Fisiopatología de la hipertensión arterial: ¿Qué hay de nuevo?

Hypertension (HT) represents the leading cause of cardiovascular disease and premature death globally. Knowledge regarding the pathogenesis of HT has greatly grown; nevertheless, obscure areas remain concerning this topic. At present, multiple renal, neurologic, endocrine, immunologic, and cardiovascular mechanisms are known to affect cardiovascular homeostasis, generating an intricate and complex conglomerate of pathophysiologic mechanisms. Despite advancements in recent years, the current pharmacological armamentarium remains insufficient for the management of all patients. Likewise, recent research concentrates on the identification of premorbid mechanisms, intending to identify therapeutic targets to delay the onset of HT as much as possible in high-risk populations. The objective of this review is to evaluate novel finding regarding the origin of HT, aiming to offer new mechanisms of intervention for future pharmacologic and non-pharmacologic therapeutic strategies.La hipertensión arterial (HTA) representa la causa líder de enfermedad cardiovascular y muerte prematura globalmente. El conocimiento en relación a la patogénesis de la HTA se ha enriquecido ampliamente; no obstante, siguen existiendo puntos oscuros en relación a dicho tópico. En la actualidad, se acepta que existen múltiples mecanismos renales, neurológicos, endocrinos, inmunológicos y cardiovasculares que pueden afectar la homeostasis cardiovascular, generando un intrincado y complejo conglomerado de mecanismos fisiopatológicos. A pesar de los avances en años recientes, el acervo farmacológico actual sigue siendo insuficiente para el manejo de la totalidad de los pacientes. Además, las investigaciones más actuales se concentran en la definición de mecanismos premórbidos, con la intención de identificar puntos terapéuticos para retrasar la aparición de la HTA tanto como sea posible en poblaciones de riesgo. El objetivo de esta revisión es evaluar los nuevos hallazgos en relación al origen de la HTA, con la finalidad de ofrecer nuevos mecanismos de intervención para futuras estrategias terapéuticas de índole farmacológica o no farmacológica

Adynaton 4

Revista de narrativa y poesía escrita en los talleres literarios de CETYS Universidad.Adynaton es una revista del Círculo de Letras de CETYS Universidad

Long-term safety of COVID vaccination in individuals with idiopathic inflammatory myopathies: results from the COVAD study

Limited evidence on long-term COVID-19 vaccine safety in patients with idiopathic inflammatory myopathies (IIMs) continues to contribute to vaccine hesitancy. We studied delayed-onset vaccine adverse events (AEs) in patients with IIMs, other systemic autoimmune and inflammatory disorders (SAIDs), and healthy controls (HCs), using data from the second COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. A validated self-reporting e-survey was circulated by the COVAD study group (157 collaborators, 106 countries) from Feb-June 2022. We collected data on demographics, comorbidities, IIM/SAID details, COVID-19 history, and vaccination details. Delayed-onset (> 7 day) AEs were analyzed using regression models. A total of 15165 respondents undertook the survey, of whom 8759 responses from vaccinated individuals [median age 46 (35-58) years, 74.4% females, 45.4% Caucasians] were analyzed. Of these, 1390 (15.9%) had IIMs, 50.6% other SAIDs, and 33.5% HCs. Among IIMs, 16.3% and 10.2% patients reported minor and major AEs, respectively, and 0.72% (n = 10) required hospitalization. Notably patients with IIMs experienced fewer minor AEs than other SAIDs, though rashes were expectedly more than HCs [OR 4.0; 95% CI 2.2-7.0, p < 0.001]. IIM patients with active disease, overlap myositis, autoimmune comorbidities, and ChadOx1 nCOV-19 (Oxford/AstraZeneca) recipients reported AEs more often, while those with inclusion body myositis, and BNT162b2 (Pfizer) recipients reported fewer AEs. Vaccination is reassuringly safe in individuals with IIMs, with AEs, hospitalizations comparable to SAIDs, and largely limited to those with autoimmune multimorbidity and active disease. These observations may inform guidelines to identify high-risk patients warranting close monitoring in the post-vaccination period

COVAD survey 2 long-term outcomes: unmet need and protocol

Vaccine hesitancy is considered a major barrier to achieving herd immunity against COVID-19. While multiple alternative and synergistic approaches including heterologous vaccination, booster doses, and antiviral drugs have been developed, equitable vaccine uptake remains the foremost strategy to manage pandemic. Although none of the currently approved vaccines are live-attenuated, several reports of disease flares, waning protection, and acute-onset syndromes have emerged as short-term adverse events after vaccination. Hence, scientific literature falls short when discussing potential long-term effects in vulnerable cohorts. The COVAD-2 survey follows on from the baseline COVAD-1 survey with the aim to collect patient-reported data on the long-term safety and tolerability of COVID-19 vaccines in immune modulation. The e-survey has been extensively pilot-tested and validated with translations into multiple languages. Anticipated results will help improve vaccination efforts and reduce the imminent risks of COVID-19 infection, especially in understudied vulnerable groups

COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study

Objectives: We investigated COVID-19 vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Methods: Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares (DF), and AID-related treatment modifications were analyzed upon diagnosis of AID versus healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine. Results: Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, p= 0.01; minor AE 40% vs 25.9%, p= 0.03; major AE 17.5% vs 4.6%, p< 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a DF were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively. Conclusion: This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and the fetus by passive immunization appear to outweigh potential risks