Clinical and cardiovascular characteristics from subjects with in COVID-19 and viral outbreaks.

Introduction: Lower respiratory tract infections remain the deadliest communicable disease worldwide. The relationship between cardiovascular diseases and viral infections is well known; for example, during the AH1N1 influenza pandemic, many patients developed acute cardiovascular disease. In the SARS-CoV2 pandemic, cardiovascular health has again become a challenge, with early reports showing cardiac damage in these patients. Objective: The study aims to describe the clinical characteristics of COVID-19 patients with an emphasis on cardiovascular compromises, compared with past outbreaks of influenza AH1N1, to identify prognostic factors of severity. Methods: A cross-sectional study of 72 subjects with a confirmed diagnosis of COVID-19 was conducted. Subjects were evaluated in two groups: 38 hospitalized patients and 34 patients in the Intensive Care Unit (ICU). Data from different outbreaks of influenza AH1N1 were then compared with this group. Results: The 34 subjects in the ICU had higher levels of high sensible troponin, D dimer, creatinine, and leukocytes compared with the 38 hospitalized subjects. The lymphocytes count was diminished in 85.29% of ICU subjects. When compared with AH1N1 patients, it was found that SARS-CoV2 patients were 10 years older on average. The proportion of overweight and obese SARS-CoV2 patients was double that in the influenza outbreaks. In addition, it was observed that a high number of SARS-CoV2 subjects presented with diabetes mellitus. Conclusion: There were various clinical and severity differences between each of these outbreaks. However, viral respiratory infection diseases such as SARS-CoV2 are a significant risk factor for acute ischemic, functional, and structural cardiovascular complications. The only way to combat this risk is a prevention approach, specifically through vaccines, but also through measures that force drastic changes in health policies to reduce perhaps the worst of pandemics, obesity, and its metabolic consequences.

Clinical and Immunological Factors That Distinguish COVID-19 From Pandemic Influenza A(H1N1).

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a global health threat with the potential to cause severe disease manifestations in the lungs. Although COVID-19 has been extensively characterized clinically, the factors distinguishing SARS-CoV-2 from other respiratory viruses are unknown. Here, we compared the clinical, histopathological, and immunological characteristics of patients with COVID-19 and pandemic influenza A(H1N1). We observed a higher frequency of respiratory symptoms, increased tissue injury markers, and a histological pattern of alveolar pneumonia in pandemic influenza A(H1N1) patients. Conversely, dry cough, gastrointestinal symptoms and interstitial lung pathology were observed in COVID-19 cases. Pandemic influenza A(H1N1) was characterized by higher levels of IL-1RA, TNF-α, CCL3, G-CSF, APRIL, sTNF-R1, sTNF-R2, sCD30, and sCD163. Meanwhile, COVID-19 displayed an immune profile distinguished by increased Th1 (IL-12, IFN-γ) and Th2 (IL-4, IL-5, IL-10, IL-13) cytokine levels, along with IL-1ß, IL-6, CCL11, VEGF, TWEAK, TSLP, MMP-1, and MMP-3. Our data suggest that SARS-CoV-2 induces a dysbalanced polyfunctional inflammatory response that is different from the immune response against pandemic influenza A(H1N1). Furthermore, we demonstrated the diagnostic potential of some clinical and immune factors to differentiate both diseases. These findings might be relevant for the ongoing and future influenza seasons in the Northern Hemisphere, which are historically unique due to their convergence with the COVID-19 pandemic.

A unique immune signature of serum cytokine and chemokine dynamics in patients with Zika virus infection from a tropical region in Southern Mexico.

OBJECTIVES: To describe the kinetics of circulating cytokines and chemokines in humans with ZIKAV infection. METHODS: Serum levels of different immune mediators in patients with ZIKAV infection were measured at distinct stages of the disease, as well as in culture supernatants from human monocytes infected with a clinical ZIKAV isolate. We also looked for clinical features associated with specific immune signatures among symptomatic patients. RESULTS: We evaluated 23 ZIKAV-infected patients. Their mean age was 32 ± 8.3 years and 65% were female. ZIKAV patients showed elevated IL-9, IL-17A, and CXCL10 levels at acute stages of the disease. At day 28, levels of CCL4 and CCL5 were increased, whereas IL-1RA, CXCL8 and CCL2 were decreased. At baseline, IL-7 was increased among patients with headache, whereas CCL2, and CCL3 were decreased in patients with bleeding and rash, respectively. Our clinical ZIKAV isolate induced a broad immune response in monocytes that did not resemble the signature observed in ZIKAV patients. CONCLUSIONS: We showed a unique immune signature in our cohort of ZIKAV-infected patients. Our study may provide valuable evidence helpful to identify immune correlates of protection against ZIKAV.

High performance of rapid influenza diagnostic test and variable effectiveness of influenza vaccines in Mexico.

OBJECTIVES: To evaluate the performance of rapid influenza diagnostic tests (RIDT) and influenza vaccines' effectiveness (VE) during an outbreak setting. METHODS: We compared the performance of a RIDT with RT-PCR for influenza virus detection in influenza-like illness (ILI) patients enrolled during the 2016/17 season in Mexico City. Using the test-negative design, we estimated influenza VE in all participants and stratified by age, virus subtype, and vaccine type (trivalent vs quadrivalent inactivated vaccines). The protective value of some clinical variables was evaluated by regression analyses. RESULTS: We enrolled 592 patients. RT-PCR detected 93 cases of influenza A(H1N1)pdm09, 55 of AH3N2, 141 of B, and 13 A/B virus infections. RIDT showed 90.7% sensitivity and 95.7% specificity for influenza A virus detection, and 91.5% sensitivity and 95.3% specificity for influenza B virus detection. Overall VE was 33.2% (95% CI: 3.0-54.0; p = 0.02) against any laboratory-confirmed influenza infection. VE estimates against influenza B were higher for the quadrivalent vaccine. Immunization and occupational exposure were protective factors against influenza. CONCLUSIONS: The RIDT was useful to detect influenza cases during an outbreak setting. Effectiveness of 2016/17 influenza vaccines administered in Mexico was low but significant. Our data should be considered for future local epidemiological policies.

CD8+ cell noncytotoxic anti-HIV response: restoration by HAART in the late stage of infection.

Highly active antiretroviral therapy (HAART) is currently the best HIV infection management strategy. However, its effects on the CD8+ T cell noncytotoxic anti-HIV response (CNAR) are not well known. We investigated if HAART has different effects on CNAR in patients at the intermediate and late stages of HIV infection. Untreated healthy HIV-infected subjects with a mean CD4+ T cell count of 606 cells/microl were examined as a reference group. Plasma viral load, CD4+ T cell count, and CNAR activity were measured at baseline and regular intervals for at least 48 weeks following initiation of HAART. Baseline CNAR activity in all subjects correlated inversely with viral load and directly with CD4 T+ cell counts. The level of CNAR in the latestage group was significantly lower than in the intermediate-stage and the healthy reference group (p < 0.01). Following initiation of HAART, substantial increases in CD4+ T cell counts and decreases in viral loads were observed in both groups, indicating treatment success. CNAR activity was found to be increased significantly during HAART, but only in the late-stage group (p < 0.01). This increase in CD8+ cell function was seen within 4 weeks of treatment initiation and resulted in levels of CNAR activity almost equal to those observed in the healthy reference subjects. Our findings suggest a beneficial effect on CNAR in those individuals with reduced activity, typically in late-stage infection.

Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco.

RATIONALE: Women exposed chronically to biomass develop airflow limitation, as tobacco smokers do, but their clinical profile and survival have not been described in detail. OBJECTIVE: To determine the clinical profile, survival, and prognostic factors of chronic obstructive pulmonary disease associated with biomass exposure and tobacco smoking. METHODS: During a 7-yr period (1996-2003), a consecutive series of 520 patients were recruited and followed up at the COPD Clinic of the National Institute of Respiratory Diseases. Prognostic factors of survival were evaluated taking into account the interaction between sex and exposure. MEASUREMENTS: Spirometry, arterial blood gases and oxygen saturation, body mass index, exercise capacity, and health-related quality of life were performed at baseline. The main outcome was survival. MAIN RESULTS: A total of 481 patients were followed up. The patients in the biomass group, mainly women (84%), were older and shorter and had a greater body mass index than those in the tobacco group (p < 0.0001). Airflow obstruction was more severe in smokers (p < 0.001). Quality of life and distance walked showed similar abnormalities in both groups. In the multivariable Cox regression analysis including an interaction term exposure-sex, we found that age (relative risk [RR], 1.02; 95% confidence interval [CI], 1.02-1.07), FEV(1) as percentage of predicted (RR, 0.96; 95% CI, 0.96-0.99), body mass index (RR, 0.95; 95% CI, 0.90-1.01), and oxygen saturation (RR, 0.96; 95% CI, 0.92-0.99) were predictors of mortality but not exposure or sex. CONCLUSIONS: Women exposed domestically to biomass develop chronic obstructive pulmonary disease with clinical characteristics, quality of life, and increased mortality similar in degree to that of tobacco smokers.

The effect of biomass burning on respiratory symptoms and lung function in rural Mexican women.

BACKGROUND: The use of biomass as a cooking fuel is commonplace in developing countries and has been associated with chronic bronchitis and obstructive airway disease. METHODS: A cross-sectional survey was done in the village of Solis, close to Mexico City. Lifelong nonsmoking women 38 yr of age or older (n=841) completed a questionnaire on respiratory symptoms and illnesses and on cooking fuel use, and performed spirometry in their homes. Particulate matter concentration was measured with a nephelometer in the kitchen for 1 h, while the subject was cooking. RESULTS: The peak indoor concentration of particulate matter (PM10, particles with a diameter of 10 microm or less) often exceeded 2 mg/m3. Compared with those cooking with gas, current use of a stove burning biomass fuel was associated with increased reporting of phlegm (27 vs. 9%) and reduced FEV1/FVC (79.9 vs. 82.8%). Levels of FEV1 were 81 ml lower and cough was more common (odds ratio, 1.7; 95% confidence interval, 1.0-2.8) in women from homes with higher PM10 concentrations. All women found with moderate airflow obstruction (Global Initiative for Chronic Obstructive Lung Disease stage II and above) were cooking with biomass stoves. CONCLUSION: Women cooking with biomass fuels have increased respiratory symptoms and a slight average reduction in lung function compared with those cooking with gas.

Prevalencia de dislipidemia en los fumadores que acuden a un programa de ayuda para dejar de fumar / Prevalence of dislipidemia in smokers from a Smoking-Cessation Clinic

Introducción: El consumo de tabaco es uno de los principales factores de riesgo para enfermedades cardiovasculares. A pesar de que se conoce la relación entre el consumo de tabaco crónico y la dislipidemia, en la Clínica para Dejar de Fumar (CDF), "Dra. Carmen Gutiérrez de Velasco" del Instituto Nacional de Enfermedades Respiratorias (INER), Ismael Cosío Villegas, todavía no se ha descrito el perfil de lípidos y la prevalencia de las dislipidemias. Objetivo: Describir el perfil de lípidos y la prevalencia de dislipidemias en fumadores que acuden a la CDF. Métodos: Se revisaron 700 expedientes consecutivos de los fumadores que acudieron a la clínica CDF durante el periodo de tres años que comprendió de enero de 2003 a diciembre de 2005. Se investigó la prevalencia del perfil de lípidos aterógeno (PLA), definido como colesterol total y triglicéridos elevados y HDL-colesterol bajo, y la prevalencia de cada componente de PLA. Se estudió la diferencia del perfil de lípidos por género y por número de cigarrillos (cig) consumidos al día. Resultados: La prevalencia de PLA, hipercolesterolemia, hipertríglicerídemia y HDL-colesterol bajo fue de 21, 50, 56y 55%, respectivamente. El promedio de colesterol total, de tríglicéridos y HDL-colesterol fue de 204 ± 44 mg/dL, 208 ± 155 mg/dL y 46 ± 14 mg/dL, respectivamente. Los niveles de tríglicéridos se encontraron más altos y HDL más bajos en los que fumaban más de 20 cig/día en comparación con los que fumaban menos de 20 cig/día (225 ± 162 mg/dL vs 185 ± 134 mg/dL, p = 0.02; 44.2 ± 12 mg/dL vs 48 ± 14 mg/dL, p < 0.001, respectivamente). Las mujeres tuvieron niveles más altos de HDL en comparación con los hombres (51 ± 14 mg/dL vs 40.3 ± 11 mg/dL, p < 0.001). Conclusiones: La prevalencia alta de PLA en la población fumadora de nuestra CDF la hace muy vulnerable de presentar ateroesclerosis prematura. Este estudio resalta la importancia de la búsqueda de alteraciones lipfdicas en fumadores.

Background: Tobacco smoking is one of the major modifiable cardiovascular risk factors. The relationship between smoking and lipid disorders has been studied; however, its prevalence among smokers from our Smoking Cessation Clinic (SCC) "Dra. Carmen Gutiérrez de Velasco " at the Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas is unknown. Objective: To describe the lipid profile of smokers at our SCC and its prevalence in this population. Methods: 700 medical records from patients admitted to the clinic during a three- year period from 2003 to 2005 were studied. We analyzed the prevalence of their atherogenic lipid profile defined as high serum total cholesterol and triglycerides and low HDL-cholesterol. In addition, we studied the prevalence of each component of the lipid profile, according to a gender and a number of cigarettes (cig) smoked per day. Results: The prevalence of atherogenic lipid profile, hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol was 21%, 50% 56% and 55%, respectively. Their total serum cholesterol and triglycerides levels were high and HDL-cholesterol was low (CT 204 ± 44 mg/dL, TG 208 ± 155 mg/dL, HDL 46 ± 14 mg/dL). Those who smoked more than 20 cig/day had higher triglycerides and lower HDL-cholesterol than those smoking less than 20 cig/day (225 ± 162 mg/dL vs 185 ± 134 mg/dL, p = 0.02 and 44.2 ± 12 mg/dL vs 48 ± 14 mg/dL, p<0.001, respectively). Women had higher HDL-cholesterol than men (51 ± 14 mg/dL vs 40.3 ± 11 mg/dL, p < 0.001). Conclusion: The high prevalence of an atherogenic lipid profile in smokers makes them prone to develop premature atherosclerosis. This study underscores the importance of lipid disorders research in smokers.