Severe and unclassifiable tremor.

BACKGROUND: Patients often exhibit very severe or disabling forms of tremor that cannot be clearly characterized. OBJECTIVE: To present a series of 37 cases of tremor considered unclassifiable. Patients diagnosed with essential tremor according to criteria of the International Parkinson Disease and Movement Disorder Society (IPDMDS), who had been previously studied, were included as controls. All patients underwent a battery of tests between 2019 and 2022, which enabled us to compare them. METHODS: Relevant demographic and clinical information were collected. The following tools were applied: the Mini-Mental State Examination (MMSE); the Hospital Anxiety and Depression Scale (HADS); the Fahn-Tolosa-Marín Tremor Rating Scale (TRS); and the Quality of Life in Essential Tremor (QUEST). A simple brain magnetic resonance imaging (MRI) scan was performed for all patients. The categorical variables were compared using the Chi-squared test and the t-test with Fisher correction if appropriate, and the quantitative variables were compared through the two-tailed Student t-test. Values of p ≤ 0.01 were considered statistically significant. RESULTS: The cases presented higher scores on the anxiety and depression subscales of the HADS than the controls (p ≤ 0.006 and 0.000 respectively). In all domains of the TRS, the cases scored significantly higher, as well as in the QUEST. History of enolism was higher among the controls, and history of orthostasis and rest tremor was higher among the cases (p ≤ 0.000). Cerebellar atrophy was present in every patient in the case group, and in 24 subjects in the control group. Dystonia was observed in 7 subjects in the case group, and in none of the patients in the control group. CONCLUSION: There are patients with unclassifiable and extremely disabling tremors who respond poorly to the pharmacological therapy options.

ANTECEDENTES: Os pacientes muitas vezes apresentam formas muito graves ou incapacitantes de tremor que não podem ser claramente caracterizadas. OBJETIVO: O objetivo deste trabalho foi apresentar uma série de 37 casos de tremor considerados inclassificáveis. Pacientes diagnosticados com tremor essencial de acordo com os critérios da International Parkinson Disease and Movement Disorder Society (IPDMDS), já estudados anteriormente, foram incluídos como controles. Todos os pacientes foram submetidos a exames entre 2019 e 2022 para permitir sua comparaç ão. MéTODOS: As informaç ões demográficas e clínicas relevantes foram coletadas. As seguintes ferramentas foram aplicadas: o Miniexame do Estado Mental (MEEM), a Escala Hospitalar de Ansiedade e Depressão (HADS, do inglês Hospital Anxiety and Depression Scale), a Escala de Avaliaç ão de Tremor de Fahn-Tolosa-Marín (TRS, do inglês Fahn-Tolosa-Marín Tremor Rating Scale) e a Qualidade de Vida em Tremor Essencial (QUEST, do inglês Quality of Life in Essential Tremor). Uma ressonância magnética simples do cérebro foi realizada em todos os pacientes. As variáveis categóricas foram comparadas pelo teste qui-quadrado e pelo teste t com correç ão de Fisher, se apropriado, enquanto as variáveis quantitativas foram comparadas por meio do teste t de Student bicaudal. Valores de p ≤ 0,01 foram considerados estatisticamente significativos. RESULTADOS: Os casos apresentaram pontuaç ões maiores nas subescalas de ansiedade e depressão do HADS do que os controles (p ≤ 0,006 e 0,000, respectivamente). Em todos os domínios do TRS, a pontuaç ão dos casos foi significativamente maior, assim como no QUEST. O histórico de enolismo foi maior entre os controles e o histórico de ortostase e tremor em repouso foi maior entre os casos (p ≤ 0,000). A atrofia cerebelar foi apresentada por todos os pacientes do grupo de casos e em 24 indivíduos do grupo de controle. A distonia foi observada em sete indivíduos do grupo de casos e em nenhum dos pacientes do grupo controle. CONCLUSãO: Há pacientes com tremores inclassificáveis e extremamente incapacitantes que respondem mal às opç ões terapêuticas farmacológicas.

Correlation between disease severity indices and quality of life measurement tools in atopic dermatitis patients / Correlación entre los índices de gravedad de la enfermedad y las herramientas de medición de la calidad de vida en pacientes con dermatitis atópica

Introduction. Reports regarding the correlation and effect size of change of the full spectrum of quality of life and disease severity measures applied in-person to patients with atopic dermatitis are scarce. Objectives. To assess quality-of-life with 3 different instruments and to evaluate disease severity indices and to determine their correlation and effect size of change between two measurements. Materials and methods. Patient-level data were obtained through two in-person visits. Sociodemographic information and data related to disease distribution, severity (through the BSA, EASI, SCORAD, POEM, and itching scales), and the impact of atopic dermatitis on quality of life using the DLQI and Skindex-29, and EQ-5D, were assessed. The correlation between change in quality-of-life scores and disease severity scores in addition to the standardized effect size were also evaluated. Results. Only 139 out of 212 patients completed the follow-up visit. BSA highly correlated with SCORAD and EASI, and the lowest correlation was found with POEM. The best correlation of pruritus VAS was found with sleep disturbance. The SCORAD score highly correlated with EASI, and the lowest correlation was found with POEM. The magnitude of the effect at initiation of the study vs follow-up was in average moderate to important. Conclusions. Patients with atopic dermatitis experience a substantial burden on quality of life. Disease activity correlates better with quality-of-life measurements when the disease is less severe after starting therapy. POEM and Skindex-29 seem to be optimal to determine disease severity and quality of life in adults with atopic dermatitis.

Introducción. La información publicada sobre la correlación entre la magnitud del efecto de todo el espectro de la calidad de vida y la gravedad de la enfermedad en pacientes con dermatitis atópica es escasa. Objetivos.Evaluar la calidad de vida con tres instrumentos diferentes y los índices de gravedad de la enfermedad en pacientes con dermatitis atópica para determinar su correlación y el tamaño del efecto del cambio. Materiales y métodos. Los datos de los pacientes se obtuvieron a partir de dos visitas. Se evaluó la información sociodemográfica y los datos relacionados con la distribución y la gravedad de la enfermedad (mediante de las escalas BSA, EASI, SCORAD, POEM, prurito) y el impacto de la dermatitis atópica en la calidad de vida utilizando el Dermatology Life Quality Index, Skindex-29 y EQ-5D. También se evaluó la correlación entre el cambio en las puntuaciones de calidad de vida y las de gravedad de la enfermedad, además del tamaño del efecto estandarizado. Resultados. Solo 139 de los 212 pacientes completaron la visita de seguimiento. El área de superficie corporal se correlacionó fuertemente con el SCORAD y el EASI, y la correlación más débil fue con el POEM. La mejor correlación del prurito medido con la escala visual análoga se halló con la alteración del sueño. El puntaje SCORAD se correlacionó altamente con el EASI mientras que la correlación más baja se encontró con el POEM. La magnitud del efecto al inicio del estudio respecto al seguimiento fue en promedio de moderada a importante. Conclusiones. Los pacientes con dermatitis atópica experimentan una carga sustancial en la calidad de vida. La actividad de la enfermedad se correlaciona mejor con las mediciones de calidad de vida cuando esta es menos grave, después de comenzar la terapia. Los índices POEM y Skindex-29 parecen ser óptimos para determinar la gravedad de la enfermedad y la calidad de vida en adultos con dermatitis atópica.

Complicaciones quirúrgicas: un tema complicado / Surgical complications: A complicated topic

Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

Polysomnographic parameters associated with cognitive function in patients with major depression and insomnia.

OBJECTIVE: To examine whether objective sleep parameters are associated with cognitive function (CF) in patients with major depressive disorder (MDD) with chronic insomnia (CI) and whether the severity of these disorders is related to CF. METHOD: Thirty patients with MDD with CI attending a tertiary care institution underwent two consecutive nights of polysomnographic (PSG) recording and a battery of neuropsychological tests, which included episodic memory, sustained attention, working memory, and executive function. The severity of MDD and CI was assessed by clinical scales. We examined the relationship between PSG parameters and CF, as well as whether the severity of the disorders is related to CF. RESULTS: Linear regression analysis revealed that total sleep time (TST) was positively associated with higher learning and recall of episodic memory, as well as better attention. Slow-wave sleep (SWS) showed a positive association with better working memory. Furthermore, wake after sleep onset (WASO) was negatively associated with episodic memory and lower attention. No significant relationships were found between the severity of MDD or CI with CF. CONCLUSION: Both sleep duration and depth are positively associated with several aspects of CF in patients with MDD with CI. Conversely, a lack of sleep maintenance is negatively related to CF in these patients. These findings could help identify modifiable therapeutic targets to reduce CF impairment.

Reduced HDL-cholesterol in long COVID-19: A key metabolic risk factor tied to disease severity.

This controlled study investigated metabolic changes in non-vaccinated individuals with Long-COVID-19, along with their connection to the severity of the disease. The study involved 88 patients who experienced varying levels of initial disease severity (mild, moderate, and severe), and a control group of 29 healthy individuals. Metabolic risk markers from fasting blood samples were analyzed, and data regarding disease severity indicators were collected. Findings indicated significant metabolic shifts in severe Long-COVID-19 cases, mainly a marked drop in HDL-C levels and a doubled increase in ferritin levels and insulin resistance compared to the mild cases and controls. HDL-C and ferritin were identified as the leading factors predicted by disease severity. In conclusion, the decline in HDL-C levels and rise in ferritin levels seen in Long-COVID-19 individuals, largely influenced by the severity of the initial infection, could potentially play a role in the persistence and progression of Long-COVID-19. Hence, these markers could be considered as possible therapeutic targets, and help shape preventive strategies to reduce the long-term impacts of the disease.

Blocking the CTLA-4 and PD-1 pathways during pulmonary paracoccidioidomycosis improves immunity, reduces disease severity, and increases the survival of infected mice.

Immune checkpoint pathways, i.e., coinhibitory pathways expressed as feedback following immune activation, are crucial for controlling an excessive immune response. Cytotoxic T lymphocyte antigen-4 (CTLA-4) and programmed cell death protein-1 (PD-1) are the central classical checkpoint inhibitory (CPI) molecules used for the control of neoplasms and some infectious diseases, including some fungal infections. As the immunosuppression of severe paracoccidioidomycosis (PCM), a chronic granulomatous fungal disease, was shown to be associated with the expression of coinhibitory molecules, we hypothesized that the inhibition of CTLA-4 and PD-1 could have a beneficial effect on pulmonary PCM. To this end, C57BL/6 mice were infected with Paracoccidioides brasiliensis yeasts and treated with monoclonal antibodies (mAbs) α-CTLA-4, α-PD-1, control IgG, or PBS. We verified that blockade of CTLA-4 and PD-1 reduced the fungal load in the lungs and fungal dissemination to the liver and spleen and decreased the size of pulmonary lesions, resulting in increased survival of mice. Compared with PBS-treated infected mice, significantly increased levels of many pro- and anti-inflammatory cytokines were observed in the lungs of α-CTLA-4-treated mice, but a drastic reduction in the liver was observed following PD-1 blockade. In the lungs of α-CPI and IgG-treated mice, there were no changes in the frequency of inflammatory leukocytes, but a significant reduction in the total number of these cells was observed. Compared with PBS-treated controls, α-CPI- and IgG-treated mice exhibited reduced pulmonary infiltration of several myeloid cell subpopulations and decreased expression of costimulatory molecules. In addition, a decreased number of CD4+ and CD8+ T cells but sustained numbers of Th1, Th2, and Th17 T cells were detected. An expressive reduction in several Treg subpopulations and their maturation and suppressive molecules, in addition to reduced numbers of Treg, TCD4+, and TCD8+ cells expressing costimulatory and coinhibitory molecules of immunity, were also detected. The novel cellular and humoral profiles established in the lungs of α-CTLA-4 and α-PD-1-treated mice but not in control IgG-treated mice were more efficient at controlling fungal growth and dissemination without causing increased tissue pathology due to excessive inflammation. This is the first study demonstrating the efficacy of CPI blockade in the treatment of pulmonary PCM, and further studies combining the use of immunotherapy with antifungal drugs are encouraged.

Caracterización del cáncer vesical en adultos según variables clínicas y epidemiológicas / Characterization of bladder cancer in adults according to clinical and epidemiological variables

Introducción: El cáncer de la vejiga es uno de los más frecuentes del tracto urinario y se manifiesta de dos formas: como tumor superficial de bajo grado o como neoplasia invasora de alto grado. Objetivo: Caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo, para caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio de los pacientes atendidos en el servicio de Urología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» en el periodo comprendido de octubre 2019 y 2022. Población del estudio: 242 pacientes diagnosticados con cáncer vesical. Resultados: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019 (45,86 %): masculinos (75,20 %); blancos (89,25 %); mayores de 70 o más años (64,46 %) y fumadores (95,45 %). La hematuria fue el síntoma principal (91,73 %), como expresión del carcinoma urotelial papilar de bajo grado (36,77 %). Tratamiento: la resección transuretral (88,01 %), sin metástasis a distancia (88,42 %). Conclusiones: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019, masculinos, blancos, mayores de 70 o más años, fumadores y con hematuria. Más frecuente: el carcinoma urotelial papilar de bajo grado. El tiempo trascurrido antes del diagnóstico de la enfermedad fue de 36-40 días, y un mes, el tiempo trascurrido antes del tratamiento de la enfermedad.

Introduction: bladder cancer is one of the most frequent cancers of the urinary tract and manifests itself in two ways: as a superficial low-grade tumor or as a high-grade invasive neoplasm. Objective: to characterize bladder cancer in adults according to clinical, epidemiological and service variables. Methods: a descriptive and retrospective observational study was carried out to characterize bladder cancer in adults according to clinical, epidemiological and service variables of patients treated in the Urology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2019 and 2022. The study population was 242 patients diagnosed with bladder cancer. Results: most of the patients diagnosed with bladder cancer correspond to the year 2019 (45.86%): male (75.20%); whites (89.25%); older than 70 or more years (64.46%) and smokers (95.45%). Hematuria was the main symptom (91.73%), as an expression of low-grade papillary urothelial carcinoma (36.77%). The treatment was transurethral resection (88.01%), without distant metastasis (88.42%). Conclusions: most of the patients diagnosed with bladder cancer correspond to the year 2019, male, whites, older than 70 years or older, smokers and with hematuria. Low-grade papillary urothelial carcinoma was the most frequent cancer. The time elapsed before the diagnosis of the disease was 36-40 days, and the time elapsed before the treatment of the disease was 1 month.

Severe COVID-19 in the context of a vaccinated population: Case-control study / COVID-19 grave no contexto de uma população vacinada: estudo caso-controle / COVID-19 grave en el contexto de una población vacunada: Estudio de casos y controles

Background and Objectives: Since its appearance in 2019, multiple risk factors have been identified for presenting a severe form of COVID-19 and different vaccines have also been developed to prevent severe manifestations. However, despite a vaccination history, some cases progress to complications or even death. The objective of this study was to determine the strength of the association between the severity of COVID-19 and the history of vaccination in patients treated at a public reference hospital in Mexico City. Methods: This was a non-experimental, retrospective, and analytical epidemiological study of cases and controls. The study population was people treated at a concentration hospital for COVID-19 care between July 1, 2021, and June 30, 2022, in Mexico City. Results: 132 participants (44 cases and 88 controls) were included in the study. The risk factors most strongly associated with COVID-19 severity were age greater than or equal to 60 years, presenting 22 breaths per minute at the first medical evaluation, systolic blood pressure greater than or equal to 140 millimeters of mercury, and a history of at least one chronic comorbidity. However, vaccination history was associated with 94% (OR 0.06) lower odds of developing severe COVID-19 compared to those without a history of vaccination, regardless of the presence of associated risk factors. Conclusion: Lacking a history of vaccination and presenting any of the identified risk factors confer higher odds of developing severe forms of the disease.(AU)

Justificativa e Objetivos: Desde o seu aparecimento em 2019, foram identificados múltiplos fatores de risco para a apresentação de uma forma grave de COVID-19 e foram desenvolvidas diferentes vacinas para prevenir o aparecimento de manifestações graves. No entanto, apesar de um histórico de vacinação, alguns casos podem evoluir para complicações ou mesmo para a morte. O objetivo deste estudo foi determinar a força de associação entre a gravidade da COVID-19 e o histórico de vacinação em pacientes atendidos em um hospital público de referência na Cidade do México. Métodos: Estudo epidemiológico não-experimental, retrospectivo e analítico, de casos e controles. A população do estudo foram indivíduos atendidos em um hospital de concentração para atendimento à COVID-19 entre 1 de julho de 2021 e 30 de junho de 2022, na Cidade do México. Resultados: 132 participantes (44 casos e 88 controles) foram incluídos no estudo. Os fatores de risco mais fortemente associados à gravidade da COVID-19 foram idade superior ou igual a 60 anos, apresentar 22 respirações por minuto na primeira avaliação médica, pressão arterial sistólica superior ou igual a 140 milímetros de mercúrio e histórico de pelo menos uma comorbidade crônica. No entanto, histórico de vacinação foi associado a uma probabilidade 94% (OR 0,06) menor de desenvolver COVID-19 grave em comparação com aqueles sem histórico de vacinação, independentemente da presença de fatores de risco associados. Conclusão: A ausência de histórico de vacinação e a presença de algum dos fatores de risco identificados conferem maiores probabilidades de desenvolver formas graves da doença.(AU)

Justificación y Objetivos: Desde su aparición en 2019, se han identificado múltiples factores de riesgo para presentar una forma grave de COVID-19 y también se han desarrollado distintas vacunas que previenen la aparición de manifestaciones de gravedad. Sin embargo, a pesar del antecedente de vacunación, algunos casos se complican o incluso fallecen. El objetivo del este estudio fue determinar la fuerza de asociación entre la gravedad de la COVID-19 con el antecedente de vacunación en pacientes atendidos en un hospital público de referencia de la Ciudad de México. Métodos: Estudio epidemiológico no experimental, retrospectivo y analítico, de casos y controles. La población de estudio fueron personas atendidas en un hospital de concentración para la atención de COVID-19 entre el 1 de julio de 2021 y el 30 de junio de 2022 en la Ciudad de México. Resultados: 132 participantes (44 casos y 88 controles) fueron incluidos en el estudio. Los factores de riesgo más fuertemente asociados con la gravedad de la COVID-19 fueron la edad mayor o igual a 60 años, presentar 22 respiraciones por minuto en la primera valoración médica, tensión arterial sistólica mayor o igual a 140 milímetros de mercurio y el antecedente de al menos una comorbilidad crónica. No obstante, el antecedente de vacunación se asoció con 94% (RM 0.06) menos posibilidades de desarrollar COVID-19 grave con respecto a aquellos sin antecedente vacunal, independientemente de la presencia de los factores de riesgo asociados. Conclusión: carecer del antecedente de vacunación y presentar alguno de los factores de riesgo identificados confieren las mayores posibilidades de presentar formas graves de la enfermedad.(AU)

Hipertensión arterial sistémica posterior a COVID-19 / Systemic arterial hypertension after COVID-19

Introducción: un nuevo tipo de coronavirus que se nombró SARSCoV-2, responsable de la enfermedad por COVID-19, tuvo esparcimiento rápido en el mundo, por alta transmisión que resultó en pandemia. Se registraron 2'397,216 casos confirmados, con 162,956 defunciones en el mundo, de acuerdo con la Organización Mundial de la Salud (OMS), en abril de 2020. Sin embargo, la hipertensión afecta a 40% de adultos, lo que significa que alrededor de 250 millones de personas padecen de presión alta. La OMS, de acuerdo con sus reportes, refiere que la hipertensión es el factor de riesgo número uno de muerte. Uno de cada cuatro mexicanos padece hipertensión arterial. Objetivos: establecer la incidencia de la hipertensión arterial sistémica posterior a padecer COVID-19 en pacientes de la Unidad de Medicina Familiar (UMF) No. 48. Material y métodos: es un estudio transversal, observacional y descriptivo, conformado por 3,238 pacientes con diagnóstico de COVID-19 positivo, de ambos sexos, con edades entre 18 y 70 años. Por medio de la fórmula para poblaciones infinitas se obtiene una muestra de 348 pacientes. Se realizó revisión de expedientes en el Sistema de Información de Medicina Familiar, versión 6.2, para obtención de la información correspondiente. Resultados: 27 pacientes diagnosticados con hipertensión arterial posterior al diagnóstico de COVID-19, 52% del sexo masculino y 48% del femenino, con media de edad de 39 años, 74% correspondió a enfermedad leve por COVID-19 y 26% a enfermedad moderada. Se documenta mediana de ocho días por periodo de infección por COVID-19. En el círculo femenino el promedio de la aparición de hipertensión arterial fue de 13 meses y en el masculino la media de desarrollo de hipertensión arterial posterior a COVID-19 fue de seis meses (AU)

Introduction: a new type of coronavirus that was named SARSCoV-2, responsible for the COVID-19 disease, with rapid spread in the world, due to high transmission that resulted in pandemic. There were 2'397,216 confirmed cases, with 162,956 deaths in the world, according to the WHO in April 2020. However, hypertension affects 40% of adults and means that around 250 million people suffer from high blood pressure. The WHO, according to its reports, refers that hypertension is the number one risk factor for death. One in four Mexicans suffers from high blood pressure. Objectives: to establish the incidence of systemic arterial hypertension after suffering from COVID-19 in patients of the UMF No. 48. Material and methods: it is a cross-sectional, observational and descriptive study, consisting of 3,238 patients with a positive COVID-19 diagnosis of both sexes, aged 18-70 years. Through the formula for infinite populations a sample of 348 patients is obtained. Will proceed with review of files in the Family Medicine Information System, version 6.2, to obtain the corresponding information. Results: 27 patients diagnosed with hypertension after the diagnosis of COVID-19, 52% of the male sex and 48% of the female sex, with a mean age of 39 years; 74% corresponds to a mild illness by COVID-19 and 26% to moderate disease. A median of 8 days per period of infection by COVID-19 is documented. In the female circle, the average onset of hypertension was 13 months and as for the male sex, the mean development of hypertension after COVID-19 was six months (AU)

Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity.

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.

A stronger antibody response in increased disease severity of SARS-CoV-2.

BACKGROUND: An assessment of the factors that interfere with serum levels and the persistence of anti-SARs-CoV-2 IgG antibodies is essential in order to estimate the risk of reinfection and to plan vaccination. We analyzed the impact of the severity of coronavirus disease 2019 (COVID-19) and the clinical and biological factors regarding the persistence of SARs-CoV-2 anti-spike protein (IgG-S) antibodies at 12 months. METHODS: This was an observational, longitudinal study with individuals who had recovered from COVID-19 between August 2020 and June 2021. Peripheral blood samples were collected from volunteers who were hospitalized (SERIOUS COVID-19) and those who required no hospitalization (COVID-19 LIGHT). Samples were grouped according to days after symptom onset: up to 90, between 91 and 180, ≥ 180 days after symptom onset. A semiquantitative test for IgG anti-spike protein S1(IgG-S1) was used. RESULTS: We analyzed 238 individuals who had recovered from COVID-19, of whom 87 had been hospitalized and 151 had not. They provided 148 and 220 samples, respectively. Among those hospitalized, males (65.5%), volunteers aged over 60 years (41.1%), comorbidities such as arterial hypertension (67.8%) and diabetes mellitus (37.9%) were most frequent. We observed higher median serum IgG-S1 titers among those who had recovered from COVID-19 and had been hospitalized, at all collection time intervals (p < 0.001). We observed a weak correlation of increasing age with humoral IgG-S1 response (Spearman correlation = 0.298). There was a greater probability of IgG-S1 antibody persistence over time among samples from hospitalized individuals compared to samples from non-hospitalized participants (p = 0.001). CONCLUSION: This study has revealed higher titers and a higher probability of the persistence of IgG-S1 in severe cases after SARs-CoV-2 primary infection in unvaccinated recovered patients. Thus, in this study, the severe clinical presentation of COVID-19 was the main factor influencing serum levels and the persistence of IgG-S1 antibodies in COVID-19.

Influenza A infections: predictors of disease severity.

Influenza affects approximately 10% of the world's population annually. It is associated with high morbidity and mortality rates due to its propensity to progress to severe acute respiratory infection, leading to 10-40% of hospitalized patients needing intensive care. Characterizing the multifactorial predictors of poor prognosis is essential for developing strategies against this disease. This study aimed to identify predictors of disease severity in influenza A-infected (IFA-infected) patients and to propose a prognostic score. A retrospective cross-sectional study was conducted with 142 IFA-infected out- and inpatients treated at a tertiary hospital between 2010 and 2018. The viral subtypes, hemagglutinin mutations, viral load, IL-28B SNPs, and clinical risk factors were evaluated according to the patient's ICU admission. Multivariate analysis identified the following risk factors for disease severity: neuromuscular diseases (OR = 7.02; 95% CI = 1.18-41.75; p = 0.032), cardiovascular diseases (OR = 5.47; 95% CI = 1.96-15.27; p = 0.001), subtype (H1N1) pdm09 infection (OR = 2.29; 95% CI = 1.02-5.15; p = 0.046), and viral load (OR = 1.43; 95% CI = 1.09-1.88; p = 0.009). The prognosis score for ICU admission is based on these predictors of severity presented and ROC curve AUC = 0.812 (p < 0.0001). Our results identified viral and host predictors of disease severity in IFA-infected patients, yielding a prognostic score that had a high performance in predicting the IFA patients' ICU admission and better results than a viral load value alone. However, its implementation in health services needs to be validated in a broader population.

Association Between Nurse Copatient Illness Severity and Mortality in the ICU.

OBJECTIVES: In the context of traditional nurse-to-patient ratios, ICU patients are typically paired with one or more copatients, creating interdependencies that may affect clinical outcomes. We aimed to examine the effect of copatient illness severity on ICU mortality. DESIGN: We conducted a retrospective cohort study using electronic health records from a multihospital health system from 2018 to 2020. We identified nurse-to-patient assignments for each 12-hour shift using a validated algorithm. We defined copatient illness severity as whether the index patient's copatient received mechanical ventilation or vasoactive support during the shift. We used proportional hazards regression with time-varying covariates to assess the relationship between copatient illness severity and 28-day ICU mortality. SETTING: Twenty-four ICUs in eight hospitals. PATIENTS: Patients hospitalized in the ICU between January 1, 2018, and August 31, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main analysis included 20,650 patients and 84,544 patient-shifts. Regression analyses showed a patient's risk of death increased when their copatient received both mechanical ventilation and vasoactive support (hazard ratio [HR]: 1.30; 95% CI, 1.05-1.61; p = 0.02) or vasoactive support alone (HR: 1.82; 95% CI, 1.39-2.38; p < 0.001), compared with situations in which the copatient received neither treatment. However, if the copatient was solely on mechanical ventilation, there was no significant increase in the risk of death (HR: 1.03; 95% CI, 0.86-1.23; p = 0.78). Sensitivity analyses conducted on cohorts with varying numbers of copatients consistently showed an increased risk of death when a copatient received vasoactive support. CONCLUSIONS: Our findings suggest that considering copatient illness severity, alongside the existing practice of considering individual patient conditions, during the nurse-to-patient assignment process may be an opportunity to improve ICU outcomes.

Lesão renal aguda em pacientes adultos com COVID-19: revisão integrativa / Lesión renal aguda en pacientes adultos con COVID-19: revisión integradora / Acute kidney injury in adult patients with COVID-19: an integrative review

Resumo Objetivo Identificar a frequência de lesão renal aguda (LRA) em pacientes hospitalizados com COVID-19, as características associadas, a mortalidade e a letalidade. Métodos Revisão realizada nas bases de dados CINAHL, Embase, LILACS, Livivo, PubMed, SCOPUS, Web of Science e, na literatura cinzenta (Google Acadêmico) em 12 de janeiro de 2022. Foram incluídos artigos em inglês, espanhol e português, publicados a partir de novembro 2019 até janeiro de 2022, em pacientes maiores de 18 anos com COVID-19 hospitalizados e LRA conforme critério Kidney Disease Improving Global Outcomes (KDIGO). Os estudos selecionados foram lidos na íntegra para extração, interpretação, síntese e categorização conforme nível de evidência. Resultados 699 artigos encontrados e 45 incluídos. A idade avançada, sexo masculino, hipertensão, doença renal crônica, ventilação mecânica, aumento da proteína C reativa, uso de drogas vasoativas e de determinadas classes de anti-hipertensivos foram associados a LRA. A LRA está relacionada à maior frequência de mortalidade. Em 30% dos pacientes hospitalizados com COVID-19 houve LRA. A taxa de mortalidade por LRA foi de 5% e a letalidade de 18%. Conclusão Estes resultados ressaltam a relevância da LRA como uma complicação significativa da COVID-19 e sugerem que um controle mais cuidadoso e precoce dos fatores associados poderia potencialmente reduzir a mortalidade e a letalidade. É crucial intensificar a pesquisa nesse campo para esclarecer melhor os mecanismos envolvidos na lesão renal em pacientes com COVID-19, bem como identificar estratégias terapêuticas mais efetivas para sua prevenção e tratamento nesse contexto.

Resumen Objetivo Identificar la frecuencia de lesión renal aguda (LRA) en pacientes hospitalizados con COVID-19, las características relacionadas, la mortalidad y la letalidad. Métodos Revisión realizada en las bases de datos CINAHL, Embase, LILACS, Livivo, PubMed, SCOPUS, Web of Science y en la literatura gris (Google Académico) el 12 de enero de 2022. Se incluyeron artículos en inglés, español y portugués, publicados a partir de noviembre de 2019 hasta enero de 2022, con pacientes mayores de 18 años con COVID-19 hospitalizados y LRA de acuerdo con el criterio Kidney Disease Improving Global Outcomes (KDIGO). Los estudios seleccionados fueron leídos en su totalidad para extracción, interpretación, síntesis y categorización según el nivel de evidencia. Resultados Se encontraron 699 artículos y se incluyeron 45. Los factores relacionados con la LRA fueron: edad avanzada, sexo masculino, hipertensión, enfermedad renal crónica, ventilación mecánica, aumento de la proteína C reactiva, uso de drogas vasoactivas y de determinadas clases de antihipertensivos. La LRA está relacionada con mayor frecuencia de mortalidad. En el 30 % de los pacientes hospitalizados con COVID-19 hubo LRA. La tasa de mortalidad por LRA fue de 5 % y la letalidad de 18 %. Conclusión Estos resultados resaltan la relevancia de la LRA como una complicación significativa de COVID-19 y sugieren que un control más cuidadoso y temprano de los factores asociados podría reducir potencialmente la mortalidad y la letalidad. Es crucial intensificar la investigación en este campo para explicar mejor los mecanismos relacionados con la lesión renal en pacientes con COVID-19, así como identificar estrategias terapéuticas más efectivas para su prevención y tratamiento en este contexto.

Abstract Objective To identify the frequency of acute kidney injury (AKI) in patients hospitalized with COVID-19, associated characteristics, mortality and lethality. Methods Integrative review carried out in the databases CINAHL, Embase, LILACS, Livivo, PubMed, SCOPUS, Web of Science and in the grey literature (Google Scholar) on January 12, 2022. Articles were included in English, Spanish and Portuguese, published from November 2019 to January 2022, in hospitalized patients over 18 years old with COVID-19 and AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The selected studies were read in full for extraction, interpretation, synthesis and categorization according to the level of evidence. Results A total of 699 articles were found and 45 included. Older age, male gender, hypertension, chronic kidney disease, mechanical ventilation, increased C-reactive protein, use of vasoactive drugs and certain classes of antihypertensives were associated with AKI. AKI is related to a higher frequency of mortality. AKI occurred in 30% of patients hospitalized with COVID-19. The mortality rate from AKI was 5% and the case fatality rate was 18%. Conclusion These results highlight the relevance of AKI as a significant complication of COVID-19 and suggest that more careful and early control of associated factors could potentially reduce mortality and lethality. It is crucial to intensify research in this field to better clarify the mechanisms involved in kidney injury in COVID-19 patients, as well as to identify more effective therapeutic strategies for its prevention and treatment in this context.

Hábitos alimentarios y caries de la primera infancia en una población uruguaya: estudio piloto / Dietary habits and early childhood tooth cavities in a uruguayan population: pilot study / Hábitos alimentares e cárie dentária na primeira infância numa população uruguaia: estudo piloto

Objetivo: conocer la relación entre el perfil de consumo de alimentos (frecuencia y tipo) con la prevalencia, extensión y distribución de las lesiones de caries en niños de 18-35 meses de la ciudad de Montevideo, Uruguay. Material y método: se realizó un estudio transversal con una muestra no probabilística de 50 niños, de ambos sexos. Los padres respondieron a un cuestionario sobre datos sociodemográficos, hábitos alimenticios e higiene bucal. Dos examinadoras calibradas registraron las lesiones de caries de acuerdo al criterio ICDAS-epi, índice de placa visible e índice PUFA. Se realizaron análisis descriptivos para caries dental y dieta (tipo de alimento, incorporación y frecuencia). Resultados: los niños examinados presentaban una edad promedio de 26,6±5,9 meses. La prevalencia de caries fue de 34%, con una extensión de 2,3 y 4,3 para ceo-d y ceo-s, respectivamente. Mayoritariamente se observaron lesiones severas, no tratadas, en el sector anterosuperior y posteroinferior. El índice PUFA fue de 8%. El 30% consumía leche materna, 54% leche con azúcar y el 100% consumía diariamente bebidas azucaradas no lácteas y alimentos azucarados antes de los 11 meses de vida. Los niños que consumían bebidas azucaradas (no lácteas) en biberón presentaron mayor extensión y severidad de las lesiones de caries (ceo-d modificado = 3,5 y ceo-s modificado = 7,8). Conclusiones: el conocimiento de los patrones de alimentación en la primera infancia necesitan ser profundizados. La población estudiada mostró la temprana incorporación de azúcar a la dieta, alertando sobre la presencia de un factor de riesgo común a diversas enfermedades no transmisibles (caries, diabetes, obesidad, enfermedades cardiovasculares).

Objective: to learn the relation between the food consumption profile (frequency and type) and the prevalence, extension and distribution of cavity lesions in children of 18-35 months of age from the city of Montevideo, Uruguay. Material y Methods: a cross-sectional study was carried out in 50 children, of both sexes. Parents answered a questionnaire regarding sociodemographic data, eating habits and oral hygiene. Two examiners recorded caries lesions on each tooth surface according to ICDAS-epi criteria, visible plaque index and PUFA index. Descriptive analysis of the variables were performed. The diet analysis considered food type, incorporation time and frequency through percentages. Results: children examined had an average age of 26.6 ± 5.9 months of age. The cavity prevalence was 34%, with an extension of 2.3 and 4.3 for ceo-d and ceo-s respectively. For the most part, severe untreated injuries were observed located in the anterior superior and posterior-inferior sector. The PUFA index was 8%. 30% consumed breast milk, 54% milk with sugar, 100% consumed beverages and sugary foods, mostly before 11 months and daily. Children who consumed sugary drinks (non-milk) in a bottle presented greater extent and severity of cavity lesions (ceo-d modificated= 3.5 and ceo-s modificated = 7.8). Conclusions: we need to deepen our knowledge of feeding patterns in early childhood. The population studied showed the early incorporation of sugar into the diet, warning about the presence of a common risk factor for various non-communicable diseases (cavities, diabetes, obesity, cardiovascular diseases).

Objetivo: conhecer a relação entre o perfil de consumo alimentar (frequência e tipo) com a prevalência, extensão e distribuição das lesões de cárie em crianças de 18-35 meses da cidade de Montevidéu, Uruguai. Métodos: foi realizado um estudo transversal em 50 crianças, de ambos os sexos. Os pais responderam a um questionário sobre dados sociodemográficos, hábitos alimentares e higiene bucal. Dois examinadores calibrados registraram lesões de cárie em cada superfície dentária de acordo com os critérios ICDAS-epi, índice de placa visível e índice de PUFA. Foi realizada análise descritiva das variáveis. A análise da dieta considerou o tipo de alimento, o tempo de incorporação e a frequência por meio de porcentagens. Resultados: as crianças examinadas tinham idade média de 26,6 ± 5,9 meses. A prevalência de cárie foi de 34%, com extensão de 2,3 e 4,3 para ceo-d e ceo-s respectivamente. Em sua maioria, lesões graves não tratadas foram observadas localizadas no setor anterossuperior e póstero-inferior. O índice PUFA foi de 8%. 30% consumiam leite materno, 54% leite com açúcar, 100% consumiram bebidas e alimentos açucarados antes dos 11 meses e diariamente. Crianças que consumiram bebidas açucaradas (não lácteos) em mamadeira apresentaram maior extensão e gravidade das lesões de cárie (ceo-d = 3,5 e ceo-s = 7,8). Conclusões: o conhecimento dos padrões de alimentação na primeira infância precisa ser aprofundado. A população estudada mostrou a incorporação precoce do açúcar na dieta, alertando para a presença de um fator de risco comum para diversas doenças não transmissíveis (cárie, diabetes, obesidade, doenças cardiovasculares).

Nursing workload and severity of COVID-19 patients in the Intensive Care Unit / Carga de trabajo de enfermería y gravedad de los pacientes con COVID-19 en la Unidad de Cuidados Intensivos / Carga de trabalho de Enfermagem e gravidade de pacientes com COVID-19 na Unidade de Terapia Intensiva

ABSTRACT Objective: To evaluate the workload and severity of patients in the Intensive Care Unit (ICU) with COVID-19. Method: Cross-sectional, analytical study carried out in the ICU of a private hospital. All patients over the age of 18 with a diagnosis of COVID-19 admitted from September 2020 to June 2021 were included. Workload assessed by the Nursing Activities Score (NAS), and severity by the Sequential Organ Failure Assessment. Descriptive and inferential analyses were performed. Results: 217 patients were included, mostly men, mean age 62.41 years, white, obese, non-smokers and sedentary. The average NAS was 84.79. Staffing was in line with legislation and NAS. NAS was not associated with severity. Severity was associated with higher age, gender, comorbidities, sedentary lifestyle, time on mechanical ventilation, hospitalization and death. Conclusion: Workload was high and not associated with severity or outcomes. Severity was associated with demographic and clinical conditions. This study shows the importance of staff sizing, with a view to promoting safety and quality of care.

RESUMEN Objetivo: Evaluar la carga de trabajo y la gravedad de los pacientes de la Unidad de Cuidados Intensivos (UCI) con COVID-19. Método: Estudio transversal y analítico realizado en la UCI de un hospital privado. Se incluyeron todos los pacientes mayores de 18 años con diagnóstico de COVID-19 ingresados entre septiembre de 2020 y junio de 2021. Carga de trabajo evaluada mediante la Nursing Activities Score (NAS), y gravedad mediante la valoración secuencial de fallo orgánico. Se realizaron análisis descriptivos e inferenciales. Resultados: Se incluyeron 217 pacientes, en su mayoría hombres, edad media 62,41 años, raza blanca, obesos, no fumadores y sedentarios. El NAS medio era de 84,79. Los niveles de personal se ajustaban a la legislación y al NAS. El NAS no se asoció con la gravedad. La gravedad se asoció a mayor edad, sexo, comorbilidades, sedentarismo, tiempo de ventilación mecánica, hospitalización y muerte. Conclusión: La carga de trabajo fue elevada y no se asoció a la gravedad ni a los resultados. La gravedad se asoció a las condiciones demográficas y clínicas. Este estudio muestra la importancia del dimensionamiento del personal, con vistas a promover la seguridad y la calidad de los cuidados.

RESUMO Objetivos: Avaliar carga de trabalho e gravidade dos pacientes na Unidade de Terapia Intensiva (UTI) com COVID-19. Método: Estudo transversal, analítico realizado na UTI em hospital privado. Incluídos todos os pacientes maiores de 18 anos, com diagnóstico de COVID-19 admitidos de setembro de 2020 a junho de 2021. Carga de trabalho avaliado pelo Nursing Activities Score (NAS), e gravidade pelo Sequential Organ Failure Assessment. Realizado análises descritiva e inferencial. Resultados: Incluídos 217 pacientes, maioria homens, média de idade 62,41 anos, brancos, obesos, não tabagistas e sedentários. A média do NAS foi 84,79. O dimensionamento de pessoal estava em concordância com legislação e NAS. O NAS não foi associado a gravidade. Houve associação da gravidade com maior idade, sexo, comorbidades, sedentarismo, tempo de ventilação mecânica, internação e óbito. Conclusão: A carga de trabalho foi alta e não associada a gravidade e desfechos. A gravidade foi associada às condições demográficas e clínicas. Este estudo mostra a importância do dimensionamento de pessoal, com vistas à promoção da segurança e qualidade assistencial.

Dental caries prevalence and severity positively associate with AMY1 gene copy number.

OBJECTIVE: To establish the possible relation between total caries (TC) and caries severity (CS) with the AMY1 gene copy number (AMY1GCN). MATERIALS AND METHODS: This was an observational, cross-sectional, population-based, and association study with 303 participants. Each participant underwent a complete anamnesis and stomatological check-up, and peripheral blood was obtained to extract gDNA. TC and CS were determined as the number of caries at the dental exploration and the number of dental surfaces affected by caries, respectively, and AMY1GCN was determined by qPCR. RESULTS: We found an elevated caries prevalence (92.7%); TC and CS were 8 ± 10 and 10 ± 13 (median ± IR). There were higher TC and CS in those participants with AMY1GCN above the mean value (0.02 and 0.01 p values, respectively). A positive correlation between TC and CS with AMY1GCN (0.11 and 0.125 r values, 0.03 and 0.01 p values, respectively) was found, in addition to an association between TC and CS with AMY1GCN (1.5 and 1.6 OR values, 0.48 and 0.26 p values, respectively). CONCLUSION: TC and CS were positively related to the AMY1GCN. CLINICAL RELEVANCE: Dental caries has a high prevalence and a multifactorial etiology and has been related to a genetic component. Indeed, the salivary enzyme alpha-amylase could play a significant role in caries susceptibility, considering that its codifying gene (AMY1) can show variation in its gene copy number. This can be considered an important factor for the development of caries at a genetic level.

MTOR gene variants are associated with severe COVID-19 outcomes: A multicenter study.

BACKGROUND: The worst outcomes linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been attributed to the cytokine storm, which contributes significantly to the immunopathogenesis of the disease. The mammalian target of rapamycin (mTOR) pathway is essential for orchestrating innate immune cell defense including cytokine production and is dysregulated in severe Coronavirus Disease 2019 (COVID-19) individuals. The individual genetic background might play a role in the exacerbated immune response. OBJECTIVE: In this study, we aimed to investigate the association between MTOR genetic variants and COVID-19 outcomes. METHODS: This study enrolled groups of individuals with severe (n = 285) and mild (n = 207) COVID-19 from Brazilian states. The MTOR variants, rs1057079 and rs2536, were genotyped. A logistic regression analysis and Kaplan-Meier survival curves were performed. We applied a genotyping risk score to estimate the cumulative contribution of the risk alleles. Tumor necrosis factor (TNF) and interleukin-6 (IL-6) plasma levels were also measured. RESULTS: The T allele of the MTOR rs1057079 variant was associated with a higher likelihood of developing the most severe form of COVID-19. In addition, higher levels of IL-6 and COVID-19 death was linked to the T allele of the rs2536 variant. These variants exhibited a cumulative risk when inherited collectively. CONCLUSIONS: These results show a potential pathogenetic role of MTOR gene variants and may be useful for predicting severe outcomes following COVID-19 infection, resulting in a more effective allocation of health resources.

COVID-19 patients display changes in lymphocyte subsets with a higher frequency of dysfunctional CD8lo T cells associated with disease severity.

This work examines cellular immunity against SARS-CoV-2 in patients from Córdoba, Argentina, during two major waves characterized by different circulating viral variants and different social behavior. Using flow cytometry, we evaluated the main lymphocyte populations of peripheral blood from hospitalized patients with moderate and severe COVID-19 disease. Our results show disturbances in the cellular immune compartment, as previously reported in different cohorts worldwide. We observed an increased frequency of B cells and a significant decrease in the frequency of CD3+ T cells in COVID-19 patients compared to healthy donors (HD). We also found a reduction in Tregs, which was more pronounced in severe patients. During the first wave, the frequency of GZMB, CD107a, CD39, and PD-1-expressing conventional CD4+ T (T conv) cells was significantly higher in moderate and severe patients than in HD. During the second wave, only the GZMB+ T conv cells of moderate and severe patients increased significantly. In addition, these patients showed a decreased frequency in IL-2-producing T conv cells. Interestingly, we identified two subsets of circulating CD8+ T cells with low and high CD8 surface expression in both HD and COVID-19 patients. While the percentages of CD8hi and CD8lo T cells within the CD8+ population in HD are similar, a significant increase was observed in CD8lo T cell frequency in COVID-19 patients. CD8lo T cell populations from HD as well as from SARS-CoV-2 infected patients exhibited lower frequencies of the effector cytokine-producing cells, TNF, IL-2, and IFN-γ, than CD8hi T cells. Interestingly, the frequency of CD8lo T cells increased with disease severity, suggesting that this parameter could be a potential marker for disease progression. Indeed, the CD8hi/CD8lo index helped to significantly improve the patient's clinical stratification and disease outcome prediction. Our data support the addition of, at least, a CD8hi/CD8lo index into the panel of biomarkers commonly used in clinical labs, since its determination may be a useful tool with impact on the therapeutic management of the patients.