Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ±â€…13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

Efficiency of neutralizing antibodies targeting the CD4-binding site: influence of conformational masking by the V2 loop in R5-tropic clade C simian-human immunodeficiency virus.

In R5-tropic clade C simian-human immunodeficiency viruses (SHIV-Cs), we identified a 3-asparagine (3N) deletion mutation in the V2 loop stem of gp120 as the major determinant of neutralization escape of the anti-CD4-binding site (anti-CD4-bs) neutralizing monoclonal antibody (nMAb) b12. However, the more potent anti-CD4-bs nMAbs VRC01 and VRC03 were not sensitive to this mutation. Using isogenic tier 1 or tier 2 proviruses differing only in the 3N mutation, we showed that this mutation might result in selective conformational b12 epitope masking. Therefore, human immunodeficiency virus (HIV) Env immunogens targeting the CD4-bs and designed to neutralize tier 2 viruses should take conformational masking by the V2 loop into account.

Bases conceptuales de la cirugía metabólica / Conceptual Bases of Metabolic Surgery

Resumen: El término de síndrome metabólico (SM) se ha utilizado desde su definición en el año 2001 por el programa nacional del colesterol (NCEP: ATP III). El concepto ha sido discutido en la literatura científica por décadas. El síndrome X y otros términos como "el cuarteto de la muerte" y el síndrome de resistencia a la insulina, han sido utilizados para describir la asociación entre factores de riesgo metabólico y cardiovascular. En México, la prevalencia de SM en la Encuesta Nacional de Salud y Nutrición (ENSANUT) fue de un 34% para el año 2000; y para el 2012, del 41%. Las modificaciones del estilo de vida junto con aumento en la actividad física, dejar de fumar y limitar el consumo de alcohol son primordiales para el manejo y la prevención debido a que juegan un rol central en las anormalidades metabólicas. Sin embargo, a pesar del impresionante armamento de medicamentos disponible para la diabetes, se ha descrito que hasta el 50% de los pacientes no alcanzan las metas adecuadas de control, definidas por la Asociación Americana de Diabetes (hemoglobina glucosilada <7%). En contraste, la cirugía bariátrica (CB) ha confirmado claramente que contribuye a mejorar la función de las células beta en pacientes con índice de masa corporal (IMC) >35 kg/m2, así como el control de la dislipidemia y otras alteraciones metabólicas.

Abstract: The term Metabolic Syndrome (MS) has been used since its introduction in 2001 by the National Cholesterol Program (NCEP: ATP III). The concept has been discussed in the scientific literature for decades. The X Syndrome and other terms such as "death quartet" and insulin resistance syndrome have been used to describe the association between metabolic and cardiovascular risk factors. In Mexico, the prevalence of MS in the National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición, ENSANUT) was 34% in 2000 and 41% in 2012. Lifestyle modifications along with increased physical activity, quitting smoking, and limiting alcohol consumption are essential for management and prevention because they play a central role in metabolic abnormalities. However, despite the large amount of medications available for diabetes, up to 50% of patients have been reported to fail to achieve adequate control goals, as defined by the American Diabetes Association (glycosylated hemoglobin <7%). In contrast, bariatric surgery (BS) has clearly confirmed that it contributes to improved beta cell function in patients with BMI >35 kg / m2, as well as control of dyslipidemia and other metabolic disorders.