Extreme Morbidity Research Articles

Extreme temperatures and morbidity in old age in Europe

Understanding the relationship between extreme temperatures and health among older adults is of paramount importance for public health in ageing societies. This study aims to enhance our understanding of the impact of extreme temperatures on morbidity, i.e. the risk of being hospitalised, using medications for heart conditions, and experiencing the onset of cardiovascular diseases (CVDs) among older adults in Europe (65+ years old) using five waves from the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004–2015). It also explores heterogeneity in this impact depending on an array of factors that affect exposure and vulnerability to climate, including geographical location, gender, age, educational level, having a partner/child and living in an urban or a rural area. Results from individual fixed-effects models show that extremely cold temperatures increase the risk of being hospitalised and suffering from CVDs, while heat exposure has no noteworthy effect. Broken down by geographical location, the results indicate that one additional extremely cold day influences the risk of hospitalisation in the coldest and the warmest European regions, while extreme heat influences this risk in the warmest European regions. Finally, the oldest old and low educated individuals appear to be the most vulnerable social groups. The study concludes by discussing the advantages and the limitations of using survey data to study climate and health, and the strategies suggested by the relevant literature to prevent temperature-related illness.

Extreme Heat and Severe Maternal Morbidity in Southern California: Evidence of Health Disparities from a Large Pregnancy Cohort

Extreme Heat and Severe Maternal Morbidity in Southern California: Evidence of Health Disparities from a Large Pregnancy Cohort

Chickenpox in pregnancy

Varicella, the number one contamination with varicella-zoster virus (VZV; human herpes virus) in pregnancy, might also cause maternal mortality or extreme morbidity. It may also be the cause of fetal varicella syndrome (FVS) and varicella contamination in new children, which incorporates congenital varicella syndrome (CVS) and neonatal varicella. This guiding principle addresses the role of varicella vaccination in women of reproductive ages. The rule also assesses evidence concerning the maternal and fetal risks of VZV contamination in pregnancy and whether these headaches may be prevented or changed beneficially with the aid of the management of varicella-zoster immunoglobulin (VZIG) or with the aid of a remedy for infected people with acyclovir. This fact should manual the prudent use of VZIG, which is made of the plasma of human blood donors and is consequently a restricted and costly aid. The control of neonates is outdoor the scope of this tenet. Guidance on neonatal publicity and disorder is to be had from other sources [1-2]

Natural Plasmodium falciparum Infection Stimulates Human Antibodies to MSP1 Epitopes Identified in Mice Infection Models upon Non-Natural Modified Peptidomimetic Vaccination.

(1) Background: Malaria, a vector-borne infectious disease, is caused by parasites of the Plasmodium genus, responsible for increased extreme morbidity and mortality rates. Despite advances in approved vaccines, full protection has not yet been achieved upon vaccination, thus the development of more potent and safe immuno-stimulating agents for malaria prevention is a goal to be urgently accomplished. We have focused our research on a strategy to identify Plasmodium spp. epitopes by naturally acquired human antibodies and rodent malaria infection models immunized with site-directed non-natural antigens. (2) Methods: Some predictive algorithms and bioinformatics tools resembling different biological environments, such as phagosome-lysosome proteolytic degradation, affinity, and the high frequency of malaria-resistant and -sensitive HLA-II alleles were regarded for the proper selection of epitopes and potential testing. Each epitope's binding profile to both host cells and HLA-II molecules was considered for such initial screening. (3) Results: Once selected, we define each epitope-peptide to be synthesized in terms of size and hydrophobicity, and introduced peptide-bond surrogates and non-natural amino acids in a site-directed fashion, and then they were produced by solid-phase peptide synthesis. Molecules were then tested by their antigenic and immunogenic properties compared to human sera from Colombian malaria-endemic areas. The antigenicity and protective capacity of each epitope-peptide in a rodent infection model were examined. The ability of vaccinated mice after being challenged with P. berghei ANKA and P. yoelii 17XL to control malaria led to the determination of an immune stimulation involving Th1 and Th1/Th2 mechanisms. In silico molecular dynamics and modeling provided some interactions insights, leading to possible explanations for protection due to immunization. (4) Conclusions: We have found evidence for proposing MSP1-modified epitopes to be considered as neutralizing antibody stimulators that are useful as probes for the detection of Plasmodium parasites, as well as for sub-unit components of a site-directed designed malaria vaccine candidate.

Calidad de vida percibida y significados de la experiencia de morbilidad materna extrema: un estudio cualitativo

Abstract Experiencing extreme maternal morbidity (EMM) implies multiple changes, where the perception of quality of life is modified, generating a gap between what is perceived and what is desired. The aim is to understand the meanings attributed to EMM by survivors of the experience and the effect of these meanings on the processes of reconstruction of daily life. A qualitative study from the perspective of symbolic interactionism that included an analysis based on elements of grounded theory by conducting semi-structured interviews with women from a Colombian city. The experience of EMM is understood by the participants as “a suffering that is worthwhile” and is constructed from the meanings given to each stage that is experienced: (1) pregnancy: an unexpected event that is better when accompanied by a partner/family; (2) the complication: separation distress; (3) life after near-death. Women’s perception of quality of life depends on both the experience of the event and social support, as well as on the baby’s survival. The role of health services is critical because loneliness, worry, and stress intensify when health personnel have a dehumanized relationship with women.

2021 Climate and Health Review - Uncharted Territory: Extreme Weather Events and Morbidity.

Extreme weather events (EWEs) affected health in every world region during 2021, placing the planet in "uncharted territory." Portraying the human impacts of EWEs is part of a health frame that suggests public knowledge of these risks will spur support for needed policy change. The health frame has gained traction since the Paris COP21 (United Nations Climate Change Conference) and arguably helped to achieve modest progress at the Glasgow COP26. However, reporting rarely covers the full picture of health impacts from EWEs, instead focusing on cost of damages, mortality, and displacement. This review summarizes data for 30 major EWEs of 2021 and, based on the epidemiological literature, discusses morbidity-related exposures for four hazards that marked the year: wildfire smoke; extreme cold and power outages; extreme, precipitation-related flooding; and drought. A very large likely burden of morbidity was found, with particularly widespread exposure to risk of respiratory outcomes (including interactions with COVID-19) and mental illnesses. There is need for a well-disseminated global annual report on EWE morbidity, including affected population estimates and evolving science. In this way, the public health frame may be harnessed to bolster evidence for the broader and promising frame of "urgency and agency" for climate change action.

Prevalencia de morbilidad materna extrema en unidad de cuidados intensivos de una institución prestadora de servicios de salud de tercer nivel en Bogotá D.C

ObjectiveTo describe the most frequent pathologies of a group of pregnant women who required management in the intensive care unit (ICU) in a third level institution in Bogota from 2014 to 2016. DesignRetrospective descriptive and analytical, observational, and cross-sectional study. FrameworkIntensive obstetric care. PatientsAll pregnant or postpartum women who required management in the Intensive Care Unit (ICU) of a third level health care centre in Bogotá (Colombia) between 2014 and 2016. ResultsOn admission to the ICU, 75% of the patients were in the immediate puerperium, while the remaining percentage were in the first and second trimester of pregnancy. The most frequent pathologies were hypertensive disorders, followed by sepsis and obstetric haemorrhage. Antihypertensive treatment, followed by transfusion of blood components were the most required interventions. ConclusionThis study presents an analysis of obstetric patients who required management in the ICU and aims to help identify risk factors and criteria for extreme maternal morbidity to allow timely diagnosis, treatment, and follow-up of pregnant women.

Tendencia actual de la mortalidad materna. Maternidad “Concepción Palacios” 2014-2020

Objective: To analyze maternal mortality in the Maternidad “Concepción Palacios” Hospital between January 2014 and December 2020. Methods: A descriptive, analytical, and retrospective study of maternal deaths occurred in the 2013-2018 period was carried out. Results: There were 73 maternal deaths, and a ratio of 135.96 per 100,000 live births. Direct maternal deaths were 60, 82.19% of the population and 13 indirect maternal deaths, 17.80%. The causes of direct maternal death were hypertensive disorders of pregnancy 48.33%, sepsis 26.66%, and obstetric hemorrhage 23.33%, with a 1: 3 ratios of maternal deaths at extreme ages of reproductive life. Conclusions: The maternal death ratio in the Maternidad “Concepción Palacios” Hospital duplicates the goals of the sustainable development goals of the 2016-2030 agenda; there is an increase in hypertensive disorders of pregnancy as a direct cause of maternal mortality. Primiparity, the absence or lack of data from prenatal control, cesarean sections, and admission-death time of less than 24 hours prevailed. Recommendations: Advances are needed in sexual and reproductive health education, education and training of health personnel in extreme maternal morbidity, analysis by theoretical premises identifying the social determinants of maternal mortality and the health reality related to its management, implementing preventive public policies with specific care guidelines. Keywords: Maternal mortality, Hypertensive disorders of pregnancy, Maternal sepsis, Obstetric hemorrhage.

Emerging Viruses Besides the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

The emergence of deadly viruses is one of the epitomes of major global health threats. Currently the world is going through the COVID-19 pandemic resulting in extreme morbidity and mortality, which is caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2). Besides, SARS-CoV-2, recent global perturbation caused by the chikungunya virus (CHIKV) infection, dengue caused by dengue virus (DENV), zika virus (ZIKV) infection, etc. are worth being noted. Although an array of research on the genome sequences within spatial geographical locations, infectious components, viral transmissibility and dynamics, treatment strategies using in silico model, animal/cell culture, and patient trials of these emerging viruses is being conducted, the human population is still at risk of being exposed to the emerging and re-emerging viral infections posing a most dreadful threat to the global public health. Besides the genomic characterization and the proteomic studies for drug repurposing or repositioning as well as the possible candidate vaccine development, the general awareness among the mass public about the preventive care against these emerging viruses is also an important concern. Lots of works have been reported on SARS-CoV-2 since its commencement on December 2019. Besides the elucidation of the respiratory viruses, present review briefly pointed on the viruses from Flaviviridae family, Paramyxoviridae family, Filoviridae family and Bunyaviridae family.

Minimally invasive co-injection of modular micro-muscular and micro-vascular tissues improves in situ skeletal muscle regeneration

Various conventional treatment strategies for volumetric muscle loss (VML) are often hampered by the extreme donor site morbidity, the limited availability of quality muscle flaps, and complicated, as well as invasive surgical procedures. The conventional biomaterial-based scaffolding systems carrying myoblasts have been extensively investigated towards improving the regeneration of the injured muscle tissues, as well as their injectable forms. However, the applicability of such designed systems has been restricted due to the lack of available vascular networks. Considering these facts, here we present the development of a unique set of two minimally invasively injectable modular microtissues, consisting of mouse myoblast (C2C12)-laden poly(lactic-co-glycolic acid) porous microspheres (PLGA PMs), or the micro-muscles, and human umbilical vein endothelial cell (HUVEC)-laden poly(ethylene glycol) hollow microrods (PEG HMs), or the microvessels. Besides systematic in vitro investigations, the myogenic performance of these modular composite microtissues, when co-injected, was explored in vivo using a mouse VML model, which confirmed improved in situ muscle regeneration and remolding. Together, we believe that the construction of these injectable modular microtissues and their combination for minimally invasive therapy provides a promising method for in situ tissue healing.

Immunity, Sex Hormones, and Environmental Factors as Determinants of COVID-19 Disparity in Women.

The current coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome virus 2 (SARS-CoV-2), has resulted in a major global pandemic, causing extreme morbidity and mortality. Few studies appear to suggest a significant impact of gender in morbidity and mortality, where men are reported at a higher risk than women. The infectivity, transmissibility, and varying degree of disease manifestation (mild, modest, and severe) in population studies reinforce the importance of a number of genetic and epigenetic factors, in the context of immune response and gender. The present review dwells on several contributing factors such as a stronger innate immune response, estrogen, angiotensin-converting enzyme 2 gene, and microbiota, which impart greater resistance to the SARS-CoV-2 infection and disease progression in women. In addition, the underlying importance of associated microbiota and certain environmental factors in gender-based disparity pertaining to the mortality and morbidity due to COVID-19 in women has also been addressed.

Analysis of Extreme Maternal Morbidity at the Women´s Hospital of Aguascalientes.

BackgroundExtreme maternal morbidity is defined as "events that potentially threaten the life of a pregnant woman during pregnancy, childbirth or the puerperium, but that due to a medical intervention the patient does not die", and this is an indicator of health quality at the hospital and demographic level.ObjectiveThe aim of this study was to determine the prevalence of extreme maternal morbidity in the Women´s Hospital of Aguascalientes, Mexico.Material and methodsA retrospective cross-sectional study was conducted under the criteria of the World Health Organization and the Latin American Federation of Obstetrics and Gynecology Societies for the definition of extreme maternal morbidity to determine the prevalence of near miss morbidity, between January 1 and December 31, 2016.ResultsWe found 165 cases of extreme maternal morbidity; no maternal death was registered during the study year. The extreme maternal morbidity rate was 0.016 and 16.69 per 1000 live births; the ratio of extreme maternal morbidity cases / obstetric admissions was 11.07. The prevalence of extreme maternal morbidity was 1.6%. The main causes of extreme maternal morbidity were hypertensive disorders (57%), obstetric hemorrhage (29%), sepsis (1%) and other (13%).ConclusionExtreme maternal morbidity in our institution had a similar prevalence to that reported in other countries and was mainly caused by hypertensive disorders.

Intubation Related Laryngeal Injuries in Pediatric Population

Introduction: Laryngeal intubation related lesions (LIRL) in pediatric patients cause extreme morbidity in both elective and emergency settings. It has a wide range of presentations from minor laryngeal edema to a life-threatening airway obstruction. We report here our units' experience with LIRL in neonates, infants, and small children.Material and Methods: This is a retrospective monocentric cohort study between January 2013 and April 2019.Results: Thirty-nine patients with intubation lesions were included in the study. We looked at the lesions type, characteristics, management, and outcome. Half the patients were premature and having comorbidities. Main LIRL were subglottic stenosis (31%), ulcers (26%), granulations (18%), retention cysts (18%), posterior glottic stenosis (13%), and vocal cords edema (5%). Unfavorable lesions causing airway stenosis were associated with an intubation duration of over 1 week and were an important factor in causing airway stenosis (p < 0.05). The endoscopic treatment performed for these lesions was lesion and anatomical site-specific. Tracheostomy was needed in five patients, and was avoided in another two. Seven patients (18%) received open surgery prior to their decannulation.Conclusions: LIRL management is challenging and stressful in the pediatric population and optimal treatment could avoid extreme morbidity in them. Intubation duration and associated comorbidities are important factors in deciding the severity of these lesions. Protocols to prevent the formation of these lesions are critical.

Patterns of Peripheral Nerve and Tendon Injury in Hand Trauma Patients in a Tertiary Care Hospital of Pakistan.

IntroductionTraumatic injury to peripheral nerves is a major medical problem worldwide. Moreover, injury to the hand and wrist can lead to extreme morbidity and disable the injured for life. In this study, we highlight the most commonly damaged nerves and tendons that get ruptured in different types of hand trauma patients. No recent study has been done to document the etiologies and quantify the patterns of nerve and tendon involvement in hand injuries to the best of our knowledge.MethodologyThis was a cross-sectional study conducted at the largest trauma center in the city and the Plastic and Reconstructive Surgery ward of Civil Hospital, Karachi. A convenient sampling of 200 patients was done with the help of a preformed, well-structured questionnaire. Patients whose hand was injured solely were included in the study and those with the involvement of the whole limb or other parts of the body were excluded.ResultsWe found that most males between the ages of 11 and 20 years presented predominantly with right-hand injury while working with machines. Nerve injury proved to be a rare occurrence. However, combined nerve injury of the ulnar, median, and radial nerve was seen in poly digit trauma. The median nerve was the most commonly damaged nerve in poly digit trauma. Among the tendon injuries, the incidence of combined tendon injury was the greatest. The flexor digitorum superficialis was the most common tendon injured overall.ConclusionThis study significantly states that tendons are frequently injured in hand accidents. Plastic surgeons must also be aware of optimal nerve repair and reconstruction techniques to limit the physical disabilities and economic burden arising from nerve injury of the dominant hand.

Myricitrin attenuates hypoxic-ischemia-induced brain injury in neonatal rats by mitigating oxidative stress and nuclear factor erythroid 2-related factor 2/hemeoxygenase-1/antioxidant response element signaling pathway

Background: Neonatal hypoxic ischemia (HI) is an overwhelming infantile neurological disability causing extreme morbidity and mortality with limited therapies available. Objectives: In this study, we aimed to explore the neuroprotective efficacy of myricitrin and elucidate the mechanism of action of myricitrin through the regulation of nuclear factor erythroid 2-related factor 2 (Nrf2)/hemeoxygenase-1 (HO-1)/antioxidant response element (ARE)-signaling pathways in neonatal rats. Materials and Methods: Seven-day-old neonatal rats were divided into four groups. Sham group served as the control group. After inducing HI through standard operation procedure, two groups of neonatal rats were intraperitoneally administered with 20 and 40 mg/kg bw of myricitrin twice a day for up to 1 week. At the end of the experiment, we assessed the brain infract area, edema, and motor coordination activity by using Rota Rod test. Furthermore, we measured the level of antioxidant enzymes and oxidative stress markers in the brain tissue samples. Real-time quantitative polymerase chain reaction was conducted to detect the inflammatory molecules expression including HO-1 being the activator of Nrf2 where further mediates the transcriptional activation of ARE. Subsequently, the hypothesis was further confirmed by the immunosorbent assay and Western blot analysis. Results: Myricitrin administration ameliorated HI-induced increase in infract volume and edema of the brain, as well as improved neurobehavioral impairments. Interestingly, myricitrin significantly reduced the level of nuclear factor kappa B (NF-κB) p65 and reduced the levels of nuclear fraction of Nrf2-ARE and cytosolic fraction of HO-1 enzyme activation. Conclusion: In summary, myricitrin improved the antioxidant defense mechanism and ameliorated the oxidative stress-associated neurological damage via modulating Nrf2/ARE-dependent HO-1 pathway in neonatal rats.

PSVII-14 Performance and health responses of feedlot cattle consuming different feed additives during a 45-day receiving period

Abstract This experiment compared performance and health responses of feedlot cattle consuming different feed additives during a 45-d receiving period. Angus-influenced steers (n = 256) were purchased from a commercial auction yard, and road-transported (12 h) to the experimental feedyard on d -1. Upon arrival, body weight (BW) was recorded and steers were ranked by BW into 1 or 18 drylot pens (14 or 15 steers/pen). Pens were randomly assigned to receive RAMP® from d 0 to d 45 with the inclusion of: 1) Rumensin + Tylan (Elanco Animal Health; Greenfield, IN; 360 mg and 90 mg per animal/daily, respectively; RT), 2) Rumensin + Celmanax + Certillus (Church and Dwight Co., Inc., Princeton, NJ; 18 g and 28 per animal/daily, respectively; RCC), or Celmanax + Certillus (18 g and 28 per animal/daily, respectively; CC). Feed intake during the initial 21 d of the experiment was greater (P ≤ 0.05) in CC vs. RCC and RT. No treatment effects were detected for steer BW gain and feed efficiency (P ≥ 0.41). Total incidence of steers treated for respiratory disease did not differ between treatments (77.9, 82.3, and 80.0%, respectively, P = 0.77). Removal of steers from the experiment due to extreme morbidity of mortality was greater (P = 0.02) in RT vs. CC, and intermediate for RCC (22.4, 7.0, and 12.9%, respectively). Accordingly, total liveweight per pen on d 45 was greater (P ≤ 0.05) for CC and RCC vs. RT (3.79, 3.61, and 3.20 ton, respectively). Inclusion of CC into a receiving diet improved initial feed intake compared with ionophore-containing diets, but without changing steer performance. Moreover, CC and RCC resulted in improved health responses during the 45-d receiving period compared with the traditional RT receiving diet. These results suggest that CC ingredients improved intake and immunocompetence of receiving cattle.

Morbilidad materna en la unidad de cuidados intensivos en un hospital de Huancavelica, Perú

Objetivo: Determinar las características personales, obstétricas y clínicas de las pacientes que presentaron morbilidad materna extrema. Material y métodos: Estudio descriptivo, retrospectivo de corte transversal, realizado en el Hospital Departamental de Huancavelica (Perú), donde se revisaron 94 historias clínicas de gestantes o puérperas atendidas en Unidad de Cuidados Intensivos (UCI) entre enero 2016 a diciembre 2018. Resultados: Las características personales de las pacientes con morbilidad materna extrema fueron; presentan una edad materna entre 20 a 34 años (53,2%), estado civil soltera (35,1%), grado de instrucción secundario (45,7%) y procedencia rural (63,8%). Respecto de las características obstétricas, presentaron una paridad de nulíparas y multíparas (26,6%), ≥ 6 controles prenatales (59,6%) y un periodo intergenésico adecuado (67,0%). Finalmente, las características clínicas más resaltantes de esta población fueron presentar preeclampsia severa (48,9%), shock hipovolémico (13.8%), síndrome de Hellp (12.8%), eclampsia (11.7%), aborto (5.3%), hemorragia posparto (3.2%) y shock séptico (3.2%). Conclusión: En mujeres con morbilidad materna extrema, más de la mitad tienen edades entre 20 a 34 años, la mayoría solteras; nivel secundario y proceden del área rural, nulíparas y multigestas, con más de 6 controles prenatales y tienen periodo intergenésico adecuado, finalmente la preeclampsia severa fue más frecuente.

Understanding Mucormycoses in the Age of "omics".

Mucormycoses are deadly invasive infections caused by several fungal species belonging to the subphylum Mucoromycotina, order Mucorales. Hallmarks of disease progression include angioinvasion and tissue necrosis that aid in fungal dissemination through the blood stream, causing deeper infections and resulting in poor penetration of antifungal agents to the site of infection. In the absence of surgical removal of the infected focus, antifungal therapy alone is rarely curative. Even when surgical debridement is combined with high-dose antifungal therapy, the mortality associated with mucormycoses is >50%. The unacceptably high mortality rate, limited options for therapy and the extreme morbidity of highly disfiguring surgical therapy provide a clear mandate to understand the molecular mechanisms that govern pathogenesis with the hopes of developing alternative strategies to treat and prevent mucormycoses. In the absence of robust forward and reverse genetic systems available for this taxonomic group of fungi, unbiased next generation sequence (NGS)-based approaches have provided much needed insights into our understanding of many aspects of Mucormycoses, including genome structure, drug resistance, diagnostic development, and fungus-host interactions. Here, we will discuss the specific contributions that NGS-based approaches have made to the field and discuss open questions that can be addressed using similar approaches.

Three novel prevention, diagnostic, and treatment options for COVID-19 urgently necessitating controlled randomized trials

PurposeAsymptomatic or minimally symptomatic infection with COVID-19 can result in silent transmission to large numbers of individuals, resulting in expansion of the pandemic with a global increase in morbidity and mortality. New ways of screening the general population for COVID-19 are urgently needed along with novel effective prevention and treatment strategies. HypothesisA hypothetical three-part prevention, diagnostic, and treatment approach based on an up-to-date scientific literature review for COVID-19 is proposed. Regarding diagnosis, a validated screening questionnaire and digital app for COVID-19 could help identify individuals who are at risk of transmitting the disease, as well as those at highest risk for poor clinical outcomes. Global implementation and online tracking of vital signs and scored questionnaires that are statistically validated would help health authorities properly allocate essential health care resources to test and isolate those at highest risk for transmission and poor outcomes.Second, regarding prevention, no validated protocols except for physical distancing, hand washing, and isolation exist, and recently ivermectin has been published to have anti-viral properties against COVID-19. A randomized trial of ivermectin, and/or nutraceuticals that have been published to support immune function including glutathione, vitamin C, zinc, and immunomodulatory supplements (3,6 Beta glucan) could be beneficial in preventing transmission or lessening symptomatology but requires statistical validation.Third, concerning treatment, COVID-19 induced inflammation and “cytokine storm syndrome” with hemophagocytic lymphohistiocytosis (HLH)/Macrophage Activation Syndrome (MAS) have resulted in extreme morbidity and mortality in those with certain comorbidities, secondary to “acute respiratory distress syndrome” (ARDS) and multiorgan dysfunction with disseminated intravascular coagulation (DIC). Deficiency in red blood cell, serum and alveolar glutathione has been published in the medical literature for ARDS, as well as viral and bacterial pneumonias, resulting from increased levels of free radical/oxidative stress. A randomized controlled trial of blocking NF-κB and cytokine formation using glutathione precursors (N-acetyl-cysteine [NAC] and alpha lipoic acid) and PO/IV glutathione with associated anti-viral effects should be performed, along with an evaluation of Nrf2 activators (curcumin, sulforaphane glucosinolate) which have been scientifically proven to lower inflammation. Since high mortality rates from sepsis induced DIC due to COVID-19 infection has also been associated with thrombotic events and elevated levels of D-dimer, randomized controlled trials of using anticoagulant therapy with heparin is urgently required. This is especially important in patients on ventilators who have met certain sepsis induced coagulopathy (SIC) criteria. The use of acetazolamide with or without sildenafil also needs to be explored with or without heparin, since increased oxygen delivery to vital organs through prevention of thrombosis/pulmonary emboli along with carbonic anhydrase inhibition may help increase oxygenation and prevent adverse clinical outcomes. Conclusion and ImplicationsA three-part prevention, diagnostic, and treatment plan is proposed for addressing the severe complications of COVID-19. Digital monitoring of symptoms to clinically diagnose early exposure and response to treatment; prevention with ivermectin as well as nutritional therapies that support a healthy immune response; treatment with anti-inflammatory therapies that block NF-κB and activate Nrf2 pathways, as well as novel therapies that address COVID-19 pneumonia and ARDS with DIC including anticoagulation and/or novel respiratory therapies with or without acetazolamide and sildenafil. These three broad-based interventions urgently need to be subjected to randomized, controlled trials.

Morbilidad materna extrema en mujeres peruanas atendidas en una institución especializada. 2012-2016

Introducción: La morbilidad materna extrema genera indicadores para evaluar y controlar el riesgo de muerte materna. Objetivo: Describir la morbilidad materna extrema en mujeres peruanas atendidas en una institución especializa de Perú, 2012-2016. Material y Método: Estudio observacional, descriptivo y transversal. Se incluyeron las pacientes atendidas en el Instituto Nacional Materno Perinatal de Perú, entre el 2012 y 2016. Los casos de morbilidad materna extrema fueron incluidos según criterios de la Federación Latinoamericana de Sociedades de Obstetricia y Ginecología. Se describieron características maternas y se evaluaron indicadores de resultado. Se aplicó estadística descriptiva e inferencial bajo intervalos de confianza al 95%, utilizando el programa Stata versión 14. Resultados: La población de estudio fue 1245 casos. La multiparidad estuvo presente en el 63,7% de casos, presentaron en promedio 4 controles prenatales y el 60% de los casos tuvo por lo menos una cesárea previa. La razón de morbilidad materna extrema varío entre 10,7 y 17,6 por cada 1,000 recién nacidos vivos, el Índice de Mortalidad fue 3%, la relación morbilidad materna extrema / muerte materna fue de 32,8 casos. Conclusiones: La prevalencia promedio de morbilidad materna extrema fue de 13 casos por cada mil nacidos vivos con tendencia al incrementó en los últimos tres años de estudio, siendo principalmente causado por trastornos hipertensivos, sepsis y hemorragias. Los índices de resultado de morbilidad materna extrema demuestran una mejora progresiva en la calidad de atención de las pacientes con una tendencia a la disminución de muerte materna.