Investigación Clínica


Investigación Clínica

Revista de investigación clínica vol. 74 num. 1 lang. es

  • Splitting the Total Dose of Cyclophosphamide in Two Blocks Apart during the Conditioning of Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis Results in Diminished Cardiotoxicity: Experience in 1,000 Patients
    el mayo 22, 2022 a las 10:25 pm
  • Adaptation to Moderate Altitude Hypoxemia: The Example of the Valley of Mexico
    el mayo 22, 2022 a las 10:25 pm

    ABSTRACT A large world population resides at moderate altitude. In the Valley of Mexico (2,240 m above sea level), its inhabitants, breathe approximately 29% more on average and have 10% increased hemoglobin concentrations compared to sea level residents, among other differences. These compensations reduce but not eliminate the impact of altitude hypoxemia. The objective of the manuscript is to review and describe the information available on health and disease at moderate altitudes, mainly with data in Spanish language from Latin-American countries. Young adults in Mexico City have an SaO2 between 92% and 94% versus 97% at sea level, frequently decreasing below 90% during sleep and intense exercise. It is likely that among the population living at this altitude, lung growth, and development during pregnancy and infancy are enhanced, and that after residing for several tens of thousands of years, more important adaptations in oxygen transport and utilization have developed, but we are not certain about it. For patients with respiratory diseases, residing at moderate altitudes implies increased hypoxemia and clinical deterioration, unless supplementary oxygen is prescribed or patients move to sea level. Hyperventilation increases exposure of residents to air pollutants compared to those living in cities with similar concentrations of pollutants, although at sea level. Humans evolved at sea level and lack the best-known adaptations to reside at moderate or high altitudes. Residents of moderate altitudes breathe deeply the city´s air with all its pollutants, and more often require supplementary oxygen.

  • Impact of COVID-19 on the Diagnosis and Management of Multiple Myeloma: Experience from a Canadian Center
    el mayo 22, 2022 a las 10:25 pm

    ABSTRACT Background: The impact of coronavirus disease-19 on the management of multiple myeloma (MM) has been recognized. However, the real effect on clinical outcomes remains poorly understood. Objective: We describe a local experience of the management of MM patients and report their outcomes during the current pandemic. Methods: All consecutive symptomatic MM patients seen at our center since 03/20 were evaluated. Results: A cohort of 156 patients diagnosed from 01/19 to 12/20 was analyzed to interrogate differences in presentation patterns. A total of 553 MM patients were seen and/or treated at Tom Baker Cancer Center in the year of 2020. From those, 47.1% (n = 261) were tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Sixteen patients tested positive and data are presented. In addition, a decrease of 21.7% in the rate of new smoldering MM/MM diagnosis was observed in 2020 as compared to 2019. Further, an increase in deaths was also observed in 2020. Conclusions: Our study confirms an increase lethality for MM patients infected with SARS-CoV-2. A balance between safety and need for cancer control should be emphasized.

  • Cardiovascular Risk Prediction Models in People Living with HIV in Colombia
    el mayo 22, 2022 a las 10:25 pm

    ABSTRACT Background: People living with HIV are at increased risk of cardiovascular disease. Cardiovascular risk (CVR) prediction scores are powerful tools for individualized assessment that inform decision-making about follow-up frequency, hypolipemiant treatment intensification, and choice antiretroviral therapy. Objectives: The objectives of the study were to evaluate the performance of multiple cardiovascular assessment scores in predicting major adverse cardiovascular events (MACE) at 5 and 10 years. Framingham (2004, 2008, and Colombia-adjusted), SCORE, PROCAM, ASCVD, and D:A:D scores were included in the analysis. Methods: Data were obtained from a medical registry of adults living with HIV attended by a teaching hospital in Colombia. All patients with complete information necessary for risk score calculations and determination of MACE at 5 and 10 years were included in the study. Receiver operating characteristic curves (ROC) were generated using calculations with all the aforementioned models for every individual. Differences between curves were compared with DeLong's test. Results: A total of 808 patients were included in the analysis. Mean age was 35 years, and 12% were female. The majority of subjects had low and very low CVR. Eight MACE occurred during follow-up. Area under ROC curves were: Framingham (0.90), Framingham ATP3 (0.92), Framingham calibrated for Colombia (0.90), SCORE (0.92), PROCAM (0.92), ASCVD (0.89), and D:A:D (0.92), with no statistically significant differences. Conclusions: The evaluated scores had an acceptable performance for HIV-infected patients in the studied cohort, especially for those in low and very low risk categories.

  • Screening Anti-inflammatory, Anticoagulant, and Respiratory Agents for SARS-CoV-2 3CLpro Inhibition from Chemical Fingerprints Through a Deep Learning Approach
    el mayo 22, 2022 a las 10:25 pm

    ABSTRACT Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), triggers a pathophysiological process linked not only to viral mechanisms of infectivity, but also to the pattern of host response. Drug repurposing is a promising strategy for rapid identification of treatments for SARS-CoV-2 infection, and several attractive molecular viral targets can be exploited. Among those, 3CL protease is a potential target of great interest. Objective: The objective of the study was to screen potential 3CLpro inhibitors compounds based on chemical fingerprints among anti-inflammatory, anticoagulant, and respiratory system agents. Methods: The screening was developed based on a drug property prediction framework, in which the evaluated property was the ability to inhibit the activity of the 3CLpro protein, and the predictions were performed using a dense neural network trained and validated on bioassay data. Results: On the validation and test set, the model obtained area under the curve values of 98.2 and 76.3, respectively, demonstrating high specificity for both sets (98.5% and 94.7%). Regarding the 1278 compounds screened, the model indicated four anti-inflammatory agents, two anticoagulants, and one respiratory agent as potential 3CLpro inhibitors. Conclusions: Those findings point to a possible desirable synergistic effect in the management of patients with COVID-19 and provide potential directions for in vitro and in vivo research, which are indispensable for the validation of their results.

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