Since its molecular isolation on January 7, 2020, the new SARS-CoV-2 coronavirus has spread rapidly, affecting regions such as Latin America. Ecuador received the worst outbreak globally if we count excess mortality per capita. This study describes the clinical, epidemiological and therapeutic characteristics of 89 patients admitted to an intensive care unit (ICU) in a second-level hospital in Quito, Ecuador. Methods: We conducted a retrospective cohort study. We collected data from health records of adult patients with severe COVID-19 admitted to an ICU in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak. We used the Chi-square test or Fisher's exact statistics to analyze risk and associations between survivors and non-survivors. We used ROC curve analysis to predict mortality and determine cut-off points for mechanical, analytical, and cytometric ventilation parameters. We used the Wald test to evaluate the categorical predictors of the model at the multivariate level during the regression analysis. Results: 89 patients were recruited. The mean age of the patients was 54.72 years. Men represented 68.54% (n=61) and women 31.46% (n=28). Significant differences in mortality were observed (men 40.98% vs. women 17.76%). LDH and IL-6 at 24 hours after hospital admission were higher among non-survivors than survivors. Persistent hypercapnia (PaCO2 >45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and positive end-expiratory pressure (PEEP) titration >9 mmHg were also associated with increased mortality. Conclusions: Elevated levels of LDH at 24 hours, IL-6 at 24 hours, lymphocyte and platelet count at 48 hours, neutrophil count at 48 hours and NLR are factors associated with higher motility, higher risk of failed extubation and reintubation in patients with acute respiratory distress syndrome due to COVID-19.

No abstract

Choque es una patología clínica aguda caracterizada por un desbalance entre la disponibilidad y el consumo de oxígeno a nivel celular, pudiendo llegar a un punto crítico llamado hipoxia tisular, de no corregir el trastorno primario puede causar disfunción multiorganica y la muerte del paciente, de ahí el interés de encontrar un biomarcador que refleje este complejo proceso. El ácido láctico o lactato en la actualidad corresponde el marcador de perfusión celular más utilizado en las unidades de terapia intensiva debido a la superioridad predictiva como marcador de mal pronóstico confirmada en estudios clínicos versus otros marcadores tradicionales en todos los tipos de choque. El lactato ha demostrado una buena relación con mayor mortalidad con una única medición inicial en el contexto de falla circulatoria, poder predictivo de mayor mortalidad de no existir una disminución del 10% en relación al lactato inicial a las 6 horas de reanimación y más importante una guía de reanimación temprana, probablemente no es el biomarcador ideal al ser considerado más una sustancia química producto del metabolismo intermedio vital como fuente de energía en un contexto de hipoxia tisular, que un biomarcador de lesión o disfunción celular. Sin embargo su poder predictivo lo hace un marcador digno de un estudio y entendimiento profundo.

In human clinics, pathologies as diverse as cancer, sepsis, autoimmune diseases, among others; of different etiology and a different pathophysiological behavior, converge in a failure of gene repression that allows the phenotypic expression of the disease; The possibility of having a biological marker that shows these events to the clinician is desirable since it would allow early diagnostic and therapeutic strategies. Micro RNAs are small and non-coding RNAs that fulfill that “genetic silencing” role, however, the step from basic research to clinical applicability, that is, their translational utility is still little diffused in specialties other than oncology. The objective of this review is to explain in a more precise way.

Background Since its molecular isolation on January 7, 2020, the novel coronavirus SARS-CoV-2 has spread rapidly, taking governments worldwide off-guard. The virus arrived in low and middle-income countries violently, especially in Latin America. Ecuador received the worst outbreak in the world if we count excess mortality per capita. Although one study has reported the epidemiological impact of COVID-19 in Ecuador, there is no clinical course or outcome data among intensive care patients with COVID-19 in Ecuador. This study describes the clinical, epidemiological, and therapeutical features of 89 patients hospitalized in a secondary-level hospital in Quito, Ecuador. Methods We did a retrospective cohort study. We collected health records data from adult patients with severe COVID-19 admitted to the intensive care unit (ICU) in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak in Ecuador. All patients had a confirmed SARS-CoV-2 RNA infection diagnostic, a positive real-time RT-PCR, and pulmonary imaging suggesting COVID-19. We used the Chi-square test or a Fisher's exact statistic to analyze risk and associations between survivors and non-survivors due to COVID-19. We used the ROC curve analysis to predict mortality, determining cut-off points for the parameters related to mechanical, analytical, and cytometry ventilation. At the multivariate level, we used the Wald test to evaluate model categorical predictors during the regression analysis. Results 89 patients with COVID-19 were recruited during the study. The average age of the patients was 54.72 years. Man represented 68.54% (n = 61) and women 31,46% (n = 28). Significant differences were observed in terms of mortality (men 40.98% vs. women 17.76%). Serological parameters demonstrated that LDH and IL-6 at 24 hours were higher among non-survivors when compared with survivors. Persistent hypercapnia ( > > 45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and a positive end-expiratory pressure (PEEP) titration greater than nine mmHg were also associated with higher mortality. Conclusions Increased levels of LDH at 24 hours, IL-6, the lymphocyte and platelet count at 48 hours, the neutrophil count at 48 hours, and the INL are factors associated with higher motility, increased risk of failed extubation and reintubation

La sepsis es una entidad potencialmente mortal a causa de la disfunción multiorgánica que genera una respuesta alterada del huésped frente a la infección y que culmina, luego de varios procesos, en un estado de inmunosupresión. Hoy en día, existen varias estrategias de manejo de la sepsis para disminuir el impacto multisistémico y mejorar la supervivencia, pero ninguna ha mostrado una clara eficacia. Es por esto que los últimos estudios se centran en aclarar y buscar alternativas terapéuticas basadas en el análisis de la fisiopatología molecular, con la finalidad de entrar en un periodo tardío de inmunosupresión continúa, conocida también como parálisis inmune. La apoptosis es un mecanismo molecular y fisiológico, cuya homeostasis es alterada en presencia de sepsis y que elimina células clave de la inmunidad innata y adaptativa, lo que conlleva a un mayor riesgo de infección secundaria, muchas veces fatal. Varios estudios post mortem han confirmado que la apoptosis de las células inmunes inducida por sepsis es un factor protagonista en la génesis de la inmunosupresión relacionada a la sepsis. Se cree que las estrategias terapéuticas dirigidas a regular la apoptosis podrían mejorar la supervivencia. Este es un artículo de revisión que describirá el rol fisiopatológico del fenómeno apoptótico en la sepsis y su repercusión en la evolución de esta entidad.

La mitocondria es una organela compleja, su función principal es producir energía en forma de ATP, esencial para la vida. Semiautónoma ya que posee ADNmt capaz de producir algunas proteínas principales de la cadena respiratoria. Alteraciones en la fisiología enzimática por inhibición de estas estructuras pueden explicar las alteraciones en el consumo de oxígeno “hipoxia citopática” en sepsis. Además, se ha demostrado que sus componentes son productores de respuesta inflamatoria desregulada al tener en su estructura DAMPs potentes como el ADNmt y el citocromo C, que perpetúan o gatillan el estres oxidativo, que clínicamente se ven asociados como marcadores pronósticos de disfunción multiorgánica y mortalidad en el paciente con choque séptico. Por lo que sus componentes podrían usarse como biomarcadores para el diagnóstico y pronostico, además de convertirse en objetivos farmacológicos. El conocimiento del papel que desempeña la mitocondria en la sepsis es de vital importancia en la práctica clínica. En este artículo de revisión intentaremos explicar la fisiopatología de la disfunción mitocondrial en la sepsis, y trasladarlos a la aplicabilidad clínica

Background Since its molecular isolation on January 7, 2020, the novel coronavirus SARS-CoV-2 has spread rapidly, taking governments worldwide off-guard. The virus arrived in low and middle-income countries violently, especially in Latin America. Ecuador received the worst outbreak in the world if we count excess mortality per capita. Although one study has reported the epidemiological impact of COVID-19 in Ecuador, there is no clinical course or outcome data among intensive care patients with COVID-19 in Ecuador. This study describes the clinical, epidemiological, and therapeutical features of 89 patients hospitalized in a secondary-level hospital in Quito, Ecuador. Methods We did a retrospective cohort study. We collected health records data from adult patients with severe COVID-19 admitted to the intensive care unit (ICU) in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak in Ecuador. All patients had a confirmed SARS-CoV-2 RNA infection diagnostic, a positive real-time RT-PCR, and pulmonary imaging suggesting COVID-19. We used the Chi-square test or a Fisher's exact statistic to analyze risk and associations between survivors and non-survivors due to COVID-19. We used the ROC curve analysis to predict mortality, determining cut-off points for the parameters related to mechanical, analytical, and cytometry ventilation. At the multivariate level, we used the Wald test to evaluate model categorical predictors during the regression analysis. Results 89 patients with COVID-19 were recruited during the study. The average age of the patients was 54.72 years. Man represented 68.54% (n = 61) and women 31,46% (n = 28). Significant differences were observed in terms of mortality (men 40.98% vs. women 17.76%). Serological parameters demonstrated that LDH and IL-6 at 24 hours were higher among non-survivors when compared with survivors. Persistent hypercapnia ( > > 45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and a positive end-expiratory pressure (PEEP) titration greater than nine mmHg were also associated with higher mortality. Conclusions Increased levels of LDH at 24 hours, IL-6, the lymphocyte and platelet count at 48 hours, the neutrophil count at 48 hours, and the INL are factors associated with higher motility, increased risk of failed extubation and reintubation