Haematological Alterations Associated with Selected Vector-Borne Infections and Exposure in Dogs from Pereira, Risaralda, Colombia.

Infections due to Ehrlichia, Anaplasma, Dirofilaria, Mycoplasma, Babesia and Hepatozoon continue to be highly prevalent in dogs, especially in tropical and subtropical areas, where vectors of many of them are present. However, many clinical aspects of dogs have not been characterized in detail, including assessing the haematological alterations associated with them, particularly in Colombia and Latin America. A group of 100 dogs with Ehrlichia, Anaplasma, Dirofilaria, Mycoplasma, Babesia and Hepatozoon infections/exposure were assessed by blood smear serology (SNAP4DX) and PCR in Pereira, Colombia. We performed blood counts to evaluate anaemia, leukopenia/leukocytosis, neutropenia, neutrophilia, lymphopenia/lymphocytosis, monocytosis, eosinophilia, and thrombocytopenia, among other alterations. Bivariate analyses were performed on Stata®14, with significant p < 0.05. From the total, 85% presented ≥1 infection (past or present), 66% with coinfections (≥2 pathogens) (Ehrlichia 75%), and 89% presented clinical alterations. A total of 100% showed anaemia, 70% thrombocytopenia, 61% monocytosis, and 47% neutropenia, among other alterations. Additionally, 11% presented pancytopenia and 59% bicytopenia. The median platelet count was lower in infected dogs (126,000 cells/µL) versus non-infected (221,000 cells/µL) (p = 0.003). Thrombocytopenia was higher among infected dogs (75%) versus non-infected (40%) (p = 0.006), with a 91% positive predictive value for infection. Median neutrophil count was lower in infected dogs (6591 cells/µL) versus non-infected (8804 cells/µL) (p = 0.013). Lymphocytosis occurred only among those infected (27%) (p = 0.022). Leukopenia was only observed among infected dogs (13%). Pancytopenia was only observed among infected dogs. Ehrlichiosis and other hematic infections have led to a significant burden of haematological alterations on infected dogs, including pancytopenia in a tenth of them, most with thrombocytopenia and all anemic.

Seroprevalence canine survey for selected vector-borne pathogens and its relationship with poverty in metropolitan Pereira, Colombia, 2020.

Background: Tick-borne diseases (TBD) and dirofilariosis are currently not under surveillance in most Latin American countries. In addition, there is a significant lack of studies describing the current situation in most endemic areas, including Colombia. Therefore, seroprevalence studies are crucial for understanding the epidemiology of these vector-borne diseases. Methods: A serosurvey for TBD and dirofilariosis among 100 dogs was carried out in the municipality of Pereira, located in the Coffee-Triangle region, Colombia. Samples were tested using a rapid assay test system (SNAP® 4Dx®); based on an enzyme immunoassay technique' screening for antibodies to Anaplasma phagocytophilum/platys (sensitivity 99.1%)' Borrelia burgdorferi s.l. (98.8%), and Ehrlichia canis/ewingii (96.2%) by using specific antigens and checking for Dirofilaria immitis antigen based on specific antibodies (99.2%). Bivariate analyses were performed on Stata®14, significant p < 0.05. Findings: Global seroprevalence to the selected vector-borne pathogens was 74% (95%CI 65-83%). The highest seroprevalence was found for E. canis/ewingii (74%), followed by A. phagocytophilum/platys (16%). Seropositivity for Borrelia spp. and Dirofilaria spp. was 0%. All Anaplasma spp. seropositive dogs showed co-detection of Ehrlichia spp. (16%). Seroprevalence was significantly higher among dogs from families of lower socioeconomic status/level (I, 86%), followed by level II (74%), and III (36%) (p = 0.001). All dogs exhibiting anorexia (12%) were invariably seropositive (100%) (p = 0.029). Seroprevalence was higher among those showing mucocutaneous paleness (95%) compared to those without paleness (68%) (p = 0.013) (OR = 9.3; 95%CI 1.18-72.9). There was high variability in seroprevalence through the studied areas, ranging from 0% (La Libertad Park) up to Combia, Cesar Nader, Las Brisas and Saturno localities (100%) (p = 0.033). Interpretation: Given the high seroprevalence obtained in an area with documented ticks, there is a potential risk of zoonotic transmission to humans. Further seroprevalence studies in humans are needed to assess the prevalence of infections. Poverty is highly associated with these tick-borne pathogens in Pereira, as shown in the present study.

Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis.

INTRODUCTION: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date. METHODS: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI). RESULTS: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 95%CI 40.8-74.4%) and dyspnea (45.6%, 95%CI 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock. Some 13.9% (95%CI 6.2-21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR). CONCLUSION: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.

Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review.

BACKGROUND: In the last three years, chikungunya virus disease has been spreading, affecting particularly the Americas, producing more than two million cases. In this setting, not only new disease-related epidemiological patterns have been found, but also new clinical findings have been reported by different research groups. These include findings on the cardiovascular system, including clinical, electrocardiographic and echocardiographic alterations. METHODS: We performed a systematic review looking for reports about cardiovascular compromise during chikungunya disease. Cardiac compromise is not so common in isolated episodes; but countries where chikungunya virus is an epidemic should be well informed about this condition. We used 6 bibliographical databases as resources: Medline/Pubmed, Embase, ScienceDirect, ClinicalKey, Ovid and SciELO. Dengue reports on cardiovascular affectation were included as well, to compare both arbovirus' organic affectations. Articles that delved mainly into the rheumatic articular and cutaneous complications were not considered, as they were not in line with the purpose of this study. The type of articles included were reviews, meta-analyses, case-controls, cohort studies, case reports and case series. RESULTS: Originally based on 737 articles, our reviewed selected 40 articles with 54.2% at least mentioning CHIKV cardiovascular compromise within the systemic affectation. Cardiovascular manifestations can be considered common and have been reported in France, India, Sri Lanka, Malaysia, Colombia, Venezuela and USA, including mainly, but no limited to: hypotension, shock and circulatory collapse, Raynaud phenomenon, arrhythmias, murmurs, myocarditis, dilated cardiomyopathy, congestive insufficiency, heart failure and altered function profile (Troponins, CPK). CONCLUSIONS: Physicians should be encouraged to keep divulgating reports on the cardiovascular involvement of chikungunya virus disease, to raise awareness and ultimately encourage suitable diagnosis and intervention worldwide.

Medicina psicosomática en enfermedad cardiovascular II* Consideraciones sobre el tratamiento / Psychosomatic Medicine in Cardiovascular Illness II

Objetivo: brindar orientación sobre las conductas terapéuticas farmacológicas, psicoterapéuticas y otras que se deben instaurar en pacientes con enfermedad cardiaca y trastornos psicoemocionales que le preceden o son consecuencia de ella. Método: se exponen las consideraciones básicas del tratamiento, los fundamentos generales de las psicoterapias que deben emplearse y una breve descripción de cada una de ellas y de las técnicas que se deben instaurar en este tipo de pacientes. Se termina con las recomendaciones farmacológicas, donde se incluyen guías de formulación, riesgos de eventos adversos de psicofármacos, dosis y seguridad de los antidepresivos, ansiolíticos y moduladores del afecto. Resultados: se introduce a consideraciones terapéuticas generales que se deben tener presentes en el paciente con cardiopatía deprimido, ansioso o estresado. Se determinan las actividades que deben ser promovidas para un estilo de vida saludable que disminuya los riesgos de cardiopatías, depresión, ansiedad y estrés. Conclusiones: la consideración de tratamientos psicoterapéuticos, de diferentes modalidades, es prioritaria para disminuir los riesgos y el agravamiento de los padecimientos.

Objective: To provide an orientation on pharmacological therapeutic conducts, psychotherapy and others which should be implemented in patients with cardiovascular disease and psychological and emotional disorders that precede or appear as a consequence of them. Method: This review exposes basic treatment considerations, general basis on psychotherapy with a brief description of each of them and the techniques that should be implemented in these types of patients. Pharmacological recommendations including guides for prescription, psychiatric pharmacological agents risk of adverse effects, dosage and security profile of antidepressants, anxiolytics and mood stabilizers are addressed. Results: This paper reviews the general therapeutical considerations that should be considered in a cardiac disease patient with depression, anxiety or stress. Lifestyle modifications and healthy habits currently recommended to decrease the risk of cardiopathy, depression, anxiety and stress are determined. Conclusions: in order to reduce risks and worsening of illness a priority should be made in regards to psychotherapeutic treatments in their different modalities.

Medicina psicosomática en enfermedad cardiovascular: consideraciones clínicas / Psychosomatic Medicine Treatments in Cardiovascular Illness

El artículo permite concebir la relación entre la enfermedad cardiaca y los estados psicoemocionales que le preceden o son consecuencia de ella. La introducción nos brinda datos estadísticos de diversos estudios clínicos y epidemiológicos que relacionan las enfermedades cardiacas con trastornos depresivos o ansiosos, estrés y el tipo de personalidad. La segunda parte se refiere, primero, a los aspectos clínicos psicoemocionales básicos, cuyos impactos biológicos se constituyen en factores de riesgo de enfermedad cardiaca, y, segundo, a los procesos inherentes a las cardiopatías, que a su vez determinan la aparición de depresión y ansiedad. Se analizan los aspectos básicos de la personalidad Tipo A y su relación con las cardiopatías; así mismo, la cascada biológica desencadenada por el estrés que predispone a alteraciones cardiacas. Finalmente, se exponen unas breves conclusiones y recomendaciones, así como de la bibliografía consultada.

Recent studies provide clear evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary disease. This evidence is composed largely of data relating cardiac disease risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation and (5) chronic and acute life stress. Pathophysiological mechanisms underlying the relationship between these entities can be due to a excessive sympathetic nervous system activation, endothelial dysfunction, immunological and hematological abnormalities. In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and cardiac disease, identify pathologic mechanisms that may be responsible, and describe a paradigm for studying positive psychologic factors that may act as a buffer; also we review new approaches to improve the delivery of behavioral services and patient compliance. These are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for cardiac disease, are not only highly interrelated, but also require team work between the cardiologist and the psychiatrist.