Chronic Comorbidities in Middle Aged Patients Contribute to Ineffective Emergency Hematopoiesis in Covid-19 Fatal Outcomes.

BACKGROUND AND AIMS: Mexico is among the countries with the highest estimated excess mortality rates due to the COVID-19 pandemic, with more than half of reported deaths occurring in adults younger than 65 years old. Although this behavior is presumably influenced by the young demographics and the high prevalence of metabolic diseases, the underlying mechanisms have not been determined. METHODS: The age-stratified case fatality rate (CFR) was estimated in a prospective cohort with 245 hospitalized COVID-19 cases, followed through time, for the period October 2020-September 2021. Cellular and inflammatory parameters were exhaustively investigated in blood samples by laboratory test, multiparametric flow cytometry and multiplex immunoassays. RESULTS: The CFR was 35.51%, with 55.2% of deaths recorded in middle-aged adults. On admission, hematological cell differentiation, physiological stress and inflammation parameters, showed distinctive profiles of potential prognostic value in patients under 65 at 7 days follow-up. Pre-existing metabolic conditions were identified as risk factors of poor outcomes. Chronic kidney disease (CKD), as single comorbidity or in combination with diabetes, had the highest risk for COVID-19 fatality. Of note, fatal outcomes in middle-aged patients were marked from admission by an inflammatory landscape and emergency myeloid hematopoiesis at the expense of functional lymphoid innate cells for antiviral immunosurveillance, including NK and dendritic cell subsets. CONCLUSIONS: Comorbidities increased the development of imbalanced myeloid phenotype, rendering middle-aged individuals unable to effectively control SARS-CoV-2. A predictive signature of high-risk outcomes at day 7 of disease evolution as a tool for their early stratification in vulnerable populations is proposed.

[Modifiable risk factors in adolescents with obesity]. / Factores de riesgo modificables en adolescentes con obesidad.

Background: Adolescence is a stage of growth with changes whose result is adulthood. Obesity increases the risk of chronic diseases; therefore, it is important to identify modifiable risk factors to prevent obesity in adolescents. Objective: To iIdentify modifiable risk factors for obesity in adolescents from a Family Medicine Unit in the city of Puebla. Material and methods: Case-control study. The Graffar scale, the World Health Organization percentile tables, the Krece Plus test and the Short Diet Quality Screener (sDQS) were applied. Chi squared, odds ratios (OR) with 95% confidence intervals (95% CI), and Pearson's phi with Cramer's V were used. Results: 348 adolescents participated, divided into 2 groups. In the group of adolescents with obesity, exclusive breastfeeding was present in 44.8%, 60.9% had at least one obese parent, 66.7% had an inadequate diet, and 63.8% had a bad lifestyle. On the other hand, the group of adolescents without obesity presented exclusive breastfeeding in 88.5%, 75.3% did not have parents with obesity, 66.1% presented an adequate diet in some aspects and 52.3% had a fair to good lifestyle. Conclusion: The absence of exclusive breastfeeding in the first 6 months of life, parental obesity, poor physical activity, and inadequate diets were associated with the presence of obesity in adolescents.

Introducción: la adolescencia es una etapa del crecimiento con cambios cuyo resultado es la adultez. La obesidad aumenta el riesgo de enfermedades crónicas; por ello, es importante identificar los factores de riesgo modificables para prevenirla en adolescentes. Objetivo: identificar los factores de riesgo modificables para obesidad en adolescentes de una unidad de medicina familiar en la ciudad de Puebla. Material y métodos: estudio de casos y controles. Se aplicó la escala de Graffar, las tablas percentilares de la Organización Mundial de la Salud, el test Krece Plus y el cuestionario breve de calidad de la dieta (sDQS). Se empleó chi cuadrada, razones de momios (RM) con intervalos de confianza del 95% (IC 95%) y el coeficiente phi de Pearson con V de Cramer. Resultados: participaron 348 adolescentes divididos en dos grupos. En el grupo de adolescentes con obesidad, la lactancia materna exclusiva estuvo presente en 44.8%, el 60.9% contaban con al menos un padre con obesidad, el 66.7% presentó dieta inadecuada y el 63.8% presentaba un mal estilo de vida. Por su parte, el grupo de adolescentes sin obesidad presentó lactancia materna exclusiva en el 88.5%, el 75.3% no contaba con padres con obesidad, el 66.1% presentó dieta adecuada en algunos aspectos y el 52.3% contó con un estilo de vida de regular a bueno. Conclusión: la ausencia de lactancia materna exclusiva los primeros seis meses de vida, la obesidad parental, la mala actividad física y las dietas inadecuadas se asociaron con la presencia de obesidad en adolescentes.