , Síndrome de Budd-Chiari/fisiopatologia , Síndrome de Budd-Chiari , Flebografia/instrumentação , Flebografia/métodos , Ultrassonografia DopplerRESUMO
No disponible
No disponible