[Assessment of a teleophthalmology program for the prevention of diabetes blindness in a rural area of Argentina.] / Evaluación de un programa de teleoftalmología para prevención de la ceguera por diabetes en una zona rural de la Argentina.

Introduction: Teleophthalmology programs have become one of the main tools for the early detection of diabetic retinopathy. Assessing the implementation of these programs is essential to contextualize and understand their effectiveness in different regions. The aim of this study was to evaluate the rate of annual eye examination in people with diabetes before and after implementing a teleophthalmology program in the province of La Pampa (Argentina). Methods: A before-and-after study design was performed, comparing the rate of eye examination performed before and after starting with the Program. The analysis was carried out with a random survey of people with diabetes. People from rural and urban areas of the province were included. The program was implemented only in the rural area, while the urban area has the traditional care system. Results: The annual eye examination rate carried out before and after the implementation of the Program in rural areas improved from 39.3% to 78.6%. Being 22.9% higher than in the urban area. Conclusion: The studied teleophthalmology program achieved a significant increase in eye examinations. These kinds of programs are essential to face blindness due to diabetes in the rural regions of Argentina.

Introducción: Los programas de teleoftalmología se han transformado en una de las principales herramientas para detectar oportunamente la retinopatía diabética. Evaluar la implementación de estos programas es fundamental para contextualizar y comprender su funcionamiento en diferentes regiones. El objetivo de este trabajo fue evaluar la tasa anual de fondo de ojos en personas con diabetes antes y después de implementar un programa de teleoftalmología en la provincia de La Pampa (Argentina). Métodos: Se llevó a cabo un diseño de antes y después, comparando la tasa de fondo de ojos realizado antes y después del comenzar con el Programa. La evaluación se realizó mediante una encuesta aleatoria a personas con diagnóstico de diabetes. Para el análisis se incluyeron personas de la zona rural y urbana de la provincia. El programa fue implementado solamente en la zona rural, mientras que la zona urbana cuenta con el sistema tradicional de atención. Resultados: La tasa anual de fondo de ojos realizado antes y después de la implementación del Programa en áreas rurales paso de un 39,3% a un 78,6%. Siendo superior en un 22,9% al de la zona urbana. Conclusión: El programa de teleoftalmología evaluado logró un aumento significativo en la evaluación del fondo de ojos de las personas con diabetes. Implementar este tipo de programas es fundamental para combatir la ceguera por diabetes en la región rural de la Argentina.

[Prevalence of diabetic retinopathy in a rural area of Argentina]. / Prevalencia de retinopatía diabética en una zona rural de Argentina.

Diabetic retinopathy is one of the major problems public health is facing in the 21st century. The worldwide prevalence is increasing; however, little is known about the frequency of this disease in Argentina. Tele-ophthalmology programs have helped to face and to better understand this disease, mainly in rural areas. The aim of this study was to estimate the prevalence of diabetic retinopathy in the province of La Pampa. A cross-sectional observational study was carried out, evaluating the characteristics of the population assisted by a tele-ophthalmology program in a rural area of the province. The images, taken with a non-mydriatic retinal camera, the intraocular pressure and general characteristics of the population were evaluated. A disease prevalence of 21.5% was estimated and 14.1% of them had a vision-threatening diabetic retinopathy. In addition, it was observed that 5.0% had glaucoma, 63.4% hypertension and 42.6% dyslipidemia. These findings are similar to those reported in other countries around the world. These data are fundamental to understand the details of the epidemiological situation in this region and to be able to develop health strategies to deal with this disease.

La retinopatía diabética es uno de los grandes problemas que enfrenta la salud pública en el siglo XXI. La prevalencia mundial se encuentra en constante aumento; sin embargo, poco se conoce sobre la frecuencia de esta enfermedad en la Argentina. Los programas de tele-oftalmología han ayudado a combatir y a comprender mejor esta enfermedad, principalmente en áreas rurales. El objetivo del siguiente trabajo fue estimar la prevalencia de la retinopatía diabética en la provincia de La Pampa. Se realizó un estudio observacional de corte transversal, evaluando las características de la población asistida por un programa de tele-oftalmología en la zona rural de la provincia. Se evaluaron imágenes de retina obtenidas con un retinógrafo no midriático, la presión intraocular y características generales de la población. Se estimó una prevalencia del 21.5% y un 14.1% de estas personas tenían una amenaza visual grave. Además, se observó que el 5.0% tenían glaucoma, 63.4% hipertensión arterial y 42.6% dislipemia. Estos resultados son similares a los presentados en otros países del mundo. Son datos fundamentales para comprender detalles de la situación epidemiológica en esta región y poder armar estrategias sanitarias para enfrentar a esta enfermedad.

Safety and Efficacy of a MEURI Program for the Use of High Dose Ivermectin in COVID-19 Patients.

Background: In the absence of antiviral alternatives, interventions under research for COVID-19 might be offered following guidelines from WHO for monitored emergency use of unregistered and experimental interventions (MEURI). Ivermectin is among several drugs explored for its role against SARS-CoV-2, with a well-known safety profile but conflicting data regarding clinical utility for COVID-19. The aim of this report is to inform on the results of a MEURI Program of high-dose ivermectin in COVID-19 carried out by the Ministry of Health of the Province of La Pampa, Argentina. Methods: COVID-19 subjects, within 5 days of symptoms onset were invited to participate in the program, which consisted in the administration of ivermectin 0.6 mg/kg/day for 5 days plus standard of care. Active pharmacosurveillance was performed for 21 days, and hepatic laboratory assessments were performed in a subset of patients. Frequency of Intensive Care Unit (ICU) admission and COVID-19-related mortality of subjects in the ivermectin intention to treat group were compared with that observed in inhabitants of the same province during the same period not participating in the program. Results: From 21,232 subjects with COVID-19, 3,266 were offered and agreed to participate in the ivermectin program and 17,966 did not and were considered as controls. A total of 567 participants reported 819 adverse events (AEs); 3.13% discontinued ivermectin due to adverse events. ICU admission was significantly lower in the ivermectin group compared to controls among participants ≥40 year-old (1.2 vs. 2.0%, odds ratio 0.608; p = 0.024). Similarly, mortality was lower in the ivermectin group in the full group analysis (1.5 vs. 2.1%, odds ratio 0.720; p = 0.029), as well as in subjects ≥ 40 year- old (2.7 vs. 4.1%, odds ratio 0.655; p = 0.005). Conclusions: This report highlights the safety and possible efficacy of high dose ivermectin as a potentially useful intervention deserving public health-based consideration for COVID-19 patients.

Prevalencia de retinopatía diabética en una zona rural de Argentina / Prevalence of diabetic retinopathy in a rural area of Argentina

Resumen La retinopatía diabética es uno de los grandes problemas que enfrenta la salud pública en el siglo XXI. La prevalencia mundial se encuentra en constante aumento; sin embargo, poco se conoce sobre la frecuencia de esta enfermedad en la Argentina. Los programas de tele-oftalmología han ayudado a combatir y a comprender mejor esta enfermedad, principalmente en áreas rurales. El objetivo del siguiente tra bajo fue estimar la prevalencia de la retinopatía diabética en la provincia de La Pampa. Se realizó un estudio observacional de corte transversal, evaluando las características de la población asistida por un programa de tele-oftalmología en la zona rural de la provincia. Se evaluaron imágenes de retina obtenidas con un retinógrafo no midriático, la presión intraocular y características generales de la población. Se estimó una prevalencia del 21.5% y un 14.1% de estas personas tenían una amenaza visual grave. Además, se observó que el 5.0% tenían glaucoma, 63.4% hipertensión arterial y 42.6% dislipemia. Estos resultados son similares a los presentados en otros países del mundo. Son datos fundamentales para comprender detalles de la situación epidemiológica en esta región y poder armar estrategias sanitarias para enfrentar a esta enfermedad.

Abstract Diabetic retinopathy is one of the major problems public health is facing in the 21st century. The worldwide prevalence is increasing; however, little is known about the frequency of this disease in Argentina. Tele-ophthalmology programs have helped to face and to better understand this disease, mainly in rural areas. The aim of this study was to estimate the prevalence of diabetic retinopathy in the province of La Pampa. A cross-sectional observational study was carried out, evaluating the characteristics of the population assisted by a tele-ophthalmology program in a rural area of the province. The images, taken with a non-mydriatic retinal camera, the intraocular pressure and general characteristics of the population were evaluated. A disease prevalence of 21.5% was estimated and 14.1% of them had a vision-threatening diabetic retinopathy. In addition, it was observed that 5.0% had glaucoma, 63.4% hypertension and 42.6% dyslipidemia. These findings are similar to those reported in other countries around the world. These data are fundamental to understand the details of the epidemiological situation in this region and to be able to develop health strategies to deal with this disease.