Analysis of the impact of the pandemic on surgical residency programs during the first wave in Argentina: A cross - sectional study.

INTRODUCTION: COVID - 19 emerged as a global pandemic in 2020 and affected the teaching methods at all levels. Surgical education has also been significantly affected by this pandemic, but the effect remains unknown. We developed a survey in order to obtain more information on how this pandemic affected the training and education of surgical residency programs. MATERIAL AND METHODS: Cross-sectional study. We surveyed 195 residents of various surgical programs, from August 20th to September 30th, 2020, in Córdoba, Argentina. The effect of the COVID - 19 pandemic was analyzed on surgical training, on the academic program, and professional burnout. RESULTS: The volume of surgical cases performed during the pandemic decreased dramatically, affecting mainly residents of lower years. Comparing the number of cases (>7) that residents carried out per week (Pre pandemic vs pandemic), we found that PGY - 1: 47% vs 9%; p = 0.01 and PGY - 2: 46% vs 8%; p = 0.03. 83.2% reported that the impact of the pandemic affected their surgical training negatively and 45% were not adequately trained to carry out their surgical activity in the residency program. On the other hand, 71.3% affirmed that this health emergency allowed them to dedicate more time to the development of their academic training. CONCLUSION: This is the first cross - sectional survey study that shows the impact of the pandemic on surgical residences during the first wave in Argentina. Surgical training performed by residents had a negative impact.

Trends in fragmentation and connectivity of Paspalum quadrifarium grasslands in the Buenos Aires province, Argentina.

BACKGROUND: Despite its wide distribution worldwide, only 4.6% of temperate grasslands are included within systems of protected areas. In Argentina, this situation is even more alarming: only 1.05% is protected. The study area (central area of the southern Salado River basin) has a large extent of grasslands of Paspalum quadrifarium (Pq) which has been target since the middle of the last century of a variety of agricultural management practices including fire burning for cattle grazing. METHODS: Five binary images of presence-absence data of Pq from a 42-year range (1974-2016) derived from a land cover change study were used as base data. Morphological Spatial Pattern Analysis (MSPA), Morphological Change Detection (MCD) and Network Connectivity Analysis (NCA) were performed to the data using Guidos Toolbox (GTB) for the estimation of habitat and connectivity dynamics of the Pq patches (fragments). RESULTS: A loss of the coverage area and habitat nuclei of this grassland was observed during the study period, with some temporal oscillation but no recovery to initial states. Additional drastic reduction in connectivity was also evident in resulting maps. The number of large Pq grassland fragments (>50 ha) decreased at beginning of the study period. Also, fragmentation measured as number of components (patches) was higher at the end of the study period. The Pq pajonal nuclei had their minimum representativeness in 2000, and recovered slightly in area in 2011, but with a significant percentage increase of smaller patches (=islets) and linear elements as bridges and branches. Large corridors (mainly edge of roads) could be observed at the end of the study period, while the total connectivity of the landscape pattern drops continuously. Statistics of links shows mean values decreasing from 1974 to 2016. On the other hand, maximum values of links decreased up to 19% in 2011, and recovered to a 54% of their original value in 2016. DISCUSSION: Pq fragmentation and habitat reduction could have an impact on the ecosystem functioning and the mobility of some species of native fauna. The connecting elements of the landscape were maintained and/or recovered in percentage in 2011 and 2016. This fact, although favoring the dispersion of the present diversity in the habitat nuclei could cause degradation by an edge effect. Part of the area has the potential to be taken as an area of research and as an example of livestock management, since it is the one that would most preserve the biodiversity of the Pq environment. On the methodological side, the use of a proved tool as GTB is useful for monitoring dynamics of a grassland-habitat fragmentation.

[Design of a simple score to predict the etiology of pneumonia in children]. / Diseño de una regla de prediccion simple para la presunción de etiología en niños con neumonía.

BACKGROUND: The etiology of pneumonia is important to indicate antibiotics. A clinical prediction score (RP) has been designed, although the radiological interpretation is not easy. OBJECTIVE: To design a simple prediction score (PRs) to identify etiology in children with pneumonia, including radiological patterns, clinical and laboratory features. METHODS: Cross sectional study. We prospectively included children under 5 years hospitalized for pneumonia with microbiological evidence (2007-2008). According to the RP, were allocated 3 points when the temperature value was ≥ 39 º C, 2 when the patient age was ≥ 9 months, 2 when the number of neutrophils was 8000/mm3 and 1 when the immature neutrophils number was ≥ 5%. Radiography was evaluated as one point when consolidation was diagnosed and 0 point when pleural effusion or other infiltrations were present. RPS range was from 0 to 9 points. We determined the best cutoff for predicting bacterial pneumonia (ROC) and was calculated based on the same sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative (NPV) and positive likelihood ratio ( RVP) and negative (NLR). RESULTS: 196 patients (viral: 82%, bacteria: 18%), 8.7 ± 10 months. We identified a score ≥ 3 (auROCc = 0.87 95% CI 0.81 to 0.94) as the best point to predict bacterial pneumonia (S: 88.6%, E: 68.9%, PPV: 38.3 %, NPV: 96.5% RVP: 2.85; RPN: 0.17). CONCLUSION: The PRs showed an acceptable performance, but less sensitive than the original score to predict bacterial pneumonia. Although this tool may be easily applied, it should be validated in future studies.

[Antibiotics prescription in infants hospitalized with respiratory syncytial virus pneumonia]. / Prescripción de antibióticos en lactantes hospitalizados con neumonía por virus sincicial respiratorio.

INTRODUCTION: Although not useful, antibiotics are commonly prescribed in infants with viral pneumonia. OBJECTIVE: To compare initial prescription and suspension rates of antibiotics in infants hospitalized with pneumonia by respiratory syncytial virus (RSV) in 2002, when introducing the viral testing, and in 2007, after 5 years of this practice. POPULATION AND METHODS: Children aged under 13 months hospitalized for RSV pneumonia during two years (2002 and 2007) were included. Prescription and discontinuation of antibiotics were registered. Data were analyzed using Chi squared and T tests, assuming p <0.05 as significance level. RESULTS: Antibiotics were prescribed in 57% (40/70) of patients in 2002 and 46% of then (29/63) in 2007. After achieving RSV diagnosis, antibiotics were more frequently discontinued in 2007 than in 2002 (31/63 vs. 14/70; p= 0.012; OR: 3.73; IC 95%:1.1512.49). CONCLUSION: Although antibiotic empirical prescription rate was similar in both periods, after achieving RSV diagnosis antibiotics were more frequently discontinued in 2007.

Prescripción de antibióticos en lactantes hospitalizados con neumonia por virus sincicial respiratorio / Antibiotics prescription in infants hospitalized with respiratory syncytial virus pneumonía

Introducción. Pese a no estar indicados, los antibióticos son frecuentemente prescriptos en lactantes con neumonía viral.Objetivo. Comparar la tasa de prescripción inicial y de suspensión de antibióticos en lactantes hospitalizados por neumonía con diagnóstico de virussincicial respiratorio (VSR), en el año 2002, cuando se incorporó el diagnóstico virológico y en el 2007,luego de 5 años de dicha práctica.Población y método. Se incluyeron menores de 13 meses internados por neumonía durante los años 2002 y 2007, con identificación de VSR y hemocultivo negativo. Se registró indicación y suspensión deantibióticos. Los datos se compararon mediante laspruebas de χ2 y T. Nivel de significación p <0,05.Resultados. Se indicaron antibióticos en 57 por ciento (40/70) de los pacientes en 2002 y 46 por ciento (29/63) en 2007. Su suspensión, luego de conocer el diagnóstico de VSR, fue mayor en 2007 (31/63 contra 14/70; p=0,012; OR:3,73; IC 95 por ciento:1,15-12,49).Conclusiones. Si bien la indicación empírica de antibióticos se mantuvo relativamente estable, ante la confirmación de etiología viral se retiraron con mayor frecuencia en el último período analizado.