[Implementation of a support system for isolated elderly people to limit the consequences of the Covid-19 epidemic in Buenos Aires]. / Un système de soutien aux personnes âgées isolées pour limiter les conséquences de la Covid-19 à Buenos Aires.

The Covid-19 pandemic with its associated quarantine and isolation has had a dramatic impact on the elderly. In order to mitigate this, the National University of La Plata and the Agence Universitaire de la Francophonie set up a health surveillance and early warning project for the elderly in Buenos Aires, Argentina. This interventional study, has included 1,964 people. A general health and quality of life questionnaire was completed by all participants at the beginning of the isolation, and another time a year later.

Disparities in antimicrobial consumption and resistance within a country: the case of beta-lactams in Argentina.

OBJECTIVE: To describe bacterial resistance and antimicrobial consumption ratio at the subnational level in Argentina during 2018, considering beta-lactams group as a case-study. METHODS: Antimicrobial consumption was expressed as defined daily doses (DDD)/1000 inhabitants. Resistance of Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus to beta-lactams was recorded. Resistance/consumption ratio was estimated calculating "R" for each region of Argentina, and this data was compared with other countries. RESULTS: The most widely consumed beta-lactams in Argentina were amoxicillin (3.64) for the penicillin sub-group, cephalexin (0.786) for first generation cephalosporins, cefuroxime (0.022) for second generation; cefixime (0.043) for third generation and cefepime (0.0001) for the fourth generation group. Comparison between beta-lactams consumption and bacterial resistance demonstrated great disparities between the six regions of the country. CONCLUSIONS: The case-study of Argentina shows that antimicrobial consumption and resistance of the most common pathogens differed among regions, reflecting different realities within the same country. Because this situation might also be occurring in other countries, this data should be taken into account to target local efforts towards better antimicrobial use, to improve antimicrobial stewardship programs and to propose more suitable sales strategies in order to prevent and control antimicrobial resistance.

[Economic impact of high-price/cost medicines on social security in Argentina. The case of the Institute for the Armed and Security Forces]. / Impacto económico de medicamentos de alto precio/costo en la Seguridad Social de Argentina. El caso del Instituto de Obra Social para las Fuerzas Armadas y de Seguridad.

INTRODUCTION: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sectors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. METHODS: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. RESULTS: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions' total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. CONCLUSION: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsector, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estudio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizumab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

Protection of homologous and heterologous boosters after primary schemes of rAd26-rAd5, ChAdOx1 nCoV-19 and BBIBP-CorV during the omicron outbreak in adults of 50 years and older in Argentina: a test-negative case-control study.

Background: After primary vaccination schemes with rAd26-rAd5 (Sputnik V), ChAdOx1 nCoV-19, BBIBP-CorV or heterologous combinations, the effectiveness of homologous or heterologous boosters (Sputnik V, ChAdOx, Pfizer-BioNTech, Moderna) against SARS-CoV-2 infections, hospitalisations and deaths has been scarcely studied. Methods: Test-negative, case-control study, conducted in Argentina during omicron BA.1 predominance, in adults ≥50 years old tested for SARS-CoV-2 who had received two or three doses of COVID-19 vaccines. Outcomes were COVID-associated infections, hospitalisations and deaths after administering mRNA and vectored boosters, < or ≥60 days from the last dose. Findings: Of 422,124 individuals tested for SARS-CoV-2, 221,993 (52.5%) tested positive; 190,884 (45.2%) and 231,260 (54.8%) had received 2-dose and 3-dose vaccination schemes, respectively. The 3-dose scheme reduced infections, hospitalisations and death (OR 0.81 [0.80-0.83]; 0.28 [0.25-0.32] and 0.25 [0.22-0.28] respectively), but protection dropped after 60 days to 1.04 [1.01-1.06]; 0.52 [0.44-0.61] and 0.38 [0.33-0.45]). Compared with 2-dose-schemes, homologous boosters after primary schemes with vectored-vaccines provided lower protection against infections < and ≥60 days (0.94 [0.92-0.97] and 1.05 [1.01-1.09], respectively) but protected against hospitalisations (0.30 [0.26-0.35]) and deaths (0.29 [0.25-0.33]), decreasing after 60 days (0.59 [0.47-0.74] and 0.51 [0.41-0.64], respectively). Heterologous boosters protected against infections (0.70 [0.68-0.71]) but decreased after 60 days (1.01 [0.98-1.04]) and against hospitalisations and deaths (0.26 [0.22-0.31] and 0.22 [0.18-0.25], respectively), which also decreased after 60 days (0.43 [0.35-0.53] and 0.33 [0.26-0.41], respectively). Heterologous boosters protected against infections when applied <60 days (0.70 [0.68-0.71], p < 0.001), against hospitalisations when applied ≥60 days (0.43 [0.35-0.53], p < 0.01), and against deaths < and ≥60 days (0.22 [0.18-0.25], p < 0.01 and 0.33 [0.26-0.41], p < 0.001). Interpretation: During omicron predominance, heterologous boosters such as viral vectored and mRNA vaccines, following Sputnik V, ChAdOx1, Sinopharm or heterologous primary schemes might provide better protection against death; this effect might last longer in individuals aged ≥50 than homologous boosters. Funding: None.

Association between Consumption of Fluoroquinolones and Carbapenems and Their Resistance Rates in Pseudomonas aeruginosa in Argentina.

BACKGROUND: Irrational use of antimicrobials (ATMs) triggers microbial resistance (AMR) which has severe consequences for human health. ATM consumption varies among countries and within each territory. These data should be known, in order to perform local policies towards AMR reduction. This work aimed to expose the association of the level of consumption of carbapenems and fluoroquinolones with their resistance rates in Pseudomonas aeruginosa in Argentina. METHOD: Consumption of antimicrobials was expressed by defined daily dose (DDD)/1000 inhabitants for each ATM during one year period, discriminating by each country region. Resistance of P. aeruginosa to carbapenems/fluoroquinolones groups was recorded. Consumption/resistance ratio "R" was calculated for each region of the country, comparing results with other countries. RESULTS: P. aeruginosa resistance rate to fluoroquinolone (F) was 26.4% in blood samples and 29.7% in urine samples, whereas resistance rates to carbapenems (C) were 19.9 and 17.7% in blood and urine, respectively. Correlation between consumption and resistance was demonstrated for both antimicrobials (C : R = 0.58; p=0.003 and F : R = 0.77; p=0.0001). Great fluctuations of resistance levels were seen among regions within the country, always correlating resistance with areas in which a higher level of ATM consumption was detected. CONCLUSION: P. aeruginosa resistance to fluoroquinolone/carbapenems in Argentina directly correlated with antimicrobial consumption levels. A great heterogeneity in resistance profile was observed among areas where ATMs were widely used. Global data at the national level might mask local realities that require specific health policies in order to control the irrational use of ATMs.

Effectiveness of BBIBP-CorV, BNT162b2 and mRNA-1273 vaccines against hospitalisations among children and adolescents during the Omicron outbreak in Argentina: A retrospective cohort study.

Background: Although paediatric clinical presentations of COVID-19 are usually less severe than in adults, serious illness and death have occurred. Many countries started the vaccination rollout of children in 2021; still, information about effectiveness in the real-world setting is scarce. The aim of our study was to evaluate vaccine effectiveness (VE) against COVID-19-associated-hospitalisations in the 3-17-year population during the Omicron outbreak. Methods: We conducted a retrospective cohort study including individuals aged 3-17 registered in the online vaccination system of the Buenos Aires Province, Argentina. mRNA-1273 and BNT162b2 were administered to 12-17-year subjects; and BBIBP-CorV to 3-11-year subjects. Vaccinated group had received a two-dose scheme by 12/1/2021. Unvaccinated group did not receive any COVID-19 vaccine between 12/14/2021 and 3/9/2022, which was the entire monitoring period. Vaccine effectiveness (VE) against COVID-19-associated hospitalisations was calculated as (1-OR)x100. Findings: By 12/1/2021, 1,536,435 individuals aged 3-17 who had received zero or two doses of SARS-CoV-2 vaccines were included in this study. Of the latter, 1,440,389 were vaccinated and 96,046 not vaccinated. VE were 78.0%[68.7-84.2], 76.4%[62.9-84.5] and 80.0%[64.3-88.0] for the entire cohort, 3-11-year (BBIBP-CorV) subgroup and 12-17 (mRNA vaccines) subgroup, respectively. VE for the entire population was 82.7% during the period of Delta and Omicron overlapping circulation and decreased to 67.7% when Omicron was the only variant present. Interpretation: This report provides evidence of high vaccine protection against associated hospitalisations in the paediatric population during the Omicron outbreak but suggests a decrease of protection when Omicron became predominant. Application of a booster dose in children aged 3-11-year warrants further consideration. Funding: None.

[Benzodiazepine and Z-drug consumption in a national social security organization in Argentina: rational or excessive use?] / Consumo de benzodiazepinas y fármacos Z en una organización de la seguridad social nacional argentina: ¿uso racional o excesivo?

Benzodiazepines and "Z-drugs" (BZD/Z) are overprescribed in many countries. This study evaluates their consumption in a social security sector health insurance provider with national coverage in Argentina. With a descriptive and observational approach, outpatient dispensations of BZD/Zs were analyzed for people over 18 years old from April 2020 to March 2021, disaggregated by sex, age, active ingredient, and half-life. An annual prevalence of use of 11.6% was found among the 431,445 adult affiliates, with higher rates in women and in those over age 60. Overall consumption of BZD/Zs was 77.6 defined daily doses (DDD) per 1000 enrollee-days. The average user received 5.1 annual dispensations and the equivalent of 1.4 DDD for each day of the year. BZD/Zs with long half-life were the most used. We found high levels of BZD/Z consumption and for longer periods than recommended. It is necessary to improve the quality of consumption and reduce the negative impact of inappropriate use of these drugs among treated individuals.

Las benzodiazepinas y los "fármacos Z" (BZD-Z) se prescriben en exceso en muchos países. Este estudio evaluó su consumo en una organización de la seguridad social (obra social) de Argentina de alcance nacional. A partir de un diseño observacional descriptivo se analizó la dispensa ambulatoria de BZD-Z, entre abril 2020 y marzo 2021, a mayores de 18 años; desagregada por sexo, edad, principio activo y vida media. Se encontró una prevalencia anual de uso del 11,6% entre los 431.445 afiliados adultos, con valores más elevados en las mujeres y mayores de 60 años. El consumo global de BZD-Z fue de 77,6 dosis diarias definidas (DDD) cada 1.000 afiliados-día. El usuario promedio recibió 5,1 dispensas anuales y el equivalente a 1,4 DDD por cada día del año. Las BZD-Z más usadas fueron las de vida media larga. El consumo de BZD-Z resultó elevado y más prolongado que lo recomendado. Es necesario mejorar la calidad en el consumo y reducir el impacto negativo del uso inapropiado de estos fármacos entre los individuos tratados.

Effectiveness of the first component of Gam-COVID-Vac (Sputnik V) on reduction of SARS-CoV-2 confirmed infections, hospitalisations and mortality in patients aged 60-79: a retrospective cohort study in Argentina.

BACKGROUND: A first-dose of various vaccines provides acceptable protection against infections by SARS-CoV-2 and evolution to the most severe forms of COVID-19. The recombinant adenovirus (rAd)-based vaccine, Gam-COVID-Vac (Sputnik V), was proven efficacious but information about effectiveness in the real-world setting is lacking. The aim of our study was to investigate the association between the rollout of the first component (rAd26) of Gam-COVID-Vac and PCR-positive tests, hospitalisations and deaths. METHODS: We conducted a retrospective cohort study which analyzed individuals aged 60-79 who self-registered in the online vaccination system of the Province of Buenos Aires, Argentina, from December 29, 2020 to March 21, 2021. Exclusion criteria were having a previous positive RT-PCR or antigen tests for SARS-CoV-2, having received other vaccines, or two doses of any vaccine.Proportions of new laboratory-confirmed SARS-CoV-2 infections, hospitalisations and deaths until 83 days of vaccination were compared between vaccinated and unvaccinated subjects. Vaccine effectiveness for the three outcomes was calculated as (1-OR) × 100. Kaplan-Meier cumulative incidence curves were constructed. FINDINGS: During the study period 415995 registered subjects received the first component of Gam-COVID-Vac; 40387 belonged to the 60-79 age group, and were compared to 38978 unvaccinated. Vaccine effectiveness for preventing laboratory-confirmed infections was 78•6% [CI95% 74·8 - 81·7]; and for reducing hospitalizations and deaths was, respectively, 87·6% [CI95% 80·3 - 92·2] and 84·8% [CI95% 75·0 - 90·7]. Effectiveness was high across all subgroups. INTERPRETATION: Similarly to other vaccines, the administration of one dose of Gam-COVID-Vac was effective for a wide range of COVID-19-related outcomes. FUNDING: This study did not receive any funding.

History of indigenous policies as trace of erythrocyte antigen Dia in the current population of the American continent relationship between indigenous policies and blood phenotypes.

OBJECTIVE: The study aim to establish a debate on the different policies implemented at indigenous population in the American continent and their relationship with the presence of DiegoA antigen (AgDia) in blood phenotype of inhabitants of Buenos Aires,Argentina. METHODS: It is a descriptive study with qualitative/quantitative approach. A comprehensive search of medical/social databases, using MeSH words. Limits were applied to include studies published after 1950 written in Portuguese, English and Spanish. RESULTS: Dia antigen in the population of several American countries is relatively high, hence, it should be considered in screening panels perform to blood donors. Noteworthy, the exception of this panorama is Buenos Aires State, where the prevalence of this antigen is low. This data was correlated with indigenous policies carried out by former governments. The results showed in population living in regions where Dia is high policy performed by the colonizers towards the indigenous peoples was domination+integration+miscegenation. In Buenos Aires, however, that policy was annihilation of the natives which could explain the low presence of the antigen in the current population. CONCLUSION: The presence of Ag-Dia in the population of Buenos Aires is low compared to other Latin- American regions. The presence of Ag-Dia in Buenos Aires population is low compared to other regions of Latin-America. The reason could be explained by the distinctive indigenous policy performed in this area. It might be possible then to predict the prevalence Dia in the current population, taking into account the history of indigenous policy in colonization of American continent.

Impacto económico de medicamentos de alto precio/costo en la seguridad social de Argentina. El caso del instituto de obra social para las Fuerzas Armadas y de Seguridad / Economic impact of high-price/cost medicines on social security in Argentina. The case of the Institute for the Armed and Security Forces

Resumen Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estu dio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizu mab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

Abstract Introduction: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sec tors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. Methods: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. Results: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions´ total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. Conclusion: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsec tor, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

Mortalidad por suicidio en la provincia de Buenos Aires: epidemiología y contexto pandémico por COVID-19 en perspectiva histórica 2009-2020 / Mortality due to suicide in the province of Buenos Aires: epidemiology and COVID-19 pandemic context in historical perspective, 2009-2020

RESUMEN INTRODUCCIÓN: El suicidio constituye una de las principales causas de muerte consideradas como violentas y evitables. El objetivo fue estimar la incidencia y modalidad de suicidios en la serie histórica 2009-2020, considerando este último año como contexto pandémico por COVID-19. MÉTODOS: Se realizó un estudio transversal, observacional y retrospectivo de línea histórica. Los datos fueron obtenidos de la Dirección de Estadística e Información en Salud del Ministerio de Salud de la Provincia de Buenos Aires. Se clasificaron según tres modalidades de suicidio: intervención de un agente invasivo, un agente externo o sin agente. Para evaluar la posible variación de la densidad poblacional sobre las tasas de incidencia, se distribuyeron las defunciones sobre la base del tamaño poblacional de residencia. Finalmente, se obtuvieron dos índices: escore p y estimación de mortalidad observada (MO). RESULTADOS: Entre 2009 y 2020 se produjeron 13 221 muertes por lesiones autoinfligidas, con un promedio de 1110 suicidios al año. Al comparar 2020 (916 suicidios) con el quinquenio inmediato anterior (2015-2019, con una media de 1139 suicidios ±26 en su error estándar), el escore p mostró una reducción del 23,1% (275 muertes menos de lo esperado) y la MO, un descenso de 19,6% (223 muertes por debajo del intervalo superior esperado). DISCUSIÓN: En 2020 se redujo la incidencia absoluta y relativa de suicidios, aunque se mantuvo la diferencia según modalidad y género observada en la línea histórica.

ABSTRACT INTRODUCTION: Suicide is one of the main causes of death classified as violent and preventable. The objective was to estimate the incidence and mode of suicide in the 2009-2020 historical series, considering year 2020 as COVID-19 pandemic context. METHODS: A cross-sectional, retrospective, observational, historical timeline study was conducted. Data were obtained from the Department of Health Statistics and Information of the Ministry of Health of the Province of Buenos Aires. They were classified according to three modes of suicide: intervention of an invasive agent, an external agent or no agent. In order to evaluate the possible variation of population density on suicide incidence rates, deaths were distributed based on the population size of residence. Finally, two indices were obtained: the p-score and the estimate of observed mortality (OM). RESULTS: During 2009-2020 there were 13221 deaths due to self-inflicted injuries, with an average of 1110 suicides per year. When comparing the year 2020 (916 suicides) with the previous five-year period (2015-2019, with a mean of 1139 suicides ±26 in its standard error), the p-score showed a reduction of 23.1% (275 deaths less than expected) and OM, a decrease of 19.6% (223 deaths below the expected upper interval). DISCUSSION: During 2020 there was a reduction in the absolute and relative incidence of suicides, while maintaining the difference according to mode and gender observed through the historical timeline.

Effects of the pandemic on non-COVID-19 deaths: analysis in the province of Buenos Aires, Argentina, 2020 / Efectos de la pandemia en muertes no covid-19: análisis en la provincia de buenos aires, argentina, 2020

RESUMEN INTRODUCCIÓN El impacto de la pandemia por COVID-19 sobre la mortalidad abarca tanto sus efectos directos, las defunciones atribuidas al virus SARS-CoV-2, como indirectos sobre otras causas de muerte. "El objetivo del estudio fue determinar la variación sobre causas de muerte no COVID-19 en la provincia de Buenos Aires durante 2020 MÉTODOS Se realizó un estudio descriptivo de base poblacional, utilizando fuentes secundarias. Se analizó la variación en la mortalidad por causas específicas codificadas según CIE-10, desagregadas a nivel de capítulo y grupos. Las variaciones entre las causas de muerte observadas y esperadas se compararon mediante el método de P-score respecto al quinquenio inmediato anterior (2015-2019) RESULTADOS Todos los capítulos CIE-10 estudiados se ubican por debajo del promedio de la serie histórica. La mayor variación se registra en causas externas (-20,0%), enfermedades del sistema respiratorio (-9,1%), tumores (-8,1%), enfermedades nutricionales, endocrinas y metabólicas (-5,7%) y finalmente enfermedades del sistema circulatorio (-2,2%) DISCUSIÓN Se observó la existencia de un reemplazo variable de otras causas de defunción por muertes COVID-19 durante 2020. El análisis de causas múltiples resultó de utilidad para reestimar, en el caso del grupo de influenza (gripe) y neumonías, la participación global de la COVID-19 en la cadena de eventos que contribuyeron al deceso.

ABSTRACT INTRODUCTION The impact of the COVID-19 pandemic on mortality encompasses both its direct effects, deaths attributed to the SARS-CoV-2 virus, as well as indirect on other causes of death. The objective of the study was to determine the variation in non- COVID-19 causes of death in the province of Buenos Aires during 2020 METHODS A population-based descriptive study was carried out using secondary sources. Specific causes of death coded according to ICD-10, disaggregated by chapter and group, were analyzed. To determine whether there were variations between the observed and expected causes of death, the values of the study period were compared with the immediately preceding five-year period (2015-2019) using the P-score method RESULTS All the ICD-10 chapters studied are below the average of the historical series. The greatest variation appears in the chapter External Causes (-20.0%), Diseases of the Respiratory System (-9.1%), Neoplasms (-8.1%), Endocrine, Nutritional and Metabolic Diseases (-5.7%) and, finally, Diseases of the Circulatory System (-2.2%) DISCUSSION There is a variable change of other causes of death by COVID-19 deaths during 2020. The analysis of multiple causes was useful to re-estimate, in the case of the group of influenza (flu) and pneumonia, the global participation of COVID-19 in the chain of events that contributed to the death.

Survival in patients admitted to intensive care units due to COVID-19 in the province of Buenos Aires, Argentina / Sobrevida en pacientes internados en unidades de cuidados intensivos por covid-19 en la provincia de buenos aires, argentina

RESUMEN INTRODUCCIÓN Uno de los problemas que ha enfrentado el sistema de salud de los diferentes países debido a la pandemia de COVID-19 es la disponibilidad de servicios y atención médica en unidades de cuidados intensivos (UCI). El objetivo fue evaluar la sobrevida en pacientes internados por COVID-19 en UCI entre enero y abril de 2021 en la provincia de Buenos Aires, Argentina MÉTODOS Se consideró a los pacientes que, incluidos en el sistema de vigilancia, tuvieran su correlato de información del porcentaje ocupacional de camas de la UCI desde el sistema general. Con esta información se realizó un análisis de sobrevida, considerando tablas de vida, Kaplan-Meier y regresión de Cox. El evento fue el óbito, el tiempo de seguimiento a 96 días y las fechas de internación, defunción y egreso dentro de la UCI como períodos individuales de cada paciente. La capacidad operativa de las UCI fue medida a través del porcentaje de ocupación de camas al momento del ingreso RESULTADOS Las UCI con un porcentaje ocupacional mayor al 80% mostraron pacientes con menor curva de sobrevida que sus pares por debajo de esas cifras al momento de ingresar a la internación DISCUSIÓN Las diferencias en promedios de sobrevida son estadísticamente diferentes, y muestran dos curvas distintas de supervivencia en el momento en que la segunda ola de COVID-19 afectaba a la Argentina. ^s+

ABSTRACT INTRODUCTION One of the problems faced by the health system in different countries due to COVID-19 pandemic is the availability of medical care services in intensive care units (ICU). The objective was to evaluate survival in patients hospitalized for COVID-19 in the ICUs during the period January-April 2021 in the province of Buenos Aires METHODS Patients included in the surveillance system who had their correlate of information on percentage of bed occupancy in the ICUs from the general system were considered. With this information, a survival analysis was performed, considering life tables, Kaplan-Meier and Cox regression. The event was death, the 96-day follow-up and the dates of admission, death and discharge within the ICUs as individual periods for each patient. Inpatient capacity of the ICUs was measured through the percentage of bed occupancy at the time of admission RESULTS The ICUs with a bed occupancy greater than 80% showed patients with a lower survival curve than those below that figure at the time of admission DISCUSSION The differences in average survival were statistically significant, and show two different survival curves at the time the second wave of COVID-19 affected the country.

Efectos de la pandemia en muertes no COVID-19: Análisis en la provincia de Buenos Aires, Argentina, 2020 / Effects of the pandemic on non-COVID-19 deaths: analysis in the province of Buenos Aires, Argentina, 2020

INTRODUCCIÓN: El impacto de la pandemia por COVID-19 sobre la mortalidad abarca tanto sus efectos directos, las defunciones atribuidas al virus SARS-CoV-2, como indirectos sobre otras causas de muerte. "El objetivo del estudio fue determinar la variación sobre causas de muerte no COVID-19 en la provincia de Buenos Aires durante 2020. MÉTODOS: Se realizó un estudio descriptivo de base poblacional, utilizando fuentes secundarias. Se analizó la variación en la mortalidad por causas específicas codificadas según CIE-10, desagregadas a nivel de capítulo y grupos. Las variaciones entre las causas de muerte observadas y esperadas se compararon mediante el método de P-score respecto al quinquenio inmediato anterior (2015-2019). RESULTADOS: Todos los capítulos CIE-10 estudiados se ubican por debajo del promedio de la serie histórica. La mayor variación se registra en causas externas (-20,0%), enfermedades del sistema respiratorio (-9,1%), tumores (-8,1%), enfermedades nutricionales, endocrinas y metabólicas (-5,7%) y finalmente enfermedades del sistema circulatorio (-2,2%). DISCUSIÓN: Se observó la existencia de un reemplazo variable de otras causas de defunción por muertes COVID-19 durante 2020. El análisis de causas múltiples resultó de utilidad para reestimar, en el caso del grupo de influenza (gripe) y neumonías, la participación global de la COVID-19 en la cadena de eventos que contribuyeron al deceso.

Sobrevida en pacientes internados en unidades de cuidados intensivos por COVID-19 en la provincia de Buenos Aires, Argentina / Survival in patients admitted to intensive care units due to COVID-19 in the province of Buenos Aires, Argentina

INTRODUCCIÓN: Uno de los problemas que ha enfrentado el sistema de salud de los diferentes países debido a la pandemia de COVID-19 es la disponibilidad de servicios y atención médica en unidades de cuidados intensivos (UCI). El objetivo fue evaluar la sobrevida en pacientes internados por COVID-19 en UCI entre enero y abril de 2021 en la provincia de Buenos Aires, Argentina. MÉTODOS: Se consideró a los pacientes que, incluidos en el sistema de vigilancia, tuvieran su correlato de información del porcentaje ocupacional de camas de la UCI desde el sistema general. Con esta información se realizó un análisis de sobrevida, considerando tablas de vida, Kaplan-Meier y regresión de Cox. El evento fue el óbito, el tiempo de seguimiento a 96 días y las fechas de internación, defunción y egreso dentro de la UCI como períodos individuales de cada paciente. La capacidad operativa de las UCI fue medida a través del porcentaje de ocupación de camas al momento del ingreso. RESULTADOS: Las UCI con un porcentaje ocupacional mayor al 80% mostraron pacientes con menor curva de sobrevida que sus pares por debajo de esas cifras al momento de ingresar a la internación. DISCUSIÓN: Las diferencias en promedios de sobrevida son estadísticamente diferentes, y muestran dos curvas distintas de supervivencia en el momento en que la segunda ola de COVID-19 afectaba a la Argentina.

Exceso de mortalidad por la pandemia de COVID-19 durante 2020 en la provincia de Buenos Aires, Argentina / Excess mortality associated with the COVID-19 pandemic during 2020 in the Buenos Aires province, Argentina

INTRODUCCIÓN: El exceso de mortalidad (EM) provee una métrica robusta del impacto en este indicador durante un evento pandémico o fuera de lo habitual. Se realizó el presente estudio con el objetivo de determinar el impacto de la pandemia por la enfermedad por el nuevo coronavirus (COVID-19) sobre el exceso de muertes ocurrido en la provincia de Buenos Aires (PBA). MÉTODOS: Estudio descriptivo retrospectivo de base poblacional. Para el análisis del EM se utilizó el método P-score, con base en la comparación de la mortalidad entre un período basal -histórico 2015-2019, respecto a las defunciones con ocurrencia en la Provincia durante 2020. RESULTADOS: La PBA tiene un registro provisorio de un EM promedio de 7,59%, considerando como línea de base el límite superior de confianza del 95% de la serie histórica 2015-2019, o del 12,15% si se considera el promedio histórico. Se observa un impacto diferencial del EM según el sexo y el grupo etario. DISCUSIÓN: Las muertes por COVID-19 en la PBA superan el EM, lo que podría indicar la existencia de reemplazo de otras causas de defunción. Este resultado, que distingue a la PBA de los países de América Latina relevados y otros países europeos y de Oceanía, no permitiría estimar un subregistro en la contabilización de defunciones por COVID-19.

Disparities in antimicrobial consumption and resistance within a country: the case of beta-lactams in Argentina

[RESUMO]. Objetivo. Descrever a relação entre o consumo de antimicrobianos e a resistência bacteriana no nível subna-cional na Argentina em 2018, considerando o grupo dos betalactâmicos no estudo de caso.Métodos. O consumo de antimicrobianos foi representado por doses diárias definidas (DDD) por 1.000 habi-tantes. Foi registrada a resistência de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae e Staphylococcus aureus aos betalactâmicos. A relação entre consumo e resistência foi calculada com base no “R” para cada região do país e os dados da Argentina foram comparados aos de outros países.Resultados. Os betalactâmicos de maior consumo na Argentina foram amoxicilina (3,64) no grupo das pen-icilinas, cefalexina (0,786) no grupo das cefalosporinas de primeira geração, cefuroxima (0.022) no grupo das cefalosporinas de segunda geração, cefixima (0.043) no grupo das cefalosporinas de terceira geração e cefepima (0.0001) no grupo das cefalosporinas de quarta geração. Ao se comparar o consumo de betalac-tâmicos e a resistência bacteriana, observou-se grande disparidade entre as seis regiões do país.Conclusões. O estudo de caso revela diferenças no consumo de antimicrobianos e na resistência dos patógenos mais comuns entre as regiões da Argentina, refletindo realidades distintas dentro do mesmo país. Como esta mesma situação pode estar ocorrendo em outros países, estes achados devem servir para dire-cionar os esforços locais a uma melhor utilização dos antimicrobianos, aperfeiçoar os programas de gestão do uso destes medicamentos e propor estratégias de venda mais apropriadas, visando a prevenir e controlar a resistência aos antimicrobianos.

[ABSTRACT]. Objective. To describe bacterial resistance and antimicrobial consumption ratio at the subnational level in Argentina during 2018, considering beta-lactams group as a case-study. Methods. Antimicrobial consumption was expressed as defined daily doses (DDD)/1000 inhabitants. Resistance of Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus to beta-lactams was recorded. Resistance/consumption ratio was estimated calculating “R” for each region of Argentina, and this data was compared with other countries. Results. The most widely consumed beta-lactams in Argentina were amoxicillin (3.64) for the penicillin sub-group, cephalexin (0.786) for first generation cephalosporins, cefuroxime (0.022) for second generation; cefixime (0.043) for third generation and cefepime (0.0001) for the fourth generation group. Comparison between beta-lactams consumption and bacterial resistance demonstrated great disparities between the six regions of the country. Conclusions. The case-study of Argentina shows that antimicrobial consumption and resistance of the most common pathogens differed among regions, reflecting different realities within the same country. Because this situation might also be occurring in other countries, this data should be taken into account to target local efforts towards better antimicrobial use, to improve antimicrobial stewardship programs and to propose more suitable sales strategies in order to prevent and control antimicrobial resistance.

[RESUMEN]. Objetivo. Determinar la razón entre la resistencia bacteriana y el consumo de antimicrobianos a nivel subnacional en Argentina en el 2018, considerando el grupo de los betalactámicos como estudio de caso. Métodos. El consumo de antimicrobianos se expresó como una dosis diaria determinada (DDD) por 1000 habitantes. Se registró la resistencia de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae y Staphylococcus aureus a los betalactámicos. Se determinó la razón entre la resistencia y el consumo calculando “R” para cada región de Argentina, y estos datos se compararon con los de otros países. Resultados. Los betalactámicos más consumidos en Argentina fueron la amoxicilina (3,64) para el subgrupo de la penicilina; la cefalexina (0,786) para las cefalosporinas de primera generación; la cefuroxima (0.022) para las de segunda generación; la cefixima (0.043) para las de tercera generación, y la cefepima (0.0001) para el grupo de la cuarta generación. La comparación entre el consumo de betalactámicos y la resistencia bacteriana demostró que había grandes disparidades entre las seis regiones del país. Conclusiones. El estudio de caso en Argentina indica que el consumo de antimicrobianos y la resistencia a los patógenos más comunes difería entre las regiones; esto demuestra que hay distintas realidades dentro del mismo país. Como esta situación también se puede dar en otros países, estos datos se deben tener en cuenta para definir las actividades locales destinadas a fomentar un mejor uso de los antimicrobianos, para mejorar los programas de manejo de los antimicrobianos y para proponer estrategias de venta más adecuadas con el fin de prevenir y controlar la resistencia a los antimicrobianos.

[RESUMO]. Objetivo. Descrever a relação entre o consumo de antimicrobianos e a resistência bacteriana no nível subncional na Argentina em 2018, considerando o grupo dos betalactâmicos no estudo de caso. Métodos. O consumo de antimicrobianos foi representado por doses diárias definidas (DDD) por 1.000 habitantes. Foi registrada a resistência de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae e Staphylococcus aureus aos betalactâmicos. A relação entre consumo e resistência foi calculada com base no “R” para cada região do país e os dados da Argentina foram comparados aos de outros países. Resultados. Os betalactâmicos de maior consumo na Argentina foram amoxicilina (3,64) no grupo das penicilinas, cefalexina (0,786) no grupo das cefalosporinas de primeira geração, cefuroxima (0.022) no grupo das cefalosporinas de segunda geração, cefixima (0.043) no grupo das cefalosporinas de terceira geração e cefepima (0.0001) no grupo das cefalosporinas de quarta geração. Ao se comparar o consumo de betalactâmicos e a resistência bacteriana, observou-se grande disparidade entre as seis regiões do país. Conclusões. O estudo de caso revela diferenças no consumo de antimicrobianos e na resistência dos patógenos mais comuns entre as regiões da Argentina, refletindo realidades distintas dentro do mesmo país. Como esta mesma situação pode estar ocorrendo em outros países, estes achados devem servir para direcionar os esforços locais a uma melhor utilização dos antimicrobianos, aperfeiçoar os programas de gestão do uso destes medicamentos e propor estratégias de venda mais apropriadas, visando a prevenir e controlar a resistência aos antimicrobianos.

Consumo de benzodiazepinas y fármacos Z en una organización de la seguridad social nacional argentina: ¿uso racional o excesivo? / Benzodiazepine and Z-drug consumption in a national social security organization in Argentina: rational or excessive use?

RESUMEN Las benzodiazepinas y los "fármacos Z" (BZD-Z) se prescriben en exceso en muchos países. Este estudio evaluó su consumo en una organización de la seguridad social (obra social) de Argentina de alcance nacional. A partir de un diseño observacional descriptivo se analizó la dispensa ambulatoria de BZD-Z, entre abril 2020 y marzo 2021, a mayores de 18 años; desagregada por sexo, edad, principio activo y vida media. Se encontró una prevalencia anual de uso del 11,6% entre los 431.445 afiliados adultos, con valores más elevados en las mujeres y mayores de 60 años. El consumo global de BZD-Z fue de 77,6 dosis diarias definidas (DDD) cada 1.000 afiliados-día. El usuario promedio recibió 5,1 dispensas anuales y el equivalente a 1,4 DDD por cada día del año. Las BZD-Z más usadas fueron las de vida media larga. El consumo de BZD-Z resultó elevado y más prolongado que lo recomendado. Es necesario mejorar la calidad en el consumo y reducir el impacto negativo del uso inapropiado de estos fármacos entre los individuos tratados.

ABSTRACT: Benzodiazepines and "Z-drugs" (BZD/Z) are overprescribed in many countries. This study evaluates their consumption in a social security sector health insurance provider with national coverage in Argentina. With a descriptive and observational approach, outpatient dispensations of BZD/Zs were analyzed for people over 18 years old from April 2020 to March 2021, disaggregated by sex, age, active ingredient, and half-life. An annual prevalence of use of 11.6% was found among the 431,445 adult affiliates, with higher rates in women and in those over age 60. Overall consumption of BZD/Zs was 77.6 defined daily doses (DDD) per 1000 enrollee-days. The average user received 5.1 annual dispensations and the equivalent of 1.4 DDD for each day of the year. BZD/Zs with long half-life were the most used. We found high levels of BZD/Z consumption and for longer periods than recommended. It is necessary to improve the quality of consumption and reduce the negative impact of inappropriate use of these drugs among treated individuals.

Disparities in antimicrobial consumption and resistance within a country: the case of beta-lactams in Argentina / Disparidades en el consumo de antimicrobianos y la resistencia a estos dentro de un país: el caso de los betalactámicos en Argentina / Disparidades internas no consumo e na resistência aos antimicrobianos: o caso dos betalactâmicos na Argentina

ABSTRACT Objective. To describe bacterial resistance and antimicrobial consumption ratio at the subnational level in Argentina during 2018, considering beta-lactams group as a case-study. Methods. Antimicrobial consumption was expressed as defined daily doses (DDD)/1000 inhabitants. Resistance of Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus to beta-lactams was recorded. Resistance/consumption ratio was estimated calculating "R" for each region of Argentina, and this data was compared with other countries. Results. The most widely consumed beta-lactams in Argentina were amoxicillin (3.64) for the penicillin sub-group, cephalexin (0.786) for first generation cephalosporins, cefuroxime (0.022) for second generation; cefixime (0.043) for third generation and cefepime (0.0001) for the fourth generation group. Comparison between beta-lactams consumption and bacterial resistance demonstrated great disparities between the six regions of the country. Conclusions. The case-study of Argentina shows that antimicrobial consumption and resistance of the most common pathogens differed among regions, reflecting different realities within the same country. Because this situation might also be occurring in other countries, this data should be taken into account to target local efforts towards better antimicrobial use, to improve antimicrobial stewardship programs and to propose more suitable sales strategies in order to prevent and control antimicrobial resistance.

RESUMEN Objetivo. Determinar la razón entre la resistencia bacteriana y el consumo de antimicrobianos a nivel subnacional en Argentina en el 2018, considerando el grupo de los betalactámicos como estudio de caso. Métodos. El consumo de antimicrobianos se expresó como una dosis diaria determinada (DDD) por 1000 habitantes. Se registró la resistencia de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae y Staphylococcus aureus a los betalactámicos. Se determinó la razón entre la resistencia y el consumo calculando "R" para cada región de Argentina, y estos datos se compararon con los de otros países. Resultados. Los betalactámicos más consumidos en Argentina fueron la amoxicilina (3,64) para el subgrupo de la penicilina; la cefalexina (0,786) para las cefalosporinas de primera generación; la cefuroxima (0.022) para las de segunda generación; la cefixima (0.043) para las de tercera generación, y la cefepima (0.0001) para el grupo de la cuarta generación. La comparación entre el consumo de betalactámicos y la resistencia bacteriana demostró que había grandes disparidades entre las seis regiones del país. Conclusiones. El estudio de caso en Argentina indica que el consumo de antimicrobianos y la resistencia a los patógenos más comunes difería entre las regiones; esto demuestra que hay distintas realidades dentro del mismo país. Como esta situación también se puede dar en otros países, estos datos se deben tener en cuenta para definir las actividades locales destinadas a fomentar un mejor uso de los antimicrobianos, para mejorar los programas de manejo de los antimicrobianos y para proponer estrategias de venta más adecuadas con el fin de prevenir y controlar la resistencia a los antimicrobianos.

RESUMO Objetivo. Descrever a relação entre o consumo de antimicrobianos e a resistência bacteriana no nível subnacional na Argentina em 2018, considerando o grupo dos betalactâmicos no estudo de caso. Métodos. O consumo de antimicrobianos foi representado por doses diárias definidas (DDD) por 1.000 habitantes. Foi registrada a resistência de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae e Staphylococcus aureus aos betalactâmicos. A relação entre consumo e resistência foi calculada com base no "R" para cada região do país e os dados da Argentina foram comparados aos de outros países. Resultados. Os betalactâmicos de maior consumo na Argentina foram amoxicilina (3,64) no grupo das penicilinas, cefalexina (0,786) no grupo das cefalosporinas de primeira geração, cefuroxima (0.022) no grupo das cefalosporinas de segunda geração, cefixima (0.043) no grupo das cefalosporinas de terceira geração e cefepima (0.0001) no grupo das cefalosporinas de quarta geração. Ao se comparar o consumo de betalactâmicos e a resistência bacteriana, observou-se grande disparidade entre as seis regiões do país. Conclusões. O estudo de caso revela diferenças no consumo de antimicrobianos e na resistência dos patógenos mais comuns entre as regiões da Argentina, refletindo realidades distintas dentro do mesmo país. Como esta mesma situação pode estar ocorrendo em outros países, estes achados devem servir para direcionar os esforços locais a uma melhor utilização dos antimicrobianos, aperfeiçoar os programas de gestão do uso destes medicamentos e propor estratégias de venda mais apropriadas, visando a prevenir e controlar a resistência aos antimicrobianos.