Serine proteases play a critical role during SARS-CoV-2 infection. Therefore, polymorphisms of transmembrane protease serine 2 (
) and serpine family E member 1 (
) could help to elucidate the ...contribution of variability to COVID-19 outcomes.
To evaluate the genetic variants of the genes previously associated with COVID-19 outcomes, we performed a cross-sectional study in which 1536 SARS-CoV-2-positive participants were enrolled.
(rs2070788, rs75603675, rs12329760) and
(rs2227631, rs2227667, rs2070682, rs2227692) were genotyped using the Open Array Platform. The association of polymorphisms with disease outcomes was determined by logistic regression analysis adjusted for covariates (age, sex, hypertension, type 2 diabetes, and obesity).
According to our codominant model, the GA genotype of rs2227667 (OR=0.55; 95% CI = 0.36-0.84;
=0.006) and the AG genotype of rs2227667 (OR=0.59; 95% CI = 0.38-0.91;
=0.02) of
played a protective role against disease. However, the rs2227692 T allele and TT genotype
(OR=1.45; 95% CI = 1.11-1.91;
=0.006; OR=2.08; 95% CI = 1.22-3.57;
=0.007; respectively) were associated with a decreased risk of death. Similarly, the rs75603675 AA genotype
had an OR of 1.97 (95% CI = 1.07-3.6;
=0.03) for deceased patients. Finally, the rs2227692 T allele
was associated with increased D-dimer levels (OR=1.24; 95% CI = 1.03-1.48;
=0.02).
Our data suggest that the rs75603675
and rs2227692
polymorphisms are associated with a poor outcome. Additionally, rs2227692
could participate in hypercoagulable conditions in critical COVID-19 patients, and this genetic variant could contribute to the identification of new pharmacological targets and treatment strategies to block the inhibition of TMPRSS2 entry into SARS-CoV-2.
The host immune response might confer differential vulnerability to SARS-CoV-2 infection. The Toll-like receptor 8 (TLR8), could participated for severe COVID-19 outcomes. To investigated the ...relationship of TLR8 rs3764879-C/G, rs3764880-A/G, and rs3761624-A/G with COVID-19 outcomes and with biochemical parameters. A cross-sectional study of 830 laboratory-confirmed COVID-19 patients was performed, and classified into mild, severe, critical, and deceased outcomes. The TLR8 rs3764879-C/G, rs3764880-A/G, and rs3761624-A/G polymorphisms were genotyped. A logistic regression analysis was performed to determinate the association with COVID-19. A stratified analysis was by alleles was done with clinical and metabolic markets. In all outcomes, men presented the highest ferritin levels compared to women (P < 0.001). LDH levels were significantly different between sex in mild (P = 0.003), severe (P < 0.001) and deceased (P = 0.01) COVID-19 outcomes. The GGG haplotype showed an Odds Ratio of 1.55 (Interval Confidence 95% 1.05-2.32; P = 0.03) in men. Among patients with severe outcome, we observed that the carriers of the GGG haplotype had lower Ferritin, C-reactive protein and LDH levels than the CAA carriers (P < 0.01). After further stratified by sex, these associations were also seen in the male patients, except for D-dimer. Interestingly, among men patients, we could observe associations between TLR8 haplotypes and Ferritin (P < 0.001), D-dimer (P = 0.04), C-reactive protein, and Lactate dehydrogenase in mild (P = 0.04) group. Our results suggest that even though TLR8 haplotypes show a significant association with COVID-19 outcomes, they are associated with clinical markers in COVID-19 severity.
To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up.
Baseline and 1-year follow-up data were used for ...5800 participants aged 55–75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact.
We observed a significant reduction in the intervention group compared to the control group in acidification levels (−13.3 vs. -9.9 g SO2-eq), eutrophication (−5.4 vs. -4.0 g PO4-eq) and land use (−2.7 vs. -1.8 m2).
Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %.
A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.
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•MedDiet adherence and calorie reduction mediate improved environmental impact.•An energy-reduced MedDiet improves acidification, eutrophication, and land use.•Meat has a greater impact on acidification, eutrophication, land use and energy.•In terms of GHGs, the main contributor in the CG was meat and, in the IG, fish.
BACKGROUND AND OBJECTIVESUnderstanding the origin and referral routes of patients seen in teledermatology and in-person dermatology consultations in Spain is of interest from the perspective of ...health care management. The objective of this study was to describe the referral routes and the frequency and characteristics of teledermatology consultations in Spain. MATERIAL AND METHODSWe performed a descriptive cross-sectional study of data collected over 6 days from the DIADERM study sample, which included the outpatients diagnosed by 80 Spanish dermatologists, selected by means of stratified random sampling. We studied the source and destination of patients based on funding, type of consultation, and age of the patients. We reported the frequency of teledermatology consultations, their origin and destination, type of funding, age of the patients, and most common diagnoses, and compared them with the same characteristics for in-person consultations. RESULTSIn private consultations, most patients were direct clients, whereas the most frequent source in public consultations was primary care and the dermatologist. Sixty-six percent of patients were referred to dermatology and 27% were discharged. No differences in these percentages were found between public and private consultations. The ratio of follow-up to initial visits was 0.8 for public consultations and 0.2 for private consultations. Teledermatology accounts for 1% of consultations. Eighty percent of these come from primary care and 17% are direct visits. Thirty-three percent of these visits are referred to primary care - a greater proportion than in in-person consultations. Galicia, Andalusia, and Catalonia are the regions with the highest percentage of consultations. CONCLUSIONSThe results suggest that dermatologists in Spain have a considerable ability to resolve cases. Teledermatology accounts for a small percentage of consultations and access to these consultations is direct in a large percentage of cases.
Understanding the origin and referral routes of patients seen in teledermatology and in-person dermatology consultations in Spain is of interest from the perspective of health care management. The ...objective of this study was to describe the referral routes and the frequency and characteristics of teledermatology consultations in Spain.
We performed a descriptive cross-sectional study of data collected over 6 days from the DIADERM study sample, which included the outpatients diagnosed by 80 Spanish dermatologists, selected by means of stratified random sampling. We studied the source and destination of patients based on funding, type of consultation, and age of the patients. We reported the frequency of teledermatology consultations, their origin and destination, type of funding, age of the patients, and most common diagnoses, and compared them with the same characteristics for in-person consultations.
In private consultations, most patients were direct clients, whereas the most frequent source in public consultations was primary care and the dermatologist. Sixty-six percent of patients were referred to dermatology and 27% were discharged. No differences in these percentages were found between public and private consultations. The ratio of follow-up to initial visits was 0.8 for public consultations and 0.2 for private consultations. Teledermatology accounts for 1% of consultations. Eighty percent of these come from primary care and 17% are direct visits. Thirty-three percent of these visits are referred to primary care —a greater proportion than in in-person consultations. Galicia, Andalusia, and Catalonia are the regions with the highest percentage of consultations.
The results suggest that dermatologists in Spain have a considerable ability to resolve cases. Teledermatology accounts for a small percentage of consultations and access to these consultations is direct in a large percentage of cases.
El conocimiento de las rutas de origen y derivación de los pacientes atendidos en consulta dermatológica presencial y de teledermatología en España tiene interés desde el punto de vista de la gestión sanitaria. El objetivo de este estudio es describir las rutas de derivación y la frecuencia y características de la teledermatología en España.
Estudio transversal descriptivo sobre la muestra del estudio DIADERM, que recogió la actividad de 80 dermatólogos españoles, seleccionados mediante muestreo aleatorio estratificado, durante 6 días. Se estudiaron el origen y destino de los pacientes en función de la financiación, el tipo de consulta y la edad de los pacientes. Se describió la frecuencia de las consultas por teledermatología, su origen y destino, el tipo de financiación, la edad de los pacientes y los diagnósticos más frecuentes, comparándolos con la consulta presencial.
El origen más frecuente en la consulta privada es el directo, mientras que en la pública es la atención primaria y el propio dermatólogo. Un 66% de los pacientes se derivan a dermatología y un 27% son dados de alta. No existen diferencias en estos porcentajes entre consulta pública y privada. El índice sucesivas/primeras fue de 0,8 para la consulta pública y de 0,2 para la privada. La teledermatología representa un 1% de las consultas. El 80% procede de atención primaria y el 17% tiene origen directo. Se deriva a atención primaria el 33%, en mayor proporción que en consulta presencial. Galicia, Andalucía y Cataluña son las regiones donde representa un mayor porcentaje de consultas.
Los resultados sugieren una alta capacidad resolutiva de las consultas de dermatología en España. La teledermatología representa un porcentaje pequeño de las consultas, y el acceso a ella se da en un porcentaje relevante de pacientes por vía directa.
Resumen Antecedentes y objetivos El conocimiento de las rutas de origen y derivación de los pacientes atendidos en consulta dermatológica presencial y de teledermatología en España tiene interés ...desde el punto de vista de la gestión sanitaria. El objetivo de este estudio es describir las rutas de derivación y la frecuencia y características de la teledermatología en España. Material y métodos Estudio transversal descriptivo sobre la muestra del estudio DIADERM, que recogió la actividad de 80 dermatólogos españoles, seleccionados mediante muestreo aleatorio estratificado, durante 6 días. Se estudiaron el origen y destino de los pacientes en función de la financiación, el tipo de consulta y la edad de los pacientes. Se describió la frecuencia de las consultas por teledermatología, su origen y destino, el tipo de financiación, la edad de los pacientes y los diagnósticos más frecuentes, comparándolos con la consulta presencial. Resultados El origen más frecuente en la consulta privada es el directo, mientras que en la pública es la atención primaria y el propio dermatólogo. Un 66% de los pacientes se derivan a dermatología y un 27% son dados de alta. No existen diferencias en estos porcentajes entre consulta pública y privada. El índice sucesivas/primeras fue de 0,8 para la consulta pública y de 0,2 para la privada. La teledermatología representa un 1% de las consultas. El 80% procede de atención primaria y el 17% tiene origen directo. Se deriva a atención primaria el 33%, en mayor proporción que en consulta presencial. Galicia, Andalucía y Cataluña son las regiones donde representa un mayor porcentaje de consultas. Conclusiones Los resultados sugieren una alta capacidad resolutiva de las consultas de dermatología en España. La teledermatología representa un porcentaje pequeño de las consultas, y el acceso a ella se da en un porcentaje relevante de pacientes por vía directa.
The use of low-molecular-weight heparin (LMWH) for long-term therapy of venous thromboembolism (VTE) in patients without cancer has not been consistently evaluated.
We used the data in the RIETE ...registry to compare the 3-month outcomes (VTE recurrences, major bleeding or death) in non-cancer patients with VTE, according to long-term therapy with LMWH or vitamin K antagonists (VKAs).
As of March 2018, 14,582 non-cancer patients with VTE had received initial therapy with LMWH and then switched to VKAs, while 9151 were prescribed LMWH for initial and long-term therapy. Overall, 11,494 had initially presented with pulmonary embolism (PE) and 12,239 with isolated deep vein thrombosis (DVT). Among 11,494 patients initially presenting with PE, 84 had VTE recurrences, 204 major bleeding and 406 died. Among 12,239 patients with isolated DVT, 133 developed VTE recurrences, 137 bled and 289 died. On propensity score analysis, PE patients on long-term LMWH therapy were at increased risk for PE recurrences (OR: 3.30; 95%CI: 1.67–6.48), major bleeding (OR: 1.68; 95%CI: 1.21–2.32) or death (OR: 3.16; 95%CI: 2.43–4.09) compared with those receiving VKAs. In patients with DVT, those on long-term LMWH also were at increased risk for PE recurrences (OR: 2.31; 95%CI: 1.13–4.73), major bleeding (OR 2.28; 95%CI: 1.51–3.44) or death (OR: 2.32; 95%CI: 1.54–3.51).
In the RIETE non-cancer patients with VTE, long-term therapy with VKAs was associated with a lower risk for recurrences, major bleeding or death.
•Patients with VTE-NC can be treated for three months with LMWH.•Meta-analysis which compared LMWH versus AVKs, not confirm s differences in VTE recurrence, bleeding and mortality.•In this report, the largest number of patients with VTE-NC, is included.•In RIETE population with VTE-NC, patients with LMWH alone had more episodes of recurrence, major bleeding and death, than AVKs.
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