Coronavirus disease 2019 (COVID-19) vaccines effectively protect against severe disease and death. However, the impact of the vaccine used, viral variants, and host factors on disease severity remain poorly understood. This work aimed to compare COVID-19 clinical presentations and outcomes in vaccinated and unvaccinated patients in Mexico City. From March to September 2021, clinical, demographic characteristics, and viral variants were obtained from 1014 individuals with a documented SARS-CoV-2 infection. We compared unvaccinated, partially vaccinated, and fully vaccinated patients, stratifying by age groups. We also fitted multivariate statistical models to evaluate the impact of vaccination status, SARS-CoV-2 lineages, vaccine types, and clinical parameters. Most hospitalized patients were unvaccinated. In patients over 61 years old, mortality was significantly higher in unvaccinated compared to fully vaccinated individuals. In patients aged 31 to 60 years, vaccinated patients were more likely to be outpatients (46%) than unvaccinated individuals (6.1%). We found immune disease and age above 61 years old to be risk factors, while full vaccination was found to be the most protective factor against in-hospital death. This study suggests that vaccination is essential to reduce mortality in a comorbid population such as that of Mexico.

The host immune response to SARS-CoV-2 appears to play a critical role in disease pathogenesis and clinical manifestations in severe COVID-19 cases. Until now, the importance of developing a neutralizing antibody response in the acute phase and its relationship with progression to severe disease or fatal outcome among hospitalized patients remains unclear. In this study, we aim to characterize and compare longitudinally the primary humoral immune host response in the early stages of the disease, looking for an association between neutralization, antibody titers, infective viral lineage, and the clinical outcome in hospitalized and non-hospitalized patients. A total of 111 patients admitted at INER from November 2021 to June 2022 were included. We found that patients with negative or low neutralization showed a significant reduction in survival probability compared to patients with medium or high neutralization. We observed a significant decrease in the median of neutralization in patients infected with viral variants with changes in RBD of the spike protein. Our results suggest that developing an early and robust neutralizing response against SARS-CoV-2 may increase survival probability in critical patients.

Artículo dE rEvisión resumen La hemorragia posparto (HPP) continúa siendo una de las principales causas mundiales de morbilidad y mortalidad materna. La atonía uterina representa el principal mecanismo subyacente, y el uso oportuno de agentes uterotónicos es clave en su prevención y manejo. Este artículo presenta una revisión detallada de los principales fármacos uterotónicos, incluyendo oxitocina, carbetocina, alcaloides del cornezuelo de centeno, prostaglandinas y calcio intravenoso, con énfasis en su farmacodinamia, farmacocinética, indicaciones clínicas y efectos adversos. Se discuten las diferencias en la dosificación recomendada para cesáreas electivas e intraparto, así como en pacientes con obesidad mórbida. Se destacan las ventajas de la carbetocina en contextos con recursos limitados y el potencial del calcio como coadyuvante, aunque aún sin evidencia robusta para su uso sistemático. Además, se aborda la importancia de protocolos estandarizados para el uso secuencial de uterotónicos de primera y segunda línea, con el fin de optimizar los resultados maternos y reducir la necesidad de intervenciones quirúrgicas. Este análisis proporciona herramientas prácticas para mejorar la atención obstétrica basada en evidencia, especialmente en escenarios quirúrgicos. Se concluye que

Introduction The laparoscopic approach has become the standard of care for many abdominal surgical procedures. Compared to laparotomy, laparoscopy allows for smaller incisions, reduces the perioperative stress response, minimizes post-operative pain, and shortens recovery time1,2. Laparoscopy relies on the establishment of a pneumoperitoneum, where a gas, typically carbon dioxide (CO2), is insufflated through the peritoneal […]