Persistence and viability of SARS-CoV-2 in primary infection and reinfections.

Since the beginning of the SARS-CoV-2 epidemic, virus isolation in the infected patient was only possible for a short period of time and it was striking that this occurred constantly and did not provide guidance on the clinical course. This fact led to confusion about the efficacy of some of the drugs initially used, which seemed to have a high efficiency in viral clearance and proved ineffective in modifying the course of the disease. The immune response also did not prove to be definitive in terms of evolution, although most of the patients with very mild disease had a weak or no antibody response, and the opposite was true for the most severe patients. With whatever the antibody response, few cases have been re-infected after a first infection and generally, those that have, have not reproduced a spectrum of disease similar to the first infection. Among those re-infected, a large number have been asymptomatic or with very few symptoms, others have had a moderate picture and very few have had a poor evolution. Despite this dynamic of rapid viral clearance, laboratory tests were still able to generate positive results in the recovery of genomic sequences and this occurred in patients who were already symptom-free, in others who were still ill and in those who were very seriously ill. There was also no good correlate. For this reason and with the perspective of this year and the half of pandemic, we compiled what the literature leaves us in these aspects and anticipating that, as always in biology, there are cases that jump the limits of the general behavior of the dynamics of infection in general.post-print116 K

COVID-19: Some unresolved issues

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia.post-print462 K

New variants of SARS-CoV-2

The emergence and spread of new variants of SARS-CoV-2 has produced enormous interest due to their possible implication in the improved transmissibility of the virus, their consequences in the individual evolution of the infection, as well as in the possible escape from the immunity generated by the current vaccines. The variants that attract most attention are those of public health concern, including B.1.1.7 (UK), P.1 (Brazilian) and B.1.351 (South African). This list is extended by the variants of interest that emerge and are expanding in certain countries but are found sporadically in others, such as B.1.427 and B.1.429 (Californians) or B.1.617 (Indian). Whole genome sequencing or strategies specifically targeting the spicule gene are used in the microbiology laboratories for characterization and detection. The number of infected individuals, the sanitary situation of each country, epidemiological measures and vaccination strategies influence its dispersion and new variants are expected to emerge. This emergence can only be avoided today by increasing the vaccinated population in all countries and by not relaxing epidemiological containment measures. It is not excluded that in the future it will be necessary to revaccinate against new variants.post-print186 K

Actions and attitudes on the immunized patients against SARS-CoV-2

The access to COVID vaccines by millions of human beings and their high level of protection against the disease, both in its mild and severe forms, together with a plausible decrease in the transmission of the infection from vaccinated patients, has prompted a series of questions from the members of the College of Physicians of Madrid (ICOMEM) and the society. The ICOMEM Scientific Committee on this subject has tried to answer these questions after discussion and consensus among its members. The main answers can be summarized as follows: The occurrence of new SARS-CoV-2 infections in both vaccinated and previously infected patients is very low, in the observation time we already have. When breakthrough infections do occur, they are usually asymptomatic or mild and, purportedly, should have a lower capacity for transmission to other persons. Vaccinated subjects who have contact with a SARS-CoV-2 infected patient can avoid quarantine as long as they are asymptomatic, although this decision depends on variables such as age, occupation, circulating variants, degree of contact and time since vaccination. In countries with a high proportion of the population vaccinated, it is already suggested that fully vaccinated persons could avoid the use of masks and social distancing in most circumstances. Systematic use of diagnostic tests to assess the immune response or the degree of protection against reinfection after natural infection or vaccination is discouraged, since their practical consequences are not known at this time. The existing information precludes any precision regarding a possible need for future revaccination. This Committee considers that when mass vaccination of health care workers and the general population is achieved, SARS-CoV-2 screening tests could be avoided at least in out-patient care and in the case of exploratory procedures that do not require hospitalizatio

Vacunación anti-COVID-19: la realidad tras los ensayos clínicos.

Tras el comienzo de la vacunación frente a SARS-CoV-2, se está acumulando ya suficiente experiencia clínica, en el mundo real y fuera de los ensayos clínicos, para resolver algunas de las cuestiones que siguen pendientes sobre este problema. El Comité Científico sobre COVID-19 del Colegio de Médicos de Madrid ha discutido y revisado algunos de estos temas con una aproximación multidisciplinar. El documento que sigue es un intento de responder a algunas de dichas cuestiones con la información disponible hasta el momento. Este documento se ha estructurado en preguntas sobre distintos aspectos de las indicaciones, eficacia y tolerancia de la vacunación anti- COVID-19.post-print214 K

La vía intraperitoneal para la administración de insulina exógena

Tesis doctoral original inédita leída en la Universidad de Autónoma de Madrid, Facultad de Medicina. Fecha de lectura: 11 de julio de 198

Association between albuminuria and both office and 24 hours ambulatory blood pressure

Objective: Albuminuria has been linked more closely with blood pressure (BP) values in ambulatory blood pressure monitoring (ABPM) than with the BP in consultation. Our purpose was to analyse this association. Design and method: Observational, crossectional study in patients with EH. Albuminuria was calculated as the average of 2 determinations (turbidimetry). The office BP was determined as the average of 3 measurements and ABPM was performed with a SPACELAB monitor, mod. 90217. Results: We included a total of 1130 patients (50.3% male) with a mean age of 57 (14) years, 25% with type 2 DM. Office BP values were 147 (19)/81 (12) mm Hg and ABPM 133(15)/80 (10) mm Hg in the daytime and 121 (16)/70 (10) mm Hg in the night time. The mean values of albuminuria and eGFR-EPI-creatinine were 30 (121) mg/g creatinine and 84 (21) ml/min/1.73 m2, respectively. Albuminuria, adjusted for age and sex, was positively correlated with BMI (r = .075, p = 0.038), office SBP (r = .082, p = 0.024), office DBP (r = .073, p = 0.043), daytime SBP (r = .119, p = 0.001) and night time DBP (r = .094, p = 0.010) and negatively for eGFR-EPI-creatinine (r = -.104, p = 0.004). The ratio of night-time/day-time SBP and DBP was not correlated with albuminuria. There were no differences in albuminuria within patients classified as non-dipper vs. dipper neither for the SBP (32 vs. 27 mg./gr., respectively, p = 0.581) nor DBP (34 vs. 27 mg./ g., p = 0.386). In multivariate analysis the only independent determinants of albuminuria were daytime SBP (beta = 1.136, 95% CI .547–1.72, p < 0.0001) and BMI (beta = 1.80, 95% CI .082–3.52, p = 0.069). Conclusions: In our patients with EH, albuminuria was only associated, in addition to BMI, with the values of diurnal SBP in 24 h. Neither the night time BP values nor the pattern of nocturnal dipping showed this association. The 24-hour ABPM may well be a more effective tool than office BP for assessing this cardiovascular risk factor.Sin financiación5.062 JCR (2015) Q1, 9/63 Peripheral Vascular DiseaseUE