El género, un factor determinante en el riesgo de somnolencia

Los trastornos del sue˜no constituyen un grupo numeroso y heterogéneo de procesos. A nivel mundial se estima que la prevalencia de trastornos del sue˜no oscila entre 35 y 45% de la población adulta mayor de 18 a˜nos. Estudios previos realizados en la Cd de México han demostrado una somnolencia excesiva diurna en el 18%, de los cuales 19% fueron mujeres y 17% hombres por lo que el objetivo de este proyecto es detectar en una población adulta del valle de Toluca, el riesgo de somnolencia. Métodos: Se empleó un instrumento validado: escala de somnolencia de Epworth que tiene por objeto evaluar la magnitud de la somnolencia diurna frente a ocho situaciones de la vida diaria. Resultados: De los 227 sujetos analizados, se encontró que 76 de ellos (33.4%): 44 hombres (19.4% del total) y 27 mujeres (11.9% del total) tenían somnolencia excesiva. Se dividió a la población en dos grupos: mayores o iguales a 50 a˜nos de edad y 49 a˜nos o menos. Al comparar el riesgo Hombre-Mujer se encontró un valor de O.R. de 4.1 en los hombres de 50 a˜nos o más, mientras que en el género femenino fue de 1.0. Al establecer una separación con los sujetos que tenían entre 9 y 11 puntos de la escala de Epworth, se demostró que el riesgo seguía siendo elevado en OR = 4.0 Conclusiones: En la población estudiada el género masculino tiene un riesgo cuatro veces mayor que la mujer de presentar somnolencia excesiva diurna. © 2014 Universidad Autónoma del Estado de México. Publicado por Masson Doyma México S.A. Todos los derechos reservados

Monitoreo de la frecuencia cardiaca como indicador de la intensidad del entrenamiento en el futbolista profesional a 2 600 m sobre el nivel del mar

Resumen Introducción: Con el objetivo de analizar el comportamiento de la frecuencia cardiaca como indicador de la intensidad del entrenamiento en el futbolista profesional a 2 600 m sobre el nivel del mar. Materiales y métodos: Se realizó un estudio longitudinal, prospectivo de la temporada apertura 2017 y clausura 2018 del fútbol mexicano, con un análisis estadístico descriptivo con medidas de tendencia central y de dispersión, así como intervalos de confianza en un análisis de 2 328 monitoreos de la frecuencia cardiaca y distancia recorrida con el sistema de seguimiento por GPS Polar Team Pro y 111 monitoreos ambientales, con una duración aproximada de 120 minutos por sesión de entrenamiento. Resultados: Se llevaron a cabo 2 328 monitoreos con registros de frecuencia cardiaca en reposo, variabilidad de la frecuencia cardiaca (vfc), frecuencia cardiaca durante el entrenamiento y la recuperación; con 111 registros ambientales. Algunas de las variables propias del monitoreo de la frecuencia cardiaca durante el entrenamiento por la dinámica del mismo, como lo es, no seguir indicaciones o impuntualidad por el deportista; así como los tiempos propios marcados por el entrenador, falla del registro por desconexión del sensor, entre otras, hacen que algunos registros no sean valorables. Conclusiones: La frecuencia cardiaca de reposo permanece en los parámetros normales, la frecuencia cardiaca media de entrenamiento se encuentra en zona 2 de control de peso entre el 60-70% de la frecuencia cardiaca máxima, y la frecuencia cardiaca máxima de esfuerzo dentro de la zona 5 de alta intensidad, mientras que la frecuencia cardiaca mínima se ubica por debajo de la zona 1 de actividad regenerativa que va de un 50-60% de la frecuencia cardiaca máxima. Abstract Introduction: The purpose of this study is to analyze the behavior of the cardiac variability as an indicator of the training intensity in football players at 2600mts altitude above sea level. Methods: This was a longitudinal and prospective study of the 2017-2018 Mexican football seasons, with a descriptive analysis and central tendency on dispersion measurements as confidence intervals. These intervals consisted of 2328 heart rate cardiac monitorizations,traveled distance with the Polar Team Pro GPS tracking system and 111 environmental monitorizations, with each training session length of 120 minutes approximately. Results: After making 2328 monitorizations the following measures were obtained: resting heart rate, heart rate variability (hrv), heart rate during training and recovery sessions amongst 111 environmental registrations. Some variables of the heart rate monitorization records during the training session couldn´t be measured or valued such as not following instructions, football players running late, the coach training marked times, and the cardiac monitor connection errors. Conclusions: The resting heart rate is between the normal parameters. The medium heart rate is between 60-70% of the maximum heart rate of the second zone of weight control. The maximum heart rate posterior to the effort is in the fifth zone of high intensity, meanwhile the minimum heart rate is below the first zone of regenerative activity that corresponds from 50-60% of the maximum heart rate

Monitoreo de la frecuencia cardiaca como indicador de la intensidad del entrenamiento en el futbolista profesional a 2 600 m sobre el nivel del mar

Resumen Introducción: Con el objetivo de analizar el comportamiento de la frecuencia cardiaca como indicador de la intensidad del entrenamiento en el futbolista profesional a 2 600 m sobre el nivel del mar. Materiales y métodos: Se realizó un estudio longitudinal, prospectivo de la temporada apertura 2017 y clausura 2018 del fútbol mexicano, con un análisis estadístico descriptivo con medidas de tendencia central y de dispersión, así como intervalos de confianza en un análisis de 2 328 monitoreos de la frecuencia cardiaca y distancia recorrida con el sistema de seguimiento por GPS Polar Team Pro y 111 monitoreos ambientales, con una duración aproximada de 120 minutos por sesión de entrenamiento. Resultados: Se llevaron a cabo 2 328 monitoreos con registros de frecuencia cardiaca en reposo, variabilidad de la frecuencia cardiaca (vfc), frecuencia cardiaca durante el entrenamiento y la recuperación; con 111 registros ambientales. Algunas de las variables propias del monitoreo de la frecuencia cardiaca durante el entrenamiento por la dinámica del mismo, como lo es, no seguir indicaciones o impuntualidad por el deportista; así como los tiempos propios marcados por el entrenador, falla del registro por desconexión del sensor, entre otras, hacen que algunos registros no sean valorables. Conclusiones: La frecuencia cardiaca de reposo permanece en los parámetros normales, la frecuencia cardiaca media de entrenamiento se encuentra en zona 2 de control de peso entre el 60-70% de la frecuencia cardiaca máxima, y la frecuencia cardiaca máxima de esfuerzo dentro de la zona 5 de alta intensidad, mientras que la frecuencia cardiaca mínima se ubica por debajo de la zona 1 de actividad regenerativa que va de un 50-60% de la frecuencia cardiaca máxima. Abstract Introduction: The purpose of this study is to analyze the behavior of the cardiac variability as an indicator of the training intensity in football players at 2600mts altitude above sea level. Methods: This was a longitudinal and prospective study of the 2017-2018 Mexican football seasons, with a descriptive analysis and central tendency on dispersion measurements as confidence intervals. These intervals consisted of 2328 heart rate cardiac monitorizations,traveled distance with the Polar Team Pro GPS tracking system and 111 environmental monitorizations, with each training session length of 120 minutes approximately. Results: After making 2328 monitorizations the following measures were obtained: resting heart rate, heart rate variability (hrv), heart rate during training and recovery sessions amongst 111 environmental registrations. Some variables of the heart rate monitorization records during the training session couldn´t be measured or valued such as not following instructions, football players running late, the coach training marked times, and the cardiac monitor connection errors. Conclusions: The resting heart rate is between the normal parameters. The medium heart rate is between 60-70% of the maximum heart rate of the second zone of weight control. The maximum heart rate posterior to the effort is in the fifth zone of high intensity, meanwhile the minimum heart rate is below the first zone of regenerative activity that corresponds from 50-60% of the maximum heart rate

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease