El SARS-CoV-2 es un nuevo tipo de coronavirus que posee un genoma de ARN monocatenario de sentido positivo, este virus se detectó por primera vez en diciembre de 2019 en la ciudad de Wuhan, China y causa la enfermedad que se denomina COVID-19. La tasa de mutación en los virus de ARN es extremadamente alta, el SARS-CoV-2 posee un mecanismo que corrige los errores en la replicación, por lo tanto, su tasa de mutación es menor. Sin embargo, a pesar de este mecanismo comete errores que generan un amplio espectro de mutaciones dentro de las cuales hay una población dominante, esto le confiere la capacidad de propagarse rápidamente, generando las variantes virales. Cuando surgen estas variantes se generan diferencias genéticas que en ocasiones no tienen efecto alguno, pero en otras le confieren un mayor potencial de transmisión, cargas virales más altas, mayor letalidad, además de permitirles evadir la respuesta inmunológica. En esta revisión presentamos el estado del arte de las nuevas variantes virales de SARS-CoV-2 reportadas hasta el momento en todo el mundo, así como sus características e impacto en la salud pública.
La COVID-19 tiene un amplio espectro de manifestaciones clínicas durante su curso y se han encontrado al menos 55 efectos a largo plazo que incluyen signos, síntomas y parámetros clínicos. Las etapas clínicas de la enfermedad se dividen en la fase aguda, fase postaguda y síndrome post-COVID-19. Estas fases se caracterizan por el desarrollo de signos y síntomas desde el inicio hasta cuatro semanas, entre cuatro a 12 semanas y más allá de 12 semanas, respectivamente. La prevalencia de signos y síntomas varía desde 35% hasta 94%; en la mayoría de los estudios (80%) predominan la fatiga, tos y disnea. Los potenciales mecanismos fisiopatológicos que explican el desarrollo de los síntomas incluyen la persistencia viral, alteraciones inmunológicas e inflamación, secuelas esperadas de una enfermedad crítica y cambios fisiopatológicos específicos de la enfermedad aguda en cada sistema. Hasta el momento, se desconoce el espectro completo del síndrome post-COVID; a pesar de haber identificado muchos de sus componentes clínicos aún faltan datos para reconocer el tiempo exacto de duración.
Introduction Disbyosis in the intestinal microbiome has been associated to disease. It has been described that newborns are sterile and get colonized in the first days. Little is known about the respiratory microbiome in the first hours of life. The aim of the study was to compare the nasal and intestinal microbiome in newborns by c‐section (C) and vaginal delivery (V). Methods Women who gave birth in the previous 24 hours were invited to have their babies to participate in the study. Nasal swabs and feces were obtained. DNA extraction from nasal and fecal samples was performed, V3‐V4 of the RNA 16S ribosomal subunit was determined by PCR and NG sequencing of this region was done for taxonomic identification of the microbiome. Results 30 C newborns and 30 V were included. There was a 10% detection of V3‐V4 in nasal washes in C compared to 50% in V, and 46% vs 53% detection of V3‐V4 in feces of C and V, respectively. Phylum analysis showed C vs V: Firmicutes in 50% vs 22% Proteobacteria 39% vs 75% Actinobacteria 6% vs 2%, Bacteroidetes 4% vs 0.9%, Verrucomicrobia 0.8% vs 0% and not classified 0.6% vs 0.2%, respectively. In nasal samples C vs V we found: Firmicutes 49% vs 45%, Proteobacteria 36% vs 27%, Actinobacteria 4.4% vs 11%, Bacteroidetes 7.6% vs 10%, Fusobacteria 0.2 vs 3% and not classified 2.8% vs 4%, respectively. The genus analysis showed in C newborns feces: Enterococcus in 20%, Streptococcus 2%, Lactobacillae 1%, Staphylococcus 22%, Clostridiales 2%, Escherichia‐Shigella 22%, Enterobacteriacea 13%, Acinetobacter 1%, Bifidobacterium 4%, Actinomycetales 2%, Bacteroides 2%; in V newborns Enterobacteriacea in 27%, Escherichia Shigella 47%, Clostridiales 18%, Sarcina 1%, Leuconostoc 1%, Bifidobacteria 2%. In nasal samples of V newborns there was a higher genus diversity (30) than C newborns (22) and less Stahylococcus (4% vs 14%) and Streptococcus (11% vs 32%), respectively. Conclusions A lower proportion of C newborns are colonized in the respiratory airway in the first hours of life. C newborns have Staphylococus and Streptococcus in their intestinal microbiome which can be found in the skin of their mothers while in V newborns Enterobacteria is predominant. A higher genus diversity and less Streptococcus and Staphylococcus is observed in the nasal microbiome of V newborns compared to C newborns. Support or Funding Information This study was funded by the Consejo Nacional de Ciencia y Tecnología (CONACYT) Mexico, grant number SALUD 2015‐878, PI Rosa M. Wong‐Chew.
Background Septic shock mortality ranges from 30 to 60%. Intracellular Hsp70 is a protein involved in the folding of mature proteins, its extracellular detection has been described in rheumatoid arthritis and several infectious diseases. The aims of the study were to determine if eHsp70 levels in adult patients with septic shock could be a prognostic marker and if it correlated with APACHE II and SOFA scores and the inflammatory cytokines response. Methods We performed an observational, longitudinal, prospective, cohort study. Adult patients with septic shock admitted to the Intensive Care Unit were included. eHsp70 levels were measured in sera by ELISA, APACHE and SOFA were determined on ICU admission and every 2 days until death or discharge for improvement. Serum cytokines were measured at the admission and discharge with flow cytometry. Results Ninety patients were included, 53 men and 37 women. Fifty percent (45) died. Higher APACHE II and SOFA scores, were found on those who died compared to survivors. Ninety‐one percent of patients who had persistent levels above 500 pg/ml of eHsp70 up to days 14 and 16 of hospitalization died; eHsp70 above 600 pg/ml was related with APACHE score higher than 30 and SOFA score higher than 15 and correlated with deaths. IL‐6, IL‐8 and IL‐18 were higher in deceased patients. eHsp70 persistent levels above 500 pg/ml could be related with mortality. Conclusions Patients with APACHE II score higher than 30 and SOFA score higher than 15 correlated with eHsp70 above 600 pg/ml and a higher proinflammatory response in the death group. eHsp70 could be a severity marker in patients with septic shock. Support or Funding Information This work was supported by Federal Funds from the Departamento de Investigación del Hospital General de México “Dr. Eduardo Liceaga”
La aparición del virus SARS-CoV-2 ha generado un alto grado de mortalidad y morbilidad severa en todo el globo, ocasionando la pandemia por COVID-19. Esta situación determinó el surgimiento y desarrollo de distintas vacunas a fin de prevenir la enfermedad grave por COVID-19, así como disminuir el número de decesos generados alrededor del mundo. La elaboración de los preparados actuales contra el padecimiento se basan en cuatro plataformas: material genético del virión, vectores víricos previamente conocidos, virión del SARS-CoV-2 de forma inactivada o que incluyen proteínas antigénicas del virión, todas ellas capaces de generar anticuerpos neutralizantes contra la infección. Estas vacunas han pasado por diferentes fases de investigación, las cuales han determinado la efectividad, seguridad e inmunogenicidad de cada una, así como el empleo y aprobación por la Organización Mundial de la Salud (OMS) y las diferentes agencias regulatorias de salud de cada país. Entre las sustancias actualmente aceptadas por la OMS para su uso de emergencia en el control de la pandemia se encuentran aquellas fabricadas por las compañías de Pfizer-
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