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The renin-angiotensin system (RAS) is an important cascade of enzymes and peptides that regulates blood pressure, volume, and electrolytes. Within this complex system of reactions, its counter-regulatory axis has attracted attention, which has been associated with the pathophysiology of inflammatory and fibrotic diseases. This review article analyzes the impact of different components of the counter-regulatory axis of the RAS on different pathologies. Of these peptides, Angiotensin-(1-7), angiotensin-(1-9) and alamandine have been evaluated in a wide variety of in vitro and in vivo studies, where not only they counteract the actions of the classical axis, but also exhibit independent anti-inflammatory and fibrotic actions when binding to specific receptors, mainly in heart, kidney, and lung. Other functional peptides are also addressed, which despite no reports associated with inflammation and fibrosis to date were found, they could represent a potential target of study. Furthermore, the association of agonists of the counter-regulatory axis is analyzed, highlighting their contribution to the modulation of the inflammatory response counteracting the development of fibrotic events. This article shows an overview of the importance of the RAS in the resolution of inflammatory and fibrotic diseases, offering an understanding of the individual components as potential treatments.
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It is discussed the relevance of quantitative approaches, specifically mathematical modelling in epidemiology, in the public health decision-making process. This topic is discussed here based on the experience of various experts in mathematical epidemiology and public health. First, the definition of mathematical modelling is presented, especially in the context of epidemiology. Second, the different uses and socio-political implications, including empirical examples of recent experiences that have taken place at the international level are addressed. Finally, some general considerations regarding the challenges encountered in the use and application of mathematical modelling in epidemiology in the decision-making process at the local and national levels.
Se trata sobre la importancia de los abordajes cuantitativos, específicamente la formulación de modelos matemáticos en epidemiología, dentro del proceso de toma de decisiones en salud pública. Esta importante temática se analiza basándose en la experiencia de algunos expertos en epidemiología matemática y salud pública. En primer lugar, se presenta la definición de modelación matemática, particularmente dentro del contexto de la epidemiología. En segundo lugar, se abordan los diferentes usos y las implicaciones socio-políticas, incluyendo ejemplos de experiencias recientes que han ocurrido a nivel internacional. Finalmente, se hace referencia a ciertas consideraciones generales respecto a los retos que representa el uso y la aplicación de modelos matemáticos en epidemiología para el proceso de toma de decisiones a nivel local y nacional.
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BACKGROUND: The interaction between modelers and policymakers is becoming more common due to the increase in computing speed seen in recent decades. The recent pandemic caused by the SARS-CoV-2 virus was no exception. Thus, this study aims to identify and assess epidemiological mathematical models of SARS-CoV-2 applied to real-world data, including immunization for coronavirus 2019 (COVID-19). METHODOLOGY: PubMed, JSTOR, medRxiv, LILACS, EconLit, and other databases were searched for studies employing epidemiological mathematical models of SARS-CoV-2 applied to real-world data. We summarized the information qualitatively, and each article included was assessed for bias risk using the Joanna Briggs Institute (JBI) and PROBAST checklist tool. The PROSPERO registration number is CRD42022344542. FINDINGS: In total, 5646 articles were retrieved, of which 411 were included. Most of the information was published in 2021. The countries with the highest number of studies were the United States, Canada, China, and the United Kingdom; no studies were found in low-income countries. The SEIR model (susceptible, exposed, infectious, and recovered) was the most frequently used approach, followed by agent-based modeling. Moreover, the most commonly used software were R, Matlab, and Python, with the most recurring health outcomes being death and recovery. According to the JBI assessment, 61.4% of articles were considered to have a low risk of bias. INTERPRETATION: The utilization of mathematical models increased following the onset of the SARS-CoV-2 pandemic. Stakeholders have begun to incorporate these analytical tools more extensively into public policy, enabling the construction of various scenarios for public health. This contribution adds value to informed decision-making. Therefore, understanding their advancements, strengths, and limitations is essential.
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COVID-19 , SARS-CoV-2 , Humanos , Estados Unidos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Pandemias/prevenção & controle , Vacinação , Avaliação de Resultados em Cuidados de SaúdeRESUMO
INTRODUCTION: The COVID-19 pandemic has negatively impacted mental health. Up to a quarter of the population has reported mental health disorders. This has been studied mainly from a nosological perspective, according to diagnostic criteria. Nevertheless, we did not find studies that have explored the daily expressions of the population. Our objective was to evaluate the perceptions of the COVID-19 pandemic and its repercussions on the emotional well-being of the Colombian population. METHODS: We performed a Twitter metrics and trend analysis. Initially, in the trend analysis, we calculated the average duration in hours of the 20 most popular trending topics of the day in Colombia and we grouped them into trends related to COVID-19 and unrelated trends. Subsequently, we identified dates of events associated with the pandemic relevant to the country, and they were related to the behaviour of the trends studied. Additionally, we did an exploratory analysis of these, selected the tweets with the greatest reach and categorised them in an inductive way to analyse them qualitatively. RESULTS: Issues not related to COVID-19 were more far-reaching than those related to coronavirus. However, a rise in these issues was seen on some dates consistent with important events in Colombia. We found expressions of approval and disapproval, solidarity and accusation. Inductively, we identified categories of informative tweets, humour, fear, stigma and discrimination, politics and entities, citizen complaints, and self-care and optimism. CONCLUSIONS: The impact of the COVID-19 pandemic generates different reactions in the population, which increasingly have more tools to express themselves and know the opinions of others. Social networks play a fundamental role in the communication of the population, so this content could serve as a public health surveillance tool and a useful and accessible means of communication in the management of health crises.
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COVID-19 , Mídias Sociais , Humanos , COVID-19/psicologia , Pandemias , Colômbia , SARS-CoV-2RESUMO
Introducción: La pandemia de COVID-19 ha impactado negativamente en la salud mental. Hasta un cuarto de la población ha reportado alteraciones de salud mental. Esto se ha estudiado principalmente desde una perspectiva nosológica según criterios diagnósticos; sin embargo, no encontramos estudios que hayan explorado las expresiones cotidianas de la población. Nuestro objetivo es evaluar las percepciones y repercusiones en el bienestar emocional de la población colombiana por la pandemia de COVID-19. Métodos: Se realizó un análisis de métricas y tendencias en Twitter. Inicialmente, en el análisis de tendencias se calculó el promedio de duración en horas de los 20 temas tendencia del día más populares en Colombia y las agrupamos en relacionadas con la COVID-19 y no relacionadas. Después se identificaron fechas de acontecimientos asociados con la pandemia relevantes para el país, y se relacionaron con el comportamiento de las tendencias estudiadas. Además, se hizo un análisis exploratorio de estas, se seleccionaron los tweets con mayor alcance y se categorizaron de forma inductiva para analizarlos cualitativamente. Resultados: Los temas no relacionados con COVID-19 tuvieron mayor alcance que los relacionados con coronavirus. No obstante, se vio un alza de estos temas en algunas fechas concordantes con hechos importantes en Colombia. Se hallaron manifestaciones de aprobación y desaprobación, de solidaridad y de acusación. De manera inductiva, se identificaron categorías de tweets informativos, humor, miedo, estigma y discriminación, política y entidades, denuncia ciudadana, y autocuidado y optimismo. Conclusiones: El impacto de la pandemia de COVID-19 genera diferentes reacciones en la población, que cada vez tienen más herramientas para expresarse y conocer las opiniones de los demás. Las redes sociales tienen un papel primordial en la comunicación de la población, por lo que este contenido podría servir como herramienta de vigilancia en salud pública y medio de comunicación útil y accesible en el manejo de crisis sanitarias.
Introduction: The COVID-19 pandemic has negatively impacted mental health. Up to a quarter of the population has reported mental health disorders. This has been studied mainly from a nosological perspective, according to diagnostic criteria. Nevertheless, we did not find studies that have explored the daily expressions of the population. Our objective was to evaluate the perceptions of the COVID-19 pandemic and its repercussions on the emotional well-being of the Colombian population. Methods: We performed a Twitter metrics and trend analysis. Initially, in the trend analysis, we calculated the average duration in hours of the 20 most popular trending topics of the day in Colombia and we grouped them into trends related to COVID-19 and unrelated trends. Subsequently, we identified dates of events associated with the pandemic relevant to the country, and they were related to the behaviour of the trends studied. Additionally, we did an exploratory analysis of these, selected the tweets with the greatest reach and categorized them in an inductive way to analyse them qualitatively. Results: Issues not related to COVID-19 were more far-reaching than those related to coronavirus. However, a rise in these issues was seen on some dates consistent with important events in Colombia. We found expressions of approval and disapproval, solidarity and accusation. Inductively, we identified categories of informative tweets, humour, fear, stigma and discrimination, politics and entities, citizen complaints, and self-care and optimism. Conclusions: The impact of the COVID-19 pandemic generates different reactions in the population, which increasingly have more tools to express themselves and know the opinions of others. Social networks play a fundamental role in the communication of the population, so this content could serve as a public health surveillance tool and a useful and accessible means of communication in the management of health crises.
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Introducción : los reportes de caso son un tipo de publicación biomédica que nos permiten compartir experiencias tanto de la etiología, diagnostico, terapéutica y pronóstico de eventos anecdóticos que ocurren tanto en uno como en varios pacientes durante la práctica clínica. Objetivo : elaborar recomendaciones metodológicas para la elaboración de la discusión de un reporte de caso clínico. Métodos : se realizó una revisión narrativa de lineamientos internacionales y evidencia disponible. Resultados: se ubicaron un total de 411 227 artículos, seleccionándose finalmente a 10 artículos de revisión narrativa. Discusión : la discusión es la sección más relevante del reporte de caso pese a considerarse por algunas revistas como un aporte opcional. Recomendamos para la elaboración de la discusión, seguir los siguientes cuatro pasos: a) hallazgo y comparación con la evidencia actual, b) fundamentación de la causalidad de los hallazgos, c) limitaciones y fortalezas en el manejo del caso expuesto e d) implicaciones clínicas y perspectivas para el futuro. Conclusión: se recomienda seguir los cuatro pasos secuenciales para la elaboración de la discusión y evaluar su impacto en la producción científica en estudiantes de pregrado y postgrado.
Introduction: Case reports are a type of biomedical publication that allow us to share experiences regarding the etiology, diagnosis, therapeutics, and prognosis of anecdotal events that occur both in one and in several patients during clinical practice. Objetivo: To elaborate methodological recommendations for the elaboration of the discussion of a clinical case report. Methods: A narrative review of international guidelines and available evidence was carried out. Results: A total of 411,227 articles were located, finally selecting 10 narrative review articles. Discussion: The discussion is the most relevant section of the case report despite being considered by some journals as an optional contribution. We recommend for the elaboration of the discussion, to follow the following four steps: a) finding and comparison with the current evidence, b) justification of the causality of the findings, c) limitations and strengths in the management of the exposed case and d) clinical implications and prospects for the future. Conclusion: It is recommended to follow the four sequential steps for the elaboration of the discussion and to evaluate its impact on the scientific production in undergraduate and postgraduate students.
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Doenças do Cão , Vacina Antirrábica , Raiva , Humanos , Animais , Cães , Raiva/epidemiologia , Raiva/prevenção & controle , Erradicação de DoençasRESUMO
BACKGROUND: Lifestyle interventions improve the metabolic control of individuals with hyperglycemia. PURPOSE: We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population. DATA SOURCES: Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022). STUDY SELECTION: We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention. DATA EXTRACTION: Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings. DATA SYNTHESIS: Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes. LIMITATIONS: Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results. CONCLUSIONS: Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.
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Sistema Cardiovascular , Diabetes Mellitus Tipo 2 , Hiperglicemia , Estado Pré-Diabético , Humanos , Estilo de VidaRESUMO
Background: Chagas disease (CD) is a neglected tropical disease, endemic in Latin America, but due to migration and environmental changes it has become a global public health issue. Objectives: To assess the global prevalence and disability-adjusted life years due to CD using findings from the Global Burden of Disease Study 2019. Methods: The Global Burden of Disease data was obtained from the Global Burden of Disease Collaborative Network; results were provided by the Institute for Health Metrics and Evaluation. The prevalence and disability-adjusted life-years (DALYs) were described at a global, regional, and national level, including data from 1990 to 2019. Results: Globally, CD prevalence decreased by 11.3% during the study period, from 7,292,889 cases estimated in 1990 to 6,469,283 in 2019. Moreover, the global DALY rate of CD decreased by 23.7% during the evaluated period, from 360,872 in 1990 to 275,377 in 2019. In addition, significant differences in the burden by sex, being men the most affected, age, with the elderly having the highest burden of the disease, and sociodemographic index (SDI), with countries with the lowest SDI values having the highest prevalence of the disease, were observed. Finally, the prevalence trends have followed different patterns according to the region, with a sustained decrease in Latin America, compared to an increasing trend in North America and Europe until 2010. Conclusion: The global burden of CD has changed in recent decades, with a sustained decline in the number of cases. Although the majority of cases remain concentrated in Latin America, the increase observed in countries in North America and Europe highlights the importance of screening at-risk populations and raising awareness of this neglected tropical disease.