Showing papers by "Félix Gutiérrez published in 2022"
TL;DR: Patients with 1-year duration long-COVID-19 syndrome exhibit a distinct immunologic phenotype that includes a poorer SARS-CoV-2 antibody response, low-degree chronic inflammation that tends to mitigate, and autoimmunity.
Abstract: Background The pathophysiology of long-COVID remains unknown, and information is particularly limited for symptoms of very long duration. We aimed to assess the serological, T-cell immune responses and ANA titers of patients with long-COVID-19 syndrome of 1-year duration. Methods Prospective, longitudinal study of hospitalized COVID-19 patients followed-up for 12 months. Sequential blood samples and COVID-19 symptom questionnaires (CSQ) were obtained, and humoral and cellular immune responses, antinuclear antibodies (ANA) and inflammation biomarkers were analyzed. Results Of 154 patients discharged from hospital, 72 non-vaccinated with available CSQ in all visits were included. Of them, 14 (19.4%) reported persistent symptoms both at 6-months and 12-months, mainly asthenia (15.3%), myalgia (13.9%), and difficulty concentrating/memory loss (13.9%). Symptomatic patients were more frequently women, smokers, showed higher WHO severity score, and a trend to higher ICU admission. In the adjusted analysis, long-COVID syndrome was associated with lower frequency of detectable neutralizing antibodies (adjusted hazard ratio [aHR] 0.98; 95% confidence interval [CI], 0.97-0.99) and lower SARS-CoV-2-S1/S2 titers (aHR [95%CI] 0.14 [0.03–0.65]). T-cell immune response measured with a SARS-CoV-2-interferon-γ release assay was not different between groups. There was a higher frequency of positive ANA titers (≥160) in symptomatic patients (57.1% vs 29.3%, p=0.04), that was attenuated after adjustment aHR [95% CI] 3.37 [0.84-13.57], p=0.087. Levels of C-reactive protein and D-dimer were higher during follow-up in symptomatic patients, but with no differences at 12 months. Conclusion Patients with 1-year duration long-COVID-19 syndrome exhibit a distinct immunologic phenotype that includes a poorer SARS-CoV-2 antibody response, low-degree chronic inflammation that tends to mitigate, and autoimmunity.
14 citations
TL;DR: Remdesivir decreases the risk of mortality and need for IMV in patients with high viral loads and low-grade systemic inflammation and in patients receiving combined immunomodulatory therapy with dexamethasone and tocilizumab, differ depending on Ct and CRP.
Abstract: OBJECTIVES
To assess the benefits of remdesivir in hospitalized COVID-19 patients receiving combined immunomodulatory therapy (CIT) with dexamethasone and tocilizumab.
METHODS
This was a cohort study of microbiologically confirmed COVID-19 hospitalized patients. The primary outcome was all-cause 28 day mortality. Secondary outcomes were need for invasive mechanical ventilation (IMV) and IMV/death. Subgroup analyses according to SARS-CoV-2 cycle threshold (Ct) values and inflammation biomarkers were performed. Multivariable marginal structural Cox proportional hazards regression models were used to analyse the association between remdesivir therapy and the risk of outcomes of interest.
RESULTS
Of 1368 hospitalized patients treated with corticosteroids, 1014 (74%) also received tocilizumab, 866 (63%) remdesivir and 767 (56%) tocilizumab + remdesivir. The 28 day mortality was 9% in the overall cohort, with an adjusted HR (aHR) of 0.32 (95% CI = 0.17-0.59) for patients receiving CIT. In the latter group, the 28 day mortality was 6.5%, with an aHR of 1.11 (95% CI = 0.57-2.16) for remdesivir use and there were no differences in secondary outcomes. The risk of primary and secondary outcomes with remdesivir differed by Ct and C-reactive protein (CRP) levels in patients receiving CIT: for 28 day mortality, the aHR was 0.48 (95% CI = 0.21-1.11) for Ct <25, 0.12 (95% CI = 0.02-0.66) for Ct <25 and <5 day symptom duration and 0.13 (95% CI = 0.03-0.50) for CRP <38 mg/L; for IMV and IMV/death, the aHR was 0.32 (95% CI = 0.13-0.77) and 0.33 (95% CI = 0.17-0.63), respectively, in patients with Ct <25.
CONCLUSIONS
The benefits of remdesivir administered with dexamethasone and tocilizumab in hospitalized COVID-19 patients differ depending on Ct and CRP. Remdesivir decreases the risk of mortality and need for IMV in patients with high viral loads and low-grade systemic inflammation.
9 citations
TL;DR: Staying on 3DR was associated with a more favorable long-term inflammatory profile than switching to 2DR and the adjusted biomarker trajectories did not reveal a distinct pattern according to the type of 2DR used (bPI vs DTG).
Abstract: Background Because inflammation is associated with mortality and has been linked to HIV transcription in lymphoid tissues during ART, it is necessary to address the long-term effects of switching 3-drug (3DR) to 2-drug regimens (2DR) on inflammation. Methods Nested study in the Spanish AIDS Research Network. We selected PWH ART-naive initiating 3DR who achieved viral suppression in the first 48 weeks and either remained on 3DR or switched to 2DR (3TC+bPI; 3TC+DTG; DTG+RPV). We assessed the trajectories on inflammatory markers during ART using multivariate piecewise mixed models. Results We analyzed 619 plasma samples from 148 patients (3DR, N=90; 2DR, N=58), the median follow-up was 4.6 (IQR 3.2-6.2) years. There were no significant differences in baseline characteristics between groups. After adjusting for potential confounders, patients with 3DR experienced a slow decline of IL6, hs-CRP, sCD14, sCD163, and D-dimer over time. In contrast, compared to 3DR, switching to 2DR was associated with increases in IL-6 (p=0.001), hs-CRP (p=0.003), and D-dimer (p=0.001) after year 3 from virologic suppression. 2DR was associated with a higher risk of hs-CRP quartile increase (aOR 3.3, 95%CI 1.1-10) and D-dimer quartile increase (aOR 3.7, 95%CI 1.1-13). The adjusted biomarker trajectories did not reveal a distinct pattern according to the type of 2DR used (bPI vs DTG). Conclusions In this study in virally suppressed individuals, maintaining 3DR was associated with a more favorable long-term inflammatory profile than switching to 2DR. The potential clinical implications of these findings on the development of non-AIDS events deserve further investigation.
5 citations
TL;DR: In this paper , the effects of IL-6 blockade on long-term immunity to SARS-CoV-2 infection were investigated in patients hospitalized for severe or critical COVID-19 with laboratory confirmed SARS CoV2 infection.
4 citations
TL;DR: Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.
Abstract: The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47–3.15), fever (OR 4.31, 95% CI 2.87–6.47), cough (OR 1.89, 95% CI 1.28–2.80), asthenia/malaise (OR 2.04, 95% CI 1.38–3.03), dyspnea (4.69, 95% CI 3.00–7.33), confusion (OR 8.87, 95% CI 1.68–46.78), and a history of hypertension (OR 1.61, 95% CI 1.08–2.41) or immunosuppression (OR 4.97, 95% CI 1.45–17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80–1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.
3 citations
TL;DR: In this paper , the association of prediabetes with development of impaired renal function (IRF) was assessed using data from PREDAPS prospective study, where a cohort of 1072 subjects with pre-diabetes and another cohort of 772 subjects without pre-Diabetes were follow-up from 2012 to 2017.
Abstract: Abstract Prediabetes and not just diabetes can cause kidney damage. This study assess the association of prediabetes with development of impaired renal function (IRF). We used data from PREDAPS prospective study a cohort of 1072 subjects with prediabetes and another cohort of 772 subjects without prediabetes were follow-up from 2012 to 2017. Prediabetes was defined according to American Association of Diabetes criteria. IRF was defined as having a glomerular filtration rate < 60 mL/min/1.73 m 2 . Incidence rates of IRF in both cohorts and in different categories of prediabetes, based on impaired glycosylated hemoglobin (HbA1c) and/or fasting plasma glucose (FPG), were calculated. Hazard ratios (HR) for the association of the prediabetes with IRF, adjusting for potential confounders, were estimated by Cox regression models. Incidence rates of IRF per 100 person-years were 1.72 (95% confidence interval [CI]: 1.34–2.21) and 1.79 (95%CI: 1.45–2.20) for those without and with prediabetes, respectively .The HR of IRF in subjects with prediabetes with respect to subjects without prediabetes was 0.76 (95% CI: 0. 54–1.07). Corresponding HRs for type of prediabetes was 0.68 (95%CI: 0.40–1.15) for those with both altered parameters, 0.68 (95%CI: 00.40–1.15) for those with only impaired HbA1c and 1.12 (95%CI: 0.68–1.85) for those with only impaired FPG. The present study reflects an overall trend towards a slightly decreased risk of IRF onset associated to prediabetes except for individuals with only isolated impaired FPG. Further studies are warranted to fully assess the renal progression of each group.
1 citations
TL;DR: In this article , the performance of FRAX and QFracture scoring systems to predict the occurrence of fragility fractures in a prospective cohort of 17,671 adults with human immunodeficiency virus (HIV) included in the HIV/AIDS research network (CoRIS) in Spain was assessed.
Abstract: Current guidelines recommend screening people with HIV (PWH) for bone disease using predictive tools developed for the general population, although data on PWH are scarce. In this study, we assessed the performance of FRAX and QFracture scoring systems to predict the occurrence of fragility fractures in a prospective cohort of 17,671 adults with human immunodeficiency virus (HIV) included in the HIV/AIDS research network (CoRIS) in Spain. The survival estimates of fragility fractures during follow-up were calculated and FRAX and QFracture scores were computed at cohort inclusion. For both tools, discriminatory measures and the observed-to-expected (O/E) ratios were assessed. During a follow-up time of 42,411.55 person-years, 113 fragility fractures were recorded. Areas under the curve were 0.66 [95% confidence interval (95% CI) 0.61-0.71] for FRAX and 0.67 (95% CI 0.62-0.73) for QFracture for major osteoporotic fractures, and 0.72 (95% CI 0.57-0.88) and 0.81 (95% CI 0.68-0.95) for hip fracture, respectively. The O/E was 1.67 for FRAX and 5.49 for QFracture for major osteoporotic fractures, and 11.23 for FRAX and 4.87 for QFracture for hip fractures. Moreover, O/E raised as the risk increased for both tools and in almost all age groups. When using the recommended assessment thresholds, <6% and 10% of major osteoporotic and hip fractures would have been identified, respectively. In conclusion, FRAX and QFracture displayed acceptable discrimination, although both tools significantly underestimated the risk of fragility fractures in PWH. The recommended assessment thresholds may not be appropriate for this population as they were unable to identify individuals with fragility fractures during follow-up.
TL;DR: In this article , the authors proposed specific criteria for diagnosis of acute cholangitis, which is a disease that occurs when a stricture or obstruction of the bile duct causes cholestasis and/or infection.
Abstract: Acute cholangitis is a disease that occurs when a stricture or obstruction of the bile duct causes cholestasis and/or infection. Biliary stricture or obstruction elevates the pressure in the biliary system and causes reflux of microorganisms or endotoxins from the infected bile into the systemic circulation, which induces a systemic inflammatory response. The Charcot triad provides high specificity, however, due to its low sensitivity (50-70%), it is very limited to make a diagnosis of cholangitis alone. Therefore, the most current guidelines suggest specific criteria for diagnosis. Antibiotic treatment is a fundamental pillar in the management of patients with cholangitis. The treatment must be carried out depending on the severity (grade I-III).
TL;DR: A 68-year-old male patient with clinical and immunohistochemical criteria for Langerhans cell histiocytosis with multisystem settlement with fatal outcome is diagnosed.
Abstract: Langerhans cell histiocytosis is a condition of exceptional onset characterized by a proliferative event of dendritic cells with mono or multisystem involvement that predominates in the pediatric population and is identified in a smaller proportion in adults. It has a clinical impact and variable prognosis according to its location and number of organs affected. A 68-year-old male patient with clinical and immunohistochemical criteria for Langerhans cell histiocytosis with multisystem settlement with fatal outcome. It is a very rare disease, it is not exclusive to the pediatric population, with little understood pathogenesis and does not have specific treatment. In adults, the clinical impact is more aggressive, with a poorer prognosis and greater short-term complications.
TL;DR: The lack of information about vaccines as well as the yellowing of the adverse effects has increased the population that refuses to be vaccinated, increasing morbidity and mortality.
Abstract: The Health Belief Model seeks an explanation for the lack of public participation in prevention programs; and as we get older, we are more exposed to different diseases, some of which, thanks to the development of vaccination schedules, can be prevented. However, due to the increase and dissemination of false beliefs, many people are against it. In March 2020, the WHO declares an emergency situation due to the number of COVID-19 cases, with high morbimortality rates affecting mainly the elderly, thus arising the need for a vaccine, generating beliefs towards it, either by ignorance, uncertainty and / or influence of third opinions, influencing its application. A total of 128 people were surveyed, of whom 50% were vaccinated and 50% were not; of those not vaccinated, they did not want to be vaccinated (45.7%) because of fear of adverse effects (32.7%), because they did not trust (26.5%), and because of lack of information (38.8%). On the other hand, of those vaccinated, 71.2% felt safer, 19.7% felt the same, and 9.1% felt less safe. The lack of information about vaccines as well as the yellowing of the adverse effects has increased the population that refuses to be vaccinated, increasing morbidity and mortality.
TL;DR: In this article , a literature search was conducted through digital platforms, in which twenty articles published during the years 2020 and 2021 were analyzed, in English and Spanish, related to anxiety during the COVID-19 pandemic, finding that the main factors that had a higher rate of causing anxiety were social isolation and concern about the economy, creating uncertainty about the health emergency being experienced.
Abstract: Anxiety is a central phenomenon that is most often characterized by a diffuse, unpleasant and vague feeling of apprehension, often accompanied by vegetative symptoms such as headache, diaphoresis, tachycardia, chest tightness and restlessness; symptoms often vary among individuals. Systematic review of articles was realized. A literature search was conducted through digital platforms. Twenty articles published during the years 2020 and 2021 were analyzed, in English and Spanish, related to anxiety during the COVID-19 pandemic. The increase in anxiety was observed as a result of the different factors that emerged from the COVID-19 pandemic; the effects on mental health, when exceeded, can have serious consequences both at the individual and societal levels. Some indicators are the public health measures, as the main factor is social distancing, misinformation and fear of contagion. However, the factor with the greatest increase in anxiety is credited to the economy, which has been affected in all countries, generating critical situations in companies around the world, unemployment and economic difficulties for most families and individuals. Based on what was observed in this analysis, it was found that there are different types of factors that trigger an increase in anxiety, however, the main factors that had a higher rate of causing anxiety were social isolation and concern about the economy, creating uncertainty about the health emergency being experienced.
TL;DR: In this article , the first case of tuberculous pericarditis caused by Mycobacterium africanum was reported in a 31-year-old man, native from Senegal, who came to the emergency room with massive perricardial effusion and cardiac tamponade requiring pericardiocentesis.
Abstract: Abstract Background Mycobacterium africanum is a member of the Mycobacterium tuberculosis complex (MTBC) and is endemic in West Africa, where it causes up to half of all cases of pulmonary tuberculosis. Here, we report the first isolation of Mycobacterium africanum from the pericardial effusion culture of a patient with tuberculous pericarditis. Case presentation A 31-year-old man, native from Senegal, came to the emergency room with massive pericardial effusion and cardiac tamponade requiring pericardiocentesis. M. africanum subtype II was identified in the pericardial fluid. The patient completed 10 months of standard treatment, with a favorable outcome. Conclusions We report the first case of tuberculous pericarditis caused by Mycobacterium africanum , which provide evidence that this microorganism can cause pericardial disease and must be considered in patients from endemic areas presenting with pericardial effusion.
TL;DR: HIV-1 RNA levels were longitudinally evaluated in 211 rectal and 152 seminal samples from 12 virologically-suppressed participants switching to monthly long-acting cabotegravir plus rilpivirine or continuing with daily dolute gravir-abacavir-lamivudine.
Abstract: HIV-1 RNA levels were longitudinally evaluated in 211 rectal and 152 seminal samples from 12 virologically-suppressed participants switching to monthly long-acting cabotegravir plus rilpivirine or continuing with daily dolutegravir-abacavir-lamivudine. Maintenance of viral suppression in rectal and seminal compartments was comparable and blips occurred with similar frequency with both treatment regimens.
TL;DR: It is essential to suspect the clinical course of DRESS syndrome before the appearance of dermatosis with multisystem involvement associated with the use of drugs, emphasis is placed on its early identification and the establishment of timely treatment to modify its prognosis.
Abstract: Among the most feared toxico-dermas is drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, a rare drug dermatitis that occurs after acute exposure to drugs whose clinical impact is based on multiple organs (skin, liver, kidneys, lungs, heart) and cell lines (eosinophils and lymphocytes). It is an entity with high mortality if it is not identified early, its treatment consists of the immediate suspension of the responsible drug and the administration of steroids, these being the therapeutic protagonists. A 64-year-old male patient with clinical, biochemical and histopathological criteria compatible with DRESS syndrome. It is essential to suspect the clinical course of DRESS syndrome before the appearance of dermatosis with multisystem involvement associated with the use of drugs, emphasis is placed on its early identification and the establishment of timely treatment to modify its prognosis.
TL;DR: In this paper , a semi-supervised system was proposed to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data, which was able to extract a good number of relationships between HIVrelated diseases that have been previously detected in the literature but are scattered and are often little known.
Abstract: Abstract Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS—so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts.
TL;DR: A 23-year-old man with Behçet's disease who debuts with clinically and histologically compatible dermatosis with KS and its immunomodulatory therapy.
Abstract: Kaposi's sarcoma (KS) is a malignant vascular neoplasm that typically appears opportunistically in patients with acquired immunodeficiency syndrome (AIDS); it can also arise in organ transplanted subjects and exceptionally in carriers of autoimmune diseases, such as Behçet's disease. A 23-year-old man with Behçet's disease who debuts with clinically and histologically compatible dermatosis with KS. Conclusions. KS is not exclusive to HIV-AIDS, it also prevails in situations of primary or secondary immunocompromision that favor its appearance, as is the case of Behçet's Disease and its immunomodulatory therapy.