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Romero García C, Iftimi A, Briz-Redón Á, Zanin M, Otero M, Ballester M, de Andrés J, Landoni G, de las Marinas D, Catalá Bauset JC, Mandingorra J, Conca J, Correcher J, Ferrer C, Lozano M. Trends in Incidence and Transmission Patterns of COVID-19 in Valencia, Spain. JAMA Netw Open 2021; 4:e2113818. [PMID: 34143191 PMCID: PMC8214162 DOI: 10.1001/jamanetworkopen.2021.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available. OBJECTIVE To describe the local spread of SARS-CoV-2 in Valencia, Spain. DESIGN, SETTING, AND PARTICIPANTS This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020. EXPOSURES Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included. MAIN OUTCOMES AND MEASURES The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated. RESULTS In total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (β2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (β1 [inhabitants per km2] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network. CONCLUSIONS AND RELEVANCE This study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown.
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Affiliation(s)
- Carolina Romero García
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
- Division of Research Methodology, European University, Valencia, Spain
| | - Adina Iftimi
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | | | - Massimiliano Zanin
- Instituto de Física Interdisciplinar y Sistemas Complejos (CSIC-UIB), Palma de Mallorca, Spain
| | - Maria Otero
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
| | - Mayte Ballester
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
| | - José de Andrés
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
- Anesthesia Unit, Department of Surgical Specialties, Valencia University Medical School, Valencia, Spain
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Jesus Mandingorra
- Department of Information Technology, University General Hospital, Universidad Católica de Valencia, Valencia, Spain
- Universidad Católica de Valencia. Valencia, Spain
| | - José Conca
- Department of Information Technology, University General Hospital, Universidad Católica de Valencia, Valencia, Spain
| | - Juan Correcher
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - Carolina Ferrer
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
| | - Manuel Lozano
- Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine Department, Universitat de Valencia, Valencia, Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Universitat Jaume I−Universitat de Valencia, Valencia, Spain
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Castillo J, Andrés JD, Gomar C, Gómez-Luque A, Hidalgo F, Llau JV, Sierra P, Torres LM, Ferrandis R. The perioperative management of new direct oral anticoagulants: a question without answers. Thromb Haemost 2017; 110:515-22. [DOI: 10.1160/th12-11-0868] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/25/2013] [Indexed: 11/05/2022]
Abstract
SummaryNew direct oral anticoagulant agents (DOAC) are currently licensed for thromboprophylaxis after hip and knee arthroplasty and for longterm prevention of thromboembolic events in non-valvular atrial fibrillation as well as treatment and secondary prophylaxis of venous thromboembolism. Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1–5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed.
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Fabregat G, García-de-la-Asunción J, Sarriá B, Mata M, Cortijo J, de Andrés J, Gallego L, Belda FJ. Expression of aquaporins 1 and 5 in a model of ventilator-induced lung injury and its relation to tidal volume. Exp Physiol 2016; 101:1418-1431. [PMID: 27424549 DOI: 10.1113/ep085729] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/11/2016] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Although different studies have attempted to find factors that influence the expression of aquaporins (AQPs) in the lung in different situations, to date no research group has explored the expression of AQP1 and AQP5 jointly in rats mechanically ventilated with different tidal volumes in a model of ventilator-induced lung injury. What is the main finding? Mechanical ventilation with a high tidal volume causes lung injury and oedema, increasing lung permeability. In rats ventilated with a high tidal volume, the pulmonary expression of AQP1 decreases. We analysed the expression of aquaporins 1 and 5 and its relation with tidal volume in a model of ventilator-induced lung injury. Forty-two rats were used. Six non-ventilated animals were killed (control group). The remaining rats were ventilated for 2 h with different tidal volumes (group 7ML with 7 ml kg-1 and group 20ML with 20 ml kg-1 ) and a respiratory rate of 90 breaths min-1 . Lung oedema was measured, and the expression of AQP1 and AQP5 was determined by Western immunoblotting and measurement of mRNA. Lung oedema and alveolar-capillary membrane permeability were significantly increased in the animals of group 20ML compared with the control group. Expression of AQP1 was decreased in groups 7ML and 20ML compared with the control group. In conclusion, mechanical ventilation with a high tidal volume causes lung injury and oedema, increasing lung permeability. In rats ventilated with a high tidal volume, the pulmonary expression of AQP1 decreases.
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Affiliation(s)
| | | | | | - Manuel Mata
- School of Medicine, University of Valencia, Valencia, Spain
| | - Julio Cortijo
- School of Medicine, University of Valencia, Valencia, Spain
| | - José de Andrés
- Hospital General Universitario, Valencia, Spain.,School of Medicine, University of Valencia, Valencia, Spain
| | - Lucía Gallego
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Francisco Javier Belda
- Hospital Clinico Universitario, Valencia, Spain.,School of Medicine, University of Valencia, Valencia, Spain
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Llau JV, Ferrandis R, Castillo J, de Andrés J, Gomar C, Gómez-Luque A, Hidalgo F, Torres LM. [Recommendations on use of direct oral anticoagulants in the perioperative period]. Med Clin (Barc) 2013; 139 Suppl 2:46-50. [PMID: 23498073 DOI: 10.1016/s0025-7753(12)70042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Because of the characteristics of direct oral anticoagulants (DOA), the lack of an antidote to completely reverse their anticoagulant effects, the absence of standardization in monitoring of their effects, and limited experience of their use, specific recommendations for their management in the perioperative period or in emergencies are required. In elective surgery, in patients with normal renal function and low hemorrhagic/ thrombotic risk, DOA should be withdrawn 2 days before the intervention; when the hemorrhagic/ thrombotic risk is higher, bridge therapy with a low molecular weight hepatin beginning 5 days before the intervention is proposed as an alternative. In emergency surgery, systematic administration of hemostatic drugs as prophylaxis is not recommended. In DOA-related acute hemorrhage, administration of prothrombin complex concentrate, fresh plasma or factor VIIa should be evaluated, and general measures to control bleeding should be implemented.
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Affiliation(s)
- Juan V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad Católica San Vicente Mártir, Valencia, España.
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