Global mapping of randomised trials related articles published in high-impact-factor medical journals: a cross-sectional analysis

BACKGROUND: Randomised controlled trials (RCTs) provide the most reliable information to inform clinical practice and patient care. We aimed to map global clinical research publication activity through RCT-related articles in high-impact-factor medical journals over the past five decades. METHODS: We conducted a cross-sectional analysis of articles published in the highest ranked medical journals with an impact factor > 10 (according to Journal Citation Reports published in 2017). We searched PubMed/MEDLINE (from inception to December 31, 2017) for all RCT-related articles (e.g. primary RCTs, secondary analyses and methodology papers) published in high-impact-factor medical journals. For each included article, raw metadata were abstracted from the Web of Science. A process of standardization was conducted to unify the different terms and grammatical variants and to remove typographical, transcription and/or indexing errors. Descriptive analyses were conducted (including the number of articles, citations, most prolific authors, countries, journals, funding sources and keywords). Network analyses of collaborations between countries and co-words are presented. RESULTS: We included 39,305 articles (for the period 1965-2017) published in forty journals. The Lancet (n = 3593; 9.1%), the Journal of Clinical Oncology (n = 3343; 8.5%) and The New England Journal of Medicine (n = 3275 articles; 8.3%) published the largest number of RCTs. A total of 154 countries were involved in the production of articles. The global productivity ranking was led by the United States (n = 18,393 articles), followed by the United Kingdom (n = 8028 articles), Canada (n = 4548 articles) and Germany (n = 4415 articles). Seventeen authors who had published 100 or more articles were identified; the most prolific authors were affiliated with Duke University (United States), Harvard University (United States) and McMaster University (Canada). The main funding institutions were the National Institutes of Health (United States), Hoffmann-La Roche (Switzerland), Pfizer (United States), Merck Sharp & Dohme (United States) and Novartis (Switzerland). The 100 most cited RCTs were published in nine journals, led by The New England Journal of Medicine (n = 78 articles), The Lancet (n = 9 articles) and JAMA (n = 7 articles). These landmark contributions focuse

Iniltration vs. instillation of ropivacaine 7.5% in radical mastectomies for postoperative analgesia

Objective: Determining the effectiveness of iniltration versus instillation with 7.5% ropivacaine in reducing the intensity of postoperative pain in patients undergoing a radical mastectomy. Material and methods: Clinical, prospective, and comparative analytical study in a sample of 20 female patients between 20 and 60 years of age, ASA I and II, weight 50-90 kg, who were divided into 2 groups (10 patients each). In Group 1 infiltration with ropivacaine 7.5% (20 ml) was applied prior to closure of the surgical wound, meanwhile in Group 2 ropivacaine 7.5% (20 ml), was instilled into the surgical wound. P ain intensity was assessed by a visual analog scale (V AS) upon extubation. The need for rescue medication and the incidence of nausea and vomiting were measured from 0 to 30 minutes postoperatively and at 2, 4, 8 and 12 hours. Results: There was no statistical difference between the groups (only the group managed through iniltration required rescue medications), but the iniltration group had a lower perception of pain. Conclusions: This study reported the same eficacy of preventive treatment of postoperative pain in patients who underwent radical mastectomy for instillation and iniltration with 7.5% ropivacaine and little need for rescue medication postoperatively

Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial)

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.This study was awarded a Health Research Fund (Fondo de Investigaciones Sanitarias/FIS) grant, dossier No. PI12/01161 of the Carlos III Institute of Health and the Ministry of Sciences, Innovation and Universities.S

Reducción de la fertilización sintética con composta y optimización del riego sobre la pudrición del tallo (Fusarium spp) del maíz

Maize is the most important grain crop in Mexico due to the largest area grown and as the main source of feeding nationwide; being Sinaloa de major producer. The same crop over repeated seasons has favored disease proliferation of stem and ear rot mainly attributed to Fusarium spp which represents a risk potential so that growers are warned top pay close attention to crop management. With the purpose of evaluating the effect of synthetic fertilization with compost and irrigation on maize stem and ear rot at Valle del Fuerte. Field experiments were conducted in the growing season of 2009 at INIFAP. The experiments were arranged under a split plot in randomized complete block design with three replicates. At the end of the season, it was found that fertilization or irrigation by themselves did not have any significant effect in yield and phenology variables evaluated. However, incidence on stem rot which was evaluated at 53 days after planting was that of 100%. Moreover, there were significant differences regarding severity of rotten ears when less irrigation was applied. Finally, morphological study showed that the main agent associated in maize stem rot was Fusarium verticilliodes. In contrast to that of ear rot that the main agents involved were Apergillus spp, Penicillum pinophilum, and with a higher incidence was Fusarium verticilliodes.El maíz es el cultivo agrícola de grano más importante de México por ser sembrado con mayor superficie y ser la base de la alimentación en toda la nación siendo Sinaloa el principal productor. La siembra repetitiva del cultivo efectuada a través de los años, ha favorecido la proliferación de enfermedades como la pudrición de tallos y la pudrición de mazorcas, atribuidas principalmente a Fusarium spp, las cuales representan un potencial de riesgo y han alertado al productor a poner mucha atención en el manejo del cultivo. Con el objetivo de evaluar el efecto de la fertilización sintética con composta y riego sobre la pudrición de tallos y mazorcas de maíz en el Valle del Fuerte; experimentos de campo se condujeron en el ciclo agrícola primavera-verano 2009 en el INIFAP. El experimento fue diseñado en parcelas divididas en bloques completos al azar con tres repeticiones; al final del ciclo se encontró que no hubo diferencias significativas del factor fertilización y riego respecto al rendimiento así como las variables fenológicas evaluadas. La incidencia de pudrición de tallos evaluada a los 53 días después de la siembra fue de 100%. Sin embargo, se encontraron diferencias significativas en cuanto a la severidad de mazorcas podridas donde se aplicaron menos riegos. Finalmente, el estudio morfológico mostro que el principal agente asociado en pudrición de tallos fue Fusarium verticilliodes y en cuanto a pudrición de mazorcas se detectó una mayor diversidad de agentes asociados tales como Apergillus spp, Penicillum pinophilum, y con mayor incidencia Fusarium verticilliodes

Expression and activity profiles of DPP IV/CD26 and NEP/CD10 glycoproteins in the human renal cancer are tumor-type dependent

[Background] Cell-surface glycoproteins play critical roles in cell-to-cell recognition, signal transduction and regulation, thus being crucial in cell proliferation and cancer etiogenesis and development. DPP IV and NEP are ubiquitous glycopeptidases closely linked to tumor pathogenesis and development, and they are used as markers in some cancers. In the present study, the activity and protein and mRNA expression of these glycoproteins were analysed in a subset of clear-cell (CCRCC) and chromophobe (ChRCC) renal cell carcinomas, and in renal oncocytomas (RO).[Methods] Peptidase activities were measured by conventional enzymatic assays with fluorogen-derived substrates. Gene expression was quantitatively determined by qRT-PCR and membrane-bound protein expression and distribution analysis was performed by specific immunostaining.Peer reviewe

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study

Background: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). Methods: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxyterminal telopeptide of type I collagen (b-CTX) were analysed. Results: Patients with RCC who died or progressed had higher baseline b-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline b-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that b-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. Conclusion: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOLNovartis Oncology Spain for supporting this stud

Bathymetry and geological setting of the Drake Passage (Antarctica)

IX Congreso Geológico de España, Huelva, Septiembre 2016The Drake Passage is an oceanic gateway of about 850 km width located between South America and the Antarctic Peninsula that connects the southeastern Pacific and the southwestern Atlantic oceans and is an important gateway for mantle flow, oceanographic water masses, and migrations of biota. This gateway developed within the framework of geological evolution of the Scotia Arc. As a consequence of this and subsequent submarine processes, this region shows a varied physiography. The new detailed map in the Drake Passage region is mainly founded on a compilation of precise multibeam bathymetric data obtained on cruises between 1992 and 2014, and covers the area between parallels 52ºS and 63ºS and meridians 70ºW and 50ºW. The new map that we present is based in a DTM with 200 m cell resolution of the seafloor in Drake Passage that permits identification of the main seafloor features and the map includes additional useful geological information. This work constitutes an international cooperative effort and is part of IBCSO project (International Bathymetric Chart of the Southern Ocean), under the SCAR umbrella.Instituto Geológico y Minero de España, EspañaBritish Antarctic Survey, Reino UnidoDepartamento de Geodinámica, Universidad de Granada, EspañaInstituto Andaluz de Ciencias de la Tierra, Consejo Superior de Investigaciones Científicas, EspañaInstituto Andaluz de Ciencias de la Tierra, Universidad de Granada, EspañaJet Propulsion Laboratory M/S 300-323, Estados UnidosAlfred Wegener Institute, AlemaniaKorea Polar Research Institute, CoreaDepartamento de Geología y Geoquímica, Universidad Autónoma de Madrid, EspañaLamont-Doherty Earth Observatory, Columbia University, Estados Unido

Ductility of wide-beam RC frames as lateral resisting system

[EN] Some Mediterranean seismic codes consider wide-beam reinforced concrete moment resisting frames (WBF) as horizontal load carrying systems that cannot guarantee high ductility performances. Conversely, Eurocode 8 allows High Ductility Class (DCH) design for such structural systems. Code prescriptions related to WBF are systematically investigated. In particular, lesson learnt for previous earthquakes, historical reasons, and experimental and numerical studies underpinning specific prescriptions on wide beams in worldwide seismic codes are discussed. Local and global ductility of WBF are then analytically investigated through (1) a parametric study on chord rotations of wide beams with respect to that of deep beams, and (2) a spectral-based comparison of WBF with conventional reinforced concrete moment resisting frames (i.e. with deep beams). Results show that the set of prescriptions given by modern seismic codes provides sufficient ductility to WBF designed in DCH. In fact, global capacity of WBF relies more on the lateral stiffness of the frames and on the overstrength of columns rather than on the local ductility of wide beams, which is systematically lower with respect to that of deep beams.Gómez-Martínez, F.; Alonso Durá, A.; De Luca, F.; Verderame, GM. (2016). Ductility of wide-beam RC frames as lateral resisting system. Bulletin of Earthquake Engineering. 14(6):1545-1569. doi:10.1007/s10518-016-9891-xS15451569146ACI (1989) Building code requirements for reinforced concrete (ACI 318-89). ACI Committee 318, American Concrete Institute, Farmington Hills, Michigan, USAACI (2008) Building code requirements for structural concrete (ACI 318-08) and commentary (318-08). ACI Committee 318, American Concrete Institute, Farmington Hills, Michigan, USAACI-ASCE (1991) Recommendations for design of beam-column connections in monolithic reinforced concrete structures (ACI 352R-91). Joint ACI-ASCE Committee 352, American Concrete Institute, Farmington Hills, Michigan, USAACI-ASCE (2002) Recommendations for design of beam-column connections in monolithic reinforced concrete structures (ACI 352R-02). Joint ACI-ASCE Committee 352, American Concrete Institute, Farmington Hills, Michigan, USAArslan MH, Korkmaz HH (2007) What is to be learned from damage and failure of reinforced concrete structures during recent earthquakes in Turkey? Eng Fail Anal 14(1):1–22ASCE (2007) Seismic Rehabilitation of Existing Buildings, ASCE/SEI 41-06. American Society of Civil Engineers, RestonASCE (2010) Minimum Design Loads for Building and Other Structures, ASCE/SEI 7-10. American Society of Civil Engineers, RestonBenavent-Climent A (2007) Seismic behavior of RC side beam-column connections under dynamic loading. J Earthquake Eng 11:493–511Benavent-Climent A, Zahran R (2010) An energy-based procedure for the assessment of seismic capacity of existing frames: application to RC wide beam systems in Spain. Soil Dyn Earthq Eng 30:354–367Benavent-Climent A, Cahís X, Zahran R (2009) Exterior wide beam-column connections in existing RC frames subjected to lateral earthquake loads. Eng Struct 31:1414–1424Benavent-Climent A, Cahís X, Vico JM (2010) Interior wide beam-column connections in existing RC frames subjected to lateral earthquake loading. Bull Earthq Eng 8:401–420BHRC (2004) Iranian Code of Practice for Seismic Resistant Design of Buildings. Standard Nº 2800, 3rd edn. Building and Housing Research Center, TehranBorzi B, Elnashai AS (2000) Refined force reduction factors for seismic design. Eng Struct 22:1244–1260Borzi B, Pinho R, Crowley H (2008) Simplified pushover-based vulnerability analysis for large-scale assessment of RC buildings. Eng Struct 30:804–820BSI (2004) Eurocode 2: Design of concrete structures: Part 1-1: General rules and rules for buildings. British Standards Institutions, LondonCalvi GM (1999) A displacement-based approach for vulnerability evaluation of classes of buildings. J Earthquake Eng 3(3):411–438CDSC (1994) Seismic construction code, NCSR-94. Committee for the Development of Seismic Codes, Spanish Ministry of Construction, Madrid, Spain (in Spanish)CDSC (2002) Seismic construction code, NCSE-02. Committee for the Development of Seismic Codes, Spanish Ministry of Construction, Madrid, Spain (in Spanish)CEN (2004) Eurocode 8: design of structures for earthquake resistance—part 1: general rules, seismic actions and rules for buildings. European Standard EN 1998-1:2003—Comité Européen de Normalisation, Brussels, BelgiumCEN (2005) Eurocode 8: design of structures for earthquake resistance—part 3: assessment and retrofitting of buildings. European Standard EN 1998-1:2005—Comité Européen de Normalisation, Brussels, BelgiumCheung PC, Paulay T, Park R (1991) Mechanisms of slab contributions in beam-column subassemblages. ACI Spec Publ 123Cosenza E, Manfredi G, Polese M, Verderame GM (2005) A multilevel approach to the capacity assessment of existing RC buildings. J Earthquake Eng 9(1):1–22Crowley H, Pinho R (2010) Revisiting Eurocode 8 formulae for periods of vibration and their employment in linear seismic analysis. Earthquake Eng Struct Dynam 39:223–235CS.LL.PP (2009) Instructions for the application of the technique code for the Constructions. Official Gazette of the Italian Republic, 47, Regular Supplement no. 27 (in Italian)De Luca F, Vamvatsikos D, Iervolino I (2013) Near-optimal piecewise linear fits of static pushover capacity curves for equivalent SDOF analysis. Earthquake Eng Struct Dynam 42(4):523–543De Luca F, Verderame GM, Gómez-Martínez F, Pérez-García A (2014) The structural role played by masonry infills on RC building performances after the 2011 Lorca, Spain, earthquake. Bull Earthq Eng 12(5):1999–2026Decanini LD, Mollaioli F (2000) Analisi di vulnerabilità sismica di edifici in cemento armato pre-normativa. In: Cosenza E (ed) Comportamento sismico di edifici in cemento armato progettati per carichi verticali. CNR—Gruppo Nazionale per la Difesa dei Terremoti, Rome (in Italian)Dolšek M, Fajfar P (2004) IN2—a simple alternative for IDA. In: Proceedings of the 13th World conference on Earthquake Engineering. August 1–6, Vancouver, Canada. Paper 3353Domínguez D, López-Almansa F, Benavent-Climent A (2014) Comportamiento para el terremoto de Lorca de 11-05-2011, de edificios de vigas planas proyectados sin tener en cuenta la acción sísmica. Informes de la Construcción 66(533):e008 (in Spanish)Domínguez D, López-Almansa F, Benavent-Climent A (2016) Would RC wide-beam buildings in Spain have survived Lorca earthquake (11-05-2011)? Eng Struct 108:134–154Dönmez C (2013) Seismic Performance of Wide-Beam Infill-Joist Block RC Frames in Turkey. J Perform Constr Facil 29(1):04014026Fadwa I, Ali TA, Nazih E, Sara M (2014) Reinforced concrete wide and conventional beam-column connections subjected to lateral load. Eng Struct 76:34–48Fardis MN (2009) Seismic design, assessment and retrofitting of concrete, Buildings edn. Springer, LondonGentry TR, Wight JK (1992) Reinforced concrete wide beam-column connections under earthquake-type loading. Report no. UMCEE 92-12. Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USAGómez-Martínez F (2015) FAST simplified vulnerability approach for seismic assessment of infilled RC MRF buildings and its application to the 2011 Lorca (Spain) earthquake. Ph.D. Thesis, Polytechnic University of Valencia, SpainGómez-Martínez F, Pérez García A, De Luca F, Verderame GM (2015a) Comportamiento de los edificios de HA con tabiquería durante el sismo de Lorca de 2011: aplicación del método FAST. Informes de la Construcción 67(537):e065 (in Spanish)Gómez-Martínez F, Pérez-García A, Alonso Durá A, Martínez Boquera A, Verderame GM (2015b) Eficacia de la norma NCSE-02 a la luz de los daños e intervenciones tras el sismo de Lorca de 2011. In: Proceedings of Congreso Internacional sobre Intervención en Obras Arquitectónicas tras Sismo: L’Aquila (2009), Lorca (2011) y Emilia Romagna (2012), May 13–14, Murcia, Spain (in Spanish)Gómez-Martínez F, Verderame GM, De Luca F, Pérez-García A, Alonso-Durá, A (2015c). High ductility seismic performances of wide-beam RC frames. In; XVI Convegno ANIDIS. September 13–17, L'Aquila, ItalyHawkins NM, Mitchell D (1979) Progressive collapse of flat plate structures. ACI J 76(7):775–808Iervolino I, Manfredi G, Polese M, Verderame GM, Fabbrocino G (2007) Seismic risk of RC building classes. Eng Struct 29(5):813–820Inel M, Ozmen HB, Akyol E (2013) Observations on the building damages after 19 May 2011 Simav (Turkey) earthquake. Bull Earthq Eng 11(1):255–283Kurose Y, Guimaraes GN, Zuhua L, Kreger ME, Jirsa JO (1991) Evaluation of slab-beam-column connections subjected to bidirectional loading. ACI Spec Publ 123:39–67LaFave JM, Wight JK (1997) Behavior of reinforced exterior wide beam-column-slab connections subjected to lateral earthquake loading. Report no. UMCEE 97-01. Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USALaFave JM, Wight JK (1999) Reinforced concrete exterior wide beam-column-slab connections subjected to lateral earthquake loading. ACI Struct J 96(4):577–586LaFave JM, Wight JK (2001) Reinforced concrete wide-beam construction vs. conventional construction: resistance to lateral earthquake loads. Earthq Spectra 17(3):479–505Li B, Kulkarni SA (2010) Seismic behavior of reinforced concrete exterior wide beam-column joints. J Struct Eng (ASCE) 136(1):26–36López-Almansa F, Domínguez D, Benavent-Climent A (2013) Vulnerability analysis of RC buildings with wide beams located in moderate seismicity regions. Eng Struct 46:687–702Masi A, Santarsiero G, Nigro D (2013a) Cyclic tests on external RC beam-column joints: role of seismic design level and axial load value on the ultimate capacity. J Earthquake Eng 17(1):110–136Masi A, Santarsiero G, Mossucca A, Nigro D (2013b) Seismic behaviour of RC beam-column subassemblages with flat beam. In: Proceedings of XV Convegno della Associazione Nazionale Italiana di Ingegneria Sismica, ANIDIS. Padova, ItalyMazzolani FM, Piluso V (1997) Plastic design of seismic resistant steel frames. Earthquake Eng Struct Dynam 26:167–191MEPP (2000a) Greek earthquake resistant design code, EAK 2000. Ministry of Environment, Planning and Public Works, AthensMEPP (2000b) Greek code for the design and construction of concrete works, EKOS 2000. Ministry of Environment, Planning and Public Works, Athens (in Greek)Miranda E, Bertero VV (1994) Evaluation of strength reduction factors for earthquake-resistant design. Earthq Spectra 10(2):357–379MPWS (2007) Specifications for buildings to be built in seismic areas. Turkish Standards Institution, Ministry of Public Works and Settlement, Ankara (in Turkish)Mwafy AM, Elnashai AS (2002) Calibration of force reduction factors of RC buildings. J Earthquake Eng 6(2):239–273NZS (2004) Structural design actions. Part 5: earthquake actions, NZS 1170.5. New Zealand Standards, WellingtonNZS (2006) Concrete structures standard: part 1—the design of concrete structures, NZS 3101 part 1. New Zealand Standards, WellingtonPan A, Moehle JP (1989) Lateral displacement ductility of reinforced concrete flat plates. ACI Struct J 86(3):250–258Panagiotakos TB, Fardis MN (2001) Deformations of reinforced concrete members at yielding and ultimate. ACI Struct J 98(2):135–148 [and Appendix 1 (69 pp)]Paulay T, Priestley MJN (1992) Seismic design of concrete and masonry structures. Wiley, New York, USAQuintero-Febres CG, Wight JK (1997) Investigation on the seismic behavior of RC interior wide beam-column connections. Report no. UMCEE 97-15. Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan, USAQuintero-Febres CG, Wight JK (2001) Experimental study of Reinforced concrete interior wide beam-column connections subjected to lateral loading. 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Mesoscopic effects in an agent-based bargaining model in regular lattices

The effect of spatial structure has been proved very relevant in repeated games. In this work we propose an agent based model where a fixed finite population of tagged agents play iteratively the Nash demand game in a regular lattice. The model extends the multiagent bargaining model by Axtell, Epstein and Young [1] modifying the assumption of global interaction. Each agent is endowed with a memory and plays the best reply against the opponent’s most frequent demand. We focus our analysis on the transient dynamics of the system, studying by computer simulation the set of states in which the system spends a considerable fraction of the time. The results show that all the possible persistent regimes in the global interaction model can also be observed in this spatial version. We also find that the mesoscopic properties of the interaction networks that the spatial distribution induces in the model have a significant impact on the diffusion of strategies, and can lead to new persistent regimes different from those found in previous research. In particular, community structure in the intratype interaction networks may cause that communities reach different persistent regimes as a consequence of the hindering diffusion effect of fluctuating agents at their borders.Spanish Ministry of Science and Innovation, references TIN2008-06464-C03-02 and CSD2010-00034 (CONSOLIDER-INGENIO 2010), and by the Junta de Castilla y Leon, references VA006A009, BU034A08 and GREX251-200

Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies

IntroductionOn March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. ObjectiveTo conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. ResultsAutonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. ConclusionSymptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease