Medicina de Familia-SEMERGEN最新文献

Introduction

The variability in expression and evolution of COVID is not completely explained by clinical factors. In fact, genetic factors play an important role. Moreover, it is unknown whether the genetic factor that contribute to susceptibility and severity are also involved in the onset and evolution of long-COVID. The objective of this review is to gather information from literature to understand which genetic factors are involved in the onset of persistent COVID.

Material and methods

Systematic review in PubMed and bioRxiv and medRxiv repositories based on MeSH-descriptors and MeSH-terms related to COVID and genetic factors. Using these terms 2715 articles were pooled. An initial screening performed by authors independently, selected 205 articles of interest. A final deeper screening a total of 85 articles were chosen for complete reading and summarized in this review.

Results

Although ACE2 and TMPSS6 are involved in COVID susceptibility, their involvement in long-COVID has not been found. On the other hand, the severity of the disease and the onset of long-COVID has been associated with different genes involved in the inflammatory and immune response. Particularly interesting has been the association found with the FOXP4 locus.

Conclusions

Although studies on long-COVID are insufficient to fully comprehend the cause, it is clear that the current identified genetic factors do not fully explain the progression and onset of long-COVID. Other factors such as polygenic action, pleiotropic genes, the microbiota and epigenetic changes must be considered and studied.

Introduction

Thyroid dysfunction during gestation impacts on maternal-fetal health and may influence the neurocognitive development of the child. Thyroid physiology changes during pregnancy and requires the establishment of specific reference levels per trimester and for each population and method. The objectives of our study were to analyse thyroid function throughout pregnancy and to establish reference levels for TSH and T4L in each trimester for our population and methodology.

Material and methods

Prospective analytical study of 598 pregnant women from March 2018 to October 2020. TSH, T4L, T3L, ATPO and ATG were determined in all of them. A total of 151 pregnant women were excluded due to positive thyroid immunity, previous thyroid disease in treatment with levothyroxine, twin pregnancy, diagnosis of hypothyroidism and hyperthyroidism in the request or absence of some of the parameters studied, with a reference population of 447 pregnant women.

Results

The reference levels for TSH were 0.07-3.14 mIU/L for the first, 0.66-3.21 mIU/L for the second and 0.52-2.97 mIU/L for the third trimester. Reference levels for T4L were 0.81-1.19 ng/dL for the first, 0.71-1.07 ng/dL for the second and 0.69-1.06 ng/dL for the third trimester.

Conclusions

The reference levels for TSH and T4L obtained in this study differ from those used for the general population, which may have led to misclassification errors and unnecessary treatment in pregnant women.

Objective

Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn.

Materials and methods

An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case–control nested in a retrospective cohort corresponding to pregnancy.

Results

A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a “U” shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed.

Conclusions

Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.

Introduction/objective

Viral and infectious diseases such as COVID-19 continue to pose a significant public health threat. In order to create an early warning system for new pandemics or emerging versions of the virus, it is imperative to study its epidemiology. In this study, we created a geospatial model to predict the weekly contagion and lethality rates of COVID-19 in Ireland.

Methods

More than forty parameters including atmospheric pollutants, metrological variables, sociodemographic factors, and lockdown phases were introduced as input variables to the model. The significant parameters in predicting the number of new cases and the death toll were identified. QGIS software was employed to process input data, and a principal component regression (PCR) model was developed using the statistical add-on XLSTAT.

Results and conclusions

The developed models were able to predict more than half of the variations in contagion and lethality rates. This indicates that the proposed model can serve to help prediction systems for the identification of future high-risk conditions. Nevertheless, there are additional parameters that could be included in future models, such as the number of deaths in care homes, the percentage of contagion and mortality among health workers, and the degree of compliance with social distancing.

Introduction

Approximately 45% of patients with heart failure had iron deficiency for the rest of their lives.

Objective

To determine the effect of iron treatment in patients with heart failure and iron deficiency or anemia.

Materials and Methods

The studies were selected in: PubMed, Scopus, Cochrane and Google Scholar, from the beginning of June to July 2023. The selected articles that met the inclusion criteria, the relevant information of the studies were collected according to the selection variables and were recorded in the Revman 5.0 program of the Cochrane collaboration. The primary outcome was composed of hospitalization for heart failure or cardiovascular death.

Results

Of the 7 included studies, 6717 patients were obtained, the average age was 70 years with a predominance of the male gender (57%). The primary outcome was lower in patients in the control group compared to the placebo group (OR, 0.62; 95%CI, 0.54-0.70). The 6-minute walk test (6-MWT) was improved in the iron-supplemented group compared to the placebo group (OR, 0.79; 95%CI, 0.64-0.98). Adverse events were fewer in the iron supplement group compared to the placebo group (OR, 0.78; 95%CI, 0.67-0.91).

Conclusion

In this meta-analysis of randomized controlled trials, the effect of iron supplementation is found to reduce the incidence rate of hospitalization for heart failure or cardiovascular death. In addition to a reduction in adverse events, such as gastrointestinal and neurological disorders, it also improves 6-MWT.

The care of a culturally and linguistically diverse population is a challenge in primary health care due to language barriers and cultural differences. For this reason, good communication and cultural competence of health personnel is key within medical consultation. Thus, during consultations with this group of people, it is the doctor's duty to identify the patient's culture, their perception of the concept of health, in what way and to what extent they want to be informed, and the role they want to assign to the members of their family before the treatment process begins. For this reason, there are interventions that seek to optimize the care provided to these patients and mitigate the cultural barrier, including the use of multimodal digital tools, the use of translators or interpreters, and training of health personnel in communication and intercultural skills.

Introduction

The worldwide pandemic of SARS-Cov2 has had a great impact on the lives of adolescents, affecting their health and well-being. There is little evidence of the emotional impact of the pandemic on adolescents.

Objective

To explore the knowledge, perceptions, and attitudes of young people regarding COVID-19 and its impact on emotional well-being.

Method

A cross-sectional observational and descriptive study based on a survey of students aged 16–20 from five high schools in Barcelona metropolitan area.

Results

The study was carried out on 291 surveys. Females made up 56.7% of the population. The average age was 16.9 years. A greater lack of knowledge about the transmission of the disease was detected. The most frequently used sources of information were social networks. In terms of emotional distress, the most important aspects were worry about getting sick (64%), family financial problems (46%), anxiety and irritability (27%), and apathy (26.5%). Gender differences were detected in terms of worries (women: 28.8%; men: 11.1%), sadness (women: 29.3%, men: 15.5%), and feelings of fear (women: 24.5%; men: 11%). 16.7% of the participants consulted a mental health professional, with this being more common in women (women: 23.8%; men: 7.4%).

Conclusions

COVID-19 has affected the emotional well-being of adolescents, especially the female population. It is necessary to implement emotional well-being strategies in early childhood to cope with possible stressful situations in daily life and avoid future mental health problems.

There is a growing use of social media to combat social isolation. The results of the study hold the potential to strategies aimed at preempting forthcoming biopsychosocial distress.