Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Epigenética, más allá de la Genética Epigenética, más allá de la Genética

Epigenetics is the study of reversible inheritable changes in gene function that occur without a change in the sequence of nuclear DNA and is transmitted from one generation of cells or organisms to the next. The chemical modifications to DNA and its associated proteins help to determine the selective use of genes and influence cell fate. Epigenetic modifications of the genome are involved in regulating many cellular processes. These include embryonic development, X chromosome inactivation and genomic imprinting. Abnormal epigenetic modifications and control can cause disease, including cancer and autoimmune diseases. Identification of inheritable epigenetic patterns such as DNA methylation and histone acetylation has been proposed as a useful marker for the early detection and prognosis of diseases caused by epigenetic errors.<br>La epigenética es el estudio de los cambios heredables reversibles en la función de los genes que ocurren sin cambios en la secuencia de ADN. Las modificaciones químicas del ADN y sus proteínas asociadas determinan la expresión selectiva de genes y su influencia en el comportamiento de las células. Las modificaciones epigenéticas del genoma regulan muchos procesos celulares, tales como el desarrollo embrionario, la inactivación del cromosoma X, la impronta genómica y, la estabilidad de los cromosomas. La alteración de las modificaciones epigenéticas o la pérdida de su control, pueden causar enfermedades como el cáncer y contribuir al desarrollo de enfermedades autoinmunes. Por lo anterior, se ha propuesto que la identificación de los patrones epigenéticos heredables tales como la metilación del ADN y la acetilación de histonas sería una herramienta útil en el diagnóstico y pronóstico de las enfermedades causadas por errores epigenéticos