[Longitudinal follow-up of a population with cognitive complaint: characteristics and progression profile]. / Seguimiento longitudinal de pacientes con queja cognitiva: características y perfiles de progresión.

Cognitive complaint is a common cause of consultation among older adults at the primary care level and it may be the first symptom of cognitive impairment, thus its assessment and follow-up are essential for an early diagnosis. AIM: to describe the baseline neurocognitive profile and evolution of patients with cognitive complaint evaluated at the geriatric assessment unit of the Hospital Italiano de Buenos Aires. METHODS: observational study of a retrospective cohort of 518 patients with cognitive complaint who underwent a comprehensive geriatric evaluation and cognitive impairment screening tests at the first visit and follow-up visits. Patients diagnosed with dementia at baseline were excluded. RESULTS: 323 (62.36%) subjects were diagnosed with mild cognitive impairment at the first visit and 195 (37.64%) had no cognitive impairment. Of the all the patients, 216 (41.7%) subjects showed worsening of their baseline cognitive status. They had an older age at baseline evaluation, a lower educational level and a worse outcome at Mini Mental State Examination and at memory, executive and language tests than those who remained stable. CONCLUSION: in this follow-up study of a cohort with cognitive complaint we verify the impact of age, educational level and poor outcomes on memory, executive function and language domains as variables associated with progression of cognitive impairment.

[Trends in the frequency of obesity and gestational diabetes in an eleven years period]. / Evaluación de la tendencia de diabetes gestacional en un período de 11 años en Buenos Aires, Argentina.

BACKGROUND: The prevalence of gestational diabetes (GDM) is increasing along with obesity and gestational age. This prevalence varies in populations and with different guidelines used for the diagnoses. AIM: To estimate the change in prevalence of GDM and obesity in a period 11 years. MATERIAL AND METHODS: Analysis of pregnancies attended at an obstetrics ward of a general hospital between 2001 and 2018. Those women who were diabetic prior to their pregnancy were excluded from the analysis. Annual crude and adjusted prevalence using direct standardization by age were estimated. RESULTS: We analyzed 33,985 pregnancies. GDM screening was performed in 20,139 (59%), and 1,466 (7%) had GDM. In 2007 the crude and adjusted prevalence of GDM were 4.9 and 5.2%, respectively. The figures in 2018 were 8.8 and 8.5%, respectively, with an annual percentage of change (APC) of 6.9% (p < 0.001). The frequency of obesity also increased with an APC of 4.1% (p < 0.001). In women with GDM the APC of obesity was 4.6% (p < 0.001). There was also an increase in the frequency of screening, with a joinpoint in 2011. The APC of screening in the periods 2007-2011 and 2011-2018 were 16.6 and 2.9%, respectively (p < 0.001). CONCLUSIONS: The prevalence of GDM increased in this period of eleven years along with the prevalence of obesity.

Incidence of Autoimmune Myasthenia Gravis in a Health Maintenance Organization in Buenos Aires, Argentina.

BACKGROUND: Different epidemiological studies, especially in Europe, have estimated the incidence density of myasthenia gravis (MG) to range between 1.7 and 21.3/1,000,000/person-year; however, data from regions such as Latin America are scarce. This study is aimed at estimating the incidence and prevalence of acquired MG in Buenos Aires, Argentina. METHODS: The study population comprised of affiliates of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in Buenos Aires. The evaluation method for case detection included a retrospective search from January 1, 2006, through December 31, 2012. RESULTS: Of the 60 cases identified, 36 (60%) were females. The median age at diagnosis was 69 years (IQR 51.5-79). The mean age at diagnosis was 63.3 years (SD ±20). A total of 28 patients (46.7%) had generalized MG and 32 had ocular MG (53.3%). Thirty five patients (58.3%) had acetylcholine receptor antibodies and 2 (3.3%) had muscle-specific receptor tyrosine kinase antibodies. The crude incidence density (ID) of MG was 61.33 per 1,000,000 person-years (95% CI 47.62-79.99). The adjusted ID for the Argentinean population was 38.8 per 1,000,000 person-years (95% CI 27.09-50.51) and for the Buenos Aires population was 47.49 (95% CI 34.73-60.25). CONCLUSIONS: The results obtained are similar to those published for other geographical areas.

[Effectiveness and safety of COVID-19 vaccines in healthcare workers in Buenos Aires City, Argentina.] / Efectividad y seguridad de las vacunas contra la Covid-19 en trabajadores de la salud en la Ciudad de Buenos Aires, Argentina.

Introduction: COVID-19 vaccination aids pandemic limitation. In Argentina, three vaccines are approved, and healthcare workers are priorized (HCWs). The aim was to determine the effectiveness of COVID-19 vaccines, analyzing change in Immunoglobulin G levels and the incidence of new COVID-19 cases up to 12 months after the second dose. Methods: Prospective cohort of HCWs between March 2021- 2022. COVIDAR IgG test was used to measure antibodies. A mixed-effects model was employed to compare the levels of immunoglobulin G at different time points, Kaplan Meier was used to estimate incident COVID-19 cases. Results: 82 participants were included Adverse events were frequent but mild. All participant showed positive antibody at 12 months. Antibodies levels showed an increase one year after 2nd dose. Sinopharm took a long time to yield positive results. More than half of the people had mild COVID-19 disease. Conclusion: COVID-19 vaccines are safe and effective.

Introducción: La vacunación COVID-19 ayuda a limitar la pandemia. En Argentina, se aprobaron tres vacunas y se priorizó a los trabajadores de la salud (TDS). El objetivo fue determinar la efectividad de las vacunas COVID-19, analizando el cambio en los niveles de Inmunoglobulina G y la incidencia de nuevos casos de COVID-19 hasta 12 meses después de la segunda dosis. Métodos: Cohorte prospectiva de TDS entre marzo de 2021 y 2022. Se utilizó la prueba COVIDAR IgG para medir los anticuerpos. Se empleó un modelo de efectos mixtos para comparar los niveles de inmunoglobulina G en diferentes puntos temporales, se utilizó Kaplan Meier para estimar los casos de COVID-19 incidentes. Resultados: se incluyeron 82 participantes. Los eventos adversos fueron frecuentes pero leves. Todos los participantes mostraron anticuerpos positivos a los 12 meses. Los niveles de anticuerpos mostraron un aumento un año después de la segunda dosis. Sinopharm tardó mucho tiempo en arrojar resultados positivos. Más de la mitad de las personas tuvieron una enfermedad leve de COVID-19. Conclusión: Las vacunas COVID-19 son seguras y efectivas.

The role of registries in improving health and bridging healthcare, research, education, innovation and development: a research department perspective.

Health registries are organized systems that collect data on individuals with a particular disease, condition or exposure. The aim of this narrative review was to provide an integrated perspective from the Research Department at the Hospital Italiano de Buenos Aires, Argentina, on how health registries can be used as a bridge between healthcare, research, education, innovation and development while addressing ethical challenges. The review includes a description of the experience of a registry implemented at our institution, which has provided healthcare for 170 years, and is committed to support, education and research. We focus on the potential of health registries to provide better value healthcare by reducing healthcare costs and improving health outcomes and quality of care, and to improve medical knowledge. However, we also acknowledge and discuss the challenges that accompany these achievements, such as that of ethical issues. Through effective collaboration and integration with other healthcare stakeholders, health registries can be a powerful tool to promote better health.

Sociodemographic and clinical characteristics and access to health care in patients with spinal muscular atrophy in Argentina.

The FAME registry gathers the majority of patients with SMA in Argentina. From it, the clinical, sociodemographic and access to treatment characteristics were analyzed in 322 patients (range 8 months-61 years) included from 2008 to 2021. Important data were obtained for the planning of medical care of these patients such as: similar distribution of patient care in public and private hospitals, time gap between onset of symptoms and diagnoses, low level of completion of SMN2 copy count, estimate of 16 new diagnoses per year between 2014 and 2018, and 68% of patient in specific pharmacological treatment.

[Prognostic value of hospital hypoglycemia]. / Valor pronóstico de la hipoglucemia hospitalaria.

BACKGROUND: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. METHODS: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and = 40 mg/dl) and critical (glycemia < 40mg/dl). RESULTS: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypoglycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. DISCUSSION: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos internados con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl = 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipoglucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

[Venous thromboembolism prevention in non-surgical adult patients admitted in a general hospital]. / Tromboprofilaxis en pacientes no quirúrgicos internados en un hospital general.

Adult patients hospitalized for a non-surgical condition, usually have a high risk of venous thromboembolism and may develop some form of this disease when they do not receive appropriate preventive treatment. The objectives of this prospective, analytical, observational and cross-sectional study were: 1) to determine what percentage of adult patients hospitalized for a non-surgical acute condition at the Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, had indication for preventive thromboprophylaxis, 2) to establish how many of them had been prescribed a preventive treatment of venous thromboembolism, 3) to establish how many of them had been prescribed a preventive treatment of venous thromboembolism without having reasons to justify the treatment. The study was performed on 93 patients for 72 consecutive hours. It resulted in 90.3% in need of preventive treatment for venous thromboembolism and 76.2% of these patients had received pharmacological thromboprophylaxis. A 33.3% of the studied patients had received preventive pharmacological treatment without having a proper indication. In this study, the percentage of patients treated is higher than in those reported in other published observational studies.

[Gestational diabetes mellitus in a hospital in the city of Buenos Aires, Argentina: incidence, treatment, and frequency of screening for reclassification after childbirth] / Diabetes mellitus gestacional en un hospital de la Ciudad de Buenos Aires, Argentina: incidencia, tratamiento, y frecuencia de tamizaje para reclasificación luego del parto

Introduction: Gestational diabetes mellitus (GDM) is defined as glucose intolerance diagnosed during pregnancy. This pathology can be associated with maternal and feto-neonatal complications, both in the short and long term. The prevalence of GDM in Argentina (based on the diagnostic criteria of the Latin American Diabetes Association (ALAD), is estimated between 7.5-10% of pregnant women. Information in Argentina on the incidence of GDM is scarce. The objective of this work was to estimate the incidence of GDM, evaluate its treatment and the frequency of screening for postpartum reclassification of diabetes in a population of pregnant women treated at a private hospital in the city of Buenos Aires. Materials and methods: Retrospective cohort of pregnant women evaluated at the Hospital Italiano de Buenos Aires, Argentina between 2015 and 2018. Results: The cumulative incidence of GDM was 7.6% (95% CI 7.0-8, two). All patients received nutritional advice (food plan). Of the total number of pregnant women studied 229 (39.3%) required pharmacological treatment; Of these, 97 patients received insulin (16.7%) and 132 metformin (22.7%). Regarding the follow-up of the pathology, between six weeks and one year postpartum, 267 women (45.9%) underwent diabetes screening for reclassification. Screening frequency was higher in the insulin-treated group. Of the patients who underwent screening, 36 women (13.5%) had impaired fasting blood glucose, 16 women (6.0%) had impaired glucose tolerance, and 3 women (1.1%) were diagnosed with type 2 diabetes mellitus. two.Of these, 36 women (13.5%) had impaired fasting blood glucose, 16 women (6.0%) had impaired glucose tolerance, and 3 women (1.1%) were diagnosed with type 2 diabetes mellitus. Conclusion: GDM incidence was 7.6%. Less than half of the women diagnosed with GDM required pharmacological treatment. The frequency of diabetes screening up to one year postpartum for reclassification was similar to that reported.

Introducción: La diabetes mellitus gestacional (DMG) se define como la intolerancia a la glucosa diagnosticada en el embarazo. Esta patología puede asociarse a complicaciones maternas y feto-neonatales, tanto a corto como a largo plazo. La prevalencia de DMG en Argentina (basada en el criterio diagnóstico de la Asociación Latinoamericana de Diabetes (ALAD), se estima entre 7,5-10% de las mujeres embarazadas.  Es escasa la información en Argentina sobre la incidencia de DMG. El objetivo de este trabajo fue estimar la incidencia de DMG, evaluar su tratamiento y la frecuencia de tamizaje para reclasificación postparto de la diabetes en una población de mujeres embarazadas atendidas en un hospital privado de la ciudad de Buenos Aires. Materiales y métodos: cohorte retrospectiva de embarazadas evaluadas en el Hospital Italiano de Buenos Aires, Argentina entre los años 2015 a 2018. Resultados: La incidencia acumulada de DMG fue 7,6 % (IC 95% 7,0-8,2). Todas las pacientes recibieron consejo nutricional (plan alimentario). Del total de embarazadas estudiadas requirieron tratamiento farmacológico 229 (39.3%); recibieron insulina 97 (16,7%) y 132 metformina (22,7%). En cuanto al seguimiento de la patología, entre las seis semanas y el año postparto realizaron tamizaje de diabetes para reclasificación 267 mujeres (45,9%). La frecuencia de tamizaje fue mayor en el grupo tratado con insulina. De las pacientes que realizaron el tamizaje, presentaron glucemia alterada en ayuno 36 mujeres (13,5%), tolerancia a la glucosa alterada 16 mujeres (6,0%) y 3 mujeres (1,1%) fueron diagnosticadas con diabetes mellitus tipo 2. Conclusión: la incidencia de DMG fue 7,6%. Menos de la mitad de las mujeres diagnosticadas con DMG requirió tratamiento farmacológico. La frecuencia de tamizaje de diabetes hasta el año postparto para la reclasificación similar a la reportada.

Tocilizumab for COVID-19 treatment. An Argentine report.

Recently it has been demonstrated the clinical effectiveness of tocilizumab (TCZ) associated with systemic steroids for the treatment of severe SARS-CoV-2 pneumonia with rapid progression. The objective of this work was to describe the epidemiological, clinical, laboratory and evolution characteristics of the patients who received this treatment. Between March and June 2021, TCZ was administered in a cohort study of adults with severe SARS-CoV-2 pneumonia, in a private hospital in the City of Buenos Aires; 30 patients were included, 63% men, middle age 55 years. Obesity (33%), arterial hypertension (26%) and diabetes (25%) were the most frequent comorbidities. We found associated infections during hospitalization in half of the cohort, within them, pneumonia associated with mechanical ventilation was the most frequent and methicillin-sensitive Staphylococcus aureus, the most prevalent germ. Patients with secondary infections had a higher requirement for invasive mechanical ventilation (IMV) (100% vs. 19% p < 0.001) and more days of hospitalization (median 23 vs. 15 p = 0.009). Of the entire cohort, seven who died during hospitalization had the highest requirement for IMV (100% vs. 43% p = 0.010) and secondary infections (100% vs. 35%, p = 0.006). In this relatively young cohort of patients with severe or critical SARS-CoV-2 pneumonia, obesity does not appear to be a predisposing factor for superinfection or death. The presence of secondary infections, organ failure and shock are presented as probable factors of worse evolution, as well as the requirement of IMV.

Recientemente se demostró la efectividad clínica del tocilizumab (TCZ) asociado a esteroides sistémicos para el tratamiento de la neumonía grave por SARS-CoV-2 con rápida progresión. El objetivo de este trabajo fue describir las características epidemiológicas, clínicas, de laboratorio y evolución de los pacientes que recibieron este tratamiento. Entre marzo y junio, 2021, se realizó un estudio de cohorte en un sanatorio privado de la Ciudad de Buenos Aires en adultos con neumonía grave por SARS-CoV-2 que recibieron TCZ. Se incluyeron 30 pacientes, hombres 63%, mediana edad 55 años, obesidad (33%), hipertensión arterial (26%) y diabetes (25%) fueron las comorbilidades más frecuentes. Encontramos infecciones asociadas durante la hospitalización en la mitad de la cohorte, dentro de ellas, la neumonía asociada a la ventilación mecánica fue la más frecuente y el Staphylococcus aureus meticilino sensible, el germen más prevalente. Los enfermos con infecciones secundarias tuvieron un mayor requerimiento de ventilación mecánica invasiva (VMI) (100% vs. 19% p < 0.001) y más días de internación (mediana 23 vs. 15 p = 0.009). De la totalidad de la cohorte, siete que fallecieron durante la internación tuvieron el mayor requerimiento de VMI (100% vs. 43% p = 0.010) e infecciones secundarias (100% vs. 35%, p = 0.006). En esta cohorte relativamente joven de pacientes con neumonía grave o crítica por SARS-CoV-2, la obesidad no parece ser un factor predisponente para sobreinfección o muerte. La presencia de infecciones secundarias, falla orgánica y shock se presentan como probables factores de peor evolución, como así también el requerimiento de VMI.

From publications to every day clinical practice: tocilizumab in patients with severe COVID-19.

INTRODUCTION: there is evidence on the effectiveness and safety of tocilizumab (TZC) used in combination with systemic corticosteroids for severe SARS-CoV-2 pneumonia treatment. The purpose of this study was to describe epidemiological, clinical, and laboratory features as well as clinical outcome of patients receiving this combination therapy compared with those receiving only corticosteroids. METHODS: a retrospective cohort study, which included adults with severe SARS-CoV-2 pneumonia, was conducted between March and August 2021. Enrolment included 101 patients, 46 with corticosteroids and 55 with corticosteroids plus tocilizumab. RESULTS: median age was 58 years old and 63.9% were females. High blood pressure was present in 36.1% and obesity in 54.6%. Survival in the cohort was 81.4%, with a median hospital stay of 19.0 days. Secondary infections were present in 47.4% of the cohort. Patients in the TZC group had a lower C reactive protein (CRP) at discharge, lower rate of multiple organ failure, better functional status at discharge and shorter hospital stay. In a bivariate analysis, no differences were found in mortality rate and secondary infections occurrence. When assessing clinical status as per WHO Ordinal Scale there was a significant difference in its variability from worsening to discharge (or 14 days), evidencing a better functional status in patients receiving TCZ. DISCUSSION: we were able to demonstrate its efficacy in reducing inflammatory biomarkers and a trend towards fewer days of hospitalization, with no impact on mortality.

Introducción: existe evidencia sobre la efectividad y seguridad de tocilizumab (TZC) utilizado en combinación con corticosteroides sistémicos para el tratamiento de la neumonía grave por SARS-CoV-2. El propósito de este estudio fue describir las características epidemiológicas, clínicas y de laboratorio, así como el resultado clínico de los pacientes que recibieron esta terapia combinada en comparación con los que recibieron solo corticosteroides. Métodos: se realizó un estudio de cohorte retrospectivo, que incluyó adultos con neumonía grave por SARS-CoV-2, entre marzo y agosto de 2021. Se incluyeron 101 pacientes, 46 con corticosteroides y 55 con corticosteroides más tocilizumab. Resultados: la mediana de edad fue de 58 años y el 63.9% eran mujeres. La hipertensión arterial estuvo presente en el 36.1% y la obesidad en el 54.6%. La supervivencia en la cohorte fue del 81.4%, con una mediana de estancia hospitalaria de 19.0 días. Las infecciones secundarias estuvieron presentes en el 47.4% de la cohorte. Los pacientes del grupo TZC tenían valores menores de proteína C reactiva (PCR) al alta, una tasa más baja de insuficiencia multiorgánica, un mejor estado funcional al alta y una estancia hospitalaria más corta. En un análisis bivariado, no se encontraron diferencias en la tasa de mortalidad y la ocurrencia de infecciones secundarias. Al evaluar el estado clínico según la Escala Ordinal de la OMS hubo una diferencia significativa en su variabilidad desde el empeoramiento hasta el alta (o 14 días), evidenciando un mejor estado funcional en los que recibieron TCZ. Discusión: pudimos demostrar su eficacia en la reducción de biomarcadores inflamatorios y una tendencia a menos días de hospitalización, sin impacto en la mortalidad.

[Epidemiology of patients with hepatocellular carcinoma in a University hospital]. / Epidemiología de pacientes con hepatocarcinoma en un Hospital Universitario.

Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 diagnosed cases and 830 180 deaths, in 2020 worldwide. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12-year period. Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while for those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who underwent a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. The study's importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.

El carcinoma hepatocelular (HCC) es el tumor primario más frecuente del hígado, con 905 677 casos diagnosticados en 2020, en todo el mundo, y 830 180 muertes. Es responsable de la novena causa de muerte por cáncer en los hombres y la décima en mujeres en Argentina. A diferencia de otros tumores de alta prevalencia, la evidencia científica acerca del HCC se limita principalmente a pequeñas cohortes y estudios retrospectivos. El objetivo de este estudio fue describir epidemiológicamente a aquellos pacientes con diagnóstico de HCC en el Hospital Italiano de Buenos Aires en un periodo de 12 años. La supervivencia global para nuestra cohorte fue de 58, 46 y 36% a 1, 3 y 5 años respectivamente. El promedio de supervivencia en pacientes con tratamiento paliativo fue de 5 meses, 23 para aquellos que recibieron tratamientos no curativos y 75 meses para los que recibieron tratamientos curativos. El porcentaje de pacientes libres de enfermedad a 1, 3 y 5 años fue de 89%, 76% y 61% respectivamente. Se realizó un estudio minucioso de la etiología, factores de riesgo, incidencia, mortalidad y tratamientos realizados. Su importancia yace en su tamaño muestral, calidad y cantidad de información disponible.

Safety and effectiveness of COVID-19 SPUTNIK V vaccine in dialysis patients.

INTRODUCTION: Given the vulnerability of chronic kidney disease individuals to SARS-CoV-2, nephrology societies have issued statements calling for prioritization of these patients for vaccination. It is not yet known whether COVID-19 vaccines grant the same high level of protection in patients with kidney disease compared to the non-dialysis population. The aims of this study were to evaluate the safety - measured by the adverse events potentially attributed to vaccines (ESAVI) - and the effectiveness - evaluated by the presence of antibodies - in dialysis patients immunized with the COVID-19 Sputnik V vaccine. METHODS: multicenter, observational and analytical study of a prospective cohort of hemodialysis patients from the Ciudad Autónoma de Buenos Aires participating in an official vaccination program. Dialysis requiring individuals older than 18 years, who received both components of the COVID-19 vaccine were included. RESULTS: Data from 491 patients were included in the safety analysis. ESAVI with either the first or second component was detected in 186 (37.9%, 95% CI 33.6%-42.3%). Effectiveness analysis measuring antibodies levels against SARS-CoV-2 were performed in 102 patients; 98% presented these IgG antibodies at day 21 after the second component. In patients with COVID-19 prior to vaccination, antibodies at day 21 after the first component reached almost the highest levels compared to patients without previous COVID-19, but IgG rise among patients with previous COVID-19 was lower than in those without this previous disease. CONCLUSION: The Sputnik V vaccine has been shown to be safe and effective in this patient's population.

Introducción: Dada la vulnerabilidad al SARS-CoV-2 de las personas con enfermedad renal crónica, las sociedades de nefrología han emitido declaraciones pidiendo priorizar a estos pacientes para la vacunación. Aún no se sabe si las vacunas COVID-19 confieren el mismo nivel de protección en pacientes con enfermedad renal. Los objetivos de este estudio fueron evaluar la seguridad, medida por eventos supuestamente atribuidos a las vacunas (ESAVI) y la efectividad, evaluada por la presencia de anticuerpos en pacientes en diálisis inmunizados con la vacuna COVID-19 Sputnik V. Métodos: estudio multicéntrico, observacional y analítico de una cohorte prospectiva de pacientes en hemodiálisis, en la Ciudad Autónoma de Buenos Aires, con plan de vacunación. Se incluyeron pacientes mayores de 18 años en diálisis que recibieron ambos componentes de la vacuna COVID-19. Resultados: 491 pacientes fueron incluidos en el análisis de seguridad. Se detectó ESAVI con el primer o el segundo componente en 186 (37.9% IC 95%: 33.6%-42.3%). La efectividad medida por presencia de anticuerpos IgG contra SARS-Cov-2 se realizó en 102 pacientes, 98% presentaba IgG contra SARS-CoV-2, 21 días después del segundo componente. En pacientes con COVID-19 previo a la vacunación, los anticuerpos al día 21 del primer componente alcanzaron niveles casi mayores que en aquellos que no habían sufrido COVID-19, aunque el aumento de los niveles a los 21 días del segundo componente fue menor que en los pacientes sin COVID-19 previo. Conclusión: Los pacientes en diálisis constituyen una población vulnerable para la infección por SARS-CoV-2, por lo tanto, más allá de las recomendaciones implementadas por las unidades de diálisis, la vacunación completa es mandatoria. Se ha demostrado que la vacuna Sputnik V es segura y eficaz en esta población de pacientes.

[Antipsychotic prescription prevalence and metabolic monitoring of patients under chronic treatment]. / [Prevalencia en la prescripción de antipsicóticos y monitoreo metabólico en pacientes bajo tratamiento crónico].

INTRODUCTION: Antipsychotics agents increase morbidity and mortality due to their metabolic impact. Information on its prescription and follow-up is scarce. The objective of this study was to estimate the chronic antipsychotic prescription prevalence and to evaluate the metabolic monitoring of patients treated with these medications. METHODS: We examined a retrospective cohort of patients older than 18 years treated in the outpatient setting of a hospital in Argentina. The crude and adjusted prevalence of chronic antipsychotic prescription was estimated by indirect standardization of the World Health Organization population, with its confidence interval (95%). It was evaluated whether the patients had biochemical determinations, systolic blood pressure (SBP), and body mass index (BMI) at the beginning and at 12 months of their treatment. RESULTS: The crude antipsychotic prescription prevalence was 23.8 ‰ (95% CI 23.0 - 24.6) and the adjusted prevalence was 10.1 ‰ (95% CI 9.5-10.7). 3702 patients were evaluated. The male:female ratio was 0.6. Median age 77.5 years (IQR 25-75: 59.5-86.1). Quetiapine was the most frequently prescribed. Initial determinations: Lipid profile 1804 (48.7%), blood glucose 2034 (54.9%), SBP 2546 (68.8%) and BMI 1584 (42.8%). At 12 months: Lipid profile 680 (18.4%), blood glucose 898 (24.3%), SAT 1609 (43.5%), and BMI 1584 (21.7%). CONCLUSIONS: We observed a higher prevalence of atypical antipsychotic prescription in the elderly and female population and scarce registry of biochemical determinations for adverse effects follow-up.

INTRODUCCIÓN: Los antipsicóticos incrementan la morbimortalidad por su impacto metabólico. Es escasa la información sobre su prescripción y seguimiento. El objetivo fue estimar la prevalencia de prescripción de antipsicóticos crónicos y evaluar el monitoreo metabólico. MÉTODOS: Cohorte retrospectiva de pacientes ambulatorios mayores de 18 años de un hospital de Argentina. Se estimó la prevalencia cruda y ajustada de prescripción crónica de antipsicóticos mediante estandarización indirecta por la población de la Organización Mundial de la Salud (OMS), con su intervalo de confianza 95%. Se evaluó si los pacientes en tratamiento tenían determinaciones bioquímicas, tensión arterial sistólica (TAS) e índice de masa corporal (IMC), al inicio y a los 12 meses. RESULTADOS: La prevalencia cruda de prescripción de antipsicóticos fue 23,8‰ (IC del 95% 23,0 ­ 24,6) y la ajustada fue 10,1 ‰ (95% CI 9,5-10,7). Se evaluaron 3702 pacientes. La razón hombre/mujer fue 0,6. La mediana de edad 77,5 años (IQR 25-75: 59,5-86,1). Predominó quetiapina. Pacientes con determinaciones al inicio: lipidograma 1804 (48,7%), glucemia 2034 (54,9 %), TAS 2546 (68,8 %) e IMC 1584 (42,8%). A los 12 meses: lipidograma 680 (18,4%), glucemia 898 (24,3%), TAS 1609 (43,5%) e IMC 1584 (21,7%). CONCLUSIONES: Observamos una mayor prescripción de antipsicóticos atípicos en la población anciana y femenina, y un escaso registro de determinaciones clínico-bioquímicas para control de efectos adversos.

Active monitoring of early safety of Sputnik V vaccine in Buenos Aires, Argentina.

This study describes the incidence of early events supposedly attributable to vaccination or immunization (ESAVI) that occurred in healthcare workers who had been inoculated with the first component of the Sputnik V vaccine. Safety at 72 h post-immunization was analyzed based on a self-reported form. Between January 5 and January 20, 2021, in Buenos Aires, Argentina, a total of 707 healthcare workers (median age 35 yrs, female 67%) were vaccinated. The response rate was 96.6% (n: 683) and 487 (71.3%) participants reported at least one ESAVI. The incidence rate was 6.3 per 1000 person/hours. The total number of ESAVIs was 1434. A total of 469 local reactions were reported, 57% of the participants reported pain at the injection site, and 11% had redness and swelling. A total of 968 systemic reactions were informed, including new or worsened muscle pain, referred by 58% of the participants, fever referred by 40%, and diarrhea referred by 5%. Five percent (n: 34) had serious adverse events and one participant had to be hospitalized. The ESAVI rate was higher in females than males (66.4% versus 51.4%; HR 1.38; 95% CI 1.13-5.38) and in workers younger than 55 yrs old (63.0% versus 28.0%; HR 2.66; 95% CI 1.32-5.38). This study demonstrates high rates of early local and systemic reactions. However, serious events were rare. Studies on long-term safety, stratified by sex and age, are needed.

Este estudio describe la incidencia de eventos supuestamente atribuibles a vacunación o inmunización (ESAVI) en trabajadores de la salud después de la inmunización con el primer componente de la vacuna Sputnik V. La seguridad a las 72 horas de la inmunización se analizó en base a un auto-reporte. Entre el 5 y el 20 de enero de 2021, en Buenos Aires, Argentina, fueron vacunados 707 trabajadores de la salud (mediana de edad 35 años, 67% mujeres). La tasa de respuesta fue 96.6% (n: 683), y 487 participantes (71.3%) informaron al menos un ESAVI. Los ESAVI totales fueron 1434 y la incidencia fue 6.3 por 1000 personas/hora. Fueron informadas 469 reacciones locales: 57% de los participantes informaron dolor en el lugar de la inyección y 11% enrojecimiento e hinchazón. Entre las 968 reacciones sistémicas, el 58% de los participantes informaron dolor muscular nuevo o empeorado, 40% fiebre y 5% diarrea. El 5% (n: 34) presentó eventos adversos graves y un paciente tuvo que ser hospitalizado. La tasa de ESAVI fue mayor entre las mujeres (66.4% versus 51.4%; HR 1.38; IC 95% 1.13-5.38) y en el grupo de trabajadores menores de 55 años (63.0 versus 28.0; HR 2.66; IC 95% 1.32-5.38). Este estudio mostró altas tasas de reacciones tempranas locales y sistémicas; sin embargo, los eventos graves fueron raros. Son necesarios estudios sobre la seguridad a largo plazo, estratificados por sexo y edad.

Severe acute respiratory syndrome coronavirus 2019. Seroepidemiology study in Argentinian slum.

Most countries in Latin America have already reported thousands of confirmed cases and vulnerable populations are the most affected by the coronavirus disease 2019 (COVID-19) pandemic. Preventive measures such as hygiene, social distancing, and isolation, essential to stop the spread of coronavirus, are difficult to accomplish for vulnerable populations due to their living conditions. Seroepidemiological surveys are assets to measure the transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Until July 1st, the incidence rate of SARS-CoV-2 infection in Barrio Padre Mugica, one of the largest slums in Buenos Aires City, was 5.9%. This study aimed to establish the prevalence of SARS-CoV-2 antibodies immunoglobulin G (IgG) immediately after the outbreak, and to identify neighbourhood, household and individual factors associated with seroconversion. The prevalence based on IgG was 53.4% (95% CI 52.8% to 54.1%). For each polymerase chain reaction (RT-qPCR) confirmed case, nine people tested IgG positive, indicating a high rate of undetected (probably asymptomatic) infections. Hence, the high rate of undiagnosed people suggests that clinical criteria and epidemiological nexus should be considered. The high seroprevalence observed in the context of an intense epidemic in a vulnerable area might serve as a reference to other countries. This study contributes to future decision making by understanding population immunity against SARS-CoV2 and its relation to living conditions and foccus that comprehensive biosocial, household-level interventions are needed.

Muchos países de América Latina han informado miles de casos confirmados y las poblaciones vulnerables son las más afectadas por la pandemia de la enfermedad por coronavirus 2019 (COVID-19). Las medidas preventivas como la higiene, el distanciamiento social y el aislamiento, fundamentales para frenar la propagación del coronavirus, son difíciles de lograr en estas poblaciones debido a sus condiciones de vida. Los estudios seroepidemiológicos son de gran utilidad para medir la transmisión del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2). Hasta el 1 de julio, la tasa de incidencia de la infección por SARS-CoV-2 en el Barrio Padre Mugica, uno de los barrios marginales más grandes de la ciudad de Buenos Aires, era del 5.9%. Este estudio tuvo como objetivo estimar la prevalencia de anticuerpos inmunoglobulina G (IgG) para SARS-CoV-2 inmediatamente después del brote, e identificar factores del barrio, hogar e individuales asociados con la seroconversión. La prevalencia basada en IgG fue del 53.4% (IC del 95%: 52.8% a 54.1%). Para cada caso confirmado por reacción en cadena de la polimerasa (RT-qPCR), nueve personas dieron positivo en IgG, lo que indica una alta tasa de infecciones no detectadas y probablemente asintomáticas. La alta tasa de personas no diagnosticadas sugiere que se deben considerar los criterios clínicos y el nexo epidemiológico. La alta seroprevalencia observada en el contexto de una intensa epidemia en una zona vulnerable podría servir de referencia a otros países. Este estudio contribuye a la toma de decisiones futuras al comprender la inmunidad de la población contra el SARS-CoV2 en su relación con las condiciones de vida y por su enfoque en la necesidad de intervenciones integrales a nivel del hogar.

[Gender approach in medical residences of a university hospital]. / Enfoque de género en las residencias médicas de un hospital universitario.

A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.

Se observa un proceso de feminización de la profesión médica, sin embargo, el acceso masivo de las mujeres se asocia a nuevas desigualdades de género, denominadas segregación horizontal y vertical. La segregación horizontal se manifiesta en la desigual distribución de hombres y mujeres en ciertas especialidades médicas y la segregación vertical, en la escasa representación de las mujeres en la mayoría de los altos cargos profesionales. El objetivo de este estudio fue determinar cómo se distribuyen hombres y mujeres en las distintas instancias del proceso que implica el ingreso al sistema de residencias médicas de un hospital universitario de Buenos Aires, Argentina y analizar la segregación horizontal y vertical de género en el proceso de ingreso a las residencias médicas. A partir de datos de postulantes a un hospital universitario, en el período 2015-2017, se realizó un análisis de regresión logística múltiple para ajustar el odds ratio de ser hombre o mujer con potenciales confundidores. No se observó asociación entre ser hombre o mujer y la realización del examen, su aprobación y el ingreso a entrevista. El odds ratio ajustado para el ingreso a la residencia de los hombres con respecto a las mujeres fue 2.03 (1.44-2.85). Para las residencias quirúrgicas fue 2.75 (1.54-4.92) y para las clínicas fue 1.89 (1.17-3.00). En la inscripción, las mujeres optaron mayormente por residencias clínicas, y los hombres por quirúrgicas. Se observó segregación horizontal y vertical en el proceso de ingreso a la residencia. Visibilizar la segregación de género permitirá generar una sociedad equitativa.

[Mortality and recurrence of venous thromboembolic disease in adult patients: prospective cohort]. / Mortalidad y recurrencia de la enfermedad tromboembólica venosa en pacientes adultos: cohorte prospectiva.

INTRODUCTION: Venous thromboembolic disease (VTE) is a pathology that increases with age. RESULTS: 446 patients were included, 63% (292) were older than 65 years. Survival was lower in the elderly compared to the young (p 0.007), at 3 months 87% vs. 95% and at one year 73% vs. 87%, respectively. The elderly had a HRc1.71 and HR at 1.68. The overall recurrence was 5% (95% CI 3-8) at one month, 6% (95% CI 4-9) at 3 months, 8% (95% CI). 6-11) at one year and 13% (95% CI 9-18) at two years. No association was found between age and recurrence sub hazard 0.8 (CI 0.34-1.86). Bleeding occurred in 9% (39) of the patients. OBJECTIVE: to compare the survival of the elderly and the young with a first episode of acute and symptomatic VTE. MATERIALS AND METHODS: Prospective cohort of incident VTE cases included in the Institutional Registry of Venous Thromboembolic Disease (NCT01372514) of the Italian Hospital of Buenos Aires between 2012-2014, divided into young groups (17-64 years old) and elderly (65 years old). All the patients were followed annually to assess the time to recurrence (progression or new symptomatic event of VTE) as competitive events in the context of death and major bleeding. Raw (c) and adjusted (a) risks were presented. CONCLUSIONS: The overall mortality in patients with confirmed VTE is higher in the elderly population. There were no differences in relation to the recurrence of VTE, or bleeding, and neither with age.

INTRODUCCIÓN: La enfermedad tromboembólica venosa (ETV) es una patología que aumenta con la edad. CONCLUSIONES: La mortalidad global en pacientes con ETV confirmada es mayor en la población anciana. No hubo diferencias en relación a la recurrencia de ETV, ni   el sangrado y tampoco con la edad. OBJETIVO: Comparar la sobrevida de los ancianos y los jóvenes con un primer episodio de ETV aguda y sintomática. MATERIALES Y MÉTODOS: Cohorte prospectiva de casos incidentes de ETV incluidos en el Registro Institucional de Enfermedad Tromboembólica venosa (NCT01372514) del Hospital Italiano de Buenos Aires entre 2012-2014, dividido en grupos jóvenes (17-64 años) y ancianos (≥ 65 años). Todos los pacientes fueron seguidos anualmente para evaluar el tiempo a la recurrencia (progresión o nuevo evento sintomático de ETV) como eventos competitivos en contexto de muerte y sangrado mayor. Se presentaron los riesgos crudos (c) y ajustados. (a). RESULTADOS: Se incluyeron 446 pacientes, el 63% (292) fueron mayores de 65 años. La sobrevida fue menor en los ancianos comparados con los jóvenes (p 0.007), a los 3 meses 87% vs 95% y al año 73% vs 87%, respectivamente. Los ancianos presentaron un HRc1,71 y HR a 1.68. La recurrencia global fue 5% (IC 95% 3-8) al mes, 6% (IC 95% 4-9) a los 3 meses, 8% (IC 95% 6-11) al año y 13% (IC 95% 9-18) a los dos años. No se encontró asociación entre la edad y la recurrencia sub hazard 0.8(IC 0,34-1,86). El sangrado ocurrió en un 9% (39) de los pacientes.

[Prevalence and incidence of disability based on the Unique Certificate of Disability at a teaching hospital in the Metropolitan Area of Buenos Aires]. / Prevalencia e incidencia de discapacidad a partir del Certificado Único de Discapacidad en un hospital universitario del Área Metropolitana de Buenos Aires.

Disability is a public health problem that affects an individual's comprehensive development opportunities. The objective of this study was to estimate the annual incidence and prevalence and the diagnostic categories associated with total disability and age groups based on the application for a Unique Certificate of Disability. This was an analytical cohort study in children aged 0-18 years conducted at a teaching hospital of the Metropolitan Area of Buenos Aires between January 2010 and December 2017. Among 22 750 active members, 726 patients applied for a Unique Certificate of Disability; the prevalence was 3.2 % (95 % confidence interval [CI]: 2.9-3.4). The annual cumulative incidence increased from 2012 (0.22 %, 95 % CI: 0.1-0.19) to 2017 (0.59 %, 95 % CI: 0.5-0.7). Mental disabilities accounted for 80 % (n = 576). This study showed an increase in the incidence of disability and also the mental disability category.

La discapacidad es un problema de salud pública que afecta las oportunidades de desarrollo integral del individuo. El objetivo del trabajo fue estimar la prevalencia e incidencia anual y de las categorías diagnósticas asociadas a discapacidad total y por grupos etarios a partir de la tramitación del Certificado Único de Discapacidad. Estudio analítico de una cohorte de niños/as de 0 a 18 años perteneciente a un hospital universitario del Área Metropolitana de Buenos Aires, entre enero de 2010 y diciembre de 2017. Sobre un total de 22 750 afiliados activos, 726 pacientes tramitaron el Certificado Único de Discapacidad; la prevalencia fue del 3,2 % (IC 95 %: 2,9-3,4). La incidencia acumulada anual aumentó desde 2012 (0,22 %; IC 95 %: 0,1-0,19) hasta 2017 (0,59 %; IC 95 %: 0,5-0,7). Las discapacidades mentales constituyeron el 80 % (n = 576). En este estudio se observó un aumento de la incidencia de discapacidad y de la categoría de discapacidad mental.