Epidemiologia de la viruela del mono, complicaciones a comorbilidades, sintomatología y diagnóstico de laboratorio.

Monkeypox is an emerging disease caused by a double-stranded deoxyribonucleic acid virus, of the Orthopoxvirus genus, of the Poxviridae family, Chordopoxvirinae subfamily, which is gaining worldwide importance as cases are re-emerging in non-endemic countries of this disease, with percentages of prevalence, incidence and mortality not so high, but somewhat worrisome due to the pandemic potential that this disease has and that causes typical symptoms and in the case of patients with existing comorbidities it can cause serious complications. The objective is to describe the epidemiology of monkeypox, its complications and comorbidities, symptoms and laboratory diagnosis. Its methodological design is a descriptive systematic review where a search for articles and scientific journals was carried in databases such as Pubmed, Scielo, Elsevier, Redalyc, Latindex that have analyzed the parameters of our study, scientific articles in Spanish, English and Portuguese were taken into consideration, that corresponded to the study period within the last 6 years between 2017 and 2023. The results indicate low rates in prevalence with 8.1%, incidence with 0.62% and mortality with 1% of the disease and that they can present multiple complications such as encephalomyelitis, high fever, bloody scabs, headaches in the course of the infection, it is concluded that great advances are being made in the epidemiological study, as well as in the detection tests of this disease and it is advancing immunization worldwide.  La viruela del mono es una enfermedad emergente ocasionada por un virus de doble cadena de ácido desoxirribonucleico, del género Orthopoxvirus, de la familia Poxviridae, subfamilia Chordopoxvirinae, que está consiguiendo importancia mundial al estar resurgiendo casos en países no endémicos de esta enfermedad, con porcentajes de prevalencia, incidencia y mortalidad no tan elevados, pero de cierta manera preocupantes debido al potencial pandémico que esta enfermedad posee y que causa una sintomatología típica y en caso de pacientes con comorbilidades existentes puede causar complicaciones graves. El objetivo es describir sobre la epidemiologia de la viruela del mono, sus complicaciones a comorbilidades, sintomatología y diagnóstico de laboratorio. Su diseño metodológico es de revisión sistemática de tipo descriptiva donde se realizó una búsqueda de artículos y trabajos científicos en bases de datos como Pubmed, Scielo, Elsevier, Redalyc, Latindex que hayan analizado los parámetros de nuestro estudio, se tomaron en consideración artículos en español, inglés y portugués que correspondían al periodo de estudio dentro de los últimos 6 años comprendidos entre el 2017 y 2023. Los resultados indican índices bajos en la prevalencia con 8,1%, incidencia con 0,62% y mortalidad con el 1% de la enfermedad y que pueden presentarse múltiples complicaciones como encefalomielitis, fiebre elevada, costras sanguinolentas, cefaleas en el curso de la infección, se concluye que se están logrando grandes avances en el estudio epidemiológico, así como en las pruebas de detección de esta enfermedad y se está avanzando en la inmunización a nivel mundial

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk